Safety of Tonsillectomy and/or Adenoidectomy in Pediatric Patients with Prolonged Activated Partial Thromboplastin Time and Factor XII Deficiency.

Objective: To evaluate the safety and feasibility of tonsillectomy and/or adenoidectomy (T&A) in pediatric patients with prolonged activated partial thromboplastin time (APTT) and coagulation factor deficiency. Methods: A prospective study was admitted to the children undergoing T&A at our institution between October 2019 and January 2020, specifically focusing on preoperative coagulation function. Within this group, we identified 5 patients exhibiting prolonged APTT and coagulation factor deficiencies, constituting the experimental group, and 10 patients matched by gender and age with normal blood coagulation function were selected as the control group. Comparative analyses between the two groups were conducted, focusing on surgical duration, intraoperative bleeding volume, duration of hospital stay, and postoperative complications such as active bleeding across the groups. At the six-month postoperative mark, a reassessment of coagulation functions and factor assays was conducted within the experimental group. Results: No statistically significant differences were discovered in terms of surgical duration or bleeding volume when comparing the experimental subgroups with their respective control counterparts. Furthermore, there were no incidences of postoperative active bleeding observed in any of the groups. Notably, postoperative APTT values (32.7 ± 1.7s) exhibited a significant disparity compared to preoperative levels (43.7 ± 1.8s, p < 0.01). Coagulation factors demonstrated normalization, evidenced by a significant difference in postoperative Factor XII levels (40.2 ± 5.4%) compared to preoperative levels (63.1 ± 5.9%, p < 0.01). Conclusion: Prolonged APTT with FXII factor deficiency does not show a significant bleeding tendency and is not a contraindication for T&A surgery. Post T&A surgery, children with abnormal coagulation function and deficient clotting factors show significant improvement compared to pre-surgery. It is important to consider that chronic inflammation in adenoids and tonsils may contribute to the prolongation of APTT and the manifestation of Factor XII deficiency.

[Clinical analyses of polysomnogram in snoring children].

OBJECTIVE: To analyze the characteristics of sleep structure, heart rate and arousal index (ArI) in children with primary snoring (PS) and mild, moderate or severe obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: A total of 113 children with sleep disorders were enrolled from January 2010 to March 2012 at Affiliated Children's Hospital, Capital Institute of Pediatrics. All of them underwent polysomnogram (PSG) and the data were analyzed statistically by SPSS 19.0. RESULTS: (1) No statistical difference existed in age, sleeping time or sleeping efficacy between PS and all OSAHS groups (all P > 0.05). (2) The proportion of stage I sleeping was 2.6% ± 1.4% in PS group, 5.4% ± 3.2% in mild OSAHS group, 4.7% ± 1.9% in moderate OSAHS group and 8.9% ± 4.0% in severe OSAHS group (F = 6.542, P = 0.000). The proportion of stage IV sleeping was 25.3% ± 5.6% in PS group, 32.4% ± 11.1% in mild OSAHS group, 30.6% ± 9.0% in moderate OSAHS group and 21.4% ± 10.8% in severe OSAHS group (F = 7.544, P = 0.000).The proportion of stage rapid eye movement (REM) sleeping was 21.1% ± 8.6% in PS group, 13.9% ± 4.0% in mild OSAHS group, 14.5% ± 4.9% in moderate OSAHS group and 12.3% ± 6.9% in severe OSAHS group (F = 11.204, P = 0.000).The proportion of stage II and III sleeping had no statistical difference among four groups. (3) The average heart rate in stage REM sleeping of four groups was (85 ± 11), (90 ± 14), (95 ± 10) and (101 ± 18) beats per minute(F = 6.452, P = 0.000) and (79 ± 10), (84 ± 14), (86 ± 7) and (93 ± 16) beats per minute in stage NREM sleeping(F = 5.369, P = 0.002). (4) In four groups, the difference of total count of spontaneous arousal, the spontaneous arousal count in stage REM and non-rapid eye movement (NREM) sleeping were all statistically significant (F = 56.379, 60.781, 44.061, all P = 0.000). And the difference of total count of respiratory arousal, the median of respiratory arousal count in stage REM and NREM sleeping were all statistically significant (F = 79.250, 36.137, 65.239, all P = 0.000). CONCLUSIONS: Heart rate is affected more obviously in moderate-severe OSAHS children. As compared with PS counterparts, OSAHS children had a reduction of spontaneous arousal and an increase of respiratory arousal. But the occurrence of spontaneous arousal of OSAHS children does not decrease with the progress of OSAHS in either stage REM or stage NREM.

Pediatric Epistaxis and Its Correlation Between Air Pollutants in Beijing From 2014 to 2017.

BACKGROUND: Epistaxis is a common symptom in children. The effect of air pollution on epistaxis is not yet clear. OBJECTIVES: To explore the characteristics of pediatric epistaxis in Beijing and its correlation with air pollutants. MATERIAL AND METHODS: Data were collected from 2014 to 2017 in Otolaryngology Department of Capital Institute of Pediatrics. Children diagnosed with epistaxis with relevant information with the same period of municipal air pollutants' concentration were compared. RESULTS: The annual visits of epistaxis showed a bimodal trend. The incidence of epistaxis in infants was low, increased with age, reached the peak between the ages of 4 to 5, and then gradually decreased with age. In different age groups, male patients were more than females. From 2014 to 2017 in Beijing, particulate matter less than 2.5 µm in diameter (PM2.5), particulate matter less than 10 µm in diameter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), and carbon monoxide (CO) showed a downtrend, lower in summer than in the other 3 seasons. Ozone (O3) was significantly higher in 2016 and 2017, showed an increase trend in summer. The incidence of epistaxis was negatively correlated with PM2.5, PM10, SO2, NO2 and CO, which was positively correlated with O3 (P < .05). CONCLUSIONS: Pediatric epistaxis in Beijing changes with age and has obvious seasonal variation. There are some correlations between air pollutants and the incidence of epistaxis in children.

Upper airway cough syndrome in 103 children.

BACKGROUND: In China, upper airway cough syndrome (UACS) is only less frequent than cough-variant asthma and accounts for 24.71% of chronic cough. This study aimed to determine the pathogenetic constituents and factors affecting UACS in children of different age groups, and to identify clinical clues for diagnosing UACS and a method for curative effect evaluation. METHODS: A total of 103 children with UACS whose chief complaint was chronic cough were studied from January to November 2013 at Children's Hospital, Capital Institute of Pediatrics. According to their age, children with UACS were divided into 3 groups: nursing children, pre-school children, and school-age children. We analyzed the differences in pathogenetic constituents and factors affecting UACS in children. The effect of UACS treatment was evaluated by the visual analog scale (VAS) and an objective examination. Chi-squared test and analysis of variance were performed with the SPSS 19.0 statistical software. RESULTS: There was a high incidence of UACS in school-age children. Rhinitis with adenoid hypertrophy was the main cause of 103 suspected UACS cases. Adenoidal hypertrophy was the major cause of UACS in the pre-school children group, while rhinitis was the major reason in the nursing children and school-age children groups. Among the 103 children, there were 45 allergen-positive children, with no significant difference among different age groups. VAS scores in the different disease groups after treatment were lower than those before treatment (all P < 0.01). VAS scores in different disease groups showed significant differences, except for 12 vs. 24 weeks after treatment (P = 0.023). Different age groups had different secondary complaints. CONCLUSIONS: There are different pathogeneses in different UACS age groups. Clinical treatment efficacy of children with UACS can be evaluated by the VAS combined with an objective examination. We recommend that the course of treatment should be 12 weeks.

Balanced Active Core in Heterogeneous Neuronal Networks.

It is hypothesized that cortical neuronal circuits operate in a global balanced state, i.e., the majority of neurons fire irregularly by receiving balanced inputs of excitation and inhibition. Meanwhile, it has been observed in experiments that sensory information is often sparsely encoded by only a small set of firing neurons, while neurons in the rest of the network are silent. The phenomenon of sparse coding challenges the hypothesis of a global balanced state in the brain. To reconcile this, here we address the issue of whether a balanced state can exist in a small number of firing neurons by taking account of the heterogeneity of network structure such as scale-free and small-world networks. We propose necessary conditions and show that, under these conditions, for sparsely but strongly connected heterogeneous networks with various types of single-neuron dynamics, despite the fact that the whole network receives external inputs, there is a small active subnetwork (active core) inherently embedded within it. The neurons in this active core have relatively high firing rates while the neurons in the rest of the network are quiescent. Surprisingly, although the whole network is heterogeneous and unbalanced, the active core possesses a balanced state and its connectivity structure is close to a homogeneous Erdös-Rényi network. The dynamics of the active core can be well-predicted using the Fokker-Planck equation. Our results suggest that the balanced state may be maintained by a small group of spiking neurons embedded in a large heterogeneous network in the brain. The existence of the small active core reconciles the balanced state and the sparse coding, and also provides a potential dynamical scenario underlying sparse coding in neuronal networks.

The Dynamics of Balanced Spiking Neuronal Networks Under Poisson Drive Is Not Chaotic.

Some previous studies have shown that chaotic dynamics in the balanced state, i.e., one with balanced excitatory and inhibitory inputs into cortical neurons, is the underlying mechanism for the irregularity of neural activity. In this work, we focus on networks of current-based integrate-and-fire neurons with delta-pulse coupling. While we show that the balanced state robustly persists in this system within a broad range of parameters, we mathematically prove that the largest Lyapunov exponent of this type of neuronal networks is negative. Therefore, the irregular firing activity can exist in the system without the chaotic dynamics. That is the irregularity of balanced neuronal networks need not arise from chaos.

Pediatric coblation total tonsillectomy: intracapsular or extracapsular?

OBJECTIVES: To compare the results of coblation intracapsular total tonsillectomy (CITT) with those of conventional coblation extracapsular total tonsillectomy (CETT) in the treatment of tonsillar hypertrophy in children with regards to efficacy and complications. METHODS: Ninety children with adenotonsillar hyperplasia underwent tonsillectomy ± adenoidectomy (48 CITT and 42 CETT). Intraoperative situation was observed and recorded. Patients were reexamined regarding recovery condition and tonsil regrowth, and were followed for at least one year. RESULTS: Significant differences were observed in four clinical features when the CITT group was compared with the CETT group: intraoperative bleeding score, intraoperative tonsillar fossa score, color of white membrane one day postoperatively, and visual analogue scale (VAS) value one week postoperatively (p < .05). There were statistical correlations between intraoperative bleeding score and age, course of disease, surgery method, number of acute tonsillitis attacks per year, and intraoperative tonsillar fossae score (p < .05). Two significant differences were noted when the tonsil hypertrophy group was compared with the chronic tonsillitis group: color of white membrane at one day and one week postoperatively (p < .05). No regrowth of tonsil was found. CONCLUSIONS: Compared with conventional extracapsular tonsillectomy, CITT has the advantages of decreased pain and bleeding, and promote healing of wounds. No tonsillar regrowth was observed after at least one year of follow-up.

Upper airway cough syndrome in children and two inflammatory factors: TRPV1 and TGF-ß2.

OBJECTIVES: The aim of the study was to investigate upper airway cough syndrome (UACS) in children and to determine alternative methods to explore the relationships among TRPV1, TGF-ß2, and UACS. METHODS: In 2012, 104 children with adenoid hypertrophy aged 2-13 years who were admitted to the otolaryngology department, Capital Institute of Pediatrics-affiliated children's hospital, were included in this study. Enzyme-linked immunosorbent assay (ELISA) and immunohistochemical (IHC) studies for TRPV1 and TGF-ß2 were performed to understand the relationship between the two inflammatory factors, and the correlations among the indices and UACS. The research was divided into three stages. In stage 1, 72 children (24 UACS and 48 controls) were enrolled in the study, and ELISAs for TRPV1 and TGF-ß2 were performed. In stage 2, 32 children (16 UACS and 16 controls) were enrolled in the study and both ELISA and IHC for TRPV1 and TGF-ß2 were performed. In stage 3, 41 children were enrolled in this research who had thick mucus secretions in the posterior nasal apertures in stage 1 and 2 (23 cases with chief complaint (or history) of chronic cough and 18 cases without). The difference between the TRPV1 and TGF-ß2 serum values and the clinical factors was determined. RESULTS: The levels of TRPV1 and TGF-ß2 were significantly increased in the UACS cases. OSAHS and thick mucus secretions correlated with a diagnosis of UACS. A history of asthma and thick mucus secretions correlated with elevation of the two inflammatory factors. There was no statistical correlation between ELISA and IHC testing. Among the children with thick mucus secretions, some had a higher possibility of chronic coughing including those who had higher levels of the two indices, larger tonsils and a history of chronic tonsillitis. CONCLUSION: The detections of TRPV1 and TGF-ß2 from serum and adenoid body specimens are valuable for UACS auxiliary diagnosis. Tonsil hypertrophy and chronic tonsillitis history are independent risk factors of UACS.

[Clinical analysis of abnormal acoustic admittance in preschool children with nasal and nasopharyngeal disorders].

OBJECTIVE: To investigate the risk factors of related disorders, which could lead to potential otitis media by observing the abnormal configuration of drum and abnormal acoustic immittance without symptoms in preschool children. METHODS: Eighty-one cases (162 ears) received flexible pharyngorhinoscopy, skin prick test, CT examination of sinus, and were diagnosed as allergic rhinitis, chronic sinusitis, adenoid hypertrophy. They had no complaints of ear related symptoms, but were observed to have abnormality in ear drum by physical examined. Acoustic immittance measurement were performed, so as to estimate whether they were accompany with potential otitis media. The changes of examination and tests were analyzed before and after the treatment. RESULTS: There were 15 cases (29 ears) with abnormal acoustic admittance among 81 cases (162 ears) who had no ear related symptoms but had different degree abnormality in ear drum. The morbidity rate of these 15 patients was 13.6% (6/44 ears) in allergic rhinitis patients, 18.2% (12/66 ears) in chronic sinusitis patients, and 21.2% (11/52 ears) in adenoid hypertrophy patients, respectively. The differences among the three diseases had statistical significance (χ² = 63.02,P < 0.05). Among 29 ears, 28 ears whose type of tympanic pressure curve were transferred from type C to type A two weeks after treatment. One ear whose type of tympanic pressure curve transferred from type B to type C four weeks after treatment. All cases had been followed up with no recurrent cases. CONCLUSIONS: Some preschool children with nasal and nasopharyngeal disorders had abnormal configuration of drum and abnormal acoustic immittance, and had potential risk for otitis media. Among the disorders, adenoid hypertrophy impact more on middle ear function. The early intervention of related diseases could prevent the developing trend of otitis media.

[Preliminary study on normal aerification of paranasal sinuses in children].

OBJECTIVE: To explore the normal aerification of paranasal sinuses in Chinese children with magnetic resonance imaging. METHODS: Two hundred and eighty Chinese children aged from 17 days to 14 years without any symptoms related to sinusitis were statistically analyzed in MRI features, including counting the number of paranasal sinus pneumatization and the maximum axial and sagittal area of the left maxillary. RESULTS: The pneumatization rate of maxillary sinus was 85% in children aged from 0 to 1 years. Until 3 years the pneumatization rate of maxillary sinus was 95% and there was no significant difference in boys and girls (χ(2) = 0.741, P = 0.389). The pneumatization rate of maxillary sinus reached 100% after 4 years old. The pneumatization rate of ethmoid sinus was 100% in this study. The pneumatization rate of sphenoid sinus was 0 within 1 year old, 49% within 4 years old and 100% after 7 years old. There was no significant difference in boys and girls on the pneumatization rate of sphenoid sinus (χ(2) = 2.452, P = 0.117). The pneumatization rate of frontal sinus was 0 within 5 years old, 62% within 9 years old and 95% after 10 years old. There was no significant difference in boys and girls on the pneumatization rate of frontal sinus (χ(2) = 0.124, P = 0.724). The axial and sagittal maximum area of maxillary sinus was (689.28 ± 221.79) and (659.76 ± 263.31) mm(2) in girls and (668.13 ± 206.38) and (638.60 ± 207.67) mm(2) in boys. The differences were significant (t = -19.78, P < 0.001; t = -19.89, P < 0.001). CONCLUSION: The study of the development and normal aerification of paranasal sinuses of children can help radiologist make correct diagnosis of paranasal sinuses in children.

[Analysis of intractable cough in 128 children].

OBJECTIVE: To disclose the etiological factors and to investigate the therapeutical effect on nasal disorders in 128 children with intractable cough. METHODS: One hundred and twenty-eight children with intractable cough were consulted by ENT doctors using electronic nasopharyngoscope, for those children with nasal diseases, relevant treatment was given. RESULTS: Among 128 children, one hundred and sixteen had nasal disorders. Upper airway cough syndrome (UACS) was diagnosed in 92 cases (71.9%), nasal disorders without UACS was diagnosed in 24 cases (18.7%), no nasal disorders were found in 12 cases (9.4%). Among children with UACS, allergic rhinitis was diagnosed in 76 cases, rhino-sinusitis in 39 cases, adenoid hypertrophy in 54 cases, and chronic rhinitis in 8 cases. However, for those children without UACS, 10 cases had chronic rhinitis and 14 cases had allergic rhinitis. Clinical symptoms, signs and the findings of electronic nasopharyngoscope were analyzed in 92 children with UACS. The results showed that regular cough occurred in 62 cases, nasal disease in 65 cases, subjective feeling of postnasal discharge in 18 cases, mouth breathing or snoring in 32 cases, purulent secretion in nasal meatus in 61 cases, retropharyngeal folliculosis in 58 cases, purulent secretion in pharynges detected from pharynx in 41 cases, and purulent or viscosity secretion were found in 91 cases by first electronic nasopharyngoscopy. After 14 days of treatment, the children with UACS (90/92) had significant higher remission rate (chi² = 32.21, P = 0.000) in cough than those who had nasal disorders but without UACS (13/24). CONCLUSIONS: The nasal disorders, especially for UACS, were common in children with intractable cough. The therapy to nasal disorders could release the chronic cough symptoms in children with intractable cough.

[Analysis of the causes of pediatric rhino-source diseases].

OBJECTIVE: To analyze clinical features of pediatric rhino-source diseases for reducing missed diagnosis and misdiagnosis. METHOD: Data of 3588 children with rhino-source diseases seen from April 2005 to May 2006 were retrospectively analyzed in this study in order to disclose the relationship of etiological factor, clinical features and diagnosis. RESULT: Among all these cases, 2090 complained of nasal discomfort including nasal obstruction, discharge, rhinalgia and epistaxis. However 1498 cases (41.76%) did not, of whom 470 cases had snoring and apnea, 332 cases of otalgia and otorrhea, 145 cases had chronic cough, 138 had headache and 92 had lower respiratory infection. CONCLUSION: A high percentage of children who suffered from pediatric rhino-source disease did not develop nasal symptoms. Pediatric rhino-source disease should be considered for patients in whom the therapeutic effect is unexpectedly poor.

[Effect of snoring on facial growth in children].

OBJECTIVE: To evaluate the effect of snoring on facial growth in children and the changes after surgery. METHODS: Observations on facial growth were taken by X-ray 1.5 - 2 years before and after surgery on 40 children snorers aged between 2 - 5 years old, whose tonsils and (or) adenoids were completely removed. The data collected before surgery in the 2 - 3 years old snorers and in the 4 - 5 years old ones were compared with the data from healthy children at the same age respectively. RESULTS: The comparison of data between 21 children snorers aged from 2 - 3 and 17 healthy children of the same ages showed that there was no significant difference in the diameter of pharyngeal cavity at tongue base (PAS), the diameter of nasopharyngeal cavity (UPW-PNS) and the angle between mandibular plane and frankfort horizontal plane (FH-MP) within 2 - 3 years group by statistically (P > 0.05). There is no significance in UPW-PNS and FH-MP angle within 4 - 5 years group by statistics (P > 0.05). Others results is significance in all groups (P < 0.05 or P < 0.01). There was no significant difference in all groups expect Y-axis Angle 1.5 - 2 years after surgery (P > 0.05). CONCLUSIONS: Abnormal facial growth was caused by the consistent force from the changed way of breathing due to the increasing narrowness of upper airway obstruction and the long-existing obstructive sleep. Surgery done as soon as possible is helpful to reduce the force caused by the obstruction and helpful to the normal facial growth.