[Expression of amphiregulin in different types of nasal polyps and its correlation with tissue remodeling].

Objective: To explore the expression of amphiregulin (AREG) in nasal polyps patients with different degrees of eosinophil infiltration, and to analyze the correlation between AREG and tissue remodeling. Methods: Forty-eight patients underwent endoscopic sinus surgery in the Department of Otorhinolaryngology Head and Neck Surgery, Remin Hospital, Wuhan University from July 2017 to August 2018 were recruited, including 40 males and 8 females, aged from 16 to 60 years old. The subjects were divided into three groups: control group (n=14), eosinophilic chronic sinusitis with nasal polyps (ECRSwNP) group (n=19) and noneosinophilic chronic rhinosinusitis with nasal polyps (non-ECRSwNP) group (n=15). The relative expression of AREG in nasal mucosa was detected by Western blot assay and immunohistochemical staining. Tissue remodeling was detected by HE staining, AB-PAS staining and Masson staining. Kruskal-Wallis test was used for comparison among multiple groups, and Spearman correlation analysis was conducted between the expression level of AREG and the related indexes of tissue remodeling. Results: The expression of AREG in ECRSwNP group was significantly higher than that in non-ECRSwNP group and control group (median protein expression of Western blot was 1.592 vs 0.617 vs0.582, all P<0.05). The degree of epithelial injury and goblet cell metaplasia in ECRSwNP group was significantly higher than that in control group (all P<0.05), the percentage of collagen fibrosis area in ECRSwNP group was significantly lower than that in control group (P=0.01). In chronic rhinosinusitis with nasal polyps (CRSwNP) patients, the area of mucous glands was negatively correlated with the expression of AREG (r=-0.616, P<0.05), and the percentage of collagen fibrosis area was negatively correlated with the expression of AREG (r=-0.738, P<0.05). Conclusion: The expression of AREG is higher in ECRSwNP patients, which is related to the process of tissue remodeling.

[Advances of studies on the occurrence of the upper respiratory disease correlative with immunity and tobacco].

SummaryTobacco smoke exposure has obvious and complex effects on the immune system of the human upper respiratory tract, including pro-inflammatory and anti-immune effects. Exposure to tobacco smoke is closely related to the occurrence and development of allergic rhinitis, the common rhinitis and sinusitis. The innate immune system is influenced by tobacco smoking through its effects on the respiratory mucosa and its adjuncts, natural killer cells, dendritic cells, neutrophils and innate immune receptors. Cigarette smoke can also affect the humoral immunity and cellular immunity, altering the acquired immune condition of the upper respiratory tract. Tobacco smoke exposure promotes the occurrence and development of the upper respiratory tract infectious diseases and allergic diseases by changing the composition of microflora in the upper respiratory tract.

[Characteristic analysis of aeroallergens of allergic rhinitis patients in Wuhan].

Objective:To analyze the distribution characteristics of common aeroallergens in patients with allergic rhinitis（AR）in Wuhan. Method:Serum specific IgE（ssIgE）was detected in 1 983 patients with clinically diagnosed AR by Midiwiss Allergen Screen system. Data was analyzed statistically. Result:Among the 1 983 patients，1 507（76.0%）had at least one positive ssIgE. The most common aeroallergens were Dermatophagoides pteronyssinus（62.0%），mixed fungi（32.1%）and house dust（27.3%）.Single positive allergen（43.8%），dual positive allergen（28.1%）and triple positive allergen（15.4%）were the most common combinations. The proportion of single positive allergens in the juvenile group（1 to 17 years old）（35.2%）was lower than adult group（≥18 years old）（46.7%），while the proportion of multiple positive allergens was higher than adult group. The positive rates of mulberry and mixed grass in male group were higher than female group. The positive rates of house dust，cat fur and dog fur in the juvenile group were higher than the adult group，while the positive rate of mulberry，cockroach and mixed grass were lower than the adult group. In the elder group（60-88 years old），the positive rates of Dermatophagoides pteronyssinus and mixed fungi were higher than the other three groups. The positive rates of Dermatophagoides pteronyssinus in summer and autumn were higher than that in winter and spring. The positive rate of mixed grass in autumn was much higher and the positive rate of mixed trees and mulberry trees in spring was higher than summer and autumn. Conclusion:Dermatophagoides pteronyssinus，mixed fungi and house dust were the most common aeroallergens among patients with allergic rhinitis in Wuhan. The distribution characteristics in different genders，ages and seasons were different..

[Expression and significance of Notch1-Jagged1 in allergic rhinitis].

Objective: To study the expression and significance of Notch1-Jagged1 in nasal mucosa of allergic rhinitis (AR) mouse model in various stages and in the serum of AR patients. Methods: Thirty-six mice were divided into 3 groups: control group, basal sensitization group (OVA) and OVA/AR group, with 12 mice in each group. Allergic symptom in each group were scored after AR model establishment. HE staining method was used to observe the nasal mucosa eosinophils infiltration. ELISA was used to detect the serum level of total IgE. Flow cytometry was used to detect the change of Treg cells in each group. Western blot was used to detect the expression of Notch1 and Jagged1 in nasal mucosa. Flow cytometric bead array (CBA) was used to detect the level of Th1/Th2/Th17 cytokines in splenic lymphocytes. The serum was obtained from 50 patients with AR and 30 control volunteers in Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University from June to October 2017. ELISA was used to detect the expression of Notch1 and Jagged1. Results: Compared with the control group, the allergy symptom, the number of nasal mucosal eosinophils and the level of total IgE were not significantly different in basal sensitization group, but increased significantly in OVA/AR group (6.11±0.78 vs 0.67±0.50, 77.67±5.61 vs 10.33±0.82, (106.80±11.91) pg/ml vs (82.45±19.80) pg/ml, t value was 19.471, 34.848, 2.542, respectively, all P<0.05). Compared with the control group, the ratio of Treg cell increased in basal sensitization group but decreased in OVA/AR group ((10.29±0.47)% vs (9.28±0.16)%, (8.49±0.15)% vs (9.28±0.16)%, t value was 5.838, 4.540, respectively, all P<0.01). Compared with control group, the expression of Notch1 increased significantly both in basal sensitization group and OVA/AR group (1.04±0.05 vs 0.71±0.05, 1.83±0.10 vs 0.71±0.05, t value was 9.293, 31.363, respectively, all P<0.01); and the expression of Jagged1 only increased significantly in OVA/AR group (0.41±0.04 vs 0.21±0.01, t=13.472, P<0.01). It was found that Notch1 was positively correlated with the level of IL-6, IL-10 by Pearson test (r value was 0.98, 0.87, respectively, all P<0.01). Compared with control volunteers, the expression of Notch1 and Jagged1 increased significantly in AR group patients ((1 135.0±254.9) pg/ml vs (436.0±139.3) pg/ml, (1 200.2±401.0) pg/ml vs (559.9±124.2) pg/ml, t value was 13.99, 11.94, respectively, all P<0.01). Conclusions: The expression of Notch1 receptor and ligand increased significantly in the pathogenesis of AR. Notch1-Jagged1 may promote the occurrence and development of AR by up-regulating the expression of IL-6 and IL-10.

[Expression and significance of polymeric immunoglobulin receptor in nasal polyps].

Objective:To explore the expression of polymeric immunoglobulin receptor in nasal polyps of patients with chronic rhinosinusitis with nasal polyps, and to investigateits relationship with the pathogenesis of nasal polyps. Method:Thirty-six specimens of nasal polyps were harvested patients were selected for the control group who had operation of nasal septal construction in the corresponding time period. The pIgR and IgA expression in nasal polyps and normal nasal inferior turbinate mucosa were detected by immunohistochemistry，and the real-time reverse transcription（RT-PCR） were used to detect the level of pIgR，IgA，RORc and Foxp3 mRNA expression in nasal polyps and normal nasal inferior turbinate mucosa. The association between pIgR mRNA and their association with the number of EOS，RORc mRNA，Foxp3 mRNA were analyzed，respectively． Result:The expression of pIgR in the nasal polyps was significantly lowerer than that in control group, and the result was statistically significant(P<0.05)；Compared with nasal polyps with no eosinophils, the expression levels of pIgR in the nasal polyps with eosinophils was lower\, and the result was statistically significant(P<0.05).The expression of IgA in the nasal polyps was significantly higherthan that in control , and the result was statistically significant(P<0.05).Compared with control, the mRNA expression of pIgR and Foxp3 in the nasal polyps were significantly lower，while the expression levels of IgA mRNA and Foxp3 mRNA in the nasal polyps was significantly higher compared to controls, and the result was statistically significant(P<0.05).In nasal polyps ,pIgR mRNA expression was correlated with RORc mRNA (P<0.05，r=-0.79)，and there was no correlation between pIgR mRNA and Foxp3 mRNA（P>0.05，r=0.36）. Conclusion:It was proved that pIgR down-regulation play an important role in the development of nasal polyps．.

Incidence and Predictors of Increased Coronary Calcium Scores in Liver Transplant Recipients.

BACKGROUND: Cardiovascular complications in liver transplant recipients are common. A coronary calcium score >400 determined by coronary computed tomographic angiography (coronary CT) provides useful information for predicting postoperative cardiovascular complications in liver transplant recipients. However, little is known about the association between risk factors and increased coronary calcium scores in coronary CT preformed as a preoperative cardiovascular evaluation before liver transplantation. We evaluated the incidence and cardiovascular risk factors of a coronary calcium score >400 in liver transplant recipients. METHODS: Between 2013 and 2014, 548 liver transplant recipients were analyzed retrospectively. Preoperative cardiovascular assessments and laboratory data were collected with coronary calcium scores. Univariate and multivariate logistic regression analyses were performed to evaluate cardiovascular risk factors of a coronary calcium score >400 in coronary CT. RESULTS: The total mean coronary calcium score was 103 ± 358. Of the 548 recipients, 41 (7.5%) had a coronary calcium score >400. The mean coronary calcium score in patients with a coronary calcium score >400 was 999.7 ± 892.1, and the mean coronary calcium score in patients with a coronary calcium score ≤ 400 was 30.1 ± 70.9. In multivariate logistic regression analysis, predictors of a coronary calcium score >400 in liver transplant recipients were age (odds ratio [OR] = 1.05, P = .029), male sex (OR = 14.42, P = .009), and diabetes mellitus (OR = 2.04, P = .040). CONCLUSIONS: We found that old age, male sex, and diabetes mellitus were predictors of a coronary calcium score >400, which is associated with cardiovascular complications after liver transplantation. This study can provide useful information for preoperative cardiovascular evaluation in liver transplant recipients.

Preoperative coronary calcium score is predictive of early postoperative cardiovascular complications in liver transplant recipients.

BACKGROUND: Coronary computed tomographic angiography (coronary CT) is a non-invasive test for diagnosis of cardiac function. Coronary calcium scores determined by coronary CT are associated with cardiovascular risk factors. However, no studies have investigated the association between coronary calcium scores and cardiovascular complications after liver transplantation (LT). We therefore evaluated the utility of preoperative coronary calcium scores for predicting early postoperative cardiovascular complications in LT recipients. METHODS: Between 2010 and 2012, 443 LT recipients were analysed retrospectively. Preoperative cardiovascular assessments, including coronary CT, were performed. A coronary calcium score >400 was defined as a positive finding. Predictive factors of early postoperative cardiovascular complications were evaluated by univariate and multivariate analyses. Major cardiovascular complications occurring during a period of 1 month after LT were noted. RESULTS: Of the 443 patients, 38 (8.6%) experienced one or more cardiovascular complications. Positive coronary CT findings were seen in 11 (2.5%) patients. In the multivariate analysis, a coronary calcium score >400 {odds ratio (OR)=4.62 [95% confidence interval (CI): 1.14-18.72], P=0.032} and female sex [OR=2.76 (1.37-5.57), P=0.005] were predictive of cardiovascular complications. CONCLUSIONS: A preoperative coronary calcium score of >400 predicted cardiovascular complications occurring 1 month after LT, suggesting that preoperative evaluation of coronary calcium scores could help predict early postoperative cardiovascular complications in LT recipients.

A comparative study of transfection efficiency between liposomes, immunoliposomes and brain-specific immunoliposomes.

This study investigated the transfection ability and efficiency of liposomes and immunoliposomes for exogenous gene delivery into the brain via the venous system. Four groups of rats underwent tail vein injection with one of the following: liposomes encapsulating pCMV (human cytomegalovirus promoter)-LacZ plasmid 80 microg (low dose) or 300 microg (high dose); general immunoliposomes encapsulating 80 microg transferrin receptor antibodies (OX26)-pCMV-LacZ plasmid; or brain-specific immunoliposomes encapsulating 80 microg OX26-pGFAP (glial fibrillary acidic protein promoter)-LacZ plasmid. A control group received no injected agent. The LacZ mRNA levels (1 h post-injection) and beta-galactosidase activity (48 h post-injection) in the brain and peripheral organs were assayed using real-time reverse transcription-polymerase chain reaction and histochemical staining, respectively. Both immunoliposomes delivered exogenous DNA containing the LacZ gene into the brain after venous injection, resulting in extensive LacZ expression in the brain. Furthermore, the brain-specific OX26-pGFAP-LacZ immunoliposome decreased the non-specific expression of LacZ in peripheral organs without affecting transfection efficiency in the brain. Thus, brain-specific immunoliposomes are an efficient and brain-specific targeting vector.

Torsades de pointes triggered by severe diastolic hypotension with low hematocrit in the neohepatic stage of liver transplantation: a case report.

We have described herein a 39-year-old male patient with hepatitis B virus-related cirrhosis (Child class C), showing a prolonged corrected QT interval, who developed torsades de pointes (TdP) in the neohepatic stage of liver transplantation (LT). There was no arrhythmia in the pre-anhepatic and anhepatic stages. Multiple premature ventricular complexes, ventricular tachycardia, and TdP suddenly developed at 16 minutes after graft reperfusion without any prodromal arrhythmia; they persisted for 118 seconds. Laboratory tests showed that serum potassium, calcium, and magnesium concentrations of 4.7 mmol/L, 1.05 mmol/L, and 1.85 mg/dL, respectively were within normal ranges. Likely causative factors for TdP in this patient included a prolonged corrected QT interval (553 msec), a low hematocrit (21%), and a low arterial blood pressure (systolic blood pressure, 80-90 mm Hg; diastolic blood pressure; 20-26 mm Hg) in the neohepatic stage. This case demonstrated the importance of optimal maintenance of coronary perfusion, with an adequate hematocrit level and electrolyte concentrations, to prevent the development of TdP in cirrhotic patients with a prolonged corrected QT interval during LT.

Association between single nucleotide polymorphisms of surfactant protein D and allergic rhinitis in Chinese patients.

The development of allergic rhinitis is considered to be determined by the interaction between genetic and environmental factors. Surfactant protein D (SP-D) has been proposed to offer protection against allergenic challenge at various levels in allergic responses. The present study aimed to investigate whether polymorphisms within the SFTPD gene (Met11Thr, Ala160Thr, and Ser270Thr) are associated with allergic rhinitis. Genotyping of SFTPD polymorphisms was performed using the pyrosequencing method. The study population comprised 216 patients with allergic rhinitis and 84 normal controls. The frequency of 11Thr/Thr genotype and Thr allele in the patient group was significantly higher than that in the control group after applying Bonferroni corrections (P = 0.007 and P = 0.006, respectively). Our subjects with the 11Thr/Thr genotype are more susceptible to allergic rhinitis. There were no significant differences between the patient group and the control group for frequencies of genotypes and alleles in either Ala160Thr or Ser270Thr single nucleotide polymorphisms (P > 0.05). No significant associations could be detected between any of these three SFTPD gene polymorphisms and the skin prick test response (P > 0.05). Meanwhile, there was a lack of association between the three loci and the levels of serum total immunoglobulin E (P > 0.05). In summary, our results suggest that the Met11Thr polymorphism in SP-D plays a major role in the genetic predisposition to allergic rhinitis in Chinese adult population, whereas the other two SP-D polymorphisms displayed no significant association with allergic rhinitis.