Qintai Yang

Outcome of Adenotonsillectomy for Obstructive Sleep Apnea Syndrome in Children

Objectives: We evaluated the outcome of adenotonsillectomy for obstructive sleep apnea syndrome (OSAS) in children using polysomnography (PSG) data and a quality-of-life (QOL) instrument. Methods: We enrolled children (4 to 14 years of age) who had OSAS diagnosed by overnight PSG and who underwent both adenoidectomy and tonsillectomy between January 2003 and February 2008. All of them had completed postoperative PSG and a paired Obstructive Sleep Apnea 18-Item Quality-of-Life Questionnaire (OSA-18) survey. The statistical analyses were performed with a statistical software package. Results: The study included 84 children with a mean age of 7.1 years. The mean preoperative apnea-hypopnea index (AHI) for the study population was 24.6, and the mean postoperative AHI was 3.8 episodes per hour. The percentage of children who had normal PSG parameters after adenotonsillectomy ranged from 69.0% to 86.9% because of fluctuation of the criteria used to define OSAS. Nine children (30%) with severe preoperative OSAS had persistent OSAS (an AHI of at least 5) after surgery. Improvements in QOL were comparable in the cured and not-cured groups (p > 0.05). Risk factors for persistent OSAS were obesity and a high preoperative AHI, on multiple logistic regression analysis. Conclusions: Adenotonsillectomy is associated with improvements in PSG, behavior, and QOL in children with OSAS. However, it may not resolve OSAS in all children. The efficacy and role of additional therapeutic options require more study.

The therapeutic efficacy of endoscopic optic nerve decompression and its effects on the prognoses of 96 cases of traumatic optic neuropathy.

BACKGROUND: Traumatic optic neuropathy (TON) is an important cause of severe loss of vision due to blunt or penetrating head trauma. The pathogenesis of TON remains unclear, and there are several potential causes for the observed loss in vision. Endoscopic optic nerve decompression (EOND) has been reported to improve the visual prognosis in TON cases, but its efficacy remains controversial. It is important to investigate the therapeutic efficacy of EOND in the treatment of TON and to evaluate the relevant prognostic factors. METHODS: A retrospective study was conducted to analyze the clinical characteristics and prognoses of 96 TON cases. The &khgr;2 test and multiple logistic regression analyses were used to evaluate potential prognostic factors. RESULTS: The overall rate of EOND effectiveness was 40.6% (39 of 96). A significantly higher effective rate (83.3%) was observed for patients with light perception compared with those without light perception (26.4%, p < 0.05). Univariate and multiple logistic regression analyses identified three variables (no light perception, undergoing EOND 3 days after trauma, and hemorrhage within the ethmoid and/or sphenoid sinus) that were significantly associated with unrecovered visual acuity. Age, loss of consciousness, optic canal fracture, preoperative steroid megadose treatment, and optic nerve sheath incision were all factors that showed no significant correlation with therapeutic efficacy. However, patients with fractures in a single medial wall of the optic canal appeared to have better prognoses than patients with multiple fractures or those with a single fracture in a lateral wall. CONCLUSIONS: The overall therapeutic efficacy of EOND for the treatment of TON is far from satisfactory, especially for patients without light perception. The factors that impact TON prognoses are complex and may be interrelated. The indication for EOND must be individualized. LEVEL OF EVIDENCE: III, epidemiological study.

The Treg/Th17 Imbalance in Patients with Obstructive Sleep Apnoea Syndrome

Obstructive sleep apnoea syndrome (OSAS) is a chronic inflammatory disease regulated by T lymphocytes. Our purpose is to assess the pattern of Th17 cells and CD4+CD25+Foxp3+ regulatory T (Treg) cells in peripheral blood of patients with OSAS. Fourty-four OSAS men and 20 healthy volunteers were enrolled. Twenty-three patients were classified into mild to moderate group and 21 cases were classified into severe group according to the severity of OSAS. We detected the frequencies of Th17 and Treg and related serum cytokines secretion and expressions of key transcription factors. OSAS patients revealed significant increase in peripheral Th17 number, Th17-related cytokines (IL-17 and IL-6), and RORγt mRNA levels. They also presented a significant decrease in Treg number, Treg-related cytokines (TGF-β 1), and Foxp3 mRNA levels as compared with normal persons. As a result, the Th17/Treg ratios were markedly more upregulated in OSAS patients than those in control group. Furthermore, the Th17/Treg ratio was positively related to the severity of OSAS and serum levels of C-reactive protein. The development of OSAS may be associated with peripheral Th17/Treg imbalance and characterized by a proinflammatory cytokine microenvironment. These results opened an alternative explanation for the substantial activation of immune cells in OSAS and the development of related complications.

Reduced E-cadherin expression is associated with lymph node metastases in laryngeal squamous cell carcinoma

OBJECTIVE To investigate the expression of E-cadherin and its relationship with clinicopathological parameters in laryngeal squamous cell carcinoma (LSCC). METHODS Sixty-four patients who had previously undergone complete resection of tumor for LSCC were studied retrospectively. The level of E-cadherin expression in tumor tissues and paired nontumor tissues were determined by immunohistochemistry. RESULTS The expression of E-cadherin in tumor tissues was significantly lower than nontumor tissues (P<0.001). Reduced E-cadherin expression was significantly correlated with lymph node metastases (P<0.001). Kaplan-Meier survival estimates showed a significant correlation between E-cadherin expression and patient survival rate (log-rank P<0.05). Multivariate Cox proportional hazards model analysis confirmed that lymph node metastases (P=0.001) and tumor stage (P=0.013) were statistically significant, independent predictor of prognosis. CONCLUSION Expression of E-cadherin is an independent predictor of lymph node metastases in LSCC. However, it does not appear to be a better prognostic predictor than other established markers in LSCC.

Expressions of IL-17, IL-21 and IL-23 in the Serum of Allergic Rhinitis Patients

Expressions of IL-17, IL-21 and IL-23 in the Serum of Allergic Rhinitis Patients The present study aimed to investigate the expressions of interleukin-17 (IL-17), IL-21 and IL-23 in the serum of allergic rhinitis (AR) patients and to explore their relationship with special IgE (sFgE) in the serum. AR patients (n=24) and healthy subjects (n=12) were recruited and serum samples were collected. The serum level of IgE specific for inhalant allergens was determined using the automatic quantitative immunofluorescence analysis system, and the contents of IL-17, IL-21 and IL-23 in the serum were detected using ELISA. The level of serum IgE in the healthy individuals was categorized as grade 0 and that in the AR patients as grade 2-6. The mean contents of IL-17, IL-21 and IL-23 were 164.71 ±39.37 pg/mL, 199±97.86 pg/mL and 78.94±26.33 pg/mL, respectively, in the AR patients, and 67.75±18.24 pg/mL, 7.58±5.49 pg/mL and 13.58± 3.93 pg/mL, respectively, in the healthy subjects. Statistical analysis showed the serum levels of IL-17 and IL-23 in the AR patients were markedly higher than those in the healthy subjects, however, no significant difference was noted in the content of IL-21. Furthermore, the IL-17 level was positively related to the levels of IL-23 and IgE and the IL-23 level was positively related to the IgE level among AR patients, but no relations were observed between the IL-21 level and levels of IL-17, IL-23 and IgE. Our study indicates IL-17 and IL-23 may play an important role in the pathogenesis of AR and maybe IL-21 is not involved in the occurrence of AR. Ekspresija IL-17, IL-21 I IL-23 u Serumu Pacijenata sa Alergijskim Rinitisom Cilj ove studije bio je da se utvrdi ekspresija interleukina-17 (IL-17), IL-21 i IL-23 u serumu pacijenata sa alergijskim rinitisom (AR) kao i da se ispita njihov odnos sa specifičnim IgE u serumu. Obuhvaćeni su pacijenti sa AR (n=24) i zdravi ispitanici (n=12) od kojih su uzeti uzorci seruma. Nivo IgE specifičnog za inhalatorne alergene u serumu određen je pomoću sistema za automatsku kvantitativnu imunofluorescentnu analizu, dok su količine IL-17, IL-21 i IL-23 u serumu utvrđene pomoću ELISA. Nivo IgE u serumu zdravih osoba obeležen je kao nulti stupanj a kod pacijenata sa AR stupnjevima od 2 do 6. Srednje vrednosti IL-17, IL-21 i IL-23 bile su 164,71±39,37 pg/mL, 199±97,86 pg/mL i 78,94±26,33 pg/mL kod pacijenata sa AR, i 67,75±18,24 pg/mL, 7,58±5,49 pg/mL i 13,58±3,93 pg/mL kod zdravih ispitanika. Statistička analiza pokazala je da su nivoi IL-17 i IL-23 u serumu pacijenata sa AR bili značajno viši nego kod zdravih ispitanika, dok za vrednosti IL-21 nije uočena značajna razlika. Štaviše, nivo IL-17 pokazao je pozitivnost u odnosu sa nivoima IL-23 i IgE, dok je nivo IL-23 imao pozitivan odnos sa nivoom IgE kod pacijenata sa AR, ali nije utvrđena povezanost između nivoa IL-21 i nivoa IL-17, IL-23 i IgE. Naša studija ukazuje na potencijalno važnu ulogu IL-17 i IL-23 u patogenezi AR, dok IL-21 možda ne učestvuje u nastanku AR.

CD4 + T-lymphocyte subsets in nonobese children with obstructive sleep apnea syndrome

Background:To characterize the distribution of both tonsillar and circulating CD4+T-lymphocyte subsets, and to explore their clinical relevance in nonobese children with obstructive sleep apnea syndrome (OSAS).Methods:A total of 53 children who underwent tonsillectomy for either OSAS (n = 25) or primary snoring (PS, n = 28) were prospectively enrolled. Nineteen healthy children without any symptoms were recruited as controls. We quantified the frequencies of CD4+T-lymphocyte subpopulations using flow cytometry, serum-related cytokines using enzyme-linked immunosorbent assay, and key transcription factors using quantitative polymerase chain reaction (qPCR).Results:Tonsillar distributions of CD4+T-lymphocyte subsets were comparable in the OSAS and PS subjects. The peripheral Th17/Treg ratio was positively correlated to severity as measured by apnea/hypopnea index (AHI), serum C-reactive protein and hypoxia-inducible factor-1α mRNA in the OSAS children (P < 0.05). And AHI was independently associated with the peripheral Th17/Treg ratio (P < 0.05). Furthermore, the response to surgery was associated with a significant reversal of the Th17/Treg imbalance and a concomitant relief of the proinflammatory profile in the OSAS subjects.Conclusion:Pediatric OSAS was associated with an altered Th17:Treg balance toward Th17 predominance. The changes in lymphocytic phenotypes that correlated with recurrent intermittent hypoxia in sleep apnea may contribute to the variance in systemic inflammation and downstream morbidities of pediatric OSAS.

Effects of Immunotherapy on the Distribution and Clonality of TCR Vγ and Vδ Subfamily T Cells in Allergic Rhinitis Patients

Effects of Immunotherapy on the Distribution and Clonality of TCR Vγ and Vδ Subfamily T Cells in Allergic Rhinitis Patients The aim of this study was to investigate the changes in the peripheral specific IgE level, distribution of TCR Vg and Vd subfamily T cells and mRNA expressions of TCR Vg I-III following specific immunotherapy (SIT) with house-dust-mite extract in allergic rhinitis (AR) patients. Ten AR patients undergoing SIT with house-dust-mite extract for 1 year were recruited. Quantitative analysis of immunofluorescence was performed to detect the serum specific IgE (sIgE) level before and after SIT; RT-PCR-genescan analysis was employed to detect the mRNA expressions of TCR Vg (I-III) and Vd (1-8) in the peripheral mononuclear cells followed by analysis of T cell clonality. Real-time quantitative PCR was applied to detect the expressions of TCR Vg I-III genes. Ten healthy volunteers served as controls. For AR patients, SIT treatment could improve the symptoms, but the serum sIgE level was not markedly decreased. Before SIT, the expressions of TCR Vg I-III gene were similar between AR patients and controls (P>0.05) but markedly decreased after SIT in AR patients (P<0.05 in TCR VgI and VgII). The expressions of TCR Vd (1-8) before and after SIT were 5.3±0.82 and 4.9±0.57, respectively, and that in healthy controls was 5.2±1.40. Vd1, 2, 3 and 6 were the most common genes found in these patients. Significant difference in the TCR Vd6 subfamily T cells was found between the two groups. Polyclonal or biclonal proliferation was found in the T cells of patients before SIT and in healthy controls, but oligoclonal proliferation in only 1 subject before SIT. After SIT, the proportion of patients with oligoclonal proliferation of T cells (6/10) was markedly increased (P<0.05). SIT for 1 year could alter the expressions of TCR Vg I-III genes, the distribution of TCR Vg and Vd T cells and the ways in which T cells proliferate. The early improvement of symptoms following immunotherapy might not be related to the serum sIgE content in AR patients, but associated with the TCR gd T cells, especially the TCR V d6 T cells. Uticaj Imunoterapije na Distribuciju i Klonalnost T Ćelija iz Potporodice TCR Vγ I Vδ Kod Obolelih Od Alergijskog Rinitisa Cilj ove studije bio je da se istraže promene u nivou specifičnog IgE u perifernoj krvi, distribuciji T ćelija iz potporodice TCR Vg i Vd i ekspresiji TCR Vg I-III u mRNK posle specifične imunoterapije (SIT) sa ekstraktom grinja iz kućne prašine kod pacijenata sa alergijskim rinitisom (AR). Uključeno je 10 pacijenata sa AR lečenih specifičnom imunoterapijom sa ekstraktom grinja iz kućne prašine tokom 1 godine. Obavljena je kvantitativna analiza imunofluorescencijom kako bi se odredio nivo specifičnog IgE (sIgE) u serumu pre i posle SIT; primenjena je RT-PCR-genescan analiza radi određivanja ekspresije TCR Vg (I-III) i Vd (1-8) u mRNK u perifernim mononuklearnim ćelijama posle čega je obavljena analiza klonalnosti T ćelija. Kvantitativna PCR analiza u realnom vremenu sprovedena je kako bi se odredila ekspresija TCR Vg I-III gena. Deset zdravih dobrovoljaca služilo je kao kontrolna grupa. Kod pacijenata sa AR, tretman SIT olakšao je simptome, ali nivo sIgE u serumu nije se značajno snizio. Pre SIT, ekspresija TCR Vg I-III gena bila je slična kod pacijenata sa AR i kontrolnih subjekata (P>0,05), ali se značajno snizila posle SIT kod pacijenata sa AR (P>0,05 u TCR VgI i VgII). Ekspresija TCR Vd (1-8) pre i posle SIT bila je 5,3±0,82 i 4,9±0,57, a kod zdravih subjekata 5,2±1,40. Vd1, 2, 3 i 6 geni bili su najviše zastupljeni kod ovih pacijenata. Značajna razlika u T ćelijama TCR Vd6 potporodice utvrđena je između dve grupe. Poliklonalna ili biklonalna proliferacija nađena je u T ćelijama pacijenata pre SIT i kod kontrolnih subjekata, ali oligoklonalna proliferacija pronađena je samo kod 1 subjekta pre SIT. Posle SIT, proporcija pacijenata sa oligoklonalnom proliferacijom T ćelija (6/10) bila je značajno povišena (P<0,05). SIT tokom 1 godine može izmeniti ekspresiju TCR Vg I-III gena, distribuciju TCR Vg i Vd T ćelija kao i načine proliferacije T ćelija. Rano ublažavanje simptoma posle imunoterapije možda nije povezano sa sadržajem sIgE u serumu kod pacijenata sa AR, ali je u vezi sa TCR gd T ćelijama, naročito TCR V d6 T ćelijama.

Chinese Society of Allergy Guidelines for Diagnosis and Treatment of Allergic Rhinitis

Allergic rhinitis (AR) is a global health problem that causes major illnesses and disabilities worldwide. Epidemiologic studies have demonstrated that the prevalence of AR has increased progressively over the last few decades in more developed countries and currently affects up to 40% of the population worldwide. Likewise, a rising trend of AR has also been observed over the last 2–3 decades in developing countries including China, with the prevalence of AR varying widely in these countries. A survey of self-reported AR over a 6-year period in the general Chinese adult population reported that the standardized prevalence of adult AR increased from 11.1% in 2005 to 17.6% in 2011. An increasing number of original articles and imporclinical trials on the epidemiology, pathophysiologic mechanisms, diagnosis, management and comorbidities of AR in Chinese subjects have been published in international peer-reviewed journals over the past 2 decades, and substantially added to our understanding of this disease as a global problem. Although guidelines for the diagnosis and treatment of AR in Chinese subjects have also been published, they have not been translated into English and therefore not generally accessible for reference to non-Chinese speaking international medical communities. Moreover, methods for the diagnosis and treatment of AR in China have not been standardized entirely and some patients are still treated according to regional preferences. Thus, the present guidelines have been developed by the Chinese Society of Allergy to be accessible to both national and international medical communities involved in the management of AR patients. These guidelines have been prepared in line with existing international guidelines to provide evidence-based recommendations for the diagnosis and management of AR in China.

Transnasal endoscopic and combined intra–extranasal approach for the surgical treatment of frontal sinus cerebrospinal fluid rhinorrhea

The aim of this study was to summarize and analyze the outcomes of frontal sinus cerebrospinal fluid rhinorrhea (FS-CSFR) treated by transnasal endoscopic and combined intra–extranasal approach. Clinical data on 20 cases of FS-CSFR patients from 2005 to 2013, with emphasis on the postoperative complications, clinical outcomes, and key technology involved in the combined intra–extranasal procedure, were retrospectively reviewed. Among the 20 cases, 12 were treated by combined intra–extranasal procedure; the other eight cases were initially treated by trans-nasal endoscopic approach alone, and five of them (5/8, 62.5%) were successfully treated and three failed. The three failed cases subsequently underwent combined intra–extranasal approach. A total of 15 cases, who received combined procedure, experienced fast recovery, had mild complications, and had no significant facial scars, and no CSFR recurrence was observed. Combined intra–extranasal approach offers advantages in not only overcoming the difficulty of insufficient exposure of defects during transnasal endoscopic procedure but also improving the success rate of repair.

Distribution of food allergens in pediatric allergic rhinitis

Aims: To investigate the distribution of food allergens in pediatric allergic rhinitis. Methods: 106 children diagnosed with allergic rhinitis were reviewed and divided into two age groups, including preschooler (2-5 years old) group, 48 cases; and school children group (6-13 years), 58 cases. Allergen-specific IgE for the food allergens and inhalant allergens in patient’s serum was determined using the AllergyScreen system (Mediwiss Analytic GmbH, Germany). Results: Out of 106 AR children, 88 (83.02%) were tested positive for food allergen-specific serum IgE (sIgG), 97 (91.51%) positive for inhalant allergen-specific sIgE. Among these children, 79 (74.53%) were positive for both food and inhalant allergens, 9 (8.49%) were positive only for food allergens, and 18 (16.98%) were negative for food allergens but positive for inhalant allergens. Out of 88 children positive for food allergens, 34 (32.08%) were positive for single food allergen, 54 (50.94%) were positive for multiple food allergens. The top 6 food allergens, in the order of their positivity rates, were milk (52.83%), eggs (30.19%), beef (26.42%), cashew (26.42%), lamb (12.26%) and crabs (10.38%). The food allergen-positive rate in the preschooler group was higher than that in the school children group (P<0.05). Conclusion: Majority of the children with allergic rhinitis are also positive for food allergens, suggesting that food allergens might be one of the main causes for pediatric allergic rhinitis.The present study was undertaken to ascertain the affinity of the amino acid D-Tryptophan (D-Trp) towards the particular receptors on the melanophores of a major carp Labeo rohita (Ham.). D-Trp, which is sweet in taste, in the dose range of 4.9 x 10 -16 M to 4.9 x 10 -4 M has induced a dose-dependent aggregation (MSI 3.72 ± 0.15 to 1.09 ± 0.02) in the isolated scale melanophores of the dorso-lateral region of this fish. The precise binding of the ligand D-Trp with its receptors is partially dependent, in eliciting its actions, on the release of neurotransmitters. The melanophores do not get desensitized under 90 min incubation within the agonist D-Trp. The general α adrenoceptors as well as the α 2 adrenoceptors are involved in the tastant (D-Trp) induced aggregation of the melanophores. D-Trp demonstrates that its aggregatory effects are mediated with the intervention of the β adrenoceptors. Inhibition of the D-Trp induced aggregatory effect has also been observed when the melanophores were pretreated with the antibiotic neomycin. The aggregating nature of D-Trp suggests that it could be binding with the receptors of aggregation causing ligands.