Effect of atmospheric pollen concentration on daily visits of allergic rhinitis in Beijing: a distributed lag nonlinear model analysis.

To investigate the influence and lag effect of atmospheric pollen concentration on daily visits of patients with allergic rhinitis (AR), we collected the AR data during the pollen seasons from 2018 to 2019 from the outpatient and emergency department of Beijing Shijitan Hospital. The distributed lag non-linear model (DLNM) was used to analyze the correlation and the lag effect between pollen concentration and the incidence of AR. R4.1.2 was used to generate the Spearman correlation coefficients and plot the lag response curves of relative risk specific and incremental cumulative effects. In 2018 and 2019, the number of AR visits was moderately positively correlated with pollen concentration. The peak value of the overall specific cumulative effect for every 10 grains/1000 mm2 increase in atmospheric pollen concentration occurred on day 0 (2018, 2019), and the lag disappearance time was day 6 (2018) and day 7 (2019), and the specific cumulative effect duration was respectively 6 days (2018) and 7 days (2019), with the curve showing a downward trend with time increase. In 2018, the peak value of the overall incremental cumulative effect was on day 7, the lag disappearance time was day 13, and the duration of the incremental cumulative effect was 13 days, forming a curve pattern of rising first and then falling. In 2019, the peak value time of the overall incremental cumulative effect was on day 8, and the curve went down afterwards until it showed the trend of ascending again after day26.

Analysis of the successful clinical treatment of 140 patients with parathyroid adenoma: A retrospective study.

BACKGROUND: Parathyroid adenoma (PA) sometimes recurs after surgery, how to improve the surgical success rate of PA is the key to the treatment of this disease. AIM: To investigate the clinical features, diagnosis, and surgical treatment of patients with PA. METHODS: Patients who were pathologically confirmed with PA and had undergone surgery for the first time between January 2010 and December 2017 at the Beijing Shijitan Hospital affiliated to Capital Medical University were included in the study. The clinical features, localization diagnosis, and surgical treatment of these patients were analyzed. RESULTS: Of the 140 patients, 32 were male and 108 were female; 132 cases had one adenoma, and 8 had two adenomas. In addition, 114 cases had clinical symptoms, among which 51, 28, 23, 8, and 4 had urinary system, skeletal system, digestive system, neuromuscular system, and neuropsychiatric symptoms, respectively, while 26 cases had no obvious symptoms. The median level of preoperative parathyroid hormone (PTH) was 201.0 pg/mL. The positive detection rate of technetium-99m sestamibi (Tc-99m MIBI) single-photon emission computed tomography/computed tomography (SPECT/CT), ultrasound examination, and the combined use of Tc-99m MIBI SPECT/CT and ultrasound examination was 92.9%, 85.5%, and 96.4%, respectively. Open surgery was performed in all patients, and PTH was monitored during surgery. The success rate of surgery was 98.6%. After surgery, 21 cases developed hypocalcemia, 1 case developed temporary hoarseness, and 19 cases had transient hypoparathyroidism but there was no permanent hypoparathyroidism, postoperative hemorrhage, or hematoma in the surgical area. CONCLUSION: For patients with clinically unexplained skeletal system, urinary system, and neuropsychiatric symptoms, the possibility of PA should be considered. Imaging examinations such as ultrasound and Tc-99m MIBI SPECT/CT could be integrated before surgery to obtain accurate localization diagnosis. Precise preoperative localization, intraoperative PTH monitoring, and delicate surgery to protect the integrity of the PA capsule ensure a minimally invasive and successful surgery.

The Role of Epithelial-Mesenchymal Transition in Chronic Rhinosinusitis.

BACKGROUND: Chronic rhinosinusitis (CRS) is a common condition in otorhinolaryngology. It is characterized by chronic inflammation of the nasal cavity and the sinus mucosa. However, its specific pathogenesis remains unclear. Epithelial dysfunction is closely related to inflammatory airway diseases. Various evidences support that epithelial-mesenchymal transition (EMT) plays a key role in the development of CRS. OBJECTIVE: The study aimed to explore our understanding of how EMT contributes to the pathogenesis of CRS and to examine the role of several signaling pathways in EMT. METHODS: PubMed database was used to review the literature related to EMT in CRS pathogenesis. The following key words were used for the search strategy: CRS, sinusitis, nasal polyps, epithelial cells, EMT, dysfunction, cytokines, signaling pathways, pathogenesis, and therapy. RESULTS: EMT is widely present in the nasal mucosa of CRSwNP patients and contributes to the pathogenesis of the disease. However, there is no sufficient evidence for the existence of EMT in CRSsNP. Multiple signaling pathways and molecules, such as transforming growth factor-ß signaling, Wnt signaling, and hypoxia-inducible factor-1α signaling, have been found to be involved in the EMT process and promote CRSwNP. CONCLUSION: EMT is closely associated with CRS pathogenesis. Our study supports further research on epithelial EMT changes in CRS patients and provides a basis for revealing its pathogenesis and exploring new treatments.

Prediction of clinical efficacy of subcutaneous immunotherapy for Artemisia sieversiana pollen allergic rhinitis by serum metabolomics.

BACKGROUND/PURPOSE: Specific immunotherapy is the only effective etiological treatment for allergic rhinitis, but subcutaneous immunotherapy has a slow onset and poor compliance. Predicting the clinical efficacy of subcutaneous immunotherapy in advance can reduce unnecessary medical costs and resource waste. This study aimed to identify metabolites that could predict the efficacy of subcutaneous immunotherapy on seasonal allergic rhinitis by serum metabolomics. METHODS: Patients (n = 43) with Artemisia sieversiana pollen allergic rhinitis were enrolled and treated with subcutaneous immunotherapy for one year. Patients were divided into the ineffective group (n = 10) and effective group (n = 33) according to the therapeutic index. Serum samples were collected before treatment. Metabolomics was determined by liquid chromatography-mass spectrometry combined with gas chromatography-mass spectrometry and analyzed differential compounds and related metabolic pathways. RESULTS: A total of 129 differential metabolites (P < 0.05) were identified and 4 metabolic pathways, namely taurine and hypotaurine metabolism, pentose and glucuronate interconversions, pentose phosphate pathway, and alanine, aspartate, and glutamate metabolism, were involved. CONCLUSION: Some metabolites, such as hypotaurine, taurine, and l-alanine, have the potential to become predictive biomarkers for effective subcutaneous immunotherapy.

[Application of proteomics in allergic rhinitis].

The prevalence of allergic rhinitis（AR）is increasing year by year, which seriously affects the quality of life of patients and causes a heavy burden of social diseases. At present, the diagnosis methods focus on clinical manifestations and allergen detection, but there is no accurate detection method for early diagnosis and prognosis of the disease. With the rapid development of proteomics technology and its wide application in disease research, there is a rapid, sensitive and high-throughput technology platform for the diagnosis and treatment of allergic rhinitis, which provides a platform for the early detection, therapeutic targets and prognosis of the disease. This article reviews the progress of AR in proteomics.

Prevalence and risk factors of allergic rhinitis and asthma in the southern edge of the plateau grassland region of northern China: A cross-sectional study.

BACKGROUND: The prevalence rates of allergic rhinitis (AR) and asthma in the border region of China may be different from those in the central region of plateau grasslands. A survey was performed to investigate the prevalence and risk factors for AR, asthma, and AR combined with asthma among adults (age ≥ 20 years) residing in the southern border of plateau grasslands in northern China. METHODS: From May to August 2018, a cross-sectional survey was completed by subjects that were selected using a cluster random sampling method. The subjects completed a questionnaire and were administered skin prick tests (SPTs). Risk factors for AR, asthma, and AR combined with asthma were examined by multivariate logistic regression analyses. RESULTS: A total of 1815 adult subjects in the selected region completed study. The prevalence rates of physician-diagnosed AR, asthma, and AR combined with asthma were 13.9% (253), 9.8% (177), and 2.9% (52), respectively. Among the patients with AR, 20.6% were found to have concurrent asthma; among the patients with asthma, 29.4% were found to have concurrent AR. Artemisia and Humulus pollen were the most common sensitizing pollen types. Approximately 70% of subjects with AR and <30% of asthma patients were sensitized to Artemisia and Humulus pollen. Symptoms of AR and asthma mainly appeared during August. A multivariable logistic regression analysis identified sensitization pollen as an independent risk factor for both AR and AR combined with asthma (AR: OR = 16.23, 95% CI: 10.15-25.96; AR combined with asthma: OR = 6.16, 95% CI: 1.28-29.66). An age >40 years old, family history of asthma, moderate-to-severe AR, adverse food reactions, and mold allergies were independent risk factors for AR combined with asthma. CONCLUSIONS: This study identified the prevalence rates of AR and asthma in the southern borders of the plateau grassland in northern China (>1500 m above sea level). Sensitization pollen is an independent risk factor for AR and AR combined with asthma.

MicroRNA-29 mediates anti-inflammatory effects and alleviation of allergic responses and symptoms in mice with allergic rhinitis.

BACKGROUND: To investigate the role of microRNA-29 (miR-29) in mice with allergic rhinitis (AR) and its underlying mechanism. METHODS: AR model was established in BALB/c mice by intraperitoneal sensitization and intranasal challenge with ovalbumin (OVA). miRNA expression was examined in the nasal mucosa tissues of mice and patients with AR, and miRNA-29 was found to be downregulated. To unveil the role of miRNA-29 in AR, it was overexpressed in the nasal mucosa of AR mice by intranasal administration of miRNA-29 agomir. The symptoms of nasal rubbing and sneezing were recorded and evaluated. miR-29 expression, OVA-specific immunoglobulin E (IgE) concentration, pro-inflammatory cytokines levels, eosinophils number, and cleaved caspase-3 and CD276 expression were examined in nasal mucosa tissues and nasal lavage fluid (NALF) by qRT-PCR, ELISA, hematoxylin and eosin staining, western blotting, or immunohistochemistry, respectively. TUNEL assay was used to analyze nasal mucosa cells apoptosis. RESULTS: Decreased expression of miR-29 was observed in AR, the symptoms of which were alleviated by overexpressing miR-29. In addition, overexpression of miR-29 markedly reduced the concentration of OVA-specific IgE, the levels of IL-4, IL-6, IL-10, and IFN-γ, the pathological alterations and eosinophils infiltration in the nasal mucosa. Furthermore, restoration of miR-29 expression reduced nasal mucosa cell apoptosis. Moreover, overexpression of miR-29 significantly attenuated CD276 mRNA and protein levels in nasal mucosa cells. CONCLUSION: MiR-29 mediated antiallergic effects in OVA-induced AR mice by decreasing inflammatory response, probably through targeting CD276. MiRNA-29 may serve as a potential novel therapeutic target for the treatment of AR.

Leukotriene A4 Hydrolase Is a Candidate Predictive Biomarker for Successful Allergen Immunotherapy.

Background: Allergic rhinitis is a common disorder that affects 10% to 40% of the population worldwide. Allergen immunotherapy (AIT) represents the only therapy that has the potential to resolve clinical symptoms of allergic rhinitis. However, up to 30% of patients do not respond to AIT. Biomarkers predicting the clinical efficacy of AIT as early as possible would significantly improve the patient selection and reduce unnecessary societal costs. Methods: Artemisia pollen allergic patients who received at least 1-year AIT were enrolled. Clinical responses before and after 1-year AIT were evaluated to determine AIT responders. Artemisia specific IgE and IgG4 levels were measured by using ImmunoCAP and enzyme-linked immunosorbent assay (ELISA) separately. Stepwise regression analysis was performed to identify which rhinitis-relevant parameters explained the most variability in AIT results. Liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based proteomics was applied to identify the potential candidate biomarkers in the sera of responders and non-responders collected before and after 1-year therapy. The diagnostic performance of the potential biomarkers was then assessed using enzyme-linked immunosorbent assay (ELISA) in 30 responders and 15 non-responders. Results: Artemisia specific IgE and IgG4 levels were elevated only in the responders. Regression analysis of allergic rhinitis-relevant parameters provided a robust model that included two most significant variables (sneeze and nasal congestion). Thirteen candidate biomarkers were identified for predicting AIT outcomes. Based on their association with allergy and protein fold change (more than 1.1 or less than 0.9), four proteins were identified to be potential biomarkers for predicting effective AIT. However, further ELISA revealed that only leukotriene A4 hydrolase (LTA4H) was consistent with the proteomics data. The LTA4H level in responders increased significantly (P < 0.001) after 1-year therapy, while that of non-responders remained unchanged. Assessment of LTA4H generated area under curve (AUC) value of 0.844 (95% confidence interval: 0.727 to 0.962; P < 0.05) in distinguishing responders from the non-responders, suggesting that serum LTA4H might be a potential biomarker for predicting the efficiency of AIT. Conclusion: Serum LTA4H may be a potential biomarker for early prediction of an effective AIT.

Relationship between serum inhibitory activity for IgE and efficacy of Artemisia pollen subcutaneous immunotherapy for allergic rhinitis: a preliminary self-controlled study.

BACKGROUND: Biomarkers of clinical efficacy for subcutaneous immunotherapy (SCIT) on allergic rhinitis (AR) have not been identified yet. This study aims to assess the clinical relevance of serum inhibitory activity for IgE by the method of enzyme-linked immunosorbent facilitated antigen binding (ELIFAB) during SCIT for Artemisia-sensitized AR patients. METHODS: 19 AR patients were studied who had undergone Artemisia-specific SCIT for more than 8 months (19.68 months on average, ranging from 9 to 33 months). Peripheral bloods were collected before and after treatment. The serum inhibitory activity for IgE was tested by ELIFAB and the level of Artemisia-specific IgG4 (Artemisia-sIgG4) was determined by ELISA. Clinical improvement was evaluated based on the symptom scores and rescue medication use (SMS). The 2-tailed Wilcoxon signed-rank test and the Spearman rank test (two-tailed) were used to analyze data by using SPSS 20.0, with P values of less than 0.05 considered as significant. RESULTS: The SMS decreased significantly after SCIT (before: 12.79 ± 4.250, after: 6.11 ± 3.828, P = 0.000 < 0.01), the treatment was remarkably effective for 6 patients, effective for 10 and ineffective for 3, along with a total effective rate 84.21%. The serum inhibitory activity for IgE increased significantly after SCIT (P < 0.05) and was correlated with the levels of Artemisia-sIgG4 (r = - 0.501, P = 0.002 < 0.01). The levels of Artemisia-sIgG4 elevated dramatically after treatment (P < 0.01) and were related with the duration of treatment (r = 0.558, P = 0.000 < 0.01). But there was no relationship between clinical improvements and the serum inhibitory activity for IgE. CONCLUSIONS: The serum inhibitory activity for IgE increased significantly after SCIT, however, there was no correlation between it and clinical improvements by statistics analysis. So whether the serum inhibitory activity for IgE can act as biomarker of efficacy for SCIT or not needs to be studied further.

Management of Sharp-Pointed Esophageal Foreign-Body Impaction With Rigid Endoscopy: A Retrospective Study of 130 Adult Patients.

OBJECTIVES: To propose a management algorithm for adult patients with sharp-pointed esophageal foreign-body impaction (EFBI) who have rigid endoscopy (RE) indications and to conduct a retrospective analysis of their data. METHODS: All adult patients who received RE at the Department of Otorhinolaryngology in Beijing Shijitan Hospital between January 2017 and May 2019 were enrolled. The demographics, clinical characteristics, and management data were collected and analyzed. RESULTS: A total of 130 patients were identified, 56.9% were female with median age 60 years. More than half (56.9%) of patients had foreign-body (FB) ingestion on holidays. The most frequent FBs were jujube pits (66.9%) and bones (23.8%). There is a significant female predominance in ingestion of jujube pits (65.5%, P = .005). The most common symptoms were odynophagia (49.2%) and sore throat (47.7%). The majority (96.8%) of FB founded were lodged at upper esophagus. In all, 74 patients were categorized as having mild complications and 54 having significant complications. Time interval from ingestion to presentation longer than 15 hours was an independent risk factor for significant complications, while esophagogram with barium as a protective factor. CONCLUSIONS: Long-time interval from ingestion to presentation will lead to high risk of significant complications. Computed tomography should be a prioritized imaging method for all patients suspected with EFBI, and multidisciplinary collaboration is recommended. Besides, mass education on eating habits is necessary.

Is it worthy to take full-course immunotherapy for allergic rhinitis? About efficacy biomarker of allergen immunotherapy.

Nowadays, people pay more attention to biomarkers that can predict clinical efficacy of immunotherapy for allergic rhinitis. As the only recognized aetiological treatment, the efficacy of allergen immunotherapy (AIT) has been proved by many studies. However, treatment success depends on compliance and persistence greatly, which can be impaired by the lengthy duration of AIT and socioeconomic status of patients. Besides, ineffectiveness is another factor that accounts for non-adherence. If the clinical efficacy can be predicted in the early stage of immunotherapy, it can help patients choose appropriate treatment plans, increase patient compliance and optimize the allocation of medical resources. This paper mainly focuses on five candidate biomarkers, the sIgE/tIgE ratio before treatment, serum inhibitory activity for IgE, decreased basophil activation, upregulation of Tregs and tolerogenic DCs, reviews the time when potential biomarkers can predict or monitor the efficacy of AIT, discusses the reason why these indicators could serve as efficacy biomarkers and interactions among potential biomarkers.

Differential expression of immune markers in the patients with obstructive sleep apnea/hypopnea syndrome.

PURPOSE: To evaluate phenotypic changes of various immune cells in the peripheral blood in the patients with sleep apnea/hypopnea syndrome (OSAHS). METHODS: This is a case-control study. The peripheral venous blood was collected. A subset of T cells, B cells, natural killer cells, and dendritic cells was analysed using various markers and flow cytometry. Regression curve analysis was made to examine the correlation between the change of immune cells and aponea hypoxia index (AHI) and oxygen desaturation. RESULTS: The percentage of CD3+/CD4+ T lymphocytes (P < 0.001) and CD19+ B cells (P < 0.001) and the CD4+/CD8+ ratio (P < 0.001) in the OSAHS patients were significantly increased compared with those in the control group without OSAHS, and CD4+/CD8+ ratio positively correlated with aponea hypoxia index (r = 0.37, P < 0.001) but negatively correlated with the lowest SaO2 (r = - 0.2, P < 0.001), whereas a greater reduction in the percentage of CD3+/CD8+ T cells (P < 0.001). Moreover, the ratios of CD3+/CD16+/CD56+ natural killer (NK)-like T cells (P < 0.05) and CD3-/CD16+/CD56+ NKT cells (P < 0.001) were significantly lower in the OSAHS group than those in the control group. However, no significant difference was observed in the percentage of CD3+ total T cells, CD8+/CD28+ T cells, CD8+/CD28- T cells, DC1, DC2, and DC1/DC2 dendritic cells between the OSAHS and control groups. CONCLUSION: Our study showed differential responses of various types of immune cells in the peripheral blood in patients with OSAHS and their correlation with severity of oxygen desaturation.

Comparison of four staining methods for detecting eosinophils in nasal polyps.

The study aimed to find a more appropriate method to detect eosinophils in formalin- fixed nasal polyps, since there is no consensus on the standard counting method of eosinophils now. Four 5 µm serial sections were obtained from each 10% neutral formalin-fixed paraffin block and were stained with Chromotrope 2R, Congo red, MBPmAb immunohistochemistry, and conventional hematoxylin and eosin stain respectively. Each section was scanned by the Aperio digital section scanner. The same selected areas were procured for assessment in the serial sections. Chromotrope 2R and MBPmAb immunohistochemistry were specific in detecting eosinophils, which had the lower background staining compared with Congo red and conventional hematoxylin and eosin stain. There were significant differences among the four methods in terms of the eosinophil counting data (p < 0.05), while no significant difference between Chromotrope 2R and Congo red (P = 0.1413). The eosinophil counts in nasal polyps could be more accurately assessed by Chromotrope 2R and Congo red compared with MBPmAb immunohistochemistry and conventional hematoxylin and eosin stain. The popularization of Chromotrope 2R and Congo red may help to unify the eosinophil count in the definition of eosinophilic CRSwNP.

Investigation of diagnosis and surgical treatment of mucosal contact point headache.

We aimed to investigate the differences in incidence of nasal anatomic abnormalities between patients with and without headache and the outcome of surgical treatment for the headache patients with mucosal contact points. We conducted the observational study and recruited 107 subjects without headache (nonheadache group) and 78 patients with recurrent headache for more than 2 years (headache group). Study participants underwent high-resolution sinus computed tomography scans, and the incidence of nasal anatomic abnormalities was calculated in both groups. An additional 25 patients with recurrent headache underwent endoscopic surgical treatment. Mucosal contact points were observed in 85.9% of patients with recurrent headache and also in 80.4% of participants without headache. The most common mucosal contact point was between a deviated nasal septum and lateral nasal wall (41.1%). The incidence of deviated nasal septum contacting with lateral nasal wall was significantly different between the headache group (55.1%) and the nonheadache group (40.2%) (p < 0.05). The postoperative pain scores of the additional 25 headache patients with recurrent headache and mucosal contact point who were treated with endoscopic surgery decreased significantly compared with their preoperative measurements (p < 0.001), but only 44% of patients had recovered from headache 7 days postoperatively. We conclude that some patients with recurrent headache may not have a mucosal contact point, and some patients with mucosal contact points may not meet the diagnostic criteria of mucosal contact point headache since pain was not resolved within 7 days after surgical treatment. The diagnostic criteria of mucosal contact point headache before surgery should be reevaluated.

Analysis on correlation between SP and NK-1R and intranasal mucosal contact point headache.

CONCLUSION: Distribution of SP and NK-1R, especially NK-1R, in nasal mucosal tissue at contact point was higher compared with non-contact point. It was suggested that SP and NK-1R were associated with mucosal contact point headache. OBJECTIVES: To observe difference of substance P (SP) and NK-1 receptor (NK-1R) expression in tissues at contact point and non-contact point among the patients with intranasal mucosal contact point headache and speculate the role of SP and NK-1R in mucosal contact point headache. METHODS: SP and NK-1R in tissues of contact point and non-contact point among 40 patients with intranasal mucosal contact point headache were stained histologically by immunohistochemistry, and the mRNA level was detected by RT-PCR. RESULTS: SP was located in cytoplasm of acini epithelial cells, distributed in nasal mucosa tissues at both contact point and non-contact point. However, stain intensity was significantly increased at contact point (Z = -2.554, p < 0.05). NK-1R was located in the cytoplasm of acinar epithelial cells, inflammatory cells, and nerve fibers of contact point; only in cytoplasm of acinar epithelial cells and nerve fibers of non-contact point. Tinctorial rate of NK-1R increased significantly at contact point (χ(2) = 40.438, p < 0.01). mRNA level of SP and NK-1R was up-regulated in nasal mucosa at contact point compared with non-contact point.

Melkersson-Rosenthal syndrome: a retrospective study of 44 patients.

CONCLUSION: When patients with recurrent facial paralysis are encountered, otolaryngologists should check for fissured tongue, and question those patients about orofacial edema, minor symptoms, and family history. Histologic evidence is not necessary for the diagnosis of Melkersson-Rosenthal syndrome (MRS), while coronary high-resolution CT (HRCT) reconstruction of temporal bone and food allergen detection may be beneficial. Prophylactic decompression of the facial nerve for patients with appropriate electrophysiological indication may prevent further facial palsy attacks. OBJECTIVES: The objective of this study was to analyze the clinical features of a group of patients with MRS with major complaints of facial palsy treated at the Department of Otorhinolaryngology, and to comment on MRS from the perspective of otolaryngologists. METHODS: A retrospective review of patient database for the last 6 years in the Department of Otorhinolaryngology in Beijing Shijitan Hospital was performed to find patients diagnosed with MRS. RESULTS: A total of 44 MRS patients were included in this study. The mean age at onset was 14.1 years. A total of 13 (29.5%) patients had family history, 17 (38.6%) revealed broadened fallopian canal on coronary HRCT reconstruction of temporal bone, and 20/23 (87.0%) patients showed positive results in food allergen detection. Thirty-one patients accepted subtotal facial nerve decompression and only one patient had facial palsy recurrence on the same side as the operation.

A specific instrument to facilitate thoracoscopic ligation.

The rigid wall of the thoracic cavity provides an ideal cavity for minimally invasive surgery without the need for the cumbersome CO2 insufflation that is essential to perform laparoscopic surgery. And by that, the novel ligation technique facilitating minithoracotomy, which we published before, is possible to be transferred to the video-assisted thoracoscopic surgery (VATS). We attempt to modify the structure of the conventional right angle forceps and its usage so as to accommodate VATS. The unique shape of this instrument facilitates its passage through a trocar or a true VATS intercostal access instead of a rib spreading minithoracotomy. Its clinical performance renders that it a cheaper and better alternative to commercially available products. This new device has the potential to make a substantial contribution to the manual ligation practice of VATS.

[Clinical observation on relation between nasal mucosa contact point and headache].

OBJECTIVE: To verify the correlation between nasal contact point and headache and to discuss the significance of nasal endoscopic surgery through observation of clinical outcomes in patients with nasal mucosa contact point treated by endoscopic surgery. METHODS: Forty-five patients diagnosed as nasal mucosa contact headache were treated by nasal endoscopic surgery. The results were analyzed retrospectively, including headache degree, headache frequency, lasting time and total time between before and 6, 18, and 24 months after operation. The data were processed by rank-sum test by SPSS 18.0 software. RESULTS: 6, 18 and 24 months after operation, the headache degree (VAS scores were 1.50 [0; 4.00], 2.00 [0; 5.00], 3.25 [0; 5.75], respectively) was relieved (VAS score was 6.00 [5.25; 8.25] before operation) dramatically (Z value were -4.913, -4.070 and -3.095, respectively, all P < 0.01). The total time of headache 6, 18, 24 months after operation (It were 0.07 [0; 3.50], 0.26 [0; 7.77], 1.04[0; 17.15] h, respectively) was shortened (It was 25.20 [4.00; 186.00] h before operation) significantly (Z value were -4.368, -3.652, -2.500, respectively, all P < 0.05). CONCLUSIONS: One of the key causes of patients suffered from intractable headaches is mucosal contact in the nasal cavity. The pain in these patients could be relieved through surgical correction of intranasal anatomic abnormalities. Nasal mucosa contact might not be the only etiology of intractable headache since the mechanism of headache is complicated and variable. The effect of endoscopic surgery needs to be estimated by long-term follow-up.

Reconstruction of cervical esophagectomy defects using laryngotracheal bloc.

Surgical treatment of cervical esophagus cancers generally requires a cervical esophagectomy followed by a reconstruction of the removed segment of the upper digestive tract. We describe the use of laryngotracheal bloc for the reconstruction of a resected cervical esophageal defect. Three patients were submitted to this technique. All operations were successfully performed without major procedure-related complications. Ability to swallow was preserved. During a period of ten to twenty-four months of follow-up, all the patients have survived, and can resume a regular diet. The preliminary results show that laryngotracheal bloc is an excellent choice for the reconstruction of the cervical esophagus segment after cancer resections, offering patients fast rehabilitation, lower morbidity, and recovery of satisfactory swallowing function.