Pathogenesis of particulate matters and IL-4 DNA methylation in CD4+T cells in children with AR / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the possible effects of meteorological and environmental factors on IL-4 gene specific DNA methylation levels in CD4+T cells of children with AR.METHODS Thirty five pediatric AR patients(6-12 years) followed up for one year from the Department of Otolaryngology, Shanghai Children Medical Center from Jan, 1, 2012 to Dec. 31, 2012 were included in this study. Data on daily particulate matter of diameter smaller than 10 micrometer(PM10) and particulate matter of diameter smaller than 2.5 micrometer(PM2.5) was available as average values derived from the data of 6 state-controlled monitoring stations distributed across Pudong District, Shanghai. We quantified IL-4(interleukin-4) gene specific DNA methylation levels in CD4+T cells from 35 patients with AR and 30 healthy controls. mRNA levels of IL-4 gene were measured by real-time reverse transcriptase-PCR. Methods of personal exposure assessment of PM2.5 and PM10 were measured.RESULTS Compared with controls, IL-4 promoter region was hypomethylated in AR CD4+T cells(P=0.038). Of all observed CpG sites in IL-4 promoter region, there was significant differences in CpG-48, CpG+54(P=0.041, 0.032). IL-4 mRNA expression was significantly increased in CD4+T cells(P=0.039). The level of IL-4 mRNA expression was negatively correlated to the mean level of methylation in IL-4 promoter region. After adjusting, level of PM10 exposure was negatively correlated with level of methylation in IL-4 promoter region(r2=0.419,β=-0.470,SD=0.781,P=0.045). CONCLUSION Level of methylation in IL-4 promoter region may be affected by PM10 exposure.

The effection of environmental and health message forecasting service offer to the allergic rhinitis in children / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the impact of environment and message information for the treatment efficacy of children with allergic rhinitis (AR).@*METHOD@#To choose 100 cases of children diagnosed with AR. The parents of children record daily symptom scores of AR of children everyday. While the doctors send the short message to the parents by using meteorological environment warning forecast technology to tell the parents the risk of AR attacks. We observe the morbidity of AR of the children and the treatment efficacy of children for 1 year. The 100 cases control group children diagnosed AR, their parents do not record daily symptom scores of AR and the doctors do not give the short message. We also observe the morbidity of AR of the control group children and the treatment efficacy of the children for 1 year.@*RESULT@#The 100 cases intervention group children with AR, there are 11 cases refused to participate the group. We included a total 89 cases, 74 cases of children did a full year of intervention, 15 cases of children gave up. The control group 100 cases, nine cases refused to participate, 91 cases were included. The average episodes in the intervention group was 4. 67 times, the control group was 8. 12 times,--there were significant differences between the groups statistically. The execution rate on the prescribed clinic date in the intervention group visits was 91. 5%, while in the control. group, was only 67%. The compliance of parents of children to complete course of medication in the intervention group was 95. 6%, while the control group was 74.1%. Both sets of data are statistically significant differences. The children with sinusitis in intervention group was 26.97%, significantly lower than the 64.04% in the control group. The incidence in the intervention group and the control group of secretory otitis media was 8.99% and 6.60%, there was no statistically significant differences.@*CONCLUSION@#It can significantly increase the degree of attention of parents of children with AR that the parents of children record daily symptom scores of AR of children everyday, while the doctors send the short message to the parents by using meteorological environment warning forecast technology to tell the parents the risk of AR attacks. It can also improve the execution rate on the prescribed clinic date and improve compliance of parents of children to complete course of medication. It can significantly reduce seizure frequency and severity of episodes of AR, thereby improving the quality of life of children with AR, reduce the economic burden on families and society.

Research meteorological environmental factors in children's allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the possible effects of meteorological and environmental factors on allergic rhinitis of children.@*METHOD@#Daily numbers of outpatients consulting general practitioners for AR between Jan 1 2007 and Dec 31 2011 were obtained from the Department of Otolaryngology-Head and Neck Surgery, Shanghai Children Medical Center. Daily maximum, average and minimum temperatures and humidity and wind power for Shanghai of the same 5 years were obtained from the Shanghai Meteorological Office. Air Quality data was provided by the Shanghai Municipal Environmental Protection Monitoring Center on daily SO2, NO2 and PM10, the average of O3 per 8 hours. The data was available as average values derived from the data of 6 state comtrolled monitoring stations distributed across Shanghai. Non-parametric generalized additive model (GAM) was used to analyze the highly non-linear or non-monotonic exposure-response relationship between meteorological and environmental factors and daily outpatient visiting for AR of children.@*RESULT@#The daily numbers of AR children in outpatients department in this study were highest in the average daily temperature 11°C and 21°C. It showed two peak. But as the humidity increased, daily numbers of outpatients of AR children went down, indicating that the higy humidity has protective effect. Every 10 microg/m3 increase of environmental pollutants O3, SO2 and PM10 was linked to 1.95%, 1.19% and 0.33% increase in the number of visitors, respectively, suggesting the air pollution may increase the risk of onset of AR in children.@*CONCLUSION@#Meteorological and environmental factors have important effects on AR in children.

Analysis on correlation between GJB2 mutations and congenital malformations of inner ear / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the correlation between GJB2 mutations and congenital malformations of inner ear in pediatric patients with sensorineural hearing loss (SNHL).@*METHOD@#Peripheral blood samples were collected from 77 pediatric patients with congenital malformations of inner ear. Two control groups were set up, which were control group 1 that contained 80 pediatric patients with congenital SNHL without inner ear malformations, and control group 2 that contained 100 cases with normal hearing, retrospectively. Genomic DNA was extracted from the blood; direct sequencing was used to detect GJB2 mutations.@*RESULT@#GJB2 was normal in 31 patients. GJB2 mutations were detected in 12 patients while the polymorphism of GJB2 was present in 34 patients. The homozygous mutations of 235delC was in 1 patient, the heterozygous carriers of 235delC in 4 patients, the heterozygous carriers of p. V37I in 7 patients in which the heterozygous carriers of p. R184Q with autosomal dominant hereditary in 1 patients. In control group 1, normal GJB2 was detected in 17 patients, GJB2 mutation in 29 patients, polymorphism in 34 patients. In control group 2, normal GJB2 was detected in 18 patients, GJB2 mutation in 12 patients, polymorphism in 70 patients. When the distribution of GJB2 genotypes was compared with phenotypes, significant difference was found (P 0.05) between inner ear malformations and control group 2.@*CONCLUSION@#GJB2 Mutations are not correlated with congenital inner ear malformations. However, GJB2 Mutations are correlated with congenital SNHL that is not caused by congenital malformations of inner ear.

Constitute, imaging and auditory characteristics of pediatric patients with congenital malformations of inner ear in sensorineural hearing loss / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the constitute, imaging and auditory characteristics of pediatric patients with congenital malformations of inner ear in sensorineural hearing loss(SNHL).@*METHOD@#Imaging and auditory data of 125 cases (225 ears) in 860 pediatric patients with congenital SNHL who referred to ENT department of Shanghai Children Medical Center from February 2005 to January 2010 were retrospectively studied.@*RESULT@#Congenital malformations of inner ear accounted for 14.5% in 860 pediatric patients with congenital SNHL. Bilateral ear was involved in 98 cases (78.4%), unilateral in 27 cases (21.6%). One hundred and sixty-seven ears (74.2%) were identified as profound deafness, 36 ears (16%) severe deafness and 22 ears (9.8%) moderate deafness in 225 ears, respectively. In present group, large vestibular aqueduct (75.6%) was the most common and next was vestibular deformity (32%), then cochleovestibular deformity (23.1%). Mondini deformity (55.8%) was the most common and common cavity deformity (28.9%) next in cochleovestibular deformity. Profound deafness in cochlea involved congenital malformations of inner ear was significantly more than those in no cochlea involved malformations.@*CONCLUSION@#The results are of importance for understanding the constitute of congenital malformations of inner ear in pediatric patients with congenital SNHL in China, for etiological diagnosis of congenital SNHL, for intervention including hearing aids or cochlear implant and prognosis.

The radical surgery for tetralogy of Fallot combined with right pulmonary artery stenosis / 中国综合临床

Objective To explore the radical surgery for tetralogy of Fallot combined with right pulmonary artery stenosis.Methods Thirteen cases with tetralogy of Fallot combined with right pulmonary artery stenosis accepted radical surgery,among them 7 cases who-had a long right pulmonary artery stenosis accepted aortic transaction for radical surgery of tetralogy of Fallot;5 cases who had the entrance stenosis of the right pulmonary artery accepted right pulmonary artery patch expansion for radical surgery of tetralogy of Fallot;One case who had the distortion and stenosis after pulmonary shunt accepted the radical surgery for tetralogy of Fallot after seperation and expansion.Results There were no operation-related deaths,post-operative low cardic output and perfusion lung occurred for all the cases.Ten cases had grade 1 cardiac function and 3 cases had grade 2,respectively.Conclusion Right pulmonary artery stenosis increased the risks during the radical surgery for tetralogy of Fallot,but it is still the primary operation choice.

Clinical analysis of sensorineural hearing loss associated with otitis media with effusion in children / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the cause, diagnosis and therapy of sensorineural hearing loss associated with otitis media with effusion (OME) in children.@*METHOD@#Thirty-five cases (37 ears) of sensorineural hearing loss associated with otitis media with effusion in children from a total 150 patients (225 ears) were analyzed retrospectively.@*RESULT@#Thirty-five cases were treated with myringotomy with insertion of ventilation tubes or adenoids removal and myringotomy with insertion of ventilation tube. All cases were treated with drugs after the operation. Thirty-four of all cases improved completely. One improved slightly during follow-up with hearing level of bone.@*CONCLUSION@#Thirty-five cases (23.3%) which had temporary threshold shift or permeant threshold shift were considered to be etiologically related to OME. The result of this study indicates that we have to be aware of a possible development of SNHL during the course of OME.

The value of the fiber laryngoscope in the diagnosis of congenital laryngeal stridor / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the value of fiber laryngoscope in the diagnosis of congenital laryngeal stridor (CLS).@*METHOD@#The clinical data of One hundred and thirty children who had been examen by laryngofiberscopy and had laryngeal stridor were analyzed retrospectively.@*RESULT@#We found 73 children having CLS, 2 children having laryngeal web, 5 children having congenital epiglottic cyst, 20 children having mass and cyst of tongue root, 1 child having laryngocele, 3 children having laryngeal papilloma, unilateral or bilateral cricoarytenoid joint of 9 children having poor activities, 17 children were normal.@*CONCLUSION@#CLS is misdiagnosed easily. Laryngeal strio caused by other diseases soule be excluded before CLS is diagnosed. Our proposal is that fiber laryngoscope should be used as a routine method in the diagnosis of CLS. CT and MRI could also be used if it is necessary.

Aggressive fibromatosis of the head and neck in children (a report of three cases) / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To discuss the therapy of aggressive fibromatosis of head and neck in children.@*METHOD@#Three cases of aggressive fibromatosis of head and neck were analyzed retrospectively.@*RESULT@#Total tumor removal was achieved in all cases and the diagnosis was confirmed pathologically. No recurrence was found during follow-up.@*CONCLUSION@#Aggressive fibromatosis is a rare, benign but locally infiltrative condition. Complete surgical removal was a chief treatment. But it was sometimes impossible in the head and neck area because of associated growth problems. Cosmic problems and facial deformity were the main obstacles of surgery.