Objective: To investigate the expression of marker proteins in vocal cord leukoplakia, and to find markers for the early stage of diagnosis and prognosis of precancerous lesions. Methods: The study included 119 cases, 68 cases of vocal cord leukoplakia (22 cases with epithelial simple hyperplasia, 46 cases with epithelial dysplasia), and 51 cases of vocal cords benign lesions(31 cases of vocal cord polyps, 20 cases of Reinke's edema). The expression of p53, Ki-67, p21, Survivin, p16, p27, PTEN, c-Myc and vascular endothelial growth factor (VEGF) in vocal cords leukoplakia were detected, vocal cord benign lesions (vocal cord polyps and Reinke's edema) acted as controls, comparing the expression differences of different pathological tissue. Data was analyzed by SPSS 22.0 software. Results: The expression of p53, p16, Ki-67, VEGF in vocal cord benign lesions and vocal cords leukoplakia with epithelial simple hyperplasia did not show significant differences. There was a grading increase in the positive expression of p53, Ki-67 in the vocal cord leukoplakia with epithelial dysplasia contrasting to those in vocal cord benign lesions and vocal cords leukoplakia with epithelial simple hyperplasia (p53: χ(2)=13.340, P=0.002, Ki-67: χ(2)=53.386, P=0.000). The expression of p27, PTEN, c-Myc in vocal cord benign lesions and vocal cords leukoplakia with epithelial dysplasia did not show significant differences. There was a grading increase in the positive expression of p21 Survivin in vocal cords leukoplakia with epithelial dysplasia contrasting to those in vocal cord benign lesions (P<0.05). Expression of Survivin in vocal cords leukoplakia with mild-moderate epithelial dysplasia showed a significant increase than those in vocal cord benign lesions (P<0.05). The positive expression grade of p21 showed a rising trend (P=0.073) between the different grades of dysplasia. Conclusion: The positive expression grade of p53, Ki-67, p21 Survivin showed an increase in vocal cords leukoplakia with epithelial dysplasia contrasting to those in vocal cord benign lesions, which might be an implication for evaluating the diagnosis and prognosis of precancerous lesions. Expression of p21 was correlated to the degrees of dysplasia and expression of Survivin showed a significant difference in early stage of epithelial dysplasia contrasting to benign lesions.

Objective: Juvenile on-set recurrent respiratory papillomatosis (JORRP) can be an aggressive and potentially life-threatening disease. To emphasize the importance of complication prevention in local excision surgery, the single-center experience of RRP treatment in a group of patients with relatively short recurrence-free-interval (>4 times/yrs) was reported. Methods: Data of 49 patients underwent papilloma resection during 2002-2013 were retrospectively analyzed. Combined techniques of laser microsurgery and microdebriders were used to remove papillomas, prevent the formation of scar tissue and improve respiratory distress. Forty-nine cases were followed up for 99.0[74.5; 121.0]months, ranging from 39 to 185 months. The age of disease onset was 2[1; 3] years old. Most of the patients had difficulty in breathing(42 of 49 cases). Seven patients had hoarseness.53.0% patients had subglottic or trachea papillomatosis spreading. The rate of complications, synechia formation, tracheal stenosis, needing for tracheostomy, mortality was recorded. Patients were followed up for at least three years. The characteristics of the patients, improvement in symptoms, recurrence-free interval, and the rate of tracheal extubation were evaluated. Wilcoxon signed ranks test and chi-square test were used for data comparation. Results: Long-term relieve in disease(≤2 surgeries were needed/year) were achieved in 29(59.1%) subjects, in which 8(16.3%) of the subjects did not need surgical treatment for at least 3 years. Long-term relieve had been achieved in 25 of subjects who did not accept tracheostomy. Seven subjects did not need surgical treatment for at least 3 years. The rate of successful tracheal extubation was 53.8% in 13 patients who had undergone tracheostomy. Three cases dead of intrapulmonary spread. Conclusions: Combined techniques of laser microsurgery and microdebriders are effective in improvement in both respiratory distress and voice quality. The combined technique are helpful to avoid inevitable long-term stenotic complications, ultimately affecting the quality of life.

Histological examination of biopsy shows usefulness in the diagnosis of vocal cord leukoplakia; however, in considerable amount of cases, the examination cannot provide definitive diagnosis of malignancy from benign conditions such as hyperplasia and dysplasia. The present work therefore was aimed to identify clinicopathological factors and molecular markers predictive of recurrence and malignant transformation of vocal cord leukoplakia.Clinical data of 555 cases of vocal cord leukoplakia enrolled from July 1999 to June 2014 were analyzed. The cohort consisted of keratosis (n=137), hyperplasia (n=139), dysplasia (n=177), and primary (n=10) and invasive (n=46) carcinoma. Correlations between patients' backgrounds, clinicopathological factors, molecular markers (p53, p16, Ki67, cytokeratin, and proliferating cell nuclear antigen), and histology backgrounds were examined using by Pearson Chi-squared or Fisher exact test. Reflux symptom index (RSI) and reflux finding score (RFS) before and after treatment were compared using Wilcoxon signed-rank test. Risk factors for disease recurrence were identified using Cox proportional hazards models of multivariate analysis. Time to recurrence was analyzed using log-rank test of Kaplan-Meier method.In the present cohort, alcohol drinking was found associated with GRBAS grade (P=.0258) and the site (P=.0298) of leukoplakia. For the different disease types, chief complaint (P=.0179), GRBAS grade (P=.0101), mucosal wave (P<.0001), and molecular markers p53 (P<.0001) and Ki67 (P<.0001) were identified as correlates. RSI and RFS were significantly lowered by surgical intervention. A single side of leukoplakia was predictive of a lower risk of recurrence (odds ratio, 0.378; 95% confidence interval, 0.197-0.723; P=.0033). Absence of mucosal wave was associated with a shorter time-to-recurrence (P=.0357).The present work identified clinicopathological factors and molecular markers associated with the different histology of vocal cord leukoplakia, and also the prognostic factor for the low risk of recurrence after surgery.

目的 探讨外伤性的喉气管狭窄手术方式以及选择原则对结果的影响.方法 利用医院在2017年8月～10月收集到的8例临床病例,根据患者的狭窄程度、根据患者喉气管狭窄程度、范围,选用支撑器扩张、喉气管切开成形、激光切除、气管镜扩张等治疗方式,观察治疗效果.结果 8例患者在医院进行相应次数的针对喉气管狭窄治疗的手术8例患者全部存活.气管,6例拔管出院,1例堵管出院,1例带管出院.术后门诊随访6个月.堵管出院者均顺利拔管.2例有活动后呼吸困难.结论 在出现喉伤后,相关医务人员要及时的对其进行诊断,并及时的对其进行手术治疗,这对于患者的康复极为重要.

Objective:To investigate the clinical and pathological characteristics of vocal fold leukoplakia and influential factors of recurrence and malignancy. Method:The study included 555 cases of vocal fold leukoplakia. All patients received surgical treatment. The relationship between the clinical and pathological features, and influential factors of recurrence and malignancy were analyzed. Result:The pathological types included squamous epithelial simple hyperplasia in 58.0%, mild hyperplasia in 15.5%, moderate hyperplasia in 10.1%, severe hyperplasia and carcinoma in situ in 8.1%, infiltrative carcinoma in 8.3%. The different pathological types varied among different ages significantly(P<0.01). The tobacco and alcohol abuse had no relationship with pathological types(P>0.05). The more severe the pathology were, the more decreasing of the mucosal waves would be(P<0.01). The pathologic severity had an apparent correlation with p53 positivity and the level of p53 and Ki67 positivity. The p53 positive proportion may increase with the increasing pathological severity(P<0.01), so were the p53 and Ki67 positive levels(P<0.01).Among 232 cases of postoperation follow-ups, 83 cases(35.8%) relapsed while 8 cases(3.4%) malignancy. Bilateral lesions had a higher rate of relapse and malignancy than unilateral lesions(95%CIOR 0.378 ［0.197-0.723］，P<0.01). The relapse and malignancy had a relationship with the pathologic severity. The incidence of disease recurrence and malignancy were positively correlated with pathological severity(P<0.05). p16 positive patients relapsed for more times(P<0.01) and with an uprising tendency of relapse and malignancy（P>0.05）. Conclusion:Pathological types of vocal fold leukoplakia are different. The older men, decreasing of mucosal wave of vocal folds and bilateral lesions were very important factors to predict disease severity. p53 and Ki67 positive rating and pathological severity were positively correlated. The bilateral lesions, pathological severity and p16 positivity had a tendency to increasing relapse and malignancy.

Objective To investigate the cause ,clinical characteristics and prognosis of functional dysphonia . Methods The clinical data and the laryngostroboscopic examination of 104 patients with functional dysphonia were retrospectively analyzed .All the patients underwent the resonant therapy and the accent therapy ,and finished the voice handicap index (VHI) and GRBAS score before and after the treatment .Results Among the 104 patients ,34 cases (32 .69% ) had no apparent cause ,29 cases (27 .88% ) caused by upper respiratory tract infection ,22 cases (21 .15% ) by emotional tension ,10 cases (9 .62% ) by excessive pronunciation ,and 9 cases (8 .65% )by other cau‐ses .The laryngostroboscopic examination showed 43 cases (41 .35% ) with normal mucosal wave ,53 cases (50 . 96% ) with unfavorable mucosal wave changes (41 cases were unable to elicit mucosal wave ,12 cases showed the de‐creased mucosal wave) .The false vocal cords were totally compensatory in 3 cases .5 cases couldn't cooperate .Dur‐ing phonating ,65 cases (62 .50% ) showed glottis insufficiency ,30 cases (28 .85% )showed the supraglottic com‐pensatory ,and 9 cases (8 .65% ) showed the larynx presssed .Of the 67 cases followed up ,53 (79 .1% ) cases scored down to 0 both in G and VHI ,6 cases got obvious voice improvement with decreased G and VHI score com‐pared to the pre-treatment ,8 cases showed no significant difference .Conclusion The causes of functional dyspho‐nia were complex ,not just by a single psychological factor .The majority of laryngoscopy showed abnormal vibration of vocal folds ,glottis insufficiency and supraglottic compensation .The treatment included the psychological counseling ,voice therapy and traditional Chinese medicine with acupuncture .Most patients can achieve a favorable outcome .

Juvenile onset current respiratory papillomatosis (JORRP), which is the commonest benign laryngeal disease in children, has not been well investigated. This study aimed at further evaluating the clinical features and surgery for such children with JORRP. Patients diagnosed as JORRP in our department from January 2011 to June 2014 were enrolled, and the demographic and clinical data were collected. All the patients were followed up after surgery, and the recurrences were recorded. A total of 124 patients were included and categorized into low recurrence (<4/year, n = 97) and high recurrence (≥4/year, n = 27) groups based on the recurrence at diagnosis, respectively. The demographic characteristics were comparable in two groups. There were more patients in high recurrence group who had dyspnea II–III, abnormal chest X-ray findings and severe illness, and needed electrocardiscope monitoring (P < 0.05). Patients who had dyspnea II (P = 0.008) and severe illness (P = 0.002) needed electrocardiscope monitoring (P = 0.014) in high recurrence group were more prone to have recurrence after surgery. Multivariate logistic regression analysis proved that high recurrence at diagnosis was an independent risk factor for recurrence after surgery in JORRP [95 %CI OR 17.342 (1.266, 237.608), P = 0.033]. The recurrence at diagnosis could be used as a prognostic factor for JORRP after surgery, which could help to improve the therapeutic efficacy in such children.

Edge impurity transport is studied in electron cyclotron resonance heating (ECRH) L-mode plasmas of the HL-2A tokamak based on space-resolved vacuum ultraviolet spectroscopy with which radial profiles of impurity line emissions are measured from the core region inside the last closed flux surface (LCFS) and the edge region in the scrape-off layer, simultaneously. The radial profile of carbon emissions of C V (2271 angstrom: 1s2s S-3-1s2p P-3) reconstructed into the local emissivity profile is analysed with a one-dimensional impurity transport code, and the diffusion coefficient and convective velocity of impurity ions are determined in the core region of the HL-2A tokamak. The impurity source is also determined with the measured absolute emissivity profiles of C IV (1548 angstrom: 1s(2)2s S-2-1s(2)2p P-2) located at the LCFS. The ratio of C V to CIV can therefore be used as an index to characterize the core impurity transport between the LCFS and the radial region of the C V emission at a normalized radius of about rho = 0.6. The ratio measured from ohmic discharges shows a gradual decrease with electron density. However, the ratio suddenly decreases by a factor of three when the ECRH focused in the plasma centre is switched on, suggesting a strong enhancement of the impurity transport. The analysis with the transport code indicates a change in the convective term. The convective velocity of C4+ ions changes from inward to outward direction during the ECRH phase, while an inward velocity usually exists in the ohmic phase. Possible mechanisms for the reversal of the convective velocity are discussed.

Objective To evaluate the effect of treating epistaxis with radiofrequency and laser via endoscopies.Methods 343 epistaxis patients with similar symptoms and signs were enrolled and randomly divided into two groups to be treated either with radiofrequency or laser via endoscopy.Primary healing rate,surgery duration and halt frequencies were compared as well as the patients discomfort and surgeons' metal pressure stree level were measured with VAS Visual Analogue Scales(VAS).Results The primary healing rates between the radiofrequency group and the laser group were 96.4% (186 cases/ 193 sides)and 94.7%(179 cases /189 sides),the difference was not statistically significant(P>0.05).The surgery duration in radiofrequency group 2.54±0.93 was shorter than that in the laser group 4.65±1.47(P<0.05);the halt frequencies in the radiofrequency group was 1.21 ±0.31 during surgery and the need of stanching was less than that in the laser group 2.87±1.47(P<0.05);the surgeons' stree level in the radiofrequency group was 2.84±0.72 which was lower than that in the laser group 5.07±1.26(P<0.05);all the above results showed statistical significante difference.There was no statistical significance in patients' discomfort grade between the radiofrequency group 6.73±2.06 and the laser group 6.91±1.78(P>0.05).Conclusions Strictly follow the rules of the procedure,satisfactory outcome can be achieved with these two methods.There is no significant difference in the treating effects and patient discomfort level between the two methods if carefully handled.Radiofrequency has more advantages in treating epistaxis in surgery duration,halt frequency and surgeons' stress level.

Objective To evaluate the effect of treating epistaxis with radiofrequency and laser via endoscopies. Methods 343 epistaxis patients with similar symptoms and signs were enrolled and randomly divided into two groups to be treated either with radiofrequency or laser via endoscopy. Primary healing rate, surgery duration and halt frequencies were compared as well as the patients discomfort and surgeons’ metal pressure stree level were measured with VAS Visual Analogue Scales (VAS). Results The primary healing rates between the radiofrequency group and the laser group were 96.4% (186 cases/ 193 sides) and 94.7% (179 cases /189 sides), the difference was not statistically significant (P > 0.05). The surgery duration in radiofrequency group 2.54±0.93 was shorter than that in the laser group 4.65±1.47 (P < 0.05); the halt frequencies in the radiofrequency group was 1.21±0.31 during surgery and the need of stanching was less than that in the laser group 2.87±1.47 (P < 0.05); the surgeons’ stree level in the radiofrequency group was 2.84±0.72 which was lower than that in the laser group 5.07±1.26 (P < 0.05); all the above results showed statistical significante difference. There was no statistical significance in patients’ discomfort grade between the radiofrequency group 6.73±2.06 and the laser group 6.91±1.78 (P > 0.05). Conclusions Strictly follow the rules of the procedure, satisfactory outcome can be achieved with these two methods. There is no significant difference in the treating effects and patient discomfort level between the two methods if carefully handled. Radiofrequency has more advantages in treating epistaxis in surgery duration, halt frequency and surgeons’ stress level.

OBJECTIVE To compare four postoperative nasal packing materials through a prospective study. METHODS All patients were divided into four groups according to the packs they used: Vaseline stripe gauze, Merocel, Rapid-Rhino and silicone ventilation tube. Packs were assessed in terms of patient discomfort (on a visual analogue scale), control of postoperative bleeding and ease of removal. RESULTS Rapid-Rhino had the least patient discomfort among four groups (P 0.01), and less removal difficulty compared with Vaseline stripe gauze and ventilation tube (P 0.01). The Vaseline stripe gauze showed more effective on bleeding control than other three packs (P 0.05) but the most tendency to cause bleeding on removal. CONCLUSION The choosing of postoperative nasal packing after functional endoscopic sinus surgery (FESS) depends on various factors. Rapid-Rhino has much advantages and can be used as routine packs after FESS,