Diagnosis and management of orbital and cranial complications of pediatric acute rhinosinusitis / 中华耳鼻咽喉头颈外科杂志

Objective: To review the clinical characteristics, to illustrate diagnosis and management experience of orbital and cranial complications of pediatric acute rhinosinusitis. Methods: The clinical data of 24 children with orbital and cranial complications of acute rhinosinusitis who received endoscopic sinus surgery combined with drug treatment in Beijing Children's Hospital from January 2017 to December 2021 were retrospectively reviewed. There were 19 boys and 5 girls. The age varied from 13 to 159 months, with a median 47.5 months. The following diagnoses were obtained: 12 isolated subperiosteal orbital abscess, 2 associated with preseptal abscess, 2 associated with intraorbital abscess, 7 associated with optic neuritis, and 1 associated with septic cavernous sinus thrombosis. Clinical characteristics, organism isolated and outcomes were analyzed through descriptive methods. Results: All 24 patients presented with fever; 9 presented with nasal congestion and purulent discharge. The clinical manifestations of orbital infection included orbital edema, pain, proptosis and displacement of globe in all patients, while visual impairment was recognized in 7 children. Purulent drainage was cultured in 17 patients, among which 12 were positive. All patients underwent nasal endoscopic surgical interventions uneventfully, excluding one patient who required a second surgical procedure. Follow-up period ranged from 5 to 64 months. All patients resolved fully, with the exception of 2 children who got permanent blindness with visual loss preoperative. There was no recurrence or death. Conclusions: Orbital and cranial complications of pediatric acute rhinosinusitis could be severe with an occult onset. For patients with vison impairment, any signs of intracranial complications and a lack of response to conservative management, an urgent endoscopic intervention is needed.

Nasal endoscopic modified mucosal flap technique for repair of congenital choanal atresia in newborns and infants / 中华耳鼻咽喉头颈外科杂志

Objective: To describe and evaluate the surgical effect and prognosis of nasal endoscopic modified mucosal flap technique for repair of congenital choanal atresia in newborns and infants. Methods: The clinical data of 38 newborns and infants with congenital choanal atresia who underwent nasal endoscopic surgery in Beijing Children's Hospital between January 2016 and May 2018 were retrospectively analysed, including 13 males and 25 females. The age ranged from 5 days to 3 years old at the time of operation (15 cases were newborns). The clinical data, imaging data, treatment effect and prognosis were collected. According to the different surgical methods, the patients were divided into the conventional operation group and the modified mucosal flap technique group. The designs of the modified mucosal flap technique were designed according to the type of congenital choanal atresia. The cross-over L-shaped flaps were performed in patients with unilateral atresia, and the mirrored L-shaped flaps were performed in patients with bilateral atresia. All the patients were followed up for 2-3 years, and the follow-up parameters included the times of operations, length of hospital stay, restenosis rate and incidence of complications. Study data was analyzed using SAS version 9.4 statistical software. Results: Sixteen cases underwent conventional operation while 22 patients underwent modified mucosal flap technique under nasal endoscope. The lightest weight (2 200 g) and the youngest age (5 days) of the patients came from the modified mucosal flap technique group. Compared with the conventional operation group under nasal endoscope, the modified mucosal flap technique group had fewer times of operations (1.14±0.47 vs 2.69±1.20, t=5.552, P<0.001), shorter hospital stay ((7.70±3.22) d vs (14.37±19.16) d, t=2.960, P=0.005), lower rate of postoperative restenosis (9.1% vs 43.8%, χ²=6.156, P=0.013), and lower rate of the incidence of complications (13.6% vs 43.8%, χ²=5.955, P=0.015), the differences were statistically significant. Conclusion: The nasal endoscopic modified mucosal flap technique is feasible for repairing congenital choanal atresia in newborns and infants, which can significantly reduce the incidence of postoperative restenosis and complications.

Pediatric nasal neuroglial heterotopia: report of 13 cases / 中华耳鼻咽喉头颈外科杂志

Objective: To summarize clinical features and our experience of the diagnosis and treatment of pediatric nasal neuroglial heterotopia (NGH). Methods: Clinical data of 13 nasal NGH patients in Beijing Children's Hospital from August 2014 to October 2019 were retrospectively reviewed, including 9 boys and 4 girls, aged from 1 to 38 months with median age of 5 months. Radiological workups and excision of nasal NGH under general anesthesia were performed for all patients. B ultra-sound and MRI were performed for all external and mixed lesions, while ultra-low-dose CT scan and MRI for all intranasal type. Surgical approaches were dependent on location and extent of the lesions according to radiographic workup, including extranasal or transnasal endoscopic approach. Patients were followed up regularly after operation to evaluate the effect. Initial presentation, locations, imaging findings, surgical approaches and follow-up results were analyzed through descriptive statistical method. Results: Eight nasal NGH patients presented with an internal nasal mass and nasal obstruction, which belonged to intranasal type. Three patients presented with an external nasal mass which belonged to extranasal type and 2 patients had mixed lesions. The sites included nasal dorsum (n=5), anterior to the middle turbinate (n=5) and olfactory cleft (n=3). Surgical resections were done through median rhinotomy approach (n=5) or transnasal endoscopic approach (n=8). All the operations were successful and no complication occurred. All cases were followed up from 3 to 65 months. No recurrence was encountered. Conclusions: Nasal NGH is a rare lesion with atypical clinical presentation. Preoperative imaging including CT scan and MRI is essential for evaluation of the location, extent of the disease and for making the surgical plan. Treatment requires complete surgical excision.

Analysis of clinical features and prognostic factors of meconium peritonitis / 上海交通大学学报（医学版）

Objective • To analyze the clinical features of meconium peritonitis (MP) and the related factors influencing its prognosis. Methods • Fiftyfour patients with MP who received surgical intervention at department of pediatric intensive care unit, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from May 2006 to May 2018 were retrospectively reviewed, and divided into complication group (n=24) and non-complication group (n=30). Risk factors of the two groups after operation were analyzed, including general condition, prenatal diagnosis and preoperative value of C-reactive protein (CRP), independent-samples t test, χ2 test or Fisher's exact test. Results • Compared with the non-complication group, days of admission and operation after birth were longer; the gestational age and the birth weight were lower (all P<0.05) in the complication group; the CRP value of the complication group was higher than that of the non-complication group (P=0.048). The prenatal diagnosis percentage of the non-complication group was higher than that of the complication group (P=0.039). However, there was no statistical significance in gender, Apgar score, surgical procedure, delivery type and prenatal ultrasound findings. Conclusion • Prenatal ultrasound detection with MP and early surgical treatment can improve the prognosis, and the preoperative inflammation level has a certain predictive value for the prognosis of children.

Effects of dexmedetomidine combined with butorphanol on postoperative analgesia and recovery in cesarean section / 基础医学与临床

Objective To investigate the effects of dexmedetomidine combined with butorphanol on postoperative an-algesia and recovery for patient-controlled intravenous analgesia (PCIA) in parturients undergoing cesarean section. Methods Eighty-four parturients scheduled for elective caesarean section under spinal anaesthesia were randomly al-located into two groups. Control group: physiological saline infusion(0.5 μg/kg) after delivery and butorphanol (10 mg) in PCIA. Experimental group: dexmedetomidine (0.5 μg/kg) infusion after delivery and dexmedeto-midine (200 μg) with butorphanol (10 mg) in PCIA. Hemodynamic variables, the visual analogue score (VAS), the sedation score, side effects, the total pump-press number and additional analgesics cases were re-corded. The quality of recovery was evaluated by using a 40-item quality of recovery questionnaire(QoR-40) and a 9 questions fatigue score(FFS). Results Compared with control group,the VAS scores,the total pump-press number, the incidence of side effects and the FSS scores in experimental group was significantly decreased (P<0.05). In addition,the QoR-40 score at POD3 was significantly increased(P<0.05). Conclusions Dexmedeto-midine combined with butorphanol for PCIA after caesarean section decreases the consumption of butorphanol,pro-motes postoperative analgesia,alleviates fatigue,and improves postoperative recovery.

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>

Toxicology and tissue distribution of Ruthenium (II) CO-releasing molecules and its interaction with endogenous substances / 药学学报

Carbon monoxide has been proved to be an important signal molecule in body. Transition metal carbonyl compounds are solidified form of carbon monoxide. Numerous studies have shown that Ruthenium carbonyl carbon monoxide releasing molecules have a strong pharmacological activity. In this paper, five Ruthenium (II) carbonyl CORMs 1-5 were synthesized and their toxicology, tissue distribution and interaction with blood endogenous substances were investigated. The results showed CORMs' IC50 to fibroblasts are ranged from 212.9 to 2089.2 micromol x L(-1). Their oral LD50 to mouse is between 800 to 1600 mg x kg(-1). After repeated administration, CORMs 1 and CORMs 5 haven't shown an obvious influence to rats' liver and kidney function, but caused the injury to liver and kidney cells. The in vivo distribution result revealed the majority of CORMs were distributed in blood, liver and kidney, only a small part of CORMs distributed in lung, heart and spleen. They could scarcely cross the blood-brain barrier and distribute to brain. The non-CO ligands in structure have an obvious relevance to their in vivo absorption and distribution. Interestingly, CORMs could enhance the fluorescence of bovine serum albumin, and this enhancement was in direct proportion with the concentration of CORMs. Under different conditions, interaction of CORMs with glutathione got different type of products, one is Ruthenium (II) tricarbonyl complexes, and Ruthenium (II) dicarbonyl complexes.