[New progress in diagnosis and treatment of congenital laryngomalacia in infants].

Congenital laryngomalacia is the most common disease causing laryngeal stridor in infants. The pathogenesis has not yet been clearly concluded. It may be related to abnormal development of laryngeal cartilage anatomical structure, neuromuscular dysfunction, gastroesophageal and laryngeal reflux disease, etc. The typical manifestations of the disease are inspiratory laryngeal stridor and feeding difficulties, which can be divided into mild, moderate and severe according to the severity of symptoms. The diagnosis is mainly based on clinical symptoms, signs and endoscopy, among which endoscopy is an important diagnostic basis. The treatment of laryngomalacia depends on the severity of symptoms. Mild and some moderate congenital laryngomalacia children can be relieved by conservative treatment, and severe and some moderate congenital laryngomalacia children should be treated by surgery. Supraglottic plasty is the main surgical method, which can effectively improve the symptoms of laryngeal stridor, dyspnea, feeding difficulties and growth retardation in most children, and the surgical effect is good.

[Effect analysis of individualized operation for congenital preauricular fistula].

Objective:To investigate the effect and influencing factors of individualized operation for congenital preauricular fistula in children. Methods:The clinical data of 98 cases （109 ears） of congenital preauricular fistula treated in Department of Otolaryngology，Fuzhou Children's Hospital of Fujian Medical University from July 2016 to December 2020 were retrospectively analyzed. According to the characteristics and infection of preauricular fistula，they were divided into common type and variant type，static period of inflammation and period of infection.Individual surgical methods such as classical fistula resection, double fusiform incision and fistula location resection were used respectively.The efficacy，complication and influencing factors of different surgical methods were analyzed. Results:The operation time of classical fistula resection was shorter, and the difference was statistically significant（t = －2.905 and－3.005 respectively, all P<0.05）. According to the stages and types of fistulas, the selection of individualized surgical methods had achieved good results. There was no significant difference in incision complications and fistula recurrence among different surgical methods （all P>0.05）. Conclusion:Once infection occurs in congenital preauricular fistula, surgical resection should be performed as soon as possible after infection control, or as early as possible after infection maximum control if infection cannot completely subside. Surgical incision design should be individualized, complete resection of fistulas and lesions, minimally invasive and aesthetic.

[Diagnostic value of total serum IgE for atopy in children and adolescents].

Objective:To explore the value of total IgE in the diagnosis of atopy in children and adolescents. Methods:This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey from 2005-2006 included measurement of total and specific IgE levels and allergy questions for 6-19 year old children and adolescents. According to the results of specific IgE, participants were divided into the atopic or non- atopic group. Based on questionnaire, participants were divided into the rhinitis or non-rhinitis group. To compare the difference of total IgE between groups. The relationship between total IgE and atopy was analyzed. The value of total IgE in the diagnosis of atopy was analyzed by ROC curve. Results:①The geometric mean total IgE level in the non-atopic subjects and the atopic subjects were 24.4 kU/L and 153.1 kU/L, respectively. The difference between the two groups was statistically significant（P<0.01）. ②In logistic regression analyses, we observed the adjusted odds ratio（OR） for atopy with a 10-fold increase in total IgE level was 17.6[95%CI：14.1-22.3], statistically significant changes（P<0.01）. ③The area under the receiver operator characteristic curve（AUC） of total IgE for diagnosing atopy in the total population were 0.857. The specificity and sensitivity of total IgE at the optimal cutoff of 54.3 kU/L on the ROC curve for diagnosing atopy were76.4%, and 80.0%, respectively. At the optimal cutoff of 54.6 kU/L for diagnosing atopy in the population with rhinitis, AUC, specificity, and sensitivity were 0.888, 86.7% and 77.0%, respectively. At the optimal cutoff of 59.0 kU/L for diagnosing atopy in the population with non-rhinitis, AUC, specificity, and sensitivity were 0.841, 74.8% and 78.6%, respectively. ④The diagnostic specificity of atopy increased with total IgE, while the sensitivity decreased. Conclusion:There was a close relationship between total IgE and atopy. Total IgE level can be used to discriminates children and adolescents with and without atopy.

[Analysis of 54 cases of thyroglossal duct cyst resection with hyoid bone preservation].

Objective:To investigate the efficacy, complications and recurrence rate of thyroglossal duct cyst resection with hyoid preservation in children. Method:Fifty-four children with thyroglossal duct cyst underwent cervical color Doppler ultrasound, CT and/or MRI before operation to make a definite diagnosis.Hyoid-preserving thyroglossal cyst resection was performed in all children.In 51 cases, the cyst wall was close to the hyoid bone, and the thin layer of the hyoid bone surface was removed, while the other 3 cases had no definite association with hyoid bone, only cysts and branches were resected.In the cases where the cyst was close to the hyoid bone, fistula tissue was found in the suprahyoid muscle group in 4 cases, which were carefully separated and excised. Result:All patients had no complications after operation, and the incision healed in the first stage. Postoperative pathology: 51 cases were thyroglossal duct cysts and 3 cases were epidermoid cysts.Follow-up for 1 years to 3 years showed that only 1 case had recurrence（2.0%,1/51）. Conclusion:Postoperative recurrence of thyroid hyoid cysts does not depend on whether the hyoid bone is removed, but on the residue of its branches.The significance of hyoid bone preservation is to narrow the scope of operation, reduce trauma and complications, and avoid the impact of hyoid bone loss on vocal and swallowing function.

Requirement for CD28 in the effector phase of allergic airway inflammation.

Central to the pathogenesis of allergic airway inflammation are the activation and differentiation of T lymphocytes. This process requires the participation of the CD28 costimulatory receptor. Blockade of CD28 has been demonstrated to prevent inflammation and airway hyperreactivity in a murine model of asthma. Whether this is due specifically to defects in initial T cell activation or whether effector responses are also impaired has not been determined. Using adoptive transfer studies of Ag-specific lymphocytes, we demonstrate that CD28 has a critical role in both the induction and effector phase of allergic airway inflammation. Transfer of in vitro activated and Th2-differentiated Ag-specific lymphocytes from wild-type hosts restored inflammation, but not tissue eosinophilia in CD28-deficient recipients. Furthermore, similarly activated and differentiated CD28-deficient lymphocytes were ineffective at mediating inflammation in wild-type recipients. Secondary cytokine and proliferative responses of activated Th2 cells were highly dependent on CD28 in vitro. Moreover, eosinophil recruitment to both the lung and peritoneum is impaired by the lack of CD28, suggesting a generalized defect in the ability of eosinophils to accumulate at sites of inflammation in vivo. These data identify a novel role for CD28 in the effector phase of allergic airway inflammation and suggest that inhibition of this pathway may be a useful therapeutic intervention in previously sensitized individuals.

Synergistic autoactivation of the Epstein-Barr virus immediate-early BRLF1 promoter by Rta and Zta.

Expression of two Epstein-Barr virus (EBV) immediate-early gene products, Zta (encoded by the BZLF1 gene) and Rta (encoded by the BRLF1 gene), are required for the switch from latent infection to virus replication. We have analyzed the regions of the BRLF1 gene promoter (Rp) that are required for Rta and Zta transactivation of Rp. Notably, significant synergy between the actions of Rta and Zta on Rp was observed in both a B cell line (DG75) and an epithelial cell line (293), suggesting that during induction of the viral lytic cycle low levels of these viral transactivators are likely sufficient to initiate the entire lytic cascade. However, while two Zta binding sites (ZREs) have been identified in Rp, the proximal ZRE was the dominant site for mediating Zta transactivation. Rta activation of Rp was diminished by mutation of the proximal Sp1 binding site, as previously reported (J. Virol. 75 (2001), 5240), but mutation of this site only had a modest impact on transactivation of Rp by Rta in the presence of Zta. Further deletion analyses of Rp failed to identify a critical site for Rta transactivation of Rp in the presence of Zta, with the exception of deleting the TATAA box of Rp, suggesting that a non-DNA binding mechanism may be involved in the observed activation of Rp by Rta. We also observed promiscuous activation of several reporter constructs by Rta, suggesting that Rta activation of gene expression may involve a general non-DNA binding mechanism. Decreasing the amount of transfected Rta expression vector reduced background Rta activation, while retaining specific activation of Rp.