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ObjectiveTo reveal the clinical efficacy of Yunpi Huatan Tongqiao prescription in relieving inflammation， hypoxia， and adenoidal hypertrophy （AH）， and improving the quality of sleep-disordered breathing in children with AH by promoting M2-type polarization of macrophages through a randomized double-blind clinical trial. MethodSeventy-one AH children who met the research criteria and were treated in the Department of Pediatrics of Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from March 2022 to February 2023 were divided into an observation group （36 cases） and a control group （35 cases）. A randomized double-blind method was adopted. The patients in the observation group were given Yunpi Huatan Tongqiao prescription combined with placebo of montelukast sodium chewable tablets， while those in the control group were given montelukast sodium chewable tablets combined with placebo of Yunpi Huatan Tongqiao prescription. The treatment course was 84 days. After treatment， the therapeutic effect and sleep monitoring indicators were compared. Before and after treatment， venous blood was collected to compare the levels of macrophage polarization-related inflammatory factors between the two groups. ResultThe adenoidal/nasopharyngeal space （A/N） integral in the nasal and pharyngeal lateral radiographs， After treatment， the AH therapeutic effect score， and the traditional Chinese medicine （TCM） syndrome therapeutic effect score in both groups were lower than those before treatment （P<0.01）. Compared with the control group after treatment， the observation group showed a more significant reduction in various integral levels （P<0.05， P<0.01）. The improvement degree of A/N in the nasal and pharyngeal lateral radiographs in the observation group was better than that in the control group （Z=-2.970， P<0.01）， and the total effective rate of the therapeutic effect of AH （χ2=7.715， P<0.01） and the TCM syndrome therapeutic effect （χ2=13.239， P<0.01） were superior to those in the control group. The levels of interleukin-6 （IL-6） and tumor necrosis factor-alpha （TNF-α） in both groups after treatment were lower， and the level of interleukin-10 （IL-10） was higher than those before treatment （P<0.01）. The level of transforming growth factor-beta （TGF-β） showed an increasing trend， but the difference was not statistically significant. Compared with the control group after treatment， the observation group showed more significant improvement in IL-10 and TNF-α levels （P<0.01）， a decreasing trend in IL-6， and an increasing trend in TGF-β， but the difference was not statistically significant. Compared with the results before treatment， the apnea-hypopnea index （AHI） and oxygen desaturation index （ODI） in both groups decreased significantly （P<0.01）. The observation group showed a significant reduction in the duration of the longest apnea and the longest hypopnea， as well as a significant increase in the mean and lowest oxygen saturation （P<0.01）. The control group also showed improvements in the above indicators， but the difference was not statistically significant. Compared with the control group after treatment， the observation group showed a more significant improvement in AHI， ODI， the duration of the longest hypopnea， and mean and lowest oxygen saturation （P<0.05， P<0.01）. There was a decreasing trend in the longest duration of apnea， but the difference was not statistically significant. ConclusionYunpi Huatan Tongqiao prescription can reduce the size of adenoids， alleviate clinical symptoms and signs in AH children， improve the constitution characterized by "spleen deficiency and phlegm obstruction"， reduce the occurrence of sleep-disordered breathing events， alleviate the degree of hypoxia in the child's body during sleep at night， and has satisfactory clinical efficacy. The improvement of clinical symptoms and sleep quality in AH children by Yunpi Huatan Tongqiao prescription may be achieved by promoting macrophage polarization from M1 to M2.
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Aim To investigate the pharmacological mechanism of the couplet medicines " Cangzhu-Yiy-iren" in treating adenoid hypertrophy (AH) of children based on network pharmacology. Methods To screen the active ingredient and relevant targets of the couplet medicines "Cangzhu-Yiyiren", a visual network map of " Drug-Component-Target " was constructed; related targets of AH were retrieved and standardized, and A PPI network to treat AH of children by " Cangzhu-Yiyiren" was constructed. Enrichment analysis was performed for the core targets, and a " targets -pathways" network was constructed. The expression of target proteins from spleen tissues of different groups was determined by Western blot to verify that atractylone regulated the expression of inflammatory factors by HIF-1 α-SUMOylation. Results A total of 71 drug-related targets and 337 disease-related targets for AH in children were obtained, and there were 30 " Drug-Disease " intersection targets. The main active components of the couplet medicines "Cangzhu-Yiyiren" were stigmaster-ol, atractylone and so on. The biological processes mainly involved in were tube morphogenesis, response to hormone, the main cellular components involved in were membrane raft, transcription regulator complex, and the molecular function of related targets were mainly enriched in the transcription factor binding, protein domain specific binding, etc. The enrichment analysis indicated that it was associated with apoptosis-multiple species, VEGF signaling pathway, and HIF-1 signaling pathway ,etc. The results of animal experiments showed that SUMO-1,HIF-1α,VEGF and VEGF-R protein expression were all down-regulated compared with the model group ( P < 0. 05 ). Conclusions The treatment of pediatric AH which takes the " Activating Spleen Treatment of Nasa" as the guiding ideology, is realized through multi-components, multi-target, multi-pathways, and mainly from the anti-inflammatory, immune regulation, antioxidant and other aspects to play its role in the treatment of children with AH.
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Abstract This study investigatedthe efficacy and safety offluticasone propionate nasal spray in treatment of adenoidal hypertrophic snoring in children.Fifty-six children with adenoidal hypertrophic snoring were enrolled. According to adenoidal-nasopharyngeal ratio (ANR) in lateral nasal X-ray examination,the children were assigned in moderategroup (23 cases) and severegroup (33 cases).The fluticasone propionate nasal spray was used for all patientsfor 4 weeks.In 56 patients, after treatment, compared with before treatment, the snoring, sleep apneaand nasal obstruction scores in moderategroupand the nasal obstruction score in severegroupwere significantly decreased,respectively (P < 0.05).The decreases of snoring, sleep apnea, mouth breathing and nasal obstruction scores after treatment in moderate group were significantly higher than those in severe group, respectively (P <0.001).After treatment, in 18 patients with ateral nasal X-ray examination,the adenoid size was obviously reduced, and the nasopharynx airway was obviously enlarged. The meanANRdropped from 0.76±0.10 to 0.72±0.09(P <0.001).Duringtreatment, only 2 of 56 patients were reported with intranasal dryness and occasional epistaxis, which were self-healed without treatment.Fluticasone propionate nasal spray is effective and safe for treatment of children's snoring caused by adenoidal hypertrophy.
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Objective To compare the effect of adenoidectomy with adenoidectomy under nasal endoscope in the treatment of adenoid hypertrophy.Methods 120 cases with adenoid hypertrophy were selected as the research subjects.The patients were randomly divided into two groups by random number table,and the control group(n =60) was treated with routine adenoidectomy.The surgical treatment of the observation group(n =60) was performed under nasal endoscope.Surgical treatment,surgery related indicators (operative time,the average amount of bleeding,hospitalization time and the incidence of postoperative complications) were compared between the two groups.Before and after operation,acoustic rhinometry examination of nasopharynx was used to detect the smallest cross-sectional area and compared.Results In the observation group,the operation time,the average amount of bleeding,hospitalization time and incidence rate of postoperative complication were (5.32 ± 2.05) min,(51.05 ± 8.26) mL,(8.50 ± 2.50) d,15.00％,respectively,which in the control group were (8.56 ± 2.68) min,(78.45 ± 10.15) mL,(12.00 ± 3.50) d,36.67 ％,respectively,there were significant differences between the two groups (t =7.44,15.98,6.30,x2 =7.35,all P ＜0.05).12 months after surgery,the nasal minimal cross-sectional area of nasal pharynx in the observation group was (1.99 ± 0.51) cm2,which of the control group was (1.81 ± 0.48) cm2,there was significant difference between the two groups(t =3.99,P ＜ 0.05).Conclusion Compared with conventional adenoidectomy,endoscopic adenoidectomy in the treatment of adenoid hypertrophy has good clinical curative effect,less bleeding,shorter operative time and less postoperative complications and other advantages,it is worthy of promotion.
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Objective To evaluate the clinical efficacy of nasal endoscope-assisted low temperature plasma adenoidectomy. Methods 100 patients who underwent adenoidectomy from May 2012 to August 2016 were enrolled in the study. All the patients were randomly divided into the observation group (50 cases) and control group (50 cases). Patients in the observation group underwent nasal endoscope-assisted low-temperature plasma adenoidectomy, and patients in control group was treated with nasal endoscope-assisted electric adenoidectomy. The operation time, bleeding volume, recovery time of nasal ventilation, clinical efficacy, postoperative complications of the two groups were analyzed and compared. Results In the observation group, the operation time, bleeding volume, recovery time of nasal ventilation was (4.9 ± 1.6) min, (19.6 ± 5.6) ml and (2.9 ± 0.5) d, respectively, which was significantly less than that of the control group (11.9 ± 3.9) min, (61.6 ± 12.1) ml and (5.9 ± 1.6) d, respectively (P < 0.05). The clinical efficacy of the observation group and the control group was 92.0%, and 86.0%, there was no significant difference between the two groups (P > 0.05). In the observation group, the pain index was (1.8 ± 1.0), which was significantly lower than that of the control group (5.6 ± 2.1), the difference was statistically significant (P < 0.05), and there was no significant difference with respect to postoperative hemorrhage, fever and snoring (P > 0.05). In addition, there was no postoperative complication observed in the observation group, while, the complication rate of the control group was 10.0%, the difference between the two groups was statistically significant (P < 0.05). Conclusion Nasal endoscope-assisted low temperature plasma adenoidectomy is effective and safe in the treatment of adenoid hypertrophy with less pain and fewer complications, which can be used as a routine clinical treatment for adenoid hypertrophy in children.
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Objective To evaluate the clinical efficacy of nasal endoscope-assisted low temperature plasma adenoidectomy. Methods 100 patients who underwent adenoidectomy from May 2012 to August 2016 were enrolled in the study. All the patients were randomly divided into the observation group (50 cases) and control group (50 cases). Patients in the observation group underwent nasal endoscope-assisted low-temperature plasma adenoidectomy, and patients in control group was treated with nasal endoscope-assisted electric adenoidectomy. The operation time, bleeding volume, recovery time of nasal ventilation, clinical efficacy, postoperative complications of the two groups were analyzed and compared. Results In the observation group, the operation time, bleeding volume, recovery time of nasal ventilation was (4.9 ± 1.6) min, (19.6 ± 5.6) ml and (2.9 ± 0.5) d, respectively, which was significantly less than that of the control group (11.9 ± 3.9) min, (61.6 ± 12.1) ml and (5.9 ± 1.6) d, respectively (P < 0.05). The clinical efficacy of the observation group and the control group was 92.0%, and 86.0%, there was no significant difference between the two groups (P > 0.05). In the observation group, the pain index was (1.8 ± 1.0), which was significantly lower than that of the control group (5.6 ± 2.1), the difference was statistically significant (P < 0.05), and there was no significant difference with respect to postoperative hemorrhage, fever and snoring (P > 0.05). In addition, there was no postoperative complication observed in the observation group, while, the complication rate of the control group was 10.0%, the difference between the two groups was statistically significant (P < 0.05). Conclusion Nasal endoscope-assisted low temperature plasma adenoidectomy is effective and safe in the treatment of adenoid hypertrophy with less pain and fewer complications, which can be used as a routine clinical treatment for adenoid hypertrophy in children.
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OBJECTIVE:To explore the clinical efficacy and safety of Leukotriene receptor antagonist combined with Gluco-corticoid nasal spray(called“intranasal steroid”for short)in the treatment of different degree of adenoidal hypertrophy(AH)com-plicated with allergic rhinitis (AR). METHODS:240 AR children with AH were randomly divided into control group,intranasal steroid group and drug combination group,with 80 cases in each group. Control group was given physiological seawater,3 presses each nostrile,in the morning and evening. The intranasal steroid group received Momestasone furoate nasal spray,one press each nostrile,qd. Drug combination group was additionally given leukotriene receptor antagonist Montelukast sodium chewable tablet,4 mg for under 5 year-old and 5 mg for 5-year-old or above,qd,at bedtime. Treatment course of 3 groups lasted for 12 weeks. The change of clinical symptoms and signs(such as nasal obstruction,snore,mouth breathing,etc)and adenoid/pharyngeal ratio(A/N ratio)were compared among 3 groups after treatment as well as the occurrence of ADR. Each group was divided into two sub-groups (medium and severe) according to the severity of AH so as to evaluate therapeutic efficacy. RESULTS:21 children withdrew from the study,including 11 cases in control group,6 in intranasal steroid group and 4 in drug combination group. After treatment,clinical symptom score and A/N in subgroups of drug combination group and intranasal steroid group were all lower than those of control group,with statistical significance(P0.05). Clini-cal symptom score and A/N of AR complicated with severe AH subgroup from drug combination group were lower than intranasal steroid group,with statistical significance (P<0.05). No obvious ADR occurred in 3 groups. CONCLUSIONS:Intranasal steroid alone and intranasal steroid combined with leukotriene receptor antagonist can improve clinical symptom of AR patients with AH, and reduce adenoid volume. It is suggested to use intranasal steroid firstly for medium AH complicated with AR,and additionally use Leukotriene receptor antagonist for severe AH complicated with AR.
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Objective:To research the efficacy and safety of fluticasone propionate spray for allergic rhinitis children suffering with adenoidal hypertrophy. Methods:Totally 160 allergic rhinitis with adenoids growth children were in the observation group, in which 109 cases were diagnosed as adenoidal hypertrophy. Totally 157 adenoids growth children were in the control group, in which 114 cases were diagnosed as adenoidal hypertrophy. The two groups both received fluticasone propionate spray treatment for 3 months, and then the nasal endoscopic adenoidectomy volume, symptom score and adverse reactions were observed and analyzed. Results:Allergic rhi-nitis children suffering with adenoidal hypertrophy were mainly in the 3-6-year-old children. After the treatment, adenoids was shrinked in 88 patients (80. 73%) in the observation group, which was significantly higher than that in the control group [67(58. 77%), P<0. 01]. Adenoidal hypertrophy was still in 44 patients (35. 03%) of the observation group after the treatment, which was lower than that of the control group [55(68. 13%), P <0. 05]. In addition, the integral differences of nasal congestion, snoring and mouth breathing in the observation group after the treatment were higher than those in the control group, and the differences were statistically significant (P<0. 05). Conclusion:The efficacy of fluticasone propionate spray used in allergic rhinitis children suffering with adenoi-dal hypertrophy is more obvious than that in adenoid hypertrophy children, which can more significantly improve the symptoms of nasal congestion, snoring and mouth breathing.
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Objective To detect the asymptomatic cardiovascular changes in children with adenoid hypertrophy.Methods One hundred and twenty children with adenoid hypertrophy underwent both chest X-ray and echocardiography before adenoidectomy,and echocardiography 6 months after operation.Results No child showed an increase in the cardiothoracic ratio on X-ray.But preoperative echocardiography showed an increase in pulmonary artery pressure [(22.6 ±3.6) mm Hg,1 mm Hg =0.133 kPa],a decrease in E/A (1.01 ± 0.17),and an increase in right ventricular end-diastolic diameters [(1.88 ± 0.18) cm].While after operation,pulmonary artery pressure decreased to(17.1 ± 3.2) mm Hg,E/A increased to 1.25 ± 0.12,and right ventricular end-diastolic diameters decreased to (1.67 ± 0.11) cm.Each index change before and after operation was statistically significant(P ＜ 0.05).Conclusion Adenoid hypertrophy can result in clinically asymptomatic cardiopulmonary changes.Early diagnosis and treatment of this disease can prevent serious cardiopulmonary complications.
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Objective To explore the relationship between adenoid vegetation children with different types of tympanograms and secretory otitis media in children and diagnosis of secretory otitis media .Methods A retrospec-tive study was carried out among 328 cases with adenoid vegetation in children ,including simple adenoid vegetation and associated with chronic tonsillitis and tonsillar hypertrophy ,from August 2010 to May 2012 .The incidence of secretory otitis media and outcomes of tympanometry for the diagnosis were analyzed .Results 104 cases were diag-nosed with secretory otitis media by tympanic membrane puncture or tympanostomy tube in 328 cases with adenoid vegetation (32 .31% );86 cases (147 ears) were finally diagnosed as secretory otitis media among 89 cases (152 ears) with type B tympanogram (147/152 ,96 .63% );16 cases (20 ears) were finally diagnosed secretory otitis media among 33 cases (49 ears) with type C tympanogram (20/49 ,40 .82% );2 cases (2 ears) with type As tympa-nogram were finally diagnosed .Conclusion With or without complaint of hearing loss ,children with adenoid vegeta-tion should be checked by routine tympanometry .Careful physical examinations and electric otoscope or ear endosco-py combined tympanometry can greatly reduce the rate of misdiagnosis of secretory otitis media .
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Objeetive:To investigate the epidemiology of EBV in adenoidal hypertrophy and chronic tonsillitis and discuss the effection of EBV on the nosogenesis of adenoidal hypertrophy and tonsillitis of children.Method:Fifty-two children with chronic tonsillitis and/or adenoidal hypertrophy had the operations of the tonsillectomy and/or the adenoidectomy.These tissues reseeted and plasma of all cases were detected to find EBV-DNA by RQPCR.Result:The infection rate of EBV in the tissues of adenoidal hypertrophy and tonsillitis of childen was 51.9%.The boys'infection rate of EBV was 50.0%,and the girls'infection rate of EBV was 55.6%,which had not significantly different.The EBV infection rate in the tissues of tonsillitis was 40.4%,The EBV infection rate in the tissues of adenoidal hypertrophy was 48.9%,which had not significant difference.The school age group(7to 14 years old)presented higher infection rate of EBV in the tissues of adenoid and tonsil(65.5%)than the preschool children group(2 to 6 years old)(34.8%).Comparing the copies numbers of BV-DNA in the different degrees of adenoidal hypertrophy,we found that the copies numbers of EBV-DNA in the severe hypertrophy group were higher than the midrange and slight hypertrophy groups(P＜0.05).Meanwhile we detected EBV-DNA in these childrens'blood plasma by RQ-PCR.No blood plasma was detected EBV-DNA copies higher than normal(＜1×10~3 copies/ml).Conclusion:The tissues of adenoidal hypertrophy and tonsillitis had same sensitivity to EBV.There was not significant difference between the infection rates of the boys and girls with adenoidal hypertrophy and/or tonsillitis.With these children growing up and the course of diseases prolonging,the infection rate of EBV increased correspondingly.There was a certain correlation between the hypertrophy of adenoid and EBV.There were NO EBV-DNA fragments in blood plasma of the children with adenoidal hypertrophy and/or tonsillitis.So there were essential different between benign hyperplasy and nasopharyngeal carcinoma.
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Objective To explore the clinical effect of temperature-controlled radiofrequency ablation of tonsil in the treatment of children obstructive sleep apnea hypopnea syndrome(OSAHS).Methods From January 2003 to January 2006,30 patients,confirmed OSAHS by polysomnography(PSG),aging from 3 to 10 years(mean:5.8 years)were treated by temperature-controlled radiofrequency ablation of tonsil,in which 21 cases with adenoidal hypertrophy were treated with adenoidectomy,and 3 of the 21 cases with secretory otitis media received auripuncture.Results Six months after the operation,the symptom of snoring and mouth breathing in all patients disappeared,tonsillar hypertrophy was kept in Ⅰ or Ⅱ grade,no pharynx stenosis was detected,and hearing was recovered to normal.After 1 year,20 cases were monitored with PSG,of which 10 cases were cured,8 cases showed apparent efficacy and 2 cases showed efficacy.Conclusions The temperature-controlled radiofrequency ablation of tonsil is an effective and safe technique in the treatment of children OSAHS.