BackgroundImmune checkpoint inhibitors (ICIs) have emerged as promising treatment strategies in cancer immunotherapy. However, a significant proportion of patients do not respond to these therapies, underscoring the need for reliable biomarkers of treatment responsiveness. Although a potential correlation between the development of immune-related adverse events (irAEs) and favorable response to ICI therapy has been demonstrated, the predictive reliability of irAEs for treatment efficacy remains to be fully established.Case summaryThis report presents a case of advanced unknown primary carcinoma of the head and neck (UPCHN) with rapid disease progression following initial treatment with neck dissection and concurrent chemoradiotherapy. Subsequent administration of a weekly regimen comprising paclitaxel, carboplatin, and cetuximab (PCC) resulted in complete response (CR). Maintenance therapy with cetuximab and tislelizumab was then initiated. After 20 months of sustained CR, the patient developed grade 3 ICI-induced inflammatory arthritis (ICI-IA), necessitating discontinuation of ICI therapy. Notably, the patient remained in complete remission for over 1 year following cessation of ICI therapy, with no clinical or radiographic evidence of tumor progression.ConclusionThis case suggests that the development of ICI-IA reflects an immune hyperactivated state that correlates with long-term antitumor response to tislelizumab. The sustained remission observed in this patient following ICI discontinuation highlights the potential role of irAEs, particularly ICI-IA, as a potential biomarker of ICI efficacy. Further prospective, large-scale studies are warranted to validate these findings and assess their clinical applicability.

Objective: Facial nerve injury induces autophagy and apoptosis in facial nerve nucleus motoneurons of the CNS, impairing nerve regeneration and functional recovery. The function of P2Y2R after facial nerve injury remains to be determined. This study hypothesizes that inhibiting P2Y2R may play a protective role in facial nerve injury by modulating the autophagy signaling pathway. Methods: An in vivo mouse model of facial nerve crush injury was utilized in this study. Mice received either a P2Y2R agonist or antagonist through intrathecal injections of 10 μL/daily for 4 weeks. This study measured facial nerve function, examined fibrogenesis, and analyzed expression of autophagy regulatory proteins. In an in vitro experiment, NSC34 cells were treated with a P2Y2R agonist or an antagonist, and changes in the levels of phosphorylated PI3K, Akt, and mTOR, as well as autophagy regulatory proteins determined. Results: Inhibition of P2Y2R significantly increased autophagy levels and enhanced facial nerve function. These protective outcomes were linked to the suppression of phosphorylated PI3K, Akt, and mTOR signaling pathways. Conclusion: The study suggests that P2Y2R inhibition may improve facial nerve function by improving autophagy, making it a promising therapeutic approach for treating facial nerve injury.

Immunotherapy has brought better survival benefits in the treatment of recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC). However, owing to the lack of relevant biomarkers that could predict the efficacy of this treatment, it often has to be maintained. Here we report on a patient with stage IVA squamous cell carcinoma of the tongue who developed an unresectable lesion in the neck after surgery and radical chemoradiotherapy. After four cycles of intermittent immunotherapy with camrelizumab, complete response (CR) was achieved. Next-generation sequencing showed that the TP53/FANCA/FAT1 gene mutations and negative PD-L1 expression were involved. The patient has been followed up for 4 years without R/M. This situation has not been reported previously, suggesting that some patients can benefit from short-term immunotherapy and even achieve CR; moreover, there may be more molecular markers to be discovered that can predict the efficacy of immunotherapy. We can conduct in-depth research on relevant molecular markers, formulate personalized immunotherapy strategies and plans, and facilitate the development of new precision treatment strategies for HNSCC.

Hypopharyngeal carcinoma, one of the common malignant tumors of the head and neck, is associated with high tumor aggressiveness, early cervical lymph node metastasis, and a poor prognosis. Neoadjuvant immunotherapy has been gradually introduced to treat locally advanced head and neck squamous cell carcinoma (LA-HNSCC), including hypopharyngeal carcinoma. Despite survival benefit advantages, there is no consensus on the treatment mode after neoadjuvant immunotherapy, especially for patients achieving a complete response (CR). It remains uncertain whether surgery, radical radiotherapy, or maintenance with immunotherapy should be chosen for patients achieving CR. Moreover, there are no reports of the successful use of monoimmunotherapy as maintenance therapy in patients who achieve CR with neoadjuvant immunotherapy. Here, we present the case of an older woman diagnosed with locally advanced hypopharyngeal carcinoma with cervical esophageal involvement who presented with dyspnea and swallowing obstruction. After 18 courses of weekly paclitaxel + carboplatin combined with cetuximab (PCC), during which she received pembrolizumab every 3 weeks, the patient’s laryngoscopy and radiologic imaging results revealed that she had achieved CR. She was subsequently maintained with pembrolizumab alone, and no tumor recurrence was observed on multiple examinations during follow-up. No surgery or radiotherapy was performed. From the beginning of treatment to the present (21 months), the patient’s general condition and quality of life improved significantly (Karnofsky performance status [KPS] = 100), and laryngeal function was well preserved. Our results indicate that patients who achieve CR after neoadjuvant immunotherapy may be maintained with immunotherapy (with surgery or radiotherapy as a salvage measure), which can improve disease-free survival in patients with relatively normal laryngeal function. This single-mode treatment may achieve long-term survival in some LA-HNSCC patients.

To evaluate the long-term efficacy of dual-target corticosteroid therapy (simultaneously targeting the endolymphatic sac [ES] and vestibule) in refractory Ménière’s disease (MD) and assess associations between treatment outcomes, vestibular aqueduct (VA) patency, and endotypes. Twenty refractory MD patients with inadequate response to conventional therapies, including intratympanic dexamethasone, underwent gadolinium-enhanced MRI for endolymphatic hydrops (EH) evaluation. VA morphology and angular trajectory (ATVA) were assessed via CT. Methylprednisolone and dexamethasone were delivered to the intact ES surface, while dexamethasone was administered via the oval window (OW) for vestibule-targeted distribution. Follow-up duration: 30.1 ± 13.7 months (mean ± SD). Younger patients exhibited more severe cochlear (p < 0.01) and vestibular (p < 0.05) EH. Vestibular EH correlated with vertigo duration (p < 0.05), and disease stage was associated with EH severity (p < 0.05). 90

Improving the prognosis of patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) who have intermediate- and high-risk factors has long been a priority for head and neck surgeons. This study aims to evaluate programmed death-1 (PD-1) inhibitors administered as maintenance monotherapy after standard of care in patients with postoperative intermediate- and high-risk LA-HNSCC. We retrospectively reviewed 47 postoperative intermediate- and high-risk patients with LA-HNSCC who underwent operative interventions between 2016 and 2022. These patients were divided into two groups: a standard therapy group (n = 24) and an adjuvant immunotherapy group (n = 23 standard therapy + immunotherapy). The primary endpoint was 2-year progression-free survival (PFS) and 2-year overall survival (OS). Stratification analysis according to baseline combined positivity score (CPS), with cutoffs set at CPS ≥ 20, was performed to analyze the correlation between CPS and treatment outcomes. The 2-year PFS and OS rates in the adjuvant immunotherapy group were 82.6

Background There is no consensus regarding the optimal regimen for de novo metastatic nasopharyngeal carcinoma (dmNPC). Locoregional intensity modulated radiotherapy (LRRT) following palliative chemotherapy (PCT) has been shown to prolong the overall survival (OS) and improve the progression-free survival (PFS) of patients with dmNPC, compared with PCT alone. However, patients with a high tumor burden do not benefit from additional LRRT, which inevitably results in toxicity. Recently, immunotherapy has made great progress in the treatment of recurrent or metastatic NPC (RM-NPC). Compared with PCT alone, programmed death-1(PD-1) inhibitors combined with PCT have shown a promising survival outcome and an acceptable safety profile. Therefore, this treatment strategy is recommended as a first-line therapy for RM-NPC. However, whether dmNPC can be treated with immunochemotherapy alone (without LRRT) remains controversial.Case presentation We report two cases of dmNPC, both in middle-aged men who mainly presented with epistaxis and systemic pain. Radiological examination with positron emission tomography-computed tomography (PET-CT) and contrast-enhanced magnetic resonance imaging (MRI) showed NPC with multiple systemic lymph node metastases, multiple bone metastases, and liver metastases. Both patients were diagnosed with dmNPC and received pabolizumab in combination with six courses of platinum-based chemotherapy treatment. After complete remission (CR) was achieved, the patients were maintained on pabolizumab alone. No LRRT was used throughout the course of the disease. Pre- and post-treatment levels of plasma Epstein-Barr virus (EBV) DNA were measured, and radiological imaging was performed before and after treatment.Results We achieved good efficacy in these two cases of dmNPC. Both patients exhibited survival benefits (PFS has reached 31 months since diagnosis), and no serious chemotherapy- or immune-related adverse reactions occurred. Treatment-related toxicity from radiotherapy was avoided. Levels of plasma EBV DNA decreased and remained below the minimum detection level consistently after four or five cycles of treatment, with no obvious symptoms of neck muscle fibrosis, throat mucosa dryness, ear congestion, or nasal congestion.Conclusion Our findings suggested that chemotherapy combined with a PD-1 inhibitor without LRRT, followed by sequential immunotherapy as maintenance, can achieve good results in some dmNPC patients. Further validation of our results may be required in large, high-quality prospective clinical studies.

Objective:To analyze the efficacy of endoscopic CO₂ laser arytenoidectomy in treating bilateral vocal cord paralysis. Methods:Ninety-five patients who underwent endoscopic CO₂ laser arytenoidectomy for bilateral vocal cord paralysis at the First Affiliated Hospital of Naval Medical University（Changhai Hospital） of Shanghai from January 2009 to December 2022 were included in this study. Among them, 59 patients underwent endoscopic CO₂ laser arytenoidectomy as their first glottic enlargement surgery（Group A）, while 36 patients, who had previously undergone two unsuccessful CO₂ laser-assisted posterior cordotomies, underwent endoscopic CO₂ laser arytenoidectomy as a subsequent surgery（Group B）. Swallowing function, electronic laryngoscopy, perceptual voice evaluation, and objective voice analysis indicators were statistically analyzed before and after surgery to evaluate clinical efficacy. Results:The extubation rate after the first surgery was 84.75% in Group A and 86.11% in Group B, with total extubation rates of 94.92% and 94.44%, respectively. There were no significant differences between the two groups in preoperative and postoperative swallowing function, glottic size, or various voice evaluation indicators（P>0.05）. Within-group comparisons showed that postoperative swallowing function, glottic closure during phonation, perceptual evaluations of G（grade of hoarseness）, A（asthenia）, and B（breathiness） significantly worsened, with increased grades. The maximum transverse diameter of the posterior glottis during inspiration significantly increased, and the VHI-10 score was significantly higher postoperatively. Jitter, shimmer, and the harmonics-to-noise ratio significantly deteriorated, and maximum phonation time significantly shortened（P<0.05）. No significant differences were observed in postoperative R（roughness） and S（strain） compared to preoperative values（P>0.05）. Conclusion:Endoscopic CO₂ laser arytenoidectomy can impair voice quality to some extent but effectively alleviates breathing difficulties in patients with bilateral vocal cord paralysis. For patients who did not achieve successful extubation with CO₂ laser-assisted posterior cordotomy, endoscopic CO₂laser arytenoidectomy is an effective reoperative method, ensuring a high extubation rate while preserving certain voice functions.

Extracellular adenosine 5′-triphosphate (ATP), as neurotransmitter, is known to be an activity-dependent signaling molecule that regulates synaptic signaling. It is known to be co-released with acetylcholine from synaptic vesicle. The P2Y2 receptor (P2Y2R) is present in gastrocnemius muscles and co-localizes with post-synaptic acetylcholine receptors (AChRs). Accumulating evidence indicates that P2Y2R plays crucial roles in assembling neuromuscular junctions (NMJs), a peripheral synapse characterized by the clustering of AChRs on post-synaptic densities. This study investigated the alterations in P2Y2R expression during muscle reinnervation and the effect on NMJ formation. We found that P2Y2R consistently co-localized with AChR and sustained high expression in post-synaptic regions during muscle reinnervation. Notably, PSB1114-dependent stimulation of P2Y2R promoted NMJ formation and muscle reinnervation. The stimulatory effect of PSB1114 was significantly blocked by administration of the P2Y2R antagonist suramin. This study revealed distinctive patterns of expression and localization and a potential role of P2Y2R in promoting NMJ formation and regeneration during skeletal muscle reinnervation.

Objective: To explore the efficacy of ansa cervicalis anterior root-recurrent laryngeal nerve (RLN) anastomosis in the treatment of unilateral vocal fold paralysis (UVFP) and to analyze the effect of different pathogenic factors on efficacy. Methods: From January 2010 to January 2022, 428 patients (187 males and 241 females) at Changhai Hospital with UVFP who underwent ansa cervicalis anterior root-RLN anastomosis due to thyroid surgery, thoracic surgery, idiopathic vocal ford paralysis or high cranial base injury were analyzed. The course of nerve injury ranged from 6 to 24 months. Videostroboscopy, auditory perceptual evaluation parameters (GRBAS including Grade, Roughness, Breathiness, Asthenia, Strain), Voice Handicap Index (VHI-10), acoustic analysis including Jitter, Shimmer and noise to harmonic ratio (NHR), maximum phonation time (MPT) and laryngeal electromyography were used to evaluate the surgery efficacy, and the therapeutic difference of the above 4 different etiology patients receiving the operation was compared. Data processing was performed using SPSS 26.0 statistical software, and Wilcoxon signed rank test was used. Kruskal Wallis one-way ANOVA was used for those with equal variance. Results: At 12 months after operation, the affected vocal ford position, vocal ford edge, glottal closure, symmetry and regularity of vocal ford vibration were significantly improved in all four groups (P<0.01). G, R, B, A, S, VHI-10, Jitter, Shimmer and NHR were significantly lower than those before operation, while, MPT was significantly longer (P<0.01). Also, the maximum voluntary motor unit recruitment (VMUR) in the affected thyroarytenoid muscles and posterior cricoarytenoid muscles was significantly improved after surgery (P<0.01). However, the results of thyroid surgery group, thoracic surgery group and idiopathic vocal ford paralysis group were better than those of high cranial base injury group respectively, and the differences were statistically significant (P<0.05). Conclusion: Ansa cervicalis anterior root-RLN anastomosis has an obvious efficacy on the recovery of phonatory function in UVFP patients with different causes, but the high cranial base injury is significantly worse than that of vocal ford paralysis caused by other causes.

Objective:Comparing the primary tumor control, vocal function recovery, postoperative adhesion rate and degree of adhesion in early glottic cancer involving the anterior commissure treated with CO₂ laser staged and lateral surgery, one-stage surgery combined with laryngeal stent placement, and simple CO₂ laser excision. Methods:This study focuses on 83 patients with T1-2N0M0 stage glottic squamous cell carcinoma involving the anterior commissure who underwent CO₂ laser treatment. The study was divided into three groups: Group A with 15 cases, treated with staged resection surgery; Group B with 18 cases, treated with one-stage surgery combined with the placement of a silicone laryngeal stent; and Group C with 50 cases, treated with simple CO₂ laser excision. The Voice Handicap Index-10（VHI-10）, the GRBAS auditory-perceptual assessment, and the maximum phonation time（MPT） were used to evaluate the vocal function of the patients before and six months after surgery. The degree of vocal cord adhesion was assessed using the Cohen classification of vocal cord adhesion. Statistical analysis was performed to determine the differences in each indicator before and after surgery, and the primary tumor control rates among the three groups. Results:Local recurrence occurred in 1 case each in Groups A and B, and in 4 cases in Group C, with no distant metastasis observed. Postoperative vocal cord adhesion of varying degrees occurred in a total of 77 cases, with an adhesion rate of 73.3%（11/15） in Group A, 88.9%（16/18） in Group B, and 100%（50/50） in Group C. The postoperative vocal cord adhesion rate and degree in Group C were significantly higher than in Groups A and B. The postoperative VHI-10 scores in all three groups were significantly increased compared to preoperative scores（P<0.05）, and when compared between groups postoperatively, Group C was significantly worse than Groups A and B （P<0.05）. The postoperative maximum phonation time（MPT） in Group C was significantly reduced compared to preoperative and was markedly shorter than that of Groups A and B postoperatively（P<0.05）. The postoperative grades of G（Grade） and R（roughness） in Group C were significantly higher than preoperatively, indicating a noticeable deterioration in voice quality, and were also significantly worse than those postoperatively in Groups A and B, with all differences（P<0.05）. Conclusion:For early glottic cancer involving the anterior commissure, choosing staged surgery or one-stage surgery combined with the placement of a silicone anterior commissure laryngeal stent were better than simple laser tumor excision in terms of secondary vocal cord adhesion and voice function preservation.

Treating an infiltration of the recurrent laryngeal nerve (RLN) by thyroid carcinoma remains a subject of ongoing debate. Therefore, this study aims to provide a novel strategy for intraoperative phenosurgical management of RLN infiltrated by thyroid carcinoma. Forty-two patients with thyroid carcinoma infiltrating the RLN were recruited for this study and divided into three groups. Group A comprised six individuals with medullary thyroid cancer who underwent RLN resection and arytenoid adduction. Group B consisted of 29 differentiated thyroid cancer (DTC)patients who underwent RLN resection and ansa cervicalis (ACN)-to-RLN anastomosis. Group C included seven patients whose RLN was preserved. The videostroboscopic analysis and voice assessment collectively indicated substantial improvements in voice quality for patients in Groups A and B one year post-surgery. Additionally, the shaving technique maintained a normal or near-normal voice in Group C one year post-surgery. The new intraoperative phonosurgical strategy is as follows: Resection of the affected RLN and arytenoid adduction is required in cases of medullary or anaplastic carcinoma, regardless of preoperative RLN function. Suppose RLN is found infiltrated by well-differentiated thyroid cancer (WDTC) during surgery, and the RLN is preoperatively paralyzed, we recommend performing resection the involved RLN and ACN-to-RLN anastomosis immediately during surgery. If vocal folds exhibit normal mobility preoperatively, the MACIS scoring system is used to assess patient risk stratification. When the MACIS score > 6.99, resection of the involved RLN and immediate ACN-to-RLN anastomosis were performed. RLN preservation was limited to patients with MACIS scores ≤ 6.99.

高原地区由于特殊的气候和地理环境,耳鼻咽喉科专业医疗技术人员短缺,而耳鼻咽喉科学内容繁多且抽象复杂,教学难度大,如何在短期内提高住院医师的耳鼻咽喉科理论和临床知识水平显得尤为重要.传统授课教学模式枯燥乏味,难以激发学生兴趣,多媒体联合基于案例教学模式(case-based learning,CBL)能将理论与临床实践有效结合,活跃课堂气氛,激发学习热情,从而在短期内提升住院医师的临床思维及应用能力.本文将探讨多媒体联合CBL教学法在高原地区耳鼻咽喉科教学中的应用优势,为培养临床功底扎实的耳鼻咽喉科住院医师提供一种有效的教学模式.

目的 探索智能手机应用程序(application,APP)应用软件在医学生耳鼻咽喉科手术操作中的应用.方法 选择全日制临床专业2016级本科生40人,分为对照组和试验组,每组20人.对照组采用以病例为基础的教学(case-based learning,CBL),试验组采用手机Touch Surgery APP结合CBL教学.两组学生的基础课程学习内容一致,在耳鼻咽喉科培训时间均为4个月,结束后进行出科考试,将成绩用统计软件进行分析,比较对照组和试验组理论考试与操作考试成绩.结果 试验组学生手术操作时间明显短于对照组,其操作的熟练程度优于对照组(P＜0.05),试验组的操作成绩明显高于对照组(P＜0.05).结论 Touch Surgery APP结合CBL教学方法可以提高学生自信心和耳鼻咽喉科手术动手能力、缩短培训学习时间、提高耳鼻咽喉科手术培训效果.

目的 探讨细胞角蛋白19(CK19)、半乳糖凝集素3(Gal-3)、p53、拓扑异构酶Ⅱ(TopoⅡ)、Ki-67、细胞周期蛋白D1(CCND1)、人骨髓内皮细胞标志物1(HBME-1)、B-Raf原癌基因丝氨酸/苏氨酸蛋白激酶V600E突变型(BRAFV600E)在甲状腺乳头状癌(PTC)病理诊断中的临床应用价值.方法 选取100例PTC和40例甲状腺良性病变标本,采用免疫组织化学染色EnVision法检测CK19、Gal-3、p53、TopoⅡ、Ki-67、CCND1和HBME-1在组织中的表达情况,通过荧光PCR检测BRAFV600E在组织中的表达情况.结果 PTC组织中CK19、Gal-3、TopoⅡ、CCND1、HBME-1和BRAFV600E阳性表达率[97.0％(97/100)、98.0％(98/100)、56.0％(56/100)、95.0％(95/100)、66.0％(66/100)、75.0％(75/100)]高于甲状腺良性组织[45.0％(18/40)、20.0％(8/40)、15.0％(6/40)、55.0％(22/40)、25.0％(10/40)、12.5％(5/40)],差异均有统计学意义(P均<0.01).8种标志物单独用于PTC的诊断时,CK19、Gal-3的灵敏度最高(97.0％、98.0％),Gal-3的准确度最高(92.9％);3种标志物联合应用并以其中任意2种阳性作为阳性判断标准时,CK19、Gal-3、HBME-1组合检测PTC的准确度最高(96.4％),其次为BRAFV600E、CK19、Gal-3组合(91.4％).结论 CK19、Gal-3、TopoⅡ、CCND1、HBME-1、BRAFV600E是诊断PTC的重要标志物,这些标志物联合应用有助于对形态不典型PTC与甲状腺良性病变进行鉴别.

目的 调查高温、高湿、高盐、强辐射、多台风环境下守礁官兵耳鼻咽喉头颈部疾病的流行病学特征,分析病因,为针对性制订科学合理的卫勤保障方案提供依据.方法 调查2018年6月至2020年6月某岛礁医院耳鼻咽喉头颈外科门诊所有就诊官兵的就诊信息,记录性别、年龄、主诉、病情概要、就诊时间及诊断结果等资料,按耳部、鼻部、咽部、喉部及头颈部疾病进行分类,统计各个部位所见疾病及构成比.结果 某岛礁医院耳鼻咽喉头颈外科门诊共1748例次就诊,占岛礁医院总就诊例次的3.79％(1748/46121).在1748例次就诊记录中,耳部疾病占27.86％(487/1748),诊断疾病24种,最常见的为急性外耳道炎(100例次,20.53％),其次为慢性外耳道炎(70例次,14.37％)、耵聍栓塞(56例次,11.50％)、耳鸣(44例次,9.03％)、真菌性外耳道炎(34例次,6.98％)等;鼻部疾病占26.26％(459/1748),诊断疾病14种,最常见的为慢性鼻炎(145例次,31.59％),其次为变应性鼻炎(136例次,29.63％)、鼻中隔偏曲(36例次,7.84％)、鼻出血(34例次,7.41％)、慢性鼻窦炎(33例次,7.19％)等;咽部疾病占32.32％(565/1748),诊断疾病12种,最常见的为慢性咽炎(302例次,53.45％),其次为急性咽炎(169例次,29.91％)、急性扁桃体炎(48例次,8.50％)、慢性扁桃体炎(25例次,4.42％)、咽部异物(7例次,1.24％)等;喉部疾病占9.55％(167/1748),诊断疾病5种,最常见的为慢性喉炎(95例次,56.89％),其次为急性喉炎(68例次,40.72％)等;头颈部疾病占2.23％(39/1748),诊断疾病8种,最常见的为颈部淋巴结炎(18例次,46.15％),其次为颌面创伤(5例次,12.82％)、颞下颌关节紊乱综合征(5例次,12.82％)等.结论 在岛礁复杂、恶劣的环境下,守礁官兵耳鼻咽喉头颈部疾病种类繁多,病情多较复杂.

目的 检测上海市杨浦区变应性鼻炎患者的血清过敏原分布情况.方法 运用敏筛过敏原检测仪专用试剂盒(免疫印迹法)对2018年1-12月就诊于我科门诊的1504例临床诊断变应性鼻炎的上海市杨浦区常驻居民患者血清中过敏原特异性IgE(sIgE)和总IgE进行半定量检测.比较不同性别(男性和女性)、不同过敏原来源(单纯食入性、单纯吸入性和混合性)、不同季节[冬季(1-3月)、春季(4-6月)、夏季(7-9月)和秋季(10-12月)]变应性鼻炎患者的过敏原阳性率.结果 1504例患者的总IgE阳性率为76.93％(1157/1504),sIgE阳性率为85.97％(1293/1504),吸入性过敏原中阳性率排前3位的依次是户尘螨(55.32％,832/1504)、狗毛皮屑(18.22％,274/1504)和屋尘(13.96％,210/1504),食入性过敏原中阳性率排前3位的依次是牛奶(13.03％,196/1504)、蟹(5.52％,83/1504)、鸡蛋白(4.45％,67/1504).男性患者过敏原sIgE阳性率高于女性患者[88.24％(705/799)vs 83.40％(588/705),P<0.01].夏季和秋季过敏原sIgE阳性率高于冬季和春季[89.76％(342/381)、89.69％(435/485)vs 79.65％(227/285)、81.87％(289/353),P均<0.05].单纯吸入性过敏原sIgE阳性率高于单纯食入性和混合性过敏原[45.68％(687/1504)vs 2.46％(37/1504)、20.28％(305/1504)],混合性过敏原阳性率高于单纯食入性过敏原(P均<0.01).结论 上海市杨浦区变应性鼻炎男性发病率高于女性,发病季节以夏秋两季为主,过敏原来源以吸入性为主、混合性次之.

耳鼻咽喉头颈外科是一门解剖结构位置隐蔽且空间关系错综复杂的临床专业学科,对临床施教提出了很高的要求.三维虚拟解剖系统以人工智能和虚拟现实为基础,在虚拟现实环境中将三维解剖立体呈现,轻松理解解剖结构之间的空间关系,从而在短时间内提升解剖学理论水平.本文拟探讨建立三维虚拟解剖授课系统并利用该系统培养本科生的耳鼻咽喉头颈外科解剖学水平,为耳鼻咽喉头颈外科教学提供了新的方法.通过采用随堂测试、单元测试及问卷调查对三维虚拟解剖系统的教学效果进行评价,以证实该系统能有效提升学生对耳鼻咽喉头颈外科专业知识和解剖的理解,显著培养学生的临床实践能力.

目的 通过分析臭氧暴露后人鼻黏膜上皮细胞中氧化应激相关基因表达的变化,初步探索臭氧暴露引发慢性鼻窦炎的机制.方法 建立人鼻黏膜上皮细胞臭氧暴露体外培养模型,用高通量PCR芯片技术对臭氧暴露前后鼻黏膜氧化应激相关基因进行检测,并用qRT-PCR进行验证.采用qRT-PCR、蛋白质印迹法及流式细胞术检测臭氧暴露前后培养细胞中环氧化酶2(Cox2)和活性氧(ROS)的表达.结果 用PCR芯片对鼻黏膜上皮细胞中84个氧化应激相关基因进行筛查,发现高强度臭氧暴露后人鼻黏膜上皮细胞中醛酮还原酶家族1成员C2(AKR1C2)、谷氨酸半胱氨酸连接酶(GCLM)、谷胱甘肽过氧化物酶2(GPX2)、谷胱甘肽还原酶(GSR)、血红素加氧酶1(HMOX1)、NADPH氧化酶(NOX5)、前列腺素内过氧化物酶合酶2(PTGS2)、超氧化物歧化酶2(SOD2)及丝氨酸肽酶抑制剂(Kazal型)1(SPINK1)9个基因表达上调,而趋化因子配体5(CCL5)、细胞球蛋白(CYGB)、可溶性环氧化酶水解酶2(EPHX2)、谷胱甘肽S-转移酶zeta 1(GSTZ1)、角蛋白1(KRT1)、组氨酸磷酸酶(LHPP)、肌球蛋白(MB)、MPV17线粒体内膜蛋白(MPV17)、硒蛋白P(SEPP1)及转运蛋白颗粒复合物6A(TRAPPC6A)10个基因表达下调.同时,臭氧暴露导致ROS大量生成(暴露组及对照组荧光强度:184.3±6.8 vs 13.0±1.4,P<0.05),Cox2 mRNA及蛋白表达水平升高(暴露组与对照组mRNA相对表达量:6.4±1.2 vs 1.0±0.0,P<0.05;暴露组与对照组蛋白相对表达量:11.7±2.6 vs 13.8±1.5,P<0.05).结论 臭氧暴露后GSTZ1、NOX5、SOD2等相关基因参与鼻黏膜氧化应激调控,臭氧暴露引发鼻黏膜炎症反应可能与这些基因调控Cox2表达的相关信号通路有关.

OBJECTIVES:The optimal surgical approach to treat recurrent laryngeal nerve (RLN) infiltration by differentiated thyroid cancer (DTC) remains a subject of debate. This study explored the feasibility and efficiency of immediate ansa cervicalis nerve (ACN)-to-RLN anastomosis for the management of RLN infiltration by DTC.MATERIAL AND METHODS:Fifty-three patients who underwent immediate ACN-to-RLN anastomosis during DTC extirpation were enrolled in the present study. Thirty-seven cases presented with unilateral vocal cord paralysis before the operation (Group A), and another 16 patients presented with normal vocal cord mobility preoperatively (Group B). Multidimensional assessments, videostroboscopy, voice assessment, and laryngeal electromyography (LEMG) were performed preoperatively and postoperatively.RESULTS:All videostroboscopy, voice assessment and LEMG parameters in Group A deteriorated 1 month after the operation and improved 1 year after the operation compared with preoperative data. In Group B, all parameters 1 year after the operation improved significantly compared with the corresponding parameters 1 month after the operation. LEMG in Group A and B provided substantial evidence for the maturation of neural regeneration from ACN and demonstrated that the laryngeal muscles were reinnervated successfully by this procedure.CONCLUSIONS:If the RLN is infiltrated by DTC, immediate ACN-to-RLN anastomosis during complete excision of DTC could restore satisfactory phonatory function and does not compromise oncological radicality.