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.

Mirabegron Ameliorated Atherosclerosis of ApoE-/- Mice in Chronic Intermittent Hypoxia but Not in Normoxia.

PURPOSE: It has been established that obstructive sleep apnea (OSA) is an independent risk factor for atherosclerosis. Chronic intermittent hypoxia (CIH) activates sympathoadrenal system and upregulates ß3 adrenergic receptor (ß3 AR). However, the effect of selective ß3 AR agonist mirabegron in CIH-induced atherosclerosis remains unknown. METHODS: We generated a CIH-induced atherosclerosis model through exposing ApoE-/- mice to CIH (8 h per day, cyclic inspiratory oxygen fraction 5-21%, 60-s cycle) for 6 weeks after 4-week high-fat dieting and investigated the effects of mirabegron, a selective ß3 AR agonist, on CIH-induced atherosclerosis. The coronary endarterectomy (CE) specimens from coronary artery disease patients with OSA and without OSA were collected. RESULTS: The expression of ß3 AR was significantly elevated in CIH-induced atherosclerosis model. Furthermore, treatment with mirabegron (10mg/kg per day by oral administration for 6 weeks) ameliorated atherosclerosis in ApoE-/- mice in CIH but not in normoxia. Mechanistically, mirabegron activated ß3 AR and ameliorated intraplaque oxidative stress by suppressing p22phox expression and reactive oxygen species (ROS) level. In addition, in human CE specimens, ß3 AR was also upregulated associated with increased p22phox expression and ROS level both in the lumen and in the plaque of coronary artery in OSA subjects. CONCLUSION: This study first demonstrated that mirabegron impeded the progression of CIH-induced atherosclerosis, at least in part, via ß3 AR-mediated oxidative stress, suggesting a promising therapeutic strategy for protecting against atherosclerosis induced by CIH.

Subclinical left ventricular systolic dysfunction detected in obstructive sleep apnea with automated function imaging and its association with nocturnal hypoxia.

BACKGROUND: Early detection of left ventricular (LV) dysfunction is crucial in obstructive sleep apnea (OSA) due to its close relationship with cardiovascular diseases. Global longitudinal strain (GLS) derived from automated function imaging (AFI) can precisely assess global longitudinal function. The aim of this study was to determine if LV GLS was reduced in patients with OSA and a normal LV ejection fraction (LVEF) and to assess any associated determinants. METHODS: Polysomnography (PSG) and echocardiography were done in consecutive patients with suspected OSA and normal LVEF in this prospective study. Patients were divided into two groups according to apnea-hypopnea index (AHI) (Group 1, normal or mild OSA: AHI < 15/h; Group 2, moderate-to-severe OSA: AHI ≥ 15/h). Clinical, PSG, and echocardiographic parameters were compared between the two groups and the associated factors were investigated. RESULTS: Of 425 consecutive patients, 244 were analyzed after exclusions. Patients in Group 2 had significantly worse GLS than those in Group 1 (p < 0.001). The prevalence of GLS reduction (defined as < - 19.7%) was 25% and 76%, respectively (χ2 = 34.19, p < 0.001). Nocturnal lowest pulse oxygen saturation (SpO2), AHI, body mass index (BMI), and gender were associated with GLS reduction (all p < 0.05). Further multivariate analysis showed that the lowest SpO2 (OR: 2.15), gender (OR: 2.45), and BMI (OR: 2.66) remained independent (all p < 0.05), and the lowest SpO2 was the most powerful determinant (χ2 = 33.0, p < 0.001) in forward regression analysis. The intra- and inter-operator variability for AFI and coefficient of repeatability was low even in those with relatively poor images. CONCLUSIONS: In patients with normal LVEF, more severe OSA was associated with a worse GLS. The major determinants were lowest nocturnal SpO2, gender, and obesity, but not AHI. GLS can be rapidly and reliably assessed using AFI.

[Effects of ginkgo biloba extract combined with glucocorticoid on olfactory function and inflammatory cytokines in mice with allergic rhinitis].

Objective:To determine whether ginkgo biloba extract(GBE)combined with dexamethasone(DEX)plays a role in the treatment of allergic rhinitis-related olfactory dysfunction using an animal model.Method:Six week old BALB/C mice were sensitized and challenged with ovalbumin.30 sensitized mice were divided into three groups:Group 1 was given high-dose GBE and DEX(n=10);Group 2 was given low dose GBE and DEX(n=10);Group 3 was given DEX alone(n=10).We assessed the histology of the olfactory mucosa and serum IL-4,IFN-γ,and caspase 1.Result:A significant higher fraction of mice in group 1 could find the food pellet within300 scompared to group 3(P<0.05).Caspase-1 levels improved during the second week compared with the first week in each group.IFN-γlevels were significantly lower during the second week compared with the first week(P<0.05,all).IL-4 levels also were significantly lower during the second week compared with the first week in all groups except those receiving DEX alone.IFN-γ/IL-4 levels in each group were significantly lower during the second week compared with the first week(P<0.05,all).Conclusion:In this animal model of allergic rhinitis-related olfactory dysfunction,the addition of ginkgo biloba extract to dexamethasone have a better anti-inflammatory effect,which can partly improve the therapeutic effect on olfactory dysfunction caused by allergic rhinitis.

[Preliminary study of DTI on cerebral white matter micro-structure of patients with idiopathic olfactory loss].

OBJECTIVES: To investigate the cerebral white matter micro-structure in patients with idiopathic olfactory loss using diffusion tensor imaging (DTI). METHODS: Sixteen patients with idiopathic olfactory loss and sixteen normal subjects matched by age and sex were recruited in this study. Sniffin'Stick olfactory test was performed to evaluate the olfactory function of all subjects. We acquired diffusion tensor images with an echo planar imaging (EPI) sequence from all subject on a 3T scanner. The fractional anisotropy (FA) images were performed using DTI-studio, and bilateral Piriform cortex, Orbitofrontal cortex, Hippocampus and Insula cortex adjacent white matter and Capsula interna were delineated as the region of interesting (ROI), the FA for each ROI was calculated. Independent sample t test analysis was used to compare the FA value of all ROIs between the controls and patients. In addition, correlation analysis between FA value and MMSE score in patients were conducted. RESULTS: Compared with the controls, patients showed significantly decreased FA value in the adjacent white matter of bilateral Piriform cortex, Orbitofrontal cortex, Hippocampus and Insula cortex (P<0.05). There is no significant difference of FA value in bilateral Capsula interna between two groups (P>0.05). CONCLUSIONS: The patients with idiopathic olfactory loss show the damage of white matter micro-structure in the olfactory center, which could be important for the pathogenesis study and early intervention of idiopathic olfactory loss.

[Effect of Betamethasone on the cAMP of olfactory receptor neurons in rat].

OBJECTIVE: To observe the effects of Betamethasone on the cyclic adenosine monophosphate (cAMP) in olfactory receptor neurons (ORNs) and explore the possible mechanisms of the recovery of olfactory disorders by steroid treatment METHODS: ORNs membrane was extracted and incubated with 0.1 mg/ml and 1.0 mg/ml Betamethasone. The concentrations of cAMP were measured by enzyme-linked immunosorbent assay at different times. RESULTS: Compared with the control group, all Betamethasone groups showed differences, indicating 0.1 mg/ml (P < 0.05) and 1.0 mg/ml (P < 0.01) Betamethasone could rise the concentration of cAMP. The Betamethasone had obvious effects on cAMP production in rat ORNs and there was a dose-dependent effect. There was no difference between 5 minutes groups and 30 minutes groups. CONCLUSIONS: Steroid hormone could enhance the production of cAMP of ORNs. Steroid hormone may thus contribute to the recovery of olfactory disorders partially, at least, through the effect on AC-cAMP in olfactory transduction.