[Characterization of otorhinolaryngologic manifestations in children with mucopolysaccharide storage disease typeâ and type â ¡].

Objective:To analyze the characteristics of otorhinolaryngological clinical manifestations in children with Mucopolysaccharide（MPS） type Ⅰ and type II in order to improve the knowledge of otorhinolaryngologists about this disease. Methods:Clinical data related to 55 children with MPS type Ⅰ and type II were retrospectively analyzed to investigate the clinical manifestations of MPS in ENT. Results:All 40 patients（72.72%） with MPS had at least one ENT symptom during the course of the disease, with 95% of them having an ENT symptom prior to the diagnosis of MPS; upper airway obstruction was the most common ENT symptom（34, 85.00%）, followed by recurrent upper respiratory tract infections（23, 57.50%）, and lastly, hearing loss（11, 27.50%）; all 26 patients had undergone at least one surgical procedure, of which 15（57.69%） had undergone ENT surgery, and all of these patients underwent ENT surgery before diagnosis. The most common ENT surgery was adenoidectomy. Conclusion:Early clinical manifestations of MPS patients are atypical, but the early and prevalent appearance of otolaryngologic symptoms and increased awareness of the disease among otolaryngologists has a positive impact on the prognosis of MPS.

[Advances in the treatment of infantile hemangiomas of the larynx].

Infantile hemangiomas are relatively common soft tissue tumors in infants and young children, with a prevalence of about 4.5% in full-term newborns. Subglottic Hemangioma （SGH） is a relatively rare type of hemangioma, and its special location often causes respiratory distress and potentially life-threatening conditions in infants. Therefore, it is necessary for clinicians to make an accurate diagnosis and formulate a detailed treatment plan based on the clinical manifestations, the auxiliary examinations, the medical history and the vital signs evaluation of patients.This review describes the pathophysiological mechanism of infantile hemangioma and provides a detailed discussion on commonly used treatment methods in detail.

Clinical characteristics of abruptly increased paediatric patients with Omicron BF.7 or BA.5.2 in Beijing.

BACKGROUND: The coronavirus disease 2019 outbreak has hit Beijing since mid-Nov, 2022, with soaring growth of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among children. Therefore, it is vital to determine the clinical manifestations of epidemic SARS-CoV-2 strains in paediatric patients. METHODS: In this study, nucleic acid tests (NATs) for SARS-CoV-2 were performed in paediatric outpatients with symptoms of acute respiratory tract infection during 18 Nov-6 Dec, 2022. Half of the outpatients positive for SARS-CoV-2 were randomly selected to screen for other respiratory pathogens, whereas those with low cycle threshold values in SARS-CoV-2 NATs were amplified and sequenced to determine the SARS-CoV-2 variants. Finally, children positive for SARS-CoV-2 with clinical information in detail were enrolled in a follow-up study to identify potential factors significantly associated with long recovery. RESULTS: Among 9625 paediatric outpatients tested for nucleic acid of SARS-CoV-2, 733 (7.62%, 733/9625) were identified as SARS-CoV-2 NAT positive, with only three (0.82%, 3/366) co-infected with other pathogens among 366 randomly selected patients, and 71 (62.83%) determined as Omicron subvariant BF.7 and 42 (37.22%) as BA.5.2 among 113 successfully sequenced. Among the 681 patients with complete clinical information, fever was the most common symptom (96.8%). In a follow-up study of 592 patients, 46.96% became asymptomatic on the third day and 65.71% on the fifth day. Only 1.7% of infected children experienced febrile seizures. Combined with abnormal C-reactive protein, a higher percentage of antibiotics administration was observed. More co-living members and longer duration of first symptoms served as independent risk factors for long-term recovery, especially in children vaccinated for SARS-CoV-2. CONCLUSIONS: BF.7 and BA.5.2 were the dominate Omicron subvariants and caused milder infections during the SARS-CoV-2 outbreak in Beijing. The number of co-living members and duration of first symptoms were independent risk factors for long-term recovery.

miR-146a-5p regulates autophagy and NLRP3 inflammasome activation in epithelial barrier damage in the in vitro cell model of ulcerative colitis through the RNF8/Notch1/mTORC1 pathway.

Ulcerative colitis (UC) is a chronic inflammatory disease affecting the colon that can be influenced by microRNAs (miRNAs). This study aims to investigate the impact of miR-146a-5p on lipopolysaccharide (LPS)-induced Caco-2/HT-29 cell autophagy and NLRP3 inflammasome activation and the underlying mechanism, with the aim of identifying potential therapeutic targets. We used LPS to establish Caco-2/HT-29 cell models and measured cell viability by CCK-8. The levels of miR-146a-5p, RNF8, markers of NLRP3 inflammasome activation and autophagy, proteins involved in the Notch1/mTORC1 pathway, and inflammatory factors were assessed by RT-qPCR, Western blot, and ELISA. Intestinal epithelial barrier function was evaluated by measuring transepithelial electrical resistance. Autophagic flux was measured using tandem fluorescent-labeled LC3. miR-146a-5p was highly-expressed in LPS-induced Caco-2/HT-29 cells, and autophagy flux was blocked at the autolysosomal stage after LPS induction. Inhibition of miR-146a-5p suppressed NLRP3 inflammasome activation, reduced intestinal epithelial barrier damage, and facilitated autophagy inhibition in LPS-induced Caco-2/HT-29 cells. The autophagy inhibitor NH4Cl partially nullified the inhibitory effects of miR-146a-5p inhibition on NLRP3 inflammation activation. miR-146a-5p targeted RNF8, and silencing RNF8 partly abrogated the action of miR-146a-5p inhibition on promoting autophagy and inhibiting NLRP3 inflammasome activation. miR-146a-5p inhibition suppressed the Notch1/mTORC1 pathway activation by upregulating RNF8. Inhibition of the Notch1/mTORC1 pathway partially nullified the function of silencing RNF8 on inhibiting autophagy and bolstering NLRP3 inflammasome activation. In conclusion, miR-146a-5p inhibition may be a potential therapeutic approach for UC, as it facilitates autophagy of LPS-stimulated Caco-2/HT-29 cells, inhibits NLRP3 inflammasome activation, and reduces intestinal epithelial barrier damage by upregulating RNF8 and suppressing the Notch1/mTORC1 pathway.

Clinical effect of wumei bolus on ulcerative colitis: A meta-analysis.

Wumei Bolus is a traditional Chinese medicine prescription, first appeared in Shennong Bencao Jing. Modern pharmacology believes that Wumei Bolus has antibacterial, antitussive, sedative, antiviral and anti-tumor effects, and plays a therapeutic role by acting on multi-target/multi-pathway. Moreover, it has great advantages in digestive system diseases, such as repairing the damaged gastrointestinal mucosa and improving the inflammatory environment. Aim of the study: This review aimed to evaluate the efficacy and safety of prescriptions based on the Wumei Bolus treating ulcerative colitis (UC). Materials and methods: In this meta-analysis, we searched CNKI, Wanfang Database, VIP, Pubmed, Web of Science (WOS) with language restrictions of Chinese and English for articles published from the establishment of the database to Dec 2022. This meta-analysis controlled randomized controlled trials (RCTs) assessing the efficacy and safety of Wumei Bolus against ulcerative colitis and using RevMan 5.4 and Stata 15.0to analyze information from the compliant studies. Results: The search incorporated 3145 results (1617 cases assigned into Wumei Bolus group and 1528 cases assigned into control group), from which 37 studies fulfilled our inclusion criteria and were included. The outcomes of this meta-analysis showed that compared to the control group, the Experiment group was significantly more effective (RR = 1.24，95%CI [1.20，1.28])and lower adverse reactions (RR = 0.32, 95%CI [0.20, 0.53]). According to the subgroup analysis, The results showed that the RR = 1.23 and 95%CI [1.16, 1.30] in the group treated with Wumei Bolus alone and the group treated with Western medicine with RR = 1.25 and 95%CI [1.20, 1.30], indicating that the efficacy of Wumei Bolus in the treatment of UC was better and the difference was statistically significant (P < 0.00001). The results showed that compared with the control group, the experimental group had more advantages in reducing inflammatory factors whether TNF-α or IL-8 (TNF-α:SMD = -4.44, 95%CI [-5.75, -3.14]; IL-8: SMD = -3.02, 95%CI [-4.06, -1.97]) and improving TCM symptoms and reduced TCM syndrome points (SMD = -3.82, 95%CI [-4.30, -3.34]). There was significant association of the basic treatment of Wumei Bolus improving clinical efficacy, reducing serum pro-inflammatory factors, improving symptoms, and reducing adverse reactions in UC patients. These results were statistically significant (P < 0.00001). Conclusions: The prescriptions based on the Wumei Bolus is greatly related to reducing serum pro-inflammatory factors, improving symptoms, improving clinical efficacy and reducing adverse reactions in the treatment of UC compared to conventional western medicine and improve the total clinical effective rate.

Promotive role of IRF7 in ferroptosis of colonic epithelial cells in ulcerative colitis by the miR-375-3p/SLC11A2 axis.

Ferroptosis is implicated in the progression of ulcerative colitis (UC), and interferon regulatory factor 7 (IRF7) contributes to cell death. This study probed the mechanism of IRF7 in ferroptosis of colonic epithelial cells (ECs) in mice with dextran sodium sulfate (DSS)-induced UC. The UC mouse model and the in vitro ferroptosis model were respectively established by DSS feeding and the treatment with FIN56 (a ferroptosis inducer). Results of quantitative real-time polymerase chain reaction and western blotting revealed the upregulation of IRF7 and solute carrier family 11 member 2 (SLC11A2/NRAMP2/DMT1) and the downregulation of microRNA (miR)-375-3p in DSS-treated mice and FIN56-treated ECs. Silencing of IRF7 improved the symptoms of UC in DSS-induced mice and decreased the levels of tumor necrosis factor α, interleukin 6, monocyte chemoattractant protein 1, and interleukin 1ß, reactive oxygen species, iron ions, lipid peroxidation, and increased glutathione and glutathione peroxidase 4. Chromatin immunoprecipitation and dual-luciferase assays showed that binding of IRF7 to the miR-375-3p promoter inhibited miR-375-3p expression, and miR-375-3p suppressed SLC11A2 transcription. The rescue experiments revealed that knockdown of miR-375-3p neutralized the role of silencing IRF7 in alleviating ferroptosis of colonic ECs. Overall, IRF7 upregulated SLC11A2 transcription by inhibiting miR-375-3p expression, thereby prompting ferroptosis of colonic ECs and UC progression in DSS-treated mice.

Development and validation of a cardiovascular disease risk prediction model for patients with non-dialysis-dependent chronic kidney diseases based on the nomogram.

Introduction Most CKD patients experience cardiovascular issues before commencing renal replacement therapy. An accuracy prediction model is helpful for physicians to assess cardiovascular prognoses in each individual, and to provide insights on how to outline individualized lines of therapy. Method This study enrolled 1138 participants with non-dialysis-dependent chronic kidney disease (NDD-CKD). Following a proportion of 7:3, patients were randomly assigned to training and validation cohorts. The relevant predictors of cardiovascular events were screened using the least absolute shrinkage and selection operator (Lasso) regression. The area under the receiver operating characteristic curve (AUC) and the calibration curve with 1000 bootstraps resamples were used to assess the nomogram's performance. Tests on the discrimination of the prediction model used Kaplan-Meier (KM) curve. Results After screening all the predictors by lasso regression, the five remaining ones (albumin, estimated glomerular filtration rate, etiology of CKD, cardiovascular disease history, and age) were used to construct the prediction model. The AUC of 1-year, 2-year, and 3-year was 0.81 (95% CI = 0.75-0.87), 0.80 (95% CI = 0.75-0.86), and 0.80 (95% CI = 0.73-0.86), respectively. The calibration curve and the KM curve showed good prediction features, and the external validation also had a good prediction performance (AUC of 1-, 2-, and 3-years were 0.77, 0.84, and 0.82, respectively). Conclusion We successfully developed a novel nomogram that has decent prediction performance and can be used for assessing the probability of cardiovascular events in patients with NDD-CKD, displaying valuable potential for clinical application.

[Presentation and management of allergic fungal rhinosinusitis in children].

Objective:To assess the presentation of allergic fungal rhinosinusitis（AFRS） in children and the role of long-term comprehensive therapy of endoscopic surgery combined with drug therapy. Methods:The 3 children with AFRS were routinely examined by nasal endoscopy, CT scan, MRI scan and allergen detection before surgery, and mycological and histomathological examination were performed on the secretions in the sinus and the mucosa of the affected sinuses. All the 3 patients underwent endoscopic surgery, preoperative and postoperative treatment with oral and nasal corticosteroid, nasal irrigation, and individualized anti-allergy therapy and immunotherapy. The patients were followed up for 3 to 12 months. Results:All 3 children had nasal polyps and headache, and 2 children had exophthalmos and facial asymmetry. There were typical CT and MRI findings on imaging. Serum total IgE were all elevated, and 2 cases were positive for fungal SIgE. All 3 children underwent endoscopic surgery. Fungal hyphae and spores were found in 1 child, and other fungi tests were positive in another 2 children. Postoperative facial asymmetry was relieved spontaneously, and mucosal swelling and polypoid changes were observed in 2 children. Conclusion:AFRS is a specific type of chronic rhinosinusitis that is not uncommon in children. Early diagnosis, prompt operation, standardized treatment and long-term follow-up are very important in the diagnosis and treatment of AFRS in children.

Pattern of anatomic disorder and surgical management of anorectal prolapse in anorectal malformation.

AIM: Due to the paucity of data and controversy regarding the etiology and surgical approach for managing anorectal prolapse (ARP) after anorectoplasty, we sought to investigate the underlying anatomic disorder and the surgical outcome in managing this challenging complication. METHODS: We performed a retrospective study on 83 patients with ARP related to anorectal malformations (ARM). Logistic regression analyses were performed to detect the risk factors for the ARP severity. Surgical procedures were stratified according to identified anatomical abnormalities and surgical outcomes were analyzed. RESULTS: 50 patients (62.7%) had high-type ARM. The original anorectoplasty had a higher rate of ARP in laparoscopic-assisted anorectoplasty (n = 49, 59.0%) versus posterior sagittal anorectoplasty (n = 11, 13.3%). ARP was associated with rectal fat hyperplasia (67.5%), dilated muscular tunnel (79.5%), longitudinal muscle (LM) discontinuity (16.9%), rectal dilation (22.9%), mislocated anus (7.2%), and excessive mobile mesorectum (3.6%). Based on the ARP severity, the patients were divided into a severe group (Group 1, n = 38) and a moderate group (Group 2, n = 45). Binary logistic regression analysis showed that hyperplasia rectal fat (OR 4.55, 95% CI 1.16-17.84), rectal dilation (OR 4.21, 95% CI 1.05-16.94), and high-type ARM (OR 2.90, 95% CI 1.14-7.39) were independent risk factors for the development of severe ARP. Complications after stratified surgical repair included wound infection in six patients (7.2%), anal stenosis in one patient (1.2%), and ARP recurrence in two patients (2.4%). Twenty-six patients without colostomy before prolapse repair were followed up for 2 to 12 years. All the patients maintained voluntary bowel movements. Following ARP repair, there was an overall higher rate of no soiling or grade 1 soiling (88.5 vs. 65.4%), but 3 of 12 patients with grade 2 constipation were upgraded to grade 3. CONCLUSION: Our study shows that ARM-related anorectal prolapse is associated with excessive rectum, hyperplasia of rectal fat, mobile mesorectum, loose muscular tunnel, LM discontinuity, and anal mislocation. Surgical repair with techniques stratified according to the patients' underlying risk factors is effective to prevent recurrence and improve the soiling continence.

A Clinical Practice Guideline for the Emergency Management of Anaphylaxis (2020).

Background: For anaphylaxis, a life-threatening allergic reaction, the incidence rate was presented to have increased from the beginning of the 21st century. Underdiagnosis and undertreatment of anaphylaxis are public health concerns. Objective: This guideline aimed to provide high-quality and evidence-based recommendations for the emergency management of anaphylaxis. Method: The panel of health professionals from fifteen medical areas selected twenty-five clinical questions and formulated the recommendations with the supervision of four methodologists. We collected evidence by conducting systematic literature retrieval and using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results: This guideline made twenty-five recommendations that covered the diagnosis, preparation, emergency treatment, and post-emergency management of anaphylaxis. We recommended the use of a set of adapted diagnostic criteria from the American National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network (NIAID/FAAN), and developed a severity grading system that classified anaphylaxis into four grades. We recommended epinephrine as the first-line treatment, with specific doses and routes of administration for different severity of anaphylaxis or different conditions. Proper dosage is critical in the administration of epinephrine, and the monitor is important in the IV administration. Though there was only very low or low-quality evidence supported the use of glucocorticoids and H1 antagonists, we still weakly recommended them as second-line medications. We could not make a well-directed recommendation regarding premedication for preventing anaphylaxis since it is difficult to weigh the concerns and potential effects. Conclusion: For the emergency management of anaphylaxis we conclude that: • NIAID/FAAN diagnostic criteria and the four-tier grading system should be used for the diagnosis • Prompt and proper administration of epinephrine is critical.

Current status of Chinese herbal medicine to treat allergic rhinitis in children: from the perspective of Western medicine-a narrative review.

Allergic rhinitis (AR) has a high prevalence and significantly affects quality of life in children. According to traditional Chinese medicine theory, AR in children can be classified as BiQiu, and the etiology lies in the lung, spleen and kidney. The internal cause is primarily related to congenital deficiencies of vital qi; dysfunction of the lungs, which will lead to inhibited nose orifices; and deficiency of the spleen and kidney, which will lead to lung qi deficiency. The external cause is cold, inadequate diet and other factors. The theoretical systems of Chinese and Western medicine represent different understandings of the life science of the human body from the different perspectives of Eastern and Western culture. Therefore, ways for these approaches to communicate with and promote one another to achieve a true combination approach is the focus of our attention. In this review, we specifically discuss the mechanisms of action of herbal monomers and compounds of Chinese herbal medicines in the treatment of AR and present some results and shortcomings of Chinese herbal medicines in combination with Western medicines in the treatment of AR. We also propose future research directions and trends to enhance combined treatment with Chinese and Western medicines.

Risk factors for bronchial asthma in children with allergic rhinitis / 中国学校卫生

Objective@#To explore the risk factors of bronchial asthma in children with allergic rhinitis, and to provide evidence for the early diagnosis, treatment and prevention of asthma in children with allergic rhinitis.@*Methods@#Children with allergic rhinitis and children with allergic rhinitis and asthma, who attended the Allergy Clinic of the Capital Institute of Pediatrics from November 2019 to October 2020, were recruited for the study. Medical history, clinical characteristics, allergen types and risk factors were collected and analyzed.@*Results@#A total of 117 children with allergic rhinitis and 111 children with allergic rhinitis that subsequently developed into asthma were included. The results of the univariate analysis showed that the occurrence of asthma in children with allergic rhinitis was associated with the course of rhinitis, severity of rhinitis, type of rhinitis, seasonal onset, history of pet contact, family history of allergic diseases, mold, ragweed, dermatophagoides culinae and dust mite sensitization( χ 2=6.15, 8.79, 3.99, 9.44, 5.17, 4.43, 8.48, 10.38, 6.18, 5.31, P <0.05). The Logistic regression analysis showed that rhinitis severity( OR = 7.03 ), family history of allergic diseases( OR =8.24), mold( OR =5.19), and household dust mite sensitization ( OR =25.25) were positively correlated with the occurrence of asthma in children with allergic rhinitis( P <0.05), and dust mite sensitization was the strongest risk factor.@*Conclusion@#The development of asthma in children with allergic rhinitis is affected by many factors, among which the severity of rhinitis, family history of allergic diseases and dust mite sensitization are the most important factors.

Pediatric Epistaxis and Its Correlation Between Air Pollutants in Beijing From 2014 to 2017.

BACKGROUND: Epistaxis is a common symptom in children. The effect of air pollution on epistaxis is not yet clear. OBJECTIVES: To explore the characteristics of pediatric epistaxis in Beijing and its correlation with air pollutants. MATERIAL AND METHODS: Data were collected from 2014 to 2017 in Otolaryngology Department of Capital Institute of Pediatrics. Children diagnosed with epistaxis with relevant information with the same period of municipal air pollutants' concentration were compared. RESULTS: The annual visits of epistaxis showed a bimodal trend. The incidence of epistaxis in infants was low, increased with age, reached the peak between the ages of 4 to 5, and then gradually decreased with age. In different age groups, male patients were more than females. From 2014 to 2017 in Beijing, particulate matter less than 2.5 µm in diameter (PM2.5), particulate matter less than 10 µm in diameter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), and carbon monoxide (CO) showed a downtrend, lower in summer than in the other 3 seasons. Ozone (O3) was significantly higher in 2016 and 2017, showed an increase trend in summer. The incidence of epistaxis was negatively correlated with PM2.5, PM10, SO2, NO2 and CO, which was positively correlated with O3 (P < .05). CONCLUSIONS: Pediatric epistaxis in Beijing changes with age and has obvious seasonal variation. There are some correlations between air pollutants and the incidence of epistaxis in children.

Emergence of spatially periodic diffusive waves in small-world neuronal networks.

It has been observed in experiment that the anatomical structure of neuronal networks in the brain possesses the feature of small-world networks. Yet how the small-world structure affects network dynamics remains to be fully clarified. Here we study the dynamics of a class of small-world networks consisting of pulse-coupled integrate-and-fire (I&F) neurons. Under stochastic Poisson drive, we find that the activity of the entire network resembles diffusive waves. To understand its underlying mechanism, we analyze the simplified regular-lattice network consisting of firing-rate-based neurons as an approximation to the original I&F small-world network. We demonstrate both analytically and numerically that, with strongly coupled connections, in the absence of noise, the activity of the firing-rate-based regular-lattice network spatially forms a static grating pattern that corresponds to the spatial distribution of the firing rate observed in the I&F small-world neuronal network. We further show that the spatial grating pattern with different phases comprise the continuous attractor of both the I&F small-world and firing-rate-based regular-lattice network dynamics. In the presence of input noise, the activity of both networks is perturbed along the continuous attractor, which gives rise to the diffusive waves. Our numerical simulations and theoretical analysis may potentially provide insights into the understanding of the generation of wave patterns observed in cortical networks.

Upper airway cough syndrome in 103 children.

BACKGROUND: In China, upper airway cough syndrome (UACS) is only less frequent than cough-variant asthma and accounts for 24.71% of chronic cough. This study aimed to determine the pathogenetic constituents and factors affecting UACS in children of different age groups, and to identify clinical clues for diagnosing UACS and a method for curative effect evaluation. METHODS: A total of 103 children with UACS whose chief complaint was chronic cough were studied from January to November 2013 at Children's Hospital, Capital Institute of Pediatrics. According to their age, children with UACS were divided into 3 groups: nursing children, pre-school children, and school-age children. We analyzed the differences in pathogenetic constituents and factors affecting UACS in children. The effect of UACS treatment was evaluated by the visual analog scale (VAS) and an objective examination. Chi-squared test and analysis of variance were performed with the SPSS 19.0 statistical software. RESULTS: There was a high incidence of UACS in school-age children. Rhinitis with adenoid hypertrophy was the main cause of 103 suspected UACS cases. Adenoidal hypertrophy was the major cause of UACS in the pre-school children group, while rhinitis was the major reason in the nursing children and school-age children groups. Among the 103 children, there were 45 allergen-positive children, with no significant difference among different age groups. VAS scores in the different disease groups after treatment were lower than those before treatment (all P < 0.01). VAS scores in different disease groups showed significant differences, except for 12 vs. 24 weeks after treatment (P = 0.023). Different age groups had different secondary complaints. CONCLUSIONS: There are different pathogeneses in different UACS age groups. Clinical treatment efficacy of children with UACS can be evaluated by the VAS combined with an objective examination. We recommend that the course of treatment should be 12 weeks.

The Dynamics of Balanced Spiking Neuronal Networks Under Poisson Drive Is Not Chaotic.

Some previous studies have shown that chaotic dynamics in the balanced state, i.e., one with balanced excitatory and inhibitory inputs into cortical neurons, is the underlying mechanism for the irregularity of neural activity. In this work, we focus on networks of current-based integrate-and-fire neurons with delta-pulse coupling. While we show that the balanced state robustly persists in this system within a broad range of parameters, we mathematically prove that the largest Lyapunov exponent of this type of neuronal networks is negative. Therefore, the irregular firing activity can exist in the system without the chaotic dynamics. That is the irregularity of balanced neuronal networks need not arise from chaos.

Balanced Active Core in Heterogeneous Neuronal Networks.

It is hypothesized that cortical neuronal circuits operate in a global balanced state, i.e., the majority of neurons fire irregularly by receiving balanced inputs of excitation and inhibition. Meanwhile, it has been observed in experiments that sensory information is often sparsely encoded by only a small set of firing neurons, while neurons in the rest of the network are silent. The phenomenon of sparse coding challenges the hypothesis of a global balanced state in the brain. To reconcile this, here we address the issue of whether a balanced state can exist in a small number of firing neurons by taking account of the heterogeneity of network structure such as scale-free and small-world networks. We propose necessary conditions and show that, under these conditions, for sparsely but strongly connected heterogeneous networks with various types of single-neuron dynamics, despite the fact that the whole network receives external inputs, there is a small active subnetwork (active core) inherently embedded within it. The neurons in this active core have relatively high firing rates while the neurons in the rest of the network are quiescent. Surprisingly, although the whole network is heterogeneous and unbalanced, the active core possesses a balanced state and its connectivity structure is close to a homogeneous Erdös-Rényi network. The dynamics of the active core can be well-predicted using the Fokker-Planck equation. Our results suggest that the balanced state may be maintained by a small group of spiking neurons embedded in a large heterogeneous network in the brain. The existence of the small active core reconciles the balanced state and the sparse coding, and also provides a potential dynamical scenario underlying sparse coding in neuronal networks.

Pediatric coblation total tonsillectomy: intracapsular or extracapsular?

OBJECTIVES: To compare the results of coblation intracapsular total tonsillectomy (CITT) with those of conventional coblation extracapsular total tonsillectomy (CETT) in the treatment of tonsillar hypertrophy in children with regards to efficacy and complications. METHODS: Ninety children with adenotonsillar hyperplasia underwent tonsillectomy ± adenoidectomy (48 CITT and 42 CETT). Intraoperative situation was observed and recorded. Patients were reexamined regarding recovery condition and tonsil regrowth, and were followed for at least one year. RESULTS: Significant differences were observed in four clinical features when the CITT group was compared with the CETT group: intraoperative bleeding score, intraoperative tonsillar fossa score, color of white membrane one day postoperatively, and visual analogue scale (VAS) value one week postoperatively (p < .05). There were statistical correlations between intraoperative bleeding score and age, course of disease, surgery method, number of acute tonsillitis attacks per year, and intraoperative tonsillar fossae score (p < .05). Two significant differences were noted when the tonsil hypertrophy group was compared with the chronic tonsillitis group: color of white membrane at one day and one week postoperatively (p < .05). No regrowth of tonsil was found. CONCLUSIONS: Compared with conventional extracapsular tonsillectomy, CITT has the advantages of decreased pain and bleeding, and promote healing of wounds. No tonsillar regrowth was observed after at least one year of follow-up.

[Treatment of obstructive sleep apnea-hypopnea syndrome for children refractory asthma].

OBJECTIVE: The aim of this study was to understand the effect of different treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) for refractory asthma in children. METHODS: Fifty two children (32 in surgical group, 20 in conservative group) with refractory asthma and OSAHS were included in the study. All children received asthma condition assessment and polysomnography (PSG) examination before and after treatment, and were followed up for 6 months. RESULTS: All children got improved in PSG values 3 months after treatment, more significant improvement was achieved in surgical group than in conservative group (P < 0.05). While compared of OSAHS treatment, there were 2 cure, 6 notable effective, 9 effective, 3 in vain cases in conservative group, 8 cure, 16 notable effective, 8 effective, 0 in vain cases in surgery group. There was significant difference between the two groups (χ² = 8.91, P = 0.031). All children got improved in asthma condition evaluation parameters and decreased the use number of short acting ß2 agonists after 6 months treatment. More significant improvement was achieved in surgical group than in conservative group. The differences of all the items had statistical significance (P < 0.05). There was statistical correlation between days mutation rate of peak expiratory flow (PEF) and apnea hypopnea index (r = 0.712, P < 0.01), and between days mutation rate of PEF and lowest oxygen saturation (r = 0.726, P < 0.01). CONCLUSIONS: Active treatment of OSAHS can improve asthma symptoms and reduce asthma medication effectively. The curative effect of surgical treatment is superior to conservative treatment.

Upper airway cough syndrome in children and two inflammatory factors: TRPV1 and TGF-ß2.

OBJECTIVES: The aim of the study was to investigate upper airway cough syndrome (UACS) in children and to determine alternative methods to explore the relationships among TRPV1, TGF-ß2, and UACS. METHODS: In 2012, 104 children with adenoid hypertrophy aged 2-13 years who were admitted to the otolaryngology department, Capital Institute of Pediatrics-affiliated children's hospital, were included in this study. Enzyme-linked immunosorbent assay (ELISA) and immunohistochemical (IHC) studies for TRPV1 and TGF-ß2 were performed to understand the relationship between the two inflammatory factors, and the correlations among the indices and UACS. The research was divided into three stages. In stage 1, 72 children (24 UACS and 48 controls) were enrolled in the study, and ELISAs for TRPV1 and TGF-ß2 were performed. In stage 2, 32 children (16 UACS and 16 controls) were enrolled in the study and both ELISA and IHC for TRPV1 and TGF-ß2 were performed. In stage 3, 41 children were enrolled in this research who had thick mucus secretions in the posterior nasal apertures in stage 1 and 2 (23 cases with chief complaint (or history) of chronic cough and 18 cases without). The difference between the TRPV1 and TGF-ß2 serum values and the clinical factors was determined. RESULTS: The levels of TRPV1 and TGF-ß2 were significantly increased in the UACS cases. OSAHS and thick mucus secretions correlated with a diagnosis of UACS. A history of asthma and thick mucus secretions correlated with elevation of the two inflammatory factors. There was no statistical correlation between ELISA and IHC testing. Among the children with thick mucus secretions, some had a higher possibility of chronic coughing including those who had higher levels of the two indices, larger tonsils and a history of chronic tonsillitis. CONCLUSION: The detections of TRPV1 and TGF-ß2 from serum and adenoid body specimens are valuable for UACS auxiliary diagnosis. Tonsil hypertrophy and chronic tonsillitis history are independent risk factors of UACS.