目的 回顾性分析颈部肿块临床病例资料,以提高对颈部肿块的诊疗水平.方法 收集南京医科大学第一附属医院耳鼻咽喉科2010年1月至2018年12月期间收治住院的601例颈部肿块患者资料,分析疾病的发病规律、影像学特点和病理结果.结果 根据术后病理,分为甲状腺疾病组98例(16.3％)和非甲状腺疾病组;非甲状腺组又分为炎性包块组75例(12.5％),先天性疾病组205例(34.1％),良性肿瘤组74例(12.3％)和恶性肿瘤组149例(24.8％).甲状腺疾病中女患者多于男患者,而颈部恶性肿瘤中男患者多于女患者,差异有统计学意义(P<0.05);不同疾病年龄差异有统计学意义(P<0.05),先天性疾病组年龄低于甲状腺疾病、炎性包块、良性肿瘤和恶性肿瘤组(P<0.05);恶性肿瘤组年龄高于甲状腺疾病、炎性包块、良性肿瘤组(P<0.05).不同疾病病程差异有统计学意义(P<0.05),炎性包块的病程短于先天性疾病、良性肿瘤、恶性肿瘤(P<0.05);而颈部非甲状腺肿瘤,恶性肿瘤的病程短于良性肿瘤,差异有统计学意义(P<0.05).结论 颈部肿块病理类型多样,临床及影像学表现多变,应掌握其各项特征,以提高常见疾病及罕见病的确诊率及诊疗水平.

目的 分析阻塞性睡眠呼吸暂停综合征(OSAS)患者炎症细胞水平与睡眠呼吸监测参数的相关性.方法 114例OSAS患者根据睡眠呼吸暂停低通气指数(AHI)分为轻度(16例)、中度(29例)和重度(69例)三组;另选取60例健康体检者作为对照组.比较各组白细胞、淋巴细胞、单核细胞、中性粒细胞、嗜酸性粒细胞及嗜碱性粒细胞计数,并分析睡眠呼吸监测指标与炎症细胞水平的相关性.结果 四组间的白细胞计数、单核细胞计数、中性粒细胞计数差异有统计学意义(P＜0.05);与对照组相比,重度组白细胞计数、中性粒细胞计数增加(P＜0.05);与轻-中度组相比,重度组单核细胞计数、嗜酸性粒细胞计数增加(P＜0.05).OSAS患者AHI与最低血氧饱和度呈负相关(r=-0.660,P＜0.05),而与氧饱和度＜90％的时间、氧减指数、白细胞计数、单核细胞计数、中性粒细胞计数均呈正相关(r=0.755、0.885、0.206、0.213、0.200,P＜0.05);最低血氧饱和度与白细胞计数、中性粒细胞计数呈负相关(r=-0.162、-0.177,P＜0.05).结论 重度OSAS患者白细胞计数和中性粒细胞计数增加;睡眠呼吸监测参数结合白细胞和中性粒细胞计数可作为OSAS严重程度的预测因子.

目的 观察慢性间歇性缺氧(chronic intermittent hypoxia,CIH)条件下大鼠颏舌肌中5-HT(5-hydroxytryptamine)、5-HT 2A受体表达量的变化,以了解5-HT在CIH所致颏舌肌功能改变中的作用.方法 将20只雄性Sprague Dawley(SD)大鼠(8周龄,体重180～200g)随机均分为4组,即常氧组、CIH组(3周、5周和8周).CIH组低氧条件为舱内氧浓度在5％～21％之间循环,每天8小时.对照组氧浓度维持在21％.分别于3周、5周、8周后观察颏舌肌的形态改变、神经递质5-HT、5-HT 2A受体及RYR(Ryanodine receptor)、SERCA(sarcoendoplasmic reticulum Ca2+-transporting ATPase)的表达量.结果 HE染色显示CIH组颏舌肌肌纤维及细胞核排列杂乱,免疫组化显示5-HT在颏舌肌的表达量3周(P<0.05)、5周(P<0.05)、8周CIH(P<0.01)组均明显升高.5-HT 2A受体3～8周CIH表达量呈现上升趋势且在8周CIH时明显升高(P<0.01).颏舌肌RYR与SERCA表达量均呈下降趋势,从5周开始具有统计学意义.Western blot显示5-HT 2A受体蛋白表达量8周CIH时明显升高(P<0.05).结论 CIH导致伸舌肌颏舌肌5-HT及其受体5-HT 2A表达持续上调,RYR与SERCA表达下降.在一定阶段内,5-HT的代偿保护机制起着主导作用,从而在整体效应上维持咽腔开放.

目的 探讨不同程度的慢性间歇性缺氧(chronic intermittent hypoxia,CIH)状态下,大鼠舌下神经核中MAPK通路相关蛋白(JNK、p38MAPK、ERK)激活后的表达水平.方法 将18只雄性SD大鼠随机分为CIH 3周、8周组和常氧对照组.CIH组大鼠于氧浓度5％～21％之间循环的低氧舱中分别饲养3周和8周,对照组大鼠常氧舱的氧浓度保持在21％饲养8周,随后观察各组大鼠舌下神经核中p-JNK、p-p38MAPK、p-ERK的表达量.结果 CIH组p-JNK、p-p38MAPK和p-ERK在舌下神经核的表达量均显著增加,且随CIH时间呈现增高趋势.p-JNK和p-p38MAPK在腹侧核的表达更显著.结论 舌下神经核对CIH的损伤与调节反应中,MAPK信号通路可能发挥了重要作用.腹侧核与背侧核对CIH的不同反应,可能是其所支配的上呼吸肌群调控的基础.

Purpose To study neurochemical reactions to chronic intermittent hypoxia (CIH) in the hypoglossal nucleus (HN) of rats. Methods Adult male Sprague-Dawley rats (n = 12) were randomly divided into two groups (the CIH and the control group). The CIH rats were housed in a hypoxic chamber with the fraction of oxygen volume alternating between 21% and 5% by providing air for 60 s and then providing nitrogen for 60 s from 8:30 am to 16:30 pm each day for 35 days. The control group was housed in a cabin with normal oxygen levels. We studied the expression of c-fos protein, 5-hydroxytryptamine (5-HT) positive terminals, and its 2A receptors in hypoglossal nuclei by immunohistochemistry. Results The expression of c-fos, 5-HT positive terminals, and accordingly 5-HT 2A receptors in the CIH group were significantly higher than that in the controls ( p < 0.05). The ventral side of the HN showed a clearly higher expression of 5-HT and its 2A receptors than the dorsal side ( p < 0.05). Conclusion There were 2 responses of the HN to CIH. First, CIH induced a higher expression of 5-HT positive terminals and its 2A receptors, and second, this reaction was much more evident in ventral side than in the dorsal side. We postulate that these responses may serve to be a protective and compensatory mechanism for CIH.

新型冠状病毒感染疫情期间,作为定点收治医院的耳鼻咽喉科门诊实施有效防控措施,做到医务人员的科学防护,就诊患者的规范防护,防护物资的精细管理,消毒措施的系统全面,发热患者的应急处置,取得良好的防疫效果,无医院内交叉感染.

目的 探讨影响鼻内镜手术术中出血量的因素.方法 选择2019年9月?2020年1月在江苏省人民医院耳鼻咽喉头颈外科需要行鼻内镜手术共48例,术后根据术中出血量的多少分为两组:出血量＞ 150ml组(A组),A组为岀血量多组;岀血量≤150ml组(B组),B组为岀血量少组.对影响术中出血量原因进行单因素和多因素分析,包括性别、年龄、疾病种类、变态反应的状态、术前鼻内镜及CT总评分、术者因素、手术时长、术前和术中收缩压(SBP)、舒张压(DBP)、术前术后1天凝血功能包括凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、术前、术后1天外周血嗜酸性粒细胞计数.结果 影响岀血的因素主要在于以下几个因素,包括术前术中血压、变态反应状态及病变范围.结论 鼻内镜术中岀血量与术前血压、术中血压、变态反应评分、术前嗜酸性粒细胞、手术时长、手术量评分、术前鼻内镜评分、术前CT评分有关,是影响鼻内镜手术出血量的重要因素.

基于器官系统的综合课程(organ system-based integrated curriculum)、以问题为基础的教学(prob-lem based learning,PBL)、临床客观能力考试(objec-tive structured clinical examination,OSCE)和多选题(multiple choice questions,MCQ)被称作是现代四大医学教育理念[1],分别体现了现代医学教学中课程设置、教学模式和考核考试手段的创新.

目的 探讨慢性间歇性缺氧(chronic intermittent hypoxia,CIH)状态下,大鼠舌下神经核中3种硫化氢合成酶(CBS,CSE,3MST)表达量的变化.方法将12只雄性Sprague Dawley(SD)大鼠(8周龄,体重180～200 g)随机均分为CIH组和常氧对照组.CIH组大鼠放置于氧浓度5％～21％之间循环的低氧箱中,对照组大鼠培养箱的氧浓度保持在21％.5周后观察大鼠舌下神经核中CBS,CSE,3MST三种酶的表达量.结果Western blot分析显示CIH组CBS和3MST在舌下神经核中的蛋白表达量均低于对照组(P<0.05).RT-PCR分析显示CIH组CBS和3MST在舌下神经核中的mRNA表达量低于对照组(P<0.05),CSE mRNA在两组中的表达量没有统计学差异(P>0.05).结论CBS与3MST-H2S通路可能参与调节舌下神经核相关的呼吸活动和保护舌下神经核免受CIH诱导损伤,提示CBS与3MST-H2S通路可能是OSA的重要发病机制之一.

目的 分析儿童与青少年鼻咽癌的流行病学、病理组织学特点、临床症状、诊断及误诊、治疗和预后.方法 检索pubmed和万方、知网等相关资料库中有关儿童青少年鼻咽癌的病例报告及临床流行病学研究,并对此作出分析.结果 儿童及青少年鼻咽癌患者发病率低,就诊时多为中晚期.常见首发症状为颈部肿块,鼻部症状(鼻塞、鼻出血),耳部症状(听力下降、耳鸣、耳闷),颅神经损害(颅神经麻痹、头痛)等.常被误诊为颈淋巴结炎、颈淋巴结结核、血管神经性头痛、中耳炎、鼻咽纤维血管瘤、腺样体肥大等.儿童青少年鼻咽癌对放疗敏感,其预后优于成人.结论 儿童青少年鼻咽癌不易早期发现、早期诊断,需要引起临床重视.

Objective To assess the efficacy of various soft palate surgeries for obstructive sleep apnea hypopnea syndrome (OSAHS).Methods Clinical studies of the soft palate surgical procedures for OSAHS were searched in databases including Cochrane,MEDLINE and PubMed,from their inception to October,2015.References of the selected studies then underwent retrospective review and citation retrieval.Two reviewers independently screened the articles according to the predefined inclusive and exclusive criteria,and then extracted necessary data and evaluated quality of the included studies.A meta-analysis was performed using RevMan 5.1.0.Results A total of 20 self-controlled trials or RCTs involving 631 patients (88％ males) were finally included.Quality evaluation was conducted independently by the two reviewers and crosschecked.Polysonnograph was adopted as a diagnostic criterion,but subjective assessment was used often for the evaluations of obstructive sites.Meta-analyses showed a significant improvement in apnea hyponea index (AHI),lowest saturation (LSAT) and Epworth sleepiness scale score (ESS).Sensitivity analysis indicated that these results were stable.Conclusion High-quality studies as well as objective indicators for the evaluation of obstructive sties are still needed.The soft palate surgeries are effective in reducing AHI and ESS,and enhancing LSAT.To date,no evidence has suggested one surgical approach is more effective than the others.

Objective This study is aimed to explore the method of assessing nasal resistance and to understand the range of nasal resistance in healthy young adults. Methods Nasal resistance was measured by rhinomanometry employing the active anterior method in 29 healthy young adults. The measurement repeated for 3 times with a 20-minute interval. The inspiratory and expiratory resistance of the left and the right nasal cavity were recorded. The total inspiratory and expiratory resistance of nasal cavity were calculated according to the formula. Results There was no significant difference in the results of the three measurements of nasal resistance. The results of the first measurement showed no significant difference in comparison with the average value of the previous two or three measurements. We selected the results of the first measurement as a reference and found that there was no difference between both sides and also between genders. We calculated the average value of nasal resistance and the reference range of 95% in nasal resistance at 75,100 and 150Pa. Conclusion The first measurement for nasal resistance could reflect the preliminary situation of nasal ventilation. The level of nasal resistance in healthy young adults provides a reference range for clinical evaluation.