Otological and hearing characteristics in children with Turner syndrome / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the otological and hearing characteristics in children with Turner syndrome (TS), to determine risk factors of hearing loss, and to discuss algorithms for future surveillance. Methods: The clinical data of otolaryngology in children with TS from January 2018 to April 2020 were reviewed retrospectively. A total of 46 female children with TS, aged from 5 to 18 years were enrolled. Karyotypes included 17 cases (37.0%) of monosomy, 16 cases (34.7%) of mosaicism, and 13 cases (28.3%) of abnormal X chromosome structures. The otoscopic characteristics, audiological performance, and otologic diagnoses were evaluated. Multivariate logistic regression and Mann-Whitney U test were used for statistical analysis. Results: The most common otologic comorbidity was otitis media with effusion (OME), including 20 cases (43.5%) with 33 ears (35.9%). 14 cases (30.4%) were diagnosed with hearing loss. The regression analysis revealed that the age (OR=1.345, 95%CI: 1.072-1.760) and comorbidity of OME (OR=9.460, 95%CI: 2.065-60.350) were risk factors associated with hearing loss. In TS with OME, when compared with the mean air conduction threshold, the hearing loss of the group with pars flaccida retractions was significantly higher ((24.3±13.8) dB HL vs. (14.4±4.2) dB HL, U=59.500, P=0.008) than that of the group with none retractions. Conclusion: OME and hearing loss are common in children with TS. As age increases or suffers from OME, the risk of hearing loss increases.

The impact of different aortic valve calcification patterns on the outcome of transcatheter aortic valve implantation: A numerical simulation study / 医用生物力学

Objective To investigate the effect of different calcification patterns on the outcome of transcatheter aortic valve implantation (TAVI) by the finite element method. Methods Three calcified human aortic root models (coaptation line calcification model, attachment line calcification model and circular calcification model) were developed according to the location of calcified plaques on the aortic valve leaflets. The processes of self-expanding transcatheter aortic valve implanted into the 3 calcified models were simulated by ABAQUS software. The effects of different calcification patterns on the aortic root stresses, valve frame distortions and paravalvular gaps were analyzed. Results Circular calcification model had the largest maximum principal stress on calcified plaques (18.42 MPa), which might result in a higher risk of stroke after implantation; the circular calcification model also had the greatest distortion of the valve frame, which might lead to worse prosthetic durability; the paravalvular gaps area of the attachment line calcification model was 37.2 mm2, which was more than twice that of the other 2 models, causing more serious paravalvular regurgitation. Conclusions Different aortic valve calcification patterns are related to aortic root stresses, valve frame distortions and paravalvular gaps after TAVI, which will have an impact on postoperative complications and prothesis durability. The research findings provide references for the prediction of clinical outcome after TAVI.

The impact of different aortic valve calcification patterns on the outcome of transcatheter aortic valve implantation: A numerical simulation study / 医用生物力学

Objective To investigate the effect of different calcification patterns on the outcome of transcatheter aortic valve implantation (TAVI) by the finite element method.Methods Three calcified human aortic root models (coaptation line calcification model,attachment line calcification model and circular calcification model) were developed according to the location of calcified plaques on the aortic valve leaflets.The processes of self-expanding transcatheter aortic valve implanted into the 3 calcified models were simulated by ABAQUS software.The effects of different calcification patterns on the aortic root stresses,valve frame distortions and paravalvular gaps were analyzed.Results Circular calcification model had the largest maximum principal stress on calcified plaques (18.42 MPa),which might result in a higher risk of stroke after implantation;the circular calcification model also had the greatest distortion of the valve frame,which might lead to worse prosthetic durability;the paravalvular gaps area of the attachment line calcification model was 37.2 mm2,which was more than twice that of the other 2 models,causing more serious paravalvular regurgitation.Cenclusiens Different aortic valve calcification patterns are related to aortic root stresses,valve frame distortions and paravalvular gaps after TAVI,which will have an impact on postoperative complications and prothesis durability.The research findings provide references for the prediction of clinical outcome after TAVI.

CO2 laser supraglottoplasty for infantile laryngomalacia / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and safety of CO2 laser supraglottoplasty for severe laryngomalacia in infants.</p><p><b>METHODS</b>From January 2009 to December 2011, 32 infants with severe laryngomalacia were confirmed by electronic laryngoscope and clinical assessment in Shenzhen Children's Hospital. According to the choice made by the parents, 16 children accepted CO2 laser supraglottoplasty (group 1), the others were treated conservatively (group 2). The beginning observation point T0 was defined as the age on the first medicine taking day or the age of surgery. T1, T3, T6 were defined as 1, 3, 6 months following T0. Clinical symptoms included stridor, dyspnea, aspiration, and respiratory infections. The body weight, PSG reports, laryngoscope findings, cure rates of the two groups were compared.</p><p><b>RESULTS</b>The anatomical abnormalities were corrected surgically, and the symptoms ,such as stridor, dyspnea, and aspiration improved rapidly after the operation. The cure rates was higher in group 1 than in group 2 on T1, T3, T6 stage. There were statistically significant differences(χ(2) were 13.9, 28.1, 24.6 respectively; all P < 0.01). Children in group 1 gained weight better than in group 2. There was a statistically significant difference in Z scores median on T1, T3, T6 stage (z score were -0.848, -2.940, -4.110; P < 0.05, or P < 0.01 respectively). The lowest oxygen saturation in group 1 improved one month after the surgery (from average 0.686 ± 0.106 to 0.901 ± 0.041). There was a statistically significant difference (t = -7.876, P = 0.001). Complications included adhesion (1 case) and temporary new-onset aspiration (1 case).</p><p><b>CONCLUSIONS</b>The CO2 laser supraglottoplasty can resolve severe laryngomalacia symptoms including stridor, dyspnea and aspiration. It can reduce the frequency of respiratory infections, and contribute to weight gaining. The CO2 laser supraglottoplasty is effective, of high security and with rare complications.</p>