Effects of acupuncture combined with Buyang Huanwu Decoction on the cerebral blood flow hypo perfusion model rats with carotid artery stenosis based on high-throughput sequencing / 国际中医中药杂志

Objective:To explore the effects of acupuncture combined with Buyang Huanwu Decoction on intestinal flora in cerebral blood flow hypo perfusion model rats with carotid artery stenosis.Methods:Totally 40 rats were randomly divided into sham-operation group, model group, TCM treatment group and acupuncture and drug combination treatment group, with 10 rats in each group. Except the sham-operation group, the other groups were prepared cerebral ischemia model by needle control and thread embolism method. TCM treatment group received Buyang Huanwu Decoction 100 mg/kg for gavage, once a day, and the intervention lasted for 2 weeks. In the acupuncture and drug combination group, based on the TCM treatment group, Baihui and its left and right sides of 2 mm were selected for acupuncture, once a day, and continuous intervention was performed for 2 weeks. Neurological function evaluation and behavioral function score were performed 7 and 14 days after administration, respectively. 16S rRNA sequencing was used to comprehensively characterize the structure and composition of fecal microflora of rats in each group. Linear discriminant analysis Effect Size (LEfSe) was used to analyze the difference of intestinal bacteria among groups.Result:On the 7th and 14th day after administration, compared with the model group, the neurological function score in the TCM treatment group and the acupuncture and drug combination group decreased ( P<0.05), and the behavioral function score increased ( P<0.05). Compared with model group, the Shannon index of TCM treatment group and acupuncture and drug combination group increased ( P<0.05). The abundance of Firmicutes increased ( P<0.05), and the abundance of Bacteroidetes and Proteobacteria decreased ( P<0.05); the abundance of Clostridia increased ( P<0.05), and the abundance of Gammaproteobacteria decreased ( P<0.05). The abundance of Escherichia-Shigella and Bacteroides decreased ( P<0.05); the abundance of lactobacillus significantly increased ( P<0.05). Conclusion:Acupuncture combined with Buyang Huanwu Decoction can improve the symptoms of cerebral hypoperfusion model rats with carotid artery stenosis, and the mechanism may be to increase the abundance of probiotics.

Bismuth, esomeprazole, metronidazole, and minocycline or tetracycline as a first-line regimen for Helicobacter pylori eradication: A randomized controlled trial / 中华医学杂志(英文版)

BACKGROUND@#Given the general unavailability, common adverse effects, and complicated administration of tetracycline, the clinical application of classic bismuth quadruple therapy (BQT) is greatly limited. Whether minocycline can replace tetracycline for Helicobacter pylori ( H . pylori ) eradication is unknown. We aimed to compare the eradication rate, safety, and compliance between minocycline- and tetracycline-containing BQT as first-line regimens.@*METHODS@#This randomized controlled trial was conducted on 434 naïve patients with H . pylori infection. The participants were randomly assigned to 14-day minocycline-containing BQT group (bismuth potassium citrate 110 mg q.i.d., esomeprazole 20 mg b.i.d., metronidazole 400 mg q.i.d., and minocycline 100 mg b.i.d.) and tetracycline-containing BQT group (bismuth potassium citrate/esomeprazole/metronidazole with doses same as above and tetracycline 500 mg q.i.d.). Safety and compliance were assessed within 3 days after eradication. Urea breath test was performed at 4-8 weeks after eradication to evaluate outcome. We used a noninferiority test to compare the eradication rates of the two groups. The intergroup differences were evaluated using Pearson chi-squared or Fisher's exact test for categorical variables and Student's t -test for continuous variables.@*RESULTS@#As for the eradication rates of minocycline- and tetracycline-containing BQT, the results of both intention-to-treat (ITT) and per-protocol (PP) analyses showed that the difference rate of lower limit of 95% confidence interval (CI) was >-10.0% (ITT analysis: 181/217 [83.4%] vs . 180/217 [82.9%], with a rate difference of 0.5% [-6.9% to 7.9%]; PP analysis: 177/193 [91.7%] vs . 176/191 [92.1%], with a rate difference of -0.4% [-5.6% to 6.4%]). Except for dizziness more common (35/215 [16.3%] vs . 13/214 [6.1%], P = 0.001) in minocycline-containing therapy groups, the incidences of adverse events (75/215 [34.9%] vs . 88/214 [41.1%]) and compliance (195/215 [90.7%] vs . 192/214 [89.7%]) were similar between the two groups.@*CONCLUSION@#The eradication efficacy of minocycline-containing BQT was noninferior to tetracycline-containing BQT as first-line regimen for H . pylori eradication with similar safety and compliance.@*TRIAL REGISTRATION@#ClinicalTrials.gov, ChiCTR 1900023646.

Insights into the progress in targeted therapy of atopic dermatitis from the perspective of its pathogenesis / 中华皮肤科杂志

The pathogenesis of atopic dermatitis is complex, and mainly related to genetic background, environmental stimuli, epidermal barrier defects, immune disorders, and other factors. Using Th2-type inflammatory cytokines and the JAK-STAT pathway as therapeutic targets has become a hotspot in drug development for atopic dermatitis. By now, multiple monoclonal antibodies and small-molecule drugs have been successfully used in the treatment of atopic dermatitis, marking that the treatment of atopic dermatitis has entered the era of precision therapy and targeted therapy.

Development and application of clinical assessment tools for cholinergic urticaria / 中华皮肤科杂志

This review comprehensively summarizes clinical assessment tools which have been developed and validated for cholinergic urticaria (CholU) , involving diagnosis and severity assessment of CholU, assessment of patients′ quality of life, and assessment of disease control. The application methods and status of relevant tools in clinical practice are introduced in detail.

Construction of "Expert consensus on diagnosis and treatment of chronic inducible urticaria in China (2023) " based on the Delphi method / 中华皮肤科杂志

Objective:To construct "Expert consensus on diagnosis and treatment of chronic inducible urticaria in China (2023) " based on the Delphi method, and to provide a methodological basis for consensus construction.Methods:After systematic search and evaluation of the literature related to chronic inducible urticaria, the first draft of "Expert consensus on diagnosis and treatment of chronic inducible urticaria in China (2023) " was written, and a questionnaire was designed for expert consultation. A representative sample of 25 experts was selected to conduct two rounds of correspondence consultation via electronic questionnaire in strict accordance with the Delphi method, and the content of the consensus was revised and improved according to the consultation results.Results:The response rates in the two rounds of questionnaire consultation were both 100%, and the expert authority coefficient was 0.92 ± 0.09. In the first round of consultation, the coefficients of variation (CV values) of 9 items were greater than 20%, and the mean agreement degree of 3 items was less than 7 points; in the second round of consultation, the CV values of all items were less than 15%, the agreement degree of the above 3 items whose mean agreement degree was less than 7 points in the first round of consultation all rose to over 7 points, and the median agreement degree of all items was greater than or equal to 8 points. Reliability analysis of the two rounds of questionnaire results showed that the Cronbach α coefficient and standardized Cronbach α coefficient were both greater than 0.9; the P values in the agreement tests by using Kendall′s coefficient of concordance for the two rounds of questionnaire results were both less than 0.001, and the Kendall′s coefficients of concordance were 0.170 and 0.219 in the first and second rounds of questionnaire consultation, respectively. Conclusion:The Delphi method-based "Expert consensus on diagnosis and treatment of chronic inducible urticaria in China (2023) " is highly representative, authoritative and reliable; this study also provides a methodological reference for the formulation and research of consensus.

Clinical analysis of allergen reactivity and atopic disease history in 168 patients with chronic inducible urticaria / 中华皮肤科杂志

Objective:To analyze the relationship between allergen reactivity, atopic disease history and clinical features in patients with chronic inducible urticaria (CIndU) .Methods:A retrospective analysis was conducted on clinical data and follow-up results from 168 patients with CIndU in the Department of Dermatology, Southwest Hospital of Army Medical University from June 2014 to June 2015. Associations were analyzed between allergen reactivity, atopic disease history and clinical characteristics (including patient global assessment [PGA] scores, pruritus intensity, dermatology life quality index [DLQI], proportions of cases with complicated angioedema, natural course, etc.) in patients with different CIndU subtypes. Chi-square test, Mann-Whitney U test and Kaplan-Meier survival analysis were used for statistical analysis. Results:Among the 168 patients with CIndU, 117 were diagnosed with symptomatic dermographism (SD) , 32 with cold contact urticaria (CCU) , 5 with heat contact urticaria (HCU) , and 14 with cholinergic urticaria (CholU) ; there were 46 (39.3%) , 14 (43.8%) , 3, and 9 patients with positive skin prick test (SPT) among the patients with SD, CCU, HCU and CholU respectively, and no significant difference was observed in the positive rate of SPT among patients with different CIndU subtypes ( χ2 = 3.86, P = 0.283) . The SPT-positive CIndU patients showed significantly increased PGA scores, pruritus scores, DLQI scores and proportions of cases with complicated angioedema compared with the SPT-negative patients (all P<0.05) ; the CIndU patients with a personal or family history of atopic diseases also showed significantly increased PGA and DLQI scores compared with those without (both P < 0.05) . For different CIndU subtypes, the pruritus scores, PGA scores, DLQI scores, and proportions of cases with complicated angioedema were significantly higher in the SPT-positive SD patients than in the SPT-negative SD patients (all P < 0.05) ; the DLQI scores were significantly higher in the SPT-positive CholU patients than in the SPT-negative CholU patients ( Z = -2.28, P = 0.019) ; the pruritus scores were significantly higher in the CCU patients with a personal or family history of atopic diseases than in those without ( Z =-2.41, P = 0.022) . Conclusion:The allergen reactivity and atopic disease history of CIndU patients were associated with disease severity, pruritus intensity, quality of life, and the proportion of cases with complicated angioedema, but their relationship with the natural course of CIndU needs to be confirmed by further studies.

Effect of microneedle radiofrequency combined with supramolecular salicylic acid on facial photoaging / 中华医学美学美容杂志

Objective:To explore the efficacy and safety of microneedle radiofrequency combined with supramolecular salicylic acid in improving facial photoaging.Methods:Thirty patients treated for facial photoaging were randomly divided into the combined treatment group and the microneedle radiofrequency group. All patients were female, aged between 30 and 50 years, with an average age of (39.4±4.1) years. The combined treatment group was treated with microneedle radiofrequency combined with supramolecular salicylic acid, and the Microneedle radiofrequency group was treated with microneedle radiofrequency alone. The patients were followed up 3 days, 7 days, 14 days, 28 days and 3 months after treatment. The results of VISIA, skin physiology and patients' satisfaction were used to compare the two groups of patients after treatment.Results:After 3 months of treatment, the skin pores (11.98±2.14 vs. 15.54±1.52), brown spots (12.40±1.85 vs. 15.84±1.42), ultraviolet spots (6.74±0.87 vs. 11.20±1.70), skin physiological status (transepidermal water loss): 11.84±1.80 vs 13.09±1.96 g/(h·m) 2, stratum corneum water content: 84.91±2.86 % vs 80.29±3.58 %, melanin index: 110.07±15.02 vs. 122.30±9.97, erythema index: 220.43±19.69 vs. 236.30±16.55), elasticity (75.98±3.94 vs. 69.89±3.58), epidermal thickness (1401.33±178.43 vs. 1217.13±139.77), skin color improvement (effective rate 86.7% vs. 40.0%) and patients' satisfaction (total satisfaction was 93.3% vs 67.0%) in the combined treatment group were significantly superior than those in the microneedle radiofrequency group, and the differences were statistically significant ( P<0.05). The reaction of moderate and severe erythema (the incidence rate 40.0% vs. 86.7%) and edema (the incidence rate 26.7% vs. 80.0%) in the combined treatment group was also significantly lower than that in the microneedle radiofrequency group ( P<0.05). No adverse pigmentation was reported in both groups after treatment. Conclusions:The combination of microneedle radiofrequency and supramolecular salicylic acid in the treatment of facial photoaging has definite clinical effect and high safety, which is worthy of clinical application.

Diagnosis of atopic dermatitis: controversies and facts / 中华皮肤科杂志

Atopic dermatitis is a common chronic recurrent atopic constitution-associated inflammatory skin disease mainly characterized by eczematous lesions and itching. Its etiology and pathogenesis are still not very clear, and there are many controversies about its origin, definition, clinical phenotypes and diagnostic criteria. This review analyzes and discusses these controversies in order to provide a meaningful reference for the diagnosis and treatment of atopic dermatitis.

Clinical analysis of 45 cases of drug-induced hypersensitivity syndrome / 中华皮肤科杂志

Objective:To analyze clinical characteristics of drug-induced hypersensitivity syndrome (DIHS) , and to compare the European, Japanese and Chinese diagnostic criteria.Methods:A total of 45 patients confirmedly diagnosed with DIHS according to the DIHS criteria originally proposed by Bocquet, were collected from the First Affiliated Hospital (Southwest Hospital) of Army Medical University between January 2009 and January 2019. Clinical data on the 45 patients were retrospectively analyzed, clinical characteristics were summarized and re-evaluated according to the European, Japanese and Chinese diagnostic criteria separately, and differences were analyzed in terms of the latency period, time to rash regression, eosinophil count, liver function indices, etc. One-way analysis of variance was used to compare means among multiple groups, and t test to compare means between two groups. Results:Of the 45 patients, 38 presented with eruptive drug eruptions, and 44 were accompanied by liver damage, 40 by elevated counts of peripheral white blood cells, 38 by eosinophilia, 21 by lymphadenectasis, and 4 by mucosal damage. Common culprit drugs included allopurinol (10 cases) , anti-tuberculosis drugs (7 cases) , cephalosporins (7 cases) , and Chinese medicine (4 cases) . Forty patients were treated with glucocorticoids, and 17 with glucocorticoids and intravenous gamma globulin. After treatment, 44 patients received improvement and 1 died. According to the European diagnostic criteria, there were 29 patients with suspected DIHS and 16 with confirmed DIHS; according to the Japanese diagnostic criteria, 37 patients could be confirmedly diagnosed with DIHS, but 8 could not be confirmedly diagnosed; according to the Chinese diagnostic criteria, 17 patients could be confirmedly diagnosed, but 28 could not be confirmedly diagnosed. According to the Japanese diagnostic criteria, the latency period was significantly longer in the patients with a confirmed diagnosis (36.91 ± 21.73 d) than in those without (20.00 ± 20.82 d, P = 0.04) . Conclusions:Common culprit drugs for DIHS include allopurinol, anti-tuberculosis drugs and cephalosporins. Most patients with DIHS are accompanied by liver damage, and the European diagnostic criteria are preferentially recommended for DIHS.

Advances in the treatment of atopic dermatitis: new medications, new methods and new models / 中华皮肤科杂志

Atopic dermatitis is a recurrent inflammatory skin disease. Although the existing systemic and topical treatment can relieve symptoms, there are still some limitations and adverse effects. In recent years, with the in-depth study on the pathogenesis of atopic dermatitis, especially the discovery of key inflammatory molecules and development of targeted therapeutic drugs, some new therapeutic methods and concepts have been brought to clinical practice. Awareness of new progress in atopic dermatitis-related biologics, small-molecule drugs, adjuvant treatment, monitoring methods and models for managing disease, will help clinicians better treat and manage atopic dermatitis.

Clinical phenotypes and endophenotypes of atopic dermatitis / 中华皮肤科杂志

Clinical phenotypes and endophenotypes of atopic dermatitis are diverse, and it is of great significance to identify characteristics of different clinical phenotypes and endophenotypes for auxiliary diagnosis and targeted treatments. This review elaborates clinical phenotypic differences of atopic dermatitis in terms of age of onset, ethnic background, disease severity, etc., and summarizes clinical significance of endophenotypes and related biomarkers.

Clinical progress in systemic contact dermatitis / 中华皮肤科杂志

Systemic contact dermatitis (SCD) is a kind of allergic inflammatory skin disease caused by contact with the same or cross-reactive allergens via systemic absorption in individuals who have been exposed to allergens. SCD lesions are diverse and easily overlooked in clinical practice. This review summarizes progress in clinical manifestations, pathogenesis, diagnosis, treatment of and sensitizers in SCD, aiming to improve its clinical diagnosis and treatment.

New insights into facial flushing and erythema in rosacea / 中华皮肤科杂志

Persistent centrofacial erythema with transient flushing is the most common clinical manifestation of rosacea. However, its pathological mechanisms are poorly understood, and there is a lack of high-level evidence from clinical studies. Based on research progress and clinical experience in China and other countries, the authors emphasize the necessity that facial flushing with erythema should be investigated as an independent clinical phenotype during the study. It is believed that mental stress, anxiety and/or depression may be driving factors in the pathogenesis of facial flushing with erythema. Based on mental factors, it is of potential clinical significance to investigate the relationship of neuroinflammation involved in facial flushing and erythema with skin immunity and blood vessels in rosacea.

The exposure of antibiotics on the eradication of bismuth quadruple therapy in H.pylori infection / 中华内科杂志

Objective:To analyze the impact of previous exposure to macrolide, quinolones and nitroimidazole antibiotics on eradication rate of bismuth quadruple therapy (BQT) in newly diagnosed patients with Helicobacter pylori( H. pylori). Methods:A total of 469 patients with H. pylori initially treated at the Third Hospital of Peking University from September 2017 to August 2020 were retrospectively recruited. The therapeutic regimens were BQT containing clarithromycin/levofloxacin/metronidazole recommended by Chinese guidelines. Clinical data were collected, including general demographic data, exposure history of antibiotics, CYP2C16 metabolic pattern, endoscopic diagnosis, bacterial density, H.pylori resistance, eradication results, etc. Univariate analysis, Chi-square test, Fisher exact probability test, Kruskal-Wallis H test and Logistic regression model were used as statistical methods. Results:Among different eradication therapies, univariate and multivariate analyses suggested that previous exposure to macrolides ( OR=3.37,95 %CI 1.04-10.98, P<0.05) was relevant to the decreased eradication rate of BQT containing clarithromycin. This may be due to increased resistance to clarithromycin ( OR=6.12,95 %CI 3.99-9.40, P<0.01).The previous exposure to quinolones ( OR=3.65, 95 %CI 1.27-10.49, P<0.05) was relevant to the decreased eradication rate of BQT containing levofloxacin, which was probably explained by the increased resistance to levofloxacin ( OR=2.50, 95 %CI 1.69-3.71, P<0.01). But the previous history of nitroimidazole did not impact the efficacy of BQT containing metronidazole. Conclusions:In patients newly diagnosed with H.pylori infection, the previous exposure to macrolide or quinolones antibiotics is related to lower eradiation rates of H. pylori. Although the exposure to nitroimidazole also indicates drug resistance to metronidazole, the clinical efficacy of BQT with metronidazole 400 mg four times a day is not affected.

Role of immunoglobulin E autoantibodies in autoimmune skin diseases / 中华皮肤科杂志

A large number of studies have shown that immunoglobulin E (IgE) not only participates in the occurrence and development of allergic reactions, but also induces and aggravates autoimmune reactions through various mechanisms. IgE autoantibodies have been confirmed to be present in a variety of autoimmune skin diseases, and may be involved in the occurrence and development of related diseases by affecting multiple immune cells such as dendritic cells, mast cells, and basophils via binding to autoantigens. This review summarizes the role and possible mechanism of action of IgE in the induction and exacerbation of autoimmune skin diseases such as systemic lupus erythematosus, bullous pemphigoid and chronic idiopathic urticaria, and provides a theoretical basis for clinical diagnosis and treatment.

Enhancing standardization of diagnostic terminology for dermatitis and eczematous disorders / 中华皮肤科杂志

Dermatitis and eczematous disorders are very common in dermatological clinic. Due to variations in understanding of these diseases, there are some confusions and controversies about the diagnostic terms of "dermatitis" and "eczema" in China and other countries. With the progress in research on dermatitis and eczematous disorders, the understanding of some diseases with unclear causes or etiologies has gradually been improved, and it has been recognized that neither "dermatitis" nor "eczema" should be regarded as an independent clinical diagnostic term. Standardizing the diagnostic process and terminology for related diseases can lay a foundation for better classification, management, epidemiological research, and targeted treatment and prevention of these diseases.

Clinical features of atopic dermatitis and evaluation of its diagnostic criteria: a retrospective analysis of 165 inpatients with atopic dermatitis from 2000 to 2020 / 中华皮肤科杂志

Objective:To analyze and summarize clinical characteristics of atopic dermatitis (AD) , and to discuss differences and consistency among the Williams′, Japanese and Chinese diagnostic criteria for AD.Methods:A retrospective analysis was performed on 165 hospitalized patients with AD diagnosed according to the Williams′ criteria or the Chinese Zhang′s criteria in Southwest Hospital of Army Medical University from October 2000 to May 2020. Clinical data were re-evaluated according to the Williams′, Japanese and Chinese diagnostic criteria, and differences were analyzed among these criteria. Measurement data were compared by using t test, analysis of variance or rank sum test, and enumeration data were compared by using chi-square test or Fisher′s exact test. Results:Among the 165 patients, 66 (40.00%) developed AD before the age of 2 years; 95 (57.58%) had a personal and/or family history of atopic diseases, of whom 75 had a personal history of atopic diseases (mainly including allergic rhinitis [28.48%] and asthma[20.00%]) , 50 had a family history of atopic diseases, and 30 had both a personal and a family history of atopic diseases. A total of 98 patients (59.39%) were allergic to dust mites, including 48 with grade Ⅵ allergy. According to the total IgE level, 130 (78.79%) patients were diagnosed with exogenous AD, and 35 (21.21%) with endogenous AD. There were significant differences in the age at onset and blood eosinophil count between the patients with exogenous AD and those with endogenous AD (both P < 0.001) . After re-evaluation, 142 (86.06%) patients met the Williams′ criteria, 23 did not, and there was a significant difference in the age at onset between the two groups of patients ( P = 0.007) ; 150 (90.91%) patients met the Chinese Zhang′s criteria, 15 did not, and there was a significant difference in blood eosinophil counts between the two groups of patients ( P = 0.001) ; 160 (96.97%) patients met the Chinese Yao′s criteria; all patients met the Japanese criteria. There were no significant differences in the age at onset, total IgE level or blood eosinophil counts among patients meeting the Williams′ criteria, meeting the Japanese criteria, meeting the Zhang′s criteria, and those meeting the Yao′s criteria (all P > 0.05) . Conclusion:Patients with early-onset AD were prone to develop the highest-grade dust mite allergy; patients with exogenous AD were characterized by lower age at onset and higher eosinophil counts compared with those with endogenous AD; patients who met the Williams′ criteria showed lower age at onset than those who did not, while patients who met the Chinese Zhang′s criteria showed higher eosinophil counts than those who did not.

Treatment of chronic inducible urticaria / 中华皮肤科杂志

At present, the pathogenesis of chronic inducible urticaria (CIndU) is not completely clear, and it is often difficult to achieve satisfactory symptom control only by avoiding triggers. In recent years, some progress has been made in the treatment of CIndU in China and other countries, such as traditional antihistamines, non-antihistamines, biological agents, small-molecule targeted drugs and other drug treatments, as well as physical therapies such as trigger-point desensitization therapy. This review comprehensively and systematically outlines and summarizes relevant progress.

An animal model of bladder reconstruction by autologous peritoneum transplantation / 中华外科杂志

Objective@#To establish experimental porcine model of reconstruction the neobladder by ileal seromuscular with transplantation of autologous peritoneum.@*Methods@#This was an animal experiment carried out from January to April 2018 at animal center of Guizhou Medical University. Randomly 6 experimental female porcines were chosen, and their body weight was 28 to 33 kg. By intravenous anesthesia, the transplantation of autologous peritoneum for bladder reconstruction operation was carried out by transplanting the peritoneum onto an ileum segment which mucosa and submucosa had been removed. These flaps were used to mend and reconstruct the neobladder by suturing with edge of the detective bladder. After removal of ureteral catheters and balloon catheter at day 5 and day 7 respectively, voiding behavior was monitored, and animals were euthanized at week 12 for routine pathology, immunohistochemistry, and electron microscopic examinations.@*Results@#Six porcines underwent reconstruction, but no one lost to complications such as peritonitis, ileus and urinary fistula. Voiding behavior was normal, and urine was clear in all animals after removal of catheters. At autopsy, reconstructed bladders were healthy. Pathological examination showed the part of reconstruction had been covered by continuous urothelium while the peritoneum disappeared and showed no ileal mucosa regrowth and residual. Scanning electron microscope showed that the transitional cells of neobladder were complete and orderly, and urothelium around suture border was continuous and no malposition.@*Conclusion@#In this experimental porcine model, reconstruction bladder by autologous peritoneum and ileal seromuscular flaps is an ideal approach.

Effect of autologous whole blood injections on expression of FcεRI and CD63 on basophils in patients with refractory chronic spontaneous urticaria and positive autologous serum skin test / 中华皮肤科杂志

Objective To evaluate the clinical efficacy of autologous whole blood injections (AWBI) combined with antihistamines for the treatment of patients with refractory chronic spontaneous urticaria and positive autologous serum skin test (ASST),to evaluate its effect on the expression of the high-affinity IgE receptor (FcεR Ⅰ) and CD63 on basophils,and to analyze the possible mechanism underlying the treatment of ASST-positive chronic urticaria with AWBI.Methods Eighty patients with ASST-positive chronic intractable urticaria were enrolled from Department of Dermatology,The First Hospital Affiliated to Army Medical University between November 2017 and June 2018,and randomly and equally divided into two groups by a random number table:AWBI group and control group were both conventionally treated with oral loratadine and ebastine,and AWBI group were additionally treated with AWBI once a week for 12 sessions.Before the treatment and after 12-week treatment,urticaria activity score of 7 days (UAS7) and dermatology life quality index (DLQI) in the two groups were evaluated.Among 30 patients in the AWBI group,flow cytometry was performed to determine the expression of FcεRⅠ and CD63 on the basophils in the peripheral blood at the baseline,weeks 4,8 and 12 after the initial treatment.Statistical analysis was carried out with GraphPad Prism 7.00 software by t test for the comparison of UAS7 or DLQI scores,Mann-Whitney U test for the comparison of FcεR Ⅰ α expression,paired Wilcoxon signed rank test for comparing FceR Ⅰ α or CD63 expression between two different time points,and Spearman correlation analysis for analyzing the correlation between FcεR Ⅰ α and CD63 expression.Results Before the treatment,no significant differences in UAS7 or DLQI scores were observed between the AWBI group and control group (UAS7:27.15 ± 4.53 vs.26.90 ± 5.22;DLQI:16.88 ± 6.01 vs.17.08 ± 6.79;both P ＞ 0.05).After 12-week treatment,UAS7 and DLQI scores both significantly decreased in the two groups compared with those before the treatment (all P ＜ 0.01),and were significantly lower in the AWBI group than in the control group (UAS7:14.25 ± 7.56 vs.19.93 ± 6.32;DLQI:8.48 ± 4.15 vs.13.93 ± 5.43;both P ＜ 0.01).At the baseline,weeks 4,8 and 12 after the initial treatment,the fluorescence intensities of FcεR Ⅰα on basophils (M [P25,P75]) in the AWBI group were 22 532 (16 740,29 220),16 911 (10 240,21 816),13 282 (7 600,16 848) and 11 466 (7 161,14 578) respectively,and the proportions of CD63+ basophils induced by ASST-positive serum (M [P25,P75]) in the AWBI group were 35.25％ (26.75％,49.13％),25.95％ (19.37％,37.54％),13.57％ (7.79％,19.57％) and 9.87％ (6.43％,16.52％) respectively.At week 4 after the initial treatment,the expression of FcεR Ⅰα and CD63 on basophils in the AWBI group both significantly decreased compared with those at the baseline (both P ＜ 0.01),but significantly increased compared with those at week 8 (both P ＜ 0.01).The changes in FcεR Ⅰ α expression from baseline to week 4,from week 4 to week 8,and from week 8 to week 12 were positively correlated with the changes in CD63 expression induced by ASST-positive serum (r =0.364,0.422,0.455,respectively,all P ＜ 0.05).Conclusion AWBI combined with antihistamines can improve the clinical symptoms of ASST-positive refractory chronic urticaria,likely by affecting the expression of FcεR Ⅰ and CD63 on basophils.