生物材料与人工器官（二）

喉切除后的发音重建,不外乎三种方法：食管声、人工喉、喉再造。但在一般情况下不作喉再造术。     

扬子鳄胚胎喉的组织发生

观察了２０例扬子鳄胚胎的喉发生过程。孵育第６天出现喉气管憩室,第８天出现喉原基。孵育１０￣２０天,原始喉腔上皮细胞分裂增殖加快,喉腔侧壁中部的上皮向两侧中胚层不断突出,喉腔渐扩大。第３０￣４８天,喉腔的背室及左右腹室逐渐明显。喉肌及喉软骨于第３４天开始分化,第４８天,喉肌发育成横纹肌,喉软骨化基本完善。固有膜及粘膜下层于第４０天开始出现,第４８￣６２天,其中的血管分布渐增多。孵育第４０天,喉上皮表     

ICP-OES法测定两种喉毛花植物中21种矿质元素

本文采用ICP-OES法,测定分析了长梗喉毛花和镰萼喉毛花中的21种矿质元素。所采用方法线性关系良好,r≥0.9990,各元素的检出限均低于0.0036 mg/L,建立了测定喉毛花中多种矿质元素含量的分析方法。结果表明,两种喉毛花中Ca、Mg、Fe三种元素的含量均较高。在检出的人体所需常量和微量元素中,除Se元素外,其他常量、微量元素在长梗喉毛花中含量均高于在镰萼喉毛花中的含量。Pb、As两种重金属元素在镰萼喉毛花中的均含量高于在长梗喉毛花中的含量,Cu则反之。     

ICP-OES法测定两种喉毛花植物中21种矿质元素北大核心CSCD

本文采用ICP-OES法,测定分析了长梗喉毛花和镰萼喉毛花中的21种矿质元素。所采用方法线性关系良好,r≥0.9990,各元素的检出限均低于0.0036 mg/L,建立了测定喉毛花中多种矿质元素含量的分析方法。结果表明,两种喉毛花中Ca、Mg、Fe三种元素的含量均较高。在检出的人体所需常量和微量元素中,除Se元素外,其他常量、微量元素在长梗喉毛花中含量均高于在镰萼喉毛花中的含量。Pb、As两种重金属元素在镰萼喉毛花中的均含量高于在长梗喉毛花中的含量,Cu则反之。     

蛇类喉门运动的力学现象

徐淑娴等(1998)曾经指出:蛇类喉门的两侧壁由杓状软骨构成,控制杓状软骨运动的3对肌肉是喉门开肌、喉门闭肌和环杓侧肌。笔者接着前文,分析前述肌肉的生理功能及其在蛇类喉门启闭运动中的力学现象。1　喉门开肌、喉门闭肌和环杓侧肌的位置与作用喉门开肌位于喉门外侧(图1:Ａ、Ｂ),起于第1～5个气管环的侧面及腹面,止于杓状软骨外缘(即侧沟缘),其拉力(Ｆ1)方向朝外朝后,作用是令杓状软骨摆向外,开喉门。喉门闭肌覆盖在杓状软骨背面,起于环状背突中线,也止于杓状软骨外缘,止点排列在喉门开肌止点的背方,其拉力(Ｆ2)方向朝内朝后,作用是令杓状…     

Proseal与Slipa喉罩在腹腔镜胆囊切除术中的麻醉效果比较

目的:比较proseal与slipa喉罩在腹腔镜胆囊切除术中的麻醉效果。方法:收集我院收治的68例胆囊行腹腔镜胆囊切除术患者,随机分为A组和B组,每组各34例,A组患者应用slipa喉罩,B组患者应用proseal喉罩进行麻醉。观察并比较两组患者各时间点血压、心率水平,患者麻醉时间、苏醒时间、喉罩插入时间与拔除时间以及患者的不良反应发生率。结果:与喉罩置入前相比,两组患者手术中收缩压(SBP)以及舒张压(DBP)水平均下降,差异具有统计学意义(P0.05)。两组患者各时间点的血压以、心率、麻醉时间及苏醒时间比较差异均无统计学意义(P0.05)。与B组相比,A组患者的喉罩插入时间较长,喉罩沾血的发生率较高,差异具有统计学意义(P0.05)。结论:Pro seal与Slipa喉罩在腹腔镜胆囊切除术中的麻醉效果相当,但Slipa喉罩的插入时间以及喉罩沾血的发生率更高。     

新疆北部鹅喉羚的食性分析

2006年10月至2007年8月,作者采用粪便显微分析法研究了新疆卡拉麦里山有蹄类保护区鹅喉羚的四季食性以及冬季绵羊的食性.结果发现:鹅喉羚共采食16科47种植物;不同季节间鹅喉羚食性有明显变化,秋季采食7科24种植物,冬季采食6科17种植物,春季采食16科41种植物,夏季采食12科30种植物;藜科、禾本科植物是鹅喉羚全年的主要食物来源,占鹅喉羚总采食量的38.8～85.1%,非禾本科草本植物也在鹅喉羚食物组成中占有重要地位;春季短命和类短命植物对鹅喉羚有重要意义,占春季采食量的27%.针茅在四季都是鹅喉羚采食的主要植物;春季和夏季鹅喉羚采食较多的驼绒藜,秋季和冬季梭梭被较多采食.由于干旱胁迫,春季、夏季和秋季鹅喉羚喜食含水量较高的多根葱、骆驼蹄瓣、粗枝猪毛菜等非禾本科草本植物.冬季鹅喉羚与绵羊间的生态位宽度相近,食物重叠指数高达76.6%,绵羊与鹅喉羚之间食物竞争明显.     

喉罩与气管插管全凭七氟醚吸入麻醉用于小儿眼科短小手术的效果分析

目的:对照研究喉罩与气管插管全凭七氟醚吸入麻醉用于小儿眼科短小手术的优缺点。方法:选取2012年1月至2013年12月于我院行行眼科手术的ASAⅠ~Ⅱ级小儿共80例,随机分为喉罩组(40例)和气管插管组(40例)两组,所有患儿均给予全凭七氟醚吸入麻醉,喉罩组采用喉罩通气,而气管插管组则采用气管插管通气。监测T1(诱导后下颌松弛)、T2(喉罩置入或气管插管后1min)、T3(喉罩或气管插管拔出前)、T4(喉罩或气管插管拔出后1min)四个时间点的血流动力学指标并记录两组患儿置入喉罩或气管插管的次数、手术时间、手术结束至拔除喉罩或气管插管的时间,以及可能产生的不良反应。结果:喉罩组血流动力学指标在四个测量时间点的差异均无统计学意义(P0.05);气管插管组血流动力学指标在四个测量时间点的差异均有统计学意义(P0.05),其中T2时间点均高于T1时间点,T4时间点均高于T1、T3时间点。两组患儿置入喉罩或者气管插管次数、手术时间、手术结束至拔除喉罩或者气管插管时间的差异均无统计学意义(P0.05);气管插管组患儿发生呛咳的比例高于喉罩组,差异有统计学意义(P0.05);气管插管组患儿发生呛咳的比例高于喉罩组,差异有统计学意义(P0.05)。结论:喉罩复合全凭七氟醚吸入麻醉可安全有效地应用于小儿眼科短小手术。     

由喉内向外缝合针输送器械

本文介绍了一种适用于显微喉镜下操作,不需作喉裂开术,由喉内向外缝针的输送器械(见图1 a、b)及其结构和使用方法,该器械可用来治疗声带疤痕粘连和双侧性喉神经麻痹所致的喉狭窄。(一)声带疤痕粘连治疗在显微喉镜下     

神经监测对甲状腺手术中喉返神经保护作用的Meta分析

目的 既往研究显示,甲状腺手术中应用神经监测以保护喉返神经仍存在争议。本文对比甲状腺手术中应用喉返神经监测与常规解剖暴露的差异,探讨术中喉返神经监测对喉返神经暂时性损伤及永久性损伤的保护作用及临床价值。方法 收集2018年1月至2022年12月PubMed、Embase、Web of Science、中国知网、万方及维普数据库发表的与神经监测对甲状腺手术中喉返神经保护作用相关的文献,使用Stata 14.0软件进行Meta分析。结果 本研究共纳入文献18篇,病例数12 877例,其中神经监测喉组7 718例,常规解剖暴露组5 159例。Meta分析结果显示,在甲状腺手术中,神经监测与常规解剖显露喉返神经相比,能减少喉返神经暂时性损伤(OR=0.524,95%CI:0.370～0.742,P<0.001)及永久性损伤(OR=0.371,95%CI:0.235～0.584,P<0.001)。试验序贯分析显示纳入研究的总样本足够。结论 神经监测在甲状腺手术中对喉返神经暂时性损伤和永久性损伤均具有保护作用,尤其在甲状腺癌复发等2次手术时,对喉返神经保护具有重要临床意义。     

Molecular cloning and characterization of human papilloma virus DNA derived from a laryngeal papilloma

Papilloma virus DNA from a laryngeal papilloma was cloned in phage lambda L 47 and characterized after cleavage with different restriction enzymes. Hybridization with the DNAs of human papilloma virus types 1, 2, 3, 4, 5, and 8 showed no homology under stringent hybridization conditions. Human papilloma virus type 6 DNA, however, was partially identical to laryngeal papilloma virus DNA; different restriction enzyme fragments hybridizing with the other DNA were identified on each genome. The degree of homology was determined by reassociation kinetics to be 25%. According to the present nomenclature, laryngeal papilloma virus therefore represents a different type of human papilloma virus and is tentatively designated as human papilloma virus type 11. Sequences homologous to laryngeal papilloma virus DNA were also found in four of nine additional laryngeal papillomas. Attempt to detect homologous DNA in 12 carcinomas of the larynx were negative.     

Vagal control of larynx resistance to the air flow (author's transl)

Air flow larynx resistance changes have been recorded in dogs after electrical stimulation and lesion of the recurrent and vagus cervicalis nerves respectively. Experiments were carried out with glottis in situ and isolated. The effects of the administration of athropine i.v. (0.3 mg/kg) were also studied. Air flow larynx resistance decreased after secting the right recurrent nerves as well as after athropine administration. Electrical stimulation of the central end of the right vagus nerve produced a complex response characterized by an initial apnaea followed by a larynx resistance decrease. After a few seconds the response continued with glottis spasms followed by typical emetic movements. During the emetic movements larynx closed and opened throughout the respiratory cycle, the closing movement being simultaneous with the inspiratory position of the thorax and with minimal values of the intraabdominal pressure. Larynx resistance increased after uni- and bilateral sections of the vagus cervicalis and after the electrical stimulation of the peripheral end of the right vagus cervicalis. According to the present results, the possible existence of a controlling reflex of laryngeal sphincter motility, generated at the bronchopulmonary level, is postulated.     

Carcinoma of the Larynx: Results of Therapy

Prognosis of laryngeal carcinoma varies considerably, depending on its site and stage of development. In the past, laryngectomy was considered the treatment of choice for all but very early lesions. Results of therapy and five-year survival rates were relatively good, but the patient deprived of his larynx frequently presented difficulties in rehabilitation.Recent advances in radiotherapy techniques have permitted treatment of a greater proportion of patients with laryngeal carcinoma by this means, with encouraging results. Results of a survey in the Toronto area suggest that radiotherapy should be used as primary treatment in early and intermediate stages of the disease; radical excision combined with radiotherapy is indicated for treatment failures among early cases and for those with far-advanced disease or carcinoma outside the larynx proper. With this program five-year survival rates are comparable to those achieved when laryngectomy is the primary treatment used, and two-thirds of those who survive maintain laryngeal function.     

Neural control of airway pressures in rabbits

In twenty anaesthetized and spontaneously breathing rabbits airway pressures were measured above and below the larynx during tidal respiration through the larynx. Peak inspiratory and expiratory pressures at both sites were recorded in control conditions and then compared to values obtained in the course of progressive denervation of the airways. The two methods of denervation consisted of (1) bilateral section of superior and recurrent laryngeal nerves and of the midcervical vagotomy (horizontal method); (2) right-sided sections of the three nerves followed by left-sided sections (vertical method). Motor denervation of the larynx due to RLNs neurotomy (horizontal method) produced significant increases in intratracheal pressures in both phases of the respiratory cycle. Less prominent increments in pressures were achieved on RLNs neurotomy in the vertical method. SLNs section and vagotomy had little additional effect on airway pressures. Our results indicate that unilateral laryngeal palsy poses far smaller obstruction to breathing than simultaneous bilateral denervation, and that afferent denervation of the larynx has no effect on airway pressures.     

The sexually dimorphic larynx of Xenopus laevis: development and androgen regulation

The aims of this study were to characterize sexual dimorphism in the larynx of adult Xenopus laevis and to determine how sex differences arise during postmetamorphic development. The larger male larynx is a result of greater cell numbers in both cartilage and muscle. The dilator laryngis muscle of the male larynx has 6-7 times more muscle fibers than that of the female. At metamorphosis, the larynx is sexually monomorphic and feminine in phenotype. The DNA content of the male larynx doubles during the first 6 months following metamorphosis; there is no net DNA increase in the female larynx during this time. Both sexes experience a marked increase in laryngeal DNA content and mass between 6 months and adulthood. The number of muscle fibers in the male larynx increases at an average rate of 150 fibers a day during the first 10 months of postmetamorphic development. There is no net change in fiber numbers in the female larynx from metamorphosis to adulthood. Administration of the antiandrogen Flutamide to metamorphic frogs prevents the net addition of laryngeal muscle fibers in males. Thus, we propose that addition of postmetamorphic laryngeal muscle fibers in males is dependent upon the presence of circulating androgens. Exogenous testosterone administration results in an increase in laryngeal mass, DNA content, and cellular proliferation in juvenile frogs. Using [3H]thymidine injections to probe ongoing, as well as testosterone-induced, cell proliferation, we conclude that cellular proliferation is regulated differently in males and females during development. Thus androgen-induced proliferation is one cellular mechanism responsible for the sexual dimorphism observed in adults.     

Computerized morphometric analysis of the fiber composition of the upper and lower laryngeal nerves in humans

Phonation troubles often arise after surgical operations on the antero-lateral region of the neck in which the recurrent laryngeal ILN), was respected. This fact allows to consider the possibility that the superior laryngeal nerve (SLN), contains also fibres responsible of the motor innervation of some intrinsic muscles of the larynx. According to the suggestion that the fibre-analysis may permit to distinguish a motor from a sensory nerve (Tomasch and Schwarzacher), a computerized morphometric analysis on the fibres of the superior and inferior laryngeal nerves in the man was carried out. The nerves investigated were taken away from five patients subjected to a total laryngectomy. The fibre perimeter and the maximum diameter were evaluated in 1500 fibres in each nerve. The histograms of the obtained data shows that: 1) Two groups of fibres are distinguishable in the SLN: the first is composed by small diameter fibres that show one spike for both the parameters considered. The second group of larger fibres shows a lower spike with a larger basis. 2) In the ILN only a spike corresponding to the greatest fibres we observed for both the parameters considered. In conclusion it seems that the number of fibres of large diameter present in the SLN can justify a motor function of this nerve for some intrinsic muscles of the larynx other than the cricotiroideus.     

Anatomy of the recurrent laryngeal nerve in normal Iraqis

A study of the anatomy of the recurrent laryngeal nerve was made on 106 post-mortem cases and fixed dissecting-room cadavers. The usual position of the nerve was in the tracheo-oesophageal groove. The nerve lay posterior to the inferior thyroid artery on the left side in most cases, while its relation was very variable on the right side. The inferior cornu of the thyroid cartilage was the best guide to the site of entry of the nerve into the larynx.     

抗VEGF药物联合532 激光治疗视网膜中央静脉阻塞的疗效分析

目的:探讨抗VEGF药物联合532激光治疗视网膜中央静脉阻塞的疗效。方法:选取60例患视网膜中央静脉阻塞患者,年龄38-65岁,研究组(31例)采用抗VEGF药物联合532激光治疗,对照组(29例)单纯给予激光治疗。监测患者治疗前,治疗后3个月的视力,黄斑中心凹厚度(Central macular thickness,CMT)以及治疗后3个月的治疗结果,对联合治疗与单纯激光方式的疗效进行对比。结果:治疗后3个月,研究组有效率明显高于对照组(P0.05)。与治疗前相比,研究组治疗后3个月,视力改善情况较明显(P0.05),且改善幅度大于对照组(P0.05)。对照组治疗后3个月,视力有了小幅度改善,然而与治疗前相比,差异没有统计学意义(P0.05)。治疗前,两组CMT相比,差异没有统计学意义(P0.05)。治疗后3个月,两组CMT均有明显改善,且研究组改变情况优于对照组(P0.05)。所有患者在治疗后3个月内均未严重并发症。结论:抗VEGF药物联合532激光治疗视网膜中央静脉阻塞,可以显著提高患者视力和治疗有效率,降低黄斑水肿,新生血管等并发症发生率,并且不会引起其他并发症。     

Irradiation influences the expression of substance P and enkephalin in the rat larynx

The effects of radiotherapy on neuropeptide expression in the rat larynx were studied. Irradiation was given for five days, 6 or 8 Gray daily. Ten days after the end of irradiation, the larynx, the laryngeal nerves and different ganglia related to the larynx were dissected out from irradiated and control animals and processed for neuropeptide immunohistochemistry. There was an increased immunolabelling for two of the neuropeptides tested, substance P and enkephalin, in the innervation of the subglottic glands and in the acetylcholinesterase-positive ganglionic cells of the local ganglia. These cells were interpreted as representing postganglionic parasympathetic ganglionic cells. The changes seen in the subglottic glands were interpreted as most likely being related to the changing pattern of staining seen in the local ganglia. No changes in substance P-and enkephalin expression were observed in other laryngeal structures, the nodose ganglia, superior cervical ganglia or laryngeal nerve paraganglia. Thus, in certain respects neuropeptide expression in the larynx is modulated by radiotherapy. Since neuropeptides have both neurotransmitter and/or neuromodulator effects in airway tissue and since they show effects as growth factors, the occurrence of this plasticity in neuropeptide expression should be taken into consideration in future studies examining the effects of irradiation on normal/diseased airway tissues.     

Voice changes after thyroidectomy: role of the external laryngeal nerve.

Hitherto voice changes have been regarded as an infrequent complication of thyroidectomy and damage to the recurrent laryngeal nerve has been given as their major cause. Voice function was assessed in 325 patients after thyroidectomy. Permanent changes occurred in 35 (25%) after subtotal thyroidectomy and in 19 (11%) after lobectomy. The commonest cause of voice change appeared to be injury to the external laryngeal nerves on one or both sides. Damage to the recurrent laryngeal nerve, which was routinely identified and protected, was rarely a cause. When the external laryngeal nerves were identified and preserved, permanent voice changes occurred in only 5% of cases; this was similar to the incidence of 3% in controls after endotracheal intubation alone. The course of the external laryngeal nerve is variable, and consequently mass ligation of the vessels at the top of the upper pole will damage it in a high proportion of cases. To minimise this serious complication these nerves should be identified and protected as well as the recurrent nerves and voice function should be assessed early in the postoperative period by laryngoscopy and by a speech therapist.