Παρασκευή 21 Μαΐου 2021

Clinical analysis of 40 newborns with head and neck occupying lesions

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 May 7;56(5):459-464. doi: 10.3760/cma.j.cn115330-20201027-00835.

ABSTRACT

Objective: To investigate the clinical features, diagnoses and treatments of head and neck occupying lesions in newborns. Methods: All newborns with head and neck occupying lesions admitted to Neonatel Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University form January 2014 to November 2019 were included. There were 23 males and 17 females, admission age was from 2 d-28 d, and the clinical manifestations, examinations, treatments and outcomes were evaluated. Results: Among 40 newborns with head and neck occupying lesions, 22 cases were admitted with dyspnea, 15 cases with masses in oral cavity or head and neck, 2 cases with fever as the first symptom, and 1 case with hoarseness as the first symptom. There were 5 cases with local infection. All cases were examined with l ocal ultrasound and CT or MRI. Nine cases with severe dyspnea were treated with invasive ventilationm, of them 6 cases underwent invasive ventilation for more than 48 hours, 4 cases received tracheal intubation and artificial nose. Diagnostic punctures were performed in 2 cases. Seven cases received conservative treatments. Surgeries were performed in 31 cases, and 25 cases obtained pathologic diagnoses, including 3 cases of soft palate mature teratomas, 1 case of hard palate teratoma, 1 case of granulosa cell tumor, 1 case of lobulated spindle cell tumor in tongue base, 1 case of polyp in right glottis, 1 case of polyp at esophageal entrance, 4 cases of lingual root cysts, 1 case of laryngeal cyst, 2 cases of thyroglossal duct cysts, 2 cases of lymphangiomas, 1 case of lymphangioma with hibernoma, 1 case of tracheal cyst, 1 case of esophageal cyst, 3 cases of left neck abscesses, 1 case of occipital hemangioma, and 1 case of left temporoparietal abscess. Conclusions: The hea d and neck occupying lesions in the newborn is prone to upper airway obstruction. Imaging examination can assist the diagnosis. Different treatments can be selected according to the natures of occupying lesions.

PMID:34010999 | DOI:10.3760/cma.j.cn115330-20201027-00835

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Parotid nuclear protein in testis midline carcinoma: a case report

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本文报道一例腮腺来源的睾丸核蛋白(nuclear protein in testis,NUT)中线癌患者,为35岁男性,因"发现右侧腮腺区肿物3年,增大2周"入院,行腮腺浅叶切除术,手术标本免疫组化及分子检测结果为NUT中线癌。患者术后接受放化疗联合靶向药物治疗,随访10个月内无疾病复发或其他不良事件。腮腺来源的NUT中线癌临床罕见,易发生误诊、漏诊,目前诊断方式依赖免疫组化(NUT抗体阳性)以及分子检测(NUT基因融合异位),其预后情况与患者年龄、融合基因类型、手术范围、术后放化疗方案以及靶向药物的使用相关,因此临床医生需警惕腮腺来源NUT中线癌的发生,尽量做到正确诊断、个性化治疗。.

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 May 7;56(5):510-513. doi: 10.3760/cma.j.cn115330-20201103-00853.

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PMID:34011009 | DOI:10.3760/cma.j.cn115330-20201103-00853

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Analysis of characteristics of Chenopodiaceae pollen induced seasonal allergic rhinitis in the Inner Mongolian grassland region of China

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 May 7;56(5):471-477. doi: 10.3760/cma.j.cn115330-20200713-00584.

ABSTRACT

Objective: To analyze the clinical characteristics of Chenopodiaceae pollen induced seasonal allergic rhinitis (SAR) as well as the distribution and sensitization characteristics of Chenopodiaceae pollen in Inner Mongolia grassland of northern China. Methods: From May 2015 to August 2015, using stratified, cluster and random sampling, a field interviewer-administered survey study and skin prick test (SPT) were conducted in six areas of Inner Mongolia grassland (Xilinhot, Erenhot, Duolun, Tongliao, Jarud, Kailu), and pollen monitoring was carried out in the above six areas from January 1 to December 31 of 2015. The clinical characteristics of Chenopodiaceae pollen induced SAR, distribution and sensitization characteristics of Chenopodiaceae pollen in these regions were observed. SAS software 9.4 was used for data processing. Results: A total of 6 043 subjects completed the study. The prevalence of Chenopodiaceae pollen induced SAR was 13.2% (795/6 043). The highest prevalence was found in the 18-39 age group. Subjects from urban areas showed higher prevalence of SAR than rural areas (61.2% vs 37.9%, P<0.001). There was significant regional difference in the prevalence rate of Chenopodiaceae pollen induced SAR among the above six areas (Xilinhot 21.5%, Erenhot 17.8%, Duolun 8.9%, Tongliao 6.9%, Jarud 15.3%, Kailu 9.7%, P<0.001). The main clinical symptoms of Chenopodiaceae pollen induced SAR were sneezing (96.5%) and nasal itching (92.2%). Eye itching was more obvious among the ocular symptoms (69.1%), while fatigue (32.1%) and drowsiness (31.5%) were more prominent among other related symptoms. Among comorbidities of Chenopodiaceae pollen induced SAR, allergic conjunctivitis accounted for 71.4% (568/795), food allergy accounted for 86.7% (689/ 795) and asthma accounted for 16.7% (133/795). The peak of Chenopodiaceae pollen spread was in August. The prevalence of Chenopodiaceae pollen induced SAR was positively correlated with the concentration of Chenopodiaceae pollen (R2=0.78, P=0.043). The SPT positive rate of Chenopodiaceae pollen was 21.2% (1 282/6 043), and Xilinhot had the highest rate in six regions (28.0%, 236/842). Conclusions: The prevalence of Chenopodiaceae pollen induced SAR in Inner Mongolia grassland stays at a high level. Sneezing is the most obvious symptom of SAR. The peak of Chenopodiaceae pollen spread is in August and the prevalence of Chenopodiaceae pollen induced SAR is positively correlated with the pollen concentration.

PMID:34011001 | DOI:10.3760/cma.j.cn115330-20200713-00584

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Hypopharyngeal schwannoma: a case report

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神经鞘瘤是一种少见的良性肿瘤,发生于下咽部的神经鞘瘤更为罕见,目前仅查阅到十余例报道。本文报道一例47岁女性下咽部神经鞘瘤患者,肿块位于右侧梨状窝。在气管切开后全麻,应用麻醉喉镜暴露术野,30°鼻内镜作为光源,应用低温等离子射频刀完整切除肿物,术中几乎无出血。术后恢复良好,随访1年无复发。.

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 May 7;56(5):514-516. doi: 10.3760/cma.j.cn115330-20210102-00002.

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PMID:34011010 | DOI:10.3760/cma.j.cn115330-20210102-00002

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Reconstruction of complex tissue defects in temporal region: report of 3 cases

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 May 7;56(5):487-492. doi: 10.3760/cma.j.cn115330-20200622-00522.

ABSTRACT

Objective: To discuss the techniques and repairing methods of various degree of compound tissue defects in the auriculotemporal region. Methods: Retrospective analysis was conducted on three cases of different repairing methods for huge compound tissue defects in different degrees in the auriculotemporal region after the resection of the malignant tumor or sinus tract due to repeated infection in our hospital. Results: Following total removal of the tumors or sinus tract in all patients, we applied retroauricular lingual flap transfer repairing, latissimus dorsi flap free transfer repairing and vascular anastomosis, scalp tissue expansion in stage Ⅰ, then repairing the lesion with expanded scalp and filling the huge mastoid cavity with abdominal fat in stage Ⅱ, respectively, according to the characteristics of compound tissue defects in the auriculotemporal region. All free flaps survived well. Conclusions: The anatomy of the auricular-temporal area is complex and involves important vascular and neural structures of head and neck and lateral skull base. The huge composite tissue defect following auriculotemporal region surgery, which is composed of skin, muscle and bone tissue, needs to be repaired in one stage. Therefore, flexible repairing methods should be chosen based on different situations, for attaining the goal of completely removing tumor and lesions, and then, covering the operation cavity.

PMID:34011003 | DOI:10.3760/cma.j.cn115330-20200622-00522

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Studies of brain function associated with otogenic vertigo

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耳源性眩晕占所有眩晕病例的半数以上,其致病机制复杂,涉及多个感觉系统和中枢信息整合,临床诊断与疗效分析普遍缺乏客观指标。前庭相关中枢网络是形成眩晕感知的最终部位,其功能改变可能是眩晕的后果及其症状慢性持续的潜在原因。脑功能评估技术从高级中枢角度探索了耳源性眩晕的特征,证实了患者的皮层多感觉前庭皮质网络发生了活动性及功能连通性改变,为临床认识提供了新的视角。本文阐述了耳源性眩晕脑功能改变的研究进展,并着重探讨脑电图在此领域的应用现状与前景。.

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 May 7;56(5):517-521. doi: 10.3760/cma.j.cn115330-20200412-00291.

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PMID:34011011 | DOI:10.3760/cma.j.cn115330-20200412-00291

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Cryptococcal meningitis with hearing loss as the first manifestation: a case report

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报告一例以听力下降为首发症状的隐球菌脑膜炎患者的诊断和治疗经过,42岁男性患者,病程中出现发热、头痛,测听示双耳对称性感音神经性听力损失。头颅增强MRI示面听神经、硬脑膜强化;脑脊液培养示隐球菌,脑脊液墨汁染色阳性、隐球菌荚膜抗原阳性;肺部病变组织六胺银染色阳性。确诊为隐球菌脑膜炎、隐球菌肺炎。给予两性霉素B及氟胞嘧啶治疗后症状明显好转,听力逐渐恢复。以听力下降为首发临床表现的隐球菌脑膜炎病例少见,特此报道以引起临床医师关注,尤其是无隐球菌感染危险因素的脑膜炎患者,也应常规筛查隐球菌,避免漏诊。.

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 May 7;56(5):496-498. doi: 10.3760/cma.j.cn115330-20200609-00484.

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PMID:34011005 | DOI:10.3760/cma.j.cn115330-20200609-00484

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Advances in differentiation mechanism and function of regulatory T cell subsets

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调节性T细胞(Treg细胞)对于免疫反应非常重要。它们通过抑制过度的免疫应答来维持免疫稳态,其功能失调可影响多种人类疾病的发生发展,包括自身免疫性疾病、变应性疾病和恶性肿瘤等。既往认为Treg细胞属于稳定细胞,但近期多项研究表明,在某些疾病中,Treg细胞可重新分化为Treg细胞亚群,我们称之为辅助性T细胞(Th细胞)样Treg细胞。这些细胞与Th细胞共存,在表达叉头状螺旋转录因子3(Foxp3)并保有常规Treg细胞强大免疫抑制功能的同时,也表达CD4+Th细胞的关键转录因子并分泌相应的炎性因子。各种Th样Treg细胞亚群的存在增加了病理条件下免疫环境的复杂性。本文对几种常见Treg细胞亚群的表型特征、分化机制和功能研究进行综述,同时对Treg细胞亚群与变应性鼻炎、慢性鼻窦� ��伴鼻息肉、头颈部肿瘤等耳鼻咽喉科常见疾病的发病关系进行总结,以期能够深入认识Treg细胞亚群的功能并为相关疾病的靶向治疗提供依据。.

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 May 7;56(5):522-527. doi: 10.3760/cma.j.cn115330-20200610-00487.

NO ABSTRACT

PMID:34011012 | DOI:10.3760/cma.j.cn115330-20200610-00487

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Application of deep convolutional neural networks in the diagnosis of laryngeal squamous cell carcinoma based on narrow band imaging endoscopy

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 May 7;56(5):454-458. doi: 10.3760/cma.j.cn115330-20200927-00773.

ABSTRACT

Objective: To explore the possibility of using artificial intelligence (AI) technology based on convolutional neural network (CNN) to assist the clinical diagnosis of laryngeal squamous cell carcinoma (LSCC) through deep learning algorithm. Methods: A deep CNN was developed and applied in narrow band imaging (NBI) endoscopy of 4 799 patients with laryngeal lesions, including 3 168 males and 1 631 females, aged from 21 to 87 years, from 2015 to 2017 in Beijing Tongren Hospital, Capital Medical University. A simple randomization method was used to select the laryngeal NBI images of 2 427 patients (1 388 benign lesions and 1 039 LSCC lesions) for the training and correction the CNN model. The remaining laryngeal NBI images of 2 372 patients (including 1 276 benign lesions and 1 096 LSCC lesions) were used as validation data set to compare performance between CNN and otolaryngologists. SPSS 21.0 software was used for Chi-square test to calculate the accuracy, sensitivity and specificity of AI and otolaryngologists. The area under the curve (AUC) of receiver operating curve (ROC) was used to evaluate the diagnostic ability of the algorithm for NBI images. Results: The accuracy, sensitivity and specificity for NBI predictions were respectively 90.91% (AUC=0.96), 90.12% and 91.53%, which were equivalent to those for otolaryngologists' predictions (accuracy, sensitivity and specificity were (91.93±3.20)%, (91.33±3.25)% and (93.02±2.59)%, t values were 0.64, 0.75 and 1.17, and P values were 0.32, 0.28 and 0.21, respectively). The diagnostic efficiency of CNN was significantly higher than that of otolaryngologists (0.01 vs. 5.50, t =9.15, P<0.001). Conclusion: AI based on deep CNN is effective for using in the laryngeal NBI image d iagnosis, showing a good application prospect in the diagnosis of LSCC.

PMID:34010998 | DOI:10.3760/cma.j.cn115330-20200927-00773

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Progress on diagnosis and treatment of thyroglossal duct cyst carcinoma

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甲状舌管囊肿癌变发病罕见,缺乏典型的临床表现,超声、CT等影像学检查前难以有效确诊。术前细针穿刺(FNA)的准确率低,通常是术后病理偶然发现。目前针对手术方式的选择争议较大,本文对甲状舌管囊肿癌变组织起源、诊断、治疗和预后进行综述。.

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 May 7;56(5):532-535. doi: 10.3760/cma.j.cn115330-20200715-00593.

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PMID:34011014 | DOI:10.3760/cma.j.cn115330-20200715-00593

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Unusual Relation of Facial Nerve and Retromandibular Vein in Parotid Surgeries: a Case Series

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Abstract

The relation between the facial nerve and the retromandibular vein is of paramount clinical significance during the parotid surgery for the protection of all the facial nerve branches as these two anatomic structures are always in close proximity. However, variations in the relationship of the facial nerve with the retromandibular vein, as presented in this paper complicate parotid surgery and increase the potentiality of unexpected bleeding and injury to the facial nerve injury. This study was conducted in a tertiary care teaching hospital. 4 cases with unusual relation of facial nerve and retromandibular vein in parotid surgeries were studied & included in this study. Out of 70 parotid surgeries which were performed, 4 variations of the retromandibular vein in relation to facial nerve were encountered. With a meticulous dissection the facial nerve branches were separated from the retromandibular vein without causing any injury to the neurovascular structure s and functional deficit. Knowledge of normal anatomy of the extra cranial facial nerve and its relation with the retromandibular vein along with the probable anatomical variations leads to a safe parotid surgery.

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