The aim of this study was to analyze negative middle ear pressure in children with obstructive sleep apnea (OSA) and establish and evaluate predictive models according to these findings. This retrospective study involved 931 children: 715 with OSA and 216 controls. Demographic, clinical, lateral head radiograph, and tympanometry data were collected. These characteristics of children with OSA were analyzed, with a particular focus on exploring the value of middle ear-related parameters for the diagnosis of pediatric OSA. Additionally, a logistic regression model incorporating optimal indicators was developed to predict pediatric OSA. The model was visualized via a nomogram and evaluated for discrimination, calibration, clinical effectiveness and external validation. Children with OSA were younger and exhibited longer soft palates, larger tonsils and adenoids than non-OSA children. Additionally, children with OSA presented higher acoustic admittance (AC) and resonance frequency (RF), lower middle ear pressure (MEP), and narrower pressure gradient (PG) than non-OSA children. The external auditory canal volume (ECV), MEP, and PG were identified as independent predictors of childhood OSA. We constructed a foundational prediction model for childhood OSA (Model 0, AUC = 0.845, 95

BackgroundYin Hu Gan Mao San (YHGMS) is a traditional Chinese herbal preparation derived from Yin Qiao San, used for topical application to treat wind-heat colds. This study aims to evaluate the clinical efficacy and safety of YHGMS in children with acute upper respiratory tract infection (AURTI) of wind-heat pattern.MethodsThis prospective, real-world cohort study enrolled 999 children with AURTI from 23 hospitals from May 2022 to June 2023. Participants were naturally divided into an exposed group (n = 671) that received YHGMS and a non-exposed group (n = 328) that did not receive YHGMS or any other traditional Chinese medicine. Propensity score matching was used to balance baseline characteristics. Primary outcomes included clinical recovery rate and time to recovery. Secondary outcomes included time to normal temperature, symptom resolution rates, and safety profile.ResultsAfter propensity score matching, the YHGMS group demonstrated significantly higher recovery rates on day 3 (52.64% vs. 36.09%), day 5 (81.00% vs. 68.81%), and day 7 (94.72% vs. 87.64%) (all P < 0.0001). Median recovery time (3.0 vs. 4.0 days) and time to normal temperature (1.0 vs. 2.0 days) were significantly shorter in the YHGMS group (both P < 0.0001). Resolution rates of individual symptoms were consistently higher in the YHGMS group. The incidence of adverse reactions was low (1.51%), comprising only mild, self-limiting local skin reactions.ConclusionYHGMS was associated with faster clinical recovery and symptom resolution in children with AURTI (wind-heat pattern), without significant safety concerns. As monotherapy, YHGMS showed better outcomes than chemical medicine alone; in combination, it also accelerated resolution of clinical symptoms and recovery.

Purpose:This study aimed to explore thyroid function changes in patients with obstructive sleep apnea (OSA) and analyze the relationships among the sleep apnea-specific hypoxic burden (SASHB), the sleep breathing impairment index (SBII), and the function during different sleep stages. Methods:This retrospective study included 452 patients with OSA who visited the Second Affiliated Hospital of Xi'an Jiaotong University between August 2017 and March 2024. The severity of OSA was evaluated, grouping patients by their apnea-hypopnea index (AHI), SASHB, SBII, and both SASHB and SBII during non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. Multiple linear regression analyzed the independent relationships between the AHI, SASHB, SBII, and thyroid function indicators while adjusting for potential confounders. Results:Significant intergroup differences were observed in thyroid function indicators under various grouping methods, with different trends. After adjusting for confounding factors, SASHB, SASHB during NREM sleep (NREM-SASHB), SASHB during REM sleep (REM-SASHB), SBII, SBII during NREM sleep (NREM-SBII), and SBII during REM sleep (REM-SBII) were independently associated with elevated serum free triiodothyronine (FT3) levels (p < 0.05). Similar results were noted in the male patients, whereas no significant associations were observed in the female patients. Conclusion:There is an association between OSA and thyroid function, with SASHB and SBII independently linked to elevated FT3 levels across different sleep stages and sex subgroups. Future research should further explore these mechanisms to optimize clinical management and treatment strategies for patients with OSA.

PurposeThis study investigated cognitive impairment in children with obstructive sleep apnea (OSA) by evaluating the utility of sleep apnea-specific hypoxic burden (SASHB) and sleep breathing impairment index (SBII) compared to the obstructive apnea-hypopnea index (OAHI).MethodsA retrospective analysis included 141 children with suspected OSA from Xi'an Jiaotong University Second Affiliated Hospital (October 2021–October 2024), categorized into OSA (n = 104) and non-OSA (n = 37) groups based on OAHI. Demographic, polysomnography (PSG), and event-related potential (ERP) data were collected. Cognitive function (full, verbal, and performance IQ: FIQ, VIQ, PIQ) was assessed using the China-Wechsler Intelligence Scale (C-WISC). Correlations between cognitive scores, ERP parameters, OAHI, SASHB, and SBII were analyzed.ResultsOSA children exhibited higher rates of snoring/sleep suffocation, prolonged apnea/hypoventilation durations, reduced mean/minimum SaO2, lower REM sleep, and elevated N3 sleep. OAHI and SASHB were higher in the OSA group, but SBII showed no group difference. OSA children had prolonged P300/N100 latencies and lower FIQ, VIQ, and PIQ scores. FIQ inversely correlated with OAHI, SASHB, and SBII; after adjusting for age, sex, and BMI, FIQ remained negatively associated with SBII. SASHB correlated with FIQ only in children <6 years, while OAHI showed no significant correlation. VIQ in younger children negatively correlated with SASHB/SBII, but only with OAHI in older children. PIQ in younger children correlated with OAHI, while no correlations existed in older children. P300 latency positively correlated with OAHI; other ERP parameters showed no associations.ConclusionOSA children demonstrate significant cognitive decline and ERP abnormalities. SASHB and SBII exhibit stronger correlations with cognitive impairment than OAHI, particularly in younger children, highlighting their potential as precise metrics for evaluating cognitive deficits in pediatric OSA.

PurposeInvestigate the clinical/hematological characteristics of children infected with the Omicron variant of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and identify an effective indicator to distinguish coronavirus disease 2019 (COVID-19) severity in children.MethodsA retrospective study was conducted through electronic medical records from pediatric patients. The demographic, clinical, and routine blood test (RBT) features of children diagnosed by real-time PCR for SARS-CoV-2 were collected.ResultsData of 261 patients were analyzed. The most common abnormality shown by RBTs was increased monocyte count (68%). Children had “mild-moderate” or “severe” forms of COVID-19. Prevalence of abnormal neutrophil count (p = 0.048), eosinophil count (p = 0.006), mean corpuscular volume (p = 0.033), mean platelet volume (p = 0.006), platelet-large cell ratio (p = 0.043), and red blood cell distribution width-standard deviation (p = 0.031) were significantly different in the two types. A combination of the neutrophil: lymphocyte ratio (NLR) and eosinophil count for diagnosing severe COVID-19 presented the largest AUC (0.688, 95% CI = 0.599–0.777; p < 0.001), and the AUC increased with a decrease in age.ConclusionsCombination of the NLR and eosinophil count might be a promising indicator for identifying severe COVID-19 in children at infection onset.

Cysteine and glycine-rich protein 2 (Csrp2) has emerged as a key factor in controlling the phenotypic modulation of smooth muscle cells. The phenotypic transition of airway smooth muscle cells (ASMCs) is a pivotal step in developing airway remodeling during the onset of asthma. However, whether Csrp2 mediates the phenotypic transition of ASMCs in airway remodeling during asthma onset is undetermined. This work aimed to address the link between Csrp2 and the phenotypic transition of ASMCs evoked by platelet-derived growth factor (PDGF)-BB in vitro. The overexpression or silencing of Csrp2 in ASMCs was achieved through adenovirus-mediated gene transfer. The expression of mRNA was measured by quantitative real-time-PCR. Protein levels were determined through Western blot analysis. Cell proliferation was detected by EdU assay and Calcein AM assays. Cell cycle distribution was assessed via fluorescence-activated cell sorting assay. Cell migration was evaluated using the scratch-wound assay. The transcriptional activity of Yes-associated protein (YAP)/transcriptional coactivator with PDZ-binding motif (TAZ) was measured using the luciferase reporter assay. A decline in Csrp2 level occurred in PDGF-BB-stimulated ASMCs. Increasing Csrp2 expression repressed the PDGF-BB-evoked proliferation and migration of ASMCs. Moreover, increasing Csrp2 expression impeded the phenotypic change of PDGF-BB-stimulated ASMCs from a contractile phenotype into a synthetic/proliferative phenotype. On the contrary, the opposite effects were observed in Csrp2-silenced ASMCs. The activity of YAP/TAZ was elevated in PDGF-BB-stimulated ASMCs, which was weakened by Csrp2 overexpression or enhanced by Csrp2 silencing. The YAP/TAZ activator could reverse Csrp2-overexpression-mediated suppression of the PDGF-BB-evoked phenotypic switching of ASMCs, while the YAP/TAZ suppressor could dimmish Csrp2-silencing-mediated enhancement on PDGF-BB-evoked phenotypic switching of ASMCs. In summary, Csrp2 serves as a determinant for the phenotypic switching of ASMCs. Increasing Csrp2 is able to impede PDGF-BB-evoked phenotypic change of ASMCs from a synthetic phenotype into a synthetic/proliferative phenotype through the effects on YAP/TAZ. This work implies that Csrp2 may be a key player in airway remodeling during the onset of asthma.

Abstract Background Childhood asthma is a common respiratory disease characterized by airway inflammation. Tumor necrosis factor-α-induced protein 8-like 2 (TIPE2) has been found to be involved in the progression of asthma. This study aimed to explore the role of TIPE2 in the regulation of airway smooth muscle cells (ASMCs), which are one of the main effector cells in the development of asthma. Materials and methods ASMCs were transfected with pcDNA3.0-TIPE2 or si-TIPE2 for 48 h and then treated with platelet-derived growth factor (PDGF)-BB. Cell proliferation of ASMCs was measured using the MTT assay. Cell migration of ASMCs was determined by a transwell assay. The mRNA expression levels of calponin and smooth muscle protein 22α (SM22α) were measured using qRT-PCR. The levels of TIPE2, calponin, SM22α, PI3K, p-PI3K, Akt, and p-Akt were detected by Western blotting. Results Our results showed that PDGF-BB treatment significantly reduced TIPE2 expression at both the mRNA and protein levels in ASMCs. Overexpression of TIPE2 inhibited PDGF-BB-induced ASMC proliferation and migration. In addition, overexpression of TIPE2 increased the expression of calponin and SM22α in PDGF-BB-stimulated ASMCs. However, an opposite effect was observed with TIPE2 knockdown. Furthermore, TIPE2 overexpression blocked PDGF-BB-induced phosphorylation of PI3K and Akt, whereas the expression of p-PI3K and p-Akt were aggravated by TIPE2 knockdown. Additionally, the effects of TIPE2 overexpression and TIPE2 knockdown were altered by IGF-1 and LY294002 treatments, respectively. Conclusions Our findings demonstrate that TIPE2 inhibits PDGF-BB-induced ASMC proliferation, migration, and phenotype switching via the PI3K/Akt signaling pathway. Thus, TIPE2 may be a potential therapeutic target for the treatment of asthma.

OBJECTIVE:To investigate and analyze the correlation between the c-fos protein expression and neuropeptide content in the lung of bronchial asthmatic rats.METHODS:Thirty-two (32) SD rats were randomly allocated into 4 groups of the normal control, the non-acute asthma, the acute asthma and the dexamethasone intervention. Immunohistochemistry was performed for histological observation, and substance P (SP) and vasoactive intestinal peptide (VIP) concentrations in the bronchoalveolar lavage fluid were measured by enzyme-linked immunosorbent assay (ELISA).RESULTS:SP concentration in the alveolar lavage of asthmatic rat was significantly higher than that in the normal control group (P < 0.0001), whereas VIP concentration was significantly lower (P < 0.0001). The optical density of c-fos protein in the lung tissues of groups of the non-acute asthma, the acute asthma and the dexamethasone intervention was positively correlated with SP concentration in the bronchoalveolar lavage fluid (r = 0.908, r = 0.967, r = 0.865), and negatively correlated with the VIP concentration in the alveolar lavage (r = -0.974, r = -0.949, r = -0.962).CONCLUSION:The c-fos protein expression and neuropeptide content in the lungs of asthmatic rats are related with asthma attacks.

Pdcd4 has been known as a tumor-suppressor gene initially and is up-regulated during apoptosis. Surprisingly, we found that Pdcd4 was differentially expressed in the lung from E3 rats with AIPI, an animal model for asthma, but the precise role of Pdcd4 in AIPI still remained to be defined. In the present study, we first evaluated the expression of Pdcd4 in lung from control and AIPI rats with RT-qPCR, Western blot, and immunohistochemistry. Then, we investigated the effects of intervention of Pdcd4 on markers of macrophage alternative activation and airway remodeling. Upon challenging E3 rats with OVA, Pdcd4 was up-regulated in lung tissue with AIPI. Immunohistochemistry results showed that alveolar macrophages and airway epithelia expressed Pdcd4 protein. Overexpression of Pdcd4 in the rat alveolar macrophage cell line, NR8383 cells, increased the mRNA expression of arginase-1 and TGF-β1, which are markers of macrophage alternative activation. In response to Pdcd4 RNAi in NR8383 cells, the mRNA expression of markers Fizz1, Ym1/2, arginase-1, and TGF-β1 was decreased significantly. In addition, Pdcd4 RNAi in AIPI rats led to a decrease of the mRNA expression of Fizz1, Ym1/2, arginase-1, and TGF-β1 in BALF cells. Finally, knockdown of Pdcd4 suppressed airway eosinophil infiltration, bronchus collagen deposition, and mucus production. Overall, these results suggest that Pdcd4 may be worthy of further investigation as a target for macrophage alternative activation and airway remodeling in allergic pulmonary inflammation.

Background: Asthma is the most common chronic respiratory disease seriously endangering the health of children. But disease awareness and self-management skills are relatively poor in children; parents play an important role in the control of childhood asthma.Objective: To investigate the status of asthma control and severity of asthma in children and to identify impact factors.Methods: We studied 1 tertiary hospital in each of the 29 provinces. A total of 2,960 parents with children with asthma who visited those hospitals were selected for the knowledge, attitude, and practice (KAP) questionnaire survey, and separated into the controlled asthma group and uncontrolled asthma group according to children's asthma conditions in the past 12 months. Multivariate analysis was carried out based on the answers to 28 tested factors.Results: In the past 12 months, 66.0% of children with asthma had asthma attacks, 26.8% visited an emergency room, and 16.2% were hospitalized. The total cost for asthma was significantly higher in the uncontrolled group than controlled group (chi(2) = 23.14, P < .01). Twelve protective factors of asthma control were founded, such as older age of children, long disease course, high KAP scores of parents, compliance with using nasal steroids, and knowledge of "3 or more times recurrent wheezing suggesting asthma." The risk factors were eczema and family history of asthma.Conclusion: Children's asthma is poorly controlled. The cost of asthma is significantly higher in uncontrolled asthma than in controlled. The age of children, course of asthma, personal history of allergy, family history of asthma, parents' education level, and parents' KAP are factors that affect asthma control. (C) 2012 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.