Advances of n-3 polyunsaturated fatty acids in food allergy / 中华实用儿科临床杂志

Food allergy is a common allergic disease threatening the growth and development of infants and children.n-3 polyunsaturated fatty acids (PUFAs) are common nutrients in the diet, which have important structural functions and immunomodulatory effects.Their protective effect in food allergy has gradually become a potential research hotspot.This review highlights the function and immune regulation of PUFAs, the regulation of n-3 PUFAs on immunological indexes, the mechanism of food allergy, and the relationship between food allergy, and the impact of n-3 PUFAs on other allergic diseases.

Sensitization characteristics of ragweed pollen in Beijing area / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the sensitization characteristics of ragweed pollen in patients with allergic rhinitis（AR） and（or） allergic asthma in Beijing area, and to provide basis for the prevention and treatment of ragweed pollen sensitized population. Methods:Patients with allergic rhinitis and/or asthma from January 2017 to December 2019 in the outpatient department of Allergy Department of Beijing Shijitan Hospital were retrospectively analyzed in this study. Skin prick test（SPT） was performed with ragweed pollen allergen reagents to compare different ages, genders and respiratory diseases allergen distribution, and to observe the sensitization characteristics of its population. All of the analyses were performed using SAS software version 9.4. Results:A total of 9 727 patients were enrolled in the end. The total positive rate of ragweed pollen SPT was 45.50%（4 426/9 727）, the highest positive rate was 65.54% in 13-17 years old group; The positive rate of ragweed pollen SPT was 49.79% in allergic rhinitis combined with asthma patients, followed by 46.46% in allergic rhinitis patients, and the lowest rate was 19.42% in single allergic asthma patients. There were more females than males in both ragweed pollen sensitized and non-ragweed pollen sensitized groups（P<0.05）, and the proportion was higher in 30-39 years old than in other age groups（P<0.05）. Ragweed pollen sensitization was higher than non-ragweed pollen sensitization in the allergic rhinitis group（98.49% vs 94.76%, P<0.05）. Ragweed pollen with other summer and autumn pollen allergens in patients with positive SPT, the top three were Chenopodium pollen, Humulus pollen and Artemisia grandis pollen, with positive rates of 90.42%, 89.63% and 85.40%, respectively. Ragweed combined with other pollen sensitization accounted for 99.57%（4 407/4 426）. Allergic rhinitis was the main disease in patients sensitized with ragweed pollen alone or combined with other pollens, and there was no significant difference between the two groups（94.97% vs 98.50%, P>0.05）. Conclusion:Ragweed pollen is highly sensitized in Beijing area, single ragweed pollen sensitization is rare, often combined with multiple pollen sensitization, and allergic rhinitis is the main disease.

Progress on allergen immunotherapy during pre-pregnancy, pregnancy, and lactation periods / 中华围产医学杂志

Allergen immunotherapy (AIT), also known as allergen vaccine desensitization, is currently the only treatment that can change the natural course of allergic diseases. AIT for pregnant women is a protective factor for neonatal allergies. Existing findings suggest that AIT should not be started during pre-pregnancy, pregnancy, or lactation periods, but can be continued if has already been started before; unexpected pregnancy during AIT does not require termination; AIT shows no obvious adverse effects on fetuses, infants, and young children. The latest evidence on the effectiveness and safety of AIT during pre-pregnancy, pregnancy, and lactation periods were reviewed.

Advance in the relationship between allergic rhinitis and ADHD in children / 国际儿科学杂志

In recent years, more and more researchers at home and abroad have realized that there is a certain relationship between allergic rhinitis(AR) and attention deficit hyperactivity disorder(ADHD) in children.Children with AR had higher ADHD related symptom scores than healthy children; ADHD children have a significantly increased risk of allergic diseases, such as asthma, eczema and atopic dermatitis.At present, it has been clear that they have the common characteristics of increasing prevalence year by year, genetic tendency, environmental and neuropsychological factors, and similar clinical manifestations.However, there is no final conclusion whether they are mutual cause and effect or comorbidities.This artide reviews the similarities between AR and ADHD in epidemiology, etiology, clinical manifestations and drug treatment, so as to further explore the correlation between AR and ADHD.

Experimental study on nasal mucosa injury and repair induced by nasal decongestants in guinea pigs / 中华耳鼻咽喉头颈外科杂志

Objective@#To observe the process of nasal mucosa injury and repair induced by nasal decongestants in guinea pigs @*Methods@#Sixty-five male guinea pigs were randomly divided into 4groups by digital random method.The guinea pigs in Group A (20 guinea pigs)were treated with 2 sprays of 0.1% Naphazoline 6 times a day for 2 weeks; Group B (20 guinea pigs)with 2 drops of 1% Ephedrine 6 times a day for 2 weeks; Group C(20 guinea pigs) with 2 sprays of Naphazolin hydrochloride and Chlorphenamine Maleate Nasal Spray 8 times a day for 2 weeks.Group D (5guinea pigs)did not do any intervention as a control group.At the end of first and second weekend, 6 guinea pigs randomly selected from each group were observed the morphological changes of the nasal cavity with nasal endoscope and pathological microscope.Two weeks after stopping use of decongestant, 24 animals were grouped.Three guinea pigs were selected randomly from each group to form Group E (n=9) and Group F (n=9)respectively. The 6 remaining guinea pigs falled into Group G. Group E received 2 sprays of Mometasone Furoate Nasal Spray once a day for 2 weeks; Group F received 1 ml 2.3% saline to wash the nasal cavities once a day for 2 weeks.Group F was used to show the natural progess without any treatment.At the end of the third and fourth weekend, nasal endoscopic and pathological microscopes were used to observe the nasal cavity structure and the pathological changes of nasal mucosa. @*Results@#Nasal mocusa congestion and edema were observed with nasal endoscopy after 2 weeks of using nasal decongestant. Cell edema, blood vessel expansion, acute and chronic inflammatory cell infiltration, cilium lodging or loss were observed under the pathological microscope in GroupA, B, C. After using MometasoneFuroate Nasal Spray and 2.3% saline for 2 weeks, the above changes were all recovered in Group E and F. No recovery was found in Group G. @*Conclusions@#Short-term and over dose of nasal decongestant can result in the injury of nasal mucosa in guinea pigs, and the injury is much severe as using decongestant last longer.MometasoneFuroate nasal spray and 2.3% saline can repair the injury.

Clinical application of extended nursing in asthmatic children with allergic rhinitis / 中国实用护理杂志

Objective@#To evaluate the effects of extended nursing mode on the asthmatic children with allergic rhinitis (AR).@*Methods@#Totally116 children aged 6-14 years old with asthma and AR were enrolled to this study from November 2015 to October 2016 in our hospital. They were divided into the regular nursing group and the extended nursing group according to the voluntary principle. The patients in regular nursing group were received routine nursing care in or out of hospital, while the patients in extended nursing group received extended care besides routine nursing. The children were required to record diary about asthma and AR And participate in asthma action projects. Before and after intervention we observed the quantitative score of symptoms and signs, the times of acute attack, the times of oblivion medication, the average days of stay in hospital, the days of fail to School or kindergarten, the lung function and the fractional exhaled nitric oxide (FeNO) in children with asthma and AR within 1 year. These above marks were assessed five times respectively at starting (baseline) , 3 months, 6 months, 9 months and 12 months (1 year) The differences between two groups were compared with appropriate statistical methods.@*Results@#1 year later, out of 58 cases in extended nursing group, 40 patients (68.97%)were in good control and 18 cases (31.03%) in partial control. Out of 58 cases in regular nursing group, 22 cases (37.93%) were in good control and 36 patients (62.07%) in partial control. There were significant differences between two groups in the effect of disease (χ2=11.23, all P<0.01), the experimental group was significantly better than the control group. The symptoms and signs of allergic rhinitis average scores in regular nursing group were 1.88 ± 0.72, extended nursing group were 0.79 ± 0.71, the difference was statistically significant (t=8.080, P<0.01) with the extended nursing group much better that the regular nursing group. The symptoms and signs of asthma average scores in regular nursing group were1.83 ± 0.75, extended nursing group were 0.88 ± 0.67, the difference was also statistically significant (t=7.133, P<0.01) with the extended nursing group much better that the regular nursing group. In extended nursing groups within 1 year the numbers of acute attack (0.60±0.59), the times of oblivion medication (11.05±7.40), the average days of stay in hospital (8.83±2.79) days,the average days of failing to school or kindergarten (8.69±5.46) days, while in regular nursing group within 1 year the numbers of acute attack(2.94±1.52), the times of oblivion medication (35.28±8.84), the average days of stay in hospital(20.95±5.46 days), the average days of fail to school or kindergarten(24.72±5.92) days, the differences were also statistically significant (t=10.50-15.87, P<0.01). The lung function in extended nursing group (PEF: 82.02±6.04, FEVI: 88.19±5.10, FEV25: 80.67±4.88, FEV50: 80.07±3.73, FEV75: 81.52±3.85) and in regular nursing group (PEF: 79.02±6.12,, FEV1: 80.52±4.72, FEV25: 75.05±7.79, FEV50: 77.59±4.60, FEV75: 78.41±4.19) . The differences were also statistically significant (t=2.90-6.15, P<0.01).The FeNO(13.66±2.87) ppb in extended nursing group and (14.95±3.12) ppb in regular nursing group. There were statistical significant differences between the two groups (t=2.30, P<0.05) with extended nursing group much better than regular nursing group.@*Conclusion@#The effect of extended care group is better than that of regular nursing group, and extended care is much more benefit to control asthma and allergic rhinitis in children.

Research progress on rhinitis medicamentosa / 中华耳鼻咽喉头颈外科杂志

Rhinitis medicamentosa (RM) refers to nonallergic inflammation in the nasal mucosa which is caused by the abuse of nasal decongestant and it often occurs in patients with allergic/nonallergic rhinitis along with nasal congestion. RM is characterized by nasal congestion based on long-term use of nasal decongestant, without rhinorrhoea or sneezing. The signs of RM include nasal swelling, thickening, loss of elasticity, and loss of sensitivity to the decongestant. The histological changes of RM are loss of nasal mucosa cilia, squamous epithelium metaplasia, edema of epithelium cell, hyperplasia of goblet cell, increased expression of epidermal growth factor receptor and infiltration of inflammatory cells, etc. There is no precise diagnosis standard for RM, making it even harder for its objective diagnosis. Patients with RM should immediately stop using nasal decongestant, in stead of using nasal glucocorticoid spray for the recovery of the nasal mucosa′s function.

Causes analysis of misdiagnosis in patients with familial nasal bleeding / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the causes of misdiagnosis in patients with familial nasal bleeding and to improve the level of diagnosis and treatment.@*METHOD@#The clinical characteristics of 7 families with nose blood were analyzed retrospectively and 2 typical cases were reported, including their treatment and misdiagnosis in consulting, out-patient and in-patient.@*RESULT@#Typical case 1 was misdiagnosed and mistreated for 42 years, misdiagnosed as blood disease so that the patient was biopsied in bone marrow, misdiagnosed as endometriosis so that the patient was performed uterus resection. Typical case 2 was misdiagnosed and mistreated for 17 years, misdiagnosed as upper digestive tract hemorrhage so that the patient was performed endoscopic sleeve ligation, misdiagnosed as inferior turbinate hemangioma so that the patient was performed nasal endoscopic surgery.@*CONCLUSION@#Neglect of family history and the typical signs are the causes of misdiagnosis. So asking about the family history and checking for the typical signs in patients with nose blood can avoid misdiagnosis.

Investigation of nasal mucosa diseases changes with age and local climate / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo study of the relationship of age and climate with the nasal mucosa lesions.METHODSAll the patients met with the inclusive criteria were registered and followed-up once a month and their nasal mucosal lesions were observed through nasal speculum and/or nasal endoscope. The recording data was analyzed by SPSS17.0 software.RESULTSA total of 259 patients, 555 person-times and 957 lesion spots were observed. The nasal mucosa was injured by airflow with the highest incidence rate from October to next year April. Patients numbers gradually increased after August, and significantly increased at November, December (P<0.05). Children aged from 2 to 12 years old and the adults aged from 40 to 80 years old were susceptible population (P<0.05), the incidence rate had a negative relation with humidity (P<0.05). The susceptible spots of the lesion were ranked as follows: Little area, inferior turbinate, mucosa of the both side of the deviated nasal septum, inferior meatus, middle meatus, middle turbinate and olfactory area. CONCLUSIONNasal mucosal injury relates to age and seasons. The nasal cavity airflow may be a factor of these lesions.

Expression and Regulation of Transcription Factor FoxA2 in Chronic Rhinosinusitis With and Without Nasal Polyps

PURPOSE: Chronic rhinosinusitis (CRS) is characterized by the excessive production of mucus. However, the molecular mechanism underlying mucin overproduction in CRS with or without nasal polyps (CRSwNP and CRSsNP, respectively) is poorly understood. This study was conducted to assess the importance of the transcription factor FoxA2 in mucin production and to investigate the targeting of FoxA2 as a potential therapeutic strategy for mucus hypersecretion in CRS patients. METHODS: We enrolled 15 CRSwNP patients, 15 CRSsNP patients, and 10 normal controls in this study. The expression levels of FoxA2, MUC5AC, and MUC5B in inflamed and healthy nasal tissues were examined via immunohistochemistry and quantitative reverse transcription-polymerase chain reaction, and the levels of several proinflammatory cytokines in nasal secretions were measured via FlowCytomix analysis. In addition, the expression of MUC5AC and FoxA2 was determined in polyp-derived epithelial cells and NCI-H292 cells after in vitro stimulation. RESULTS: FoxA2 was significantly down-regulated, and MUC5AC and MUC5B were significantly up-regulated in both the CRSwNP and CRSsNP patients compared to the controls (P<0.05), and the protein level of FoxA2 was negatively associated with the IL-6 level in the CRS patients (P<0.05). IL-6 significantly increased MUC5AC expression but inhibited FoxA2 expression in vitro (P<0.05). Transfection with a FoxA2 expression plasmid significantly decreased MUC5AC promoter activity (P<0.05) and inhibited IL-6-induced MUC5AC production (P<0.05). In addition, clarithromycin significantly alleviated IL-6-induced FoxA2 suppression and decreased MUC5AC expression in vitro (P<0.05). CONCLUSIONS: Our findings suggest that FoxA2 may be considered a therapeutic target for the modulation of mucus hypersecretion in CRS patients.

Systemic complications of functional endoscopic sinus surgery in patients with chronic rhinosinusitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyses the causes and prevention of systemic complications of functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis.@*METHOD@#Three typical cases were reported including their medical history, preoperative diagnosis, medications during preoperational period, complications and treatment. The causes and preventive measures of systemic complications were analyzed.@*RESULT@#Three patients were all suffered from chronic rhinosinusitis with nasal polyps (CRSwNP). After FESS, 1 case was complicated with coma and hyponatremia, 1 case with acute myocardial infarction, and 1 case with lower extremity deep venous thrombosis. The patient with coma and hyponatremia was soon waked after intravenous infusion of 10% sodium chloride. Two patients with acute myocardial infarction and lower extremity deep venous thrombosis were soon completely rehabilitated after emergency thrombolytic therapy and endovascular intervention. Three patients were completed recovered from their systemic complications without any severe sequela.@*CONCLUSION@#Systemic hemostatic drugs should be banned in patients with hypercoagulable state in perioperation period of FESS in order to avoid severe systemic complications. Timely vascular interventional treatment can prevent severe sequels.

Clinical characteristics of primary ciliary dyskinesia / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical characteristics of primary ciliary dyskinesia(PCD) so as to improve the diagnostic level of this rarely seen disease.</p><p><b>METHODS</b>Ten patients with PCD were retrospectively reviewed, the medical history, symptoms, signs, lung CT or chest X-ray, rhino-sinus CT scan, nasal nitric oxide (NO) levels, nasal ciliary ultrastructure, DNAH5 and DNAH11 genetic mutation, as well as treatment outcome were analyzed.</p><p><b>RESULTS</b>All 10 patients had recurrent chronic sinusitis, otitis media, bronchitis/bronchiectasis since childhood. Nine cases with translocation of heart and big vessels were diagnosed as Kartagener syndrome. One woman was suffering from barrenness and one man sterility after marriage for long time without birth control. Nasal NO levels were significantly lower in 2 patients with PCD but it was almost normal in one patient. Ciliary ultrastructure investigated by transmission electron microscope were almost normal in 4 cases without missing of inner or outer dynein arms. Two cases taking exome capture sequencing showed that mutations happened in DNAH5 and DNAH11. Five subjects underwenting sanger sequencing on 6 common exon fragments of DNAH5 and DNAH11 did not show any abnormality. Ten cases took medication therapy, while 5 patients once underwent functional endoscope sinus surgery. All of the 10 patients had improvement of their symptoms and signs after treatment.</p><p><b>CONCLUSIONS</b>The PCD is so rare in clinic that it is easily misdiagnosed. Clinical characteristics, nasal NO levels, ciliary ultrastructure and genetic testing are significant for clinical diagnosis.</p>

Clinical analysis of 49 cases of esthesioneuroblastoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the optimal treatment and prognostic factors of esthesioneuroblastoma (ENB).</p><p><b>METHOD</b>Forty-nine cases of ENB, received therapies in Chinese people liberation army general hospital from October 2004 to June 2013, were reviewed retrospectively. The therapeutical strategies and prognostic factors were analyzed using the Kaplan-Meier method. Efficacy of different therapeutical strategies was compared.</p><p><b>RESULT</b>The 5-year overall survival (OS) in the group was 63.8%. The 5-year OS of Kadish stage A, B, C were 90.0%, 77.1%, 32.6%, respectively, with significant difference (χ(2) = 7.379, P = 0.03). The 5-year OS of the patients treated by surgery and radiotherapy, chemoradiotherapy, surgery with chemoradiotherapy were 68.6%, 0, 92.3%, respectively, with significant difference (χ(2) = 8.140, P = 0.02). The 5-year OS of the patients with transnasal endoscopic resection (or combined with transcranial resection) and lateral rhinotomy ( or combined with transcranial resection) were 63.7%, 50.0%, respectively, which had no significant difference (χ(2) = 3.818, P = 0.05).</p><p><b>CONCLUSIONS</b>ENB has a relatively good prognosis in head and neck malignancies, the prognosis is associated with clinical stages and treatment approaches. Transnasal endoscopic surgery based multimodality is the preferable choice.</p>

Noninvasive measurement of nasal NO and fractional exhaled NO in healthy people and patients with allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To measure the nasal nitric oxide (NNO) and fractional exhaled nitric oxide (FENO) in healthy people and patients with allergic rhinitis (AR), and to discuss the clinical significance of the results.</p><p><b>METHODS</b>Ninety-six healthy volunteers and 51 patients with moderate-severe persistent AR, but without asthma, were enrolled. NNO and FENO concentrations were measured noninvasively by using of NIOX MINO (Aerocrine AB, Solna, Sweden).SPSS 13.0 software was used to analyze the data.</p><p><b>RESULTS</b>The concentration of NNO in healthy people was 245.0 [189.8;331.3] ppb (median [25th percentile; 75th percentile], the followings were same as). The concentration of FENO was 14.0 [10.0; 18.0] ppb. The concentration of NNO in patients with AR was 304.0[179.5; 397.5]ppb. The concentration of FENO was 21.0 [16.0; 40.5] ppb. The concentration of NNO in the AR patients was higher than that in the healthy persons, but the difference did not reach statistical significance (Z = 1.349, P = 0.177).On the other hand, FENO concentrations were significantly increased in patients compared with concentrations in healthy persons (Z = 5.555, P = 0.000).</p><p><b>CONCLUSIONS</b>FENO concentrations of patients with moderate-severe persistent AR are increased significantly even though the patients do not have typical symptoms of asthma. This finding suggests that AR patients should be treated actively in order to prevent asthma from developing in them.</p>

Diagnosis and clinical characteristics of patients with non-allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore a step-by-step exclusive diagnosis and analyze the clinical characters of non-allergic rhinitis (NAR).</p><p><b>METHODS</b>Patients with symptoms (nasal itching, sneezing, rhinorrhea, nasal congestion) were selected to take four-step exclusive diagnosis for NAR and we tried to eliminate the false NAR and retain the true NAR. First step was to exclude the patients who were not suitable for skin prick test (SPT, such as during pregnancy, breastfeeding, asthma, oral antihistamine medication in 7 day, severe skin diseases). The second step was to exclude the patients with positive SPT and the third step was to exclude the patients with 1 level or above of specific sero-immunoglobulin E (sIgE). The fourth step was to exclude the patients with infection rhinitis, clear abnormal nasal structure, drug-induced rhinitis, nasal neoplasm. The remained patients were finally diagnosed as NAR and who were further differential diagnosed as vasomotor rhinitis (VMR) or non-allergic rhinitis with eosinophilia syndrome (NARES) according to the eosinophilia counts in nasal secretion and venous blood. The common characters of patients with NAR were analyzed and their symptoms and quality of life were evaluated by visual analogue scale (VAS) and rhino-conjunctivitis quality of life questionnaire (RQLQ) separately.</p><p><b>RESULTS</b>One thousand four hundred and thirty-seven patients were included after first step exclusion and 735 cases with negative SPT were remained after second step exclusion. Of 735 patients, 302 were tested in vitro for sIgE and 93 cases with 0 level of sIgE and total IgE were remained after third step exclusion. Sixty-two patients were finally diagnosed as NAR after fourth step exclusion. The NAR diagnosis rate was 51.15% (735/1 437) with negative SPT alone and the NAR diagnosis rate was 29.06% (93/302) with combination of negative SPT and sIgE. Of 62 patients with NAR, 47 patients (75.81%) were diagnosed as VMR and 15 cases (24.19%) as NARES. There were 23 males and 39 females in the 62 patients aged 11 - 77 years. The history was 11-47 months. The biggest numbers of patients with VMR or NARES were among 41-50 years. Their onset ages were among 21-30 years in both two groups. VAS scores of nasal congestion in VMR patients were the highest with significant difference among nasal symptoms (F = 3.958 0, P = 0.009 1). VAS scores of sneezing in NARES patients were the highest but without significant difference among nasal symptoms. There were no difference in seven domain scores of RQLQ and the total mean scores between VMR group and NARES group but the nasal symptoms got the highest scores with significant difference among the seven domains in each group (VMR group, F = 9.771 2, P = 0.000 0;NRAES group, F = 3.226 9, P = 0.006 2).</p><p><b>CONCLUSIONS</b>SPT combined with sIgE may exclude much more patients with AR. Females with NAR are much more than males. Patients with NAR aged 21-30 years. The characters of NAR are helpful to improve our knowledge about NAR. VAS and RQLQ may be a suitable tool in assessment of NAR.</p>

Analysis of diagnosis and treatment for blunt trauma in the neck / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the organ damage character and complications of blunt trauma in the neck, and the advantage and disadvantage of CT and ultrasound for blunt trauma in the neck.@*METHOD@#The data of 7 neck blunt trauma cases was analyzed. Cricoarytenoid joint reduction, tracheotomy, exploratory surgery of neck were performed respectively for these cases.@*RESULT@#Of the 2 cases with vocal cord paralysis, one had his vocal cords fixed in the the para-median position. one had his vocal cords move freely. 2 cases of epiglottis edema had been cured. Among the 2 cases of thyroid area swelling and congestion, one died from respiratory failure, one was cured. One case died of carotid artery embolism.@*CONCLUSION@#Circulation of the head should be noticed as well as keeping respiratory tract clear and anti-shock treatment. Some patient with negative laryngeal examinations might get worse in the following hours, and swelling of the neck, dyspnea, obnubilation may appear in these cases. Dynamic monitoring could be helpful for the diagnosis and treatment of neck blunt trauma.

Early genetic diagnosis in patients with HHT induced severe nosebleed / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the early gene diagnosis of hereditary hemorrhagic telangiectasia (HHT) induced severe nosebleed.@*METHOD@#Clinical features of 23 family members in two HHT pedigrees were examined. Genomic DNA was extracted from peripheral blood samples. PCR amplification was conducted to screen ENG and ACVRL-1 genes with their specific primers. Direct sequencing was performed to detect the mutation. Mutation analysis was carried out to evaluate its significance.@*RESULT@#A heterozygous c. 263A > G mutation was identified in exon 3 of ACVRL-1 in 6 out of 11 members in NMG-1 pedigree. In GD-2 pedigree, 5 of 11 members carried c. 199C > G mutation. Mutation detection rate was 100% in subjects with nosebleed history and 25% in family members without epistaxis.@*CONCLUSION@#Gene diagnosis characterized by high sensitivity and specificity is of great practi-cal significance and early genetic screening should be a clinical routine test for HHT induced severe nosebleed.

Secondary laryngeal tuberculosis at high altitudes of Tibet / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To improve the diagnostic and therapeutic efficiency for secondary laryngeal tuberculosis through an analysis on the clinical features of patients with this disease.@*METHOD@#A retrospective study was made among 49 cases with laryngeal tuberculosis treated in Tibetan General Hospital of Chinese PLA, and the clinical data were carefully analyzed to summarize the clinical experience of this disease.@*RESULT@#Of 49 patients, 24 cases had 1 year history, 11 cases had 1 to 3 years, 9 cases had 3 to 5 years, 5 cases had 5 years or more. Thirty-eight patients had the history of tuberculosis and 11 had none. Thirty-four patients had taken anti-tuberculosis drugs but none had standard therapy as demanded. All cases had mild general symptoms (mild fever, night sweats, weight loss, et al) and atypical local symptoms (hoarseness, sore throat). Therefore, 42 cases were misdiagnosed as non-specific chronic laryngitis, of which 15 cases got worse after oral administration or inhaling of steroid hormones. Seven persons were misdiagnosed as laryngeal cancer. All patients were confirmed pulmonary tuberculosis by X ray exam or CT scanning. Twelve cases had strong positive PPD tests and 2 cases were detected positive by sputum smear. All patients was treated by standard systematic and local chemical therapy against tuberculosis (inhaling of antituberculosis drugs for 1 to 2 months). All were cured but one died in a road accident, and none had recurrence after 1- to 9- year follow-up.@*CONCLUSION@#All of those the patients with long period hoarseness and sore throat should take chest CT scan or X-ray exam for the highest incidence of pulmonary tuberculosis at high altitudes. CT scanning is the prefer for its high resolution. Pathological biopsy and diagnostic therapy should be taken to make accurate diagnosis. Usually steroid hormones should not be recommended.

Efficacy and safety of Mizolastine in the treatment of perennial allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the efficacy and safety of Mizolastine in the treatment of perennial allergic rhinitis.@*METHOD@#Multicentric random Double-blind parallel-controlled study was adopted, and compared with placebo and Cetirizine. Patients (n = 177) were grouped, seventy-two in Mizolastine group, sixty-nine in Cetirizine and thirty-six in placebo group.@*RESULT@#In the seventh curative day symptomatic and sign marks in Mizolastine group and Cetirizine group were lower, but the mark in Mizolastine group reduced more than in Cetirizine group and placebo group. Mizolastine group is better than Cetirizine group in improvement of nasal obstruction and itching with Visual analogue scale. In the twenty first curative day reduction of symptomatic and sign marks in Mizolastine group was lower than Cetirizine group, but no statistic difference. There were 27 adverse events, no serious adverse events in 177 patients during experimental period. Most adverse events were headache and dryness in mouth and eyes. There were 10 cases adverse events in Mizolastine group, one case was related with experiment and four cases might be related with experiment. There were 14 cases adverse events in Cetirizine group, one case was related with experiment and four cases might be related with experiment. There were three cases adverse events in placebo group.@*CONCLUSION@#Generally speaking the efficacy of Mizolastine in treatment of perennial allergic rhinitis is better than Cetirizine, Bad events are less. It is safe.