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Objective:To analyze the results of polysomnography(PSG) in 523 children, and explore the sleep monitoring results and related influencing factors of obstructive sleep apnea hypopnea syndrome(OSAHS).Methods:The PSG monitoring results of children with OSAHS and non-OSAHS were analyzed for children aging from 0 to 16 years old, who were monitored at Sleep Medicine Center of Gansu Maternal and Child Health Hospital from January 2014 to December 2019.Results:A total of 523 children underwent PSG monitoring during the past 5 years.The male to female ratio was 1∶0.47, of which 66.9%(350/523)were children with OSAHS.The average proportion of rapid eye movement sleep was 1.95%(7.7/394). The height of non-OSAHS group was significantly higher than that of OSAHS group[(108.72±16.39)cm vs.(104.80±16.60)cm, P=0.016]. The incidence of OSAHS decreased with age( P=0.038). The apnea index, hypopnea index, apnea hypopnea index, obstructive apnea index, microarousal index, oxygen desaturation index, mean apnea time, and longest apnea time in the OSAHS group were higher than those in the non-OSAHS group( P<0.05). And the lowest oxygen saturation and the mean oxygen saturation during sleep were lower than those in the non-OSAHS group( P<0.05). Logistic regression analysis on the clinical data of OSAHS children showed that open mouth breathing and snoring at night had significant effects on children′s OSAHS, and the differences were statistically significant( P<0.05). Conclusion:PSG is of great significance for the diagnosis of OSAHS.The more severe the degree of OSAHS, the worse severe the night sleep hypoxemia.PSG should be recommended before taking any treatment for children with sleep disorders.
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Objective:To investigate the clinical manifestations and characteristics of tracheobronchial foreign bodies in children, and improve the diagnosis and treatment of foreign bodies.Methods:A retrospective analysis was performed on the clinical data of children with tracheobronchial foreign bodies confirmed by fiberoptic bronchoscopy between January 2010 to December 2019.The children with tracheobronchial foreign body who were treated in the Maternal and Child Health Hospital of Gansu Province.Results:A total of 967 cases were operated by soft electronic bronchoscope, and foreign bodies were removed by means of foreign body forceps or nets.Among them, 19 cases(3 cases with subglottic foreign bodies, one with row of pins, and the rest 15 cases with foreign bodies completely wrapped by granulation)were not removed, two cases were spontaneously coughed, and 946 cases (97.8%)were removed.Bronchial foreign bodies in children were more common in boys, with the ratio of male to female being 2.14∶1.The main age of onset was 1-3 years old(88.8%). The incidence was slightly higher in rural areas than that in urban areas(46.5% in urban areas, 53.5% in rural areas). Foreign bodies were inhaled most in March and least in June.From the perspective of season, winter and spring were more than summer and autumn.The foreign body types inhaled were mainly exogenous plant foreign body, accounting for 93.0%, among which peanut(31.7%)and melon seeds(19.2%)were the most common.The duration of foreign body inhalation was up to 347 cases(35.9%)in 1-3 days.There were 501 cases(51.8%)with endoscopic endobronchial inflammation, and 196 cases of children with varying degrees of granulomatous hyperplasia, accounting for 39.1% and 20.3% of the total.The foreign body in the right bronchus accounted for 50.0% and the left bronchus for 43.7%.There were 793 cases confirmed by imaging, with a positive rate of 81.9%, and 90.9% confirmed by CT.Conclusion:About 88.8% of tracheobronchial foreign bodies occurred in 1 to 3 years of age.The occurrence of foreign bodies had obvious gender, urban-rural and seasonal distribution characteristics, and more cases were male, in rural and winter as well as spring.
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Objective To explore the clinical characteristics of severe infant laryngomalacia diagnosed by flexible bronchoscopy,and to investigate the effectiveness and safety of treatment on it.Methods Data of 29 severe laryngomalacia patients from Gansu Provincial Maternity and Child-Care Hospital diagnosed by flexible bronchoscopy were analyzed from March 2013 to July 2015,retrospectively.Twelve cases of them received laser therapy under balanced intravenous anesthesia.Preoperative and postoperative pulse oxygen saturation(SpO2),pulmonary function,and dyspnea index were analyzed statistically.Results After supraglottoplasty with laser,the findings were as follows:SpO2(94.26 ± 1.30) ％,tidal volume (6.11 ± 0.77) mL/kg,time to peak tidal expiratory flow/expiratory time 27.42 ±3.51,volume at time of peak expiratory flow/expiratory volume 30.95 ± 5.46,and dyspnea index 1.95 ± 1.05;while preoperative findings were SpO2 (82.45 ± 1.35)％,tidal volume(5.30 ± 1.03) mL/kg,time to peak tidal expiratory flow/expiratory time 27.42 ± 3.51,volume at time of peak expiratory flow/expiratory volume 21.93 ± 7.23,and dyspnea index 2.75 ± 0.84,respectively,and there were significant differences between the preoperative and postoperative therapy (all P ＜ 0.05).Complications were not observed over the next 6 months after operations.Conclusions Severe infant laryngomalacia has influence on living quality of patients,which can be diagnosed by flexible bronchoscopy.Laser therapy is a safe effective cure for it.
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The livers from 5 week 14～32 human fetuses were studied. The results are summarized as follows:1. Two kinds of liver cells revealed by EM: the "light" and "dark" cells. The light ones are larger in size, more numerous in number, containing larger mitochondria and obvious RER and SER, but less free ribosomes than the dark ones. Both of them may contain hemosiderin granules and the configuration of mitochondria enclosed by circular or semicircular RER cisternae.2. Bile canaliculus: Beside canaliculi between two adjacent liver cells, canaliculi situated between 3 or 4 liver cells are not infrequently revealed. That is due to the fetal liver cells are arranged in groups rather than in cords. The stereoscopic configurations of bile canaliculus and the tight junction surrounding it are demonstrated more clearly in freeze-fracture micrograph than that of the TEM. In addition, one intracellular bile canaliculus is found in the freeze-fracture preperation.3. The blood sinusoid and hemopoietic focus: In the 4-week fetus, the endothelium of the sinusoid can hardly be recognized While its lumen is quite large. Many erythrocytes accompanied by their immature components can be seen among it. As to the 32-week fetal liver, the endothelium and Kupffer cell may be easily recognized but the lumen of the sinusoid dimenishes enormously. The hemopoietic foci are localized extra-sinusoidially and in close contact with liver cells. Their volume exceeds one half of the fetal liver lobule before the age of 28 weeks, then it dimenishes gradually. In the space of Disse a fat storage cell is revealed.4. The portal canal : The mensenchyma and immature erythrocytes in the portal canal dimenishes with the increase of the fetal age. The portal canal is surrounded by the pigmented limiting plate cells of the liver lobules. The interlobular bile duct is differentiated from the limiting plate cells. Its epithelium is composed of both light and dark cells. The former is more numerous and contains many large mitochondria in its apical portion, while the latter shows higher electron density. Microvilli are located on the surfaces of both kinds of cells and finger like processes in the enlarged intercellular spaces are revealed.
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A 14-week human fetal kidney was studied by the method of freeze-fracture, the results were as follows:1. All the nuclei of various cells at this stage of development possess distinct nuclear pores with the same diameter and they are distributed randomly on the nuclear membrane. The intramembraneous particles on the PF of both the inner and outer nuclear membranes are more numerous than that of the EF. The morphological features of the nuclear pores vary according to the plane of their fracture face; they appear as dimples on the EF and as valcano mouth on the PF. The interior of the nucleus usually contains homogeneously dispersed particles, but no such structures were seen in thin sections. In some nuclei a round vesicle was revealed.2. The cell membrane of various cells, at this stage, shows special structures to manifest their degree of differentiation. In the less differentiated epithelial cells of the renal tubules, the cell membrane is straight and the intramembraneous particles are randomly distributed, the intromembraneous particles on PF are more than on EF, comparetively well developed tight junctions are located at the latexal surface near the apical portion of the cell while in the differentiated proximal tubules, there are many microvilli on their luminal surface, but their lateral cell membrane is still straight without interdigitations. In some tubules small processes near the basal part may be seen, however, basal fold is still absent. The basal membrane of the renal tubules is very prominent. As to the epithelial cells of the viseral layer of the renal corpuscle, gap and tight junctions are revealed while they are columnar in shape, but as they differentiated into podocyte with primary and secondary processes, the structure of tight junctions become simple, less prominent and discontinuous.3. Cytoplasm: In the process of cell differentiation the amount of cytoplasm increases and the ratio of nuclear end cytoplasmic volume decreases. The orgauelles are less in the undifferentiated cells, so the structure of the cytoplasm of them is much simpler than that of the more differentiated ones. The compartmentation phenomenon of the cytoplasm of differentiated cells become distince. In the freeze-fracture micrographs the membraneous structures, such as mitochondria, Golgi complex and secretion granules etc. are more stereoscopic than those in thin sections, but the opportunity to reveal the fine structures of various cells is minimized due to only one fracture face for each specimen and what structure will be fractured is beyond the control of the operator.