Han Demin

Rigid bronchoscopy for inhaled pen caps in children

PURPOSE The aim of this study was to present the clinical findings and treatment of pen cap inhalation with emphasis on the importance of managing aspirated foreign bodies by rigid bronchoscopy. METHODS AND PATIENTS Of 1280 patients with foreign body inhalation treated from 1997 to 2007, 34 (2.65%) were because of pen cap inhalation. Medical records of these 34 patients were retrospectively reviewed and analyzed for age, sex, symptoms, location of pen cap, treatment, complications, and outcomes. RESULTS Of the 34 children with pen cap inhalation, 22 (64.7%) were boys and 12 (35.3%) were girls. They ranged in age from 6 to 14 years, pen caps were most frequently found in the right main stem bronchus (26 cases, 76.4%). A history of an episode of foreign body inhalation (34 cases, 100%) and acute cough (28 cases, 82.3%) were the most common presenting findings. All inhaled pen caps were successfully removed by reverse grasping forceps during rigid bronchoscopy. Tracheotomy, thoracotomy, and bronchotomy were not performed in any patients. There were no severe complications or deaths. CONCLUSIONS Pen cap inhalation mostly occurs in school-aged children. Patients usually can depict a clear history of pen cap inhalation, which is vital to early diagnosis. Inhaled pen caps can be removed safely by rigid bronchoscopy under general anesthesia combined with topical anesthesia. Open surgical techniques such as tracheotomy, thoracotomy, and bronchotomy can be avoided in most cases. More attention to programs of prevention, public and parent education, and awareness is needed to reduce the incidence of pen cap inhalation.

Relationship of body position, upper airway morphology, and severity of obstructive sleep apnea/hypopnea syndrome among Chinese patients.

Abstract Conclusions: This study has shown that the body mass index (BMI), neck circumference, and modified Mallanpati grade (MMP) are predictive of severity of obstructive sleep apnea/hypopnea syndrome (OSAHS). The neck circumference and MMP were revealed to be important morphological features in the responders whose apnea/hyoponea index (AHI) was substantially decreased by positioning during sleep. Objective: The aim of this study was to assess the predictive power of routine physical examination of the upper airway by an otorhinolaryngologist to identify OSAHS in Chinese patients, and to clarify the interaction of lateral and supine sleeping positions with upper airway morphology in patients with OSAHS. Methods: In all, 103 consecutive patients with OSAHS (48 men and 65 women) underwent polysomnography and upper airway morphological examination. Upper airway morphology and anthropometric variables were evaluated to determine different severity of OSAHS in the responders and nonresponders. Results: The neck circumference, BMI, and MMP showed statistical correlations with AHI and decreased AHI for changed sleeping position. Multiple logistic regression analysis showed that the neck circumference and MMP were significant predictors for the responders (p = 0.023, odds ratio = 1.180 and p = 0.006, odds ratio = 1.922, respectively).

End-tidal carbon dioxide concentration monitoring in obstructive sleep apnea patients

PURPOSE The objective of this study was to investigate the end-tidal carbon dioxide concentration (ETco(2)) monitoring in obstructive sleep apnea (OSA) patients during sleep and to explore whether the ETco(2) value may explain a significant portion of the relationship between ETco(2) value and apnea/hypopnea index (AHI) and nocturnal oxygenation indices. MATERIALS AND METHODS Thirty-eight consecutive patients underwent overnight polysomnography and were synchronously monitored for ETco(2) using an microstream capnometer. Mean and maximum values during wake time and different sleep stages were recorded. We grouped 38 OSA patients into 2 subgroups on the basis of their difference of mean total sleep time and wake time ETco(2) [(T - W) ETco(2)]; one group, 20 patients with (T - W) ETco(2) less than 0, and the other group,18 patients with (T - W) ETco(2) greater than 0. RESULTS Group with (T - W) ETco(2) less than 0 patients exhibited higher AHI (mean ± SD, 68.58 ± 22.78 vs. 27.61 ± 19.44 events/h) and lower nocturnal oxygenation indices (minimum Sao(2), 67.85 ± 10.08 vs. 82.61% ± 6.07%; mean Sao(2), 91.29 ± 3.31 vs. 95.15% ± 1.88%) compared with the other group. CONCLUSIONS In summary, the study provides preliminary data showing that ETco(2) potentially can be used in continuous monitoring of OSA patients. And, (T - W) ETco(2) can indicate the severity of OSA.

Endoscopic anatomic characterization of the frontal recess and its implications in frontal sinus surgery.

Objective: This study was designed to describe the anatomic features of the frontal recess by transnasal endoscopy (nasoscope), to analyze its implications in endoscopic frontal sinus surgery and to discuss the issues that may be experienced during such operations. Materials and Methods: The patients included in this analysis were adults with chronic sinusitis or nasal polyp (n = 301, 562 sides) hospitalized in our hospital from August 1998 to April 2001. Chronic frontal sinusitis was confirmed in 280 cases (479 sides) by coronal and axial CT scan. Patients with a previous surgical history were excluded from the analysis. The surgical outcomes of these patients and CT imaging data were retrospectively reviewed and analyzed. The drainage pattern of the frontal sinus was identified based on CT scans preoperatively. Endoscopic frontal sinus surgery was performed in 250 cases (421 sides). The anatomic features of the frontal recess under nasoscope were classified into 2 types. Results: The coronal CT results confirmed the position of the frontal sinus ostium between the uncinate process and the middle turbinate in 203 sides (48.2%) of all operated patients and the ostium was found to be located between the uncinate process and the lamina papyracea in 218 sides (51.8%). According to the location of the frontal sinus ostium, we grouped the anatomic features of the frontal recess into 2 types. Type I was documented in 203 sides (48.2%) and type II was seen in 218 sides (51.8%). Conclusions: The anatomic features of the frontal recess under nasoscope and their classification are very important and helpful for endoscopic frontal sinsus surgery. The upper part of the uncinate process is a dependable anatomic landmark for the localization of the frontal sinus ostium in CT scan and endoscopic frontal sinus surgery.

Significance and mechanism of microsatellite instability in laryngeal squamous cell carcinoma.

OBJECTIVE To evaluate the significance and mechanism of microsatellite instability (MSI) in laryngeal squamous cell carcinoma (LSCC). METHODS We investigated the expression frequency and clinical significance of MSI in 50 LSCC patients. The status of MSI was evaluated by using microdissection, polymerase chain reaction, single-strand length polymorphism, and silver staining. Five markers on chromosomes 1p, 3p, 5q, 9p, and 17p were used. Two of the six components of mismatch repair (MMR)-hMLH1 and hMSH2-were investigated by an immunohistochemical approach. RESULTS The informative case numbers of the five markers (D17S796, D3S3544, D5S656, D1S375, D9S162) were 44, 42, 45, 44, and 40 in all 50 cases, respectively. The incidence of MSI on D17S796 (TP53) was 20.5% (9 of 44), on D3S3544 (FHIT) was 14.3% (6 of 42), on D5S656 (APC) was 31.1% (14 of 45), on D1S375 (BCAR3) was 20.5% (9 of 44), and on D9S162 (CDKN2A) was 15.0% (6 of 40). Although there was no relationship between MSI status and age, gender, smoking history, tumour location, tumour differentiation, and T stage (p > .05), there was a strong relationship between MSI and relapse condition (p < .01). Also, MSI status correlated with MMR expression to some degree (p < .01). But it was common that negative and positive staining of MMR coexisted on the same slide. CONCLUSION MSI and abnormal MMR may contribute to the carcinogenesis of a subset of LSCC. MSI may be a characteristic signal of tumour recurrence.

PROAPOPTOTIC FUNCTION OF FHIT GENE

Tumor suppressor gene plays an important role in maintaining the homeostasis between cell loss and growth. Fragile histidine triad (FHIT) gene found recently was studied in a deep going way; it becomes the focus as a result of its role of anti-tumor in human various type of tissue. Due to the high efficiency of FHIT gene benefiting the anti-tumor, it is proposed as a candidate of tumor suppressor gene though there are several opposite opinions.We stress the summary of some properties of FHIT gene on proapoptosis according to the published data which showed the stronger proapoptotic function of FHIT gene; the apoptosis induced by FHIT depends on the expression level and status of FHIT; and FHIT gene can alternate the cell cycling properties and reduce the tumorigenic potential; the apoptotic process induced by FHIT has no relation to p53 gene. In a ward, in consideration of its multiple functions against malignancies, FHIT gene deserves attention and exploration as a selective target for searching the mechanism of tumorigenesis and clinical therapeutic applications in further.

Research Advances in Post-Operative Rehabilitation Following Cochlear Implant

Cochlear implantation is a unique method to re-construct audition for patients with severe to profound hearing loss. With increasing clinical application of this technique, its rehabilitative effects in patients has become an important topic of hearing and speech rehabilitation research. This article is an overview of hearing and speech rehabilitative training, rehabilitative efficacy evaluation and factors affecting rehabilitation efficacy following cochlear implantation.

Virtual Temporal Bone Anatomy

Background The Visible Human Project (VHP) initiated by the U.S. National Library of Medicine has drawn much attention and interests from around the world. The Visible Chinese Human (VCH) project has started in China. The current study aims at acquiring a feasible virtual methodology for reconstructing the temporal bone of the Chinese population, which may provide an accurate 3-D model of important temporal bone structures that can be used in teaching and patient care for medical scientists and clinicians. Methods A series of sectional images of the temporal bone were generated from section slices of a female cadaver head. On each sectional image, SOIs(structures of interest) were segmented by carefully defining their contours and filling their areas with certain gray scale values. The processed volume data were then inducted into the 3D Slicer software (developed by the Surgical Planning Lab at Brigham and Womens Hospital and the MIT AI Lab) for resegmentation and generation of a set of tagged images of the SOIs. 3D surface models of SOIs were then reconstructed from these images. Results The temporal bone and structures in the temporal bone, including the tympanic cavity, mastoid cells, sigmoid sinus and internal carotid artery, were successfully reconstructed. The orientation of and spatial relationship among these structures were easily visualized in the reconstructed surface models. Conclusion The 3D Slicer software can be used for 3-dimensional visualization of anatomic structures in the temporal bone, which will greatly facilitate the advance of knowledge and techniques critical for studying and treating disorders involving the temporal bone.

Hearing Impairment in Senile Dementia of Alzhaimer's Type*

Abstract Objectives To evaluate peripheral auditory dysfunction in senile dementia of Alzheimer’s disease (AD) and its relationship with cognitive dysfunction. Methods Pure tone thresholds, word recognition scores (WRS), acoustic immittance and auditory brain-stem responses (ABR) were tested to evaluate the auditory function in 43 AD patients and 50 normal subjects. The test reliability in these subjects was examined before the test results were evaluated for their correlation with the Mini Mental State Examination (MMSE) score. Results There were no statistically significant differences in peripheral auditory functions between the two ears in the tested subjects or between the two groups when the auditometric results of the right ear were compared (P > 0.05). Also, there were no statistically significant differences between the two groups when audiometric test reliability, acoustic impedance and ABR results were compared (P > 0.05). Conclutions The pure tone audiometric threshold and WRS in AD patients are similar to those in comparable non-AD senile subjects. Peripheral auditory dysfunction is not related to cognitive dysfunction.