[Blinatumomab as bridging therapy in two children with B-cell acute lymphoblastic leukemia complicated by invasive fungal disease]. / 2例急性Bæ·‹å·´ç»†èƒžç™½è¡€ç— åˆå¹¶ä¾µè¢­æ€§çœŸèŒç— å„¿ç«¥åº”ç”¨è´æž—å¦¥æ¬§å•æŠ—æ¡¥æŽ¥æ²»ç–—åˆ†æž.

This article reports two cases of children with B-cell acute lymphoblastic leukemia (B-ALL) complicated by invasive fungal disease (IFD) who received bridging treatment using blinatumomab. Case 1 was a 4-month-old female infant who experienced recurrent high fever and limb weakness during chemotherapy. Blood culture was negative, and next-generation sequencing (NGS) of peripheral blood, bronchoalveolar lavage fluid, and cerebrospinal fluid were all negative. Chest CT and cranial MRI revealed obvious infection foci. Case 2 was a 2-year-old male patient who experienced recurrent high fever with multiple inflammatory masses during chemotherapy. Candida tropicalis was detected in peripheral blood and abscess fluid using NGS, while blood culture and imaging examinations showed no obvious abnormalities. After antifungal and blinatumomab therapy, both cases showed significant improvement in symptoms, signs, and imaging, and B-ALL remained in continuous remission. The report indicates that bridging treatment with blinatumomab in children with B-ALL complicated by IFD can rebuild the immune system and control the underlying disease in the presence of immunosuppression and severe fungal infection.

[Prognostic Factors Analysis of Children with Hemophagocytic Lymphohistiocytosis].

OBJECTIVE: To analyze the risk factors affecting prognosis of children with hemophagocytic lymphohistiocytosis (HLH). METHODS: The clinical manifestations and laboratory data of 143 HLH children who met the HLH-2004 diagnostic criteria in Shenzhen Children's Hospital from January 2009 to May 2017 were retrospectively analyzed, and the independent factors affecting prognosis were also analyzed. RESULTS: The median age of 143 HLH children was 1.9 (0.1-14.3) years old, and the median follow-up time was 6.7 years (1 day - 11.9 years). The overall survival rate of 1 month, 1 year, and 10 years was (87.4±5.5)%, (81.1±6.5)%, and (81.1±6.5)%, respectively. The deaths occurred within 1 year after onset. Multivariate analysis showed that central nervous system (CNS) involvement (P=0.047), low hemoglobin (P=0.002), prolonged activated partial thromboplastin time (APTT) (P<0.001), high triglyceride (P=0.005) were all the independent risk factors affecting survival of the children. Receiver operating characteristic curve indicated that APTT (AUC=0.753, P<0.001) was more valuable than other risk factors in predicting death of the children. The cut-off value of APTT was 56.6 s, and the sensitivity and specificity of which was 55.6% and 89.7%, respectively. CONCLUSION: Hypohemoglobinemia, prolonged APTT, hypertriglyceridemia, and CNS involvement the risk factors affecting prognosis of HLH, and prolonged APTT shows a strong predictive value for death.

[The mechanism of prophylactic effects of nasal tolerance with a dual analogue on experimental autoimmune myasthenia gravis in young mice].

OBJECTIVE: To study the prophylactic effects of nasal tolerance with a dual analogue, Lys262-Ala207, on the mouse model of experimental autoimmune myasthenia gravis (EAMG) and the underlying mechanism. METHODS: Mouse model of EAMG was induced by intraperitoneal injection of mAb35. Lys262-Ala207 or PBS was given nasally before 10 days (study group A and control group A) or on the day (study group B and control group B) of immunization for 10 days. Clinical syndromes were evaluated after immunization. Serum level of acetylcholine receptor antibody (AChR-Ab) IgG was detected using ELISA. The number of monouclear cells expressing CD4+ and CD4+ CD25+T from spleen was measured using flow cytometry. RESULTS: Compared with the corresponding control groups, the clinical syndromes were improved (P<0.01) in mice from the study groups A and B. The positive rate of the repetitive nerve stimulation (RNS) test in the study groups A and B was significantly lower than that in the corresponding control groups (P<0.01). The study group A showed lower positive rate of RNS than the study group B (P<0.05). The serum levels of AChR-Ab IgG in the study groups A and B (15.01+/-1.09 and 19.23+/-1.31 microg/mL) decreased compared with that in the corresponding control groups (28.12+/-1.28 and 29.35+/-1.28 microg/mL) (P<0.01). The study group A mice had lower serum AChR-Ab IgG levels than the study group B (P<0.01). The number of CD4+ CD25+T cells in the study groups A (4.516+/-0.598%) and B (3.671+/-0.300%) increased significantly compared with that in the corresponding control groups (2.661+/-0.411% and 2.412+/-0.500%) (P<0.01) and more CD4+ CD25+T cells were found in the study group A than in the study group B (P<0.01). CONCLUSIONS: Nasal administration with dual analogues may ameliorate clinical syndromes in EAMG rats, which may be associated with decreased serum AChR-Ab IgG levels and increased number of CD4+ CD25+T cells from spleen.

[A study of high altitude environment affecting on worker's health during the constructing Qinghai-Xizang railway].

OBJECTIVE: To study high altitude environment affecting on worker's health METHODS: Using the cohort study, the altitude reaction was investigated and the WBC, RBC, Hb and oxygenation indexes were measured on workers in several periods, namely, acclimatization period, initially arrived high altitude and resident 90 days. RESULTS: The 83.3% of men had altitude reactions with different kinds at initially arrived high altitude. The headache was the most. The rate of abnormal blood pressure increased with altitude and resident time (P < 0.01). The rate of 90 day's group was 41.7%. The rise of diastole pressure was obvious (P < 0.01). As the beginning of arrived highland, the increase of WBC, RBC were significant (P < 0.01). The increase of Hb appeared only in 90 day's group. The level of malondialdehyde (MDA) obviously increased during acclimatization period and increased with altitude and resident time (P < 0.01). The activity of catalase (CAT), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) increased significantly in 90 day's group [(222.36 +/- 36.52) x 10(3) U/L, (158.49 +/- 14.42) U/L, (45.74 +/- 8.31) NU/ml respectively] (P < 0.01). CONCLUSION: The high altitude environment may result in the abnormal blood pressure, the rise of diastolic pressure was important. It lead to the increase of WBC, RBC, Hb. It initiated activity of oxygenation reaction. The symptoms of headache, dizziness, loss of appetite and insomnia appeared as working in high altitude environment.

Prevalence and associated risk factors of allergic rhinitis in preschool children in Beijing.

OBJECTIVES/HYPOTHESIS: To investigate the prevalence of allergic rhinitis (AR) and its associated risk factors in preschool children in Beijing. STUDY DESIGN: Two-stage, clustered, stratified random sample study. METHODS: Parents of 4,075 children aged 3, 4, and 5 years in urban and suburban areas were surveyed using a questionnaire. A random subgroup of 1,067 children was examined by otolaryngologists with skin prick test (SPT). RESULTS: The survey response rate was 98.3%. Based on the criteria published by ARIA document, the prevalence of epidemiologic AR was 48% (53.2% in urban areas; 43.4% in suburban areas). Among 795 children with epidemiologic AR, sensitization to common inhalant allergens was confirmed by a positive SPT in 248 children (31.2%). Thus, the adjusted prevalence of clinical AR was 14.9% (19.5% in urban areas; 10.8% in suburban areas). In these AR children, 166 (67.1%) were intermittent and 82 (32.9%) persistent, with moderate/severe symptoms in 103 (41.5%). The most common inhalant allergens were Alternaria tenuis (55.7%), followed by Dermatophagoides farina (39.4%), and Dermatophagoides pteronyssinus (38.6%). Both asthma (adjusted OR 4.88, 95% CI: 3.48-6.86) and eczema (adjusted OR: 1.49, 95% CI: 1.15-1.94) appear to be significant concomitant risk factors for AR. CONCLUSIONS: The prevalence of AR in young children can be overestimated using epidemiologic criteria. AR is a common disease in Asian preschool children, with an increasing trend as children get older, and is higher in urban than suburban areas--suggesting an important role for environmental risk factors in AR.

[A clinical study of paradoxical breathing during sleep in children].

OBJECTIVE: Abnormal breathing during sleep included many patterns. In this study, we investigated paradoxical breathing patterns during sleep in children using standard polysomnography (PSG). METHODS: Children who come to the ENT because of snoring were included into the study consecutively. Those who had craniofacial anomalies, diabetes, chronic lung diseases, and neuromuscular diseases were excluded. At the same time, no sleep snoring children were include as controls. Thirty-eight snoring children and twenty-six no snoring children were recruited. Polysomnography (PSG) was performed on all subjects. We determined the frequency of paradoxical breathing patterns during sleep through blind analysis of polysomnograms obtained in all subjects and compared the difference between children with snoring and normal controls. RESULTS: The appearance of paradoxical breathing was assessed in all subjects. Among children with snoring, the apparent amount of paradoxical breathing time and the percent of paradoxical breathing time spent in total sleep time (x(-) ± s) were (70.1 ± 40.4) min and 17.9% ± 11.0% respectively. Comparing with control group (28.2 ± 25.7) min and 7.3% ± 6.8%, there was obvious difference (paradoxical breathing time t = 5.060, percent of paradoxical breathing time t = 4.767, P < 0.05). Thirty-eight snoring children were divided into normal-mild group (eighteen children) and moderate-severe group (twenty children). The children whose PSG results were normal and mild had more paradoxical breathing time and the percent of paradoxical breathing time than moderate-severe group. The apparent amount of paradoxical breathing time of normal-mild group, moderate-severe group and control group were (85.9 ± 31.7) min, (55.8 ± 42.7) min and (28.2 ± 25.7) min. Among the three groups, there was obvious difference (F = 15.897, P < 0.05). The percent of paradoxical breathing time of the three groups were 22.0% ± 10.2%, 14.1% ± 10.5% and 7.3% ± 6.8% (F = 14.167, P < 0.05). CONCLUSIONS: Currently published polysomnographic scoring recommendations overlook some common breathing abnormalities during sleep that are associated with clinical complaints. Paradoxical breathing is abnormal breathing patterns during sleep and its appearance is used to aid in the identification of respiratory events.

[Diagnostic procedures for pediatric otitis media with effusion].

OBJECTIVE: To evaluate the fluid in middle ear of otitis media with effusion (OME) by tympanometry, hearing threshold and in order to an effective and promptly way for treatment. METHODS: Forty Patients (75 ears) with OME were collected since January 2007 to June 2008. The history of hearing loss, hearing threshold, CT results and the final fluid in the middle ear during operation were analyzed. RESULTS: There were 28 males and 12 females enrolled in this study. The average age of the patients was 78 months. All the 75 ears were with type "B" according to tympanometry test. For all the patients myringotomy was performed and the ventilation tubes were placed in 23 ears. Among all the ears, there were fluid in 62 ears (82.7%) and no fluid in 13 ears (17.3%). There was correlation between the levels of hearing loss, CT results and the fluid in middle ear (P < 0.05). CONCLUSIONS: Tympanometry and hearing threshold results should have a better sensitivity and specificity rates for diagnosis of OME.

[Comparison of the low and high frequency tympanometries as diagnostic tests of middle ear function in infants].

OBJECTIVE: To evaluate the effect of low frequency and high frequency tympanometry in the diagnosis of middle ear function of infants. METHODS: Tympanometries with 226 Hz, 678 Hz and 1000 Hz probe tones were obtained from infants aged 5-25 weeks with normal ABR (15 infants, 30 ears) and those with prolonged Wave I latency suggesting middle ear dysfunction (17 infants, 20 ears) using GSI Tympstar middle ear analyzer. RESULTS: The type, peak pressure, peak compensated static acoustic admittance and gradient of 226 Hz tympanometry were of no significant differences between two groups. The pattern of 678 Hz tympanograms for admittance, susceptance and conductance included non-peaked, single-peaked, W-shaped and three-peaked type in both groups. The consistency between auditory brainstem response (ABR) and 678Hz tympanometry for admittance, susceptance and conductance were 70.0%, 58.0%, 64.0% (kappa = 0. 324,0. 234,0. 118) respectively. A single peaked tympanogram was typical in normal infants for 1000 Hz admittance, susceptance and conductance tympanograms and there were 28 ears (93.3%), 25 ears (83.3%) and 26 (86.7%) respectively. Tympanogram without any positive peak was the most characteristic for a probe frequency of 1000 Hz in infants with prolonged wave I latency and there were 15 ears (75%), 17 ears (85%) and 13 ears (65%) respectively. For admittance, susceptance and conductance, the consistency between 1000 Hz tympanometry and ABR were 90.0%, 92.0% and 86.0% and kappa were 0.783, 0.831 and 0.690, respectively. CONCLUSIONS: 1000 Hz probe tone tympanometry was accurate diagnostic tests for middle ear function in infants younger than 25 weeks of age, while 226 Hz and 678 Hz probe tone tympanometries were not.

[Influence of obstructive sleep apnea-hypopnea syndrome in children on hearing problem].

OBJECTIVE: To analyze the effects of obstructive sleep apnea hypopnea syndrome on hearing among children. METHODS: One hundred and forty three apnea children proved with overnight polysomnography received pure tone audiometry, acoustic impedance test, and lateral nasopharyngeal airway X-ray. Hearing threshold level and blood oxygen's saturation, apnea hypopnea index were analyzed. RESULTS: Among the 127 cases,63 cases had type C or B tympanograms, and 33 of them had lifted hearing threshold level. The remaining 64 cases had normal hearing and tympanograms. It was found correlation between the A/N ratio and blood oxygen's saturation, and no correlation between the A/N ratio and average of hearing threshold level. There was no correlation between AHI and average of hearing threshold level of each group. Hearing level can be improved after adenoidectomy or adenotonsillectomy. CONCLUSIONS: The upper airway obstruction due to adenotonsillar enlargement is common in children. It also affects the middle-ear impedance. Although short -term and mild degree of hypoxemia has few influence on hearing threshold level, it may affect cochlear function.