Table of Content

16 April 2017 Volume 31 Issue 2

  

Application of imaging navigation technique in the endoscopic sinonasal and skull base surgery.

J Otolaryngol Ophthalmol Shandong Univ. 2017, 31(2):  1-6.  doi:10.6040/j.issn.1673-3770.0.2017.143

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With development and introduction of imaging navigation technique, much progress has been made in the endoscopic sinonasal and skull base surgery. In the present review, the principles and working mechanisms, development history and indications of imaging navigation as well as the attitude towards its clinical applications are discussed systematically. Meanwhile, the recent progresses in the clinical applications of the imaging navigation technique and its future developing trends are also described.

The clinical use of nasal endoscopic surgical technique in treatment of rhinosinusal malignant tumor involving in the anterior skull base.

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2017, 31(2):  7-11.  doi:10.6040/j.issn.1673-3770.0.2017.085

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For the treatment of rhinosinusal malignant tumors involving the anterior skull base, nasal endoscopic surgical technique has a comparable short-term curative effect, lower complications, and better quality of life compared with anterior craniofacial resection. Although the scope and indications of nasal endoscopic surgical technique are expanding, present evidence regarding these issues is low. Furthermore, there is still a lack of unified surgical indications and methods, and the curative effect also needs to be verified.

Treatment of tumors in pterygopalatine fossa by endoscopy.

J Otolaryngol Ophthalmol Shandong Univ. 2017, 31(2):  12-15.  doi:10.6040/j.issn.1673-3770.0.2017.112

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Treatment of tumors in pterygopalatine fossa adjacent to complex structure includes traditional approach and nasal endoscopic approach. This article aims to introduce microanatomy, tumor types and treatment methods in pterygopalatine fossa.

The endoscopic endonasal transpterygoid approach in lateral midline skull base.

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2017, 31(2):  16-24.  doi:10.6040/j.issn.1673-3770.0.2017.115

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It is very important to select the appropriate surgical approach in the operation of endoscopic skull base surgery. There are two principles: (1) the field of view should be well exposed; (2) the important neurovascular injury should be avoided. In the endoscopic endonasal approach to the lateral midline skull base, the anatomical structures of the pterygoid process, the vidian canal, the foramen rotundum, the foramen ovale and the eustachian cushion are relatively fixed. By the endoscopic endonasal transpterygoid approach, we can handle the pterygopalatine fossa, infratemporal fossa, cavernous sinus, Meckle cavity, paraclival to cavernous segment of internal carotid artery, petroclival region, petrous apex, eustachian tube area, and the upper parapharyngeal space. Pterygoid process can be used as the anatomical landmark for endoscopic skull base surgery and be chosen as the operation center for inward and outward expansion. Making full use of the space location, increasing the sense in the operation of three-dimensional space, is helpful in expanding the endoscopic skull base surgery.

The clinical application of image-guided endoscopic technique in the management of nasal sinus, skull base and orbital disease.

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2017, 31(2):  25-30.  doi:10.6040/j.issn.1673-3770.0.2017.086

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Objective To evaluate the clinical application of image-guided endoscopic techniques in the management of nasal sinus, skull base and orbital disease. Methods Retrospective review was performed in 751 transnasal endoscopic surgeries with the help of the image navigation system, including 565 cases with Medtronic Stealth Station^TM optical based system and 186 cases with Medtronic Fusion electromagnetic system. The accuracy of image navigation system, preoperative registration time, benefits and undesirable problems of intra-operative navigation and surgical complications were analyzed. Results Both platforms had been shown to be accurate to within 2 mm. The benefits of navigational technology were evaluated by VAS scores, which decreased to(8.3±1.2). The anatomic sites were frontal sinus, optic nerve and carotid artery,which the best guided effects applied by navigational orientation. The major undesirable problems in navigation procedures were image-drifting, failing to real-time orientation, and failing to registration. All surgeries completed successfully without any complications. Conclusion The image-guided techniques can assist endoscopic surgeons to identify surgical markers with precision and eliminate anatomic illusion possible under endoscopy. The incidence of undesirable problems in navigation procedures was low. The experience of surgeon for endoscopic and navigational operation was very important under this situation.

Endoscopic surgery of sinonasal benign osteogenic tumors with involvement of nasal skull base region.

J Otolaryngol Ophthalmol Shandong Univ. 2017, 31(2):  31-36.  doi:10.6040/j.issn.1673-3770.0.2017.142

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Objective To explore and discuss the treatment strategy of benign osteogenic tumors with involvement of nasal skull base area, including osteoma, ossifying fibroma and fibrous dysplasia. Methods 140 patients with benign fibro-osseous lesion of naso-siunses were treated surgically, including 116 cases of osteoma, 14 cases of ossifying fibroma and 10 cases of fibrous dysplasia. Surgical methods include simple nasal endoscopic surgery in 95 cases, image navigation assisted nasal endoscopic surgery in 24 cases, nasal endoscopy combined with external nasal approach in 21 cases. Results No serious complications occurred in all cases who underwent different operations. All osteomas were completely removed. Ossifying fibromas were completely removed in 12 cases, except 2 cases with residual lesions. All cases of fibrous dysplasia were received the palliative surgery, and the facial appearances of the patients were recovered and the compressive symptoms of the surrounding tissues were relieved. The follow-up period ranged from 6 to 36 months. No recurrence was found in patients with osteoma; recurrence occurred in 2 cases ossifying fibroma; the symptoms of fibrous dysplasia get different degree of ease, except 1 patient with visual loss remained unchanged. Conclusion Osteoma, ossifying fibroma and fibrous dysplasia are common benign osteogenic lesions of paranasal sinuses. High resolution CT and(or)MRI are important means for early diagnosis. Endoscopic sinus surgery under the guidance of image navigation or combined with external nasal approach is an effective method for the treatment of these diseases. The choice of operation opportunity and surgical methods should be based on the type of lesion, the patients symptoms, the location and scope of the tumor.

Transnasal removal of a metal foreign body piercing through the left orbit to the ethmoid sinus and nasal septum under image-guided navigation system.

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2017, 31(2):  37-38.  doi:10.6040/j.issn.1673-3770.0.2017.117

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Comparison of endolymphatic spaces between patients suffering from menieres disease and normal volunteers.

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2017, 31(2):  39-42.  doi:10.6040/j.issn.1673-3770.0.2017.005

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Objective To compare the endolymphatic spaces between Menieres disease(MD)group and normal volunteer group. Methods Patients were performed administration of gadolinium to mid-ear affected by MD via non-invasive method through eustachian tube, and then performed 3D-FLAIR MRI scanning afer one day. After measurement and calculation, the RV and RC(area of endolymphatic space divided by total lymphatic space in vestibule and cochlea, respectively)between the MD group and the normal group were compared. Results The endolymphatic spaces were distinct from perilymphatic spaces in vestibule and cochlea, the average of RV was 0.39, and the standard deviation of RV was 0.07; the average of RC was 0.16, and the standard deviation of RC was 0.05. RV of the MD group had significant difference compared to that of the normal group(t=-6.07, P<0.05); RC of the MD group had no significant difference compared to that of the normal group(t=0.783, P>0.05). According to diagnosis standard raised by Liu F in previous research, the positive ratio of RV was 42.9%, while the positive RC was 9.52%. The two patients during attack period both had positive RVs. Conclusion RV of the MD group had significant difference compared to that of the normal group; RC of the MD group had no significant difference compared to that of the normal group.

Evaluation of hearing levels, speech functions and cognitive abilities of cochlear implantation in deaf children with abnormal white matter.

J Otolaryngol Ophthalmol Shandong Univ. 2017, 31(2):  43-48.  doi:10.6040/j.issn.1673-3770.0.2017.018

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Objective To analyze the feasibility cochlear implantation(CI)for deaf children with abnormal white matter and to compare their hearing levels, speech function, cognitive abilities before and after surgery. Methods Six deaf children with abnormal white matter among 425 patients who had received CI from November 2012 to April 2015 in our department were selected as the experimental group, and another 6 patients with normal white matter at almost the same time were enrolled as the control group. The outcome of speech functions in the experimental group before and after surgery were compared. Statistical analysis was conducted by repeated measures analysis of variance, Rank sun test, t test and Chi-squared test with the hardware SPSS19.0. Results (1) Statistical significances in meaningful auditory integration scale(MAIS), categories of auditory performance(CAP)and speech intelligibility rating(SIR)were found 山东大学耳鼻喉眼学报31卷2期 -董健菲,等.合并脑白质异常聋儿人工耳蜗植入后听力言语及认知能力评估分析 \=-in the experimental group before and after surgery. (2) No statistical significances in hearing threshold before and after surgery between the two groups were found. (3) No statistical significances in MAIS,CAP and SIR between the two groups were found before and after a 6-month follow-up, but statistical significances were found after a 12-month follow-up. (4) Statistical significances in Wechsler young children scale of intelligence(C-WYCSI)were found between the two groups after a 12-month follow-up. Conclusion Speech function of deaf children with abnormal white matter was significantly improved after CI. The hearing levels of deaf children with abnormal white matter are basically the same compared with deaf children with normal white matter after CI. As are result, CI could be conducted after strict examinations before operation. Nevertheless, speech functions and cognitive abilities between them were still different after a 12-month follow-up. Therefore, adequate communication with parents of deaf children whose white matter are abnormal should be done before surgery.

Construction of c-Met target chimeric antigen receptor T cells and evaluation the role on nasopharyngeal carcinoma cells.

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2017, 31(2):  49-54.  doi:10.6040/j.issn.1673-3770.0.2017.017

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Objective To construct c-Met target chimeric antigen receptors(chimeric antigen receptor, CAR)retrovirus vector and to explore its expression and effects of modified T lymphocytes on the c-Met positive nasopharyngeal carcinoma cells. Methods Genetic engineering method was used to construct the c-Met scFv, and then the c-Met scFv was inserted into retrovirus vector containing signaling molecules such as CD28, CD137 and CD3ζ.The build c-Met CAR retrovirus vector was confirmed by sequencing. Western blotting was used to analyze c-Met CAR expression in T lymphocyte after the virus vector infected T lymphocyte. CCK8 assay was employed to detect the cytotoxicity against the nasopharyngeal carcinoma cell lines, and changes of IFN-γ and IL-2 was analyzed by ELISA after c-Met CAR-T co-culture with nasopharyngeal carcinoma cells. Results The sequencing result showed that the c-Met CAR vector sequences were right. Western blotting could detect the expression of CD3ζ. CCK-8 assay indicated that c-Met CAR-T cells suppressed proliferation of nasopharyngeal carcinoma cells, and ELISA assay demonstrated that c-Met CAR-T cells could effectively release IFN-γ and IL-2 with the help of nasopharyngeal carcinoma cells. Conclusion c-Met CAR retrovirus vector was established successfully. The CAR could be expressed by the vector in T cells. c-Met CAR-T inhibited proliferation of c-Met positive nasopharyngeal carcinoma cells and increased the secretion of IFN-γ and IL-2.

Effects of concurrent chemotherapy and radiotherapy on the quality of life in children and adolescents with nasopharyngeal carcinoma.

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2017, 31(2):  55-58.  doi:10.6040/j.issn.1673-3770.0.2016.409

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Objective To investigate the effects of concurrent chemotherapy and radiotherapy on the quality of life and adverse reactions in children and adolescents with nasopharyngeal carcinoma. Methods A total of 21 children and adolescents with nasopharyngeal carcinoma treated with concurrent chemotherapy and radiotherapy were surveyed with Pediatric Quality of Life Inventory 4.0 Generic Core Scales(Peds QL^TM4.0)and Pediatric Quality of Life Inventory 3.0 Cancer Module(Peds QL^TM3.0)questionnaires. The quality of life scores were calculated and toxic reactions were observed. Results After proper periods of concurrent chemoradiotherapy, patients’ quality of life dropped. In Peds QL^TM4.0, the scores of physical, emotional and school functioning dimensions were markedly reduced(P<0.01), especially the school functioning item. In Peds QL^TM3.0, such dimensions as pain, nausea, procedure anxiety, cognitive and communication were markedly lowered(P<0.01). Adverse reactions mainly included skin damage, mouth mucitis, dry mouth, nausea, vomiting and neutropenia. Conclusion More attention should be attached to childrens self-reported quality of life. The adverse reactions of concurrent chemoradiotherapy can significantly affect the quality of life. Targeted interventions are supposed to be taken to improve patients’ quality of life.

Comparison of self-made metal rod and bipolar coagulation in the treatment of bleomycin-aorta hemorrhage following nasal septum deviation correction.

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2017, 31(2):  59-61.  doi:10.6040/j.issn.1673-3770.0.2016.487

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Objective To explore the effect of self-made metal rod and bipolar electrocoagulation in palate aorta hemostasis during nasal septum correction. Methods A total of sixty patients who underwent nasal septum orthopedic surgery in our hospital from May 2013 to August 2016 were randomly divided into two groups according to the order of admission. Group A(n=30)was treated with a round rod, which was used to punch the maxillary palatine artery. Group B(n=30)was treated with bipolar electrocoagulation to stop bleeding of the maxillary palatine artery. The amount of bleeding and hemostasis time of the two groups were compared. Results The hemostasis cost 1.93±0.94 min in group A and 5.96±1.62 min in group B, respectively. Group A had bleeding(25.5 amp 10.5)mL and group B had(72 amp 17.6)mL. No one had hematoma in group A and 3 had hematoma in group B. Conclusion The self-made metal rod for palate aorta hemostasis during nasal septum correction has advantages of less blood loss, less secondary hemorrhage of the posterior palate artery and high economy, and it is worthy of promotion in the clinic application.

Application of inferior nasal concha sequential surgery in the treatment of chronic hypertrophic rhinitis.

J Otolaryngol Ophthalmol Shandong Univ. 2017, 31(2):  62-66.  doi:10.6040/j.issn.1673-3770.0.2016.295

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Objective To explore the application value of inferior nasal concha sequential surgery in the treatment of chronic hypertrophic rhinitis, so as to provide a optimized inferior nasal concha surgical protocol for clinical treatment. Methods A total of 109 patients with hypertrophic rhinitis were randomly enrolled and divided into sequential surgery group(n=54)and single plasma treatment group(n=55). The severity degree of rhinobyon, nasal stuffy, rhinocnesmus, mycteroxerosis, nasal pain, and nasal discomfort, visual analogue scale(VAS)score and Lund-Kennedy endoscope scores were recorded 2 weeks, 2 months and 6 months after the treatment. Results There was no significant difference between two groups in Lund-Kennedy endoscope score after treatment for 2 and 6 months respectively(P>0.05), but the difference was significant after 2-week treatment(P<0.05). Sequential surgery group was markedly lower in the total Lund-Kennedy endoscope score than single plasma treatment group. There were significant differences between the two groups in the severity scores of VAS like rhinobyon, nasal stuffy, rhinocnesmus and running nose(P<0.05), and the differences in the severity scores of VAS like mycteroxerosis, nasal pain, and nasal discomfort were also significant(P<0.05). Sequential surgery group was markedly lower in the total VAS score than single plasma treatment group. Conclusion Both groups have obtained satisfactory efficacy in the treatment of hypertrophic rhinitis. There is no significant difference between the two groups in objective Lund-Kennedy endoscope evaluation score. According to subjective VAS evaluation, sequential surgery group is evidently better than single plasma treatment group in clinical efficacy. Inferior nasal concha sequential surgery has excellent clinical efficacy in the treatment of chronic hypertrophic rhinitis, and also has significant advantages in protecting the physical function of inferior nasal concha and avoiding patients’ postoperative subjective discomfort.

Curcumin combined with resveratrol enhances their anti-tumoral effects in the head and neck carcinoma.

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2017, 31(2):  67-72.  doi:10.6040/j.issn.1673-3770.0.2016.425

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Objective To study the effect of curcumin in combination of resveratrol on proliferation in the head and neck neoplasm cell lines. Methods Hep2 cells and FaDu cells were treated with Curcumin and resveratrol. MTT was used to determine cell proliferation. Colony formation was used to detect the cell viability. Hoechst 33258 staining was performed to observe the cell apoptosis. The mRNA expressions of Bax and Bcl-2 were analyzed by Real-time PCR. Results Hep2 and FaDu cell proliferation could be inhibited with curcumin and resveratrol in a dose-dependent manner. Their combination exhibited the best inhibitory effects. Curcumin combined with resveratrol exhibited colony repression and showed a more significant apoptosis in Hep2 and FaDu cells. Real-time PCR demonstrated that Bax mRNA was upregulated and Bcl-2 mRNA was downregulated by curcumin and resveratrol. Meanwhile, Bax mRNA was upregulated and Bcl-2 mRNA was downregulated by curcumin and resveratrol. Conclusion The combination of curcumin and resveratrol can inhibit the proliferation of Hep2 and FaDu cells more significantly. The potential mechanism may be related with the up-regulation of Bax and the down-regulation of Bcl-2.

Efficacy of mometasone furoate and Yupingfeng particles for adenoid hypertrophy in children.

J Otolaryngol Ophthalmol Shandong Univ. 2017, 31(2):  73-76.  doi:10.6040/j.issn.1673-3770.0.2016.504

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Objective To explore the efficacy of Mometasone furoate and Yupingfeng particles in adenoid hypertrophy in children. Methods A total of 90 children aged 4-10 years completed 8 weeks treatment were enrolled in a prospective and randomized controlled study. The symptoms and degree of obstruction were evaluated by nasopharyngoscopy conducted pre-treatment and 8weeks post-treatment. Subjects received Mometasone furoate nasal spray alone at a daily dose of 200 μg or combination with Yupingfeng particles by a dose of 5 g twice a day for 8 weeks. Actual data were compared between the two groups. Results With Mometasone treatment, there was an 19.5 percent reduction in total clinical symptom score, and the degree of obstruction dropped from 82.2 to 73.6 percent(P<0.01). With Mometasone and Yupingfeng particles treatment, there was a 31.7 percent reduction in total clinical symptom score, and the degree of obstruction dropped from 85.4 to 71.4 percent(P<0.01). A statistically significant incidence of upper respiratory tract infection was seen in patients treated with Mometasone furoate nasal spray and Yupingfeng particles(16.7%)as compared with Mometasone alone(44.2%). Conclusion Mometasone furoate appears to be effective in treating children with adenoid hypertrophy. In combination with Yupingfeng particles, it can reduce the incidence of upper respiratory tract infection.

Surgical treatment of laryngotracheal stenosis.

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2017, 31(2):  77-82.  doi:10.6040/j.issn.1673-3770.0.2016.433

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Objective To explore the operation method and curative effect of laryngeal tracheal stenosis. Methods A retrospective analysis of 16 cases of laryngotracheal stenosis surgery hospitalized in 2009-2015 in the department of otorhinolaryngology, Qianfoshan Hospital of Shandong Province, including 3 cases of laryngotracheal blunt contusion, 1 case of laryngeal papilloma recurrent postoperative stenosis and 1 case of laryngeal cancer following resection of granulation formation were implemented to support CO₂ laser under laryngoscopy. 1 case of laryngeal squamous cell carcinoma, 1 case of adenoid cystic adenoma and 1 case of adenoid cystic carcinoma of the trachea were removed under nasal endoscopy. 1 case of long time endotracheal intubation tracheal stenosis and 1 case of cystadenocarcinoma received tracheal sleeve resection of trachea anastomosis. 1 case of tracheal adenoid cystic carcinoma, 2 cases of thyroid carcinoma and 1 case of tracheal trauma were performed laryngotracheal reconstruction. 1 case of esophageal cancer with advanced laryngeal stenosis and 1 case of laryngeal and tracheal trauma in elderly patient were performed nickel titanium memory alloy stent implantation. Results All were followed up in a duration of 12 -24 months. Except that 2 cases were unable to successfully extubated and were lost after discharge, of which 1 case of laryngotracheal reconstruction placed T tube had still granulation growth and 1 case of nitinol stent implantation after rejection was removed the stent, others were successfully extubated. Conclusion The surgical treatment on laryngotracheal stenosis can obtain good results according to the narrow position and degree.

Coblation for benign hyperplasia of the tongue base.

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2017, 31(2):  83-84.  doi:10.6040/j.issn.1673-3770.0.2016.499

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Objective To explore the clinical effects of coblation for hyperplasia of the tongue base. Method A total of 40 cases using low-temperature plasma during the period of January 2015 to December 2016 were retrospectively analyzed. Subjective symptoms such as pharyngeal pain, pharyngeal foreign body sensation and swallowing barrier were assessed before the operation and 2 weeks, 6 months after the operation via VAS scores. Results All patients had a small amount of bleeding or no bleeding during surgery and no postoperative wound bleeding. The VAS score of preoperative subjective symptoms was 38.8±5.94. At 2-week follow-up after surgery, the VAS score was 7.50±2.96, and difference between the two groups was statistically significant. At 6-month follow-up, the wound surface was smooth and no recurrence was observed. The VAS score was 7.25±2.67 and there was no statistical difference between 2-week follow-up and 6-month follow-up. Conclusion Low temperature plasma in the treatment of tumor of the tongue has obvious therapeutic effects of less bleeding, postoperative pain and complications.

Clinical analysis of 18 patients with laryngeal tuberculosis.

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2017, 31(2):  85-89.  doi:10.6040/j.issn.1673-3770.0.2016.380

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Objective To analyze the clinical characteristics and diagnostic points of 18 patients with laryngeal tuberculosis. Methods The clinical data of 18 patients with laryngeal tuberculosis were retrospectively analyzed in Tianjin First Center Hospital. Results The major manifestations of laryngeal tuberculosis include hoarseness, sore throat, foreign body sensation in the throat, dysphagia, hemoptysis and cough, but the general symptoms were not obvious. The throat was characterized by pale swelling, proliferative nodules, and ulcerative erosion. According to the results of chest computed tomography(CT)or X radiography, 10 patients had pulmonary tuberculosis, but did not receive anti-tuberculosis treatment. One of 9 patients undergoing sputum smear acid-fast staining was shown positive. Through pathological examination, 6 out of 14 patients were found gram-positive bacteria, and the positive rate was 42.9%. There was 1 patient with laryngeal tuberculosis and laryngocarcinoma after all the diagnosed patients were given anti-tuberculosis treatment in Tuberculosis Dispensary. Conclusion Laryngeal tuberculosis is closely related to lung tuberculosis, and is easily caused by the respiratory tract of patients with pulmonary tuberculosis in Tianjin. Laryngeal tuberculosis tends to be missed diagnosis and misdiagnosed due to atypical general symptoms. Pathological biopsy under the fibrolaryngoscope or general anesthesia should be taken as a major method to make the accurate diagnosis.

Effects of PGMS on the expression of vascular endothelial growth factor in the rat of diabetic retinopathy.

J Otolaryngol Ophthalmol Shandong Univ. 2017, 31(2):  90-95.  doi:10.6040/j.issn.1673-3770.0.2016.146

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Objective To investigate the influence of propylene glycol mannate sulfate(PGMS)on the expression of vascular endothelial growth factor(VEGF)in diabetic retinopathy(DR)by a rat model, to study the mechanism of PGMS againstDR, and to provide a reliable theoretical and experimental evidence for the PGMs to be applied to clinical prevention and treatment of DR. Methods Male Wistar rats were randomized into the normal control group, the diabetic control group and the PGMS group. The PGMS group was subdivided into the low-dose PGMS group and high-dose PGMS group, with doses of 50 mg/kg and 100 mg/kg, respectively. The 1% Streptozotocin(STZ)of 60 mg/kg was intraperitoneally injected in rats to establish the diabetic models. The PGMS with the doses of 50 mg/kg and 100 mg/kg were used to gavage in different groups of models for 12 weeks. Twelve weeks later, the animals were sacrificed and retinas were isolated. The aqueous humor and serum were taken, expressions of VEGF protein in retina, aqueous humor and serum were detected by ELISA, respectively. The location and the expression of VEGF protein in 山东大学耳鼻喉眼学报31卷2期 -周玮琰,等.甘糖酯对糖尿病大鼠视网膜病变中血管生成因子VEGF表达的影响 \=-retina tissue was detected by immune-histochemistry. Real-time RT-PCR was used to measure the expression of VEGF mRNA in retinas. Results Twelve weeks after the use of PGMS,the level of blood glucose was not changed. ELISA showed that the expression of VEGF protein in serum was not significantly changed in different groups(P>0.05), but the expression of VEGF protein in aqueous humor and retina was significantly increased in diabetic control group than normal control group(P<0.05), but the groups which PGMS was given reduced, lower than that DM group, showing statistically significant differences(P<0.05). Immunohistochemistry showed that the VEGF protein was almost not expressed in normal control group, but the VEGF protein was highly expressed in diabetic control group. The expression mainly located in the ganglion cell layer, the inner plexiform layer, outer nuclear layer. The VEGF protein was weakly expressed at the group of PGMS. Real-time RT-PCR showed the expression of VEGF mRNA was lower in normal control group. The expression of VEGF mRNA in diabetic control group was almost 2.12 times than normal control group. The expression was decreased obviously in the group of PGMS. Conclusion PGMs has a good control effect on early diabetic retinopathy. PGMS can treat the diabetic retinopathy by downregulating the expressions of VEGF in early diabetic retinopathy.

Clinical observation on the treatment of CSME and NCSME by intravitreal injection of ranibizumab.

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2017, 31(2):  96-98.  doi:10.6040/j.issn.1673-3770.0.2017.033

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Objective To explore the clinical efficacy of clinically significant macular edema(CSME)and non-clinically significant macular edema(NCSME)treated with Ranibizumab intravitreal injection. Methods A total of 77 BRVO-ME cases were divided into 2 groups: CSME group(n=51)and NCSME group(n=26). The two groups received Ranibizumab intravitreal injection. Best corrected visual acuity(BCVA)and highest thickness of macular edema of the two groups were observed. Results One months after treatment, BCVA of the two groups were improved(P<0.05). No significant difference between two groups was found in the highest thickness of macular edema(P>0.05). Conclusion Ranibizumab intravitreal injection can improve visual acuity and reduce the highest thickness of macular edema in patients with CSME and NCSME. The highest thickness of macular edema can not completely reflect the visual acuity.

Influencing factors of tonometry of intraocular pressure following LASIK.

J Otolaryngol Ophthalmol Shandong Univ. 2017, 31(2):  99-103.  doi:10.6040/j.issn.1673-3770.0.2016.458

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Objective To establish and validate the regression formula of intraocular pressure(IOP)by analyzing the influencing factors of IOP following laser assisted in situ keratomileusis(LASIK). Methods A prospective case study was performed on 235 myopia patients receiving LASIK. After self-contrast of randomized paired design, the influencing factors of IOP noncontact tonometer(IOP_NCT)were analyzed. The multiple regression formula to forecast the changes of IOP_NCT after LASIK was established and verified. Results The preoperative IOP_NCT was not related to gender, dominant eye, age or keratometry of the patients(P>0.05), but positively related to the central corneal thickness(CCT)and absolute value of spherical equivalent. The IOP_NCT changes after LASIK(△IOP_NCT)were not related to age, keratometry or stroma bed thickness of the patient(P>0.05), but positively related to the preoperative IOP_NCT, CCT, ablation depth, ablation rate(AR)and absolute value of spherical equivalent. The multiple linear regression formula of the IOP_NCT changes after LASIK was: △IOP_NCT = IOP_NCT-preop×0.552 + AR×0.158-6.219(R2=0.561, P<0.01). After Verification by practical cases, there was no statistically significant difference between the estimated values and measured values of the IOP_NCT changes after LASIK(t=-0.129, P=0.897). Conclusion The IOP_NCT of pre-LASIK is not related to gender, dominant eye, age or keratometry of the patient, but positively related to the central corneal thickness and absolute value of spherical equivalent. The △IOP_NCT is not related to age, keratometry or stroma bed thickness of the patient, but positively related to the IOP_NCT of pre-LASIK, central corneal thickness, absolute value of spherical equivalent, ablation depth and rate. The values of △IOP_NCT can be estimated by the regression formula.

Efficacy and safety of EX-PRESS implanation versus trabeculectomy for open-angle glaucoma: a meta-analysis.

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2017, 31(2):  104-111.  doi:10.6040/j.issn.1673-3770.0.2016.230

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Objective To evaluate the efficacy and safety of EX-PRESS implantation(EX-PRESS)compared with trabeculectomy(Trab)in open-angle glaucoma(OAG). Methods Databases including PubMed, EMbase, CNKI, VIP and WanFang Data were electronically searched for all randomized controlled trials(RCTs)about comparing the efficacy and safety between EX-PRESS implantation and trabeculectomy in open-angle glaucoma before the date of March 31, 2016. Two reviewers independently screened literature according to the inclusion and exclusion criteria, and evaluated the included studies. Then, meta-analysis was performed using RevMan5.3 software. Results A total 7 RCTs involving 447 patients with 462 eyes were included, 234 eyes in the EX-PRESS group and 228 eyes in the Trab group. The results of meta-analysis showed that there was significant difference between EX-PRESS and Trab in the postoperative 6 months and 1 year IOPR% ［WMD=-7.67, 95%CI(-14.85, -0.50), P=0.04］ and ［WMD=11.38, 95%CI(1.55, 21.22, P=0.02］, there was no significant difference between EX-PRESS and Trab in 24 months and end of follow-up after surgery IOPR%. The pooled OR was ［OR=2.29, 95%CI(1.27, 4.13), P=0.006］ comparing EX-PRESS with Trab for the complete success rate at one year after surgery and there was no significant difference between Ex-PRESS and Trab in the qualified success rate at one year after surgery ［OR=1.59, 95%CI(0.73, 3.44), P= 山东大学耳鼻喉眼学报31卷2期 -王越,等.EX-PRESS引流器植入术与小梁切除术治疗开角型青光眼有效性和安全性的Meta分析 \=-0.24］ and the number of anti-glaucoma medication ［WMD=-0.10, 95%CI(-0.36, 0.17), P=0.48］. But postoperative 2 year visual acuity ［WMD=-0.12, 95%CI(-0.23,-0.00), P=0.04］ had difference compared EX-PRESS with Trab. The pooled ORs of shallow or flat anterior chamber, hypotony, encapsulated bleb, wound leak, and choroidal effusion respectively was ［OR=1.43, 95%CI(0.71, 2.87), P=0.32］, ［OR=1.03, 95%CI(0.54, 1.96), P=0.94］, ［OR=0.25, 95%CI(0.05, 1.25), P=0.09］, ［OR=0.96, 95%CI(0.35, 2.64), P=0.94］, and ［OR=0.69, 95%CI(0.28, 1.72, P=0.43］ compared EX-PRESS with Trab. But EX-PRESS compared to Trab, with pooled ORs of hyphema ［OR=0.13, 95% CI(0.04, 0.42), P=0.0006］. Conclusion Trab had a better effect in IOPR% at 6 months after surgery, but EX-PRESS had a better effect in 1 year after surgery. But EX-PRESS surgery complete success rate was higher and EX-PRESS was associated with a significantly lower frequency of the hyphema compared to trabeculectomy. Moreover, Trab got better recovery of visual acuity. And there was no difference in the number of anti-glaucoma medication for the people need medications control the IOP between the two surgeries.

Progress of tight junctions and chronic rhinosinusitis.

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2017, 31(2):  112-115.  doi:10.6040/j.issn.1673-3770.0.2017.042

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Chronic rhinosinusitis(CRS)is a common inflammatory disease. TJs are the most apically located of the intercellular junctional complexes, and may have critical role in barrier function of epithelium. Found in the recent years, the changes of tight junctions(TJs)may play important roles in the pathogenesis of chronic rhinosinusitis. The component of TJs are the spot-light in current area of research. This review article explores the pathogenesis of CRS, especially the tight junctions, for the sake of further understanding of CRS.

Advances in clinical diagnosis and treatment of sinonasal mucosal malignant melanoma.

J Otolaryngol Ophthalmol Shandong Univ. 2017, 31(2):  116-120.  doi:10.6040/j.issn.1673-3770.0.2016.293

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Sinonasal mucosal malignant melanoma(SMMM)is a rare sinonasal malignant tumor. Due to the atypical symptoms, most patients were diagnosed as the advanced stage, and the 5-year survival rate is limited to 20%-30%. Pathology is the gold standard for diagnosis. Black pigment particles found in the tissue cells can help the diagnosis; for the non-pigmented melanoma, immunohistochemistry can help to identify the diagnosis. Compared with Ballantyne staging, the 7th edition of American Joint Committee on Cancer(AJCC)malignant melanoma tumor node metastasis(mmTNM)staging may be more suitable for SMMM. At present, the surgical treatment is the first choice for early SMMM, and a comprehensive treatment method, such as surgery combined with radiotherapy and biochemotherapy is favorable to improving the survival rate of patients.

Gargle with sodium bicarbonate solution combined with nystatin suspension atomization inhalation in 32 cases of mycotic pharyngitis.

J Otolaryngol Ophthalmol Shandong Univ. 2017, 31(2):  121-122.  doi:10.6040/j.issn.1673-3770.0.2016.115

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Castlemans disease in the neck: two cases report.

JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2017, 31(2):  123-126.  doi:10.6040/j.issn.1673-3770.0.2016.226

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