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    20 October 2016 Volume 30 Issue 5
      
    Obesity and obstructive sleep apnea.
    LI Yanzhong
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  1-4.  doi:10.6040/j.issn.1673-3770.0.2016.404
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    The relationship between obesity and obstructive sleep apnea-hypopnea syndrome(OSAHS)has become a new hot spot in the research of sleep-disordered breathing. Whether there is a cause-and-effect or accompanying relationship between them is not yet clear. Compared with craniofacial malformations, obesity is more likely to induce obstructive sleep apnea syndrome(OSA). The frequency and severity of OSA are related to BMI and obesity. This paper discusses the relationship from four aspects: lipid metabolism disorder, fatty liver, metabolic inflammation, and oxidative stress.
    Progress in the classification and treatment of sleep respiratory diseases in children.
    WANG Yan
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  5-8.  doi:10.6040/j.issn.1673-3770.0.2016.405
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    The incidence of sleep-disordered breathing(SDB)in children goes up gradually. However, obstructive sleep apnea(OSA)is the worst disorder of SDB diseases. Nasal obstruction, mouth breathing and hypoxia are known to cause different abnormalities that include craniofacial structure, nasal structure, growth, mental development and behaviors. Early diagnosis and treatment can prevent complications. The rational and effective treatment could relieve the snore, sleep apnea, hypoxemia and sleep disturbance, thus improve the childrens quality of life.
    Relationship between obstructive sleep apnea and pharyngeal muscles and structure.
    XUE Rong, ZHANG Xilong
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  9-12.  doi:10.6040/j.issn.1673-3770.0.2016.317
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    The upper airway is composed of the nose, pharynx, larynx, and extrathoracic trachea. The segment of great interest is the pharynx, where partial or complete airway obstruction occurs during sleep in patients with obstructive sleep apnea syndrome(OSAS). Under the neural and chemical control, contraction of pharyngeal muscles surrounding the collapsible conduit of the pharynx modulates the size and stiffness according to the required purpose. The objective of this review is to describe normal pharyngeal airway maintenance achieved by interaction between the pharyngeal muscles and structures during sleep, and to share new information that may relate to the pathophysiology of sleep-disordered breathing.
    Treatment for obstructive sleep disordered breathing from the oral angle.
    LU Xiaofeng, ZHU Min, WANG Bing
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  13-17.  doi:10.6040/j.issn.1673-3770.0.2016.429
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    Interpretation of “The Third Edition of the International Classification of Sleep Disorders(ICSD)”.
    SHANG Wei
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  18-20.  doi:10.6040/j.issn.1673-3770.0.2016.386
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    The third edition of the International Classification of Sleep Disorders(ICSD-3)is the key reference for the diagnosis of sleep disorders. ICSD-3 is built on the same basic outline as ICSD-2, preserving the major diagnostic classifications. Significant modifications have been made to the nosology of insomnia, narcolepsy, and sleep-related breathing disorders. Major changes of the manual are reviewed in this article.
    Lipid metabolism and plaque development of carotid artery in patients with obstructive sleep apnea-hypopnea syndrome.
    LIU Yaxuan, GAO Ximei, XU Ping, WANG Yan, LI Yanzhong
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  21-23.  doi:10.6040/j.issn.1673-3770.0.2016.413
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    Objective To explore the lipid metabolism disorder and plaque development of carotid artery in obstructive sleep apnea-hypopnea syndrome(OSAHS). Methods A total of 99 OSAHS patients diagnosed by polysomnogram(PSG)were divided into the mild-moderate group(n=10), the severe group(n=34),and the profound group(n=55)according to the apnea-hypopnea index(AHI), and 48 healthy people severed as controls. Peripheral blood was collected from every individual after fasting. Blood lipid indexes including total cholesterol(TC), plasma triglycerides(TG), high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-C)were measured. All patients in the OSAHS group underwent color Doppler ultrasonography of cervical artery. The intima-media thickness(IMT)and carotid plaques were recorded. Results Compared with the control group, BMI in different severity OSAHS groups were higher(P<0.05), the level of HDL-C was lower(P<0.01), the level of TG in severe and profound OSASH groups was higher(P<0.05), but the levels of TC and LDL-C had no significant differences(P>0.05). In the OSAHS groups, the IMT was positively correlated with AHI(P<0.05), but negatively correlated with mean SpO2(P>0.05). There was no significant correlation between AHI and minimum SpO2(P>0.05). There were significant differences in the incidence rate of carotid artery plaque among profound and other two OSAHS groups(P<0.05). Conclusion Abnormity of blood lipid metabolism existed in OSAHS patients, meanwhile, the incidence of carotid artery plaque of profound OSAHS patients increased more significantly.
    The correlation analysis between the ratio of palate tongue and symptom in patients with obstructive sleep apnea hypopnea syndrome.
    SHI Chunhai, SHANG Xiaomin, LIU Fuchao, TANG Weiwei, HEI Renyi, LI Shuhua
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  24-28.  doi:10.6040/j.issn.1673-3770.0.2016.234
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    Objective To analyze the correlation between the palate/tongue(P/T)ratio and the severity of obstructive sleep apnea hypopnea syndrome(OSAHS)patients with symptoms of level, and make a comparison of P/T ratio with Friedman stage. Methods One hundred and ten patients with OSAHS who were referred to our hospital between December 2010 and August 2012, were enrolled in this study. Computed tomography(CT)scans were performed from the skull base to the thyroid cartilage, and the middle and sagittal reconstruction images of the pharyngeal region were obtained. The length of the soft palate means the distance from the base of the soft palate to the tip of the uvula, and the lingual thickness means the distance from the genial tubercle to the foramen cecum linguae. The P/T ratios of length of the soft palate to the lingual thickness were measured. Finally, we analyzed the correlation between P/T ratio and apnea hypopnea index(AHI)and compared the P/T ration and Friedman Stage. Results (1) The P/T ratio had significantly positive correlation with AHI(r=0.313, P=0.001)and had negative correlation with Friedman stage(r=-0.196, P=0.041). (2) The P/T ratios had significant differences among different severity OSAHS groups(F=3.478, P=0.019). (3) The P/T ratios had significant differences among different Friedman stage groups(t= 2.131, P=0.035). (4) The multinomial step regression analysis showed that the P/T ratios was the most important factor of AHI(R=0.265, F=19.333, P< 0.001). Conclusion The P/T ratio had significantly positive correlation with AHI in 山东大学耳鼻喉眼学报30卷5期 -史春海,等.阻塞性睡眠呼吸暂停低通气综合征患者腭舌比值与症状程度的相关性分析 \=-OSAHS patients. When P/T ratio increased, the severity of OSAHS also increased. Meanwhile, P/T ratio has a certain consistency with the Friedman stage.
    Endoscopy with Müllers maneuver and airway pressure measurement method on the evaluation of the upper airway of obstructive sleep apnea hypopnea syndrome.
    TIAN Xu, HUO Hong, LI Wuyi, WANG Jian, YANG Dahai
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  29-32.  doi:10.6040/j.issn.1673-3770.0.2016.340
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    Objective To compare daytime video-endoscopy with Müllers maneuver and nocturnal airway pressure measurement for upper airway(UA)assessment in patients with obstructive sleep apnea and hypopnea syndrome(OSAHS), in order to explore the clinical value of daytime endoscopy in airway evaluation. Methods A total of 125 OSAHS cases were evaluated by daytime video-endoscopy with Müllers maneuver to determine the sites of obstruction and patterns of collapse. The cases also underwent nocturnal pressure measurements(ApneaGraph, AG)to identify obstruction sites. The results of the two methods were compared. Results Endoscopy with Müllers maneuver detected retropalatal obstruction in all cases, of which 74 had retroglossal obstruction, and the patterns of collapse were different. AG results showed that lower apnea hypopnea index(AHI)and the proportion of lower AHI were significantly higher in multilevel obstruction group than in isolated retropalatal obstruction group(all P<0.01). Conclusion Daytime endoscopy with Müllers maneuver is of clinical value to evaluate the sites of obstruction and patterns of UA collapse. Combined with AG, it can help to guide the choice of surgical plan.
    Correlation between neutrophil / lymphocyte ratio and severity of obstructive sleep apnea syndrome.
    XU Meijie, SU Mei, XUE Rong, ZHANG Xilong
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  33-37.  doi:10.6040/j.issn.1673-3770.0.2016.347
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    Objective To investigate the relationship between the neutrophil / lymphocyte ratio(NLR)and severity of obstructive sleep apnea syndrome(OSAS). Methods A total of 158 subjects were recruited and divided into 4 groups based on their apnea hypopnea index(AHI)during sleep: control group(n=39), mild OSAS group(n=38), moderate OSAS group(n=41)and severe OSAS group(n=40). In addition, 31 patients in the severe OSAS group underwent 3-month continuous positive airway pressure(CPAP)treatment. White blood cells, neutrophils, lymphocytes and NLR were compared among groups as well as before and after CPAP treatment. Results The NLR in the severe OSAS group(3.29±1.19)was significantly higher than that in the normal control group(1.71±0.69), mild OSAS group(1.70±0.71); the NLR in the moderate OSAS group was significantly higher than that in the normal control group and mild OSAS group(all P<0.05); there was no significant difference in NLR between the normal control group and mild OSAS group as well as between the moderate OSAS group and severe OSAS group(all P>0.05). Comparison before and after CPAP treatment showed that NLR was significantly lowered after CPAP treatment(P<0.05). There was a positive correlation between AHI and NLR(r=0.758, P= 0.034), and a negative correlation between AHI and minimal oxygen saturation(r=-0.179, P=0.012). Conclusion NLR may elevate as OSAS becomes more severe and therefore it may serve as a new auxiliary parameter to evaluate the severity of inflammatory status in OSAS patients.
    Analysis of IGF-1 and IGFBP-3 level in liver tissue of rat with intermittent hypoxia.
    GAO Tianxi, XIA Cui, YAN Jing, HOU Jin, KANG Quanqing, WANG Zhenghui, REN Xiaoyong
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  38-41.  doi:10.6040/j.issn.1673-3770.0.2015.448
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    Objective To detect the insulin-like growth factor 1(IGF-1)and insulin-like growth factors binding protein 3(IGFBP-3)levels in liver tissue of rat with intermittent hypoxia, and to investigate theeffect of intermittent hypoxia on liver, in order to provide pathophysiologic evidence of obstructive sleep apnea-hypopnea syndrome(OSAHS)in children. Methods A total of 20 day-old Sprague-Dawley female rats were randomly divided into 3 groups: mild hypoxia group, severe hypoxia group and control group, the first two groups were raised in sealed hypoxia box 8-hour per day and were sacrificed 35 days after, The level of IGF-1 and IGFBP-3 of liver tissure was detected by immunohistochemical method. Results The expression of IGF-1 and IGFBP-3 of liver in control group, mild hypoxia group and severe hypoxia group increased gradually. The positiveexpression rate of IGF-1 were 2/8, 3/8 and 6/8 in control group, low oxygen group and severe hypoxia group, respectively. The positiveexpression rate of IGFBP-3 were 3/8、4/8 and 7/8 in there group respectively. There was no significant difference in level of IGF-1 and IGFBP-3 between the control group and the mild hypoxia(χ=20.157, P=0.315), and between the control group and thesevere hypoxia(χ=20.066, P=0.132). Spearman-test showed a positive correlation between level of IGF-1 and IGFBP-3 in severe hypoxia group(r=0.746, P<0.05). Conclusion GH-IGF1-IGFBP3axisdysfunctionhas little effect on IGF-1and IGFBP-3 in liver tissue of rate withintermittent hypoxia.There was no significant difference in level of IGF-1 and IGFBP-3 among three groups.
    A systemic review system to evaluate the effects of different tonsil and adenoid surgical methods on children with obstructive sleep apnea-hypopnea syndrome.
    YU Qingqing, TANG Jun, WANG Yuejian
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  42-48.  doi:10.6040/j.issn.1673-3770.0.2016.086
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    Objective To establish a systematic review system to compare the therapeutic effects of different tonsil and adenoid surgical procedures on childrens obstructive sleep apnea-hypopnea syndrome(OSAHS). Methods CNKI, Wanfang Data, CBM and VIP were searched for randomized controlled trials on the therapeutic effects of different tonsil and adenoid surgical procedures on childrens OSAHS from the date of establishment of the databases to July of 2016. The extracted data were analyzed by Revman 5.0. Results A total 7 studies were included. Meta-analysis showed the differences between the case group and control group in curative ratio, effective rate, AHI and LSaO2 werent significant(P>0.05), but the differences in the operation time and intraoperative blood loss were significant(P<0.05). Only one paper compared humoral and cellular immunity index before and 6 months after partial and total tonsillectomy with adenoidectomy, which could not be included in the meta-analysis. Conclusion Few researches on the effects of different surgical procedures on childrens immunity have been found, and control tests could not be carried out because of different observing time after surgery. The results from the present study indicate that partial tonsillectomy plus adenoidectomy does not impact on the humoral and cellular immunity of children. It is an ideal method for patients below eight with simple hypertrophy of tonsil and adenoid, which can not only improve ventilation disorder, but also retain the tonsil immune function and reduce the operation time and intraoperative blood loss.
    The effects of multimodal analgesia with parecoxib sodium and tramadol on patients treated with uvulopalatopharyngoplasty.
    BAO Yang, WANG Chunling, ZHANG Li, JIN Min, ZHOU Changqing, PAN Xinliang
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  49-53.  doi:10.6040/j.issn.1673-3770.0.2016.367
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    Objective To observe the effects of multimodal analgesia with parecoxib sodium and tramadol on postoperative analgesia, incidence of adverse reactions and inflammatory factors in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS)after uvulopalatopharyngoplasty(UPPP). Methods A total of 60 OSAHS cases were randomly divided the into the test group(T group, n=30, receiving parecoxib sodium and tramadol)and control group(C group, n=30, receiving tramadol only). Both groups received patient-controlled intravenous analgesia with tramadol after UPPP. Data of visual analog scale(VAS)for pain in 48 h postoperatively, rescue analgesic use and adverse reactions were collected. Inflammatory factors including TNF-α, IL-6, IL-10 and ICAM-1 were measured with ELISA. Results Lower VAS scores, less use of rescue analgesic and fewer adverse reactions were showed in T group(P<0.01, P<0.05, P<0.05). Decreased levels of TNF-α and IL-6 were found in T group(P<0.01, P<0.05), while there were no statistically significant differences in the levels of IL-10 and ICAM-1 between the two groups. Conclusion Multimodal analgesia with parecoxib sodium and tramadol can prolong the postoperative analgesia, demand less use of rescue analgesic, and cause fewer adverse reactions, which may play a positive role in the inhibition of inflammatory reaction after UPPP.
    Association between findings of drug-induced sleep endoscopy and hypoxemia.
    ZHOU Peng, SHEN Ping, LIU Wen, LI Peihua, LI Hongquan
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  54-57.  doi:10.6040/j.issn.1673-3770.0.2016.205
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    Objective To explore the correlation between patterns of upper airway collapse and results of polysomnography(PSG)in patients with obstructive sleep apnea-hypopnoea syndrome(OSAHS)by reviewing drug-induced sleep endoscopy(DISE)findings. Methods A total of 51 OSAHS cases confirmed by PSG underwent DISE after taking dexmedetomidine. The findings were observed using the VOTEL(velum, oropharynx, tongue base, epiglottis and larynx)classification system. Associations between DISE and polysomnographic parameters were analyzed. Results Both velum collapse and complete lateral oropharyngeal collapse were significantly associated with increased severity of OSAHS, reflected by elevated apnea-hypopnea index(AHI), oxygen desaturation index(ODI), and T<90%, but decreased lowest oxygen saturation(LSaO2). If both collapses were on the X axis, the collapses were presented as lateral collapses. Conclusion There is strong association between complete lateral oropharyngeal wall and velum collapse and increased OSAHS severity.
    The application of Sinus Jel in adult patients of nasal polyps with sleep-disordered breathing.
    WANG Haipeng, XU Huijuan, ZHANG Xiufang, WANG Huizhong, LI Yanzhong
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  58-60.  doi:10.6040/j.issn.1673-3770.0.2016.153
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    Objective To explore whether PureRegen Gel Sinus is a suitable nasal packing material for patients with sleep-disordered breathing(SDB)caused by chronic rhinosinusitis plus nasal polys(CRSwNP). Methods A total of 216 CRSwNP cases including 156 SDB and 60 non-SDB cases were divided into 4 groups. Group A(60 non-SDB cases)and group B(56 SDB cases)were treated with PureRegen Gel Sinus after nasal sinus surgery. Group C included 47 SDB cases treated with Nasopore. Group D included 53 SDB cases treated with Medical Sponge. The nasal reactions of the 4 groups were compared with Visual Analogue Scale(VAS). Results There were significant differences in headache, rhinalgia and postoperative bleeding between group A and B(P<0.05). Patients with SDB were more intolerant to these complications. There were statistical differences in headache, rhinalgia, rhinobyon and lacrimation between group B and C(P<0.05). PureRegen Gel Sinus was was superior to Nasopore. There were statistical differences in headache, rhinalgia, rhinobyon, lacrimation, dysphagia and postoperative bleeding between group B and D(P<0.05). PureRegen Gel Sinus was no better than medical sponge in dealing with postoperative bleeding, but it was still acceptable. PureRegen Gel Sinus was superior to medical sponge in other aspects. Conclusion PureRegen Gel Sinus is more suitable for clinical practice as a packing material. In addition, SDB can worsen headache, rhinalgia and postoperative bleeding, which may be associated with inflammation resulted from long-term oxygen depletion.
    Application of portable sleep monitor(YH-600B)in diagnosis of obstructive sleep apnea-hypopnea syndrome.
    YUAN Wei, ZHANG Rong, WANG Honghong, YU Leilei, SUN Jianjun, LI Jinrang, ZHAN Muxia
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  61-64.  doi:10.6040/j.issn.1673-3770.0.2016.289
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    Objective To validate the portable sleep monitor(YH-600B)in the diagnosis of obstructive sleep apnea hypopnea syndrome( OSAHS)for use as a screening tool. Methods A total of 156 patients with suspected OSAHS were measured with SomteV2 polysomnography(PSG)and YH-600B portable sleep monitor in the meantime. The difference in apnea hypopnea index( AHI),the lowest SaO2(LSaO2), oxygen desaturation index and percentage of time spent at SaO2 below 90%(CT90%)of each parameter provided by the two diagnostic methods were compared, as well as the sensitivity and specificity of portable sleep monitor was evaluated. Results Sensitivity and specificity of YH-600B portable sleep monitor were 99.0% and 86.3% in detecting OSAHS comparing with PSG. The consistency of the two diagnostic methods was 94.9%(Kappa=0.91). The consistency of two methods in assessing the degree of OSAHS was 89.1%(Kappa=0.82). Conclusion The portable sleep monitor(YH-600B)is highly sensible and more exact especially in diagnosis of OSAHS, and therefore is suitable for routing clinical diagnosis.
    Clinical comparison of polysomnography with portable sleep monitoring device.
    ZHANG Rong, WANG Honghong, YU Leilei, LIU Liang, SUN Jianjun, LI Jinrang, ZHAN Muxia
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  65-67.  doi:10.6040/j.issn.1673-3770.0.2016.247
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    Objective To evaluate the sensitivity and specificity of portable sleep monitoring device in measuring apnea hypopnea syndrome events. Methods A total of 120 patients were inspected by polysomnography and portable sleep monitor with synchronous monitoring, and the data were recorded and analyzed to evaluate its diagnostic efficiency. Results The polysomnography results was in agreement with portable sleep monitoring results. Apnea hypoventilation index, lowest oxygen saturation, oxygen index reduction had correlate statistical significance. Conclusion The portable sleep monitoring as a simple and convenient detection method, can be widely applied to clinic.
    The study of cognitive disorderin patients with obstructive sleep apnea hypopnea syndrome.
    ZHU Yue, HUANG Zhichun, YANG Ming, ZHU Xin
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  68-74.  doi:10.6040/j.issn.1673-3770.0.2016.026
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    Objective Using Neurocognitive function scalesto evaluate the changes of cognitive function in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS). And analyzing the cognitive disorderin patients by the polysomnography(PSG). Methods A collection of 55 patients with OSAHS and 27 cases of normal control group, collecting their PSG results and related cognitive function to assess cognitive damage in patients with OSAHS. Analysisof the correlation between parameters associated with the PSG, and the parameters associated with impaired cognitive function best bound values. Results (1) There were no significant differences in gender, age and level of education(P>0.05); 山东大学耳鼻喉眼学报30卷5期 -朱越,等.阻塞性睡眠呼吸暂停低通气综合征患者认知功能损害的研究 \=-(2) There weresignificant differences in AHI, apnea index between the two groups, the longest time of apnea, low ventilation index, ODI, TST < 0.9, MSaO2, LSaO2(all P<0.05); (3) There were no significant differences in sleep structure comparison and total sleep time(P>0.05); (4) There were significant differences in MMSE scale results, including directional force(P<0.05); (5) There were significant differences in ESS, STOP Bang, LMT, LMT DR(P<0.05); (6) Neurocognitive function scale and PSG related parameters of the correlation of the results show that the AHI and apnea index are the strongest correlation between neurocognitive function scale; The longest time of apnea, low ventilation index, ODI, TST < 0.9, MSaO2 and LSaO2 has certain correlation with the scale, and number of awakening and snoring is no significant correlation; (7) MMSE standard for cognitive dysfunction screening validity comparison, results show that the AUC is 0.664. When the boundary value of 29.5, the Youden index is highest, about 0.32, and the sensitivity is 76.4%, while the specificity is 55.6%; (8) PSG validity screening, the best boundary value analysis of the parameters. The results showed that the best of apnea index value is 5.15, the longest apnea time the best value is 105 seconds, hypoventilation index the best value is 0.55, ODI the best value is3.1,TST < 0.9 the best value is 0.27%, MSaO2 the best value is 96.5%, and LSaO2 best value is 81.5%. Conclusions (1) Patients with OSAHS have low ventilation and apnea at night, leading to the occurrence of cognitive dysfunction; (2) There were no significant differences in sleep structure and total sleep time; (3) Cognitive function in patients with OSAHS exist different degree of damage, and is closely related to the severity of disease; (4) Directional force, logical memoryand memory ability in cognitive function in patients with OSAHS are impaired obviously; (5) Apnea index > 5.15, and(or)the longest apnea time > 105 seconds, and(or)apnea-hypopnea index > 0.55, and(or)ODI > 3.1, and(or)TST < 0.9 > 0.27%, and(or)MSaO2 < 96.5%, and(or)LSaO2 < 81.5%, can quickly promptclinical doctors OSAHS patients that may have impaired cognitive function.
    The effect of obstructive sleep apnea-hypopnea syndrome on pulmonary function of child:a literature review.
    GUAN Lejing, ZHANG Yamei
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  75-80.  doi:10.6040/j.issn.1673-3770.0.2015.511
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    The incidence of obstructive sleep apnea-hypopnea syndrome(OSAHS)is relatively high among children. The hyoxemia caused by apnea can lead to multiple organ dysfunctions. Recent studies find that the OSAHS can affect the pulmonary function to varying degrees, which can be improved by surgical treatment. This review focused on the clinical manifestations of children with OSAHS and related outcomes of varying treatment.
    Obstructive sleep apnea hypopnea syndrome and Fibroblast growth factor 21.
    LIANG Xiaohong, LI Yan, LI Chong
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  81-84.  doi:10.6040/j.issn.1673-3770.0.2016.319
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    The prevalence of OSAHS has been dramatically increasing during the last decade, which has become one of the major diseases that endangers human health. The pathogenesis of OSAHS is not yet fully clear. Some studies have shown that FGF21 is closely linked with OSAHS. The correlation between FGF21 and OSAHS will be discussed in this chapter.
    Packing material on outcomes of sinus mucosa with chronic rhinosinusitis after endoscopic sinus surgery.
    XU Haibo, HONG Yanli, LI Zhaosheng, XU Zhenyue
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  85-87.  doi:10.6040/j.issn.1673-3770.0.2016.182
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    Objective To explore the effect of different packing materials on sinus mucosa with chronic rhinosinusitis after endoscopic sinus surgery. Methods A total of 167 patients with chronic rhinosinusitis were divided into the fragmentable nasal dressing group A(n=93)and the swell sponge group B(n=74). Using Lund-Mackay CT scoring system, visual analogue scales(VAS)and Lund-Kennedy endoscopic scoring system, all patients were assessed in recover in pre-operation period, and the second week, the fourth week, and the twelfth week after the surgery. The data were analyzed by SPSS18.0 statistics software to compare the differences of outcomes of sinus mucosa. Results There was no difference about Lund-Mackay CT scores, the VAS scores and Lund-Kennedy endoscopic scores in two groups before surgery(P>0.05). About Lund-Kennedy endoscopic scoring, the scores of the two groups presented significant difference(P<0.01). Comparing with the scores of the second week, the scores of group A of the fourth week, and the twelfth week were lower than those of the group B(P<0.01). The VAS scores of group A were all significantly different from those of group B at same period(P<0.01), and the scores of group A at the post-operative 4 and 12 week were lower than those of group B. 5 cases of group A and 7 cases of group B had sinus region oedema seriously, ves hyperplasy and polypus recurrence. After individualized treatment, sinus mucosa presented recovery tendency. Conclusion Applying of fragmentable nasal dressing can promote preferable outcomes of sinus mucosa with chronic rhinosinusitis after endoscopic sinus surgery.
    Severe nasal bleeding caused by traumatic injury of the internal carotid artery: with a report of 12 cases.
    LI Yuguang, LIU Fengying, LIU Qian
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  88-91.  doi:10.6040/j.issn.1673-3770.0.2016.028
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    Objective To explore the the pathogenesis, characteristics, diagnosis and treatment of severe nasal bleeding caused by traumatic injury of the internal carotid artery. Method The clinical data of 12 cases were retrospectively analyzed. Result Of the 12 cases, 6 cases underwent nasal endoscopy and were found beating bleeding at the submucosal lateral nasal wall, then were treated by the Caldwell Luc approach to stop bleeding, meanwhile 4 cases of them were treated by maxillary fracture and zygomatic fracture reduction and titanium plate internal fixation. Another 6 cases were made definite diagnosis with digital subtraction angiography(DSA)and were treated by parallel vascular embolization. Conclusion As for patients with maxillofacial injury with repeated nasal hemorrhage, they should be considered and treated by nasal endoscopy and/or DSA examination and embolization. If embolization is too late in the process of nasal endoscopy bleeding, ligation or electric coagulation could be performed out by the Caldwell Luc approach, also iodoform gauze could be used for stuffing. After stopped bleeding, maxillofacial fracture reduction and internal fixation should be done.
    Comparison of nasal septum suture and nasal packing in septoplasty.
    ZHANG Meng, XU Jun, JIN Xianghua, JIN Jun, WANG Lusha, JIN Yongde
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  92-93.  doi:10.6040/j.issn.1673-3770.0.2016.039
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    Objective To explore the effect of nasal septum suture and nasal packing in septoplasty. Methods A total of 95 patients who were diagnosed as deviation of the nasal septum were undergone septoplasty in Yanbian University Hospital, Department of Otorhinolaryngology & Head and Neck from September 2014 to August 2015. All patients were randomly divided into two groups based on operative methods: the nasal packing group and the suture group. The VAS of headache, nasal pain, lacrimation, nasal obstruction and costs related to the operation and post-operative complications were analyzed between the two groups. Results In post-operative symptoms of headache, nasal pain, lacrimation and nasal obstruction, the VAS of the packing group was obviously higher than that of the suture group(P<0.05), and the costs related to the operation was also the same. Conclusion The application of nasal septum suture in septoplasty can relieve the post-operative suffering of patients and lower the costs related to the operation, which is worthy of promotion.
    Computed tomographic analysis of the relationship between nasal structure and fungal maxillary inflammation.
    LIU Dingrong, SHI Yuyong, ZHAN Xianjin, LIU Guiling, LIAO Xinchun,YANG Ji, LUO Zehui, LUO Yonghua, LIAO Kuan, WU Ke
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  94-97.  doi:10.6040/j.issn.1673-3770.0.2016.158
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    Objective To investigate whether there is abnormal anatomy of the nasal cavity for fungal maxillary sinusitis(FMS). Methods A total of 102 individuals(204 sides)of unilateral FMS were performed coronal plane CT scanning and measured the nasal structure including nasal septum, the middle turbinate, uncinate, ethmoid bulla and Haller cell. The CT images from 89 patients were used for image processing. The percentage of cross sectional area of inferior turbinate, uncinate process and middle turbinate(PCSA)in respective nasal cavity was calculated and compared. Results The percentage of nasal septal deviation(NSD)was 85.29%. In these patients with unilateral FMS diseases, 51 had wide side of nasal cavity, 36 had narrow side(P<0.05). The number of high NSD and low NSD were similar. In patients with high NSD, the number of FMS of wide side was more than that of narrow side(P>0.05). The anatomic variation of ostiomeatal complex(OMC)was as fellows: diseased side was significantly different from the healthy side, with respect to middle concha reverse deviation, uncinate process deviation and Haller cell(P<0.05), incontrast, diseased side was insignificantly different from the healthy side, with respect to uncinate process hypertrophy, ethmoid bulla. About the PCSA, It had no significant differences between the two sides of the nasal cavity(P>0.05). Conclusion As NSD, and anatomic variation of the middle turbinate and uncinate played an important role pathogenesis of FMS. Therefore, while treating FMS, NSD, and antatomical variation of the middle turbinate and uncinate should be cleared at the same time.
    Long-term curative effect of CO2 laser surgery for glottic laryngeal carcinoma.
    MA Lingguo, ZHENG Chaopan, ZHOU Jingchun, ZHANG Bo, GONG Taogen, ZHANG Yunjing
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  98-100.  doi:10.6040/j.issn.1673-3770.0.2015.426
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    Objective To evaluate the long-term curative effect of CO2 laser surgery for glottic laryngeal carcinoma under microscopic suspension laryngoscope. Methods Clinical data of 106 cases of glottic laryngeal carcinoma were retrospectively analyzed, including 4 cases of TisN0M0, 62 cases of T1aN0M0, 16 cases of T1bN0M0, 22 cases of T2N0M0, and 2 cases of T3N0M0. All cases were treated with microscopic suspension laryngoscope CO2 laser surgery during 2004 and 2015. Results All operations were successful without serious complications. Of all 106 cases, 4 died of recurrence, 4 died of accidents, 2 died of distant metastases, 4 failed to be followed up, and 2 received a second operation due to recurrence and survived well. A total 92 patients were still alive without recurrence, with good quality of life. The 3, 5 and 10-year survival rate were respectively 98.7%, 95.2% and 89.0%. The local recurrence rate was 5.7%. Conclusion Microscopic suspension laryngoscope CO2 laser surgery is the preferred method for glottic laryngeal carcinoma Tis and T1a, which produces few surgical trauma, fast postoperative recovery, good laryngeal function preservation and high long-term survival rate. This operation method also has good clinical effect for selected cases of glottic laryngeal carcinoma T1b, T2 and T3.
    A clinical analysis of CO2 laser microsurgery for early glottic laryngeal carcinoma with anterior commissure involvement.
    BAO Weijing, NING Jiayu, ZHU Zhongshou, WEI Rifu, LIN Chang
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  101-105.  doi:10.6040/j.issn.1673-3770.0.2016.019
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    Objective To explore the clinical safety and curative effect of CO2 laser microsurgery in the treatment of early glottis carcinoma with anterior commissure involvement. Methods Clinical data of 26 cases of early glottic laryngeal carcinoma with anterior commissure involvement treated with CO2 laser microsurgery were retrospectively analyzed. Surgical specimens were conventionally embedded with paraffin and serially sectioned, and then stained using hematoxylin-eosin for pathologic examination. All patients were closely followed up to observe the local recurrence rate. Results Of all 26 surgical margins, 20 were negative and 6 were positive. Relapse was detected in 7 cases, the recurrence rate being 26.9%(7/26). The recurrence rate of positive and negative surgical margins was 83.3%(5/6)and 10%(2/20), respectively, with statistical differences(P=0.002). Conclusion CO2 laser microsurgery can safely and effectively preserve the vocal function of early stage glottis carcinoma with anterior commissure involvement. However, the operation indications should be strictly followed in order to guarantee safe surgical excision and reduce local recurrent rate.
    Efficacy of CO2 laser combined with proton pump inhibitors in the treatment of recurrent vocal process granuloma.
    JIA Yanfeng, YANG Chunwei, SONG Fuchun, YANG Xiangli, WANG Lin, LIU Jixiang
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  106-109.  doi:10.6040/j.issn.1673-3770.0.2016.073
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    Objective To observe the therapeutic effect of CO2 laser combined with proton pump inhibitor in the treatment of recurrent vocal fold granuloma. Methods The clinical data of 28 cases of recurrent vocal process granuloma treated in our hospital were retrospectively analyzed.Of all cases, 16 had gastroesophageal reflux symptoms, and 12 had no clear symptoms of gastroesophageal reflux. All patients underwent CO2 laser surgery under suspension laryngoscope, and then received anti acid reflux drug treatment with proton pump inhibitors for 8-12 weeks. Results The symptoms of hoarseness and foreign body sensationin all patients were obviously improved. The pathological results were granulation tissue. After one-year follow-up, all patients were examined with electron laryngoscope. The two recurrent cases orally took Esomeprazole 40 mg daily for one month. In one case, the granuloma significantly shrank; in the other case, the granuloma did not progress. Neither case received a second operation as they had no symptoms of hoarseness and foreign body sensation. Conclusion Acid reflux is an important factor of postoperative recurrence of vocal process granuloma; CO2 laser surgery combined with proton pump inhibitors is an effective treatment with advantages of small trauma and low recurrence rate.
    Effect of silencing PDCD4 gene on proliferation of Hep-2 cells and the expression of β-catenin by RNA interference technique.
    XU Yuanteng, CHEN Ruiqing, LIN Gongbiao, FANG Xiuling, YU Shujuan, LIANG Xiaohua, ZHANG Rong
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  110-114.  doi:10.6040/j.issn.1673-3770.0.2016.322
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    Objective To study the effect of silencing PDCD4 gene on proliferation of Hep-2 cells and the expression of β-catenin by RNA interference technique. Methods Specific shRNA plasmid and negative control plasmid of PDCD4 gene were designed and synthesized. Hep-2 cells were transfected with shRNA plasmid and negative control plasmid. Real-time RT-PCR and Western blotting analysis were performed to determine the expressions of PDCD4 and β-catenin mRNA and protein after transfection, respectively. The proliferation of Hep-2 cells was observed by colony-forming assay. Results Compared to the control group, the colony formation rate of Hep-2 cells was significantly increased in the shRNNA plasmid group(P=0.01); the expressions of PDCD4 mRNA and protein were significantly reduced(P<0.01);the expressions of β-catenin mRNA and protein were significantly increased(P<0.01). Conclusion RNA interference technique can effectively silence PDCD4 gene expression of Hep-2 cells,enhance the colony forming ability of Hep-2 and increase the expressions of β-catenin mRNA and protein.
    Effect of different doses of dexmedetomidine preoperative intranasal medication on the safety in children tonsillectomy.
    WANG Lei, LOU Feng, ZHANG Yuan, ZHAO Xin
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  115-119.  doi:10.6040/j.issn.1673-3770.0.2016.239
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    Objective To observe the safety effect of different doses of dexmedetomidine preoperative intranasal medication in children tonsillectomy. Methods Sixty children for tonsillectomy were randomly assigned into the H, L and C groups(n=20). Group H was given dexmedetomidine 2 μg/kg(adding saline to 0.3 mL), group L was given dexmedetomidine 1 μg/kg(adding saline to 0.3 mL)and group C was given physiological saline 0.3 mL, 40 min before the induction of anesthesia, respectively. The sedation, separated state, hemodynamics, breath, extubation time, PACU stay, as well as side effects were observed among groups. The serum levels of inflammatory cytokine TNF-α and IL-6 after extubation immediately(T1), postoperative 4 h(T2), postoperative 12 h(T3)and postoperative 24 h(T4)were measured, respectively. Results The sedation and separated state in groups H and L were much better than those in group C. BP and HR in groups H and L were lower than those in group C at different time points(P<0.001). Oxygen saturation, extubation time and PACU stay time showed no significant difference among groups(P>0.05). The incidences of adverse events in groups H and L, such as postoperative agitation and choking cough, were lower than those in group C(P=0.024 & P=0.025). The plasma levers of TNF-α and IL-6 in groups H and L were lower than those in group C(P<0.001)at T1, T2, T3 and T4. Conclusion Dexmedetomidine preoperative intranasal medication can improve children sedation level, improve parent-child separation state, maintain stable hemodynamics with no respiratory depression and less adverse events, reduce perioperative inflammatory factor release, and increase security. Dexmedetomidine 2 μg/kg provides more stable circulation by reducing inflammatory cytokine release.
    Comparison of allogeneic broad fascia preserved with different methods for ocular transplantation.
    SONG Qi, TANG Juan, CAI Kejie, PANG Kunpeng, WEI Yan, XU Tonghui, ZHAI Yonghua
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  120-124.  doi:10.6040/j.issn.1673-3770.0.2016.106
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    Objective To compare the biological property changes of allogeneic broad fascia preserved with different methods and provide guidance for clinical application. Methods Fresh allogeneic broad fascia was randomly divided into three groups according to storage methods: groupⅠwas preserved in gradient alcohol, group Ⅱ in glycerin under deep low temperature and group Ⅲ in composite antimicrobial solution under mildly low temperature. Changes of the physical, chemical and biomechanical performance were observed in three groups.The fresh broad fascia was used as control. Results GroupⅠhad the same physical and chemical properties as fresh broad fascia after 3 months preservation, while the color and flexibility changed after being stored for 6 months. HE staining showed that the fiber density decreased gradually with the extension of storage time. Group Ⅱ and group Ⅲ had the similar physical and chemical properties as fresh broad fascia after being preserved for 6 months. There was no statistical difference of biomechanics in 3 groups after 6 months observation compared with fresh broad fascia. Conclusion All of the three methods can be used to preserve allogeneic broad fascia. However, the method of gradient alcohol is not recommended to use in the long-term or large-quantity storage of allogeneic broad fascia.
    One case of primary non-Hodgkins lymphoma of the hypolarynx and the trachea.
    WANG Lusha, HAN Ruining, ZHANG Meng, JIN Yongde
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  125-126.  doi:10.6040/j.issn.1673-3770.0.2015.508
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    Thyroid leiomyosarcoma in 1 cases and literature review.
    WANG Nana, YANG Chuan, LIU Tao, ZHAO Jumei
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2016, 30(5):  127-128.  doi:10.6040/j.issn.1673-3770.0.2015.547
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