PurposeAdenoid hypertrophy (AH) is a prevalent cause of otitis media with effusion (OME) in children, although its pathogenesis remains poorly understood. The objective of this study is to assess the levels of interleukin-17 (IL-17) and interleukin-10 (IL-10) in children with isolated AH and those with AH in conjunction with OME.MethodsThirty children with AH and OME who underwent adenoidectomy and tympanostomy tube placement were included in the OME group, whereas 30 children with isolated AH who underwent adenoidectomy were included in the AH group. Adenoid tissue samples were collected during surgery, and preoperative venous blood samples were acquired. Concentrations of IL-17 and IL-10 in both adenoid tissue and serum were measured using enzyme-linked immunosorbent assay (ELISA).ResultsLevels of IL-17 (4.20 ± 1.51 ng/mL) and IL-10 (3.77 ± 1.06 ng/mL) in adenoid tissue were significantly lower in the OME group than in the AH group (5.29 ± 2.16 ng/mL and 4.80 ± 1.93 ng/mL, respectively; P < 0.05). No significant differences in serum levels of IL-17 or IL-10 were observed between the two groups (P > 0.05). ROC analysis revealed that adenoid tissue IL-17 and IL-10 exhibited higher AUC values, specificity, and sensitivity for predicting AH in combination with OME compared to their serum counterparts (P < 0.05).ConclusionThe reduced local expression of IL-17 and IL-10 in adenoid tissue is associated with the development of OME in children with AH. Targeting these cytokines may provide potential therapeutic strategies for preventing or treating AH-related OME.

To analyze the relationship between laryngopharyngeal reflux (LPR) represented by pepsin and trypsin, and pathogenesis of otitis media with effusion (OME) in children with adenoid hypertrophy. Children with OME who required adenoidectomy and tympanostomy/tympanostomy tubes placement were enrolled in OME group, whereas children with adenoid hypertrophy (AH) who only required adenoidectomy were enrolled in AH group, respectively. Pepsin and trypsin concentrations were evaluated by enzyme-linked immunosorbent assay in adenoid tissue from the OME and AH groups. Pepsin and trypsin concentrations were also evaluated by enzyme-linked immunosorbent assay in middle ear effusion (MEE) and plasma from the OME group. The size of adenoids and the concentrations of pepsin and trypsin in the adenoid tissue between the OME group and the AH group had no statistically significant differences. The concentrations of pepsin and trypsin in MEE were 157.30 ± 182.59ng/mL and 1144.79 ± 1302.85ng/mL, respectively, which were significantly higher than those in the serum (P <.05). Furthermore, the concentration of trypsin in MEE was significantly higher than that of pepsin (P <.05). The concentrations of pepsin and trypsin in adenoids cannot be used as separate evaluation indicators for whether OME will be concurrented. In addition, pepsin and trypsin in MEE are probably caused by LPR and may be involved in the pathogenesis of OME. And, trypsin may have a greater destructive effect on the middle ear cavity.

Objective:To analyze and summarize the clinical characteristics, diagnosis, treatment and prognosis of benign upper airway space occupancy in infants. Methods:The clinical data of 141 cases with begin upper airway space from January 2012 to January 2022 were analyzed. Among them, 101 were male and 68 were female, the age is 0-3 years old. In which there were 24 newborns. The clinical characteristics, auxiliary examination and treatment results were summarized and analyzed. Results:The main clinical manifestations of 141 infants were dyspnea and/or laryngeal wheezing, including 116 cases of congenital cyst of tongue, 15 cases of hair polyps, 4 cases of nasopharyngeal second pharyngeal fissure cysts, 2 cases of congenital laryngeal cysts, 2 cases of pharyngeal bronchial cyst, 1 case of nasopharyngeal teratoma and 1 case of myofibroma. All the infants had completed the corresponding examination and treatment. The diagnosis was clear, and there was no missed diagnosis or misdiagnosis. Among them, 19 infants with congenital cyst of tongue were given cyst puncture to relieve dyspnea. 2 cases of congenital cyst of tongue recurred half a year after operaion, and then they underwent reoperation. The prognosis of the remaining infants were good. Conclusion:The most common occupying of benign upper airway space occupancy is cyst, and low-temperature plasma resection under endoscope is the main treatment method. Timely puncture therapy is also a safe and effective treatment for infants who are dyspnea and life threatening.

Fungal keratitis is a severely vision-threatening corneal infection, where the prognosis depends on both fungal virulence and host immune defense. Inappropriate host responses can induce substantial inflammatory damage to the cornea. Therefore, in the treatment of fungal keratitis, it is important to concurrently regulate the immune response while efforts are made to eliminate the pathogen. Ebselen is a widely studied organo-selenium compound and has been demonstrated to have antifungal, antibacterial, anti-inflammatory, and oxidative stress-regulatory properties. The effectiveness of ebselen for the treatment of fungal keratitis remains unknown. In this study, ebselen was demonstrated to produce a marked inhibitory effect on Aspergillus fumigatus (A. fumigatus), including spore germination inhibition, mycelial growth reduction, and fungal biofilm disruption. The antifungal activity of ebselen was related to the cell membrane damage caused by thioredoxin (Trx) system inhibition-mediated oxidative stress. On the contrary, ebselen enhanced the antioxidation of Trx system in mammalian cells. Further, ebselen was proven to suppress the expressions of inflammatory mediators (IL-1β, IL-6, TNF-α, COX-2, iNOS, and CCL2) and reduce the production of oxidative stress-associated indicators (ROS, NO, and MDA) in fungi-stimulated RAW264.7 cells. In addition, ebselen regulated PI3K/Akt/ Nrf2 and p38 MAPK signaling pathways, which contributed to the improvement of inflammation and oxidative stress. Finally, we verified the therapeutic effect of ebselen on mouse fungal keratitis. Ebselen improved the prognosis and reduced the fungal burden in mouse corneas. Expressions of inflammatory mediators, as well as the infiltration of macrophages and neutrophils in the cornea were also obviously decreased by ebselen. In summary, ebselen exerted therapeutic effects by reducing fungal load and protecting host tissues in fungal keratitis, making it a promising treatment for fungal infections.

目的:探讨血清白三烯C4(LTC4)、D4(LTC4)及C-C趋化因子配体21(CCL21)水平与腺样体肥大患儿腺样体肥大程度及预后的相关性.方法:选取82 例腺样体肥大患儿为研究对象,根据腺体样肥大程度将患儿分为中度组(n =48)和重度组(n =34),根据不同预后分为非增生组(预后良好,n =65)和再增生组(预后不良,n =17).比较各组患儿血清LTC4、LTC4、CCL21 水平;采用受试者特征工作曲线(ROC曲线)评估上述指标对腺样体肥大患儿预后不良的预测价值.结果:重度组患儿血清LTC4、LTD4、CCL21 水平高于中度组(P<0.05);再增生组患儿血清 LTC4、LTD4、CCL21 水平均高于非增生组(P<0.05).ROC曲线分析显示,当LTC4≥346.68 ng/L时,预测腺样体肥大患儿预后不良的曲线下面积(AUC)为0.789,敏感度为0.706,特异度为0.738;当LTD4≥270.19 ng/L时,预测腺样体肥大患儿预后不良的AUC为0.665,敏感度为0.765,特异度为0.600;当CCL21≥144.57 ng/mL时,预测腺样体肥大患儿预后不良的AUC为0.738,敏感度为0.706,特异度为0.692;三者联合预测的AUC为0.853,敏感度为0.882,特异度为0.769.结论:血清LTC4、LTD4 及CCL21 水平与腺样体肥大患儿腺样体肥大程度及预后密切相关,可将三者联合检测用于腺样体肥大患儿预后不良的辅助预测.

目的 探讨婴幼儿急性上颌骨骨髓炎合并鼻中隔脓肿的临床表现、诊断思维、治疗方法及预后.方法 回顾性分析1例急性上颌骨骨髓炎合并鼻中隔脓肿患儿的临床资料,并检索1956～2021年间国内外发表的相关文献,将包括该病例共有84例患者纳入研究,总结其临床表现、治疗方法及预后.结果 典型急性上颌骨骨髓炎84例中,男53例,女29例,未知2例,症状以鼻塞、面部肿胀及发热多见.根据影像学上颌骨骨质破坏与骨质增生硬化间杂分布特点及患儿临床表现可以诊断.细菌培养以金黄色葡萄球菌多见,另外还有表皮葡萄球菌、链球菌及醋酸钙不动杆菌.一般易合并眶周脓肿或上颌牙槽脓肿,合并鼻中隔脓肿患儿少见.文献中只检索到1例14岁患上颌骨骨髓炎合并鼻中隔脓肿病例,既往有牙病史.静脉滴注广谱抗生素及局部脓肿切开引流取得良好治疗效果.结论 婴幼儿急性上颌骨骨髓炎细菌培养多为金黄色葡萄球菌,应在早期应用针对该细菌的抗生素控制感染.对局部出现的脓肿如眼部、口腔内上颌牙槽、鼻腔内部等,应该做到早发现早切开引流,可以避免炎症继续发展导致上颌骨死骨形成或导致牙胚坏死脱落或鼻中隔软骨坏死导致外鼻塌陷.

目的 探讨婴儿耳溢液流脓性疾病在耳内镜下的临床表现和耳内镜检查在该类疾病鉴别诊断的重要价值.方法 收集2018年9月～2020年2月于我院门诊就诊的1085例(1421耳)以外耳道溢液流脓为主诉的1岁以内患儿的耳内镜检查结果,分为1月内患儿组,2～6月患儿组,7～12月患儿组进行回顾性分析.结果 耳内镜检出外耳道疾病5种和中耳疾病2种,包括急性弥漫性外耳道炎、外耳道疖肿、外耳道湿疹、真菌性外耳道炎、油状耵聍以及大疱性鼓膜炎和急性化脓性中耳炎,同时发现随着月龄的增长疾病谱有所变化,6月内小婴儿以外耳道湿疹和炎症性疾病为主,6月以上婴儿以外耳道和中耳炎症性疾病常见.结论 耳内镜检查安全无创,操作简便、费用低廉,各级医院均可有效开展,有助于婴儿耳溢液流脓性疾病的及时准确的诊断,指导临床治疗,值得广泛推广.

目的 创立基于河北全省多中心联动的孕妇耳聋基因筛查新模式,探讨聋病出生缺陷防控效果.方法 由河北省卫生健康委员会主导组织成立河北省孕妇耳聋基因筛查项目技术专家组,在全省范围内实施统一培训、统一宣教,建立覆盖全省的孕妇耳聋基因筛查新模式.采用高通量测序技术对辖区内孕妇免费进行常见耳聋4个基因20个位点筛查,由经过培训的医生负责结果解读与遗传咨询.对阳性孕妇的配偶进行相应基因全序列测序,发现耳聋高危家庭并施行产前诊断与生育指导.阳性孕妇生育后给予定期随访,发现耳聋患儿及时转诊、及时干预.结果 2019年9月1日至2021年8月31日间,河北省各地市建档孕妇1,053,232例,其中709,386例孕妇选择进行常见耳聋基因筛查,2年筛查覆盖率达67.4％(709,386/1,053,232),共检出常见耳聋基因携带者41,216例,未通过率达5.81％(41,216/709,386),25,546例阳性孕妇进行了面对面遗传咨询,遗传咨询率为62％(25,546/41,216).34,188例GJB2或SLC26A4突变携带者的配偶中有9,778例选择进行相应基因全序列检测,配偶检测率为28.6％(9,778/34,188),783对(8％,783/9,778)夫妇被证实同为GJB2或SLC26A4基因致病变异携带者,预测后代出现耳聋的风险为25％;164对双阳夫妇经知情同意后选择进行产前诊断,产前诊断率为20.94％(164/783).发现36例胎儿为GJB2或SLC26A4基因复合杂合变异,其中33例家庭选择终止妊娠,3例自然分娩.4,892例孕妇检测发现为线粒体MT-RNR1基因突变携带者,给予咨询指导孕妇及其母系家族成员避免使用耳毒性药物.结论 河北省孕妇遗传性耳聋基因携带率为5.819％,为41,216名孕妇明确了常见耳聋基因携带情况及进行遗传咨询与生育指导,将耳聋预防窗口前移至出生前,形成了全省联动的聋病预防新模式.

Abstract Background Bacterial infection of adenoid is currently considered to be an important cause of adenoid hypertrophy (AH) in children. Although several bacteriology studies on adenoid diseases have been reported, the aerobic bacterial study regarding risk factors and antibiotic sensitivity of AH in Chinese children is lacking. This study aims to investigate the risk factors for aerobic bacterial colonization of AH in Chinese children and to elucidate aerobic bacterial profiles and antibiotic sensitivity. Methods Samples were collected from the adenoid core and surface tissue of 466 children undergoing adenoidectomy. Aerobic cultures and antibiotic sensitivity were observed. The risk factors for bacterial colonization of adenoid were analyzed statistically. Results A total of 143 children could be detected opportunistic pathogens in adenoid surface and/or core tissue, with a carriage rate of 30.7%. The presence of chronic rhinosinusitis, tonsillar hypertrophy and adenoidal size were the risk factors for aerobic bacterial colonization of adenoid in univariate analysis. Multivariate analysis showed that chronic rhinosinusitis and tonsil hypertrophy were significant variables associated with the aerobic bacterial colonization. The most frequently isolated aerobic bacteria were Haemophilus influenzae, followed by Staphylococcus aureus and Streptococcus pneumoniae. There was no statistically significant difference in bacterial species between the adenoid surface and core. The above common bacteria were more sensitive to cephalosporins and quinolones antibiotics, and significantly resistant to penicillin antibiotics and non-β-lactamase inhibitors. Conclusion Our results provide recent aerobic bacterial profiles for AH among Chinese children and confirm the risk factors and antibiotic sensitivity. This study contributes to understanding the role of different risk factors in the development of AH and will be helpful to the treatment of AH among Chinese children.

In this paper, a case of middle ear cholesteatoma with sigmoid sinus thrombophlebitis and retroauricular subperiosteal abscess was reported. The female patient was hospitalized with bilateral ear abscess for more than 20 days and fever with vomiting for 14 days. Anti-infection treatment after admission, emergency right mastoid radical resection and tympanoplasty were performed under general anesthesia. The patient recovered well after surgery, and there was no recurrence after in the follow-up for more than 2 years.The clinical manifestations, imaging features and prognosis of this disease were discussed and analyzed in the paper.

Purpose:The purpose of this study was to explore the antifungal and anti-inflammatory effects of gallic acid (GA) on Aspergillus fumigatus (A. fumigatus) keratitis.Methods:CCK-8 assay and Draize eye test were used to determine the non-cytotoxic concentration of GA in RAW264.7 cells and an A. fumigatus keratitis mouse model. The antifungal effects of GA were analyzed using minimal inhibitory concentration (MIC), biofilm formation test, fungal adherence assay, calcofluor white staining, and propidium iodide staining. The therapeutic effects of GA were estimated by slit lamp photographs, clinical score, hematoxylin and eosin (H&E) staining, and Periodic acid-Schiff staining in vivo. Immunofluorescence staining and myeloperoxidase assay were conducted to identify neutrophil infiltration and activity. RT-PCR, ELISA, and Western blot were performed to detect the expression of pro-inflammatory cytokines and Nrf2/HO-1.Results:In HCECs and A. fumigatus keratitis mouse model, GA at 100 µg/mL did not affect cell viability, thus this concentration was applied to subsequent experiments. In vitro, GA significantly inhibited A. fumigatus growth, biofilm formation, and adhesion. In vivo, 100 µg/mL GA alleviated the severity of fungal keratitis (FK) by repressing fungal load, reducing neutrophil infiltration, and lowering MPO activity. Besides, the expression of IL-1β, TNF-α, LOX-1, and COX-2 was inhibited, whereas Nrf2 and HO-1 expression was enhanced at both mRNA and protein levels in the 100 µg/mL GA treated group in comparison to PBS control.Conclusions:GA ameliorates FK severity through inhibiting A. fumigatus load, reducing neutrophils infiltration, downregulating the expression of pro-inflammatory cytokines, and enhancing the Nrf2/HO-1 pathway, which provides new insight into A. fumigatus keratitis treatment.

支气管异物继发肺实变是儿童支气管异物较少见的并发症,但肺实变会加重支气管异物患儿呼吸困难等症状,大面积肺实变可引起呼吸循环衰竭,严重威胁患儿生命安全。术中患儿支气管内会有大量脓性分泌物,处理不当可增加围手术期风险。本文回顾性分析我院收治的支气管异物继发肺实变患儿33例的临床资料及诊治情况,为提高该疾病的救治水平提供参考。1 资料与方法1.1 临床资料2011年6月-2019年6月我院收治支气管异物继发肺实变患儿33例,

气管、支气管异物是严重危及儿童生命的急症,异物性质以坚果等有机物最为多见,笔帽类特殊异物较为少见,此类异物体积较大,气道堵塞较为严重,且异物取出具有一定难度,其中又以笔帽底部无通气孔的病例病情更为危重,一旦处理不当,会出现危及生命的严重后果 [1] 。现回顾我院收治的42例经硬质支气管镜检查证实为笔帽类异物的患儿资料（图1）,按照笔帽底部是否有通气孔进行分组（图2、3）,并对两组患儿的临床特点及诊治情况进行比较,以提高对此类疾病的认识。

支气管异物合并纵隔皮下气肿患儿临床上并不少见,大部分患儿随着异物取出,气体逐渐吸收,得以康复,但部分支气管异物患儿合并严重纵隔皮下气肿,加之异物堵塞一侧支气管,影响患儿呼吸功能,威胁患儿生命安全。现回顾我院收治的68例支气管异物合并纵隔皮下气肿患儿的临床资料,分析其中7例伴有上气道梗阻Ⅲ度及以上表现的危重患儿,旨在为提高对该病的救治措施提供参考。1资料与方法1.1临床资料选取我院2011年1月—2018年11月收治的支气管异物合并纵隔气肿患儿68例,其中7例为危重患儿,表现为Ⅲ度及以上上气道梗阻。其中男4例,女3例;年龄1岁1个月～8岁,平均2.25岁;病程2～9d,平均5.57d。

目的 研究腺样体肥大儿童的鼻咽部细菌学特点.方法 选取住院手术的345例腺样体肥大患儿,术中留取腺样体表面分泌物及腺样体实体组织标本,行细菌培养及药敏试验,根据细菌培养条件致病菌检出情况,比较患儿在性别、年龄、孕周、喂养方式等多个相关因素间的差异,并分析其药敏特点.结果 腺样体肥大患儿中条件致病菌检出率为29.86％(103/345),以流感嗜血杆菌为主,其次为金黄色葡萄球菌和肺炎链球菌.伴鼻窦炎患儿条件致病菌检出率高于不伴鼻窦炎患儿(x2=5.729,P=0.022);伴扁桃体肥大患儿条件致病菌检出率高于不伴扁桃体肥大患儿(x2=6.231,P=0.013);腺样体Ⅲ度患儿条件致病菌检出率高于腺样体Ⅳ度患儿(x2=6.518,P=0.011).在性别、年龄、孕周、喂养方式、家庭宠物、生活环境、病史长短等方面各组无显着性差异(P＞0.05).以上常见细菌对β-内酰胺酶抑制剂复合药物、喹诺酮类抗生素较敏感,对非β-内酰胺酶抑制剂和磺胺类药物耐药明显.结论 流感嗜血杆菌、金黄色葡萄球菌和肺炎链球菌是儿童腺样体肥大的菌群分布中3种主要的条件致病菌.鼻窦炎、扁桃体肥大及腺样体分度是影响儿童腺样体肥大菌群的重要因素.腺样体相关疾病诊治中,头孢类抗生素仍是用药首选,但二代头孢中的头孢呋辛耐药明显,为不推荐用药.

先天性喉小囊囊肿(congenital laryngeal saccular cysts,CLSCs)又称为先天性喉囊肿,是一种较为少见的先天性喉部畸形,可导致新生儿及婴幼儿出现喉喘鸣,哭声微弱及喂养困难,严重者可致呼吸道梗阻,危及生命[1].该病极易与喉软化症、声带麻痹、会厌囊肿等疾病相混淆,且手术治疗操作空间狭小,术后有复发、喉返神经麻痹及声带运动不良的可能[2],诊治具有一定难度.

毛息肉是一种罕见的口咽或鼻咽部的先天畸形,是局部组织发育异常所致,一般由中胚层(纤维脂肪组织、软骨或肌肉)和外胚层(角化层状鳞状上皮和皮肤附件)构成,生长于婴幼儿咽后壁的中线或近中线处.文献报道毛息肉多发生于鼻咽部,而发生在鼻中隔的较为罕见.其性质是畸胎瘤还是发育异常,尚有争议.现将河北省儿童医院耳鼻咽喉科治疗的鼻中隔毛息肉2例报道如下.

目的 分析过敏原筛查在儿童分泌性中耳炎中的结果并探讨其临床意义.方法 选取住院治疗的100例慢性分泌性中耳炎患儿为SOM组,选取40例不伴分泌性中耳炎患儿为对照组,对血清过敏原筛查结果进行不同组间比较.结果 总体过敏原阳性率、食入性过敏原阳性率、吸入性过敏原阳性率SOM组均高于对照组;食入性过敏原中牛奶、鸡蛋白、牛/羊肉组合SOM组均高于对照组;总体过敏原阳性项数、食入性过敏原阳性项数、吸入性过敏原阳性项数SOM组均高于对照组;以上差异均有统计学意义.SOM组中,总体过敏原阳性率随年龄增长呈下降趋势,总体过敏原阳性项数中位数随年龄增长逐渐下降,两者在四个年龄组间比较,差异均有统计学意义.结论 过敏原刺激是分泌性中耳炎发生的病因之一,6岁以下患儿表现较为突出,其中食入性过敏原刺激作用不容小觑.

目的 讨论变应原筛查在腺样体肥大患儿中的结果及临床意义.方法 选取我院住院治疗的200例腺样体肥大患儿为腺样体肥大组,40例不伴腺样体肥大患儿为对照组,检测血清变应原筛查,对结果进行不同组间比较.结果 腺样体肥大组总过敏原阳性率、食入性过敏原阳性率、吸入性过敏原阳性率均高于对照组(χ2=8.048、8.000、6.938,P均<0.05);腺样体肥大组中总过敏原阳性率随年龄增长呈下降趋势(χ2=13.132,P<0.05)).总过敏原阳性项数、食入性过敏原阳性项数、吸入性过敏原阳性项数腺样体肥大组均高于对照组(Z=2.925、2.631、2.362,P均<0.05);腺样体肥大组中总过敏原阳性项数中位数以3～6岁组最高(Z=2.582,P<0.05),食入性过敏原中牛奶、鸡蛋白、牛/羊肉组合均高于对照组.结论 过敏原刺激是腺样体肥大的病因之一,患儿发病年龄越小,过敏易感性程度越高,其中牛奶、鸡蛋白、牛/羊肉组合类食入性过敏原刺激作用不容小觑.