颗粒细胞瘤(granular cell tumor,GCT)是一种病因不明确的软组织肿瘤,发生于声带的GCT较少见且临床表现无特异性,普通的喉镜等检查难以与声带息肉等区分,当声带GCT合并其他声带病变时,易单纯误诊为声带其他病变.我院收治声带颗粒细胞瘤合并声带息肉1例,现报道如下.

1 临床资料 患者,女,14岁,主因右侧鼻塞伴异味10余年为主诉于2018-04-20入院.患者10年前无明显诱因出现右侧鼻塞、伴脓涕、异味、痰多、头部闷沉感、间歇性头痛、嗅觉减退等,自觉左侧鼻腔正常,发病时给予药物治疗(具体不详),效果欠佳,症状反复.患者家属否认患者幼时打鼾、呼吸困难、吸奶困难等症状.外院行鼻窦CT示:右侧鼻腔占位(图1A),建议手术治疗.

Objective:To investigate the clinical characteristics, family history, treatment and prognosis of patients with Crouzon syndrome. Method:We reviewed and analyzed the clinical data of 6 patients with Crouzon syndrome. All patients suffered from snore during sleep, along with mouth opening, in which 5 cases had apnea and could be awaken. In addition, five of six experienced hearing loss, including one case with right ear discharging repeatedly. During the treatment, all patients were operated under general anesthesia. Among six cases, two were performed by tonsillectomy, adenoidectomy, and myringotomy; one was treated by adenoidectomy and myringotomy; two were performed by adenoidectomy; one was treated by external auditory canal cholesteatoma exenteration. Result:Within half a year to seven years' follow-up, 5 patients snore occasionally at night but without sleep apnea, while 1 patient performed by external auditory canal cholesteatoma exenteration has no improvement in sleep snoring. Additionally, the hearing of 5 patients have been greatly improved after operation and the cranial facial deformity of 2 cases have been alleviated than before, while 4 patients have no alleviation in oxycephaly, exophthalmos, mandibular prognathism and malocclusion.Conclusion:Understanding the clinical characteristics of Crouzon syndrome significantly contributes to early diagnosis of this disease. Individual-based treatment should be carried out according to the clinical symptoms and signs of patients. Early intervention benefit to the improvement of prognosis and the life quality of patients.

木村病即嗜酸性淋巴肉芽肿，是以长期存在并易反复的无痛性头颈部皮下软组织肿物为主要临床表现的一种病因尚未明确、临床少见的慢性炎症性疾病。现将我院2011～2015年所收治的7例木村病患者的临床资料报道如下。

目的 探讨白细胞介素-5 (interleukin-5,IL-5)和白细胞介素-16 (interleukin-16,IL-16)在变应性鼻炎(allergic rhinitis,AR)患者血清中的表达及临床意义.方法 采用酶联免疫吸附试验检测64例持续性AR患者及20例正常对照组血清中IL-5、IL-16水平,并分析与AR之间的相关性.结果 与对照组相比,持续性AR患者血清中IL-5、IL-16均明显升高(P＜0.05).持续性中重度组患者血清中IL-5、IL-16水平均明显高于持续性轻度组,二者比较差异有统计学意义(P＜0.05).持续性AR患者血清中的IL-5与IL-16水平呈正相关(r=0.566,P＜0.05).结论 IL-5、IL-16参与变应性鼻炎的发生发展,二者在AR的临床诊断、治疗中具有广阔应用前景;IL-16具有较高特异性,对AR患者早期诊断具有重要临床意义.

目的：探讨基质金属蛋白酶（ MMP）－2、9在喉鳞状细胞癌（ LSCC）患者血清中的表达水平及与临床特征的相关性。方法采用SDS－PAGE Zymography法检测56例LSCC患者及40例正常对照组血清中MMP－2、MMP－9水平。结果喉癌患者血清MMP－2、MMP－9浓度明显高于正常对照组（P＜0．05），其血清MMP－2、MMP－9浓度升高与淋巴结转移显著相关（P＜0．05），与肿瘤原发部位、病理分级无明显相关性（均 P＞0．05）。血清MMP－9浓度与肿瘤临床分期无明显相关性。血清 MMP－2浓度在 T4期中明显升高，与其他分期之间差异显著（均 P＜0．05）。结论血清 MMP－2、MMP－9在喉癌患者中的浓度明显升高，有助于喉癌的诊断；可能对预测淋巴结转移具有一定作用，并可成为喉癌手术方案选择的依据。

目的：探讨白介素（IL）－13、（IL）－25与变应性鼻炎（AR）发病机制的关系及临床意义。方法采用双抗体夹心酶联免疫吸附试验（ELISA）检测64例AR患者和20例正常对照组血清中 IL－13、IL－25水平，并分析相关性。结果持续性 AR患者血清中 IL－13，IL－25水平明显高于对照组（P＜0．05）。持续性中重度组AR患者血清中IL－13、IL－25水平均明显高于持续性轻度组（P＜0．05）。 IL－13与 IL－25在持续性 AR患者血清中的水平呈正相关（ r＝0．979 P＜0．05）。结论 IL－13、IL－25参与了AR的发生与发展，且与病情严重程度呈正相关。

目的：探讨 Smac和 XIAP 在喉鳞状细胞癌（ LSCC）中的表达水平及临床意义。方法采用免疫组织化学法（ S-P 法）检测31例LSCC组织和10例正常腭帆黏膜（ NVPM）组织中Smac和XIAP的表达，并用统计学方法分析各组结果及相关性。结果 Smac在 LSCC 组的表达水平明显低于NVPM组（ P＜0.01）， XIAP 在 LSCC 中的表达水平明显高于 NVPM 组（ P＜0.01）。 Smac 和 XIAP 在 LSCC 中的表达水平呈负相关（r＝－0.65，P＜0.01）。结论 Smac在喉癌组织中的低表达、XIAP在喉癌中的高表达与LSCC的发病及恶性程度密切相关。

随着互联网和智能移动终端技术的快速发展,大规模网络在线式开放课程(MOOC-慕课)随之兴起.本文通过比较国内外普通化学网络课程概况、课程形式、课程内容设置等,对我国普通化学类网络开放课程的建设提供一些思路和可借鉴之处.

浆细胞瘤是一组来源于B淋巴细胞，以单克隆性浆细胞异常增生并分泌大量单克隆免疫球蛋白为特点的罕见恶性肿瘤，包括多发性骨髓瘤（ MM）、孤立性骨髓瘤（ SPB）和髓外浆细胞瘤（EMP）〔1〕。其中EMP约占所有浆细胞肿瘤4％，可发生于全身任何髓外的组织和器官，但90％发生于头颈部，尤其是上呼吸道〔2〕。为提高对本病的认识，本文对我院2008年3月至2013年12月收治的6例鼻及鼻咽部EMP患者的临床及病理特点、治疗情况进行回顾性分析。

Objective:To discuss the therapeutic effects of Nd:YAG laser operation in treating the cysts of otolaryngology.Meth-ods:51 patients with epiglottic cysts,15 patients with pharyngeal pouch cysts,46 patients with tonsil cysts,6 patients auricular pseudo-cysts,5 patients with nasal vestibule cysts were treated with Nd:YAG laser operation.Results:After 1 month-1 year follow-up. All au-ricular pseudocyst (6 cases) and tonsil cyst (41 cases) of the patients were one-time cure, no recurrence. 1 case of pharyngeal pouch cyst, five cases of tonsil cysts, six cases of epiglottis cysts were lost to follow after treatment. One case of pharyngeal pouch cyst pa-tients, after operation still have some symptoms of postnasal drip. A month later, the patient underwent secondary Nd:YAG laser treat-ment to cure. Two cases of patients with giant cysts of epiglottis , after one month later and found in the primary cyst site is still small cyst exist. Underwent secondary YAG laser treatment to cure. One case of nasal vestibule cyst patients relapsed after a month,under-went a labiogingival groove approach to cure.Conclusion:The method of Nd-YAG laser in treating epiglottis cyst, pharyngeal pouch cyst and tonsillar cyst is one of the ideal methods should be introduced. In treating auricular pseudocyst and nasal vestibule cysts is not recommended. After operation local swelling reaction was violent and there were scars at the punch.

OBJECTIVE To explore the causes and prevention of children's postoperative bleeding after tonsillectomies and adenoidectomies with low-temperature plasma scalpel.METHODS Form November 2010 to February 2013,a retrospective analysis of 188 cases done tonsillectomies or/and adenoidectomies with low-temperature plasma scalpel.The age was between 19 months to 12 years old,and the average age was 5.3±3.1 years old.Among the 188 cases,60 cases were tonsillectomy-only,69 case were tonsillectomy-and-adenoidectomy while 59 cases were adenoidectomy-only.RESULTS There were 4 postoperative bleeding cases,all of cases were after tonsillectomies,3 cases started bleeding from 7 to 10 days after the surgery and 1 case within 24 hours after the surgery.The adenoidectomy postoperative bleeding did not occur.CONCLUSION The condition of the children and the skill level of surgeon are the important reasons to cause postoperative bleeding.The keys to reduce postoperative bleeding are as follow: to consult the patients for preoperative and postoperative,adequate hemostasis during the surgery and good surgical techniques.

低温等离子射频系统具有消融、切割、止血、冲洗、吸引等功能,工作温度低,对周围组织损伤小等优势.较广泛应用于一些耳鼻咽喉头颈外科疾病的治疗,已从开始的低温等离子射频扁桃体切除、腺样体切除、喉乳头状瘤切除,不断拓宽其应用范围,用于鼻内翻性乳头状瘤切除[1]、鼻咽纤维血管瘤[2,3]切除等.我科自2011年3～5月在鼻内镜引导下,应用低温等离子射频治疗鼻咽部肿瘤3例,取得良好效果,总结报道如下.

　　庞维国教授主张自主学习要从学习的维度和过程两个角度来定义，从学习的维度界定自主学习是指从学习的诸方面来综合地规定自主学习的本质[1]，具体说来，如果学生有自我驱动的学习动机，能够自己选择所需要的学习内容，自己主动来计划和管理学习时间等等，那么他的学习就是充分自主的。从学习的过程界定自主学习是指从学习活动的整个过程来阐述自主学习的实质[2]。那么，也就是说，在学习活动前，如果学生自己能够做好充足和具体的学习准备，在学习活动中，能够对学习进展进行自我监控、对学习方法进行调节、对学习过程中所遇到的问题进行及时的反馈，在学习活动后，能够对学习结果进行深刻的自我检查和认真的自我评价，那么他的学习就是自主的。在我国，大学生的自主学习意识薄弱，而医学院校医学知识内容丰富，体系庞杂，且医学教育的实践性强，就业形势严峻，这一现状导致医学生的学业负担过重。所以说，加强学生自主学习能力培养有利于促进医学生制定科学的学习目标，加强自我管理。与此同时，近年来，我国实施了新课程，不同区域的实行力度有所差别，这导致了来自不同地域的大学新生们参差不齐的化学基础水平，这就要求我国教育工作者要重视大学生自主学习能力的培养。

目的线粒体膜电位的缺失是线粒体凋亡途径的早期事件。我们用线粒体膜电位去极化剂（valinomycin）处理3个喉癌细胞系,研究它们的凋亡反应和细胞色素C释放的能力。方法 3个喉癌细胞系和对照细胞系HL-60经过valinomycin处理后,用细胞膜电位探针JC-1染色和凋亡特异性探针annexinV染色,用流式细胞仪分别测量它们的线粒体膜电位和凋亡率。Western印记用来检测细胞浆内的细胞色素C的释放。结果在经过24小时的处理后所有细胞均显示完全的线粒体去极化,只有对照细胞HL-60出现凋亡和细胞色素C释放,而喉癌细胞系没有出现。结论喉癌细胞系表现出线粒体膜电位去极化诱导的凋亡途径的缺陷,线粒体膜电位去极化而没有细胞色素C的释放。线粒体凋亡途径的缺陷是喉癌的一个特点。

OBJECTIVE To explore the role of IL-17 and IL-27 in the pathogenesis of allergic rhinitis and their clinical significance.METHODS The protein level of IL-17 and IL-27 in serum of patients with allergic rhinitis were measured with enzyme-linked immunosorbent assay(ELISA) and their correlation with the severity of disease was analyzed.RESULTS Compared with the control group,the protein level of IL-17 in serum of patients with persistent AR was significantly increased (r=-5.654,P0.01),and the protein level of IL-27 was significantly decreased(Z=-4.944,P0.01).There were significant difference of IL-27 levels among control group and patients with mild,moderate or severe persistent AR (P0.05).There was a negative correlation between the serum levels of IL-17 and IL-27 in patients with persistent AR(r=-0.405,P=0.022).CONCLUSION IL-17 and IL-27 may play a role in the pathogenesis of AR.Relative immune therapy may become a new target of clinical treatment of AR.

OBJECTIVE To determine the level of chemotatic factor Eotaxin-2 and thymus and activation regulated chemokine(TARC)in serum of patients with allergic rhinitis(AR),and discuss their role and clinical significance.METHODS ELISA was applied to assay the chemokines of TARC and Eotaxin-2.RESULTS ① High level of TARC and Eotaxin-2 was detected in the AR patients,which was significantly different from that of NAR.②TARC and Eotaxin-2 in the mild and moderatesevere persistent AR patients significantly increased,compared with NAR,as determined by Student's t test.The TARC OD results were 0.475±0.035,0.475±0.015,0.425±0.030 separately(t =2.100,P =0.011;t =3.080,P =0.010);the Eotaxin-2 OD results were 2.660± 0.900,3.13±1.375,1.055±0.33(t =6.874,P =0.032;t=5.900,P=0.034),in both of which the listed turn was mild persistent AR,moderate-severe persistent AR and NAR.③TARC showed positive correlation with Eotaxin-2 by linear correlation analysis(r =0.880,P 0.01).CONCLUSION The increased expression of TARC and Eotaxin-2 in AR was well evidenced.TARC showed positive correlation with Eotaxin-2.This result may be due to Th2 cell response,which could directly lead to morbidity.Yet,the expression level of TARC and Eotaxin-2 had no relation to varying severity of allergic symptoms.

目的探讨5-氟尿嘧啶(5-FU)联合热疗对人喉癌细胞株Hep-2细胞增殖抑制率、细胞凋亡率及细胞周期进程的影响。方法应用噻唑蓝(MTT)染色法检测不同条件下Hep-2细胞的增殖抑制率,流式细胞仪检测细胞周期进程的变化及凋亡率。结果单纯热疗组、单纯5-FU组及联合组对Hep-2细胞的增殖抑制率分别为13.7%、22.3%和46.5%,与对照组相比差异显著(P<0.01)。流式细胞仪结果显示,G0/G1期细胞增多,S期细胞减少,G2/M期细胞相对增多,细胞凋亡率升高,组间比较差异显著。结论 5-FU联合热疗能显著提高Hep-2细胞的增殖抑制率,抑制Hep-2细胞G1期向S期转化进程,诱导Hep-2细胞凋亡。

OBJECTIVE:To study the effect of silencing survivin on the growth of Hep-2 human laryngeal cancer cells in vitro and in vivo.METHODS:Hep-2 cells were transfected with pGCsilencer-siRNA-survivin (psi-survivin)by Lipofectamine 2000. The mRNA and protein expressions of survivin were detected by semi-quantitative RT-PCR and Western blot, respectively. Cell proliferation activity was measured by MTT assay. Apoptosis was assessed by flow cytometry. The implanted tumors were formed from injected Hep-2 cells in nude mice. After the tumor formation, psi-survivin was injected into peritumor tissues. The growth of tumor were observed. The tumor volume was calculated and the tumor growth curve was plotted. The expression of survivin in tumor tissues was detected by Western blot. The tumor cell apoptosis was observed by Tunel staining.RESULTS:The sequence-specific siRNA of survivin inhibited the expressions of survivin mRNA and protein. The inhibition rates of survivin mRNA and protein expression were 54.4% and 37.0% respectively. Also the growth of Hep-2 cells was inhibited significantly, with a decrease by 71.7%. By the day 32 of tumor growth, the mean tumor volumes were (1443.9 ± 230.5) mm(3) (x(-) ± s) in saline control group, (1348.5 ± 198.4) mm(3) in plasmid-negative control group, and (624.6 ± 188.4) mm(3) in psi-survivin group, respectively (t = -5.917, P < 0.01). In the implanted tumors injected with psi-survivin, survivin protein expression was down-regulated significantly, with a inhibition rate of 41.8%. Tunel staining showed the apoptosis occurred in the implanted tumors.CONCLUSION:Silencing survivin could significantly inhibit the growth of Hep-2 human laryngeal cancer cells in vitro and in vivo.

OBJECTIVE To observe the inhibition of elemene combined with heperthermia on the cultured Hep-2 cell line(human laryngeal cancer cell line).METHODS MTT was applied to detect Hep-2 cell proliferation inhibition rate.Flow cytometry was applied to detect cell cycle and apoptosis rate of Hep-2 cells and electronic microscope was applied to detect subcellular changing of Hep-2 cells.RESULTS The inhibition rates were 28.8%,25.7% and 47.1% in elemene group,heperthermia group and elemene combined with heperthermia group respectively.The result of elemene combined with byperthermia group was the most effective.Elemene combined with hyperthermia can significantly increase the proliferation inhibition rate and the apoptosis rate of the Hep-2 cell.The cell cycle progression can be changed obviously.The number of G1 phase cells increased,the number of S phase cells decreased while the cells in G2/M phase increased relatively.At the subcellular level,the swelled mitochondrial,the chromatin agglutination edge trended and apoptotic bodies were observed under electronic microscope.CONCLUSION Elemene combined with hyperthermia can keep Hep-2 from proliferation and inhibit the changing from G1 phase to S phase,so the apoptosis rate can be induced.