[Progress in application of aspirin desensitization and maintenance therapy in aspirin-exacerbated respiratory disease].

Aspirin-exacerbated respiratory disease (AERD) is a clinical syndrome characterized by chronic rhinosinusitis with nasal polyps, asthma and the development of significant airway symptoms following the ingestion of aspirin and other nonsteroid anti-inflammatory drugs (NSAIDs). At present, aspirin challenge is the gold standard for diagnosis. Aspirin desensitization and aspirin therapy after desensitization (ATAD) is one of the classical therapies. This paper described the application of aspirin desensitization and ATAD in AERD and provided the reference for the comprehensive treatment of AERD.

[Clinical observation and preliminary economic study of rush immunotherapy in patients with allergic rhinitis].

Objective: To observe the clinical efficacy, safety, compliance, and cost-effectiveness of rush immunotherapy (RIT) and conventional immunotherapy (CIT) in patients with allergic rhinitis (AR), so as to evaluate the clinical significance of CIT and preliminarily explore its economic value. Methods: A study was conducted on 72 AR patients who had received specific immunotherapy from Oct 2019 to Jun 2020 in the Department of Otorhinolaryngology, the First Affiliated Hospital of Chongqing Medical University, including 39 males and 33 females, aging 8 to 60 years. RIT or CIT was performed respectively according to the patients' wishes. There were 35 cases in the RIT group and 37 cases in the CIT group, all subjects were followed up for 1 year. Visual analysis scale (VAS) and effectiveness were used to evaluate the clinical efficacy. Systemic adverse reactions were used to assess safety. Failure rate was calculated to evaluate the compliance. The cost and cost-effectiveness ratio (CER) were conducted to evaluate the health economics preliminarily. Results: After half a year and one year's treatment, both RIT and CIT groups had significant clinical efficacy and RIT group had more significant clinical efficacy than CIT group at half a year (76.67% vs 46.67%, χ2=7.37, P=0.007). During the dose accumulation phase, there was no significant difference in the incidence of systemic adverse reactions between the two groups (8.57% vs 8.10%, χ2=0.05, P=0.943), while the drop-out rate in the RIT group was significantly lower than that in the CIT group (0 vs 13.51%, χ2=5.08, P=0.024). After one year, the costs in RIT group were significantly higher ((8 163.08±452.67) yuan vs (7 385.87±369.92) yuan, t=-2.78, P=0.009), while there was no statistical differences in CER between the two groups ((3 298.06±1 374.09) yuan/point vs (3 154.38±1 532.51) yuan/point, t=-0.36, P=0.418). Conclusions: Both RIT and CIT are beneficial for AR, and they have similar clinical efficacy, safety, and CER. RIT is more effective in the early stage, with higher patient compliance. Thus, RIT is worth promoting and exploring in clinic.

[Application of the subjective and objective evaluation in functional rhinoplasty].

Objective: To explore the subjective and objective evaluation methods in functional rhinoplasty. Methods: Sixty-four patients who underwent rhinoplasty in the Department of Otorhinolaryngology, the First Affiliated Hospital of Chongqing Medical University were included in this study from January 2017 to October 2018. There were 32 males and 32 females, with the age ranging from 18 to 45 years old. Before and 6 months after operation, nasal ventilation function was evaluated by Visual Analogue Scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE), nasal acoustic reflex and nasal resistance. Satisfaction with nasal appearance was evaluated by VAS, Rhinoplasty Outcome Evaluation (ROE) and facial proportions evaluation. Psychological state was assessed by Emotional Balance Scale and Rosenberg Self-esteem Scale. Finally, the Pearson correlation analysis of patient satisfaction was performed. SPSS 23.0 software was used for statistical analysis. Results: Compared with pre-operation, nasal obstruction VAS, NOSE scores, total nasal resistance and difference ratio of nasal resistance showed significantly decline after surgery (1.62±0.85 vs 7.56±1.44, 22.62±3.54 vs 69.75±7.85, (0.16±0.08) Pa·s/ml vs (0.31±0.43) Pa·s/ml, 0.33±0.28 vs 0.71±0.32, all P<0.05). VAS of appearance and ROE scores showed an increase after surgery (11.20±3.66 vs 2.70±0.97, 17.80±2.71 vs 7.50±1.12, all P<0.05). The measurement of the external nasal subunits showed that the length of the dorsum of the nose, the angle of the face to the nose, the angle of the frontal and the angle of the alar of the nose were obviously reduced ((29.33±4.26) mm vs (33.61±5.24) mm, (135.11±3.81)° vs (139.91±6.30)°, (130.63±2.88)° vs (136.74±5.72)°, (99.71±4.02)° vs (106.27±5.60)°, all P<0.05). The scores of postoperative Emotional Balance Scale and Rosenberg Self-esteem Scale increased significantly (5.88±1.54 vs 4.31±1.85, 28.31±2.64 vs 22.13±2.77, all P<0.05). The Pearson correlation analysis showed that patients' satisfaction was positively correlated with subjective score of nasal ventilation (VAS, NOSE), subjective score of nasal appearance (VAS, ROE) and emotional balance scale, while negatively correlated with nasal resistance, and not correlated with the measurement of external nasal subunit. There was a significant positive correlation between the subjective score of nasal ventilation and the measurement of nasal resistance, but there was no significant correlation between the subjective score of nasal appearance and the measurement of external nasal subunit. Conclusion: The subjective and objective evaluation of nasal ventilation function, aesthetics of nasal appearance and psychological state can evaluate the effect of functional rhinoplasty effectively.

[Situation analysis of timing of first visit of anti-mitochondrial antibody-positive patients].

Objective: To understand the basic information of anti-mitochondrial antibody (anti-AMA)-positive patients after initial diagnosis, and to set groundwork for further exploring the clinical significance of AMA in various diseases. Methods: Demographic data and related clinical information recorded through the Information System of Peking University People's Hospital from January 2013 to December 2016 were collected. Patients whose AMA and/or AMA-M2 first- tested as positive were recorded. Complications were classified according to the International Classification of Diseases. Results: A total of 1323 AMA positive cases were discovered for the first time. Among them, 78.0% were women, and the age of initial diagnosis was 56.8 ± 16.0 years. The first three initially diagnosed departments were rheumatology and immunology (37.4%), liver Disease (15.9%) and hematology (15.9%) relevant to musculoskeletal and connective tissue diseases (45.2%), hematology and hematopoietic organs and immune diseases (30.6%) and circulatory system diseases (29.7%). There were 297 newly confirmed cases of primary biliary cholangitis (PBC); accounting for 89.2% of women, and the age of initial diagnosis was 60.1 ± 12.4 years. The top three departments of initially diagnosed as PBC were liver disease (37.7%), rheumatology (33.0%) and gastroenterology (15.2%), of which 39.7% had musculoskeletal and connective tissue diseases, 27.9% had circulatory diseases, and 24.9 % were combined with endocrine and metabolic diseases. Conclusion: Besides PBC and other autoimmune diseases, AMA and / or AMA-M2 positivity can be observed in a variety of diseases in several clinical departments, and its clinical significance remains to be further clarified.

Long non-coding HOTTIP regulates preeclampsia by inhibiting RND3.

OBJECTIVE: Preeclampsia (PE) is an important disease affecting maternal and neonatal pregnancy. Long non-coding RNA plays an important role in preeclampsia. This study aims to explore the role of HOXA distal transcript antisense RNA (HOTTIP) in preeclampsia. PATIENTS AND METHODS: The expression of HOTTIP in placentas of preeclampsia and normal pregnancy was detected by polymerase chain reaction (PCR). The difference of clinical data between high expression HOTTIP group and low expression HOTTIP group was compared to explore the relationship between HOTTIP and the progress of preeclampsia. Cell proliferation and cell cycle were detected after overexpression and interference with HOTTIP. Western blot was finally used for detecting protein expression. RESULTS: By analyzing the clinical data, we found that systolic blood pressure, diastolic blood pressure, and urinary protein in preeclampsia patients were significantly higher than those in normal pregnant women. The birth weight of fetuses was significantly lower than that of normal pregnant women. Through PCR results, we found that the expression of HOTTIP in patients with preeclampsia was significantly lower, and the maternal systolic blood pressure, diastolic blood pressure and urinary protein in the low expression HOTTIP group were significantly higher than that in the high expression group. Fetal birth weight was significantly lower than the high expression group. After overexpression and interference with HOTTIP, it was found that overexpression of HOTTIP significantly increased the proliferation of trophoblast cells and markedly accelerated the cycle. Interfering with HOTTIP, trophoblast cell proliferation was significantly reduced and cell cycle was arrested. By Western blotting, we found that HOTTIP regulated the progression of preeclampsia via Rho family GTPase 3(RND3). CONCLUSIONS: HOTTIP was lowly expressed in preeclampsia and was able to suppress the progression of preeclampsia.

[Observation of systemic adverse reactions by specific immunotherapy and analysis of risk factors in allergic rhinitis].

Objective: To investigate the systemic adverse effects of specific subcutaneous immunotherapy (SCIT) in patients with allergic rhinitis (AR) and explore the possible risk factors. Methods: A retrospective study was conducted on AR patients who underwent SCIT from January 2014 to January 2017 in Department of Otorhinolaryngology, the First Affiliated Hospital of Chongqing Medical University. For patients with adverse reactions, the detailed medical history during treatment was reviewed. Results: A total of 1608 injections were performed on 102 patients, there were 12 cases / 21 times systemic adverse events, including systemic urticaria, angioedema and Grade Ⅰ systemic adverse reactions. There were 3 cases of grade Ⅳ adverse reactions. Systemic adverse reaction was prone to an initial treatment phase where the dose and concentration of the injection were increasing. Meanwhile, it was more common in young patients aged 20-40 years old and easy to occur in May and June. About the possible risk factors, the most common one was obvious local adverse reactions (17/21), followed by prolonged injection interval (9/21), the recent exposure to a large number of allergens (7/21) and strong positive skin prick results (7/21). Conclusions: The systemic adverse effects, which were induced by SCIT, mainly included systemic urticaria, angioedema and Grade Ⅰ systemic adverse reactions. Systemic adverse reaction was prone to an initial treatment phase where the dose and concentration of the injection were increasing.

[Rosai-Dorfman disease with nasal septum involvement:two cases report].

Clinical data of 2 cases with Rosai-Dorfman disease(RDD) originating from nasal septal mucosa were reported retrospectively,and the pertinent literature was reviewed. Without specific clinical features,RDD in nasal cavity could be misdiagnosed easily. Pathology revealed different morphologies of cell proliferation with engulfed lymphocytes,plasma cells and neutrophils. Immunohistochemical staining showed S-100(+),CD68(+)，CD1(-).RDD disease generally has a benign course and is self-limited. Its diagnosis depends mainly on biopsy．As for the treatment of this disease,the strategies are not systemic and standard. Surgical treatment is used to excise the mass in nasal cavity,glucocorticoids treatment after surgery is inconclusive. The long-term effect need to be further observed．.

[Association of CTLA-4 gene polymorphism in allergic rhinitis with asthma or not in children].

Objective:To evaluate the involvement of the cytotoxic T lymphocyte associated antigen (CTLA-4) gene polymorphisms in susceptibility of allergic rhinitis(AR) with/without asthma in children.Method:Three hundred and two AR children,288 AR with asthma children,and 327 healthy Chinese Han children were enrolled in the study.The SNPs of CTLA-4(rs3087243,rs11571302,rs11571315,rs231725,rs35219727,and rs4553808) were sequenced using a PCR restriction fragment length polymorphism assay.Result: An increased frequency of the AA genotype and A allele in rs3087243 of CTLA-4 was found in AR with asthma group.For rs231725,AA genotype and A allele were obviously increased in AR group, while they were significantly decreased in AR with asthma group(P<0.05).Conclusion:We found a significant association between CTLA-4 gene polymorphism and AR with asthma in Chinese Han children, which might be an autoimmunity risk factor for AR with asthma.

[Association between IL-27 gene polymorphisms and susceptibility to allergic rhinitis].

Objective: To evaluate the potential association of IL-27 polymorphisms with allergic rhinitis(AR) in a Chinese Han population. Method:A case-control study was performed in 445 Chinese AR patients and 691 healthy controls. Three SNPs in the IL-27p28 gene, including rs153109, rs17855750 and rs181206, were detected using a polymerase chain reaction-restriction fragment length polymorphism assay(PCR-RFLP). Result:A significantly increased prevalence of the rs153109 TT genotype and the T allele was found in AR patients, while a decreased prevalence of the CT and CC genotypes and the C allele was found. For rs153109, the TT genotype and the T allele were significantly associated with the risk of AR, but the CT and CC genotypes and the C allele decreased the risk of AR; for rs17855750, the TT genotype and T allele were risk factors for AR, and the GT genotype and G allele provided protection. TTT and TTC haplotypes in the IL-27 p28 gene were positively correlated with AR, while CGT, CTC and CTT haplotypes were associated with a significantly decreased risk of AR. Conclusion:This study indicates that IL-27 p28 polymorphisms rs153109 and rs17855750 are likely involved in AR susceptibility, making them potentially useful genetic biomarkers for AR susceptibility in the Chinese Han population.

[The guiding role of preoperative visual analog scale symptom scores in patients with chronic rhinosinusitis during perioperative period].

Objective:To assess the guiding role of preoperative visual analog scale(VAS) symptom scores in patients with chronic rhinosinusitis(CRS) during perioperative period.Method:The patients with CRS undergoing endoscopic sinus surgery were divided into experimental group and control group according to doctor group.Preoperative VAS symptom scores which including the overall symptom score and every single symptom scores were assessed. Patients with symptom(nasal congestion, nasal discharge, dizziness or headache, hypoamia or anosmia, rhinocnesmus, sneeze) scores more than 5 points were taken corresponding appropriate strategies in experimental group, but conventional empirical measures in control group during perioperative period.Nasal endoscopic surgeries were performed under local or general anesthesia after preoperative preparation. Postoperative followup were performed in six months and one year for the overall symptom and each symptom scores in both groups. SPSS17.0 was used for statistical analysis.Result:There was no statistical difference in general condition, overall symptom score and every symptom scores before operation between experimental group(120 cases) and control group(82 cases) (P >0.05). At the three time points (preoperative, six months, one year after operation), significant differences were found in the two groups about VAS overall symptom score (P <0.05). Except hypoamia, VAS for the other symptoms in different postoperative time showed statistical significance (P <0.05).Conclusion:Preoperative VAS symptom score can be used not only in the evaluation of severity and treatment effect,but also in the guiding of perioperative treatment for CRS, which is worthy of using widely in clinic.

Increased aryl hydrocarbon receptor expression in patients with allergic rhinitis.

BACKGROUND: A predominant Th17 population is a marker of allergic rhinitis (AR). As a ligand-activated transcription factor, the aryl hydrocarbon receptor (AhR) plays a vital role in promoting or inhibiting the development of specific Th cells. However, its role in AR remains undefined. OBJECTIVE: To analyze the potential role of AhR in the pathogenesis of AR. METHODS: In total, 30 AR patients and 13 healthy controls were recruited for this study and AR patients had clinical features, as demonstrated by rhinoconjunctivitis quality of life questionnaires, total symptom scores and visual analog scale scores. The expression of AhR, IL-17 and IL-22 and the presence of Th17 cells in peripheral blood mononuclear cells were measured before and after treatment with the nontoxic AhR ligand 2-(1'H-indole-3'-carbonyl)-thiazole-4-carboxylic acid methyl ester (ITE). RESULTS: Pretreatment ITE studies revealed that all AR patients had a significant increase in AhR expression compared with controls and AhR expression positively correlated with clinical parameters. After ITE intervention, a severe reduction in the differentiation of Th17 cells and the production of IL-17 and IL-22 was noted in both AR patients and normal subjects. Simultaneously, a dramatic enhancement of AhR expression was also observed in all healthy controls, but not in AR patients. CONCLUSION: The results suggested that the AhR may be one of the mechanisms underlying the Th17 response during the pathogenesis of AR and AhR levels were closely related to clinical severity in all AR patients. Additionally, ITE may represent a new drug candidate in the treatment of AR.

Transforming growth factor-beta1 in inflammatory airway disease: a key for understanding inflammation and remodeling.

Airway diseases such as chronic rhinosinusitis, asthma, and chronic obstructive pulmonary disorder are characterized by inflammation and remodeling. Among inflammatory and extracellular matrix regulatory cytokines, transforming growth factor-beta (TGF-ß) stands central, as it possesses both important immunomodulatory and fibrogenic activities, and should be considered a key for understanding inflammation and remodeling processes. This review will briefly summarize the recent findings on the role of TGF-ß1, from the view points of inflammation and remodeling, and discuss the role of TGF-ß in the upper and lower airway diseases. This may reveal new perspectives in the understanding of airway inflammation and remodeling processes and may open innovative treatment strategies for the regulation of TGF-ß1.

Similarity in the dynamics of contralateral motor overflow through increasing frequency of movement in a single limb.

This study was designed to investigate the effects of increasing movement frequency of a single limb on the degree of similarity and coherence of the motor outflow in the non-active limb. Twelve young adults performed a series of unilateral hand-clapping tasks (horizontal and vertical in 25-s trials) while seated. Individuals began the movements at a frequency of 1 Hz for 5 s and were required to increase the movement frequency so as to reach their maximum movement frequency during the latter parts of the trial. Hand and finger kinematics and surface EMG of each arm were recorded. The results showed a progressive emergence of overflow muscle activity and involuntary motion in the non-active arm as the movement frequency of the unilateral action increased toward the upper frequency limits of voluntary movement. This ceiling occurred within the range of 6-7 Hz. Activity in the non-active limb emerged as the movement frequency requirements increased, irrespective of the direction of motion for the task (vertical, horizontal), hand used (preferred, non-preferred) or the auditory timing stimulus provided (metronome, no-metronome). The dynamics of the motor overflow in the non-active limb exhibited time- and frequency-dependent patterns similar to those of the active arm. Together, these results demonstrate that the high-frequency unilateral movements of one limb drives the emergence of motor outflow to the opposite limb with the motor output dynamics being produced across both limbs being progressively similar as movement speed increases.

Impaired balance of Th17/Treg in patients with nasal polyposis.

Nasal polyposis (NP) is a chronic inflammatory disease of the nasal cavity and sinuses that is regulated by T lymphocyte subsets. Imbalance of Th17/Treg has been considered critical in the development of inflammation and atopic reactions. To assess whether the balance of Th17/Treg is disrupted in patients with NP, we evaluated the distribution of Th17 and Treg cells among peripheral blood mononuclear cells (PBMCs) in atopic patients with NP, non-atopic patients with NP and controls. We then determined mRNA levels of RORc and Foxp3 and protein levels of IL-17, TGF-ß and IL-10 in polyp tissue among the three groups. Finally, we investigated the correlation between Th17-, Treg- and Th1-, Th2-related cytokines (INF-γ, IL-4, IL-5). The results demonstrated that both atopic and non-atopic patients with NP revealed significantly increased Th17 proportion and decreased Treg proportion in PBMCs, as well as significantly increased RORc and IL-17 levels and decreased Foxp3 and TGF-ß levels in polyp tissue. Furthermore, these differences were significant between atopic and non-atopic groups. The frequency of Treg in PBMCs was found to be negatively correlated with Th1 and Th2 cytokines in polyps. These results indicated that an impaired balance of Th17/Treg existed in patients with NP and was more severe in atopic patients, suggesting that the imbalance of Treg/Th17 may play an important role in the development of NP and that atopy may aggravate NP by promoting the imbalance of Th17/Treg.

Upper frequency limits of bilateral coordination patterns.

This study examined what changes occur in upper-limb bilateral coordination during clapping as the movement frequency requirements were increased to the maximum. Subjects were required to begin the clapping action at approximately 1Hz and gradually increase the movement speed until their maximal frequency was achieved. Hand and finger displacement and surface electromyograms (EMG) from finger flexor/extensor muscles were recorded. The results showed that the maximal attainable movement frequency was between 7 and 8Hz. As the action approached the ceiling frequency (>5Hz), there was a significant reduction in movement amplitude of the non-preferred limb accompanied by increased co-activation of the muscles within this limb. The movement amplitude of preferred limb was maintained. Subsequently, there was a decrease in coupling between the two limbs with the bilateral coordination pattern transitioning from an in-phase pattern to an asymmetric mode, where only the preferred limb was moving. These findings reveal that there is a frequency induced transition to single-limb motion that reflects a stability boundary at the upper frequency limits of bimanual coordination.

Magnitude and structure of isometric force variability: mechanical and neurophysiological influences.

This experiment examined the magnitude and structure of force variability in isometric index finger force production tasks at 5, 15, 25, 35, 45, 55, 65, 75, 85, and 95% of maximal force in two different finger orientations. In the finger flexion task, the participants generated a downward isometric force through index finger flexion. In the finger abduction task, isometric force was generated by adducting the index finger (mediolateral motion of the middle finger and forearm were restricted). The task-related, normal force (Fz) and tangential forces (Fx and Fy) were collected with a three-dimensional force transducer. The standard deviation (SD) of the task-related force output (Fz) increased exponentially with force level. With increasing force level, approximate entropy (ApEn, a measure of irregularity) of Fz followed an inverted-U function for finger flexion, but decreased linearly in finger abduction. However, changes in the ApEn of the tangential forces were generally opposite to that of Fz, revealing compensations in the irregularity of force output between force dimensions. The findings provide evidence that force variability is related to muscle force-length characteristics (Feldman, 1966; Gottlieb %%% Agarwal, 1988).

Inverse relations in the patterns of muscle and center of pressure dynamics during standing still and movement postures.

The aim of this study was to investigate the postural center of pressure (COP) and surface muscle (EMG) dynamics of young adult participants under conditions where they were required to voluntarily produce random and regular sway motions in contrast to that of standing still. Frequency, amplitude and regularity measures of the COP excursion and EMG activity were assessed, as were measures of the coupling relations between the COP and EMG outputs. The results demonstrated that, even when standing still, there was a high degree of regularity in the COP output, with little difference in the modal frequency dynamics between standing still and preferred motion. Only during random conditions was a significantly greater degree of irregularity observed in the COP measures. The random-like movements were also characterized by a decrease in the level of synchrony between COP motion on the anterior-posterior (AP) and medio-lateral (ML) axes. In contrast, at muscle level, the random task resulted in the highest level of regularity (decreased ApEn) for the EMG output for soleus and tibialis anterior. The ability of individuals to produce a random motion was achieved through the decoupling of the COP motion in each dimension. This decoupling strategy was reflected by increased regularity of the EMG output as opposed to any significant change in the synchrony in the firing patterns of the muscles examined. Increased regularity across the individual muscles was accompanied by increased irregularity in COP dynamics, which can be characterized as a complexity tradeoff. Collectively, these findings support the view that the dynamics of muscle firing patterns does not necessarily map directly to the dynamics at the movement task level and vice versa.

Test-retest reliability and criterion validity of the Chinese version of CBCL, TRF, and YSR.

BACKGROUND: Psychometric properties of the Chinese version of CBCL, TRF, and YSR were understudied. This study aimed at examining their test-retest reliability and criterion validity. METHODS: Three Chinese community and clinic samples were recruited in Hong Kong. The parents, teachers, and youths respectively completed the CBCL, TRF, and YSR. RESULTS: The Chinese CBCL, TRF, and YSR were test-retest reliable and valid. However, there was score/case attenuation at retest. CBCL and TRF appeared to screen externalizing and ADHD problems better, while YSR screened internalizing problems better. CONCLUSIONS: Clinicians should be cautious about score/case attenuation at retest while using CBCL, TRF, and YSR to chart patients' progress. They should also recognize their different strengths in screening various disorders.

Change in the organization of degrees of freedom with learning.

The authors examined the effects of learning on the change in the organization of the mechanical and dynamical degrees of freedom in 5 men who performed a ski-simulator task. A 3-dimensional analysis of the motion of the total-body center of mass and the segmental centers of mass (head, torso, thighs, and shanks) over practice showed that the recruitment of mechanical degrees of freedom was strongly influenced by anatomical and task constraints. Principal components analysis of the body segments' motions revealed that practice shifted their relative contributions but did not change the number of principal components. The present findings show that there can be independence in the patterns of change in the mechanical and dynamical degrees of freedom that arise from practice.