Preterm Birth, Low Birth Weight, and Medical Comorbidities Are Risk Factors for Severe Laryngomalacia in Children.

Objective: To analyze the clinical characteristics and the risk factors associated with severe laryngomalacia in children. Methods: In this study, the clinical data of children (0-18 years), including gender, age at presentation, preterm delivery, low birth weight, delivery mode, feeding mode, fetal delivery, medical comorbidities, maternal gestational age at presentation, and calcium supplementation during pregnancy, diagnosed with laryngomalacia between January 2013 and January 2023 were retrospectively analyzed. The children were divided into mild-moderate and severe groups. Several risk factors were compared and analyzed between the 2 groups. The statistically significant risk factors were included in the logistic regression analysis. Results: A total of 224 children with severe laryngomalacia were enrolled in this study. The ratio of male to female patients was 1.55:1. All patients had severe laryngomalacia manifested by inspiratory laryngeal stridor. The average age of patients at symptom presentation was 2.7 (1.5-5.2) months. There were significant differences between the 2 groups in the age at presentation, premature delivery, low birth weight, medical comorbidities, and calcium supplementation during pregnancy (P < .05). Multivariate logistic regression analysis showed that premature delivery [odds ratio (OR) = 3.177, 95% confidence interval (CI): 2.329-4.334], low birth weight (OR = 3.188, 95% CI: 2.325-4.370), and medical comorbidities (OR = 1.434, 95% CI: 1.076-1.909) were independent risk factors for severe laryngomalacia (P < .05). Conclusion: Children with severe laryngomalacia exhibited persistent stridor at an earlier age at presentation. Premature delivery, low birth weight, and medical comorbidities were potential risk factors for severe laryngomalacia in children.

Profiling the clinical characteristics and surgical efficacy of laryngomalacia in children.

OBJECTIVE: To analyze the clinical characteristics of laryngomalacia in Chinese children and explore the surgical efficacy and factors influencing severe laryngomalacia. METHODS: Children (0-18 years) diagnosed with laryngomalacia in our hospital from January 2016 to January 2022 were enrolled in this study. Clinical data of patients, including general conditions, clinical symptoms, grading and classification, medical comorbidities, surgical efficacy, and the risk factors influencing severe laryngomalacia were retrospectively analyzed. RESULTS: A total of 1810 children were enrolled (male:female; 2.02:1), among which most were infants under 1 year (77.18%). Inspiratory laryngeal stridor (69.56%) was the most common symptom. Most patients had mild laryngomalacia (79.28%), with type IV laryngomalacia being the most common classification (52.27%). Congenital heart disease (37.85%) was the most common medical comorbidity. A total of 168 severe laryngomalacia cases were treated via supraglottoplasty with an effective rate of 83.93%. Notably, preterm birth (OR = 3.868, 95% CI 1.340 ~ 11.168), low birth weight (OR = 4.517, 95% CI 1.477 ~ 13.819) and medical comorbidities (OR = 7.219, 95% CI 2.534 ~ 20.564) were independent risk factors for poor prognosis (P < 0.05). CONCLUSION: Laryngomalacia is common among infants under the age of one, and it is mostly characterized by inspiratory laryngeal stridor with various medical comorbidity. Supraglottoplasty is the first treatment choice for severe laryngomalacia cases with high success rates. However, premature delivery, low birth weight, and medical comorbidities significantly affect the efficacy of surgery.

[Application of endoscopic surgical repair through bracing laryngoscope in children with type â ¢ laryngeal clefts].

Objective:To analyze the efficacy of endoscopic surgical repair in the treatment of type Ⅲ laryngeal clefts and to explore the feasibility of the treatment for type Ⅲ laryngeal clefts. Methods:The clinical data of 6 children with type Ⅲ laryngeal clefts who underwent endoscopic surgical repair in our department from June 2018 to January 2023 were analyzed retrospectively. The operation was performed under combined intravenous and general anesthesia,preserving the spontaneous breathing of the children. With the assistance of 4 mm/0° endoscope, radiofrequency knife or laryngeal scissors were used to make fresh wounds along the edge of laryngeal clefts,and cotton pads infiltrated with adrenaline （1:10 000） were used to compress the wound. 6-0 PDP suture was used to suture 3-6 stitches according to the extent of laryngeal clefts. Modified barium swallowing test （MBS） was performed 3 months after operation. Results:All the children were successfully treated with endoscopic surgical repair. After surgery, 2 cases were transferred to pediatric intensive care unit （ICU） for 7 days of monitoring, and the rest were transferred back to the general ward. There were no postoperative complications. The symptoms of dysphagia, laryngitis and recurrent pneumonia were improved in all children. According to the follow-up results of postoperative MBS,no aspiration was found in all children, and 2 children had intermittent cough when drinking large amounts of water. During the follow-up, there were 2 cases of recurrence, and the cracks were completely repaired after the second endoscopic surgical repair treatment,and no recurrence has been observed so far. Conclusion:Endoscopic surgical repair can be applied to some children with type Ⅲ laryngeal clefts with less intraoperative bleeding and fewer operative complications. It can significantly improve the symptoms such as swallowing dysfunction and recurrent pneumonia. It is a safe and effective surgical treatment.

[Application of peroral endoscopic-assisted laryngeal microsurgery in children with laryngeal neurofibromas].

Objective:To investigate the clinical manifestations and the effect of peroral endoscopic-assisted laryngeal microsurgery for children with laryngeal neurofibroma, and to provide clinical reference for the diagnosis and treatment of this disease. Methods:The clinical data of 4 children with laryngeal tumors admitted to the Department of Otorhinolaryngology, Children's Hospital of Chongqing Medical University from January 2021 to June 2023 were retrospectively analyzed. Laryngeal tumors were removed by peroral endoscopic-assisted laryngeal microsurgery. One case underwent tracheotomy at the same time, and one case was simultaneously performed with laryngeal T tube placement and tracheotomy. Results:Surgical resection is the best treatment for laryngeal neurofibroma, and laryngeal microsurgery should be actively used for patients with surgical indications.This surgical method has the advantages of good efficacy, minimal invasion, aesthetics and preservation of laryngeal function, which not only ensures safety, but also improves the quality of life after surgery, and has the value of development and promotion.

[Present situation and progress of surgical treatment for laryngeal clefts].

At present, there is no unified gold standard for the treatment of laryngeal clefts. Type Ⅰ laryngeal clefts with mild symptoms can be treated conservatively, such as thick diet feeding and using proton pump inhibitor to control reflux, while Ⅱ-Ⅳ laryngeal clefts mostly requires surgical intervention.There are many different surgical methods for the treatment of laryngeal clefts, including injection laryngoplasty, endoscopic surgical repair of laryngeal clefts and open laryngoplasty through anterior cervical approach. How to choose a more suitable surgical plan for children is a problem worth discussing. This article will review the literature on the surgical treatment of laryngeal clefts both domestically and internationally, and summarize the current situation and challenges of surgical treatment of laryngeal clefts.

Electrochemical selenocyclization of 2-ethynylanilines with diselenides: facile and efficient access to 3-selenylindoles.

An efficient electrochemical selenocyclization strategy for the synthesis of 3-selenylindoles from 2-ethynylanilines and diselenides has been developed in simple tube- or beaker-type undivided cells under ambient conditions. Notably, these sustainable transformations are completed within a short time with low equivalents of charges, diselenides and electrolytes, exhibiting a broad substrate scope with excellent functional group compatibility. Moreover, a gram-scale electrosynthesis and late-stage functionalization of complex molecules further demonstrate the practical synthetic potential of this facile electrochemical system.

Analysis of Multimorbidity of Moderate to Severe Allergic Rhinitis in Children: A Real-World Study.

INTRODUCTION: Allergic rhinitis (AR) in children is associated with various comorbidities, posing challenges for treatment and management. There have been few investigations of these multimorbidities in Chinese children with AR. Here, we investigated the prevalence of multimorbidities in children with moderate to severe AR and analyzed the influencing factors using real-world data. METHODS: In total, 600 children who visited the outpatient clinic of our hospital and were diagnosed with moderate-severe AR were prospectively enrolled. All children underwent allergen detection and electronic nasopharyngoscopy. Parents or guardians completed a questionnaire that included age, sex, mode of delivery, feeding pattern, and familial history of allergy. The multimorbidities investigated included atopic dermatitis (AD), asthma, allergic conjunctivitis (AC), chronic rhinosinusitis (CRS), adenoid hypertrophy (AH), tonsil hypertrophy (TH), recurrent epistaxis, and recurrent respiratory tract infections (RRTIs). RESULTS: The AR multimorbidities reported in children were as follows: recurrent epistaxis (46.5%), AC (46.3%), AD (40.7%), asthma (22.5%), RRIs (21.3%), CRS (20.5%), AH (19.7%), and TH (12.5%). In univariate logistic regression analysis, age (<6 years), birth mode, familial history of allergy, and single dust mite allergy were associated with AR multimorbidity (p < 0.05). Multivariate logistic regression revealed that a familial history of allergy was an independent risk factor for AC (odds ratio [OR] = 1.539, 95% confidence interval [CI]: 1.104-2.145) and AH (OR = 1.506, 95% CI: 1.000-2.267) (p < 0.05). Age (<6 years) was independently associated with the risk of AD (OR = 1.405, 95% CI: 1.003-1.969) and RRTIs (OR = 1.869, 95% CI: 1.250-2.793) (p < 0.05), cesarean section with AR and CRS risk (OR = 1.678, 95% CI: 1.100-2.561), and single dust mite allergy with asthma (OR = 1.590, 95% CI: 1.040-2.432) and CRS (OR = 1.600, 95% CI: 1.018-2.515) risk (p < 0.05). Further, non-dust mite allergy was independently associated with AR and CRS (OR = 2.056, 95% CI: 1.084-3.899). CONCLUSION: AR was found to be accompanied by different comorbidities, including both allergic and non-allergic comorbidities, complicating disease treatment. These findings demonstrated that age (<6 years), familial history of allergy, types of allergens, and cesarean section were risk factors for different multimorbidities associated with AR.

Endoscopic percutaneous repair of laryngeal cleft.

Objective: The aim of this study was to describe a novel surgical technique of endoscopic percutaneous repair in pediatric patients with type 1, type 2 and type 3 laryngeal cleft (LC). Methods: A retrospective study involving 12 patients with LC was performed at a tertiary pediatric hospital between February 2021 and June 2022. Endoscopic percutaneous repair was performed in all the patients. Information such as demographics, comorbidities, history of tracheostomy and the open approach for the repair, type of cleft and complications were analyzed. Results: Twelve patients were diagnosed with LC. The median age of the patients at the time of surgery was 8.50 months (interquartile range, 49.50 months). Seven patients had tracheomalacia, four patients had subglottic stenosis, three patients had laryngomalacia. No surgical complications occurred in the 10 patients who underwent the primary procedure. For two patients who underwent a secondary procedure, endoscopic percutaneous repair failed again to heal the cleft. During the follow-up period after surgery, none of the patients had stridor, recurrent pneumonia, feeding difficulties, or dyspnea. Follow-up modified barium swallow postoperatively demonstrated no aspiration in 10 patients. Only the 2 patients with a secondary procedure had intermittent cough while taking large gulps of water. The cure rate of endoscopic percutaneous repairer was 83.3% (95% confidence interval: 73.9%-92.8%). Conclusion: Endoscopic percutaneous repair should be considered as an alternative to the open transcervical approach and the traditional endoscopic approach for type 1, type 2 and type 3 LC.

Immediate extubation after single-stage laryngotracheal reconstruction for subglottic stenosis in children.

PURPOSE: To evaluate the feasibility and clarify the appropriate indications for extubation immediately after single-stage laryngotracheal reconstruction (SS-LTR) in pediatric subglottic stenosis (SGS). METHODS: A retrospective study was performed from July 2017 to July 2022. All patients underwent SS-LTR with anterior costal cartilage graft. Information such as demographics, comorbidities, history of intubation or tracheostomy, Classification and grading of airway stenosis, the operation-specific decannulation rate and overall decannulation rate were analyzed. RESULTS: Twenty-two patients with simple SGS were identified. The median age at SS-LTR was 19 months (IQR = 18.5 months). Fourteen patients (63.6%) were intubated prior to the presentation of symptoms. Fourteen patients (63.6%) required preoperative tracheostomy to maintain a secure airway. Eight patients (36.4%) had congenital SGS, 10 patients (45.5%) had acquired SGS, and 4 patients (18.2%) had mixed SGS. Three patients had Grade II stenosis. Nineteen patients had Grade III stenosis. Comorbidities were found in 10 patients (45.5%). Major comorbidities were pneumonia. Congenital airway anomalies were found in 6 patients (27.3%). After anesthesia, all 22 patients were successfully extubated and returned to the general ward. Twenty patients had a satisfactory airway after SS-LTR. Two patients required reintubation or tracheostomy after operation. Operation-specific decannulation rate was 90.9%. The overall decannulation rate is 100%. CONCLUSION: SS-LTR with anterior costal cartilage graft is an effective method to treat simple SGS ranging from Grades I to III in children. Extubation immediately after surgery is safe and feasible.

Increased expression of type 2 innate lymphoid cells in pediatric patients with allergic rhinitis.

Type 2 innate lymphoid cells (ILC2s) are a newly identified group of innate immune cells. ILC2s promote features of allergic airway diseases through the secretion of Th2 type cytokines, including interleukin (IL)-4, IL-5 and IL-13. It remains unknown whether ILC2s aggregate in the peripheral blood. The present study examined the ILC2 levels in pediatric patients with allergic rhinitis (AR), and the correlation with the severity of clinical symptoms. Flow cytometry detected the ILC2s frequency in the peripheral blood of 12 healthy controls (HCs), 12 patients with AR sensitized only to house dust mites (HDM-AR), and 18 AR patients monosensitized to other antigens including weeds, animal danders and Blattella germanica, but not including HDM (non-HDM-AR). Clinical symptoms of AR were expressed according to the Total 5 Symptom Score (T5SS). The percentages of ILC2s in the peripheral blood were increased significantly in patients with HDM-AR and non-HDM-AR, compared with that in the HCs. A subgroup analysis of patients with AR indicated that the proportion of ILC2s was significantly increased in HDM-AR in comparison with that in non-HDM AR. Furthermore, there was a notable correlation between ILC2 levels and T5SS scores. ILC2s frequencies in PBMC were increased significantly in pediatric patients with AR, irrespective of the type of allergen. HDM may trigger more severe allergic reactions and an increase in the number of ILC2s. These discoveries indicate the unique function of ILC2 in AR and provide a potential therapeutic target.

Silencing of CD86 in dendritic cells by small interfering RNA regulates cytokine production in T cells from patients with allergic rhinitis in vitro.

The aim of the present study was to investigate the expression and role of the co­stimulatory molecule T­lymphocyte activation antigen CD86 (CD86) in dendritic cells (DCs) from the peripheral blood of patients with allergic rhinitis (AR) compared with those from healthy individuals. It was observed that mature DCs from the peripheral blood of patients with AR expressed high levels of the co­stimulatory molecule CD86, but not CD80, compared with healthy control subjects. CD86 expression levels in DCs decreased significantly following transfection with siRNA in a lentiviral vector. Furthermore, the level of transforming growth factor­ß1 produced by T cells co­cultured with DCs was significantly increased in the siRNA group, while interleukin (IL)­4 and IL­5 production was significantly decreased. The findings of the present study indicated that CD86 may play a pivotal role in the regulatory T cell/type 2 helper T cell imbalance in allergic inflammation.

Genetic risk of FCRL3 and FCRL5 polymorphisms in children with asthma and allergic rhinitis in a Chinese Han population.

OBJECTIVES: Asthma and allergic rhinitis (AR) frequently occur as comorbid diseases of the upper airways. Single-nucleotide polymorphisms (SNPs) in the FCRL3 and FCRL5 genes have recently been shown to be associated with various immune-related disorders. This study evaluated the association of FCRL3 and FCRL5 polymorphisms with asthma and allergic rhinitis (AR) in a Han Chinese population. METHODS: Seven single nucleotide polymorphisms (SNPs) of the FCRL3 and FCRL5 were genotyped in 300 asthmatic children, and 206 healthy unrelated individuals using PCR-restriction fragment length polymorphism (PCR-RFLP) assay. Genotyping was validated by direct sequencing. RESULTS: Our results showed that the frequencies of the rs6692977 CT genotype and T allele within FCRL5 were significantly higher in asthma with comorbid AR compared to healthy controls (Bonferroni-corrected p (Pc) = 3.75 × 10-6; Pc = 0.006, respectively), whereas these of the CC genotype and C allele were significantly lower (Pc = 4.15 × 10-5; Pc = 0.006, respectively). The frequencies of the rs7528684 A allele (Pc = 1.80 × 10-3) and the rs10489678 G allele (Pc = 0.04) within FCRL3 were higher in asthma with comorbid AR than in controls. However, no differences in the tested genetic polymorphisms were detected between asthma and healthy individuals. CONCLUSION: This study identified novel SNPs in FCRL3 and FCRL5 significantly associated with the risk for asthma with comorbid AR in the Chinese population. The genetic variants may play role in the development of the asthma phenotype in children with asthma.

Genetic variations in interleukin-12B in allergic rhinitis.

Interleukin (IL)-12B is a key regulator in the protection against allergic reaction induced by various allergens in patients with allergic rhinitis (AR). This study was performed to investigate the associations between single nucleotide polymorphisms in the IL-12B gene and AR in a Chinese Han population. A total of 543 patients with AR and 600 healthy controls were genotyped for IL-12B/rs6887695, rs10045431, rs3212227, rs3212217, and rs2082412 using polymerase chain reaction (PCR) restriction fragment length polymorphism and PCR direct sequencing. The expression of IL-12B mRNA in peripheral blood mononuclear cells (PBMCs) obtained from normal controls was detected by quantitative real-time PCR. Levels of interferon (IFN)-γ and IL-4 in culture supernatants were measured by enzyme-linked immunosorbent assay. The frequencies of the rs3212227 genotype with the CC and C alleles were higher in patients with AR (p c = 8.55 × 10(-4); p c = 4.20 × 10(-4), respectively) than in normal controls. After peptidoglycan stimulation in PBMCs, IL-12 mRNA expression was reduced in healthy carriers of the CC genotype of rs3212227. Additionally, decreased production of IFN-γ was observed in patients having the CC genotype as compared with that in patients having the AC and AA genotypes. In contrast, IL-4 expression was higher in patients with the CC genotype than in patients with the other two genotypes. The IL-12B gene was involved in mediating susceptibility to AR.

Establishment of a new animal model of allergic rhinitis with biphasic sneezing by intranasal sensitization with Staphylococcal enterotoxin B.

Allergic rhinitis (AR) is a global health problem. The effectiveness of currently available medications is limited and therefore investigation for more effective drugs is essential. The aim of the present study was to establish a model of AR in guinea pigs that can be utilized for the further investigation of new drugs. Guinea pigs were intranasally sensitized with 1 µg Staphylococcal enterotoxin B (SEB) dissolved in 40 µl saline once daily for 14 days. One week after the last sensitization, the same treatment was applied intranasally once every four days for a total of 30 times. In the treatment group, terfenadine was administered orally 70 min before the 4th, 14th and 24th challenge. Sneezing and nasal scratching were evaluated following each of the 30 challenges. The quantity of antigen-specific antibodies in the serum was measured. Between the 19th and 30th challenges, the guinea pigs in the model group produced significant biphasic elevations in sneezing number, with peaks 10 min-2 h and 4-8 h after the SEB challenges. In addition, the guinea pigs produced significantly more sneezing in the first peak during the 19th to 30th challenges than during the first to 18th challenges (P<0.01). Terfenadine significantly inhibited the early- and late-phase sneezing at all challenge times. The serum levels of SEB-specific immunoglobulin (Ig) E and IgG1 were higher in the model group in comparison with those in the control group (P<0.01). This experiment demonstrated that SEB can induce typical AR with biphasic sneezing in guinea pigs. Histamine may play an important role in the early- and the late-phase sneezing in the model of AR. This model can be potentially used for the investigation of new drugs.

(18)FDG-PET/CT for the detection of regional nodal metastasis in patients with head and neck cancer: a meta-analysis.

We performed a meta-analysis to evaluate the role of (18)FDG-PET/CT for detection of regional nodal metastasis in patients with head and neck cancer (HNC). Studies about (18)FDG-PET/CT were systematically searched in the MEDLINE and EMBASE databases. The Stata software was used to obtain pooled estimates of sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for (18)FDG-PET/CT. We also compared the performance of (18)FDG-PET/CT with that of conventional imaging (CT, MRI, and CT/MRI) by analyzing studies that had also used conventional imaging on the same patients. 24 articles bulled all inclusion criteria (1270 patients). The pooled per-patient, per-neck-side, and per-neck-level sensitivities/specificities for (18)FDG-PET/CT were 0.91/0.87, 0.84/0.83, and 0.80/0.96, respectively. Across 13 studies (3460 neck levels) with per-neck-level data, the sensitivity and specificity of PET-CT were 0.84 and 0.96, and of conventional imaging were 0.63 and 0.96, respectively. (18)FDG-PET/CT has good diagnostic performance for the detection of regional nodal metastasis in HNC patients. Compared with conventional imaging, (18)FDG-PET/CT may have higher per-neck-level sensitivity.

Allergen induced Treg response in the peripheral blood mononuclear cells (PBMCs) of patients with nasal polyposis.

BACKGROUND: Nasal polyposis (NP) is a chronic inflammatory disease of the nasal cavity and sinuses regulated by T cells. Regulatory T (Treg) cells are involved in controlling immune responses and inhibiting the allergen-specific effector cell response. The aim of this study was to evaluate whether NP patients had defects in Treg cells after specific allergen exposure and the possible correlation between atopy and Treg cells. METHODS: Peripheral blood mononuclear cells (PBMCs), isolated from NP patients and controls, were cultured with allergen+phytohemagglutinin (PHA) or PHA stimulation for 48h. The frequency of CD4+CD25+Foxp3+ cells was measured by flow cytometry. The level of Foxp3 was measured by Real-time PCR. Concentrations of Interferon-γ (IFN-γ), Interleukin-4 (IL-4), Interleukin-5 (IL-5), Interleukin-10 (IL-10) and transforming growth factor-ß (TGF-ß) in culture supernatants were determined by ELISA. RESULTS: Both atopic and non-atopic NP patients had a significantly decreased frequency of Treg cells and Foxp3 level in allergen stimulated PBMCs, also significantly decreased TGF-ß level in culture supernatants. The decrease was even more striking in the atopic group. Also, there were significantly negative correlations between Treg cells and IFN-γ, IL-4, IL-5. Moreover, inthe atopic group, allergen stimulation downregulated Treg cells and increased IFN-γ, IL-4, IL-5 levels, while upregulating Treg cells and decreasing IFN-γ, IL-4, IL-5 levels in controls. CONCLUSIONS: Patients with NP have a defective Treg cell response after allergen stimulation which is related to excessive Th1 and Th2 responses to specific allergens. Atopy may increase the impairment of Treg and exacerbate NP through the defective suppression of Treg on Th1 and Th2.

Andrographolide suppresses IL-6/Stat3 signaling in peripheral blood mononuclear cells from patients with chronic rhinosinusitis with nasal polyps.

The mechanisms underlying the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP) remain largely unknown. CRSwNP has garnered considerable public health concern owing to its high incidence and unsatisfactory treatment outcomes. Herbal remedies are promising candidates for the treatment of CRSwNP. We examined the utility of andrographolide, a diterpenoid lactone extracted from the Chinese herb Andrographis paniculata, an anti-inflammatory agent for CRSwNP treatment by evaluating interleukin (IL)-6 and IL-17 production and monitoring T helper 17 (Th17) differentiation of peripheral blood mononuclear cells (PBMCs) isolated from 20 Chinese CRSwNP patients and 11 control subjects. All CRSwNP patients exhibited clinical features of CRSwNP. Andrographolide significantly inhibited IL-6 and IL-17 production, suppressed p-Stat3 expression, and inhibited Th17 differentiation of PBMCs in vitro. These findings suggested that andrographolide has useful anti-inflammatory properties and could be used for the treatment of CRSwNP.

Differential expression of Immunoglobulin A in the adenoids of children with and without exudative otitis media.

OBJECTIVE: To evaluate the variation of Immunoglobulin A (IgA) levels in the adenoids of children with otitis media with effusion (OME) and the correlation to age. METHODS: A total of 129 children were enrolled in this study, including 60 children with OME and 69 children without OME. The children were divided into two groups according to age: aged ≤ 4 years (33 children with OME and 39 children without OME) and aged > 4 years (27 children with OME and 30 children without OME). The samples were collected from hypertrophic adenoids, which could cause obstructive symptoms and/or OME. The IgA concentrations were analyzed by immunohistochemistry in the two groups. RESULTS: The expression of IgA in the adenoids of children ≤ 4 years was significantly lower than in those aged > 4 years. Among children > 4 years, lower levels of IgA in the adenoids were observed in patients with OME than in patients without OME. However, no statistically significant differences in the IgA levels were found between patients aged ≤ 4 years with and without OME. CONCLUSIONS: The differential expression of IgA in the adenoids between patients with and without OME was correlated to age.

Allergen induced Th17 response in the peripheral blood mononuclear cells (PBMCs) of patients with nasal polyposis.

BACKGROUND: Nasal polyposis (NP) is a chronic inflammatory disease of the nasal cavity and sinuses. Th17 cells have been considered to play roles in allergic airway diseases and various chronic inflammatory disorders. AIM OF THE STUDY: This study aimed to investigate the population and function of peripheral Th17 cells in response to house dust mite extracts (HDM) allergen in NP patients, and evaluate the possible correlation between Th17 cells and atopy, to explore the role of atopy in the pathogenesis of NP. METHODS: Peripheral blood mononuclear cells (PBMCs) obtained from atopic NP patients, non-atopic NP patients, and controls were stimulated by phytohemagglutinin (PHA) or HDM plus PHA. The resulting frequency of Th17 cells was detected by flow cytometry and the expression of RORc was measured by real-time PCR. Then the concentrations of IL-17A, INF-γ, IL-4 and IL-5 in the supernatants were assayed by specific ELISAs. RESULTS: The population and function of Th17 cells in allergen stimulated PBMCs were significantly higher in atopic NP patients. In addition, in atopic group, HDM+PHA stimulation induced significant increase of Th17 population and IL-17A production versus those in PHA stimulated ones. However, the frequency of Th17 cells was not correlated with Th1, Th2 cytokine productions. CONCLUSION: Th17 immunity is involved in the systemic immune responses to allergen in atopic NP and atopy may aggravate NP by stimulating the increase of Th17 population and IL-17A production. The mechanism of Th17 cells response to allergen may be regulated differently from the regulation of Th1 and Th2 immunity in NP.

[Imbalance of Th17/Treg cell ratio in peripheral blood of patients with nasal polyposis and its clinical significance].

AIM: To observe the distribution of Th17 cells and Foxp3(+);CD4(+);CD25(+); regulatory T cells in peripheral blood of patients with nasal polyposis(NP) and their correlation with clinical patients' condition, and to explore the role of Th17/Treg cell ratio imbalance in pathogenesis of nasal polyposis and significance. METHODS: The frequencies of Th17 cells and Treg cells were determined in 46 patients with NP and 10 controls by flow cytometry. The 46 patients were divided into two groups according to endoscopy score and CT score: the 1 group (endoscopy score: 2-8 scores; CT score: 3-10 scores, n=23) and the 2 group (endoscopy score: 8-12 scores; CT score: 10-19 scores, n=23). RESULTS: Th17 cells were significantly higher in the blood of patients with NP compared with the control group (P<0.01), and the percentage was higher in the 2 group than the 1 group (P<0.05). The frequency of Treg cells was significantly decreased in patients with NP compared to the control group (P<0.01), whereas the difference between two groups was not significant. The ratio of Th17/Treg cells was highest in the 2 group (P<0.01), lower in the 1 group (P<0.01) and lowest in control subjects, and the differences were also significant between two groups (P<0.05). Furthermore, it was confirmed that the ratio of Th17/Treg positively correlated with endoscopy score and CT score (P<0.01). CONCLUSION: The imbalance of Th17/Treg cell ratio characterized by increased Th17 cells and decreased Treg cells exists in peripheral blood of NP patients and may play an important role in the onset and development of NP. The degree of Th17/Treg cell imbalance may associate with clinical presentation.