喉罩通气下七氟醚全凭吸入麻醉在小儿先天性心脏病介入手术的临床麻醉效果

目的:探讨喉罩通气下七氟醚全凭吸入麻醉在小儿先天性心脏病介入手术的临床麻醉效果。方法:选取2017年4月～2019年5月期间我院收治的行先天性心脏病介入手术患儿98例,根据随机数字表法将其分为对照组(n=49)和研究组(n=49)。对照组给予氯胺酮诱导,全凭丙泊酚维持,面罩吸氧;研究组给予全凭七氟醚诱导、维持,喉罩通气。比较两组患儿麻醉前(T0)、切皮前(T1)、切皮后1 min(T2)、切皮后30 min(T3)、术后(T4)的血流动力学指标[平均动脉压(MAP)、心率(HR)]及应激反应指标[血糖、皮质醇],记录两组患儿手术时间、麻醉诱导时间、术后苏醒时间等围术期指标情况。记录两组围术期不良反应发生情况。结果:研究组手术时间、麻醉诱导时间、术后苏醒时间均短于对照组(P0.05)。两组T0时间点血糖、MAP、皮质醇、HR比较差异无统计学意义(P0.05);对照组T1～T4时间点MAP、血糖、皮质醇、HR均较T0升高(P0.05);研究组T1～T4时间点血糖、MAP、皮质醇、HR与T0时间点比较无差异(P0.05);研究组T1～T4时间点血糖、MAP、皮质醇、HR低于对照组(P0.05)。两组不良反应发生率比较无差异(P0.05)。结论:小儿先天性心脏病介入手术中应用喉罩通气下七氟醚全凭吸入麻醉,诱导迅速且安全、术后苏醒快、手术时间短,可有效维持血流动力学稳定,减少应激反应。     

线粒体DNA4977bp大片缺失突变与喉癌的相关性研究

目的:探讨线粒体DNA4977bp大片缺失突变与喉癌的相关性。方法:选择2016年1月～2017年6月我院收治的喉乳头状瘤、喉癌患者,分别纳入良性肿瘤组、恶性肿瘤组,每组各150例。取两组患者的病变组织标本,分离癌及癌旁组织,提取总DNA,采用PCR扩增测序技术检测两组标本中线粒体DNA4977bp大片缺失突变情况。结果:基因测序结果显示恶性肿瘤组患者的线粒体DNA4977bp缺失突变率为39.33%,高于良性肿瘤组患者的1.33%,差异具有统计学意义(P0.05)。不同肿瘤分期患者的线粒体DNA4977bp缺失突变率比较,差异具有统计学意义(P0.05),且III期患者的突变率II期 I期 IV期;淋巴结转移患者的线粒体DNA4977bp缺失突变率高于淋巴结未转移患者差异具有统计学意义(P0.05)。结论:线粒体DNA4977bp大片缺失突变与喉癌的发生有关,可能促进的发生和进展。     

Role of NAD(P)H:quinone oxidoreductase polymorphism at codon 187 in susceptibility to lung,laryngeal and oral/pharyngeal cancers

NAD(P)H:quinone oxidoreductase (NQO1) has been proposed to play a protective role against the toxic effects of benzo[a]pyrene quinones. The C⁶⁰⁹T base change in the NQO1 gene, resulting in a Pro¹⁸⁷Ser amino acid change in the protein, has been associated with deficient enzyme activity. We examined whether this polymorphism modified the risks of smoking-related cancers in a case-control study involving patients with lung cancer (n = 150), laryngeal cancer (n = 129), oral/pharyngeal cancer (n = 121) and control individuals (n = 172), all Caucasian smokers. No statistically significant associations were observed between the NQO1 genotypes and smoking-related cancers, although the Ser/Ser genotype was associated with a tendency towards increased risk for lung cancer (odds ratio [OR] = 2.2, 95% confidence interval [CI] 0.7-6.7) and for oral/pharyngeal cancer (OR = 2.3, 95% CI 0.6-8.2). No significant interaction between the NQO1 genotype and either smoking exposure or GSTM1 genotype was found. Our results are consistent with the hypothesis that lack of NQO1 activity may be involved in some smoking-related cancers. However, they were based on small numbers of individuals with the putative atrisk genotype, and the associations did not reach statistical significance. Moreover, these results contrast with those observed in some other ethnic populations, where a protective effect of the NQO1 Ser allele was found. Further studies are therefore clearly needed for a better understanding of the potential role of NQO1 activity in tobacco-related cancers.     

A simple method for using silicone elastomer masks for quantitative analysis of cell migration without cellular damage or substrate disruption

Cell migration is fundamental to many biological processes, including development, normal tissue remodeling, wound healing, and many pathologies. However, cell migration is a complex process, and understanding its regulation in health and disease requires the ability to manipulate and measure this process quantitatively under controlled conditions. This report describes a simple in vitro assay for quantitative analysis of cell migration in two-dimensional cultures that is an inexpensive alternative to the classic “scratch” assay. The method described utilizes flexible silicone masks fabricated in the lab according to the research demands of the specific experiment to create a cell-free area for cells to invade, followed by quantitative analysis based on widely available microscopic imaging tools. This experimental approach has the important advantage of visualizing cell migration in the absence of the cellular damage and disruption of the substrate that occurs when the “wound” is created in the scratch assay. This approach allows the researcher to study the intrinsic migratory characteristics of cells in the absence of potentially confounding contributions from cellular responses to injury and disruption of cell–substrate interactions. This assay has been used with vascular smooth muscle cells, fibroblasts, and epithelial cell types, but should be applicable to the study of practically any type of cultured cell. Furthermore, this method can be easily adapted for use with fluorescence microscopy, molecular biological, or pharmacological manipulations to explore the molecular mechanisms of cell migration, live cell imaging, fluorescence microscopy, and correlative immunolabeling.     

一例喉真菌病病例报道并文献复习

目的:探讨喉真菌病的临床特征、诊断要点和治疗方案。方法:回顾我院收治的一例喉真菌病患者的临床病例资料,并对1992年至今国内外报道的类似病例33例进行文献复习。本研究共纳入患者34例,男性16例,女性18例,年龄14-67岁,临床表现以声嘶为主,可伴有咽痛、咽干等咽喉不适感,其中有16例患者被误诊为急性喉炎,27例患者有不同程度的抗生素和(或)糖皮质激素使用史。结果:34例患者中,13例通过病理确诊为喉真菌病。所有患者均予抗真菌药物治疗,其中有1例同时行手术治疗,均治愈。结论:喉真菌病临床罕见,症状无特异性,易误诊,但病理学检查可靠,全身或局部使用抗真菌药物疗效佳,预后良好。     

Assessment of cartilage invasion in case of laryngeal cancer by means of longitudinal sectioning for histopathology – Clinical implications

AimThe aim of the study was to assess the accuracy of radiological diagnosis of laryngeal cartilage infiltration by histopathological examination of laryngeal specimen after total laryngectomy.BackgroundDespite the development of new medical technologies and significant clinical advances allowing early diagnosis and treatment of laryngeal cancer, mortality is still on the rise. Neoplastic infiltration of the laryngeal cartilages is the most common source of error in the assessment of cancer staging. Furthermore, cartilage invasion is listed as a contraindication to partial surgical techniques as well as radiotherapy.Materials and methodsThe study was carried out on 21 larynges following total laryngectomy. Before taking the decision to perform surgery, high-resolution CT scans were performed in all cases. An extended histopathological examination was conducted using a unique vertical cross-section of the whole larynx.ResultsPathology reported 2 cases of arytenoid cartilage invasion, 5 cases of cricoid cartilage invasion, 12 cases of thyroid cartilage penetration, 1 case of internal cortex invasion and 9 cases of extra-laryngeal spread. CT imaging identified 8 of 13 cases (61.5%) of pathologically proven invasion of thyroid cartilage and only 2 cases (2/9, 22%) of extra-laryngeal spread. According to CT results, arytenoid cartilage invasion was correctly identified in 2 cases, cricoid cartilage invasion in 4 (4/5, 80%). The positive predictive values for thyroid, cricoid and arytenoid cartilage invasion and penetration were 80%, 66.7% and 50%, respectively. In case of pre-laryngeal spread the positive predictive value was 100%.ConclusionDespite increasingly advanced methods involved in the diagnosis of laryngeal cancer, many discrepancies may be observed between the radiological and histopathological assessments. CT imaging has limitations especially in thyroid cartilage penetration and extra-laryngeal spread assessment in advanced laryngeal cancer cases. An extended histopathological examination, involving vertical cross-sections of the whole larynx is a very precise study that allows a precise determination of local cancer staging (T).     

The number distribution for involved lymph nodes in cancer

The number of involved lymph nodes exhibits considerable heterogeneity within populations. Here, the implications of population heterogeneity are explored with respect to the kinematics of nodal metastases. Data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program for 224656 breast, 12404 gastric, 18015 rectal, 4117 cervical and 2443 laryngeal cancers as well as 9118 melanomas were used to construct frequency distributions for the number of involved nodes which were then fitted to the negative binomial distribution. The negative binomial distribution described the heterogeneity in nodal involvement well. The patterns of nodal involvement can be explained by either of two models: one where involved nodes could seed further nodal metastases, the other where the number of nodal metastases in any individual was randomly distributed, with the deviations between patients accounted for by population heterogeneity. Since the number of sampled nodes similarly approximated a negative binomial distribution, random involvement with superimposed population heterogeneity would more credibly explain both sets of observations.     

不同部位喉黏膜间充质细胞的分离培养

目的:探讨不同部位喉黏膜间充质细胞的分离、培养方法,为喉部组织工程提供更多的可供选择的种子细胞。方法:收集临床上喉部手术病人切下的不同部位的喉黏膜,主要是会厌的背侧黏膜和声带的黏膜,各3例,共计6例。对会厌背侧的黏膜采用消化培养的方法,对声带部位的黏膜采用组织块培养法。最后通过免疫荧光染色对两种方法所获得的细胞进行鉴定,确定其来源于喉黏膜的间充质。结果:通过两种方法均可以成功获得相应部位的细胞,免疫荧光染色vimentin均呈阳性表达且CK均呈阴性表达,证明了获得的细胞确实是来源于间充质。结论:本实验成功的培养出了喉部不同部位的间充质细胞,为喉部的组织工程提供了更多的可供选择的种子细胞。     

Air-liquid interface promotes invasive growth of laryngeal squamous cell carcinoma with or without hypoxia

Air-liquid interface (ALI) is a microenvironment of aerodigestive tract. In our previous study, ALI promoted invasive growth of laryngeal squamous cell carcinoma (SCC); but its mechanism was unclear. Hypoxia is also related to cancer spread. Here we show that ALI with or without hypoxia accelerated invasive growth of laryngeal SCC cells, using collagen gel invasion assay. Submerged condition (SMC) without ALI did not induce the invasion with or without hypoxia. ALI enhanced expression of the following growth-, invasion-, and motility-related molecules in the cells with or without hypoxia more greatly than SMC: c-Met, Ras, mitogen-activated protein kinase cascade proteins (Raf-1, MEK-1, and ERK-1/2), matrix metalloproteinase-1, and filamin A. The data indicate that ALI promotes invasive growth of SCC cells by enhancement of the invasive growth-related molecules above, through mechanisms that differ from hypoxia, suggesting that ALI microenvironment should be taken into account for the study of cancer biology.     

Spectrographic analysis of laryngeal air sac resonance in rhesus monkey.

Laryngeal air sacs are circular out-pocketings, located in the hyoid bone with their ostium in the midline of the anterior part of the larynx. From previous cadaver studies of the rhesus monkey it was deduced that the function of the air sac is to act as a resonating chamber. The present study was designed to test this hypothesis. Recordings were made of three rhesus monkeys before and after surgical removal of the air sac. Spectrographic analysis of the monkeys' vocalizations indicated that differences in formant frequency characteristics between pre-and post-surgical recordings were negligible. This finding suggests that the laryngeal air sac does not play an important role in the resonant properties of the monkeys' vocal tracts.