Table of Content

24 May 2023 Volume 37 Issue 3

  

论著

Effects of a neuron specific AAV2 viral vector on the imaging efficiency of primary cultured spiral ganglion neurons in vitro

LIU Yaoqian, ZHANG Zhen, ZHANG Boya, CHEN Zhengnong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  1-6.  doi:10.6040/j.issn.1673-3770.0.2022.129

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Objective To explore the effects of AAV2/Anc80L65-hSyn-eGFP virus containing a neuron-specific human synapsin promoter(hSyn)and enhanced green fluorescent protein(eGFP)on the imaging of spiral ganglion neuron(SGN)morphologies in vitro. Methods Dissociated SGNs were transfected with AAV2/Anc80L65-hSyn-eGFP in vitro. Using fluorescence microscopy, the transfection specificity and efficiency of the virus were evaluated by calculating the proportion of fluorescent neurons as observed under low magnification. Elaborate morphologies of single neuron were then observed under high magnification. The imaging application of AAV2/Anc80L65-hSyn-eGFP on living SGNs was further verified by patch clamp studies. Results The AAV2/Anc80L65-hSyn-eGFP virus had both high transfection specificity and efficiency for SGNs in vitro, and did not produce obvious cytotoxicity. Importantly, the virus could reveal the morphology of somas and neurites both rapidly and clearly without causing damage to their structures. Compared with neuron-specific Tuj1 fluorescent staining, AAV2/Anc80L65-hSyn-eGFP was able to mark delicate neurite structures such as filopodia. When utilized for the identification and localization of SGNs in patch clamp studies, AAV2/Anc80L65-hSyn-eGFP significantly promoted the efficiency and accuracy of the experiments. Conclusion AAV2/Anc80L65-hSyn-eGFP is a competent and ideal tool for highlighting the morphology of living SGNs in vitro.

Clinical effect of new neck brace receiver in external auditory canal irrigation

ZHANG Huaxiu, LIU Qin, LUO Wugen, YANG Jian, CHEN Lingyun

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  7-10.  doi:10.6040/j.issn.1673-3770.0.2022.165

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Objective To design and manufacture a neck brace water receiver and discuss its effect on external auditory canal irrigation. Methods A total of 201 outpatients with cerumen embolism and external auditory canal infection needing external auditory canal irrigation were randomly divided into an observation group(101 cases)and a control group(100 cases). In the observation group, the external auditory canal was irrigated with a new neck brace. However, the external auditory canal was irrigated with a metal bent plate in the control group. Results The flushing time(P<0.001), patient comfort(P<0.001), compliance degree(P=0.013), satisfaction(P=0.017). in the observation group were all higher than in the control group. The difference in water leakage was not statistically significant between both groups(P=0.78). Conclusion The new neck support water receiver for external auditory canal flushing water can improve work efficiency, increase patient comfort and satisfaction, and increase patient compliance; it is especially suitable for children and worthy of clinical promotion.

Data mining on the pattern of medication in the management of vertigo by famous veteran Chinese medicine practitioners in modern times

ZHOU Yixing, LI Dan, CHEN Tengyu, ZHOU Min, HUANG Jiaqian, WANG Sen, LUO Shiwei, HE Weiping

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  11-20.  doi:10.6040/j.issn.1673-3770.0.2022.262

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Objective To provide a reference for the clinical treatment of dizziness in Chinese herbal medicine by analyzing the prescriptions of modern famous veteran Chinese medicine practitioners for vertigo and compatibility rules. Methods The researchers in this study collected and sorted medical records on vertigo in seven books in accordance with the inclusion and exclusion criteria. After recording the frequency, four properties, five kinds of flavors, meridian entry and action classification of drugs, the researchers used the Origin 2022 software to draw radar charts of Chinese herbal medicine actions and medicinal properties. IBM SPSS Modeler 18.0 and Cytoscape 3.9.1 were used to display the core herbal medicine network, and the R 4.2.0 software was used to analyze and visualize the correlation and association rules. Additionally, SPSS Statistics 26.0 was used for cluster analysis of high-frequency drugs. Results A total of 178 medical records, 297 prescriptions and 289 Chinese herbal medicine data were collected for the management of vertigo. The total frequency was 3 684. Among them, the Chinese herbs were mainly tonics, liver-soothing drugs, heat-clearing drugs, exterior-relieving drugs and blood-activating and stasis-resolving drugs. The four properties of the herbs were mainly cold and warm, the distribution of the five kinds of flavor included mostly sweet, bitter and acrid the main meridians were the liver, spleen and lung. Thirty-seven herbs were used ≥ 30 times. The top forty drug pairs with high correlation coefficients were mostly tonics, blood-activating and stasis-resolving drugs and liver-soothing drugs. The most used two-drug pair was “Fossilia Mastodi Ossis and Concha Ostreae” and there were six groups of three-drug combinations. There were four new prescriptions for the management of vertigo. Conclusion The treatment of vertigo by the famous veteran Chinese medicine practitioners was mainly with liver-soothing drugs, qi and blood-nourishing drugs, phlegm-resolving and dampness-eliminating drugs, blood-activating and orifice-dredging drugs, and more, which reflect the basic principles of clinical management of dizziness. The study provides a theoretical basis for the research and development of clinical Chinese patent medicines and new drugs by exploring and analyzing the pattern of medication in the management of vertigo by famous veteran Chinese medicine practitioners, and helps to inherit and carry forward the valuable experience of vertigo treatment from famous veteran Chinese medicine practitioners.

Effects of high fat diet on allergic rhinitis mice and intestinal flora

WANG Weiyi, SHI Lei, ZHANG Zhiyu, ZHANG Guiling, SHI Guanggang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  21-29.  doi:10.6040/j.issn.1673-3770.0.2022.137

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Objective We investigated the effect of high-fat diet(HFD)on the sensitization of allergic rhinitis(AR)mice and change of intestinal flora and its regulatory mechanism. Methods The control(CN), allergic rhinitis model(AR)induced by chicken ovalbumin(OVA), and allergic rhinitis model(HFD-AR)groups exposed to high-fat diet were set up, with seven mice in each group. The times of sneezing and scratching the nose of each mouse were recorded, and the concentration of anti OVA IgE in serum and IL-4 in nasal lavatory were detected by ELISA. The nasal mucosa and lung were sectioned and stained with HE. Additionally, the total DNA of stool samples was extracted to determine the purity and integrity of the genome for 16S rRNA sequencing and data analysis. Results The frequency of nose scratching and sneezing in the AR group was higher than that in the CN group after OVA stimulation. Compared with the AR group, the HFD-AR group exhibited increased nose scratching and sneezing in mice. Compared with the CN group, the level of specific IgE against OVA in serum and the level of IL-4 in the nasal lavage fluid of mice in the HFD-AR and AR groups increased. HFD intervention aggravated eosinophil infiltration in nasal mucosa and inflammatory cell infiltration in lung tissue of AR group mice. The diversity and number of flora in the HFD-AR group were lower than those in the AR group. The intestinal microflora structure of mice in the CN, AR, and HFD-AR groups were isolated, while the sample isolation in the group was small. At the phyla and genus levels, numerous different bacterial populations were observed among the three groups of mice. Conclusion The intervention of high-fat diet aggravates the symptoms and inflammatory infiltration of tissues in OVA-induced AR mice and reduces the diversity and abundance of intestinal flora. The nasal inflammation of mice aggravated by high-fat diet is related to intestinal flora imbalance.

Nasal ameloblastoma: a case report and literature analysis

LI Xiaoying, LI Yan, WU Yungang, ZHANG Hui, MA Linxiang, ZHAO Yufeng, SUN Juxing, ZHANG Jin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  30-34.  doi:10.6040/j.issn.1673-3770.0.2022.150

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Objective To investigate the clinical characteristics and treatment of nasal ameloblastoma for its early detection and diagnosis. Methods The clinical data of one patient with nasal ameloblastoma were retrospectively analyzed and the related literatures were reviewed. Results Ameloblastoma occurred frequently in the oral cavity and jaw but rarely in the nasal cavity and sinus. Patients can present with nasal congestion and bleeding, tenderness in the sinus area, decreased vision, etc., and in severe cases, facial deformity can be caused. Imaging can determine the extent of the lesion and the relationship between adjacent tissues. The main treatment is complete removal of the lesion by surgery, combined with targeted therapy for comprehensive treatment. The postoperative recurrence rate is high, and ameloblastic carcinoma transformation is common. Conclusion Ameloblastoma of the nasal cavity is a rare and benign tumor but its biological behavior is invasive. The clinical manifestations and imaging examinations of patients are not specific and need to be confirmed by pathological biopsy.

Meta-analysis of clinical intradermal acupuncture efficacy for treatment of allergic rhinitis

ZHAI Rui, LI Yuan, YU Jinglong, CHEN Xi, ZHENG Youyou, LIU Zhaolan, WANG Junhong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  35-45.  doi:10.6040/j.issn.1673-3770.0.2022.364

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Objective To systematically evaluate the clinical efficacy and safety of intradermal acupuncture in the treatment of allergic rhinitis using Meta-analysis. Methods PubMed, The Cochrane Library, Web of Science, SinoMed, VIP, CNKI, and Wanfang databases were searched for randomized controlled trials which used intradermal acupuncture to treat allergic rhinitis from database inception to October 1, 2022. Two researchers conducted independent screening, data extraction, bias risk assessment, and meta-analysis of the literature. Results This study included 29 clinical trials and 2342 patients. Compared with the positive control group, the intradermal acupuncture combined therapy group showed improvements in clinical total effective rate ［RR=1.24, 95%CI(1.16, 1.33), P<0.001］, quantitative scores of symptoms and signs ［MD=-0.67, 95%CI(-1.12, -0.22), P=0.003］, visual analogue score of nasal symptoms ［MD=-0.62, 95%CI(-0.97, -0.28), P<0.001］, number of recurrences ［RR=0.58, 95%CI(0.41, 0.82), P=0.002］, nasal resistance ［MD=-0.13, 95%CI(-0.21, -0.05), P=0.001］, and quality of life score for nasal conjunctivitis［MD=-4.17, 95%CI(-6.06, -2.29), P<0.001］. Compared with antihistamines, there was no significant difference in clinical total effective rate［RR=1.01, 95%CI(0.92, 1.11), P=0.78］ and quality of life score for nasal conjunctivitis［MD=0.43, 95%CI(-1.78, 2.65), P=0.70］ after treatment. No serious adverse reactions occurred after intradermal acupuncture treatment. Conclusion Using intradermal acupuncture to treat allergic rhinitis shows good curative effects and safety, and can reduce recurrence rates and nasal resistance, as well as improve quality of life. Due to the limits of our experimental design and issues related to the quantity and quality of original literature, the results of our meta-analysis still need to be further verified. In the future, relevant research should utilize other methodologies and strict experimental designs to provide more powerful, high-quality evidence-based data for the development of clinical diagnosis and treatment guidelines.

The complications of tracheal injury in da Vinci robotic thyroidectomy: four case reports and literature review

YUE Tao, ZHUANG Dayong, ZHOU Peng, LI Xiaolei, XU Jing, ZHU Jian, HE Qingqing

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  46-50.  doi:10.6040/j.issn.1673-3770.0.2022.073

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Objective To investigate the causes, clinical characteristics, diagnosis and treatment of tracheal injury in da Vinci robotic thyroidectomy and improve the understanding of this complication. Methods Four patients with tracheal injury in da Vinci robotic thyroidectomy were retrospectively analyzed, and relevant literature was reviewed. Results The clinical manifestations of tracheal injury in da Vinci robot thyroidectomy lack specificity; cough and subcutaneous emphysema of neck/chest are usually the initial presentation, which may be accompanied by pneumomediastinum or pneumothorax. Respiratory obstruction symptoms such as wheezing and dyspnea may occur in severe cases. Tracheal injury progresses rapidly, and delayed diagnosis or treatment may lead to serious consequences. Enhanced computed tomography and three-dimensional reconstruction of the trachea or bronchoscopy can confirm the diagnosis. Conclusion Tracheal injury in da Vinci robotic thyroidectomy is a rare but life-threatening complication. Subcutaneous emphysema and respiratory changes in patients who underwent da Vinci robotic thyroidectomy should indicate the possibility of tracheal injury.

Effect of nutritional support on postoperative pharyngeal fistula after laryngeal cancer surgery: a Meta-analysis

ZHANG Xi, DENG Qicheng, ZHANG Zhen, CHEN Yao, WANG Jingsong, ZHAO Rui, LIU Hai

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  51-59.  doi:10.6040/j.issn.1673-3770.0.2022.283

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Objective To systematically evaluate the influence of nutritional support on pharyngeal fistula after laryngeal cancer surgery and to provide support for preventing or reducing the onset of pharyngeal fistula after laryngeal cancer surgery. Methods The relevant original studies on nutritional support for pharyngeal fistula that were published in China and abroad from were collected by systematically retrieving Pubmed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP and sinoMed database articles, up to June 2022. The Cochrane bias risk assessment tool was used to carry out the quality assessment on the included literature and Revman 5.4.1 software was used to produce a bias risk assessment diagram for data extraction from the included literature. Revman 5.4.1 software was used to synthesize the effectors of the extracted data and generate a forest plot. According to the Chi² and I2 values of the analysis results, the heterogeneity of the included literature was judged. In view of outcome indicators, GRADEprofiler 3.6 software was used for evidence quality grading, and Stata15.1 software was used for Begg's funnel plot and Egger's test analyses. Results In the forest plot, with OR as the indicator(OR=0.37, 95% CI: 0.27-0.52), the upper and lower limits were located on the left side of baseline 1 and did not intersect with the baseline. In terms of the heterogeneity of the analysis results, P=0.97, I2=0, GRADE: MODERATE. Begg's funnel plot and Egger's test showed that there was little funnel plot symmetry, with potential publication offset(T=-2.85, P=0.019). Thus, the adjustment shall be carried out using the trim and filling method. After adjustment, OR=0.42, 95% CI: 0.30-0.58. Conclusion The forest plot results support that nutritional support can prevent and reduce the onset of pharyngeal fistula after laryngeal cancer surgery. The OR value does not change significantly after being adjusted using the trim and filling method. The heterogeneity analysis shows that the included literature has good homogeneity and is suitable for the synthesis of effectors. Nutritional support can be adopted as an important prevention measure for preventing laryngeal cancer, so as to reduce the onset of pharyngeal fistula after laryngeal cancer surgery.

Atypical foreign body in the paralaryngeal space: a case report and review of literature

SHE Zhiqiang, LIU Jiyuan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  60-63.  doi:10.6040/j.issn.1673-3770.0.2022.069

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Objective To explore the clinical diagnosis and treatment of foreign bodies in the paralaryngeal space, to provide a reference for avoiding misdiagnosis. Methods The clinical data of a patient with a foreign body in the paralaryngeal space were analyzed retrospectively, and the relevant literature on foreign bodies in the larynx was reviewed and summarized. Results Foreign bodies in the paralaryngeal space were identified by electronic nasopharyngoscope combined with CT examination and successfully removed using endoscopy and plasma technology during the operation. The curative effect was satisfactory. Conclusion Laryngeal foreign bodies with atypical clinical symptoms may be easily misdiagnosed. Detailed inquiry of medical history, physical examination, and electronic nasopharyngoscope combined with high-quality CT may help avoid misdiagnosis effectively. Similarly, surgery in the paralaryngeal space assisted by endoscopy and low-temperature plasma technology is a better treatment method.

Acute suppurative tonsillitis caused by Mycoplasma pneumoniae and influenza B virus infection: a case report and literature review

YU Bianbian, CHEN Ying, DENG Kebin, YI Xinlin, LEI Xixi, LI Hui, MA Xin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  64-66.  doi:10.6040/j.issn.1673-3770.0.2022.059

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Objective To investigate the importance of pathogens in the clinical diagnosis and treatment of acute suppurative tonsillitis, in order to treat it accurately. Methods The clinical information of a patient with acute suppurative tonsillitis caused by mycoplasma pneumoniae and influenza B virus infection was retrospecively reviewed, and discussed the diagnosis and treatment process. Results and discussion: Acute suppurative tonsillitis is a common acute infectious disease, and beta-hemolytic streptococci are the main pathogenic bacteria. However, some respiratory viruses, Mycoplasma pneumoniae, and anaerobic bacterial infection can also lead to the occurrence of this disease. It is critical to identify the causative agents of the disease as soon as possible to guide the choice of medication administered. Conclusion The detection of pathogens is not only important for the diagnosis, treatment, and prevention of Acute suppurative tonsillitis, but also can effectively avoid antibiotic abuse, which is particularly important in the current context of the worldwide COVID-19 pandemic.

A case of Madelung's disease with scrotal fat accumulation

PENG Xinran, LI Yongtuan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  67-71.  doi:10.6040/j.issn.1673-3770.0.2022.140

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Objective To investigate the clinical features and the selection of diagnosis and treatment methods for Madelung's disease. Methods Clinical data of a patient with Madelung's disease with scrotal fat accumulation treated surgically in the author's hospital and the related literature were analyzed. Results The patient underwent surgical resection of the adipose tissue and was followed up for half a year. There was no recurrence during the follow-up period. Conclusion Madelung's disease mainly occurs in middle-aged men with a long-term drinking history. It is characterized by the presence of multiple, progressive, excessive lipomas with a symmetrical distribution. During physical examination, the accumulation of abnormal fat mass in other parts may be observed. Timely referral to the corresponding department for intervention is important. To avoid recurrence, surgical resection is currently the preferred treatment. Surgery also aims to improve the patient's appearance and any functional impairment. Complications such as occult penile syndrome, sexual dysfunction, or testicular atrophy should be avoided in patients with scrotal fat accumulation.

Analysis of macular retinal-choroidal thickness changes in patients with internal carotid artery occlusion

ZHAO Lu, TIAN Huiwen, MENG Bo, WANG Wei, WANG Yanling

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  72-76.  doi:10.6040/j.issn.1673-3770.0.2023.015

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Objective This study aimed to discuss the changes in macular retinal thickness and subfoveal choroidal thickness(SFCT)in patients with internal carotid artery occlusion(ICAO). Methods The data of 50 patients(100 eyes)diagnosed with ICAO were retrospectively analyzed. The patients included in the study had complete ICAO in one eye and ≤50% stenosis of the internal carotid artery in the contralateral eye. All eyes were scanned through the central fovea of the macula using spectral domain optical coherence tomography. The central macular thickness(CMT), average inner and outer retinal thickness within 1 mm from the fovea, and SFCT were then measured. Results The affected and contralateral eyes had a CMT of(244.56±18.25)μm and(248.02±23.12)μm, respectively, and this difference was not statistically significant(t=-1.673, P=0.101). The inner retinal thickness was(63.76±10.16)μm and(64.92±10.89)μm and the outer retinal thickness was(180.80±17.31)μm and(184.22±22.01)μm, for the affected and contralateral eyes, respectively. The differences between the two eyes in these aspects were also not statistically significant(t=-1.569,P=0.123;t=-1.839,P=0.072). In contrast, the SFCT of the affected eye was thinner at(240.36±27.03)μm compared to that of the contralateral eye at(248.06±30.33)μm, and this difference was statistically significant(t=-2.496,P=0.016). Conclusion The CMT and inner and outer retinal thickness were not significantly changed, whereas SFCT was significantly decreased in eyes with ICAO. These findings suggested that changes in choroidal morphology precede those in retinal morphology.

Optimization of the effect of pulsed light in the treatment of Demodex-associated squamous blepharitis and its effect on ocular surface function and corneal cell density

AN Lin, WEI Qiuhong, ZENG Yue, GAO Weina, CHEN Chen, ZHANG Rong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  77-82.  doi:10.6040/j.issn.1673-3770.0.2022.145

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Objective To explore the efficacy of adjuvant therapy with optimized pulsed light for Demodex-associated scaly blepharitis and its effect on ocular surface status. Methods A cohort of 60 cases(120 eyes)of Demodex-related squamous blepharitis were selected as the research objects. Patients/eyes were divided into the observation and control groups according to the random number table method in a ratio of 1∶1, with 30 cases(60 eyes)in each group. The control group was treated with tobramycin dexamethasone ointment and tea tree oil ointment, and the observation group was treated with optimized pulsed light adjuvant therapy on the basis of the control group. We subsequently compared the treatment efficacy, symptom scores before and after treatment, sign scores, demodex count, ocular surface function ［tear film rupture time(TBUT), conjunctival hyperemia, corneal fluorescence staining(FL), tear river height(TMH)］, and safety between the two groups. Results The total effective rate of the observation group(91.67%)was higher than that of the control group(78.33%)(P=0.041); the observation group's symptom score, physical sign score, and demodex count after treatment were lower than those of the control group(all P<0.001); the observation group had a lower TBUT than the control group after treatment high, conjunctival hyperemia, FL, TMH lower than the control group(P=0.012,P<0.001,P<0.001,P<0.001). There was no significant difference in the occurrence of complications between the two groups. Conclusion Optimized pulsed light assisted treatment is an effective treatment modality for Demodex-related squamous blepharitis, which can effectively promote the improvement of symptoms, reduce the number of Demodex, improve ocular surface function, and relieve corneal damage with high safety.

Association of macular retinoschisis severity with choroidal parameters in patients with high myopia

YOU Ran, GUO Xiaoxiao, WANG Wei, CHEN Xi, WANG Yanling

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  83-87.  doi:10.6040/j.issn.1673-3770.0.2022.528

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Objective This study aimed to evaluate the characteristics and clinical significance of macular choroidal parameters according to the different severity classifications of retinoschisis in patients with high myopia. Methods This cross-sectional study included 74 patients(74 eyes)diagnosed with high myopia of grades T0~T3, according to the atrophy-traction-neovascularization(ATN)classification, from January 2019 to March 2022 at the Ophthalmology Department of the Beijing Friendship Hospital, which is affiliated with the Capital Medical University. Of these patients, there were 20 male(20 eyes)and 54 female(54 eyes)patients with a mean age of(64.3±11.2)years and axial length(AL)of 29.2±2.78 mm. All patients underwent enhanced depth imaging optical coherence tomography. They were then classified as having T0, T1, T2, or T3 grades(n=20, 23, 18, and 13 eyes, respectively)according to the severity of their lesions based on the ATN classification. The choroidal thickness of multiple parts of the fovea was measured, and the macular choroidal volume(MCV)was calculated using the MATLAB software. Correlation analysis of the different parameters was performed. Differences between the groups were compared using univariate and multivariate analyses. Results The mean MCV of the patients in the T0, T1, T2, and T3 groups was(4.6±2.3)mm³,(3.1±1.2)mm³,(2.9±1.3)mm³, and(2.1±1.1)mm³, respectively, and the differences between these groups were statistically significant(P=0.006). The best corrected visual acuity of patients in the T1-T3 groups was significantly lower than that of patients in the T0 group. The AL and absolute value of the spherical equivalent were significantly higher(P<0.05), while the subfoveal choroidal thickness(SFCT)was significantly lower(P<0.05)than those in the T0 group. Differences in the value of the spherical equivalent between the T1 and T3 groups and between the T2 and T3 groups and in SFCT and MCV between the T1 and T2 groups and between the T1 and T3 groups were AL- and age-dependent. Meanwhile, differences in SFCT and MCV between the T2 and T3 groups were independent of AL and age. Conclusion The study revealed a gradual decrease in MCV associated with the increasing severity of retinoschisis in patients with high myopia. The change in MCV was affected by AL, age, and other factors.

Boucher-Neuhäuser syndrome: a case of two siblings with two PNPLA6 mutations and literature review

WEI Hui, ZHANG Mingxi, SUN Yue, XIE Ruxin, CHENG Qiong, LI Linna, XIANG Qianqian, WU Lan, CHEN Zhongshan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  88-92.  doi:10.6040/j.issn.1673-3770.0.2022.153

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Objective To explore and analyze the clinical features and diagnostic method of patients with Boucher-Neuhäuser syndrome caused by PNPLA6 gene mutation, and to reveal and make clear the importance of genetic testing method in the diagnosis of the genetic disease. Methods Two cases of Boucher-Neuhauser syndrome caused by PNPLA6 gene mutation were retrospectively analyzed. The structure and function of PNPLA6 gene as well as the clinical characteristics of other diseases caused by the mutation were analyzed and discussed. Results The proband and her brother were short stature since childhood. The fundus oculi was gray and dark with atrophied retina. There were some osteocytic pigmentation can be seen in the fundus oculi and the blood vessels' shape was normal. There were some exudations can be detected around the macula. Whole-exome sequencing results revealed a pair of compound heterozygous mutations in the PNPLA6 gene on the proband's chromosome 19. The first mutation was chr19:7621349, c.2990C>T(p.Ser997Leu,Exon 28). The second mutation was chr19:7623819, c.3367G>A(p.Gly1123Arg,Exon 31). The elder brother at these locus were also heterozygous mutation. Their parents were all carried disease-causing genes at these locus. Conclusion The two children were diagnosed with Boucher-Neuhäuser syndrome based on their medical history, clinical nanifestations and genetic testing results.

Oculocerebrorenal syndrome of lowe with glaucoma: a case report

ZHANG Yi, TANG Li

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  93-97.  doi:10.6040/j.issn.1673-3770.0.2022.044

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Lowe syndrome is a rare X-linked disease. The diagnosis mainly depends on clinical manifestations and gene sequencing. We present a male patient with Lowe syndrome with glaucoma, which was diagnosed after cataract surgery. The patient also underwent surgical treatment for the glaucoma. It is suggested that patients with Lowe syndrome need long-term follow-up. To the best of our knowledge, this frameshift mutation has not yet been reported in domestic literature. Our findings expand the phenotypic and genotypic spectrum of Lowe syndrome.

综述

Development status of robot-assisted surgery for the pharynx and larynx

XIAO Qiyi, FENG Chen, DONG Pin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  98-103.  doi:10.6040/j.issn.1673-3770.0.2022.070

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Surgical robots make use of minimally invasive advantages of endoscopic systems and can transcend the limitations of human operation, perform more detailed operations in a narrow space, and improve postoperative survival and quality of life of patients. It has high potential in the field of pharynx and larynx surgery. This study discusses the current status of the use of an oral surgery robot in pharynx and larynx surgery at home and abroad in recent years. It addresses the advantages of robot-assisted surgery, including lesser damage, clearer image production, and higher accuracy and safety than traditional surgery. It also addresses the disadvantages such as high cost, limitations posed by the narrow space of the pharynx and larynx, lack of tactile feedback, and lack of bone cutting. It proposes that there is still room for progress in the use of robot-assisted surgery systems for the pharynx and larynx. Finally, it also discusses the future development direction of robot-assisted surgery.

Study progress on the mechanism of human papillomavirus-related oropharyngeal squamous cell carcinoma

LI Yanan, LIANG Hui

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  104-110.  doi:10.6040/j.issn.1673-3770.0.2022.172

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This article briefly describes the biological characteristics of human papillomavirus(HPV), the mechanism of persistent infection of human papillomavirus in the oropharyngeal mucosa, and introduces the biological process of viral proteins in the process of causing oropharyngeal squamous cell carcinoma(OPSCC). By reviewing relevant clinical studies, summarizing the relevant literature, we concluded that in HPV-associated OPSCC, the unique anatomy of the oropharynx makes it difficult to clear the HPV infected and maintain a persistent infection state. The persistently infection of HPV affects the occurrence and development of tumors through the expression of viral proteins and interacts with the tumor microenvironment. We propose some mechanism pathway with viral protein in host cells, especially viral proteins E6, E7, which not only promote the occurrence of OPSCC, but also increase the sensitivity of chemotherapy drugs against tumors. we believe that this dual role of viral proteins provides a new direction for us to further understand HPV-related OPSCC and propose better treatment options.

Research progress on the relationship between mitochondrial autophagy and squamous cell carcinoma of the head and neck

SUO Anqi, YANG Xinxin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  111-117.  doi:10.6040/j.issn.1673-3770.0.2022.147

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Head and neck squamous cell carcinoma(HNSCC)is among the six most common cancers worldwide. Many patients in advanced stages of HNSCC die because of tumor recurrence or resistance to chemotherapy drugs. New treatment strategies are needed to improve the prognosis of HNSCC patients. Mitochondrial autophagy is a selective form of macro autophagy which reduces oxidative stress and prevents cancer by regulating related pathway proteins or drugs, or by promoting the survival of tumor cells under some adverse conditions. Mitochondrial autophagy is the key factor to control the quality of cancer cells which is closely related to the occurrence and development of cancer. Mitochondrial dysfunction promotes cell carcinogenesis, and mitochondrial autophagy dysfunction can induce apoptosis of cancer cells. The discovery and development of new drugs has created new options in targeting mitochondria to treat tumors. Mitochondrial autophagy shows great potential for the prevention and treatment of tumors. This article reviews the regulatory mechanism of mitochondrial autophagy, relationship between mitochondrial autophagy and tumor, and prevention and treatment of HNSCC and clinical drug resistance. The aim of this study is to provide new research directions and targets for the treatment of HNSCC.

Research progress on the pathogenesis and treatments of central serous chorioretinopathy

LI Lu, ZHAO Jie, ZHAO Bojun

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  118-124.  doi:10.6040/j.issn.1673-3770.0.2022.032

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Central serous chorioretinopathy(CSC), one of the most common causes of visual impairment among fundus oculi diseases, typically presents with central vision loss and micropsia. Having a type A personality, administration of exogenous glucocorticoids, and endogenous hypercortisolism have been recognized as risk factors for CSC. Fundus fluorescein angiography and indocyanine green angiography have shown that CSC may be secondary to choroidal vascular hyperpermeability and retinal pigment epithelial dysfunction. However, its exact pathophysiology and management remain unknown. Photodynamic and laser photocoagulation have been used as managements for patients with CSC. This article provides an overview of CSC's risk factors, pathogenesis, pathophysiology and treatments.

Diagnosis and treatment of exudative age-related macular degeneration combined with retinal pigment epithelial detachment

XU Enpei, SUN Xianyong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  125-142.  doi:10.6040/j.issn.1673-3770.0.2022.052

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Retinal pigment epithelial detachment(PED)is the separation of the collagen layer in the retinal pigment epithelial(RPE)layer of the base film from the glass membrane(Bruch's membrane), which can be divided into many forms depending on the properties of the fluid substrate of the RPE layer. Among these forms, serous pigment epithelium detachment(sPED)is most commonly used for slurry-liquid retinal pigment epithelial disengagement. Exudative age-related macular degeneration(eAMD)is the most common form of disease in PED. Clinically, the specific pathogenesis of PED is still unclear. The current clinical and widely recognized PED pathogenesis is that the Bruch's membrane and vein membrane permeation coefficient decreases, resulting the reduction of fluid exchange in the RPE layer and vein membrane. This can lead to liquid accumulation under the RPE layer, thus resulting in the separation of the RPE layer. At present, the treatment of PED in clinical practice mainly includes under-eye retina laser photocoagulation, anti-neovascular drug vitreous body injection therapy, and photodynamic therapy. Based on the latest progress of research locally and internationally, this paper summarizes the epidemiology, pathogenesis, diagnosis, and treatment of eAMD with PED, and discusses and prospects of its treatment methods.

Mechanism and clinical applications of subthreshold diode micropulse laser

TANG Huixin, LI Jingjing, ZOU Hong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  143-148.  doi:10.6040/j.issn.1673-3770.0.2022.254

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The subthreshold diode micropulse laser(SDML)is a multiple repeated energy micropulse emitted by multiple thresholds within a short time. Currently, it can be used in retinal diseases, such as diabetic retinopathy, central serous chorioretinopathy, and retinal vein occlusion macular edema. The SDML can preserve the visual contrast sensitivity better than the traditional laser, reducing the risks of subretinal fibrosis and scar formation. The current research shows that it can selectively act on the retinal pigment epithelial, improve the function of Müller cells, inactivate microglia, reduce the expression of inflammatory factors such as the vascular endothelial growth factor, and up-regulate the expression of protective factors such as the pigment epithelium-derived factor to inhibit the formation of neovascularization and reduce macular edema to protect retinal function and preserve patients' vision. However, problems still exist in its clinical applications, such as the nonstandardization of the energy, time, density, and other parameters of SDML treatment and the unclear molecular mechanism. Therefore, further clinical trials and basic experimental studies are required. The purpose of this study is to review the molecular mechanism and current clinical applications of SDML to provide a reference for the clinical applications of SDML

Progress in the diagnosis and treatment of retinopathy of prematurity using artificial intelligence

DU Yueshanyi, WANG Xian, ZHANG Guoming

Journal of Otolaryngology and Ophthalmology of Shandong University. 2023, 37(3):  157-162.  doi:10.6040/j.issn.1673-3770.0.2022.374

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Retinopathy of prematurity(ROP)is one of the main causes of blindness in children, while early screening and diagnosis of ROP are highly dependent on ophthalmologists. With the rapid development of modern medical imaging technology and the rise of telemedicine, artificial intelligence(AI)has also been further applied in the field of ROP. In recent years, AI based on neural convolutional network and deep learning has been applied in the field of eye screening, disease detection, diagnosis and treatment, especially for the clinical diagnosis and treatment of ROP. It is expected that AI will aid primary pediatricians and ophthalmologists in early diagnosis and standardized treatment of ROP, and reduce the subjective differences among first-line doctors. This review summarizes the current status, shortcomings, and challenges faced by AI in automated ROP screening, diagnosis, and prediction, which enables the further understanding of new trends and progressment made by its clinical application in ROP.