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    Improving the standard treatments for thyroid nodules and malignant tumors
    PAN Xinliang
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 1-12.   DOI: 10.6040/j.issn.1673-3770.1.2020.037
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    A review of autofluorescence imaging of the parathyroid gland
    SONG Xicheng, ZHENG Haitao
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 19-25.   DOI: 10.6040/j.issn.1673-3770.1.2020.025
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    The temporary and permanent dysfunction caused by parathyroid injury are inevitable. The parathyroid contains a special fluorescent substance, although its mechanism is not clear. At present, two kinds of autofluorescence detection equipment(FLUOBEAM ® imaging system, PTeye fiber probe contact system)can be used for real-time localization of the parathyroid gland for intraoperative localization and protection. The major advantage of this technique is that is allows detection of the parathyroid in excised specimens. The ratios of autofluorescence intensities of the parathyroid and thyroid are 1.23 and 7.71, respectively. The proportion of autofluorescence parathyroid identification sensitivity was 76.3-98.0% and the accuracy was 90.5-99.0%. The parathyroid gland autofluorescence technique is non-invasive, less time-consuming, provides accurate real-time information, and does not use dye as a contrast agent.
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    The safety and feasibility of transoral endoscopic thyroidectomy vestibular approach(TOETVA)in papillary thyroid cancer
    ZHENG Guibin, ZHANG Guojun, MA Chi, WEI Shujian, SUN Haiqing, WU Guochang, GUO Yawen, ZHENG Haitao, SONG Xicheng
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 58-63.   DOI: 10.6040/j.issn.1673-3770.1.2020.021
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    Objective To explore the safety and efficiency of transoral endoscopic thyroidectomy vestibular approach(TOETVA)in papillary thyroid cancer(PTC). Methods This study retrospectively reviewed 146 patients who underwent TOETVA between June 2017 and January 2020 at the Affiliated Yantai Yuhuangding Hospital of Qingdao University. Of those, 139 patients with pathologically confirmed PTC were enrolled in this study. Analyses were performed of the workflow experience, visual pain score on the first postoperative day, length of hospital stay, number of central neck lymph nodes removed, complications, and results of follow-ups. Results A total of 135 cases required hemithyroidectomy plus isthmectomy and central neck dissection(CND)with a mean operation time of 132±34.9 min; 4 cases required total thyroidectomy and CND with a mean operation time of 168±38.5 min. The mean number of central neck lymph nodes removed was 7.1±4.6 and the metastasis rate was 47.5%(66/139). Postoperative hospital stay was 1.9±0.7 days. Regarding postoperative complications, the incidence of transient recurrent laryngeal nerve injury(RLN)and transient hypoparathyroidism was 1.4%(2/139)and 0.7%(1/139), respectively. No permanent RLN injury and hypoparathyroidism occurred. Mental nerve injury occurred in 5.0%(7/139). Transient abnormal motor function of the lower lip and marginal mandibular branches of the facial nerve was observed in nine cases and two cases, respectively. Conclusion TOETVA can be performed by standard workflow with the principle of enhanced recovery after surgery(ERAS). TOETVA is feasible in selected PTC patients for its cosmetical results and oncological safety.
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    A radiomics nomogram based on computed tomography for predicting benign and malignant thyroid nodules
    WU Xinxin, LI Jingjing, MAO Ning, ZHENG Guibin, ZHENG Haitao, CUI Jingjing, JIA Chuanliang, CHU Tongpeng, MOU Yakui, SONG Xicheng
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 32-39.   DOI: 10.6040/j.issn.1673-3770.1.2020.028
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    COVID-19 prevention and control scheme in an ENT endoscopy unit in China
    Huimin LIANG,Liqin WANG,Wenjin WAN,Sailei SHI,Jing YUAN,Yujie SHEN,Jiacheng ZHANG,Zefan MAO,Jingzi NI,Yiwen PAN,Zhibin CHEN,Lei CHENG
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (2): 88-92.   DOI: 10.6040/j.issn.1673-3770.0.2020.078
    Accepted: 13 March 2020

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    Due to the increasing spread of the novel coronavirus disease (COVID-19), prevention and control measures have become increasingly important. As a key location for diagnosing and treating upper airway diseases, strict precautions are required in ear nose and throat (ENT) endoscopy units. Endoscopy workers have a high risk of occupational exposure. Therefore, procedures must be strictly performed according to the prevention and control plan. The prevention and control requirements for COVID-19, as directed by the National Health Commission of China, have been universally deployed in our hospital. We have carefully analyzed the risk factors of infection during the epidemic period and subsequently formulated a prevention and control scheme for COVID-19 based on the infection control measures in the ENT endoscopy unit. These have helped to avoid cross-infection in the hospital and ensure the safety of patients and medical staff during the COVID-19 epidemic.

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    Clinical analysis of malignant thyroid tumors with laryngotracheal invasion
    XIA Tongliang, WEI Dongmin, QIAN Ye, LI Wenming, JI Wei, PAN Xinliang, LEI Dapeng
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 46-51.   DOI: 10.6040/j.issn.1673-3770.1.2020.033
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    Objective To explore the clinical treatment outcomes in thyroid papillary carcinoma patients with laryngotracheal invasion. Methods The study involved 87 patients with papillary thyroid carcinomas involving the larynx and trachea who reported to the Department of Otolaryngology at the Qilu Hospital of Shandong University between January 2010 and December 2019. Their basic demographic data, tumor resection procedures, tracheal repair procedures, postoperative extubation rate, and 3-year and 5-year survival rates were retrospectively analyzed. Results All the 87 patients were treated surgically. Tumor resection procedures included sharp shaving of the tracheal wall tumor(60 cases), tracheal wall wedge resection(15 cases), tracheal sleeve resection(3 cases), partial laryngectomy(1 case), total laryngectomy(4 cases), and palliative resection(4 cases). Airway reconstruction procedures included, suturing(5 cases), pectoralis major muscle flap repair(1 case), sternocleidomastoid clavicle periosteum flap repair(1 case), end-to-end anastomosis(3 cases), laryngoplasty(1 case), and tracheostomy(12 cases). Seventy-nine patients were followed for 4–122 months, of which 15 patients underwent tracheotomy, with an extubation rate of 66.7%(10 out of 15 patients). The 3-year and 5-year survival rates were 100% and 93.0%, respectively. Conclusion Accurate preoperative evaluation and reasonable surgical treatment may significantly improve the quality of life and facilitate the satisfactory survival of patients with thyroid papillary carcinoma involving the larynx and trachea.
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    Prediction of cervical lymph node metastasis in papillary thyroid cancer based on XGBoost artificial intelligence and enhanced computed tomography
    CHEN Haibing, WEI Ya'nan, XU Xiaoquan, CHEN Xi
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 40-45.   DOI: 10.6040/j.issn.1673-3770.1.2020.031
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    Objective Incorporating eXtreme Gradient Boosting(XGBoost)artificial intelligence, we aimed to build a predictive model using pre-operative enhanced computed tomography(CT)of cervical lymph node metastasis in patients with thyroid cancer, to provide a reference for pre-operative planning. Methods The clinical data of 38 patients with thyroid papillary carcinoma from October 2017 to May 2019 were retrospectively analyzed. A total of 135 lymph nodes were included. Using XGBoost artificial intelligence, the lymph node metastasis prediction model was established, and the accuracy of the prediction model was tested. Results The average accuracy of the XGBoost model was 87.41%, which was higher than that of the SVM model(79.2%). Important CT characteristics that are indicative of lymph node metastasis include degree and distribution of enhancement, location, and capsule invasion. Conclusion The predictive model of cervical lymph node metastasis in patients with thyroid cancer exhibits high accuracy and could help in the pre-operative evaluation of cervical lymph node metastasis, tumor staging, and surgical procedures.
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    Advances in molecular mechanisms of anaplastic thyroid cancer
    QING Xiaoyan, XU YiquanOverview, LI ChaoGuidance
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 26-31.   DOI: 10.6040/j.issn.1673-3770.1.2020.029
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    Anaplastic thyroid cancer(ATC)is a rare invasive thyroid tumor associated with rapid progression and poor prognosis. Currently, there is no effective treatment or early diagnosis. Some scholars have shown that the poor prognosis of ATC is due to the early mutation and invasive growth of the tumor; consequently, new directions in research involve the driving mutation of the pathogenesis of ATC and targeted drug therapies. Different molecular pathways related to tumor progression are involved in ATC. Some scholars have explored the implementation of new therapies that act on these molecular pathways to improve patients' quality of life. The research results on the molecular structural characteristics of ATC bring hope for new targeted therapies. The new molecular mechanisms will help us discover more potential therapeutic targets. We have reviewed the recent research on the molecular mechanisms of ATC.
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    Two-stage reconstructive strategy using a flap for non-circumferential tracheal defects
    DENG Di, LIU Jun, LI Linke, WANG Ji, LIU Jifeng, LV Dan, WANG Haiyang, GAN Weigang, WANG Jun, LI Bo, CHEN Fei
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 52-57.   DOI: 10.6040/j.issn.1673-3770.1.2020.032
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    Objective This study aimed to investigate the clinical value of two-stage reconstructive strategy using a flap for the treatment of non-circumferential tracheal defects. Methods Patients who underwent tracheal reconstructions with a two-stage reconstructive strategy using a flap between March 2013 and December 2018 were retrospectively evaluated. Results Thirty-seven patients, with a tracheal defect length of 6-14 tracheal rings and circumferential ratio of 1/2 to 3/4, underwent stage I surgery. Twenty-two free flaps and 15 pedicled flaps were used in the stage I surgery, and the sizes of the flap ranged from 6×4 cm to 12×9 cm. Thirty-three patients underwent stage II surgery, and the postoperative respiratory, deglutition, and articulation functions recovered satisfactorily. Conclusion The two-stage reconstructive strategy using a flap is safe and effective for the treatment of non-circumferential tracheal defects.
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    Relationship between sinusitis and adenoid hypertrophy in children
    ZHANG Liqiang
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (6): 25-28.   DOI: 10.6040/j.issn.1673-3770.1.2019.058
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    There is a high incidence rate of sinusitis in children. Adenoid hypertrophy is a common cause of sinusitis in children. Adenoid hypertrophy can affect the occurrence and development of sinusitis by hindering nasal cavity development and nasal drainage, as well as releasing pathogenic bacteria. Sinusitis can cause adenoid hypertrophy through inflammatory stimulation. Allergies can affect both sinusitis and adenoid hypertrophy and might be an important therapeutic target to be considered during treatment.There is a closed relationship between adenoid hypertrophy and pediatric sinusitis. An adenoidectomy can be used to treatrefractory sinusitis in children.
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    The difficulties, challenges, and strategy for diagnosing and treating pediatric sinusitis
    LI Yong
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (6): 1-7.   DOI: 10.6040/j.issn.1673-3770.1.2019.055
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    Sinusitis in children is a common disease in pediatric otorhinolaryngology. The incidence of sinusitis has gradually increased over the last 10 years. However, there is a lack of epidemiological research that focusses on pediatric sinusitis in China. Pediatric sinusitis is often accompanied by an acute viral upper respiratory tract infection, adenoid hypertrophy, and allergic rhinitis. As symptoms overlap it can be challenging to diagnose pediatric sinusitis. Nasal endoscopy is an important diagnostic method that can be used. A computed tomography(CT)scan of the sinus can often be inconsistent. Additionally, as the radiation dose is high, it should be carefully used in children. Treatment of pediatric sinusitis is different from sinusitis in adults. Also, there is less high-quality evidence available. An intranasal steroid and nasal spray are the first-line treatment used for children with sinusitis. The role of antibiotics has become increasingly controversial over the last few years. The difficulties and challenges in diagnosing and treating pediatric sinusitis need to be addressed so that clinical consensus can be reached and countermeasures can be used.
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    CT scans should not be routinely used for diagnosing chronic sinusitis in children
    XU Geng
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (6): 8-9.   DOI: 10.6040/j.issn.1673-3770.1.2019.059
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    Correct interpretation of the predictors of ocular ischemic syndrome to improve diagnostic performance HUANG Yingxiang, WANG Yanling Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China Abstract:
    Ocular ischemic syndrome(OIS)is a severe ophthalmic disease caused by ocular hypoperfusion, which occurs due to stenosis or occlusion of the common or internal carotid arteries. The clinical presentations and signs of OIS are complex, incidental, and different. OIS is easily misdiagnosed or remains undiagnosed because of its asymptomatic onset and complicated ocular manifestations. Therefore, it is crucial to trace the etiology of OIS. Presently, different imaging modalities can evaluate the carotid artery blood supply, collateral circulation, and brain perfusion. Thus, appropriate modalities must be selected for OIS diagnosis based on their advantages and disadvantages. Furthermore, the auxiliary examination results should be accurately and promptly considered and interpreted when establishing a diagnosis of OIS. Thus, the management of OIS requires cooperation with ophthalmologists, cardiologists, and neurologists.
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (4): 1-4.   DOI: 10.6040/j.issn.1673-3770.1.2020.047
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    Ocular ischemic syndrome(OIS)is a severe ophthalmic disease caused by ocular hypoperfusion, which occurs due to stenosis or occlusion of the common or internal carotid arteries. The clinical presentations and signs of OIS are complex, incidental, and different. OIS is easily misdiagnosed or remains undiagnosed because of its asymptomatic onset and complicated ocular manifestations. Therefore, it is crucial to trace the etiology of OIS. Presently, different imaging modalities can evaluate the carotid artery blood supply, collateral circulation, and brain perfusion. Thus, appropriate modalities must be selected for OIS diagnosis based on their advantages and disadvantages. Furthermore, the auxiliary examination results should be accurately and promptly considered and interpreted when establishing a diagnosis of OIS. Thus, the management of OIS requires cooperation with ophthalmologists, cardiologists, and neurologists.
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    Clinical experience in diagnosis and treatment of stone in nasal cavity and sinusZHAI Xingyou1, HOU Junsheng2, LI Xinjian1, WANG Xin1, XIE Yingli1, WANG Wenjia1 1. Department of Otorhinolaryngology Head and Neck Surgery, Hainan Hospital, General Hospital of PLA, Hainan Province Otorhinolaryngology Head and Neck Surgery Clinical Medical Research Center, Sanya 572013, Hainan, China; 2. Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Henan University, Kaifeng 475001, Henan, ChinaAbstract:Objective
    To explore the genesis, clinical diagnosis, treatment, and prevention mechanisms of the formation of stones within the nasal cavity and sinus as well as measures toreduce the rate of clinical misdiagnosis. MethodsA comprehensive analysis was conducted on six patients with nasal and sinus calculi who visited the hospital between April 2012 and November 2017. The etiology, pathology, clinical diagnosis, differential diagnosis, treatment, prevention, and complication management of the disease were summarized for each patient. ResultFive patients underwent surgery for the removal of stones from the nasal cavity and sinus under general anesthesia. Nasal endoscopy was also performed for the assessment of the related sinus passages. One patient recovered upon nasal irrigation and anti-inflammation treatment. All the patients were followed up for six months and the mucosal layer within the operation area that was epithelialized, recovered well. The symptoms disappeared without any additional complications. ConclusionNasal endoscopy in combination with the assessment of clinical manifestation and imaging are conducive to the diagnosis of the disease. Together, these could develop into an effective treatment regimen for nasal cavity and sinusoidal lithiasis.
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (4): 92-96.   DOI: 10.6040/j.issn.1673-3770.0.2019.376
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    Objective To explore the genesis, clinical diagnosis, treatment, and prevention mechanisms of the formation of stones within the nasal cavity and sinus as well as measures toreduce the rate of clinical misdiagnosis. Methods A comprehensive analysis was conducted on six patients with nasal and sinus calculi who visited the hospital between April 2012 and November 2017. The etiology, pathology, clinical diagnosis, differential diagnosis, treatment, prevention, and complication management of the disease were summarized for each patient. Result Five patients underwent surgery for the removal of stones from the nasal cavity and sinus under general anesthesia. Nasal endoscopy was also performed for the assessment of the related sinus passages. One patient recovered upon nasal irrigation and anti-inflammation treatment. All the patients were followed up for six months and the mucosal layer within the operation area that was epithelialized, recovered well. The symptoms disappeared without any additional complications. Conclusion Nasal endoscopy in combination with the assessment of clinical manifestation and imaging are conducive to the diagnosis of the disease. Together, these could develop into an effective treatment regimen for nasal cavity and sinusoidal lithiasis.
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    Rhinosinusitis and asthma in children: united airway disease
    YANG Yifan, CHENG Lei
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (6): 10-15.   DOI: 10.6040/j.issn.1673-3770.1.2019.061
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    Rhinosinusitis and asthma are common heterogeneous diseases in children and have a number of complex risk factors. It has been reported that chronic rhinosinusitis may contribute to asthma and that there is a close interaction between them. The concept of ‘united airway disease’ has been well accepted, and is supported by the coexistence of upper and lower airway inflammation as well as similar potential mechanisms involved in the pathogenesis. For patients with asthma, particularly those with severe asthma, the presence of rhinosinusitis needs to be detected, as it can influence asthma severity and clinical management. Therefore, controlling rhinosinusitis may benefit asthma. Physicians should be aware of these conditions, and an improved understanding of the underlying pathophysiological mechanisms may be useful for diagnostic and therapeutic purposes. In this article, we discuss the clinical features, pathogenesis, medical intervention, and biological treatment of rhinosinusitis and asthma in children.
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    A child with acute rhinosinusitis, acute glomerulonephritis and an orbital abscess: case report
    ZHU Luping, CHEN Juan, ZHU Lei, CHEN Renjie
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (6): 41-44.   DOI: 10.6040/j.issn.1673-3770.0.2019.505
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    Acute rhinosinusitis is an acute infection of the mucous membrane in the nasal cavity and sinus that results in inflammation. The nasal sinus is adjacent to the orbit anatomically, which makes it easy for a sinus infection to break through the anatomical barrier into the orbit. Due to antibiotics being widely used, this does not commonly occur. However, in children with a weakened immune system, it can result in orbital cellulitis and an orbital abscess. However, glomerulonephritis is a very rare complication. In this case report, we report a child with acute rhinosinusitis accompanied with acute glomerulonephritis and an orbital abscess. We also discuss our diagnosis and treatment process for the case.
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    The efficacy and disadvantages of three excimer laser surface cutting surgeries
    Ge CUI
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (2): 67-71.   DOI: 10.6040/j.issn.1673-3770.1.2020.010
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    Contemporary excimer laser surgery includes both stoma and surface cutting surgeries. The advantages of surface cutting surgery are stable postoperative biomechanics and no flap related complications. However, the disadvantages include postoperative pain, haze under the corneal epithelium, long term use of glucocorticoids, and refractive regression. Surface cutting operations include photorefractive keratectomy (PRK), TransPRK, laser-assisted sub-epithelial keratectomy (LASEK), and Epi-laser assisted in-situ keratomileusis (Epi-LASIK). Of these, TransPRK is a truly contactless operation and involves only one set of epithelial and matrix cutting. The procedure is widely favored due to the ability to make more accurate cuts. Complications such as postoperative pain, haze, and retractive regression are the three most common complications after surface cutting surgery.

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    Lens vault changes and associated factors after implantation of implantable collamer lenses with central flow
    Bo WAN,Donghui LI,Yan LUO,Ying LI
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (2): 36-41.   DOI: 10.6040/j.issn.1673-3770.1.2020.008
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    Objective

    To investigate the changes to the lens vault (LV) and anterior chamber structures after implantation of implantable collamer lenses (ICL) with central flow in patients with myopia. The relationship between LV and its associated factors, both preoperatively and postoperatively, will also be analyzed.

    Methods

    One hundred and forty eyes of 72 patients who underwent ICL implantations were enrolled between January 2015 and January 2017. Visual acuity, intraocular pressure (IOP), corneal endothelial cell count (ECD), refractive outcomes, LV, and other anterior chamber structures were evaluated and compared after 1 week, 1 month, 3 months and 1 year, postoperatively. We analyzed the relationship between LV and other anterior chamber structures.

    Results

    After 1 year, 73% of eyes had gained 1 or more lines of corrected distance visual acuity, progressively fewer eyes had gained an uncorrected distance visual acuity above 20/20, more than 63% were within±0.5D of the prospective mean refractive spherical equivalent (MRSE), and more than 86% were within±0.1D of the prospective MRSE. There were no significant differences in MRSE, IOP, and ECD, postoperatively (p>0.05). No complications occurred during the postoperative time. There were no significant LV differences at 1 month and 3 months postoperatively. Meanwhile, LV had decreased significantly in the first postoperative year and was negatively correlated with age, keratometric power, 500 μm angle open distance, 500 μm trabecular iris space area, and the anterior chamber angle. LV was positively correlated with the white-to-white distance, angle-to-angle distance, anterior chamber depth, axial length, and ICL length. Axial length and ICL length were independent factors of LV.

    Conclusion

    Implantations of phakic ICL with center flow are safe, effective, and predictable in correcting myopia. LV decreased significantly at 1 year postoperatively, which correlated with multiple factors, both preoperatively and postoperatively.

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    Advances in the surgical treatment of pediatric patients with chronic rhinosinusitis
    LIU Jia, FU Yong
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (6): 29-33.   DOI: 10.6040/j.issn.1673-3770.1.2019.060
    Abstract319)      PDF(pc) (595KB)(67)       Save
    In recent years, increasing attention has been given by otolaryngology doctors to pediatric patients with chronic rhinosinusitis(CRS). Pediatric patients with CRS are often successfully managed using standard drug therapy of no less than 12 weeks. However, some pediatric patients with CRS suffer from frequent recurrences and treatmentfailure. Surgery is an option when medical management fails.However, the decision regarding surgical therapy inchildren is difficult.Balloon sinuplasty was introduced to otolaryngology in 2005 to treat nasal sinus inflammatory diseases. Evidence now strongly supports its safety and efficacy in treating chronic rhinosinusitis(CRS). As it requires no bone or tissue removal and retains most or all of the sinus mucosa, this procedure could be suitable for children.We will review the literature relating to the surgical treatment of chronic rhinosinusitis in children.
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    Diagnosis and treatment of pediatric rhinosinusitis
    LI Huabin, CAO Yujie
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (6): 16-19.   DOI: 10.6040/j.issn.1673-3770.0.2019.057
    Abstract305)      PDF(pc) (543KB)(90)       Save
    Pediatric rhinosinusitis has distinctly different clinical characteristics and outcomes compared to rhinosinusitis in adults. This is due to the immature development of the paranasal sinuses and immune system. Pediatric rhinosinusitis and other airway diseases, such as allergic rhinitis, otitis media, tonsillitis, and asthma, are closely related. Additionally, patients with pediatric rhinosinusitis are at risk of developing orbital and intracranial complications. Therefore, pediatric rhinosinusitis deserves great attention. This article discusses the pathogenesis, diagnosis, and treatment of chronic rhinosinusitis in children as well as the medication and surgical treatment options.
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    Standardized treatment of auricular complications with temporal bone fractures
    Jia XU,Haijin YI
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (1): 4-8.   DOI: 10.6040/j.issn.1673-3770.1.2019.048
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    Temporal bone contains cochlea and vestibule, with numerous vessels and nerves. Auricular complications commonly occur when the temporal bone is fractured. Auricular complications must be identified when dealing with craniocerebral trauma, especially with temporal bone fractures. The principles to use for auricular complications with a temporal bone fracture depend on the position and severity of the injury. Individualized treatment can improve the patient's prognosis and quality of life.

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    Surgical skills required for small incision lenticule extraction (SMILE), and the prevention and management of SMILE-related complications
    Caipei SU,Yabo YANG
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (2): 13-16.   DOI: 10.6040/j.issn.1673-3770.1.2020.007
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    The rising incidence of myopia is a major global public-health problem. Small incision lenticule extraction (SMILE) is widely accepted by refractive experts and patients, owing to its advantages, such as its flap-free nature, requirement for a small incision, good safety, effectiveness, and predictability. However, SMILE surgery requires corneal micro-surgical skills, and the learning curve is relatively steep. Thus, surgical skills required for SMILE as well as the prevention and management of complications associated with SMILE will be discussed in this article.

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    The role of antibiotics for pediatric sinusitis
    LI Yong
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (6): 20-24.   DOI: 10.6040/j.issn.1673-3770.1.2019.056
    Abstract289)      PDF(pc) (606KB)(95)       Save
    Pediatric sinusitis is one of the most common childhood diseases. Recurrent upper respiratory infections are associated with its high incidence and relapse rates, which increases the burden on families and society. In the past, the use of antibiotics has been advised in Chinese and foreign guidelines for the treatment of sinusitis as the first-line response. However, differences between children and adults in anatomy, pathophysiology, and associated diseases have led to controversy regarding antibiotic treatment for pediatric sinusitis. Further, in recent years, there have been debates about the use of antibiotics as the first-line therapy. This paper reviews the efficacy of antibiotics in the treatment of pediatric sinusitis.
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    Clinical diagnosis and treatment of orbital complications following pediatric acute rhinosinusitis
    ZHANG Chanyuan, SUN Yulin, WANG Lin, ZHANG Li, CHEN Min, YI Longgang, LI Na, CUI Xin, JIANG Yan
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (6): 34-40.   DOI: 10.6040/j.issn.1673-3770.1.2019.062
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    Objective To study the clinical features and therapeutic strategies for orbital complications of pediatric rhinosinusitis. Methods The clinical data of 31 children with orbital complications caused by sinusitis treated in the Department of Otorhinolaryngology Head and Neck Surgery from October 2010 onwards were retrospectively analyzed and summarized. Results The orbital complications of pediatric sinusitis have different stages, which correspond with clinical characteristics and imaging findings. All cases were cured and discharged from our hospital. No recurrence occurred during the follow-up period of 9 to 24 months. One case was left with an eyelid ectropion, and one with a saddle nose. No serious complications such as cavernous sinus suppurative inflammation or an intracranial infection occurred. The bacterial culture rate in the patients pus and nasal secretions was 55%, including 4 cases of Staphylococcus aureus and 4 of Streptococcus pneumoniae. Conclusions In children, orbital complications caused by sinusitis occur more often in winter and spring, and males. It is closely related to other upper respiratory tract infections. The primary symptoms are atypical resulting in delayed treatment. Adequate and sensitive antibiotics should be used to control any infection early. Cefoperazone sodium and sulbactam sodium are usually used for treating children with rhinogenic orbital complications. If conservative treatment is ineffective, the stage of the disease should be assessed along with any changes in clinical and imaging manifestations examined. Satisfactory results can be obtained according to surgical indications.
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    Giant cyst formation from lymph node metastasis in papillary thyroid cancer: a case study
    WANG Jiashuo, GUO Xing, YAN Aihui
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 111-113.   DOI: 10.6040/j.issn.1673-3770.1.2020.020
    Abstract258)      PDF(pc) (3053KB)(22)       Save
    Benign cystic tumors of the neck are relatively common. However, malignant manifestations, such as thyroid cancer, are rare. Accurate identification of cervical cystic masses in these patients is important in preventing incorrect diagnosis and misdiagnosis. We report a case of giant cystic formation by cervical lymph node metastasis in papillary thyroid carcinoma. Processes and their potential influence in diagnosis and treatment are briefly described.
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    Epidemic control practices of an otolaryngology-head and neck surgery ward in an area with non-high incidence of COVID-19
    Zhenhua JIANG,Lijun ZHANG,Ying LI,Yanqin XIAO,Chao LI,Bo SHI,Guiying ZHANG,Bin XU,Wei DENG,Gang LUO,Jifang LUO,Guoqi LIU
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (2): 93-98.   DOI: 10.6040/j.issn.1673-3770.0.2020.057
    Abstract256)   HTML586)    PDF(pc) (4368KB)(73)       Save

    The COVID-19 epidemic is still severe. As a non-high incidence area outside Hubei, the epidemic prevention and control of primary otolaryngology-head and neck surgery has its own characteristics. Daily diagnosis and treatment are performed in the ward to prevent cross infection by medical staff. This article combines our department's experience and the measures taken in this area with respect to ward diagnosis and treatment practices. We hope that our experience will be helpful to our otolaryngology-head and neck surgery colleagues in non-high incidence areas outside Hubei.

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    A discussion on the choice of surgical methods for correction of myopia
    Ying LI,Yang JIANG
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (2): 1-6.   DOI: 10.6040/j.issn.1673-3770.1.2020.001
    Abstract245)   HTML115)    PDF(pc) (1288KB)(68)       Save

    Adult myopia refractive surgery has developed rapidly over the past 30 years, and the number of operations has increased yearly. The main surgical methods include laser corneal refractive surgery and posterior chamber intraocular lens implantation (ICL). Laser corneal refractive surgery is suitable for low to moderate myopia and high myopia customized correction, which is safe, effective, and predictable and provides good long-term stability. Some special cases, however, including high refractive diopters, high corneal curvature, high corneal astigmatism, high corneal topography asymmetry, and thin corneal thickness, as well as too small a corneal diameter and irregular corneal shape, are not appropriate for laser corneal refractive surgery. For these cases, ICL provides many advantages, such as wide range of correction, stable effect, no need to remove corneal tissue, small effect of aberration, and good visual quality. ICL has been widely used in clinical practice, and the number of operations has increased year by year. However, ICL is not recommended for conditions such as insufficient anterior chamber depth, large corneal aberration, intraocular structural variation, and special occupation. These two surgical methods complement each other, widening the scope of refractive surgery indications and correction, and therefore, patients can receive the best choice of operation.

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    Comparative study of the effects of different protective measures of the non-operative eye during SMILE surgery on tear film stability
    Tao ZHANG,Kaiwei CAO,Lina LIU,Ting LIU,Ji BAI
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (2): 32-35.   DOI: 10.6040/j.issn.1673-3770.1.2020.004
    Abstract241)   HTML3)    PDF(pc) (1127KB)(48)       Save
    Objective

    To observe the changes in the first non-invasive keratograph tear break-up time (NIKBUTf) and average non-invasive keratograph tear break-up time (NIKBUTav) of the non-operative eye with different protective measures during small incision lenticule extraction (SMILE) using the Keratograph 5M ocular surface analyzer and to observe the effects of different protective measures on tear film stability.

    Methods

    A prospective cohort study was conducted. From September 2019 to November 2019, patients who underwent SMILE in the Chongqing Vision Institute were included. The left eye was the observation eye. During SMILE of the right eye, the left eye was protected using deproteinized calf blood eye gel or eyeshade. The control group did not receive protective measures. The NIKBUTf and NIKBUTav of the left eye were measured using the Keratograph 5M ocular surface analyzer before and after the surgery of the right eye. SPSS 25.0 was used for statistical analysis.

    Results

    Thirty-five patients accounting for 35 left eyes were included in the study, of which 12 were allocated to the gel group, 11 to the eyeshade group, and 12 to the blank control group. Per the results of repeated-measurement analysis of variance, the variations in the NIKBUTf and NIKBUTav were significant in each group regarding time and grouping (P < 0.05). These two parameters also showed an interaction between time and grouping (P < 0.05). There was no significant difference in the left eye NIKBUTf of the gel group before and after surgery of the right eye (P<0.05). The NIKBUTav of the left eye in the gel group was longer immediately after surgery of the right eye (P < 0.05). In the eyeshade and blank control groups, both the NIKBUTf and NIKBUTav in the left eye decreased immediately after surgery of the right eye (P < 0.05). In the control group, the reductions in the NIKBUTf and NIKBUTav were the most significant (P < 0.05).

    Conclusion

    Different protective measures and time changes had an impact on the NIKBUTf and NIKBUTav. The protective measure of deproteinized calf blood eye gel in the non-operative eyes during SMILE played a protective role in the stability of the tear film. The protective effect of eyeshade on the tear film of the non-operative eye was not obvious, and the stability of the tear film was the worst during the conventional surgery with no protective measures for the non-operative eye.

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    Value the diagnosis and treatment of ear trauma
    Haijin YI,Shiming YANG
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (1): 1-3.   DOI: 10.6040/j.issn.1673-3770.1.2019.045
    Abstract238)   HTML16)    PDF(pc) (1095KB)(72)       Save
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    Surgical treatment of iatrogenic facial paralysis
    Yuxin TIAN,Jingjing WANG,Hui WANG,Yaqin WU,Haibo SHI,Zhengnong CHEN
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (1): 20-24.   DOI: 10.6040/j.issn.1673-3770.1.2019.054
    Abstract236)   HTML6)    PDF(pc) (2090KB)(70)       Save
    Objective

    To evaluate the surgical treatment of iatrogenic facial paralysis and discuss its cause, treatment and therapeutic effect.

    Methods

    A retrospective study of 21 iatrogenic facial paralysis cases who underwent ear surgery in the ear, nose, and throat (ENT) Department between 2015 and 2017.

    Results

    Of those that underwent middle ear surgery, 10 iatrogenic facial nerve injuries cases were observed in the following segments: the horizontal segment in 7 cases, the pyramidal segment in 2 cases, and the vertical segment in 1 case. After evaluating the degree of damage, decompression was performed in 7 cases, and facial nerve-great auricular nerve transplantation in 3 cases. The other 11 cases with facial paralysis after acoustic neuroma surgery underwent hypoglossal-facial anastomosis. Sixteen cases (about 76%) achieved HB Ⅰ-Ⅲ one year after surgery.

    Conclusions

    Although scientific and technological developments have reduced the probability of facial nerve injuries, iatrogenic facial paralysis cannot be entirely avoided. Clinical doctors need to have excellent anatomical knowledge and correct operation technique to prevent iatrogenic facial paralysis. Once iatrogenic facial paralysis occurs, early diagnosis and treatment are required to achieve ideal outcomes of patients' facial nerve function.

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    Analysis of clinical characteristics and prognosis of post traumatic hearing loss
    Yujing DING,Lan LAN,Qiuju WANG,Fei JI,Fen XIONG,Linyi XIE,Haina DING,Yin XIA,Hui ZHAO
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (1): 9-14.   DOI: 10.6040/j.issn.1673-3770.1.2019.063
    Abstract229)   HTML1)    PDF(pc) (2826KB)(113)       Save
    Objective

    The clinical characteristics and prognosis of post traumatic hearing loss were retrospectively evaluated to aid further diagnosis, medical evaluation, early identification, and effective treatment.

    Methods

    We recruited 84 patients (96 ears) and obtained their clinical examination findings, hearing test results, and audiograms from a single-institution otolaryngology service with comparative data generated from their first and follow-up visits.

    Results

    Among all the recruited patients, 34 ears (35.4%) had normal hearing, while 62 ears (64.6%) had hearing loss after trauma, at their first visit. Among 62 ears with hearing loss, 33 ears (53.2%) had conductive hearing loss, 25 ears (40.3%) had sensorineural hearing loss, and four ears (6.5%) had a mixture of conductive and sensorineural hearing loss. At the follow-up visit, the air conduction threshold of ears with conductive hearing loss had significantly decreased from 45.77±4.28 dB HL to 34.48±4.53 dB HL (t=2.906, P < 0.05), while the bone conduction threshold decreased from 23.45±2.31 dB HL to 19.63±2.20 dB HL (t=2.906, P < 0.05). However, no significant differences between the first and follow-up visits were observed in ears with sensorineural hearing loss or ears with mixed hearing loss. Of all the 96 ears, 39 (40.6%) had intact tympanic membrane, while 57 (59.4%) had traumatic tympanic membrane perforation. At follow-up, 40 ears (70.2%) with traumatic tympanic membrane perforation had healed spontaneously, while 12 ears (21.1%) had healed after tympanoplasty. However, five ears (8.8%) did not heal. Among the ears that spontaneously healed, 83.0% had grade Ⅰ and 16.7% had grade Ⅱ tympanic membrane perforation. Ears with grade Ⅲ and grade Ⅳ tympanic membrane perforations did not heal spontaneously.

    Conclusions

    Hearing impairment is a common clinical presentation in patients with traumatic injury. In most patients, this manifests as conductive hearing loss, while severely affected patients may have sensorineural or mixed hearing loss. Patients with conductive hearing loss have a favorable prognosis, while patients with sensorineural or mixed hearing loss have a poor prognosis. Trauma could cause different degrees of tympanic membrane perforation. With gradually aggravated tympanic membrane perforation, the spontaneous healing rate decreases. Therefore, for patients with large tympanic membrane perforations, which rarely heal spontaneously, tympanoplasty is warranted.

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    Research advances on vault and relevant factors after implantable collamer lens implantation
    Xuanqi WANG
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (2): 72-78.   DOI: 10.6040/j.issn.1673-3770.1.2020.016
    Abstract228)   HTML12)    PDF(pc) (2423KB)(52)       Save

    Implantable collamer lenses (ICL) have been widely used, with their implantation considered technically safe, efficient and stable. Vault, the distance between the posterior ICL surface and anterior crystalline lens surface, is an important follow-up index. A higher or lower vault results in a greater risk for potential complications and can affect the operation. Therefore, research on how to obtain the ideal vault and reduce postoperative complications has become increasingly important. This article summarizes the issues related to vault and attempts to provide a clinical basis for improving the safety of operations conducted and explore the direction of future clinical research.

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    Transmastoid facial nerve decompression for treating traumatic facial paralysis involving the geniculate ganglia
    Jia XU,Xin LI,Wenjing CHEN,Juanjuan GAO,Haijin YI
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (1): 25-27.   DOI: 10.6040/j.issn.1673-3770.1.2019.052
    Abstract216)   HTML1)    PDF(pc) (1947KB)(46)       Save
    Objective

    To explore the clinical effects of geniculate ganglion decompression of the facial nerve using the transmastoid-epitympanum approach in patients with traumatic facial nerve paralysis.

    Methods

    A retrospective analysis of 30 traumatic facial nerve paralysis cases was conducted. Facial nerve function and hearing levels were compared.

    Results

    All patients had improved facial function after surgery, of which 26 cases recovered to HB Ⅰ or Ⅱ level. The adverse effects on their auditory function were less than 10 dB in most cases.

    Conclusion

    The transmastoid-epitympanum approach to the decompression of the geniculate ganglion is simple, minimally invasive, safe, and effective, which results in little postoperative hearing change.

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    Facial nerve reconstruction in the parotid area under a variety of circumstances
    Zhili WANG,Zhe CHEN,Fangyu LIN,Yongchuan CHAI,Zhaoyan WANG
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (1): 15-19.   DOI: 10.6040/j.issn.1673-3770.1.2019.064
    Abstract212)   HTML1)    PDF(pc) (3687KB)(69)       Save
    Objective

    To discuss the efficacy of surgical facial nerve (FN) reconstruction in the parotid area under various circumstances.

    Method

    We considered 46 cases of surgical facial nerve reconstruction with nerve involvement in the parotid area. Among these cases, 3 required facial nerve relaxation (facial nerve intact), 7 required facial nerve suturing, 22 required sural nerve grafting (long distance nerve defects), and 14 required additional masseteric-facial nerve anastomosis due to sural nerve grafting.

    Results

    All patients in the study received postoperative follow-up at 6 to 12 months. Using the House-Brackmann grading system at follow-up, 2 of the 3 facial nerve relaxation cases received grade Ⅲ, while the third received grade Ⅱ; all 7 facial nerve suturing cases received grades Ⅲ-Ⅳ. The 22 sural nerve grafting cases received grades Ⅲ-Ⅳ, however in one of these cases severe synkinesis was observed; 3 cases presented obvious synkinesis, and tight synkinesis was observed in the other 7 cases. The 14 sural nerve grafting and masseteric-facial nerve anastomosis cases received grades Ⅲ-Ⅴ with no obvious synkinesis observed in any of these cases.

    Conclusion

    Immediate, individualized surgical facial nerve reconstruction could lead to satisfactory results for various circumstances of facial nerve damage. Nerve suturing was preferred for achieving tension-free anastomosis, and masseteric-facial nerve anastomosis was preferred as a means to avoid synkinesis.

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    Recent advances and clinical applications in excimer laser surface ablation surgery
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (2): 79-84.   DOI: 10.6040/j.issn.1673-3770.1.2020.011
    Abstract206)   HTML6)    PDF(pc) (959KB)(65)       Save

    Laser corneal refractive surgery is widely performed, and corneal surface excimer laser ablation surgery is one of the main surgical options. Corneal surface excimer laser ablation surgery includes:photorefractive keratectomy (PRK), laser-assisted subepithelial keratomileusis (LASEK), epipolis laser-assisted in situ keratomileusis (Epi-LASIK), transepithelial photorefractive keratectomy (TransPRK), and phototherapeutic keratectomy (PTK). It is mainly used to correct various refractive errors and corneal disorders. From epithelium-off PRK, alcohol soaking assistant LASEK, microkeratome-associated Epi-LASIK, to laser ablation corneal epithelial TransPRK, all of the procedures have no flap-related complications and they are of less corneal injury, painess and betrer visual quality after surgery. This review summarized the choice of current commonly used surgical options, clinical applications, and recent advances in excimer laser surface ablation surgery.

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    Detection of four infection indicators in 4 630 patients before refractive surgery
    Yabin HU,Yan ZHENG,Jing ZHANG,Yan WANG,Qiulu ZHANG,Jing LIU,Wen XU,Changbin ZHAI,Yuehua ZHOU
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (2): 53-56.   DOI: 10.6040/j.issn.1673-3770.1.2020.006
    Abstract196)   HTML2)    PDF(pc) (936KB)(41)       Save
    Objective

    To study and analyze the test results used for the detection of HBsAg, anti-HCV, anti-Treponema pallidum antibody (anti-TP) and anti-HIV in patients, prior to refractive surgery and to standardize the surgical management.

    Methods

    Enzyme-linked immunosorbent assay was used to detect four different indicators of infection in 4630 patients and the results were analyd retrospectively.

    Results

    The observed total positive rate, in the 4630 patients involved in the study, was 3.02% (n=140). The positive rates observed for HBsAg, anti-TP, anti-HCV, and anti-HIV were 2.13% (n=99), 0.62% (n=29), 0.19% (n=9), and 0.06% (n=3), respectively. In the present study, the total positive rate and the positive rates for HBsAg and anti-HIV were observed to be higher in male patients, compared to female patients (χ2 was 8.04, 16.11 and 6.05, respectively, P < 0.01).

    Conclusions

    Detection of infection indicators, prior to laser corneal refractive surgery, can aid in understanding the infection status of patients, which helps in decreasing the risk of infection and enhances the safe implementation of the surgical procedure.

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    Key criteria for screening before corneal refractive surgery
    Fengju ZHANG,Yu LI
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (2): 7-12.   DOI: 10.6040/j.issn.1673-3770.1.2020.014
    Abstract191)   HTML6)    PDF(pc) (1291KB)(116)       Save

    Safety, efficacy, predictability, and long-term stability are the prerequisites for satisfied outcomes after corneal refractive surgery. The most important factors are strict pre-operative screening and reasonable selection for surgical indications. This article put forward the main criteria for screening before corneal refractive surgery, which purpose is to select surgical indications rationally and avoid medical pitfalls and risks effectively. And make sure the patients could achieve the safe, effective, and stable results as well as high visual quality after corneal refractive surgery.

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    Efficacy of different transplantation schemes for parathyroid gland resection in patients with secondary hyperparathyroidism
    WANG Maolin, LI Julan, XIAN Kunlun
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 114-119.   DOI: 10.6040/j.issn.1673-3770.1.2020.041
    Abstract191)      PDF(pc) (1954KB)(19)       Save
    Objective Retrospectively summarize the efficacy of different transplantation schemes for parathyroid gland resection in patients with secondary hyperparathyroidism. Methods A total of 86 patients who had undergone total parathyroid gland transplantation in our hospital between March 2013 to March 2018 were divided into three groups according to the three different transplantation schemes. The preoperative, postoperative, and follow-up PTH results, hospital stay, postoperative calcium supplementation days, postoperative complications, and recurrence were collected to determine the efficacy. Results The short-term treatment efficacy(1 day after surgery-1 month after surgery)was different among the three groups, while the long-term treatment effect was not different. The short-term treatment effect of group A was the worst. The short-term treatment effect of group B and group C were similar, but overall, group C was better than group B. Conclusion The particle size of the transplanted parathyroid and the blood supply of the transplanted bed are closely related to the survival and growth of the transplanted parathyroid. Refractory secondary hyperparathyroidism can be efficaciously treated by the transplantation of small particles of parathyroid tissue into the sternocleidomastoid muscle sac.
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    Implantable collamer lens implantation for regression of refraction after radical keratotomy:case report
    Shali YUE,Yingping DENG
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (2): 85-87.   DOI: 10.6040/j.issn.1673-3770.1.2020.009
    Abstract182)   HTML4)    PDF(pc) (4355KB)(55)       Save
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    Efficacy of 0.1% diclofenac sodium eye drops post-SMILE
    Yang JIANG,Ying LI,Ge CUI
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (2): 57-60.   DOI: 10.6040/j.issn.1673-3770.1.2020.012
    Abstract178)   HTML6)    PDF(pc) (959KB)(39)       Save
    Objective

    To study the safety, efficacy, and tolerability of 0.1% diclofenac sodium eye drops after the small incision lenticule extraction (SMILE) procedure.

    Methods

    Two groups were observed, including 60 patients (60 eyes) with myopia. Thirty patients (30 eyes) were treated with topical compound tobramycin eye drops 4 times daily for 10 days as the control group. Meanwhile, 30 patients (30 eyes) were treated with topical compound tobramycin eye drops 4 times daily for 10 days, and diclofenac sodium eye drops 4 times daily for 20 days. All of the patients were observed in the preoperative and postoperative periods. The visual acuity, intraocular pressure, topography and adverse reactions were recorded at 10 d and after 1 month. The differences between the 2 groups were analyzed by the single factor analysis of variance (one-way ANOVA).

    Results

    There was no significant difference between the 2 groups in terms of uncorrected visual acuity at 10 d(P=0.12, F=2.50). However, there was after 1-month (P=0.001, F=29.78). There were no significant differences between the intraocular pressure values pre-operation, and postoperatively at 10 d and 1 month (P=0.45, 0.97, 0.66, F=0.56, < 0.001, 0.19). There were no significant differences between the 2 groups in the SRI and SAI values pre-operation and at 1 month in the SRI index(P=0.32, 0.05, 0.07, F=1.01, 3.86, 3.27). However, there was a significant difference in the SAI value 1-month post the operation (P=0.01, F=7.70). Eight patients (26.67%) in the diclofenac sodium eye drops group suffered from transient mild eye pain. However, this discomfort was relieved after a short time.

    Conclusion

    Diclofenac sodium eye drops can be an effective treatment combined with corticoids after SMILE. They are safe and were satisfactory in the recovery of visual acuity and ocular surface regularity.

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    Comparison of corneal epithelial remodeling after FS-LASIK and SMILE treatment for myopia and astigmatism
    Ye TAO,Yuehua ZHOU,Fusheng LI,Shen WANG,Hongzhi YIN,Si QI,Haihong YANG,Tianfeng SHAN,Fang WANG
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (2): 61-66.   DOI: 10.6040/j.issn.1673-3770.1.2020.003
    Abstract178)   HTML2)    PDF(pc) (987KB)(40)       Save
    Objective

    To compare the characteristics of corneal epithelial remodeling after FS-LASIK and SMILE.

    Methods

    There were 33 males (65 eyes) and 27 females (54 eyes) with an average age of 26±6.5years. The mean spherical equivalent was -5.25±2 D. Patients were divided into two groups:the FS-LASIK group (29 patients, 58 eyes) or SMILE group (31 patients, 61 eyes). The RTvue-OCT system was used to measure the epithelium thickness within 0-2 mm and 2-5 mm from the central cornea of patients before and 1, 3, and 6 months after surgery.

    Results

    One month after surgery, however, there was a statistical difference between the average corneal epithelium thickness within 2 mm and 2-5 mm from the cornea in the FS-LASIK group (P=0.036). In the superior, nasal superior, temporal superior region, the thickness of the corneal epithelium within 2-5 mm increased less than the inferior, nasal inferior, and temporal inferior regions. These differences were statistically significant (P=0.042, P=0.031, P=0.049, respectively). There was a statistically significant difference between the average corneal epithelium thickness within 2 mm and 2-5 mm of the cornea in the SMILE group at 6 months after operation (P=0.047). In the range of 2-5 mm, the corneal epithelium thickness increased less in the superior, nasal superior, temporal superior regions than the thickness in the inferior, nasal inferior, and temporal inferior regions. These differences were statistically significant (P=0.012, P=0.035, P=0.009, respectively). Compared with the nasal and temporal sides, the thickness of the superior part was less, and the difference was statistically significant (P=0.045, P=0.017, respectively). For the FS-LASIK group, the corneal epithelium thickened from 1 to 6 months after surgery. It gradually decreased within 2 mm, and this difference was statistically significant (P=0.035). During this time period, the corneal epithelial thickness of the FS-LASIK group and the SMILE group was statistically significant at each position within a range of 0-5 mm (P<0.05).

    Conclusion

    Corneal epithelium thickening is more pronounced in FS-LASIK than in SMILE post-operation. The corneal epithelium thickening in FS-LASIK changes more obviously in the central area of the corneal resection. The corneal epithelium thickening in SMILE changes more obviously in the peripheral area of the corneal resection. Over time, the localized thickening of the corneal epithelium, which is located opposite to the incision location, continued after both procedures.

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    Analysis of the advantages of flaps created with an optical coherence tomography-guided femtosecond laser
    Jing ZHANG,Ye TAO,Fusheng LI,Shen WANG,Dongyi QU,Ying LI,Yuehua ZHOU
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (2): 17-21.   DOI: 10.6040/j.issn.1673-3770.1.2020.002
    Abstract178)   HTML2)    PDF(pc) (1165KB)(109)       Save
    Objective

    To compare the features of corneal flaps created by using an optical coherence tomography (OCT)-guided femtosecond laser and those created by three other femtosecond lasers.

    Methods

    Four types of femtosecond laser laser-assisted in situ keratomileusis procedures were performed on 107 patients (200 eyes) with myopia and myopic astigmatism. Patients were divided into four groups of 50: group A, FEMTO LDV Z8 femtosecond laser; group B, Ziemer Crystalline femtosecond laser; group C, Wavelight FS200 femtosecond laser; and group D, Zeiss VisuMax femtosecond laser. Corneal flap thickness was measured and analyzed by RTVue OCT.

    Results

    At 1 week postoperatively, the corneal flap thickness in group A was close to the expected value and the variation range was small. The corneal flap thickness in group B was close to the expected value, but the variation range was large. The corneal flap thickness in group C was thin, that of group D was close to the expected value, and the variation ranges of both groups were small. The corneal flaps created by the four femtosecond lasers were regular and uniform in shape, and there was no statistically significant difference between central and peripheral thicknesses (P>0.05). The differences between the corneal flap thickness value and the predicted value of 110μm among the four groups were obviously different. The results of groups A(3.43±2.81)μm and D(3.13±2.89)μm were obviously better than those of groups B(6.88±4.13)μm and C(5.44±3.62)μm (F=2.397; P=0.018).

    Conclusion

    Compared with the Ziemer Crystalline and Wavelight FS200 femtosecond lasers, the OCT-guided femtosecond laser and the Zeiss VisuMax femtosecond laser featured higher accuracy and better predictability

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    Changes in visual quality during the ultra-early stage of SMILE for middle and low myopia
    Yang ZHAO,Yanyan FU,Xiaoying WU,Yewei YIN,Aiqun XIANG,Ying LU,Kaixuan DU,Yuanjun LI,Tu HU,Xingli LI,Dan WEN
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (2): 42-46.   DOI: 10.6040/j.issn.1673-3770.1.2020.015
    Abstract177)   HTML2)    PDF(pc) (1146KB)(55)       Save
    Objective

    To observe the changes in visual quality within 24h (the ultra-early stage) after small incision lenticule extraction (SMILE) and explore the possible reasons behind these changes.

    Methods

    Forty-six eyes of 23 patients who underwent SMILE were chosen for this study. A subjective visual quality of questionnaire (SVQ) was competed by the patients before the procedure and 24 hours after treatment. The best-corrected visual acuity of the patients (distant vision 5 m, middle vision 60 cm, near vision 33 cm), contrast sensitivity (CS), glare sensitivity (GS), the near point of convergence (NPC) and the amplitude of accommodation (AA) were measured using a Binocular Vision Function Instrument (OCULUS Binoptometer 4p).

    Results

    The SVQ score illustrated a decrease in visual quality after SMILE at the ultra-early stage (P=0.001). However, uncorrected distance visual acuity (UCVA) significantly improved (P=0.0001). When comparing best-corrected visual acuity (BCVA), there was no difference between the distant vision results (P=0.096), but both the middle vision and near vision results were lower than before treatment (P=0.039, 0.003). CS and GS decreased following treatment (P=0.0001, 0.04), but there was no difference in the NPC and AA (P=0.68, 0.13).

    Conclusion

    Patients can expect improved distant vision in the ultra-early stage of SMILE. However, at the ultra-early stage, the middle vision and near vision have not yet recovered. The SVQ changes at the ultra-early stage of SMILE may be related to the changes in CS and GS.

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    Combined treatment of chylous leakage after lymph node dissection for thyroid cancer
    FANG Zhongju, ZHANG Yongxia, ZHAO Jiandong, ZONG Liang, ZHAI Xingyou, LI Xinjian, PENG Xin, REN Nan, CHEN Liwei, LIU Mingbo
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 64-68.   DOI: 10.6040/j.issn.1673-3770.1.2020.040
    Abstract176)      PDF(pc) (725KB)(28)       Save
    Objective To explore the causes and treatment of chyle leakage after lymph node dissection(LND)for thyroid carcinoma. Methods A retrospective analysis was conducted in 647 patients who underwent LND for thyroid carcinoma. For the 11 patients who developed chyle leakage, measures such as intravenous nutrition, low-fat diet, local compression and negative pressure drainage were taken. Results Chylous leakage occurred on day 0.5 to 3 after surgery, and the incidence was 1.7%. The peak drainage of chylous leakage was 120 to 1100 mL/d. Unilateral lobectomy + isthmectomy was performed in 449 cases, total thyroidectomy in 152 cases, and unilateral lobectomy + isthmectomy + contralateral subtotal thyroidectomy in 46 cases. Simple central lymph node dissection was performed in 395 cases, 5 of whom developed chyle leakage, and the incidence was 1.26%(5/395). Lateral neck+central lymphatic dissection was performed in 83 cases, 4 of whom developed chyle leakage, and the incidence was 4.8%(4/83). Upper mediastinal dissection with endoscope was performed in 6 cases, 2 of whom developed chyle leakage, and the incidence was 33.3%(2/6). The ratio of left to right chylous leakage was 7:4. Three patients had relapse dissection(rRLN). When the daily drainage volume was less than 20 mL/d, the drainage tube was removed. The closing time of chylous leakage was 6 to 23 days, median 11 days. No second operation was performed. Conclusion When lymph node dissection for thyroid carcinoma is performed, the procedures should be standardized to prevent chylous leakage. In case chylous leakage occurs, measures such as diet adjustment and negative pressure drainage can help the cure. Surgery must be performed when the conservative treatment is ineffective.
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    Temporal bone trauma complicated with cerebrospinal fluid leakage: a case series and literature review
    Juanjuan GAO,Xin LI,Jia XU,Wenjing CHEN,Sichao LIANG,Zhenping GUO,Manlin LU,Haijin YI
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (1): 28-32.   DOI: 10.6040/j.issn.1673-3770.1.2019.051
    Abstract172)   HTML4)    PDF(pc) (4154KB)(55)       Save
    Objective

    This study aimed to analyze the clinical characteristics of temporal bonetrauma complicated with cerebrospinal fluid (CSF) leakage and to discuss its diagnosis and appropriate management.

    Methods

    Eighteen patients with temporal bone trauma complicated with CSF were analyzed retrospectively.

    Results

    During follow-up, no CSF recurred after the operation except for in one patient. In this, the CSF recurred, a second operation was performed, and the CSF leakage ceased. No postoperative infection occurred in any patient.

    Conclusion

    Surgical exploration and repair is the most effective method for those who have poor outcomes with conservative treatment of the temporal bone trauma. Medical history, clinical manifestations, laboratory examination and imaging analyses are all essential for diagnosing CSF leakage, locating the CSF, and selecting an appropriate surgical method. Perioperative antibiotics to prevent infection and appropriate drugs to control cranial pressure can improve postoperative recovery.

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    Nasal septum-nasal deformity surgery for correction of severe traumatic nasal deformity: a case report
    CHEN Kai, WANG Jun, TANG Yuedi
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (1): 121-124.   DOI: 10.6040/j.issn.1673-3770.0.2019.381
    Abstract168)      PDF       Save
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    Lateral neck lymph node mapping in thyroid cancer surgery
    HUANG Naisi, MA Ben, GUAN Qing, WANG Yunjun, WEI Wenjun, LU Zhongwu, YANG Shuwen, XU Weibo, XIANG Jun, JI Qinghai, WANG Yu
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 69-74.   DOI: 10.6040/j.issn.1673-3770.1.2020.042
    Abstract165)      PDF(pc) (983KB)(22)       Save
    Objective Despite the high incidence of lateral neck lymph node metastasis in papillary thyroid carcinoma(PTC), its management has remained controversial. The accuracy of ultrasound and computed tomography(CT)in lateral neck evaluation for PTC is unsatisfactory. An unnecessary neck dissection may lead to increased complications, while undetected lymph node metastasis may facilitate recurrences and necessitate resurgery. We aimed to map the draining lymph nodes in the lateral neck using carbon nanoparticles and explore its potential in neck assessment. Methods We conducted a multicenter, prospective study from August 2016 to April 2019 in PTC patients who had unpalpable lateral lymph nodes that appeared suspicious on ultrasound and/or CT. Carbon nanoparticles were injected peritumorally into the thyroid gland, and modified lateral neck dissection(compartment Ⅱ-Ⅴ)was performed. The lateral lymph nodes were classified into dyed and undyed and sent for pathological analysis. Thyroidectomy and central neck compartment dissection were performed. Results A total of 125 neck dissections were performed in 122 patients. Of the dissections, 117 were for lateral neck metastases, 7 were for central metastases, and metastasis was absent in the remaining 1. A total of 4302 lateral lymph nodes were removed, 952 of them were dyed. The median number of dyed nodes was 6 per case(range: 1-33). The distribution of dyed nodes in the neck compartments was Ⅳ> Ⅲ> Ⅱ> Ⅴ, independent of tumor size, location, or extra-thyroidal extension. The percentages of dyed lymph node metastasis in Ⅱ-Ⅴ compartments were 33.3%, 60.0%, 68.8%, and 40.0%, respectively, on a per-case basis and 10.2%, 31.4%, 27.5%, and 20.8%, respectively, on a per-node basis. Compared to undyed nodes, the risk of metastasis in dyed nodes was significantly higher in all neck compartments(compartment Ⅱ: 19.9% vs. 5.6%, P<0.001; compartment Ⅲ 35.0% vs. 18.3%, P<0.001; compartment Ⅳ: 37.1% vs. 15.2%, P<0.001; compartment Ⅴ: 14.8% vs 3.7%, P<0.05). A lateral sentinel lymph node biopsy was performed in 51 patients. The sensitivity of the lateral neck sentinel lymph node biopsy was 89.5%, the false-negative rate was 26.7%, and the overall accuracy rate was 91.8%. Conclusion Using carbon nanoparticles, we successively mapped the lateral neck lymph nodes. We found that dyed nodes had a significantly higher risk of metastasis than that of undyed nodes. This method may be useful for lateral neck sentinel lymph node biopsies in PTC.
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    Early clinical observations of intraoperative corneal stromal pocket irrigation with dexamethasone in small incision lenticule extraction
    Gang LIANG,Rong MA,Fengju ZHANG
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (2): 22-31.   DOI: 10.6040/j.issn.1673-3770.1.2020.005
    Abstract162)   HTML4)    PDF(pc) (27671KB)(32)       Save
    Objective

    This study aimed to evaluate the postoperative vision recovery and corneal morphological changes after corneal stroma pocket irrigation with dexamethasone during Small Incision Lenticule Extraction (SMILE).

    Methods

    This was a prospective case-control study, which included 48 eyes from 24 patients who underwent SMILE. One eye from each case was randomly selected to have corneal pocket irrigation with dexamethasone (experimental group, EG), while the other eye did not undergo irrigation (control group, CG). The morphological changes of the cornea were observed using in vivo confocal microscopy and anterior segment optical coherence tomography (OCT), 1 day and 7 days after surgery. The uncorrected visual acuity (UCVA), spherical equivalent (SE), corneal center thickness (CCT), and non-contact tension (NCT) values between the groups were compared 1 day, 7 days, and 1 month after surgery.

    Results

    No significant differences were observed in the UCVA (EG: 4.99±0.07, 5.06±0.08, 5.05±0.06; CG:5.01±0.07, 5.05±0.08, 5.06±0.09, P>0.05) and SE between the two groups (EG: 0.03±0.49, 0.1±0.37, 0.02±0.4; CG: 0.09±0.54, 0.19±0.48, 0±0.52) the same day as the procedure, and 1 day, 7 days, and 1 month after surgery, p>0.05. The two groups were compared at the same time, 1 day and 7 days before and after SMILE using confocal microscopy and anterior segment OCT. The cell shape, density, cell size and arrangement of the corneal epithelium[pre-operation(4 578.73±268.40, 4 539.57±329.25)cell/mm2, post-1d (4 565.21±247.31, 4 627.23±271.03)cell/mm2, post-7d(4 640.01±246.79, 4 517.71±281.43)cell/mm2] and endothelium [pre-(2541.50±259.59, 2 443.52±305.58)cell/mm2, post-1d(2 387.01±248.55, 2 495.27±238.52) cell/mm2, post-7d (2 484.49±223.71, 2 482.53±323.82)cell/mm2] were not significantly different (P>0.05). There were no significant differences observed in the corneal sub-epithelial nerve fibers. The degree of active corneal stromal cells near the cutting interface was similar between the groups, without any significant differences. Regarding the density of the corneal superficial-stromal cells [pre-(789.51±67.17, 802.03±6 794)cell/mm2, post-1d(889.37±60.62, 912.27±95.87)cell/mm2, post-7d (96.67±75.03, 818.39±59.65)cell/mm2], both groups revealed no significant difference pre- or post-operation. However, a significant difference (P < 0.05)was observed after SMILE in both groups between the day immediately before and after the procedure. Both groups revealed no significant differences regarding the density of the deep stromal cells. Comparisons of the preoperative and postoperative anterior segment OCT show no obvious inter-lamellar space and effusion in the corneal stromal pocket in the two groups. There was no significant difference in the CCT between the groups (P>0.05).

    Conclusion

    Irrigation with dexamethasone in the corneal stromal pocket during SMILE did not have a significant effect on postoperative UCVA, SE, and corneal morphological changes after surgery.

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    Analysis of choroidal thickness in patients with ocular ischemic syndromeFU Qiang, WANG Hongxing Department of Ophthalmology, Beijing Chuiyangliu Hospital, Beijing 100022, ChinaAbstract: Objective〓
    Spectral-domain optical coherence tomography(SD-OCT)was used to measure and observe the characteristics of the subfoveal choroidal thickness(SFCT)in patients with ocular ischemic syndrome(OIS)as well as explore the indicators for early evaluation of OIS. MethodsThis was a retrospective case-control study. Forty-eight patients(48 eyes)were included between January 2017 and January 2020. The patients were divided into two groups: the OIS and the control groups, with each consisting of 24 patients(24 eyes). Their basic information, including age, gender, body mass index(BMI), and the history of diabetes, hypertension, and hyperlipidemia, was collected. SFCT was measured using SD-OCT in EDI mode. The basic data and SFCTs of the two groups were compared. ResultsThere were no significant differences between the ages, gender, BMIs, and the prevalence of diabetes, hypertension, and hyperlipidemia of the two groups(all P>0.05). The mean SFCT of the OIS group was 204.83±27.34 μm, and that of the control group was 226.58±33.49 μm. The differences between the two groups were statistically significant(t=2.464, P=0.018). ConclusionsSFCT was thinner in patients with OIS. SFCT can be used as an indicator for early assessment of OIS.
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (4): 60-63.   DOI: 10.6040/j.issn.1673-3770.1.2020.056
    Abstract127)      PDF(pc) (2389KB)(17)       Save
    Objective Spectral-domain optical coherence tomography(SD-OCT)was used to measure and observe the characteristics of the subfoveal choroidal thickness(SFCT)in patients with ocular ischemic syndrome(OIS)as well as explore the indicators for early evaluation of OIS. Methods This was a retrospective case-control study. Forty-eight patients(48 eyes)were included between January 2017 and January 2020. The patients were divided into two groups: the OIS and the control groups, with each consisting of 24 patients(24 eyes). Their basic information, including age, gender, body mass index(BMI), and the history of diabetes, hypertension, and hyperlipidemia, was collected. SFCT was measured using SD-OCT in EDI mode. The basic data and SFCTs of the two groups were compared. Results There were no significant differences between the ages, gender, BMIs, and the prevalence of diabetes, hypertension, and hyperlipidemia of the two groups(all P>0.05). The mean SFCT of the OIS group was 204.83±27.34 μm, and that of the control group was 226.58±33.49 μm. The differences between the two groups were statistically significant(t=2.464, P=0.018). Conclusions SFCT was thinner in patients with OIS. SFCT can be used as an indicator for early assessment of OIS.
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    2- aminoethoxydiphenyl borate inhibits inflammatory reactions of neutrophilic nasal polyps in vitroDAI Fei, WEI Jinjin, TANG Xinyue, CHEN Zheng, LIN Lin Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital North of Fudan University, Shanghai 201907, ChinaAbstract:Objective〓
    Nasal polyps(NP)are frequently divided into subtypes, including eosinophilic and neutrophilic, among others, according to their endotypes. However, the mechanisms of neutrophilic NP need to be further elucidated. This study explores the influence of 2-aminoethoxydiphenyl borate(2-APB)on inflammatory reactions of neutrophilic NP in vitro. MethodsWe used immunofluorescence and immunohistochemical staining to detect the infiltration of neutrophils(NEU)in normal nasal mucosa and NP tissues. These tissues were subsequently cultured in vitro using an organ culture technique, and concentrations of Orai1 and myeloperoxidase(MPO)were determined using enzyme-linked immunosorbent assay(ELISA). 2-APB was administered to both cultures, and the measurement of Orai1 and MPO concentrations using ELISA was repeated. ResultsAll samples were identified as neutrophilic NP. The number of NEU was higher in NP than in normal nasal mucosa. Concentrations of Orai1 and MPO were also higher in NP cultured in vitro than in normal tissue. After the administration of 2-APB, Orai1 protein and the mediator MPO were reduced significantly in the cultures. Conclusion2-APB may inhibit inflammatory reactions of neutrophilic NP in vitro.
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (4): 97-100.   DOI: 10.6040/j.issn.1673-3770.0.2019.413
    Abstract125)      PDF(pc) (1512KB)(7)       Save
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