[Clinical characteristics and serious complications of esophageal button battery ingestion in the pediatric on 83 cases].

Objective: To analyze the clinical characteristics and complications of esophageal foreign bodies of button battery ingestion in children. Methods: A retrospective descriptive study included 83 children who were hospitalized in our hospital on account of button battery ingestion from January 2011 to December 2021. There were 50 males (60.2%) and 33 females (39.8%). The age ranged from 7.6 months to one month off 10 years, with a median age of 18 months. The data of patient demographics and time from ingestion to admission, location, symptoms, management, complications, and follow-up outcome were recorded. SPSS17.0 software was used for statistical analysis. Results: Seventy-two children (86.7%) were younger than 3 years old. The time from ingestion to admission ranged from 1 h to 2 months, with a median time of 8 h. Among the 63 children who were first diagnosed in our hospital, the most common clinical symptoms were nausea and vomiting (32 cases, 50.8%), dysphagia (31 cases, 49.2%), salivation (11 cases, 17.5%) and fever (10 cases, 15.9%). Seventy-three of 83 cases had complete preoperative diagnostic tests, and 55 cases (75.3%) were diagnosed by X-ray. In 56 cases (76.7%), the foreign badies were impacted in the upper third of esophagus. In 72 cases (86.7%), the foreign badies were removed by rigid esophagoscopy. 23 (27.7%) had serious complications, including tracheoesophageal fistula in 15 cases(TEF;65.2%), vocal cord paralysis (VCP;34.8%) in 8 cases, esophageal perforation in 3 cases (EP;13.0%), hemorrhage in 3 cases(13.0%), mediastinitis in 3 cases (13%), and periesophageal abscess in 1 case (4.3%). There were significant differences in the exposure time of foreign bodies and unwitnessed ingestion by guardians in the complications group (P<0.05). 2 cases died (2.4%)respectively due to arterial esophageal fistula bleeding and respiratory failure caused by stent displacement during the treatment of tracheoesophageal fistula. Conclusion: Accidental button battery ingestion can be life-threatening. and it mostly happens in children under 3 years old. Serious complications may happen cause of non-specific clinical manifestations and unwitnessed ingestions. Anterior and lateral chest X-ray is the first examination choice. Tracheoesophageal fistula is the most common serious complication.

[Clinical diagnosis and treatments of type â ¡-â £ congenital laryngotracheoesophageal cleft in 8 children].

Objective: To investigate the clinical diagnosis and treatment of congenital laryngotracheoesophageal cleft (LTEC) in children. Methods: The clinical data of 8 children (including 7 males and 1 female)with congenital laryngotracheoesophageal cleft from January 2016 to June 2020 were retrospectively analyzed. The median diagnosing age was 3.75 months (5 days to 12 months). According to the modified Benjamin Inglis classification proposed by Sandu in 2006,there were 3 cases of type Ⅱ, 3 cases of type Ⅲa, 1 case of type Ⅲb and 1 case of type Ⅳa. All children were followed up regularly. Results: Six patients were treated for recurrent bronchopneumonia and aspiration during feeding. The patients were first treated in the pneumology departmentt or intensive care unit. Six patients combined with other malformations. Endoscopic repair operations were performed in 6 cases (3 cases of type Ⅱ, 3 cases of type Ⅲ a), 1 case of LTEC was operated through cervical approach, and 1 case of type IVa LTEC associated with VACTERL was repaired under thoracoscope combined with suspension laryngoscope. Seven patients underwent tracheotomy before or during the repair operations. Gastrostomy was performed in 2 children. The operations were successfully performed in all cases. Three children with type Ⅱ LTEC recovered well and decannulated. One case of type Ⅲa was followed up for 5 months with occasionally choking while feeding. Two cases of type Ⅲa, 1 case of type Ⅲb and 1 case of type Ⅳa died due to severe reflux, tracheomalacia or respiratory failure. Conclusions: Congenital LTEC is a rare congenital malformation which is difficult to diagnose for the poor specificity of clinical manifestations. LTEC needs to be classified by endoscopy examination under general anesthesia. Severe cases of LTEC have poorer outcomes than the mild cases, and the perioperative managements need multi-disciplinary cooperation to reduce the mortality.

[Analysis of complications and outcomes of tracheotomy with different etiology in children].

Objective: To discuss the complications and postoperative outcomes of tracheotomy with different etiology in children. Methods: One hundred and eighty-six patients underwent tracheotomy were retrospectively analyzed from January 2016 to December 2018,including 117 males and 69 females. The children aged from 4 days to 14 years (median age 31.5months). One case was operated under local anesthesia in emergency room, 2 cases were operated under local anesthesia in pediatric intensive care unit, the rest 183 cases were operated under general anesthesia in operation room. The 186 children were divided into four groups according to their direct causes of tracheotomy. Group A(90 cases): Neuromuscular disease and severe infection,Group B(26 cases): Head and neck tumor,Group C(57 cases): Congenital malformation and upper airway obstruction,Group D(13 cases): Accidental injury. The basic information, surgical complications and postoperative outcomes were recorded and analyzed. All patients were followed up by clinic or by telephone. Spss 19.0 software was used for statistical analysis. Results: One hundred and eighty-six patients were followed up for one to four years. 33 children lost the follow-up and 46 died. Among the 186 patients, 23 cases had emergency tracheotomy (12.4%). The rate of emergency tracheotomy in group C(16 cases, 28.1%) was higher than that in the other three groups(χ2=28.08,P<0.05). The average age of patients and hospital stay in group C were significantly lower than those in the other three groups (F=33.76,P<0.05; F=14.95,P<0.05). Incision bleeding occurred in 11 cases, Subcutaneous emphysema occurred in 6 cases and accidental decannulation occurred in 10 cases (4 cases within 2 weeks and 6 after 2 weeks). Six patients underwent tracheocutaneous fistula closure operation after decannulation and the stoma healed spontaneously in other extubated children. Two patients underwent secondary tracheotomy due to accidental decannulation, and three patients underwent secondary tracheotomy for dyspnea after decannulation. In 107 cases of survival children, decannulation was successful in 65 patients and failed in 42 patients. The average duration of wearing tracheal tube was 8.8 months. The decannulation rates in the four groups were 55.6%, 45%, 69% and 77.8%, with no significant difference. Conclusions: The complications after tracheotomy in children are rare, and no severe complications occurred in long-term tracheotomy patients. The duration of wearing tracheal tube is related to the treatment of their primary disease.

[Correlation between the visiting rate of patients with allergic rhinitis and airborne pollen concentrations in Beijing in recent 3 years].

Objective: To evaluate the daily airborne pollen concentrations and visiting rate of patients with allergic rhinitis (AR) and their correlation during 2012-2014 in Beijing. Methods: Daily airborne pollen concentrations (55 998 numbers in total and 549 numbers in average) and its constitution from April to September each year (2012 to 2014) were compared. The number of patients with AR (44 203 in total) who visited the outpatient department of Otorhinolaryngology Head and Neck Surgery, Peking University Third Hospital between January 2012 and December 2014 was analyzed by month. Using SPSS 22.0 software, Kruskal-Wallis test was done for the comparison of visiting rate of patients with AR and airborne pollen concentrations. Correlation analysis between them was made as well. Results: χ(2) value of airborne pollen concentrations between different months in 2012 to 2014 was 110.7, 108.4 and 121.4, respectively; all P<0.01. The airborne pollen concentrations had two peaks per year, respectively: April to May, August to September. χ(2) value of visiting rate of patients with AR between different months in 2012 to 2014 was 175.0, 185.1 and 134.5, respectively; all P<0.01. Visiting rate of patients with AR showed two scattering peaks each year, respectively: April to May, August to September. The highest pollen concentration of spring (April to May) was in early and middle April. Tree pollen was the major portion in spring, which were poplar pollen, pine tree pollen, ash tree pollen, cypress tree pollen and birch trees pollen. The highest pollen concentration of autumn (August to September) was in late August and early September. Weed pollen was the major portion in summer and autumn, which were artemisia pollen, chenopodiaceae pollen and humulus japonicas pollen. The visiting rate of patients with AR showed significant correlation with airborne pollen concentrations (r value was 0.537, 0.484 and 0.566, respectively; all P<0.01). Conclusion: The visiting rate of patients with AR showed positive correlation with airborne pollen concentrations in recent three years.

[The application of 3D simulationtemporal-bone-system for temporal bone anatomy training].

Objective:The aim of this study is to investigate the application of 3D simulation temporal-bone-system for temporal bone anatomy training.Method:3D simulation temporal-bone-system in the anatomy workshop was introduced in Beijing Children's Hospital from 2014 to 2015.Each participant was trained by cadaver dissection and 3D simulation temporal-bone-anatomy,and they also completed the questionnaires and evaluated the procedure.Then the difference was analyzed.Result:①In stage of mastoid outline,the damage of structure in 3D systemis higher than that in cadaver dissection(33.3%>22.2%),but there were no significant difference between them in the proportion of exposure.On the opening of attic,facial recess,facial nerve,the damage and the proportion of the non-exposed of cadaver dissection is higher.②There were no significant difference between them in the anatomical structures,levels of pollution,taste,cost and reproducibility(P>0.05),but in the aspect of time,relevance of CT with temporal bone,the similarity,and the force feedback,they had significant differences(P<0.01).Conclusion:3D simulation temporal-bone-system had better training effect in specialized otolaryngologist.It not only to help clinicians better understanding the temporal bone and surrounding structures,but also to emphasize the knowledge of the anatomy in temporal bone.

[Relationship between full flowering stages of anemophilous and ligneous plants and consultation rate of allergic rhinitis].

Objective:The aim of this study is to investigate the climatic changes on spring phenology impacting on the consultation rate of patients with allergic rhinitis.Method:We analyzed the periods of full flowering stages of 15 kinds of flowers in Beijing from 2013 to 2014,and the number of patients with allergic rhinitis in the outpatient clinic of Otolaryngology Department of Peking University Third Hospital in the same time.The correlation test, analysis of variance and rank sum test were used to investigate the inherent laws and associations between the full flowering stages and the ratio of patients with allergic rhinitis.Result:①Between 2013 and 2014,the early and middle April were the full flowering stages of Platycladus orientalis,Salix matsudana, Fraxinus chinensis,Elms and Birches.The number of patients with allergic rhinitis in outpatient clinic elevated obviously in this period.②There were overlaps of full flowering stages among different plants.During periods in which three or more kinds of pollens in full flowering stages,the consultation rate of patients with allergic rhinitis is higher than less overlaping flower period.The difference was statistically significant(F value were -2.281,-2.964 respectively, P <0.05).Also,there were obvious positive linear correlations between the number of overlap of different pollens and the consultation rate of patients with allergic rhinitis in in 2013 and 2014(r=0.957, 0.964 respectively).Conclusion:During the overlaping flower periods,there was a higher consultation rate of patients with allergic rhinitis.In prevention and treatment of allergic rhinitis,the overlapping effect of full flowering stages of different pollens should be taken into account.Upgrade the alarm level will reduce the incidence of AR and the degree of allergic rhinitis episodes.

Increasing production of matrix metalloproteinases, tumor necrosis factor-α, vascular endothelial growth factor and prostaglandin E2 in rheumatoid arthritis synovial fibroblasts by different adiponectin isoforms in a concentration-dependent manner.

Adipokines have been known to play a significant role in rheumatic disease via synovial fibroblasts. However, to date, the concentration effects of adiponectin isoforms on the pathophysiology of rheumatoid arthritis (RA) have not been extensively studied. Therefore, the present study examined the different effects of the adiponectin isoforms on rheumatoid arthritis synovial fibroblasts (RASF) and investigated the relations between the concentration of individual adiponectin isoforms and the production of the inflammatory factors of RASF. Articular synovial tissues were obtained from the patients fulfilled with diagnostic criteria of RA, and health people. RASF and human fibroblast—like synoviocytes (HFLS) were isolated and cultured. They were stimulated with increasing concentrations of 25 μg/ml, 50 μg/ml, and 100μg/ml of different human adiponectin isoforms. The levels of matrix metalloproteinase (MMP)—3, MMP—10, tumor necrosis factor (TNF)—α, vascular endothelial growth factor (VEGF), and prostaglandin E2 (PGE2) in culture supernatants were measured by immunoassays. The results showed the levels of MMP—3, MMP—10, TNF—α, VEGF and PGE2 were significantly increased in RASF which were treated with individual adiponectin isoforms compared to untreated RASF (p<0.01), and the increases also had significances compared to HFLS which were treated with the same conditions (p<0.05). Moreover, the effect of HMW (high molecular weight)/ MMW (middle molecular weight) was the strongest among them. In conclusion, all three adiponectin isoforms may contribute to proinflammatory effect by stimulating the production of MMP—3, MMP—10, TNF—α, VEGF and PGE2 of RASF in a concentration—dependent manner. HMW/MMW adiponectin could play an important role in matrix destroying and synovial vascular creating of the pathology of RA.

Pro-inflammatory cytokine-mediated ferroportin down-regulation contributes to the nigral iron accumulation in lipopolysaccharide-induced Parkinsonian models.

Pro-inflammatory cytokines induced by inflammation and iron accumulation in the substantia nigra (SN) have been implicated in the pathogenesis of Parkinson's disease (PD). In the present study, we aimed to investigate the relationship between inflammation and iron accumulation in a lipopolysaccharide (LPS)-induced Parkinsonian rat model. The activation of glial cells and elevated levels of pro-inflammatory cytokines were observed in the SN of LPS models, accompanied by iron deposits in the same region. Moreover, ferroportin (Fpn), the only channel for iron export, was down-regulated. SH-SY5Y dopaminergic cells were pre-incubated with conditioned media enriched in pro-inflammatory cytokines, and abnormal iron deposits and a drop of Fpn were observed. The expression of heme oxygenase-1 (HO-1) was also upregulated in vivo and in vitro. These results suggested that pro-inflammatory cytokines might induce Fpn downregulation, which leads to iron accumulation and dopaminergic neurons' degeneration in PD. HO-1 may also contribute to the iron accumulation in neurons, but its mechanism needs to be further investigated.

Role of phosphate and kinetic characteristics of complete iron release from native pig spleen ferritin-Fe.

The kinetics for complete iron release showing biphasic behavior from pig spleen ferritin-Fe (PSFF) was measured by spectrophotometry. The native core within the PSFF shell consisted of 1682 hydroxide Fe3+ and 13 phosphate molecules. Inhibition kinetics for complete iron release was measure by differential spectrophotometry in the presence of phosphate; the process was clearly divided into two phases involving a first-order reaction at an increasing rate of 46.5 Fe3+/PSFF/min on the surface of the iron core and a zero-order reaction at a decreasing rate of 6.67 Fe3+/PSFF/min inside the core. The kinetic equation [C(PSFF-Fe3+)max - C(PSFF-Fe3+)t](1/2) = Tmax - Tt gives the transition time between the two rates and represents the complex kinetic characteristics. The rate was directly accelerated twofold by a mixed reducer of dithionite and ascorbic acid. These results suggest that the channel of the PSFF shell may carry out multiple functions for iron metabolism and storage and that the phosphate strongly affects the rate of iron release.

H2-uptake activity, spectra, reduction potentials, and kinetics of iron release on the surface of iron core from Azotobacter vinelandii bacterial ferritin.

Bacterial ferritin from Azotobacter vinelandii (AvBFo) has a function in H2 uptake. The Fe3+ reduction on the surface of the iron core from AvBFo is accompanied simultaneously by H2 uptake, with a maximum activity of H2 uptake of 450 H2/AvBFo. A reduction potential of -402 mV for iron reduction on the surface of the core is found. A shift to the red the protein absorbance peaks ranging from 280 to 290 nm is observed between pH 5 and 9 under 100% H2 reduction. The reduction potential for iron release becomes negative at a rate of 0.025 mV/Fe2+ released. The kinetics of iron release on the surface of the core is a first-order reaction.

[Clinical study on early use of Chinese medicinal herbs and chemotherapy after operation of gastric cancer].

In order to study the efficacy of early chemotherapy after operation of gastric cancer, 84 cases of gastric cancer were divided randomly into two groups. The treated group received both Chinese medicinal herbs and chemotherapy on the first postoperational day and the control group were treated routinely in the same way two weeks later. The results showed that complications of incision and anastomoses of the treated group did not rise and all kinds of blood cells reduce in comparison with those of control group (P > 0.05). Meanwhile, nutritious condition of the treated group was improved significantly as compared with that of control group (P < 0.05) because of use of Chinese medicinal herbs and nutrition support. This study suggested that chemotherapy could be used early after operation of gastric cancer in combination with Chinese medicinal herbs.