[The clinical treatment of laryngotracheal rupture injury].

Objective:To investigate the therapeutic effect of laryngotracheal rupture injury and management of related complications. Methods:A retrospective analysis was conducted on 10 patients with laryngotracheal rupture injury caused by trauma, admitted between October 2014 and October 2022. Results:Anti-shock treatment, local debridement, tracheal-cricoid cartilage or tracheal-tracheal anastomosis, laryngeal cartilage reduction and fixation, local transposition flaps repair and phase-Ⅱ airway reconstruction were performed respectively on 10 patients. Nine patients underwent operations of tracheal-cricoid cartilage or tracheal-tracheal anastomosis, with five of these were performed by cartilage broken reduction and fixation, placed with intraluminal stents of iodoform gauze fingerstalls for （8.2±1.6） days. Tracheal reconstruction surgery was performed on 2 cases during phase-Ⅱ and both were placed with T-shaped silicone tube to support for 3 months. Two cases required tracheoesophageal fistula surgical repair, and vocal cord suturing was conducted for three vocal fold injuries. Anti-shock treatment was given to one emergency case and closed thoracic drainage treatment was given to another one. We removed the tracheal cannula from 10 patients after surgery and one case was diagnosed with Ⅰ-level swallowing function of sub-water test. All cases recovered to take food per-orally. Conclusion:Maintenance of circulation and respiration functions is the major target during early treatment of laryngotracheal rupture. It should strive to complete the reconstruction of airway structure on phase-Ⅰ, among which end-to-end anastomosis to reconstruct airway and broken laryngeal cartilage reduction and fixation are the vital methods for airway structure reconstruction to achieve good results. It is suggested that the reconstruction of trachea and esophagus structures should be performed simultaneously to patients with tracheoesophageal fistula.

Compound heterozygous variants of the SLC26A4 gene in a Chinese family with enlarged vestibular aqueducts.

BACKGROUND: To investigate the genetic causes of hearing loss in patients with enlarged vestibular aqueduct (EVA), the SLC26A4-related genotypes and phenotypes were analyzed. SLC26A4 gene is closely associated with EVA and its homozygous mutations or compound heterozygous mutations may cause deafness and strongly affect quality of life. METHODS: The patients who came to our hospital for hearing test and accompanied by bilateral hearing abnormalities were collected for fifteen deafness-related gene mutations detection. Those who are positive will be verified by Sanger sequencing, combined with family history, hearing test, and computerized tomography (CT) of the temporal bone, aiming to diagnose the enlarged vestibular aqueducts. Whole-exome sequencing were performed when necessary. RESULTS: Our patient failed hearing screening on both sides twice, and EVA (> 1.5 mm) was diagnosed by CT. This study has identified a novel missense mutation in the SLC26A4 gene, c.2069T>A, which in compound heterozygosity with c.1174A>T is likely to be the cause of hearing loss. The novel heterozygous c.2069T>A mutation of SLC26A4 gene has been submitted to Clinvar with Variation ID 1,048,780. CONCLUSION: Our findings expand the gene mutation spectrum of SLC26A4 and provide additional knowledge for diagnosis and genetic counseling associated with EVA-induced hearing loss.

A Computed Tomography-Based Radiomics Nomogram to Preoperatively Predict Tumor Necrosis in Patients With Clear Cell Renal Cell Carcinoma.

Objective: To develop and validate a radiomics nomogram for preoperative prediction of tumor necrosis in patients with clear cell renal cell carcinoma (ccRCC). Methods: In total, 132 patients with pathologically confirmed ccRCC in one hospital were enrolled as a training cohort, while 123 ccRCC patients from second hospital served as the independent validation cohort. Radiomic features were extracted from corticomedullary and nephrographic phase contrast-enhanced computed tomography (CT) images. A radiomics signature based on optimal features selected by consistency analysis and the least absolute shrinkage and selection operator was developed. An image features model was constructed based on independent image features according to visual assessment. By integrating the radiomics signature and independent image features, a radiomics nomograph was constructed. The predictive performance of the above models was evaluated using receiver operating characteristic (ROC) curve analysis. Furthermore, the nomogram was assessed using calibration curve and decision curve analysis. Results: Thirty-seven features were used to establish a radiomics signature, which demonstrated better predictive performance than did the image features model constructed using tumor size and intratumoral vessels in the training and validation cohorts (p <0.05). The radiomics nomogram demonstrated satisfactory discrimination in the training (area under the ROC curve [AUC] 0.93 [95% CI 0.87-0.96]) and validation (AUC 0.87 [95% CI 0.79-0.93]) cohorts and good calibration (Hosmer-Lemeshow p>0.05). Decision curve analysis verified that the radiomics nomogram had the best clinical utility compared with the other models. Conclusion: The radiomics nomogram developed in the present study is a promising tool to predict tumor necrosis and facilitate preoperative clinical decision-making for patients with ccRCC.

Preoperative CT Radiomics Predicting the SSIGN Risk Groups in Patients With Clear Cell Renal Cell Carcinoma: Development and Multicenter Validation.

Objective: The stage, size, grade, and necrosis (SSIGN) score can facilitate the assessment of tumor aggressiveness and the personal management for patients with clear cell renal cell carcinoma (ccRCC). However, this score is only available after the postoperative pathological evaluation. The aim of this study was to develop and validate a CT radiomic signature for the preoperative prediction of SSIGN risk groups in patients with ccRCC in multicenters. Methods: In total, 330 patients with ccRCC from three centers were classified into the training, external validation 1, and external validation 2 cohorts. Through consistent analysis and the least absolute shrinkage and selection operator, a radiomic signature was developed to predict the SSIGN low-risk group (scores 0-3) and intermediate- to high-risk group (score ≥ 4). An image feature model was developed according to the independent image features, and a fusion model was constructed integrating the radiomic signature and the independent image features. Furthermore, the predictive performance of the above models for the SSIGN risk groups was evaluated with regard to their discrimination, calibration, and clinical usefulness. Results: A radiomic signature consisting of sixteen relevant features from the nephrographic phase CT images achieved a good calibration (all Hosmer-Lemeshow p > 0.05) and favorable prediction efficacy in the training cohort [area under the curve (AUC): 0.940, 95% confidence interval (CI): 0.884-0.973] and in the external validation cohorts (AUC: 0.876, 95% CI: 0.811-0.942; AUC: 0.928, 95% CI: 0.844-0.975, respectively). The radiomic signature performed better than the image feature model constructed by intra-tumoral vessels (all p < 0.05) and showed similar performance with the fusion model integrating radiomic signature and intra-tumoral vessels (all p > 0.05) in terms of the discrimination in all cohorts. Moreover, the decision curve analysis verified the clinical utility of the radiomic signature in both external cohorts. Conclusion: Radiomic signature could be used as a promising non-invasive tool to predict SSIGN risk groups and to facilitate preoperative clinical decision-making for patients with ccRCC.

The relationship between hearing loss and vestibular dysfunction in patients with sudden sensorineural hearing loss.

OBJECTIVE: To investigate the relationship between hearing loss and vestibular dysfunction in patients with sudden sensorineural hearing loss (SSHL). METHODS: Clinical data including the symptom of vertigo of 149 SSHL patients were investigated retrospectively. Pure tone audiometry, ocular vestibular-evoked myogenic potential (oVEMP) and cervical vestibular-evoked myogenic potential (cVEMP) evoked by air-conducted sound (ACS), and caloric test were employed for cochlear and vestibular function assessment. The relationship between hearing level and vestibular dysfunction was analyzed. RESULTS: The pure tone averages (PTAs) (mean ± SD) of SSHL patients with and without vertigo were 88.81 ± 21.74 dB HL and 72.49 ± 21.88 dB HL (Z = -4.411, p = 0.000), respectively. The PTAs of SSHL patients with abnormal and normal caloric test were 84.71 ± 22.54 dB HL and 70.41 ± 24.07 dB HL (t = -2.665, p = 0.009), respectively. Conversely, vertigo and abnormal caloric results also happened more frequently in patients with profound hearing loss. However, no consistent tendency could be found among vestibular evoked myogenic potentials (VEMPs) responses or hearing loss. CONCLUSIONS: SSHL patients with vertigo or abnormal caloric test displayed worse hearing loss; and vice versa, vertigo and abnormal caloric results happened more frequently in SSHL patients with profound hearing loss.

[Cervical vestibular evoked myogenic potential elicited by different types air conducted sounds among normal young Chinese people].

OBJECTIVE: To observe waveform difference among cervical vestibular evoked myogenic potentials (cVEMP) elicited with different types of air conducted sound in normal young Chinese subjects. METHOD: Twenty adult volunteers (40 ears) were recruited as research subjects including 10 males and 10 females aged between 19 and 30.500 Hz Tone Burst, 1000 Hz Tone Burst and Click were employed as stimulus for conventional air conducted sound-cVEMP (ACS-cVEMP) examinations in bilateral ears of each subject. The response rate, threshold, P1 latency, N1 latency, P1-N1 latency interval, amplitude and inter-aural asymmetry were recorded and compared among groups. RESULT: The response rate was 97.5% in 500Hz Tone Burst (39/40), 87.5% in 1 000Hz Tone Burst (35/40)and 67.5% in Click (27/40), There were no statistically significant difference between 500Hz Tone Burst and 1000Hz Tone Burst (P > 0.05) but there were statistically significant difference between click and the other groups (P < 0.05). We collected the waveform parameters (the threshold, P1 latency, N1 latency, P1-N1 latency interval, amplitude) which had statistically significant difference between 500 Hz Tone Burst and the other groups (P < 0.05). The inter-aural asymmetrys had no statistically significant differents among groups. CONCLUSION: The response rate and parameter could be affected by different types of air conducted sound in normal young Chinese subjects. 500 Hz Tone Burst was the best stimulus of type what we have known.

[Ocular vestibular evoked myogenic potential elicited by different types of stimulus among normal young Chinese people].

OBJECTIVE: To observe waveform differences among ocular vestibular evoked myogenic potentials (ACS-oVEMP) elicited by different types of air conducted sound in normal young Chinese subjects. METHOD: Twenty-two adult volunteers (44 ears) were recruited as research subjects including 12 males and 10 females aged between 18 and 35. Five hundred Hz tone burst, 125 Hz tone burst and click were employed as stimulus for conventional ACS-oVEMP examinations in bilateral ears of each subject. The response rate, threshold, n I latency, p I latency, n I-p I latency interval, amplitude and inter-aural asymmetry were recorded and compared among groups. RESULT: The response rate was 100% (44/44) in 500 Hz tone burst group, 40.9% (18/44) in 125 Hz tone burst group and 29.6% (12/44) in click group There were statistical significant differences between the 500 Hz tone burst group and the other groups (P < 0.05). Waveform amplitude was the largest in the 500 Hz tone burst group (7.3 +/- 5.5) muV than that in the 125 Hz tone burst group (3.8 +/- 1.5) muV and that in the click group (5.8 +/- 1.3) muV, which had statistically significant differences between the former and the later two groups (P < 0.05). Other waveform parameters presented similar differeces. CONCLUSION: ACS-oVEMP waveforms could be largely affected by different stimulus. 500 Hz tone burst was the best stimulus with highest response rate, biggest amplitude and therefore most easily recognizable waveform in ACS-oVEMP examination.

[Effect of acoustic stimulus intensity on air-conducted sound elicited ocular vestibular-evoked myogenic potential and cervical vestibular-evoked myogenic potential].

OBJECTIVE: To observe the effect of acoustic stimulus intensity on air-conducted sound elicited ocular vestibular- evoked myogenic potential (oVEMP) and cervical vestibular-evoked myogenic potential (cVEMP) in normal young Chinese subjects. METHODS: Thirty-five normal subjects aged 4-40 years (20.80∓8.89 years), including 16 males and 19 females, were recruited for conventional oVEMP and cVEMP examinations. The responses obtained from each side using 500 Hz tone bursts were divided into 6 groups according to different sound intensities (100, 95, 90, 85, 80 and 75dB nHL). The response rate and normal parameters of each stimulus intensity group were calculated. RESULTS: As the acoustic stimulus intensity decreased, the oVEMP response rate decreased from 100% in both 100 dB nHL and 95dB nHL groups to 97.14% (90 dB nHL), 54.29% (85 dB nHL), 14.29% (80 dB nHL), and 2.86% (75 dB nHL), and the response rate of cVEMP, 100% in both 100 dB nHL and 95dB nHL groups, was lowered to 97.14% (90 dB nHL), 84.29% (85 dB nHL), 38.57% (80 dB nHL) and 8.57% (75 dB nHL). The response rate and the parameters were comparable between 100 and 95 dB nHL groups. CONCLUSION: As the acoustic stimulus intensity decreases, both oVEMP and cVEMP show decreased response rate and amplitude. For Chinese subjects under 40 years of age, we recommend 95dB nHL as the maximum initial stimulus intensity in VEMPs test.

[Familial nasal bottom supernumerary tooth dentigerous cyst: report of 1 case and review of literatures].

Nasal supernumerary teeth and additional dental cyst is a common disease in Department of ENT and Department of Stomatology. In reported diseases, patients with a variety of additional teeth appeared in differ ent parts have varied clinical manifestations. Because of no obvious early symptoms, it is more difficult to diagnose, but CT examination in corresponding site can make it easy to diagnose the maxillary sinus and dentigerous cyst diagnosis. Operation is an effective method to cure the disease. Operation is simple, but the defect and tooth cavity after operation is one unavoidable problem for ENT doctor. In relevant literature it can be seen that the disease has a genetic tendency.