The reduced contraction capacity of palatopharyngeal muscle in OSAHS is related to the decreased intra-cellular [Ca2+] mediated by low RyR1 and DHPRα1s expression.

PURPOSE: To aim of the study was to explore the possible mechanisms for the decreased contraction capacity of the palatopharyngeal muscle in cases with obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: Palatopharyngeal muscle specimens from patients with OSAHS were taken as the case group. Palatopharyngeal muscle tissue by surgical removal of oropharyngeal malignant tumors was used as a control cohort. The palatopharyngeal muscle contraction capacity was measured by assessing diaphragm peak-twitching force / cross-sectional area (Pt/CSA), fatigue index (FI) twitch tension, and force per cross-sectional area (Force/CSA). Myofibril and sarcoplasmic reticulum (SR) ultra-structures were observed by electron microscopy. The intra-cellular calcium concentration was measured by fluorescence spectrophotometry. DHPRα1s and RyR1 expression profiles were probed through RT-qPCR and Western blot, and the colocalization of them was determined by immunofluorescence. RESULTS: In comparison with the control cohort, the OSAHS cohort demonstrated decreased Pt/CSA (P < 0.01), FI twitch tension (P < 0.01), together with contraction capacity (P < 0.01). This cohort also had lower intra-cellular [Ca2+] of palatopharyngeal muscle cells with abnormal ultrastructure of sarcoplasmic reticulum (SR) (P < 0.01). In addition, transcriptomic (P < 0.01) and proteomic expression (P < 0.01) for RyR1 and DHPRα1s were markedly reduced within OSAHS cohort, although the degree of colocalization of them was not altered. CONCLUSION: RyR1 and DHPRα1s downregulation may disrupt intra-cellular [Ca2+] homeostasis and subsequently decrease the palatopharyngeal muscle contraction capacity in patients with OSAHS, thus providing a novel insight into the pathogenesis of OSAHS.

Confounding Effect in Clinical Research of Otolaryngology and Its Control.

Confounding effect is a critical issue in clinical research of otolaryngology because it can distort the research's conclusion. In this review, we introduce the definition of confounding effect, the methods of verifying and controlling the effect. Confounding effect can be prevented by research's design, and adjusted by data analysis. Clinicians would be aware and cautious about confounding effect in their research. They would be able to set up a research's design in which appropriate methods have been applied to prevent this effect.They would know how to adjust confounding effect after data collection. It is important to remember that sometimes it is impossible to eliminate confounding effect completely, and statistical method is not a master key. Solid research knowledge and critical thinking of our brain are the most important in controlling confounding effect.

Genetic Effects on Sensorineural Hearing Loss and Evidence-based Treatment for Sensorineural Hearing Loss.

In this article, the mechanism of inheritance behind inherited hearing loss and genetic susceptibility in noise-induced hearing loss are reviewed. Conventional treatments for sensorineural hearing loss (SNHL), i.e. hearing aid and cochlear implant, are effective for some cases, but not without limitations. For example, they provide little benefit for patients of profound SNHL or neural hearing loss, especially when the hearing loss is in poor dynamic range and with low frequency resolution. We emphasize the most recent evidence-based treatment in this field, which includes gene therapy and allotransplantation of stem cells. Their promising results have shown that they might be options of treatment for profound SNHL and neural hearing loss. Although some treatments are still at the experimental stage, it is helpful to be aware of the novel therapies and endeavour to explore the feasibility of their clinical application.

Identification of potential core genes and pathways predicting pathogenesis in head and neck squamous cell carcinoma.

Head and neck squamous cell carcinoma (HNSCC) is the most common subtype of head and neck cancer; however, its pathogenesis and potential therapeutic targets remain largely unknown. In the present study, we analyzed three gene expression profiles and screened differentially expressed genes (DEGs) between HNSCC and normal tissues. The DEGs were subjected to gene ontology (GO), Kyoto encyclopedia of genes and genomes (KEGG), protein-protein interaction (PPI), and survival analyses, while the connectivity map (CMap) database was used to predict candidate small molecules that may reverse the biological state of HNSCC. Finally, we measured the expression of the most relevant core gene in vitro and examined the effect of the top predicted potential drug against the proliferation of HNSCC cell lines. Among the 208 DEGs and ten hub genes identified, CDK1 and CDC45 were associated with unfavorable HNSCC prognosis, and three potential small molecule drugs for treating HNSCC were identified. Increased CDK1 expression was confirmed in HNSCC cells, and menadione, the top predicted potential drug, exerted significant inhibitory effects against HNSCC cell proliferation and markedly reversed CDK1 expression. Together, the findings of the present study suggest that the ten hub genes and pathways identified may be closely related to HNSCC pathogenesis. In particular, CDK1 and CDC45 overexpression could be reliable biomarkers for predicting unfavorable prognosis in patients with HNSCC, while the new candidate small molecules identified by CMap analysis provide new avenues for the development of potential drugs to treat HNSCC.

Clinical observation of soft palate-pharyngoplasty in the treatment of obstructive sleep apnea hypopnea syndrome in children.

BACKGROUND: Childhood obstructive sleep apnea hypopnea syndrome (OSAHS) is a common clinical disease that can cause serious complications if not treated in time. The preferred treatment for OSAHS in children is surgery. AIM: To observe the effects of soft palate-pharyngoplasty on postoperative outcome, pharyngeal formation, and possible complications. METHODS: A total of 150 children with snoring, hernia, and mouth breathing were selected. A polysomnography test was performed to confirm the diagnosis of OSAHS. The children were randomly divided into experimental and control groups. The experimental group underwent adenoidectomy, tonsillectomy, and soft palate-pharyngoplasty. The control group underwent adenoidectomy and tonsillectomy. The t-test and chi-square test were used to compare conditions such as postoperative fever, postoperative hemorrhage, and pharyngeal reflux. Postoperative efficacy and complications were interrogated and observed in the form of outpatient follow-up and telephone follow-up at 6 mo and 1 year after surgery. The curative effects were divided into two groups: Cure (snoring, snoring symptoms disappeared) and non-cure. RESULTS: The effective rate of the experimental group was significantly higher than that of the control group, but the difference was not statistically significant (P > 0.05). The incidence of postoperative bleeding was lower in the experimental group. There was no postoperative pharyngeal reflux in either group. In the experimental group, the incidence of hyperthermia (body temperature exceeded 38.5 °C) was lower than that in the control group. The difference in postoperative swallowing pain scores between the experimental and control groups was significant. CONCLUSION: Soft palate-pharyngoplasty can more effectively enlarge the anteroposterior diameter and transverse diameter of the isthmus faucium. Compared with surgery alone, it can better treat OSAHS in children, improve the curative effect, reduce the risk of perioperative bleeding, close the surgical cavity, reduce the risk of postoperative infection, reduce the proportion of postoperative fever, and accelerate healing. Although this process takes more time, it is simple, safe, and effective.

The Therapeutic Effect of the Combination of Intratumor Injection of Bleomycin and Electroresection/Electrocautery on the Hemangiomas in Hypopharynx and Larynx Through Suspension Laryngoscopy.

OBJECTIVES: The treatment of hemangiomas in the hypopharynx and larynx can be challenging and stressful because of the high tumor recurrence rate. The objective of this study was to investigate the therapeutic effect of the combination of intratumor injection of bleomycin and electroresection/electrocautery on the hemangiomas in the hypopharynx and larynx through suspension laryngoscopy. METHODS: With patients under general anesthesia, the hemangiomas were fully exposed through suspension laryngoscopy. After intratumor injection of bleomycin, in some patients, the hemangiomas were completely resected along the bottom of the tumor pedicle by polypus-forceps electroscalpel; for other patients, the hemangiomas were pinched and held, and then the whole-tumor tissues were cauterized and coagulated by the electroscalpel. Prior to commencing the study, all participants signed informed consents, and all procedures were approved by the hospital ethical committee. RESULTS: There was almost no bleeding during the operations, no postoperative dyspnea, and no hemorrhage. The patients were followed up for 3 years; the 3-year cure rate was 97%. CONCLUSION: The hemangioma in the hypopharynx and larynx can be cured by a single-session treatment, using the combination of intratumor injection of bleomycin and electroresection/electrocautery through suspension laryngoscopy. Our method is reliable, affordable, and effective, and it could be widely applied in other hospitals.

A Case of a Very Elongated Styloid Process.

Eagle syndrome is characterized by recurrent pain in the oropharynx and face due to an elongated styloid process or calcified stylohyoid ligament. In this article, we experienced a case of an elongated styloid process which is very rare in size and detailed treatment process. The patient was a 53-year-old Chinese woman with a chief complaint of frequent episodes of radiating pain in left preauricular region for 2 years. An intraoral approach was chosen to shorten part of her styloid process, and the chief complaint disappeared immediately after the operation.

Tauroursodeoxycholic acid attenuates endoplasmic reticulum stress and protects the liver from chronic intermittent hypoxia induced injury.

Obstructive sleep apnea that characterized by chronic intermittent hypoxia (CIH) has been reported to associate with chronic liver injury. Tauroursodeoxycholic acid (TUDCA) exerts liver-protective effects in various liver diseases. The purpose of this study was to test the hypothesis that TUDCA could protect liver against CIH injury. C57BL/6 mice were subjected to intermittent hypoxia for eight weeks and applied with TUDCA by intraperitoneal injection. The effect of TUDCA on liver histological changes, liver function, oxidative stress, inflammatory response, hepatocyte apoptosis and endoplasmic reticulum (ER) stress were investigated. The results showed that administration of TUDCA attenuated liver pathological changes, reduced serum alanine aminotransferase and aspartate aminotransferase level, suppressed reactive oxygen species activity, decreased tumor necrosis factor-α and interleukin-1ß level and inhibited hepatocyte apoptosis induced by CIH. TUDCA also inhibited CIH-induced ER stress in liver as evidenced by decreased expression of ER chaperone 78 kDa glucose-related protein, unfolded protein response transducers and ER proapoptotic proteins. Altogether, the present study described a liver-protective effect of TUDCA in CIH mice model, and this effect seems at least partly through the inhibition of ER stress.

[Superior horn of thyroid cartilage dysplasia in 1 case].

The external stimuli and other reasons may result in hyperplasia and abnormal angle of the upper corner of the thyroid cartilage. The upper corner of the thyroid cartilage has anatomical variations. To oppression stimulate carotid artery, cervical sympathetic dry section and so on, could causing pharyngeal foreign body sensation and sore throat. By surgical removal of the thyroid cartilage hyperplasia upper corner, postoperative symptoms would be resolved.

[Pathologic changes of the genioglossus in patients with obstructive sleep apnea hypopnea syndrome dominated by lingual region obstruction].

OBJECTIVE: To study the pathological changes of genioglossus with transmission electron microscope (TEM) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) dominated by lingual region obstruction, and to explore the role of tongue organizations in the pathogenesis and its clinical significance. METHOD: Thirty-eight cases of genioglossus were collected from the patients received UPPP and partial glossectomy (3060 severe group 15 cases), 6 adult patients without oropharyneal and hypopharyneal obstructive disease received tongue tumor resection or trauma debridement surgery were collected as control group. The features of morphological changes in genioglossus were observed by TEM. RESULT: Under the TEM, in the control group,the muscle fibers of the genioglossus organization arranges regular, mitochondrial shape between muscle was regular; The below 3 kinds of variations existed simultaneously in all genioglossus specimens of all the OSAHS patients. In the mild group, myofibrillar atrophied, arranged sloppily, the gap was increased, localized filaments were edema, connective tissue between muscle bundles was proliferated, mitochondria were swelling, some were spherical, crests were still clear; In the moderate group, myofibrillar obviously atrophied with different diametric sizes and disorderliness, the Z lines were shortened or distorted, part of the myofibrillar ruptured, dissolved or disappeared, the connective tissues between muscle bundles were obviously proliferated, mitochondria were swellen, vacuolar degeneration, crests were vague, shorten and irregulatio; In the severe group, a large number of myofibrillar were fractured, dissolved, disorganized, integrated condensate lumpy, spotty or flake arranged, Z-lines were distorted or disappeared. Mitochondria were sizes, showed vacuolar degeneration, crests were disappeared, some changes were flocculent, mitochondria accumulation phenomenon was visible in some samples. Moreover, with the AHI increased, the occurence ratio of mild changes was decreased while severe changes occurence ratio increased. CONCLUSION: The changes of genioglossus and mitochondrial in OSAHS patients is a continuous, progressive process, moverover, with the aggravation of OSAHS, genioglossus histopathological changes had gradually worsening tendency.

[The clinical investigation of the potential complications of H-UPPP surgery in removing the partial pharyngeal muscle].

OBJECTIVE: In order to improve the postoperative effect of modified UPPP, removing the partial pharyngeal muscle in surgery, we investigate the postoperative effect, the characteristics of pharyngeal cavity and the potential complications in OSAHS patients. METHOD: To choose 82 OSAHS patients with obstructive oropharyngeal plane diagnosed by Apneagraphy (AG), Fibre nasopharyngoscope combined with Müller examination and nasopharyngeal 3D-CT, which had completed clinical data inpatients in the anesthesia underwent of the partial pharyngeal muscles in the postoperative, divided into a control group of 26 cases, operating the H-UPPP surgery which did not remove partial pharyngeal muscle; The experimental group of 56 cases did a H-UPPP surgical which removed partial pharyngeal muscle of possible concurrent symptoms such as nasal regurgitation, Eustachian tube dysfunction and other follow-up study in six months after the monthly telephone follow-up or outpatient exams to understand the disease. Patients were evaluated the sleepiness by ESS(Epworth sleepiness scale) in 6 months after the surgery, compared with the preoperative ESS scores, do a t test for statistical analysis. AG can be used to evaluate effects of the UPPP after 6 months. By measuring uvula length (L1), extent from free edge of soft palate to postpharyngeal (L2) and stenosis of nasopharynx width (L3) mean, we investigate the characteristics of pharyngeal cavity using the multiple linear regression to do the hypothesis test and evaluate the association between measuring mean and effect. Using SPSS19.0 software do the preoperative contrast analysis. RESULT: After 6 months in surgery, 56 cases in the experimental group, effect in 50 cases (89.29%), effective in 6 cases (10.71%); ESS score: Preoperative 11.74 +/- 2.48, after the first 6 months 3.84 +/- 2.05. Twenty-six cases in control group,effect in 19 cases (73.08%), effective in 7 cases (26.92%); ESS score: Preoperative 11.91 +/- 2.40, after the first 6 months 6.92 +/- 2.47, t-test P value of less than 0.05 between the experimental group and the control group; There are no ear fullness, hearing loss, increase their own sound which reflect eustachian tube dysfunction and other complications in two groups; The function of pharyngeal cavity could be recovered normal lever after 6 months; After 6 months of the operation, in the experimental group and the control group L1 mean was respectively (5.91 +/- 3.38) mm and (6.20 +/- 3.76) mm (P>0.05); L2 mean was respectively (15.70 +/- 3.29)mm and (15.35 +/- 1.44) mm (P> 0.05); L3 mean was respectively (20.54 +/- 3.33) mm and (16.43 +/- 2.21) mm (P<0.05). Nasal fauces pitch mean was significantly widened. By the multiple linear regression analysis, the postoperative effect has the linear correlation between L2 and 1,3 residual mean with the negative correlation. Due to the standardized coefficient, L3 residual mean has the most influence on the postoperative effect. CONCLUSION: Modified UPPP surgery removing the partial pharyngeal muscle is in favor of upgrading the postoperative effect with significantly increasing the width of postoperative nasal pharyngeal isthmus area, then there are not occur the eustachian tube dysfunction, the soft palate function, swallowing and articulation function disabled.

[Research on failure reasons of surgical treatment of obstructive sleep apnea hypopnea syndrome and reoperation method].

OBJECTIVE: To analyze failure reasons of surgical treatment of obstructive sleep apnea hypopnea syndrome (OSAHS), and explore the methods of reoperation. METHOD: By selecting 27 patients, who accepted surgical treatment for OSAHS and recurred, we analyzed failure reasons and obstructive location by apneagraph, nasopharyngeal 3D-CT, electronic nasopharynlaryngoscope. Among them, 14 patients accepted reoperation, such as uvulopalatopharyngoplasty (UPPP), nasoendoscopic surgery, adenoidectomy, partial glossectomy, tracheotomy were applied matching to differential obstructive location. AHI, lowest SaO2, Epworth sleepiness scale (ESS), complication were recorded after 6 months. RESULT: After 6 months, their AHI decreased from 48.19 +/- 13.11 to 11.32 +/- 4. 42, ESS scores decreased from 12.93 +/- 4.60 to 4.93 +/- 1.44, P<0.05. Two of the 14 patients were cured, while the other 12 were efficient. No complications were observed. CONCLUSION: Obstructive location judgement and proper surgical operation are the keys of the treatment. Preoperative AG sleep monitoring, nasopharyngeal 3D CT, electronic nasopharynlaryngoscope examination for determining blocking plane, the decision of surgery which is significant.

[Significance of AG in OSAHS operation treatment guidance and evaluation of postoperative efficacy].

OBJECTIVE: Apneagraph can be used to discuss which the best operation scheme is for OSAHS. Effects of uvulopalatopharyngoplasty can be assessed by Apneagraph in obstructive sleep apnea hypopnea syndrome (OSAHS) patients. METHOD: Fifty-six patients with OSAHS received the modified UPPP operation were randomly selected in our hospital. The AG and PSG were applied for diagnosis and evaluation of operation effects. The sleepiness state was assessed by ESS (Epworth sleepiness scale) 6 months after the surgery, compared with the preoperative ESS scores using attest for statistical analysis. We used the SPSS19.0 software to carry our data analysis. RESULT: After 6 months, the evaluation of postoperative efficacy came out to be completely controlled in 42 cases (75%), significantly effective in 14 cases (25%), and uncured in 0 cases. Correlation between the transpalatal obstruction proportion and the AHI reduction percentage was significantly positive (r = 0.667). There were 38 patients with oropharynx obstruction percentage more than 73.35% presented completely controlled in 34 cases (89.47%), significantly effective in 4 cases (10.33%), and uncured in 0 cases. CONCLUSION: AG has the dual functions of analyzing sleep-related respiratory disturbance events and determining upper airway obstruction sites. AG application in the postoperative evaluation of modified uppp has significantly objective guide significance. The modified UPPP for treatment of OSAHS can improve the operation effect. Patients with oropharynx obstruction percentage more than 73.5% don't need to receive the operation for treatment of retroglottal region.

[Histopathologic and morphological changes of palatopharyngeal soft tissue in patients with mild, moderate, and severe obstructive sleep apnea hypopnea syndrome].

OBJECTIVE: To observe the histopathologic and morphological changes of palatopharyngeal soft tissues in patients with different degrees of obstructive sleep apnea hypopnea syndrome (OSAHS) patients. METHOD: Thirty-eight male OSAHS patients were divided into 3 groups according to AHI, namely mild group (n = 10), moderate group (n = 13),and severe group (n = 15). The soft palate tissues with partial palatopharyngeal arch and palatoglossal arch tissues were obtained from surgery and processed with conventional paraffin embedding. The sections were stained by HE and observed under a light microscope. The histological quantitative changes of the specimens were measured by analyzing the constituent ratios of glandular tissue, fat tissue and interstitial elements. Statistical analysis was performed. RESULT: 1) Optical microscope showed that (100 times), as the aggravation of the OSAHS, the soft palate squamous epithelial cells are swollen and irregular, exhibiting hyperkeratosis, accompanied by liquefied degeneration of basal cell; The mucous membrane and submucosal connective tissue contain a certain number of lymphocytes infiltration. The mucosa and submucosal layer of loose connective tissue contain inflammatory cells and a lot of fat vacuoles can be observed; The soft palate mucous acini have inconsistent and irregular shape, among which there are a certain amount of fat cells infiltration. Some mucous acini are replaced by serous acini with dark stained cytoplasm; The palatoglossal muscle and palatopharyngeus muscle fibers can't be identified with disordered arrangement of structure, showing pleomorphic changes including swelling, atrophy and degeneration. Some of elastic fibers were disrupted and a lot of fat cells infiltration was observed. (2) The constituent ratios of the three kinds of tissues in soft palate from different degrees of OSAHS patients show that quantitative changes of glandular tissue and interstitial elements among the mild, moderate and severe OSAHS group patients exhibit statistically significant differences (P < 0.05). The constituent ratio of vascular components between mild and severe groups and that between moderate and severe groups exhibit statistically significant differences (P < 0.05). The constituent ratio changes of vascular components between mild and moderate groups show no statistically significant difference (P > 0.05). CONCLUSION: With the rising of severity of OSAHS, the soft palate squamous epithelial cells are swollen and irregular, exhibiting hyperkeratosis. Between acinar cell we could see a certain amount of fat cells infiltration. Some mucous acini are replaced by serous acini. Muscle fibers of palatopharyngeal tissue have pleomorphic changes of swelling, atrophy and degeneration.

[Pathologic changes of the palatopharyngeal muscles in patients with obstructive sleep apnea hypopnea syndrome of different degrees].

OBJECTIVE: To study the pathologic changes of the palatopharyngeal muscles with transmission electronmicroscopy (TEM) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS), the role of the above muscle in OSAHS pathogenesis was discussed. METHODS: Thirty-eight palatopharyngeal muscle from OSAHS patients receiving uvulopalatopharyngoplasty (UPPP) were collected in in-patient department of Chinese Medical University and five palatal tumor patients receiving resection without snoring were chosen as the control. The palatopharyngeal muscle fiber and the feature of changes in mitochondrial morphology were observed by TEM. RESULTS: The pathological changes were not observed in the normal control group. The muscle fibers were regularly arranged, and the mitochondrial between muscles were normal. The palatopharyngeal myofibrillar in mild OSAHS group was regularly arranged. The Z lines were straight, and most mitochondria structure were normal. In the moderate group, the myofibrillar was disorganized, and the Z lines were shortened or distorted. The myofibrillar in severe group was disorganized, similar to point-like or flake, and the Z lines and the structures of sarcomeres were disappeared. And organelle were disintegrated and mitochondria were disappeared similar to flocculent. There existed obvious fatty infiltration in the palatopharyngeal muscle. In the control, mild, moderate and severe group, pharyngeal muscle fiber disarrangement of the occurrence rate was 0, 2/10, 8/13, 14/15, the occurrence rate of mitochondrial degeneration was 0, 2/10, 8/13, 14/15, increased with the severity of the ultrastructural changes in the trend of increasing incidence. CONCLUSIONS: The degree of OSAHS is correlated with the pathological changes of palatopharyngeal muscles. Incidence of myopathy is an important part of OSAHS secondary to chronic intermittent hypoxia in OSAHS and other pathological lesions, but also an important reason for increasing pharyngeal collapse.

[Clinic and pathological analysis the larynx leukoplakia in 74 cases].

OBJECTIVE: To study the clinic and pathological features of leukoplakia of the larynx, and reduce canceration rate. METHOD: Seventy-four postoperative patients of leukoplakia of the larynx were followed up for four years by telephone or clinic service. RESULT: None of eighteen cases of pure leukoplakia was recurrence. Fifty-six cases were leukoplakia with epithelial dysplasia histologically. Seven out of fifty-six postoperative cases occurred hoarseness; three out of fifty-six postoperative cases recurred, and accepted twice or more operations successively; three out of fifty-six postoperative cases occurred canceration. CONCLUSION: Operation is the main means for the treatment of leukoplakia of the larynx, and the effect is comparatively well. The patients with histological epithelial dysplasia should be pay great attention because of their higher canceration rate, and enlarged operation ranges appropriately with the patient consent could effectually prevent recurrence or canceration during the early lesions. Close observation is important for these patients.

[Effective evaluation of multiple level surgery in obstructive sleep apnea-hypopnea syndrome].

OBJECTIVE: To investigate the therapeutic effects of multiple level surgery in treating obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: One hundred ninety two patients with OSAHS diagnosed by polysomnography were treated through uvulopalatopharyngoplasty (UPPP). Thirty patients were combined with sub-mucous resection of the nasal septum. Forty four patients received sub-mucous resection of the nasal septum and partial inferior turbinectomy. Two patients received sub-mucous resection of the nasal septum and partial resection of the tongue base. Two patients received genioglossus advancement and partial resection of the tongue base. Three patients received partial resection of the tongue base. In addition, the patients with the nasal disease and/or the lingual fat, AHI > 40 times/h, LSaO(2) < 0.64 and/or BMI > 30 kg/m(2) received tracheotomy before general anaesthesia. RESULTS: One hundred ninety two patients were treated through UPPP. One hundred ninety one patients were successful, one patient died of pneumothorax and cardiac arrest during the incision of the trachea. All patients were followed-up for 6-37 months, among them, 132 patients showed therapeutic effect, with the effective rate as 68.7%. Fifty five patients were cured (AHI < 5 times/h); 39 patients had significant effect (AHI < 20 times/h and decreased > or = 50%); 38 patients were effective (AHI decreased > or = 50%). However, 60 patients did not have any therapeutic effect, with the ineffective rate as 31.3%. Fifty four patients had palatopharyngeal and nasal cavity emphasis, 24 patients had palatopharyngeal and oropharyngeal emphasis, 96 patients had palatopharyngeal and nasal cavity and oropharyngeal emphasis. Some patients were treated with UPPP, which made effective rate as 15 (68.2%), 12 (63.2%), 29 (55.8%). The others were treated with multiple level operations, which made effective rate as 25 (78.1%), 5 (5/5), 33 (75.0%). The effective rate was 60.2% (56/93) by simple UPPP and it was 77.8% (63/81) by multiple level treatment in patients with multiple level obstruction. There was statistical significance between them (chi(2) = 6.2, P = 0.01). CONCLUSIONS: The effective rate was improved through multiple level operations in OSAHS patients. The serious complications could be prevented through tracheotomy before general anaesthesia in patients with severe OSAHS who needed multiple level surgery.

[Expression of gene BRMS1 and CD44v6 protein in supraglottic laryngeal carcinoma and its clinical significance].

OBJECTIVE: To investigate the expression of breast cancer metastasis suppressor 1 (BRMS1) and CD44v6 protein in supraglottic cancer and to evaluate its clinical significance. METHOD: The expression of BRMS1 protein and CD44v6 protein were examined by using immunohistochemical method in 70 cases of paraffin-embedded supraglottic cancer tissues and their surrounding laryngeal normal mucosa tissues (LNT). RESULT: The expression of BRMS1 protein in LNT of supraglottic cancer was positive, and the positive rate was 85.7% (60/70); in tumor tissue was negative or lower expression, and the positive rate was 35.7% (25/70). The expression of CD44v6 protein in tumor tissue of supraglottic cancer was positive, the positive rate was 82.9% (58/70), in LNT was negative. There was a significant difference in BRMS1 and CD44v6 protein expression between the supraglottic cancer tissue and LNT (P<0.01). The expression of BRMS1 and CD44v6 protein had correlation with clinical stage and pathologic differentiation and cervical lymph node metastasis of supraglottic cancer (P<0.01). No correlation was found between the two proteins expression and sex and age (P>0.05). The expression of BRMS1 protein was related to the expression of CD44v6 protein (r = -0.9042, P<0.01). Calculated by Kaplan-Meier method, there is no survival difference at 3-year between the group with positive BRMS1 protein expression and the group with negative BRMS1 protein expression in tumor tissues (P>0.05), there is a significant survival difference at 3-year between the group with positive CD44v6 protein expression and the group with negative CD44v6 protein expression in tumor tissues (P<0.05). CONCLUSION: The expression of BRMS1 protein in supraglottic cancer is significantly decreased and the expression of CD44v6 protein in supraglottic cancer is significantly increased. The expression of BRMS1 protein and CD44v6 protein has a close relationship with pathologic differentiation and clinical stage and cervical lymph node metastasis of supraglottic cancer. Combined detection of the expression of them in supraglottic cancer may provide a significant parameter to judge the cervical lymph node metastasis of supraglottic cancer.

[Expression and clinical significance of breast cancer metastasis suppressor 1 mRNA in supraglottic laryngeal carcinoma].

OBJECTIVE: To investigate the expression of breast cancer metastasis suppressor 1 (BRMS1) mRNA in supraglottic cancer and to evaluate its clinical significance. METHOD: The expression of BRMS1 mRNA was examined by using RT-PCR method which take beta-actin mRNA as reference template in 66 cases of supraglottic cancer tissues and their adjacent normal mucosa tissues (ANT). RESULT: The expression of BRMS1 mRNA in the tissues of supraglottic cancer is lower significantly than that in the tissues of ANT ( P<0.05). There is correlation between BRMS1 mRNA expression and the clinical stage, differentiation and cervical lymph node metastasis in the laryngeal supraglottic cancers (P<0.05). There is no correlation between BRMS1 mRNA expression and sex and age. CONCLUSION: Expression of BRMS1 mRNA in supraglottic cancer is lower than that in adjacent normal mucosa. The decrease of BRMS1 mRNA expression may be related to clinical stage and low differentiation and lymph node metastasis of supraglottic laryngeal cancer.