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    16 February 2011 Volume 25 Issue 1
      
    Articles
    The relationship between tumor-associated macrophage infiltration and  lymphangiogenes in supraglottic laryngeal carcinoma
    LIN Jia-ying1, LI Xiao-yan2, DONG Pin1, Tadashi Nakashima3
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(1):  4-8. 
    Abstract ( 1225 )   PDF (1690KB) ( 1016 )   Save
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    Objective    To study the correlation between intratumoral and peritumoral tumor associated macrophage(TAM)  infiltration and lymphatic microvessel density (LMVD) in supraglottic laryngeal carcinoma.Methods    Immunohistochemistry was used to detect CD68 and podoplanin's expression in intratumoral and peritumoral areas of 84 specimens of supraglottic laryngeal carcinoma and  the associations between LMVD、TAM count and clinicopathological features, and survival rate of supraglottic laryngeal carcinoma were analyzed.Results    TAM  infiltration showed a significant positive connection with lymphangiogenesis in the intratumoral (r=0.253, P=0.02) and peritumoral areas(r=0.270, P=0.013).Patients with  high intratumoral TAM count showed a higher T staging and demonstrated a poorer outcome. The peritumoral TAM count of patients with lymph node metastasis were significantly higher than that of patients without lymph node metastasis.  Patients with high intratumoral or peritumoral LMVD suffering from remote metastasis  were more numerous than those with low intratumoral or peritumoral LMVD.Patients with high peritumoral LMVD had a poorer outcome, the difference was significant(P<0.05). Kaplan-Meier survival analysis showed the 5-yearsurvival rate of high intratumoral  TAM and LMVD (47.6%)was significantly lower than the contrary(86.4%). Also, the 5-year survival rate of high peritumoral TAM and LMVD  (50.7%)was significantly lower than  the low group(81.0%,P<0.05). Conclusions    TAM and lymphangiogenesis are associated with metastases and poor prognosis of supraglottic laryngeal carcinoma.

    Expression and clinicopathological significance of Notch-1,NF-kB and  β-catenin in oral squamous cell carcinoma
    LI Xue-zhen1, JIN Xiao-ming1, LIU Min-sheng2
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(1):  9-13. 
    Abstract ( 1437 )   PDF (939KB) ( 1134 )   Save
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    Objective    To investigate expressions of Notch-1,NF-kB and β-catenin in oral squamous cell carcinoma, and explore their  associations with the clinicopathological features. Methods    Expressions of Notch-1,NF-kB and β-catenin were analyzed in 58 oral squamous cell carcinoma samples and 30 normal tissues adjacent to the carcinomas by immunohistochemistry. Results    a) Notch-1 and NF-kB protein were up-regulated in most oral squamous cell carcinoma samples but not in normal tissues. The difference of weighted scores between these two groups was significant (P<0.01). Although there were no correlations between the expressions of Notch1,NFkB protein and some tumor parameters, such as age, gender, tumor site and histological grade,  expressions of Notch-1,NF-kB protein were significantly associated with clinical staging (P<0.01) and lymph node metastasis (P<0.05). b) Higher abnormalβ-catenin expression was noted in most oral squamous cell carcinoma samples than in normal tissues. The difference of weighted scores between these two group was also significant (P<0.01). There were no correlations between expressions of abnormalβcatenin expression and some tumor parameters, such as age, gender, tumor site and histological grade, while expression of abnormalβ-catenin was significantly associated with clinical staging (P<0.01) and lymph node metastasis (P<0.05). c) In oral squamous carcinoma tissues, there were correlation between expression of Notch-1 and NF-kB, and there were also correlation between expression of Notch-1 and ectopic expression of β-catenin (P<0.05). But there was no correlation between expression of NF-kB and ectopic expression of β-catenin (P>0.05). Conclusions    Over-expression of Notch-1, NF-kB or ectopic expression of β-catenin expression are common in oral squamous cell carcinoma. Expression of Notch-1 and NF-kB or ectopic expression of β-catenin expression are significantly correlated with tumor staging and lymph node metastasis. Expression of Notch-1 were correlatied with expression of  NF-kB and ectopic expression of β-catenin, but there was no correlation between expression of NF-kB and ectopic expression of β-catenin.

    Clinical analysis of parotid pleomorphic adenoma in 187 cases
    HONG Yu-ming1, GAN Wei-gang2, LIANG Zhen-yuan1, WU Wen-yuan1
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(1):  14-16. 
    Abstract ( 1275 )   PDF (360KB) ( 1419 )   Save
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    Objective    To explore the clinical diagnosis and surgical method for parotid pleomorphic adenoma, as well as the prevention and therapy of postoperative recurrence and complications. Methods    Clinical data of 187 parotid pleomorphic adenoma cases were collected and analyzed, including 86 cases of partial parotidectomy (extra capsular resection of tumor), 72 case of subtotal parotidectomy with facial nerve preservation,  and 29 cases of total parotidectomy with facial nerve preservation. Results    After operation, 12 patients relapsed. No relapse occurred after the  second operation. There were 20 transient facial nerve paralysis, 6 buccal branch′s facial paralysis, 10 marginal mandible branch′s facial paralysis, and  4 intermix facial paralysis. Treated with hormones, neurotrophy, and traditional Chinese physical medications, permanent facial nerve paralysis only remained in 2 cases, which lasted more than 6 months without complete recovery. In addition, parotid fistula appeared in 15 cases, and Frey′s syndromes were found in 36 cases. Conclusions    The final diagnosis of parotid pleomorphic adenoma must rely on pathological examination. The best strategy is extracapsular resection combined with frozen pathology during the operation. The surgical method to remove the parotid pleomorphic adenoma should be chosen according to the size and position of  the tumor, and the relationship between the tumor and  facial nerve. The key point of surgery is anatomy of facial nerve, which can reduce the  postoperative recurrence and complications.

    Expression of macrophage migration inhibitory factor  in human carcinomas of the hypopharynx
    ZENG Zhi-mei1, LIANG Yong-hui2, YANG Yi-fang2, DOU Xiao-qing2,LUO Bi-qiang2, ZHANG Li-wei2, CHEN Xian-ming2
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(1):  17-19. 
    Abstract ( 1072 )   PDF (877KB) ( 1267 )   Save
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    Objective    To study expression of macrophage migration inhibitory factor (MIF) in hypopharynx carcinoma,and to explore the relationship between MIF and invasion and metastasis of hypopharynx carcinoma. Methods    Expression of MIF was detected in 22 hypopharynx carcinomas and 10 benign lessions(vocal polyp) by immumohistochemistry. The tumor tissues 、lymph node metastasis  and adjacent normal tissue  were tested. Results     Expression of MIF in the tumors and metastases was higher than the adjacent normal tissue and benign lession(P<0.05).Expression rates of MIF in tumors with lymph node metastasis was significantly higher than those without (P<0.05).The difference of MIF expressions between stages I、Ⅱ and llI、IV  was significant(40.00% vs 94.12%)(P<0.05). Conclusion    MIF may play an important role in invasion and metastasis of hypopharynx carcinoma.The later stage of disease, the higher expression of MIF is shown in primary tumors and metastasis.

    Potential mechanism of Platelet derived growth factor-BB to  promote the proliferation and invasion of Hep2 cells
    GAO Shang, DONG Pin, LI Da-Wei, SHEN Bin
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(1):  20-23. 
    Abstract ( 1262 )   PDF (685KB) ( 814 )   Save
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    Objective     To investigate dynamic changes of focal adhesion kinase(FAK), phosphorylated focal adhesion kinase-397(FAKpY397), matrix metalloproteinase-2(MMP2),  and  matrix metalloproteinase-9(MMP9) in Hep2 cells stimulated by different concentrations of PDGF-BB, and to explore the relations of those factors with cell proliferation and invasion. Methods    Stimulated by different concentrations of PDGF-BB, the dynamic changes of FAK and FAKpY397, MMP2, and MMP9 in Hep2 cells were determined by Western blot. and the changes in cell proliferation and invasive ability were determined by MTT and cell invasion assay, respectively.Results    Proliferation ability and number of invasive cells increased and reached their peaks in the 20ng/mL group(0.488±0.133, 22.75±1.42, respectively) ,  which were markedly different from the control group(P<0.05). FAK, FAKpY397, MMP2 and MMP9 expression in Hep2 cells were upregulated after the stimulation, and reached theirs peak at a PDGF-BB concentration of 20ng/mL . Conclusion    PDGF-BB can up-regulate expressions of FAK, FAKpY397, MMP9 and MMP2 in Hep2 cells, which can further facilitate invasion and proliferation of  Hep2 cells.

    Relationship between intratumoral lymphangiogenesis in hypopharyngeal  neoplasms and lymphatic metastasis
    YE Ting1, MA Chao2, PAN Xin-liang1
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(1):  24. 
    Abstract ( 1534 )   PDF (571KB) ( 970 )   Save
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    Objective    To investigate the role of D2-40 in lymphangiogenesis in hypopharyngeal neoplasms and its clinical pathological significance. Methods    47 specimens of hypopharyngeal neoplasms were analyzed by immunohistochemiatry with the specific lymphatic endothelial marker D2-40. Lymphatic vessel density (LVD) was counted in the intratumoral and normal tissues, and its relationship with clinical pathological parameters was analyzed. Results    Lymphangiogenesis was observed in the intratumoral tissue, and higher LVD was correlated with lymphatic metastasis(P<0.05). There was no significant association between LVD and age, gender, T stages and histological differentiation(P>0.05). Conclusions    New lymphatic vessels exist in hypophyaryngeal neoplasms. There is a correlation between high LVD and lymphatic metastasis, and tumor metastasis may take place by intratumoral lymphatics.

    Clinical application of VEMP combined with PTA in LVAS′ patients
    LI Ping, ZHANG Rong, CHEN Xi, LIN Shao-lian
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(1):  37-40. 
    Abstract ( 1708 )   PDF (1159KB) ( 1339 )   Save
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    Objective    Recording and analyzing vestibular evoked myogenic potentials (VEMP) and pure tone audiometry(PTA) in large vestibular aqueduct syndrome(LVAS), may reveal the function of the saccule and vestibular nerve, describe the characteristics of PTA, and investigate its clinical application and significance in LVAS.  Methods    The results of the examination and clinical symptoms of 22 cases of LVAS (42 affected ears) who were all underwent high resolution CT scan of inner ear, PTA and VEMP were summarized and analyzed. Results    25 of 42(59.5%) affected ears which were excited by VEMP with bilateral short sound stimulation showed a high amplitude and/or low threshold. 30 of 42(71.4%) affected ears excited by PTA showed mixed hearing loss with the feature of significant air-bone gap in low and intermediate frequency (below 2KHz). In the low-threshold group of VEMP, the mean value of the vestibular aqueduct was (4.30±0.53) mm, and the pure tone average of the air-bone gap in low frequency was (36±17) dB HL. 19 ears were easily influenced by external factors or fluctuations of internal cranial pressure caused by fever. In the non-low threshold group of VEMP, the mean value of vestibular aqueduct was (2.80±0.67) mm, and the pure tone average of the air-bone gap in low frequency was (32±15) dB HL. 4 ears were easily influenced by external factors or the fluctuations of internal cranial pressure caused by fever.  Conclusions    The average value of vestibular aqueduct diameter is larger in patients with a lower VEMP threshold whose subjective hearing are affected by the external factors orthe fluctuations of internal cranial pressure caused by fever. But there is no correlation between the degree of the hearing loss with the mean value of vestibular aqueduct, nor with the characteristics of VEMP.

    A survey of hearing loss in college students caused by portable music players  
    XUE Qiu-hong, CHEN Xiao-lin
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(1):  41-43. 
    Abstract ( 1323 )   PDF (590KB) ( 1369 )   Save
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    Objective    To investigate the impact of portable music players on hearing loss in college students. Methods    A total of 312 college students were randomly enrolled in the survey under the same criteria. The students were interviewed regarding their basic information and use of portable music players. Each student underwent a pure tone audiometry test (Siemens-SD50). Correlations between hearing threshold and sex, ear, playing time, and total time were evaluated by multiple linear regression (SPSS 16.0). Results    Among all the  students, the hearing loss of the right ear was more significant than the left. In the students using portable music players, the bilateral hearing loss was higher than those without. Significant elevations of hearing threshold were observed in students who used portable music players over 3 years. Conclusions    Long-term use of portable music players can lead to chronic hearing loss, or even noise-induced hearing loss in college students.

    Audiological analysis of aged patients with chronic suppurative otitis media
    LIU Qian-xu1, LIU Jun-hui2, ZHANG Zhi-gang3, ZHAO Xiao-ming1, CHEN Tao3, DOU Xiao-hui1
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(1):  44-46. 
    Abstract ( 1196 )   PDF (318KB) ( 1397 )   Save
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    Objective    To study audiological characteristic of aged patients with chronic suppurative otitis media. Methods    The data of 68 aged patients(>60 years old) with unilateral chronic suppurative otitis media were reviewed. Speech frequencies(0.5,1.0,2.0,4.0kHz), air conduction threshold and bone conduction threshold were analyzed. The affected tissue in the middle ear and the damages of the ossicular chain were observed in the operation.  Pathological examination was performed on the affected tissue. Results    The air conduction threshold and bone conduction threshold at all frequencies but 4kHz of the ears with otitis media were higher than the opposite side .There was no obvious difference of the air or bone conduction threshold between patients with cholesteatoma and without . There were significant divergences in the air conduction threshold between patients with a normal ossicular chain and without, however, no divergences in the bone conduction threshold at 0.5,1.0,4.0kHz were found between the two groups. Conclusions    There are individualized audiological changes in aged patients with chronic suppurative otitis media. It is helpful for the treatment of aged patients with chronic suppurative otitis media when the corresponding audiological characteristics are fully understood.

    Over-under myringoplasty in 60 cases
    HUO Hong
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(1):  47. 
    Abstract ( 1108 )   PDF (310KB) ( 1204 )   Save
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    Objective    To explore the approaches to repair large tympanic perforation complicated with narrowed external auditory canal. Methods    Over-under myringoplasty was performed in sixty patients (62 ears) who suffered  from large tympanic perforation and narrowed external auditory canal. Half  to one year follow-ups were carried out to observe the changes of hearing ability and healing rate of the perforations. Results     Successful healing was achieved in 58 ears with the healing rate at 93.5%. 53 ears(85.5%) demonstrated improved hearing ability. No one-sdie healing of the eardrum or cholesteatoma of skin graft occurred. Conclusion    Over-under myringoplasty is a satisfactory method to treat patients with large eardrum perforation and narrowed external auditory canal. It provides good exposure to ease eardrum transplantation. Moreover, it is helpful to place the graft stably and prevent possible adhesion between the eardrum and promontory.

    Effects of sodium nitroprusside or remifentanil used  in  rabbits on nasal mucosal blood flow
    SHANG Li-mei1, LI Gang1, SUN Mei-jie2,BIAN Wen2
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(1):  49-52. 
    Abstract ( 1234 )   PDF (368KB) ( 1299 )   Save
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    ObjectiveTo evaluate the effect of continuous infusion of sodium nitroprusside (SNP) or remifentanil on nasal mucosal blood flow in rabbits. MethodsTwenty New Zealand white rabbits were randomly divided into the S group SNPinfusion (n=10) and the R group remifentanil infusion (n=10). After the anesthesia model of rabbit was established, SNP was infused in the S group and remifentanil was infused in R group. Heart rate (HR), mean arterial pressure (MAP), common carotid artery blood flow (CABF) and nasal mucosal blood flow (NBF) were measured during each period before and during infusion of SNP or remifentanil. ResultsIn the R group, MAP, HR and CABF showed a mild decrease during infusion remifentanil, and NBF showed a significant decrease in the R group(P<0.05). In the S group, MAP and CABF showed a significant decrease during infusion SNP(P<0.05), whereas, HR and NBF showed a significant increase in the S group(P<0.05). The decreases in MAP measured as percent change were greater in the S group than in the R group. But the increases in NBF measured as percent change were greater in the S group than in the R group(P<0.05). A significant negative correlation was observed between MAP and NBF in the S group(P<0.05), however, little correlation was observed between MAP and NBF in the R group. In both groups, the correlation between MAP and NBF was not significant(P>0.05). ConclusionInfusion of remifentanil reduces NBF, without a major decrease in MAP and CABF and may be safer and more effective in endoscopic sinus surgery.

    Effects of corticosteroid on expressions of HIF-1α and  VEGF in nasal polyps
    LI Zhen
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(1):  53. 
    Abstract ( 1289 )   PDF (1405KB) ( 748 )   Save
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    Objective    To study expression and relationship of hypoxia-inducible factor-1α (HIF-1α) and vessel  endothelium growth factor(VEGF )in nasal polyps, and to investigate the mechanism of action of corticosteroid on these cell factors. Methods    Expressions of HIF-1α and VEGF  in nasal polyps before and after treatment with corticosteroid were detected by SP immunohistochemical methods, and their relationship was calculated by linear correlation analysis. Results      Expressions of HIF1α and VEGF in nasal polyps were higher than those in inferior turbinate tissues. Expressions of HIF-1α and VEGF were significantly reduced in nasal polyps after treatment with corticosteroid. There was a positive correlation between expression of HIF-1α and that of VEGF. Conclusion    Corticosteroid is effective in nasal polyps by restraining expressions of HIF-1α and VEGF.

    Initial clinical observation of Smart Plug lacrimal plug in the treatment of aqueous tear deficiency dry eye
    GUO Li1, YUAN Fang2, LI Bin1
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(1):  63-66. 
    Abstract ( 1362 )   PDF (390KB) ( 1504 )   Save
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    Objective    To evaluate the clinical efficacy of SmartPlug lacrimal plug in the treatment of aqueous tear deficiency dry eye.  Methods    SmartPlug lacrimal plugs were inserted to treat 42 cases of aqueous tear deficiency dry eye (84 eyes). All patients were followed-up for 5-15 months(average 8.3 months). Schirmer I test (SIT) ,tear breakup time (TBUT), and fluorescent of cornea (FL) were used to evaluate the clinical efficacy. Results     ①Pre- and posttreatment SIT  were 3.41±0.60mm and 5.75±0.44mm(P<0.05), respectively; ② Pre- and post-treatment  TBUT  were 3.75±1.26 seconds and 6.46±1.47 seconds (P<0.05), respectively; ③Pre- and posttreatment FL were 2.45±0.06 and 0.04±0.02 (P<0.05), respectively;④The subjective symptoms improved in most patients. Conclusions    The SmartPlug lacrimal plug is effective in the treatment of aqueous tear deficiency dry eye. Moreover, it is recommended that lacrimal punctual occlusion should be done before irreversible damages of the ocular surface.

    Histological research of tracheal reconstruction by free jejunal graft with the mucosa partially preserved
    CHEN En-Kuan1, WANG Yue-jian2, SONG Wen-guang1, ZHUANG Ying-ying2, ZHENG Li-gang2, CHEN Wei-xiong2, WANG Lei2
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(1):  72-76. 
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    Objective    To explore the histopathological changes by microscope and transmission electron microscope. Methods    Six Beagle dogs were randomly divided into two groups: the experimental group and the control group. Operations were performed on these dogs under general anesthesia by intravenous ketamine. A 4cm length of segment of the jejunum was resected. The experimental group was prepared by scraping the partial muscosa with an operating knife blade and dry gauze, while in the control group the muscosa of jejunum was not scraped. One third of circumferential tracheal wall was resected from the third to tenth tracheal rings, and nick area about 1.2cm×4.0cm, During the resecting course, micro-vascular anastomoses were done between the mesenteric artery and the right common carotid artery, and the mesenteric vein with the right common carotid vein. Then, the free jejunum was uesed to reconstruct the tracheal defects, Fibrescope and biopsy were performed and recorded at the 1st, 2nd, 3rd and 6th postoperative months. All specimens were observed by microscope and transmission electron microscope examinations. Results    No dogs died in the operation, and the wound healed  well at  period I, but one dog died from obstruction of secretion in the tracheal tract at the 2nd postoperative week in the experimental group, another dog died from tracheostomy infection at the 50th postoperative days in the control group, and the others survived more than 6 months. After two month,  squamous epithelium  was found in the scraped jejunal mucosa. After three month, interestingly, ciliated columnar epithelium was found in the scraped jejunal mucosa. But in control group,  squamous epithelium was found in the scraped jejunal mucosa of the autografts at three months post-operation. After six months the new tracheal lumen was covered by ciliated columnar epithelium in all experimental Beagle dogs. Conclusions    A free scraped partial jejunum accelerated the process of mucous epithelization and promoted the metaplasia of the ciliated columnar epithelium.

    Surgical treatment of 10 mandibular coracoid fractures
    XU Yan, ZHU Guo-xiong, HUANG Di-yan
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(1):  77-78. 
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    Objective    To explore an effective surgical treatment for mandibular coronid fracture. Methods    10 patients with mandibular coronid fracture were operated by the mandibular-vestibular approach. The incision ran from the front edge of mandibular ramus to the first molar along the external oblique line of the mandible. Fractured coracoid processes were well exposed and then removed after carefully stripping off the temporalis adhension to the coracoid process. Results    All the patients  were well healed with satisfactory mandibular motor function after 6 to 12 months′follow-up.  Conclusion    Surgical removal of fractured mandibular coracoid processes via intraoral mandibular-vestibular approach is simple and effective.