Acupuncture combined with auricular point sticking for girls aged 3-8 years with incomplete precocious puberty: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the efficacy and safety of acupuncture combined with auricular point sticking for girls aged 3-8 years with incomplete precocious puberty (IPP).@*METHODS@#Sixty girls with IPP were randomly divided into an observation group (30 cases, 2 cases dropped off) and a control group (30 cases, 2 cases were eliminated). The girls in the control group were treated with healthy diet and proper exercise for 12 weeks. On the basis of the treatment in the control group, the girls in the observation group were treated with acupuncture combined with auricular point sticking. The acupuncture was applied at Sanyinjiao (SP 6), Guanyuan (CV 4), Guilai (ST 29), etc., the needles were retained for 20 min, acupuncture was given twice a week (once every 3 days). The auricular point sticking was applied at Luanchao (TF2), Neishengzhiqi (TF2), Neifenmi (CO18), Yuanzhong (AT2,3,4i), etc., twice a week. The treatment was given for 12 weeks. Before treatment, after treatment and in follow-up after 12 weeks of treatment completion, the Tanner stage of breast, serum contents of sex hormone (luteinizing hormone [LH], follicle-stimulating hormone [FSH], estradiol [E2]) were observed. The ovarian volume, the number of follicles with diameter>4 mm, and the uterine volume were measured by abdominal color Doppler ultrasound. In addition, the safety of the observation group was evaluated.@*RESULTS@#Compared with before treatment, the Tanner stage of breast in the observation group was improved after treatment and in follow-up (P<0.05); after treatment and in follow-up, the Tanner stage of breast in the observation group was better than that in the control group (P<0.05). Compared with before treatment, the serum levels of LH and E2 in the observation group were increased (P<0.05), and the volume of bilateral ovaries was larger (P<0.05) in follow-up. Compared with before treatment, the serum contents of LH, FSH and E2 in the control group were increased (P<0.05), the volume of bilateral ovaries was larger (P<0.05), and the number of follicles was increased (P<0.05) after treatment and in follow-up. The serum levels of LH, FSH and E2 in the observation group were lower than those in the control group (P<0.05), the volume of bilateral ovaries was smaller than that in the control group (P<0.05), and the number of follicles was lower than that in the control group (P<0.05). Compared with before treatment, the uterine volume in the two groups was larger in follow-up (P<0.05). There was no statistically significant difference between the two groups after treatment and in follow-up (P>0.05). During the treatment, 3 cases in the observation group had slight abdominal pain and subcutaneous blood stasis, without serious adverse reactions.@*CONCLUSION@#Acupuncture combined with auricular point sticking could improve the Tanner stage of breast, reduce the level of sex hormone, slow down the development and maturation of ovary and follicle, and control the degree and speed of sexual development in girls aged 3-8 years with IPP.

Ethanol extract of Herpetospermum caudigerum Wall ameliorates psoriasis-like skin inflammation and promotes degradation of keratinocyte-derived ICAM-1 and CXCL9 / 中西医结合学报

OBJECTIVE@#To explore whether the ethanol extract of Herpetospermum caudigerum Wall (EHC), a Xizang medicinal plant traditionally used for treating liver diseases, can improve imiquimod-induced psoriasis-like skin inflammation.@*METHODS@#Immunohistochemistry and immunofluorescence staining were used to determine the effects of topical EHC use in vivo on the skin pathology of imiquimod-induced psoriasis in mice. The protein levels of interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), and interleukin-17A (IL-17A) in mouse skin samples were examined using immunohistochemical staining. In vitro, IFN-γ-induced HaCaT cells with or without EHC treatment were used to evaluate the expression of keratinocyte-derived intercellular cell adhesion molecule-1 (ICAM-1) and chemokine CXC ligand 9 (CXCL9) using Western blotting and reverse transcription-quantitative polymerase chain reaction. The protein synthesis inhibitor cycloheximide and proteasome inhibitor MG132 were utilized to validate the EHC-mediated mechanism underlying degradation of ICAM-1 and CXCL9.@*RESULTS@#EHC improved inflammation in the imiquimod-induced psoriasis mouse model and reduced the levels of IFN-γ, TNF-α, and IL-17A in psoriatic lesions. Treatment with EHC also suppressed ICAM-1 and CXCL9 in epidermal keratinocytes. Further mechanistic studies revealed that EHC suppressed keratinocyte-derived ICAM-1 and CXCL9 by promoting ubiquitin-proteasome-mediated protein degradation rather than transcriptional repression. Seven primary compounds including ehletianol C, dehydrodiconiferyl alcohol, herpetrione, herpetin, herpetotriol, herpetetrone and herpetetrol were identified from the EHC using ultra-performance liquid chromatography-quadrupole-time of flight-mass spectrometry.@*CONCLUSION@#Topical application of EHC ameliorates psoriasis-like skin symptoms and improves the inflammation at the lesion sites. Please cite this article as: Zhong Y, Zhang BW, Li JT, Zeng X, Pei JX, Zhang YM, Yang YX, Li FL, Deng Y, Zhao Q. Ethanol extract of Herpetospermum caudigerum Wall ameliorates psoriasis-like skin inflammation and promotes degradation of keratinocyte-derived ICAM-1 and CXCL9. J Integr Med. 2023; 21(6): 584-592.

Analysis of complications and outcomes of tracheotomy with different etiology in children / 中华耳鼻咽喉头颈外科杂志

Objective: To discuss the complications and postoperative outcomes of tracheotomy with different etiology in children. Methods: One hundred and eighty-six patients underwent tracheotomy were retrospectively analyzed from January 2016 to December 2018,including 117 males and 69 females. The children aged from 4 days to 14 years (median age 31.5months). One case was operated under local anesthesia in emergency room, 2 cases were operated under local anesthesia in pediatric intensive care unit, the rest 183 cases were operated under general anesthesia in operation room. The 186 children were divided into four groups according to their direct causes of tracheotomy. Group A(90 cases): Neuromuscular disease and severe infection,Group B(26 cases): Head and neck tumor,Group C(57 cases): Congenital malformation and upper airway obstruction,Group D(13 cases): Accidental injury. The basic information, surgical complications and postoperative outcomes were recorded and analyzed. All patients were followed up by clinic or by telephone. Spss 19.0 software was used for statistical analysis. Results: One hundred and eighty-six patients were followed up for one to four years. 33 children lost the follow-up and 46 died. Among the 186 patients, 23 cases had emergency tracheotomy (12.4%). The rate of emergency tracheotomy in group C(16 cases, 28.1%) was higher than that in the other three groups(χ2=28.08,P<0.05). The average age of patients and hospital stay in group C were significantly lower than those in the other three groups (F=33.76,P<0.05; F=14.95,P<0.05). Incision bleeding occurred in 11 cases, Subcutaneous emphysema occurred in 6 cases and accidental decannulation occurred in 10 cases (4 cases within 2 weeks and 6 after 2 weeks). Six patients underwent tracheocutaneous fistula closure operation after decannulation and the stoma healed spontaneously in other extubated children. Two patients underwent secondary tracheotomy due to accidental decannulation, and three patients underwent secondary tracheotomy for dyspnea after decannulation. In 107 cases of survival children, decannulation was successful in 65 patients and failed in 42 patients. The average duration of wearing tracheal tube was 8.8 months. The decannulation rates in the four groups were 55.6%, 45%, 69% and 77.8%, with no significant difference. Conclusions: The complications after tracheotomy in children are rare, and no severe complications occurred in long-term tracheotomy patients. The duration of wearing tracheal tube is related to the treatment of their primary disease.

Therapeutic efficacy observation on auricular point sticking therapy for cardiac syndrome X in women / 针灸推拿医学（英文版）

Objective: To observe the clinical effect of auricular point sticking therapy for cardiac syndrome X (CSX) in women. Methods: A total of 64 patients were randomized into two groups by the random number table, with 32 cases in each group. Patients in the control group received conventional treatment for angina, while patients in the treatment group received auricular point sticking therapy on the basis of conventional treatment. After 8 weeks of treatment, the levels of serum estradiol (E2), nitric oxide (NO) and endothelium-1 (ET-1) were compared to evaluate the therapeutic effect. Results: After 8 weeks of treatment, the total effective rate and markedly effective rate in the treatment group were significantly higher than those in the control group, and the between-group comparisons showed statistical significance (both P<0.05). After treatment, the scores of chest pain and tightness in the control group dropped significantly, and the intra-group comparisons showed statistical significance (both P<0.05); the scores of chest pain and tightness, palpitations, weakness and shortness of breath in the treatment group dropped significantly, and the intra-group comparisons showed statistical significance (all P<0.05); there were significant inter-group differences in the scores of chest pain and tightness. After treatment, the intra-group comparisons of E2, NO and ET-1 contents in the control group showed no statistical significance (all P>0.05), while the E2, NO and ET-1 contents in the treatment group changed significantly after treatment and were significantly different from those in the control group (all P<0.05). Conclusion: Auricular point sticking on the basis of conventional treatment was effective for CSX in women, and is worth clinical application.

Pneumomediastinum Secondary to Foreign Body Aspiration: Clinical Features and Treatment Explorement in 39 Pediatric Patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pneumomediastinum (PM) secondary to foreign body aspiration (FBA) is rare in children. Although it is mainly benign, some cases may be fatal. Due to the rare nature of this clinical entity, proper assessment and management have been poorly studied so far. Here, we characterized the presentation and management of this clinical entity and provided an evaluation system for the management.</p><p><b>METHODS</b>We retrospectively reviewed children with PM secondary to FBA, who were treated in Beijing Children's Hospital from January 2010 to December 2015. All patients were stratified according to the degree of dyspnea on admission, and interventions were given accordingly. Bronchoscopic removals of airway foreign bodies (FBs) were performed on all patients. For patients in acute respiratory distress, emergent air evacuation and/or resuscitations were performed first. Admission data, interventions, and clinical outcomes were recorded.</p><p><b>RESULTS</b>A total of 39 patients were included in this study. The clinical severity was divided into three grades (Grades I, II, and III) according to the degree of dyspnea. Thirty-one patients were in Grade I dyspnea, and they simply underwent bronchoscopic FBs removals. PM resolved spontaneously and all patients recovered uneventfully. Six patients were in Grade II dyspnea, and emergent drainage preceded rigid bronchoscopy. They all recovered uneventfully under close observation. Two exhausted patients were in Grade III dyspnea. They died from large PM and bilateral pneumothorax, respectively, despite of aggressive interventions in our hospital.</p><p><b>CONCLUSIONS</b>PM secondary to FBA could be life-threatening in some patients. The degree of dyspnea should be evaluated immediately, and patients in different dyspnea should be treated accordingly. For patients in Grade I dyspnea, simple bronchoscopic FBs removals could promise a good outcome. For patients in Grade II dyspnea, emergent air evacuation and/or resuscitation should precede a bronchoscopy before the children become exhausted.</p>

Chemical constituents from Goldfussia pentstemonoides / 中草药

Objective: To study the chemical constituents from the whole plant of Goldfussia pentstemonoides. Methods: The compounds were separated and purified by chromatographic methods. The structures were identified by spectroscopic analyses. Results: Ten compounds were isolated from the n-butanol fraction of 95% ethanol extract in the whole plants of G. pentstemonoides and identified as salidroside (1), 1-(α-L-rhamnosyl-(1→6)-O-β-D-glucopyranosyloxy)-3,4,5-trimethoxybenzene (2), isoacteoside (3), isonuomioside A (4), benzyl-O-β-D-glucopyranoside (5), lcariside F2 (6), (-)-lyoniresinol 3α-O-β-D-glucopyranoside (7), (+)-isolariciresinol-9-O-β-D-glucopyranoside (8), decaffeoylverbascoside (9), and dehydrodiconiferyl alcohol 4-O-β-D-glucopyranoside (10). Conclusion: All compounds are isolated from G. pentstemonoides for the first time.

Development of allergic rhinitis and its impact on asthma: 4-5 year follow-up study of preschool children / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To observe the development of allergic rhinitis (AR) in preschool children, and the variation of sensitization to airborne allergens 5 years later, also the link between AR and asthma.</p><p><b>METHODS</b>Two hundred and fourty-eight children with AR (AR group) and 217 non-AR children (non-AR group) were surveyed using a questionnaire and examined by otolaryngologists with skin prick test (SPT) between 2006 and 2007. Among them, 63 children were asked to return to hospital to participate in a routine ENT examination and SPT for common inhalant allergens. All statistical analysis was performed by a professional statistician using SPSS 17.0 statistical software.</p><p><b>RESULTS</b>Two hundred and sixteen questionnaires were acquired in AR group and 156 questionnaires were acquired in non-AR group. (1) The remission of AR occurred in 37.0% (80/216) 5-years later, 70.0% (56/80) children who had remission of AR symptoms received the correct medication; there was only 49.3% (67/136) children who had nonremission of AR symptoms received the correct medication, and there was a statistically significant difference (χ(2) = 0.114, P = 0.736). (2) Asthma prevalence was increased from 12.5% (27/216) to 14.8% (32/216) in AR group children, there was no statistically significant difference (χ(2) = -0.491, P = 0.484). The prevalence of asthma was increased slightly from 2.6% (4/156) to 3.2% (5/156) in no-AR group children, there was no statistically significant difference (χ(2) = 0.114, P = 0.736). When asthma in AR group children had tendency of remission, AR could also be controlled, and there was a statistically significant difference (χ(2) = 5.423, P < 0.05). (3) The total number of sensitization allergen decreased compared to the originally test. Dermatophagoides farinae was the most common allergen in our survey, while in the originally test, Alternaria tenuis was the most common allergen. There was age-dependent tendency to sensitize to new classes of allergens was present in children with AR, the number of children sensitized to fungal was minimum.</p><p><b>CONCLUSIONS</b>Remission of AR in preschool children occurred in 37.0% 5 years later. There is a strong relationship between childhood AR and childhood asthma. Sensitization to the airborne allergens may change with age.</p>

Treatment of infantile subglottic hemangioma with oral propranolol / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To observe the efficacy of oral Propranolol in the treatment of infantile subglottic hemangioma.</p><p><b>METHODS</b>Eleven children (6 females and 5 males) with a median age at onset of treatment being 4 months were included in this study. Propranolol was given after laryngoscopy and a CT scan with contrast of the trachea confirming the presence of a subglottic hemangioma. The starting dose of Propranolol was 0.5 mg/kg per day, given in 2 or 3 divided doses. Heart rate and blood glucose were monitored during the treatment. If no side effects occurred, the dose was increased to 1 mg/kg per day at the third day and to 2 mg/kg per day at the sixth day. Treatment was continued at home after 10 days of inpatient treatment and the children were reevaluated monthly.</p><p><b>RESULTS</b>After 24 - 48 hours of treatment, all of the children had improvement in their airway obstruction which was confirmed by fibro-laryngoscopy. The diameter of the subglottic stenosis from the hemangioma decreased from 3.9 - 5.0 mm to 1.5 - 2.0 mm,and the color was also lighter than before. In 3 children with cutaneous hemangioma, there was also significant improvement in the cutaneous lesions after treatment, with the color becoming lighter. There were no significant ECG, blood pressure or blood biochemical changes during the treatment. Two of the children had hypoglycemia at the first dose, but improved after blood transfusion and changing their diet. In five children, the treatment was stopped after 6 to 11 months when the obstructive symptoms improved. None of the children in this group had any evidence of recurrence. In the 5 children who stopped treatment, the obstructing mass in the subglottis was less than 10% of the diameter.</p><p><b>CONCLUSION</b>Oral propranolol is a safe and effective treatment for infantile subglottic hemangioma. It may be used as a first-line therapeutic modality.</p>

Altered expression of matrix metalloproteinases and tight junction proteins in rats following PEMF-induced BBB permeability change / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the expression of occludin, ZO-1, MMP-2, and MMP-9 in cerebral microvasculature following Pulse Electromagnetic Field (PEMF) induced BBB permeability change.</p><p><b>METHODS</b>Sprague-Dawley rats were randomized into PEMF and sham exposed groups (n = 8). After exposure to PEMF at 0.5, 1, 3, 6, and 12 h, BBB permeability was measured by Evans-Blue extravasation. The expression of occludin, ZO-1, MMP-2, and MMP-9 were detected by real-time quantitative reverse transcriptase PCR and western blotting. MMP-2 and MMP-9 activity were detected by EnzChek gelatinase assay.</p><p><b>RESULTS</b>Compared with the sham group, PEMF exposure led to increased permeability of the BBB to EB, which was prolonged after exposure. BBB permeability became progressively more severe, and recovered at 6 h. The gene and protein expression of occludin and ZO-1 were significantly decreased, while MMP-2 and MMP-9 expression were significantly increased after exposure to PEMF. All levels of expression recovered 12 h following PEMF.</p><p><b>CONCLUSION</b>Changes to BBB permeability were related to the alteration expression of tight junction proteins and matrix metalloproteinase after exposure to PEMF.</p>

Clinical analysis of allergic rhinitis in children between 1 and 3 years of age / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the atopy spectrum and its related factors in 1 to 3 years old children with allergic rhinitis.</p><p><b>METHODS</b>Ninety-six children with allergic rhinitis, aged between 1 and 3 years old, referred to ENT department of Beijing Children's Hospital between August 2009 and November 2010 were retrospectively reviewed. Data were recorded for patients' age, age stratification, sex, the age of first symptom, the duration of history, and the allergic history of children, the allergic history of parents. The screening tests on inhalant and food allergens were conducted by immunoblot assay using the Allergy Screen system. The total serum IgE level was also measured. The distribution of the inhalant and food allergens was summarized. The influence of the clinical characteristics was analyzed according to the age subgroup determined by month, allergen category and positiveness of eczema or asthma. Logistic regression was used to analyze the relationship of clinical characteristics and allergen spectrum.</p><p><b>RESULTS</b>The total positive rates of allergic screening test rate were 81.3%. The inhalant and food allergens were 62.5% and 53.1% respectively. The commonest allergy was mixed fungal (50.0%), followed by milk (34.4%), lamb (31.3%), beef (26.0%), dust mite (21.0%), wheat (18.8%), mugwort (12.5%), egg white or egg yolk (11.5%).62.5% of patients could be diagnosed as AR, the remaining could be diagnosed temporarily as non-allergic rhinitis temporarily. Single factor analysis of clinical characteristics in different subgroup determined by month showed that: inhalant allergen (positive/negative) (χ2=13.699, P=0.001), father suffered from AR (χ2=14.060, P=0.001), and father or mother suffered from AR (χ2=7.396, P=0.025) were statistically significant at three monthly age groups. The personal history of eczema (OR=3.143, P=0.034) might increase the possibility of sensitization to allergens. The personal history of eczema (OR=3.125, P=0.015) and the total serum IgE level>200 IU/ml (OR=3.119, P=0.030) might increase the possibility of sensitization to inhalant allergens. No clinical features for food allergen sensitization was statistically significant. There was no significant difference in positive rates between inhalant and food allergens groups. The presence of inhalant allergens (OR=3.594, P=0.046), insect bites dermatitis (OR=11.941, P=0.002) were the risk factors for positiveness of eczema or asthma, and the father with AR (OR=0.251, P=0.040) as protective factors.</p><p><b>CONCLUSIONS</b>Inhalant and food allergens all can be sensitized in the children with AR symptoms between 1 to 3 years old, and the positive rate of inhalant group is slightly higher. The differences of the inhalant allergen (positive/negative) and father suffered from AR are statistically significant at three monthly age groups. The history of eczema is the risk factor for allergen screening positive. Serum total IgE>200 IU/ml and eczema history are risk factors for inhalant allergen screening positive. The factors of inhalant allergens, insect bites dermatitis and father suffered from AR relate to any positive of eczema or asthma.</p>

Study on factors related to allergic rhinitis natural course in children / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the natural course of allergic rhinitis (AR) in children and to evaluate the effect of following factors including gender, age, family history, environment and infection on AR.</p><p><b>METHODS</b>Two hundred and forty-eight children aged between 3 and 5 years-old diagnosed as AR by questionnaire and skin prick test were included in this study. These children were selected 3 years ago in Beijing suburb and urban in an epidemiological study by Beijing Children's Hospital. One hundred and eighty-eight children (boy:girl was 112:76) were followed-up and asked to re-answer the questionnaire by telephone. The follow-up rate was 75.8%. Two-time questionnaires were compared. Factors related to AR, including gender, age, residence change, degree of AR, upper respiratory tract infectious history, personal or family allergic disease history, and so on, which related with AR, were analyzed by SPSS 17.0.</p><p><b>RESULTS</b>One hundred and eighty-eight valid paired questionnaires were acquired. Among this population, 116 cases (boy: girl was 74:42) were still consistent with the diagnosis of AR, which were named as AR continuing, and 72 cases (38.3%) became less serious, which were named as AR controlled. Factors related to AR continuing included residence change [P = 0.017, OR = 0.435, 95% confidence interval (CI) were 0.220 - 0.860], personal eczema history in the last year (P = 0.028, OR = 2.959, 95%CI were 1.124 - 7.792), more than 3 times upper respiratory tract infection (URTI) in the last year (P = 0.006, OR = 2.625, 95%CI were 1.317 - 5.234). AR progressed from mild to moderate-severe in 26 children.</p><p><b>CONCLUSIONS</b>AR in children during growth development became remission. Gender and age were not the decisive factors for AR natural course. Residence change from suburb area to city made the incidence of AR low. Personal eczema history and URTI history in the last year related to AR continuing. In children with AR continuing, the severity of AR became serious with age.</p>

A clinical study of paradoxical breathing during sleep in children / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Abnormal breathing during sleep included many patterns. In this study, we investigated paradoxical breathing patterns during sleep in children using standard polysomnography (PSG).</p><p><b>METHODS</b>Children who come to the ENT because of snoring were included into the study consecutively. Those who had craniofacial anomalies, diabetes, chronic lung diseases, and neuromuscular diseases were excluded. At the same time, no sleep snoring children were include as controls. Thirty-eight snoring children and twenty-six no snoring children were recruited. Polysomnography (PSG) was performed on all subjects. We determined the frequency of paradoxical breathing patterns during sleep through blind analysis of polysomnograms obtained in all subjects and compared the difference between children with snoring and normal controls.</p><p><b>RESULTS</b>The appearance of paradoxical breathing was assessed in all subjects. Among children with snoring, the apparent amount of paradoxical breathing time and the percent of paradoxical breathing time spent in total sleep time (x(-) ± s) were (70.1 ± 40.4) min and 17.9% ± 11.0% respectively. Comparing with control group (28.2 ± 25.7) min and 7.3% ± 6.8%, there was obvious difference (paradoxical breathing time t = 5.060, percent of paradoxical breathing time t = 4.767, P < 0.05). Thirty-eight snoring children were divided into normal-mild group (eighteen children) and moderate-severe group (twenty children). The children whose PSG results were normal and mild had more paradoxical breathing time and the percent of paradoxical breathing time than moderate-severe group. The apparent amount of paradoxical breathing time of normal-mild group, moderate-severe group and control group were (85.9 ± 31.7) min, (55.8 ± 42.7) min and (28.2 ± 25.7) min. Among the three groups, there was obvious difference (F = 15.897, P < 0.05). The percent of paradoxical breathing time of the three groups were 22.0% ± 10.2%, 14.1% ± 10.5% and 7.3% ± 6.8% (F = 14.167, P < 0.05).</p><p><b>CONCLUSIONS</b>Currently published polysomnographic scoring recommendations overlook some common breathing abnormalities during sleep that are associated with clinical complaints. Paradoxical breathing is abnormal breathing patterns during sleep and its appearance is used to aid in the identification of respiratory events.</p>

Use of noninvasive ventilation in surgical treatment of obstructive sleep apnea hypopnea syndrome in children / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the efficacy of noninvasive ventilation in the surgical treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) in children.</p><p><b>METHODS</b>Since 2002.5 - 2007.12, eleven children with adenotonsillar hypertrophy and seven children with post-adenoidtonsillectomy were enrolled in the study. All children were confirmed as OSAHS by polysomnography (PSG) or portable oximetry monitor. Male:female ratio was 17:1. The age ranged from 1 to 11 years (median 3.8 years). The noninvasive ventilation treatment was carried out in all children pre- or postoperatively. PSG was the index for therapy effect. SPSS 11.5 was used to analyse the data. The parameters, x(-) +/- s, were normal distribution, and paired t-test for significancy. A P value of < 0.05 was considered statistically significant.</p><p><b>RESULTS</b>Six children after adenotosillectomy, with AHI < 10/h, lowest pulse oxygen saturation (SpO2) > 0.85, did not need nasal continuous positive airway pressure (nCPAP). Eleven patients with preoperative nCPAP, did not have anesthesia comlications. Post-nCPAP, apnea and hypopnea index AHI (4.7 +/- 3.9)/h, the lowest SpO2 0.867 +/- 0.069, and the average time percents SpO2 < 0.90 during sleep (0.3% +/- 0.5%) improved significantly compared to pre-nasal continuous positive airway pressurecn (nCPAP), which were (77.6 +/- 39.8)/h, (0.535 +/- 0.151) and (46.9% +/- 34.5%), t value were 7.77, -11.62, 5.69, P < 0.001.</p><p><b>CONCLUSIONS</b>Noninvasive ventilation is an effective treatment for severe OSAHS children pre- or postoperation. nCPAP could be used to treat children still with OSAHS after adenotonsillectomy, and also an effective treatment to the ones who had surgical contraindication. Regular follow-up should be done for patients with nCPAP at home.</p>

Effects of electromagnetic pulse on blood-brain barrier permeability and tight junction proteins in rats / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To study the effect of electromagnetic pulse (EMP) on the permeability of blood-brain barrier, tight junction (TJ)-associated protein expression and localization in rats.</p><p><b>METHODS</b>66 male SD rats, weighing (200 approximately 250) g, were sham or whole-body exposed to EMP at 200 kV/m for 200 pulses. The repetition rate was 1 Hz. The permeability of the blood-brain barrier in rats was assessed by albumin immunohistochemistry. The expression of typical tight junction protein ZO-1 and occludin in both cerebral cortex homogenate and cerebral cortex microvessel homogenate was analyzed by the Western blotting and the distribution of ZO-1 and occludin was examined by immunofluorescence microscopy.</p><p><b>RESULTS</b>In the sham exposure rats, no brain capillaries showed albumin leakage, at 0.5 h after 200 kV/m EMP exposure for 200 pulses; a few brain capillaries with extravasated serum albumin was found, with the time extended, the number of brain capillaries with extravasated serum albumin increased, and reached the peak at 3 h, then began to recover at 6 h. In addition, no change in the distribution of the occludin was found after EMP exposure. Total occludin expression had no significant change compared with the control. However, the expression level of ZO-1 significantly decreased at 1 h and 3 h after EMP exposure in both cerebral cortex homogenate and cerebral cortex microvessel homogenate. Furthermore, immunofluorescence studies also showed alterations in ZO-1 protein localization in cerebral cortex microvessel.</p><p><b>CONCLUSION</b>The EMP exposure (200 kV/m, 200 pulses) could increase blood-brain barrier permeability in rat, and this change is associated with specific alterations in tight junction protein ZO-1.</p>

Audiological characteristics of young children with otitis media with effusion / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To characterize the audiological features in the infants with otitis media with effusion (OME) and to investigate the utility of variety of objective audiometry methods in diagnosis and intervention on OME.</p><p><b>METHODS</b>Fifty six infants (40 males and 16 females) were investigated, who were referred to our clinic at the General Hospital of Chinese People's Liberation Army by the other hospitals from December 2004 to June 2007 when the infants were diagnosed or highly suspected of OME. The ages at the initial diagnosis ranged from 42 days to three years, with an average of five months. The infants, after receiving the conventional otolaryngological exams, were subjected to the tests of auditory brainstem response (ABR), otoacoustic emission (OAE), tympanometry (226 Hz and 1000 Hz) and behaviors audiometry.</p><p><b>RESULTS</b>Among 56 affected infants, 87 ears were diagnosed with OME, of which 31 infants were affected bilateral and 25 with monaural. For the 49 infants who received hearing screening at birth, 36 infants were referred at the initial screening. For the 52 infants who received repeated screening, all subjects were referred. Six infants without receiving hearing screening came to clinic when their parents observed their kids' hearing impairment. Among the 52 cases (104 ears) who received tympanometry test, 20 subjects (28 ears) showed B or C type tympanometry curve. Thirty-nine cases (78 ears) were given tympanometry test at 1000 Hz, of which 38 cases (55 ears) showed abnormal hearing. Among 56 infants (112 ears) with ABR test, 49 subjects (74 ears) exhibited prolonged ABR type I curve. All 56 infants (112 ears) received OAE test, of which 55 subjects (81 ears) were referred. Four infants (8 ears) accepted the behavior test and all of them showed A-B Gap.</p><p><b>CONCLUSIONS</b>The combined tympanometry test at both 226 Hz and 1000 Hz, ABR latency or threshold test, infant's behavior test and OAE, used jointly, enable characterizing better OME in infants, thus helping early diagnosis of this hearing disorder.</p>

Diagnostic procedures for pediatric otitis media with effusion / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the fluid in middle ear of otitis media with effusion (OME) by tympanometry, hearing threshold and in order to an effective and promptly way for treatment.</p><p><b>METHODS</b>Forty Patients (75 ears) with OME were collected since January 2007 to June 2008. The history of hearing loss, hearing threshold, CT results and the final fluid in the middle ear during operation were analyzed.</p><p><b>RESULTS</b>There were 28 males and 12 females enrolled in this study. The average age of the patients was 78 months. All the 75 ears were with type "B" according to tympanometry test. For all the patients myringotomy was performed and the ventilation tubes were placed in 23 ears. Among all the ears, there were fluid in 62 ears (82.7%) and no fluid in 13 ears (17.3%). There was correlation between the levels of hearing loss, CT results and the fluid in middle ear (P < 0.05).</p><p><b>CONCLUSIONS</b>Tympanometry and hearing threshold results should have a better sensitivity and specificity rates for diagnosis of OME.</p>

Analysis of poor-responding sleep apnea children to adenoidtonsillectomy and further treatment / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze factors on sleep apnea children's poor responding to adenoid tonsillectomy, and discuss the further treatment.</p><p><b>METHODS</b>Two hundred and forty three obstructive sleep apnea hypopnea syndrome (OSAHS) children who had adenoid tonsillectomy or adenoidectomy were reviewed, all cases had follow-up sleep study (polysomnogram, PSG) after surgery.</p><p><b>RESULTS</b>According to the results obtained in 3 to 12 months after surgery with PSG, 221 cases (90.9%) were cured (apnea and hypopnea index, AHI, < 5/h), while the remaining 22 cases AHI > 5.0/h. In the latter group, 2 cases who only had adenoidectomy received tonsillectomy afterwards, 7 cases who have nasal congestion were treated with medication, 5 overweight cases and 3 cases with cerebral palsy, pectus excavatum or hyperplastic tori were treated with CPAP.</p><p><b>CONCLUSIONS</b>Adenoid tonsillectomy is effective for OSAHS children. For the poor responding cases, suitable treatment should be selected accordingly.</p>

Noninvasive ventilation for obstructive sleep apnea hypopnea syndrome in children / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the efficacy and safety of noninvasive ventilation (NV) for treating children with obstructive sleep apnea.</p><p><b>METHODS</b>Twenty-one children confirmed obstructive sleep apnea hypopnea syndrome (OSAHS) with full-night polysomnography (PSG) or ambulatory screening device were enrolled in the study. The NV treatment was carried out successfully for all cases. Nasal continuous positive airway pressure (nCPAP) compliance data were gathered via clinical follow-up examination, telephone interview, or mailed questionnaire. The statistical analysis was performed with SPSS 11.0 statistical software. Pre- and on-nCPAP parameters were compared with paired t-test. Twenty-one OSAHS children (17 boys, 4 girls) were enrolled into the study. The mean age of the children was 4. 5 years; ranging from 40 days to 11 years.</p><p><b>RESULTS</b>nCPAP pressure was increased from 4 cm H2O by (1 cm H2O = 0.098 kPa) 0.2 cm H2O each time to the treating pressure which was between 4.8 and 16 cm H2O. Before nCPAP treatment, apnea hypopnea index (AHI) was (80.8 +/- 45.1)/h, the lowest pulse oxygen saturation (SPO2) 0.557 +/- 0.135 and SPO2 <0.90 time during sleep (42.9 +/- 31.9) %, which were much worse compared to that with nCPAP treatment, the above parameters decreased to (6.7 +/- 12.4)/h, 0.862 +/- 0.082, (1.1 +/- 2.5) % respectively(P <0.01).</p><p><b>CONCLUSIONS</b>Noninvasive ventilation is a safe and effective treatment for OSAHS children. It is possible to use nCPAP as a short-term treatment or as a long-term treatment at home.</p>

Influence of obstructive sleep apnea-hypopnea syndrome in children on hearing problem / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the effects of obstructive sleep apnea hypopnea syndrome on hearing among children.</p><p><b>METHODS</b>One hundred and forty three apnea children proved with overnight polysomnography received pure tone audiometry, acoustic impedance test, and lateral nasopharyngeal airway X-ray. Hearing threshold level and blood oxygen's saturation, apnea hypopnea index were analyzed.</p><p><b>RESULTS</b>Among the 127 cases,63 cases had type C or B tympanograms, and 33 of them had lifted hearing threshold level. The remaining 64 cases had normal hearing and tympanograms. It was found correlation between the A/N ratio and blood oxygen's saturation, and no correlation between the A/N ratio and average of hearing threshold level. There was no correlation between AHI and average of hearing threshold level of each group. Hearing level can be improved after adenoidectomy or adenotonsillectomy.</p><p><b>CONCLUSIONS</b>The upper airway obstruction due to adenotonsillar enlargement is common in children. It also affects the middle-ear impedance. Although short -term and mild degree of hypoxemia has few influence on hearing threshold level, it may affect cochlear function.</p>

Risk of tuberculosis in rheumatoid arthritis and ankylosing spondylitis patients treated with tumor necrosis factor antagonists / 中华风湿病学杂志

Objective To study the risk of tuberculosis (TB) infection in rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients before and after treated with tumor necrosis factor (TNF) antago- nists.Methods RA and AS patients treated with TNF antagonists infliximab and etanercept between 2003 and 2006 were followed up for the risk of TB infection.The protein purified derivative (PPD) test and chest anteroposterior and lateral view X-ray were done at screening for all these patients.Results Among 67 RA patients screened,1 was PPD positive.One patient developed right supraclavicular lymph node TB 4 months after study completion.Among 203 AS patients screened,27 patients were PPD positive,2 had calcified pul- monary TB foci and 2 had pulmonary TB.PPD positive rates and calcified TB foci or active TB found in RA and AS patients screened were significantly lower than national TB infection rates and prevalence (P＜0.01). Conclusion In this short-term clinical observation,increased risk of TB infection was not found after TNF antagonists treatment in RA and AS patients.However,it is necessary to screen patients for signs of TB infec- tion before TNF antagonists treatment.