Vocal nodules in children: Laryngoscopic morphological classification aids prognostic judgment.

Objective: Vocal fold nodules (VFNs) are benign lesions, occurring at the junction of the anterior and middle thirds of bilateral vocal cords, for which pediatric prognosis and treatment remains controversial. There is a requirement for a correlation indicator to assess the prognosis by pediatric otolaryngologists. Materials and methods: Patients with VFNs, who were admitted to the department of otolaryngology, were enrolled. The patient's gender, age, duration of dysphonia, laryngoscopy results and related diseases [allergic rhinitis, sinusitis, laryngopharyngeal reflux (LPR)] were collected and recovery from dysphonia followed up. Correlations between clinical factors and type of laryngoscopic morphology of VFNs were analyzed. Results: A total of 432 patients with dysphonia were identified, 208 agreed to undergo laryngoscopy and 194 were diagnosed with VFNs as a result. The modal age of patients with dysphonia was between 3 and 7 years with a male: female ratio of 2.1:1 (294:138) and 116 (26.85%; 116/432) had symptoms of allergic rhinitis. The boy to girl ratio among the 194 children with VFNs was about 2.6:1 (140:54) and modal age was consistent with dysphonia. Vocal nodules were the cause of most phonation disorders (93.27%; 194/208) and those with long duration of dysphonia presented more mature (p = 0.026) and discrete types (p = 0.022). Boys were more likely to have mature (p = 0.050) and discrete nodules (p = 0.008). Dysphonia recovery time was closely related to age (p = 0.000), duration of dysphonia (p = 0.000) and morphology of vocal nodules under laryngoscopy (p = 0.000). Conclusion: Vocal nodules are the most frequent cause of phonation disorders in children. The morphological classification by endoscopy may help with clinical diagnosis and therapy choice. In the case of the older child with longer duration of dysphonia and the appearance of mature, large, discrete nodules by laryngoscopy, active treatment is recommended, such as drug therapy, voice therapy or surgical treatment.

[Epidemiology of acute kidney injury in Chinese critical patients].

OBJECTIVE: To investigate the epidemiological profile of acute kidney injury (AKI) in the Chinese critical patients. METHODS: The hospitalization data and serum creatinine data of critically ill adult patients were collected from 9 regional central hospitals across China in 2013. Kidney Disease Improving Global Outcomes (KDIGO 2012) criteria was used to define and stage AKI. The demographic characteristics of the patients, comorbidities, stage of AKI, in-hospital outcomes and risk factors were retrospectively analyzed. RESULTS: Of the total of 14 305 critically ill patients included in the study, 4298 (30.04%) were identified to have AKI, including 2240 (52.1%) in stage 1, 845 (19.7%) in stage 2, and 1213 (28.2%) in stage 3. The in-hospital mortality rate was 16.7% (716/4298) and the odds ratio for death was 7.59 (95%CI 6.54-8.79, P<0.001). The length of hospital stay, daily cost, and mortality rate were associated with the stage of AKI. Multivariate analysis identified chronic kidney disease (OR=5.45, 95%CI: 4.71-6.32, P<0.001), extra-renal organ failure (OR=12.57, 95%CI: 11.24-14.07, P<0.001), shock (OR=2.44, 95%CI: 2.01-2.96, P<0.001) and cardiac surgery (OR=5.96, 95%CI: 5.16-6.87, P<0.001) as the independent risk factors for AKI. Only 5.4% of the AKI patients whose serum creatinine change met the KDIGO criteria during hospitalization received the diagnosis of AKI upon discharge. CONCLUSION: AKI is common in critically ill patients and associated with high mortality rates and poor outcomes. The stage of AKI is related with the in-hospital outcomes of the patients. Chronic kidney disease, extra-renal organ failure, shock and cardiac surgery are the major risk factors for AKI in these patients. Missed diagnosis occurs in most of the AKI cases, which urges more awareness of the condition in the critically ill patients during hospitalization.

[Inhibitory effect of chondroitinase ABC on ephrin A4 expression after spinal cord injury in rats].

The aim of the study was to investigate the effect of chondroitinase ABC (ChABC) on ephrin A4 (EphA4) expression after spinal cord impairment (SCI) in rats. Adult female SD rats were randomly divided into three groups: ChABC group, normal saline (NS) group and sham group. In the ChABC and NS group, the SCI model was produced by the spinal cord hemisection. The rats in sham group received sham operation without the spinal hemisection. ChABC and NS groups were intrathecally injected with ChABC and normal saline, respectively. At different time points after SCI, injured region of spinal cord was taken out as sample. The levels of EphA4 expression were measured by immunofluorescence technique and Western blot. And the expressions of growth associated protein 43 (GAP-43) and glial fibrillary acidic protein (GFAP) were detected using double immunofluorescent staining. Immunofluorescent results showed that, compared with that in sham group, the EphA4 expression was significantly down-regulated on 1, 3 and 7 d after SCI, then up-regulated on 14 and 21 d after SCI in NS group. In ChABC group, the level of EphA4 expression was significantly less than that in the NS group during the whole time after SCI. Western blot showed an identical result to that of immunofluorescent staining. The double labeling results showed that on 3 d after SCI, the number of GFAP, glial cells marker, positive cells in NS group was lower than that in sham group, but higher than that in ChABC group. Moreover, GAP-43 was not detected in all three groups. These results suggest that ChABC can decrease the expression level of EphA4 and reduce the number of astrocytes after SCI, thus improving microenvironment of the injured region and promoting axonal growth and extension.