Clinical implications of concentration of alveolar nitric oxide in asthmatic and non-asthmatic subacute cough.

Asthma is an important cause of subacute cough. The concentration of alveolar nitric oxide (CANO) is a sensitive inflammatory indicator in peripheral airways, and it has received much less attention than the fraction of exhaled nitric oxide (FeNO50). The main objective of this study was to explore the correlation between CANO and clinical parameters in asthmatic and non-asthmatic subacute cough, which might promote understanding of the clinical utility of CANO in these special patient populations. 155 patients with subacute cough were included consecutively, of which 25 were diagnosed as asthmatic. Data for demographic characteristics, FeNO50, CANO, baseline spirometry, bronchial provocation test (or bronchodilation test) and response dose ratio (RDR) were collected. Differences between the asthmatic and non-asthmatic groups were analyzed. Spearman's correlation coefficient (ρ) was used to evaluate the correlation between FeNO50, CANO and other clinical parameters. In patients with subacute cough, baseline CANO values did not differ between asthmatic and non-asthmatic patients (4.4(1.3, 11.4) versus 4.0(2.1, 6.8) ppb,P> 0.05). Besides, CANO exhibited a stronger association with pulmonary function parameters when compared with FeNO50. For asthmatic subacute cough, CANO was inversely correlated with FEV1/FVC (ρ= -0.69,P< 0.01) and small airway parameters including MEF25 (ρ= -0.47,P< 0.05) and MMEF (ρ= -0.45,P< 0.05). For non-asthmatic subacute cough, CANO was inversely correlated with MEF25 (ρ= -0.19,P< 0.05) and RDR (ρ= -0.21,P< 0.05). In subacute cough, asthmatic and non-asthmatic patients had similar values of baseline CANO. In both asthmatic and non-asthmatic subacute cough, CANO exhibited a stronger association with pulmonary function parameters when compared with FeNO50. A low CANO value in non-asthmatic subacute cough corresponded to a higher value of RDR, which implied a stronger tendency towards airway responsiveness.

Risk Factors of Difficult Pharyngeal Accidental Fishbones Ingestion.

OBJECTIVE: Accidental pharyngeal fishbone ingestion is a common complaint in ear, nose, and throat clinics. Approximately two-thirds of the accidentally ingested fishbones can be removed using tongue depressors and indirect laryngoscopy. However, the remaining third is challenging to identify and remove using these methods. These difficult fishbones require identification and removal via more advanced approaches. Video-guided laryngoscope is used to deal with difficult fishbones in our center. This study aimed to explore the risk factors for difficult fishbones. METHODS: A prospective study was performed at a teaching hospital on 2080 patients. Univariate and multivariate analyses were performed to identify the risk factors. RESULTS: The common fishbone locations were the tonsils (39.8%; defined as STEP-I), tongue base (37.1%), vallecula (13.3%; STEP-II), and hypopharynx (9.8%; STEP-III). With increasing STEP level, the ratio of difficult fishbones correspondingly increased (Z = 13.919, P < .001), and the proportions were 21.1%, 41.9%, and 70% in STEP-I, II, and III, respectively. In particular, fishbones in STEP-III (vs STEP-I) had a higher risk of difficult fishbones (odds ratio [OR]: 11.573, 95% CI: 7.987-16.769). Complaints of neck pain (yes vs no), foreign body sensation (yes vs no), and shorter length of fishbones always had a lower risk of difficult fishbones (OR: 0.455, 95% CI: 0.367-0.564; OR: 0.284, 95% CI: 0.191-0.422; OR: 0.727, 95% CI: 0.622-0.85). Missing teeth (yes vs no), swallowing behavior after fishbone ingestion (yes vs no), and male patients (vs female) had a higher risk of difficult fishbones (OR: 1.9, 95% CI: 1.47-2.456; OR: 1.631, 95% CI: 1.293-2.059; OR: 1.278, 95% CI: 1.047-1.56). CONCLUSIONS: Neck pain, foreign body sensation, fishbone length, patient age and sex, tooth status, and swallowing behavior after fishbone ingestion are independent risk factors for difficult fishbones.

Diagnostic value of FeNO and MMEF for predicting cough variant asthma in chronic cough patients with or without allergic rhinitis.

OBJECTIVE: To evaluate the diagnostic value of fractional exhaled nitric oxide (FeNO) and maximum mid-expiratory flow (MMEF) for differentiating cough variant asthma (CVA) from chronic cough in patients with or without allergic rhinitis. METHODS: In total, 328 patients with chronic cough who underwent spirometry and FeNO testing were consecutively included in the retrospective analysis. Patients were divided into the CVA (n = 125) or NCVA (n = 203) groups according to the diagnostic criteria of CVA. Receiver operating characteristic (ROC) curves were established to assess the diagnostic efficiency and optimal cutoff points of FeNO and MMEF for the prediction of CVA. RESULTS: The optimal cutoff values of FeNO and MMEF to discriminate CVA from chronic cough were 24.5 ppb (AUC, 0.765; sensitivity, 69.60%; specificity 72.91%; PPV, 61.27%; NPV, 79.57%) and 66.2% (AUC, 0.771; sensitivity, 67.20%; specificity 78.33%; PPV, 65.63%; NPV, 79.50%). The optimal cutoff values of combining FeNO with MMEF to discriminate CVA from chronic cough were >22 ppb for FeNO and <62.6% for MMEF (AUC, 0.877). In patients with and without allergic rhinitis, the optimal cutoff point of FeNO to discriminate CVA from chronic cough was 24.5 ppb (AUC, 0.820) and 33.5 ppb (AUC, 0.707), respectively. CONCLUSIONS: FeNO and MMEF might have greater value as negative parameters for differentiating CVA from chronic cough. Combining FeNO and MMEF provided a significantly better prediction than either alone. The diagnostic accuracy of FeNO for predicting CVA in chronic cough patients with allergic rhinitis was higher than in chronic cough patients without allergic rhinitis.

Pleomorphic adenoma of the trachea: A case report and review of the literature.

BACKGROUND: Pleomorphic adenoma (PA) is the most common benign tumor that occurs in the salivary glands; however, tracheobronchial PA is rarely observed. To the best of our knowledge, fewer than 50 cases have been reported in the literature. We report a 49-year-old woman who had been treated for asthma for 2 years before being diagnosed with PA of the trachea. CASE SUMMARY: A 49-year-old woman was referred to our hospital due to dyspnea upon exertion and chronic cough with wheezing for 2 years. Laboratory tests showed an elevated white blood cell count, absolute neutrophil count, and percentage of neutrophils. A chest computerized tomography scan showed a well-defined, soft-tissue density lesion measuring 2.4 cm × 2.1 cm in the lower trachea. Flexible bronchoscopy revealed that nearly 90% of the tracheal lumen was obstructed. The histopathological and immunohistochemistry features suggested PA of the trachea. Furthermore, we review the characteristics of 29 patients with tracheobronchial PA over the last 30 years. CONCLUSION: Tracheobronchial PA occurs without gender predominance, mostly in the lower or upper trachea, and has a low recurrence rate. The median age at diagnosis is 48 years. The most common symptoms are cough, stridor, dyspnea, and wheezing.

Epithelial­mesenchymal transition in chronic rhinosinusitis (CRS) and the prognostic value of α­SMA in postoperative outcomes of patients with CRS.

Tissue remodeling is the pathological basis of the symptoms encountered in chronic rhinosinusitis (CRS). Epithelial­mesenchymal transition (EMT) may participate in this process. The present study was designed to investigate the involvement of EMT in CRS. In addition, the prognostic value of the EMT biomarker α­smooth muscle actin (α­SMA) was assessed in patients with CRS who underwent endoscopic sinus surgery (ESS). A total of 13 patients with CRS without nasal polyps (CRSsNP), 13 patients with CRS with nasal polyps (CRSwNP) and 13 control subjects were enrolled. The expression of EMT markers was determined in sinonasal specimens by qPCR, western blot and immunofluorescence assays. EMT features were evaluated in primary nasal epithelial cells (NECs) with transforming growth factor (TGF)­ß1 stimulation. The associations were assessed between α­SMA expression and the clinical features of CRS. Epithelial and mesenchymal markers were overexpressed in the sinonasal specimens of both CRSsNP and CRSwNP patients. Alterations in the expression pattern were more apparent in the CRSsNP patients. Following incubation of primary NECs with TGF­ß1, a mesenchymal shape was acquired. In addition, NECs that co­expressed α­SMA and cytokeratin were readily detected and the protein levels of α­SMA were elevated. In contrast to α­SMA, the levels of E­cadherin were decreased. The protein levels of α­SMA were negatively correlated with endoscopic scores and several postoperative symptoms. In conclusion, partial EMT occurred in patients with CRS, notably in CRSsNP patients. Moreover, primary NECs could undergo EMT following TGF­ß1 treatment in vitro. In addition, α­SMA could be considered an efficient predictor for postoperative endoscopic and symptomatic outcomes in patients with CRS treated with ESS.

The relationship between steps of 6MWT and COPD severity: a cross-sectional study.

BACKGROUND AND OBJECTIVE: The distance of 6-minute walk test (D6MWT) has been widely used in the assessment of functional status in patients with COPD, while very little attention has been paid to the role of steps of 6-minute walk test (S6MWT). The purpose of this study was to investigate the relationship between S6MWT and other physiologic parameters of COPD. PATIENTS AND METHODS: Seventy patients with stable COPD were enrolled consecutively in this cross-sectional study. Pulmonary function tests, including spirometry, impulse oscillometry (IOS) and the single-breath diffusing capacity of the lungs for carbon monoxide (DLCO), were carried out at rest. Quality of life was assessed by health-related quality of life (HRQoL) questionnaires, including modified Medical Research Council dyspnea scale (mMRC), St George's Respiratory Questionnaire, Chronic Obstructive Pulmonary Disease Assessment Test (CAT) and Clinical Chronic Obstructive Pulmonary Questionnaire. Both steps and distance were measured in the following 6-minute walk test (6MWT). RESULTS: Both S6MWT and D6MWT showed significant correlation with spirometry, IOS, DLCO parameters and HRQoL questionnaires score. Both pre- and post-6MWT inspiratory capacity showed significant correlation with S6MWT (ρ=0.338, P=0.004; ρ=0.359, P=0.002, respectively), whereas did not correlate with D6MWT (ρ=0.145, P=0.230; ρ=0.160, P=0.189, respectively). In stepwise multiple regression analysis, mMRC grade, age and CAT score remained as significant predictors in the final model for D6MWT (adjusted R 2=0.445, P<0.01). DLCO and CAT score remained as significant predictors in the final model for S6MWT (adjusted R 2=0.417, P<0.01). CONCLUSION: S6MWT is efficient in the evaluation of functional status and quality of life in COPD and has significant correlation with various parameters indicating disease severity. Additionally, S6MWT might be better in predicting lung hyperinflation in COPD compared with D6MWT.

Overexpression of GLP-1 receptors suppresses proliferation and cytokine release by airway smooth muscle cells of patients with chronic obstructive pulmonary disease via activation of ABCA1.

Glucagon-like peptide-1 (GLP­1) is an important insulin secretagogue that possesses anti­inflammatory effects. GLP­1 receptor (GLP­1R) agonists have been demonstrated to serve a pivotal role in the treatment of obstructive lung diseases, including chronic obstructive pulmonary disease (COPD). However, the specific function and underlying mechanisms of GLP­1R in COPD remain uncertain. The aim of the present study was to investigate the action and underlying mechanisms of GLP­1R in airway smooth muscle (ASM) cells from COPD patients. GLP­1R expression levels were markedly decreased in ASM cells from COPD patients compared with those from healthy controls. ASM cell proliferation and migration, and the levels of the inflammatory cytokines interleukin (IL)­1ß, IL­4, tumor necrosis factor (TNF)­α, and granulocyte­macrophage colony­stimulating factor (GM­CSF) were measured. Transfection of pcDNA3.1­GLP­1R had inhibitory effects on ASM cell proliferation and migration, whereas GLP­1R small interfering (si)RNA reversed these effects. Furthermore, the present study demonstrated that GLP­1R overexpression markedly suppressed IL­1ß, IL­4, TNF­α and GM­CSF levels. GLP­1R overexpression upregulated the expression levels of adenosine triphosphate­binding cassette, subfamily A, member 1 (ABCA1) in ASM cells, and the effects of GLP­1R on cell proliferation and migration, and inflammatory cytokine expression in ASM cells was abolished by siRNA­mediated silencing of ABCA1. The results of the present study suggested that GLP­1R contributes to COPD pathology, potentially via an ABCA1­mediated pathway.

[Comparison of functional parameters of small airways between patients with typical asthma and cough-variant asthma].

OBJECTIVE: To compare the functional parameters of the small airways and clinical characteristics between patients with typical asthma (TA) and cough-variant asthma (CVA). METHODS: Forty-three newly diagnosed asthmatic patients were enrolled, including 15 with TA and positive bronchial provocation test [TA BPT(+)], 12 with TA and positive bronchial dilation test [TA BDT(+)] and 16 with CVA, and 27 healthy subjects served as the control group. All the subjects were required to complete data acquisition, asthma control test, asthma control test scale, fractional exhaled nitric oxide, airway resistance and pulmonary function tests, BPT or BDT. RESULTS: The interval from onset to a definite diagnosis of TA BDT(+) was longer than that of TA BPT(+), while that of CVA was the shortest (P=0.022). The pulmonary functional parameters of TA BDT (+) was significantly lower than those of the other 3 groups (P<0.05). MMEF, MEF75, MEF50, and MEF25 in patients with TA BDT(+), TA BPT(+) and CVA were significantly lower than those in the control group (P<0.01). The resonant frequency, respiratory impedance, resistance at 5 Hz, resistance at 20 Hz, and reactance at 5 Hz were significant higher in patients with TA BDT (+) than in the control subjects, while these parameters showed no significant differences among TA BPT (+), CVA and control groups. The airway resistance in TA BPT(+), CVA, and control groups increased after BPT, and the patients with TA BPT(+) showed greater changes in airway resistance than those in CVA and control groups. In CVA patients, FeNO showed a strong positive correlation with respiratory impedance (r=0.523, P=0.038), resistance at 5 Hz (r=0.542, P=0.030), and resistance at 20 Hz (r=0.524, P=0.037), and the airway responsiveness showed a strong positive correlation with resistance at 20 Hz (Rho=-0.512, P=0.043). CONCLUSION: CVA is the early stage of TA, and CVA, TA BPT(+), and TA BDT(+) may represent different stages of asthma. Uncontrolled, prolonged CVA may evolve into TA BPT (+), whose further progression can cause damages of the pulmonary function and small airway function and leads eventually to TA BDT (+).

Emodin suppresses LPS-induced inflammation in RAW264.7 cells through a PPARγ-dependent pathway.

Inflammation is a defense and protective response to multiple harmful stimuli. Over and uncontrolled inflammation can lead to local tissues or even systemic damages and injuries. Actually, uncontrolled and self-amplified inflammation is the fundament of the pathogenesis of a variety of inflammatory diseases, including sepsis shock, acute lung injury and acute respiratory distress syndrome (ALI/ARDS). Our recent study showed that emodin, the main active component of Radix rhizoma Rhei, could significantly ameliorate LPS-induced ALI/ARDS in mice. However, its underlying signal pathway was not still very clear. Then, the aim of current study was to explore whether emodin could attenuate LPS-induced inflammation in RAW264.7 cells, and its involved potential mechanism. The mRNA and protein expression of ICAM-1, MCP-1 and PPARγ were measured by qRCR and western blotting, the production of TNF-α was evaluated by ELISA. Then, the phosphorylation of NF-κB p65 was also detected by western blotting. And NF-κB p65 DNA binding activity was analyzed by ELISA as well. Meanwhile, siRNA-PPARγ transfection was performed to knockdown PPARγ expression in cells. Our data revealed that LPS-induced the up-regulation of ICAM-1, MCP-1 and TNF-α, LPS-induced the down-regulation of PPARγ, and LPS-enhanced NF-κB p65 activation and DNA binding activity were substantially suppressed by emdoin in RAW264.7 cells. Furthermore, our data also figured out that these effects of emdoin were largely abrogated by siRNA-PPARγ transfection. Taken together, our results indicated that LPS-induced inflammation were potently compromised by emodin very likely through the PPARγ-dependent inactivation of NF-κB in RAW264.7 cells.

Dexamethasone decreases IL-29 expression in house dust mite-stimulated human bronchial epithelial cells.

The aim of this study was to explore the effect of IL-29 on the progression of airway allergic disease by detecting the level of IL-29 in airway allergic cell models stimulated by house dust mite (HDM) in the presence or absence of dexamethasone (DEX). The same batch of human bronchial epithelial cells in exponential growth phase was randomly divided into five groups: blank group (A), 300 ng/mL HDM group (B), 1000 ng/mL HDM group (C), 3000 ng/mL HDM group (D), and 300 ng/mL HDM+100 ng/mL DEX group (E). The IL-29 mRNA expression was detected by quantitative reverse transcription polymerase chain reaction (qRT-PCR). The IL-29 protein expression in cell suspension was detected by ELISA. The results showed that after stimulation with HDM for 24 h, the expression of IL-29 was increased significantly, and after co-stimulation with HDM and DEX for 24 h, the expression of IL-29 in group E was significantly lower than that in the groups stimulated by HDM alone but higher than that in the group A. The differences between the different groups were significant (F=132.957, P<0.01). Additionally, the higher the concentration of HDM was, the more significant the increase in the IL-29 expression was. In conclusion, IL-29 may play a role in the progression of airway allergic disease including asthma.

IB-LBM simulation of the haemocyte dynamics in a stenotic capillary.

To study the behaviour of a haemocyte when crossing a stenotic capillary, the immersed boundary-lattice Boltzmann method was used to establish a quantitative analysis model. The haemocyte was assumed to be spherical and to have an elastic cell membrane, which can be driven by blood flow to adopt a highly deformable character. In the stenotic capillary, the spherical blood cell was stressed both by the flow and the wall dimension, and the cell shape was forced to be stretched to cross the stenosis. Our simulation investigated the haemocyte crossing process in detail. The velocity and pressure were anatomised to obtain information on how blood flows through a capillary and to estimate the degree of cell damage caused by excessive pressure. Quantitative velocity analysis results demonstrated that a large haemocyte crossing a small stenosis would have a noticeable effect on blood flow, while quantitative pressure distribution analysis results indicated that the crossing process would produce a special pressure distribution in the cell interior and to some extent a sudden change between the cell interior and the surrounding plasma.

Endoglin (CD105) expression on microvessel endothelial cells in juvenile nasopharyngeal angiofibroma: tissue microarray analysis and association with prognostic significance.

BACKGROUND: The purpose of this study was to examine endoglin (CD105) expression on microvessel endothelial cells (ECs) in juvenile nasopharyngeal angiofibroma (JNA) and its relationship with recurrence. METHODS: Immunohistochemistry was performed to detect CD105 expression in a tissue microarray from 70 patients with JNA. Correlation between CD105 expression on microvessel ECs and clinicopathological features, as well as tumor recurrence, were analyzed. RESULTS: Immunohistochemistry revealed CD105 expression on ECs but not in stroma of patients with JNA. Chi-square analysis indicated CD105-based microvessel density (MVD) was correlated with JNA recurrence (p = .013). Univariate and multivariate analyses determined that MVD was a significant predictor of time to recurrence (p = .009). The CD105-based MVD was better for predicting disease recurrence (AUROC: 0.673; p = .036) than other clinicopathological features. CONCLUSIONS: MVD is a useful predictor for poor prognosis of patients with JNA after curative resection. Angiogenesis, which may play an important role in the occurrence and development of JNA, is therefore a potential therapeutic target for JNA.

[Inhibition of lipopolysaccharide-induced myeloid-derived suppressor cells in the proliferation of spleen T lymphocytes].

OBJECTIVE: To explore the effects of lipopolysaccharide (LPS)-induced myeloid-derived suppressor cells (MDSCs) on the proliferation of spleen T lymphocytes. METHODS: BALB/c mice were randomly divided into two groups: LPS group and normal control group. They were injected intraperitoneally with LPS and normal saline solution respectively. MDSCs were separated with CD11b immunomagnetic beads from the spleen extract of mice. The morphological characteristics of MDCSs were observed by Wright-Giemsa staining and the characteristic molecules on cell surface identified by flow cytometry. And the effects of MDSCs on the in vitro proliferation of T cells were determined by methyl-thiazolyl-tetrazolium bromide (MTT). RESULTS: The proportion of MDSCs in the spleen of the LPS group was much more than that of the normal control group (27.4% ± 6.6% vs 5.1% ± 3.8%; t = 5.06, P = 0.007). CD11b(+)Gr-1(+)MDSCs could be separated by CD11b immunomagnetic beads from the spleen of mice injected with LPS at a high purity of 84.0% ± 4.2%. MTT method showed that the proliferation of T cells decreased significantly after a co-cultivation with CD11b(+)MDSCs versus the control group. And it was positively correlated with the number of MDSCs (F = 46.26, P = 0.000). CONCLUSIONS: A high purity of LPS-induced myeloid-derived suppressor cells may be separated with CD11b immunomagnetic beads. And it has dose-dependent inhibitory effects on the proliferation of the spleen T lymphocytes.

Endoscopic assisted sublabial and buccolabial incision approach for juvenile nasopharyngeal angiofibroma with extensive infratemporal fossa extension.

OBJECTIVE: The aim of this study is to evaluate endoscopic assisted sublabial and buccolabial incision approach as treatment option for Juvenile nasopharyngeal angiofibroma (JNA) with extensive infratemporal fossa (ITF) extension. METHODS: Seven patients diagnosed as JNA with extensive ITF extension and underwent surgery at our department between 2006 and 2010 were retrospectively reviewed. All patients underwent diagnostic arteriography followed by embolization preoperatively and intratumor injection with N-butyl cyanoacrylate (NBCA). Endoscopic assisted sublabial and buccolabial incision approach was used to remove the tumors. RESULTS: Complete resections of the tumors were achieved in all patients. Mean blood loss was 700 ml. The follow-up period ranged from 9 to 20 months, with a mean of 14.3 months. One patient had a recurrent tumor six months after operation. CONCLUSIONS: Endoscopic assisted sublabial and buccolabial incision is an optional approach to remove JNA with extensive ITF extension.

[Effect and mechanism of lipopolysaccharides-induced myeloid-derived suppressor cells on airway inflammation in asthmatic mice].

OBJECTIVE: To explore the effect and mechanism of lipopolysaccharides (LPS)-induced CD11b⁺Gr-1⁺ myeloid-derived suppressor cells (MDSCs) on airway inflammation in asthmatic mice. METHODS: A total of 34 female BALB/c mice were selected. Among them, 4 mice received an intraperitoneal injection of LPS for inducing the accumulation of MDSCs. And the MDSCs were separated with CD11b immunomagnetic beads from spleen extract. Another 30 mice were randomly divided into normal control, asthmatic and cell treatment groups. The mice in the asthmatic and cell treatment groups were sensitized with ovalbumin by a combination of intraperitoneal injection and challenges to establish the murine asthmatic model. At Days 14 and 21 post-sensitization, the mice in cell treatment group received an intravenous injection of LPS-induced MDSCs. At 24 hours after the last allergen challenge, the number of inflammatory cells were counted and morphological identification of leucocytes in bronchoalveolar lavage fluid (BALF) was performed to analyze the degree of airway inflammation in conjunctions with pathological sections. The BALF and serum levels of interleukin-13 were measured by enzyme-linked immunosorbent assay (ELISA). The number of CD4⁺CD25⁺Foxp3⁺ regulatory T cells (Tregs) in peripheral blood was measured by flow cytometry. RESULTS: The total number of cells, the percentage of neutrophils and eosinophils of BALF in the cell treatment group [(17.0 ± 8.3)×104/ml, 11.1% ± 2.0%, 9.8% ± 2.9%] were significantly lower than those in the asthmatic group [(36.0 ± 15.9)×104/ml, 20.8% ± 4.0%, 14.1% ± 4.2%] (P = 0.000, 0.000, 0.011). Compared to the asthmatic group, the BALF and serum levels of IL-13 were significantly lower [(34.7 ± 7.1) vs (105.0 ± 9.0) ng/L, (34.0 ± 4.7) vs (48.1 ± 6.1) ng/L] (both P = 0.000) and the number of CD4⁺CD25⁺Foxp3⁺ regulatory T cells increased in peripheral blood (8.0% ± 1.3% vs 5.1% ± 2.1%, P = 0.002) and airway inflammation was significantly relieved in the cell treatment group. CONCLUSION: LPS-induced MDSCs may improve airway inflammation through up-regulating Tregs in peripheral blood and suppressing Th2 effector function in asthmatic mice.

[Pathogenic mechanism of CD8(+)CD28(-)T cell and the effect of dexamethasone in asthmatic mouse].

OBJECTIVE: To explore whether or not CD8(+)CD28(-)T cell play a pathogenic role in asthma and detect the effects of dexamethasone (DXM). METHODS: A total of 30 mice were randomly divided into 3 groups: asthmatic group, DXM group and control group (n = 10 each). The asthmatic and DXM groups were sensitized twice and inhaled ovalbumin. The DXM Group received an intraperitoneal injection of DXM 1mg/kg before inhaling ovalbumin. After successful modeling, 3 mice were selected randomly from each group to measure the airway responsiveness. Also a bronchoalveolar lavage cytological study was performed and lung tissue sections were prepared for histopathologic examination to evaluate the airway inflammation. The content of IgE in bronchoalveolar lavage fluid (BALF) was detected with a murine IgE ELISA kit. And the fractions of CD8(+)CD28(-)T cell of peripheral blood and BALF were tested by flow cytometry to analyze the correlation between IgE, eosinophils (EOS) of BALF and CD8(+)CD28(-)T cell of blood. RESULTS: The airway hyperresponsiveness in asthmatic and DXM groups were significantly higher than that in the control group. The number of total cells and EOS of BALF in the asthmatic group [(5.56 ± 4.06) × 10(2)/L; (3.29 ± 2.23) × 10(2)/L] were significantly higher than that in control group [(0.91 ± 0.65) × 10(2)/L, P = 0.003; (0.43 ± 0.37) × 10(2)/L, P = 0.001] and DXM group [(2.59 ± 1.69) × 10(2)/L, P = 0.044; (1.11 ± 0.73) × 10(2)/L, P = 0.008]; while the DXM group was insignificantly higher than the control group (P = 0.234, P = 0.363). There were significant differences in the contents of IgE of BALF for the asthmatic, DXM and control groups [(23.85 ± 5.97) g/L, (13.15 ± 2.22) g/L, (6.54 ± 1.03) g/L, F = 38.558, P = 0.000]. The percentages of CD8(+)CD28(-)T cell in peripheral blood in asthmatic and DXM groups [(18.68 ± 4.12)% and (13.43 ± 2.91)%] were significantly higher than those in control mice [(8.43 ± 4.60)%, both P < 0.05]. The percentages of CD8(+)CD28(-)T cell of BALF in asthmatic group and DXM group [(1.25 ± 0.40)% and (0.66 ± 0.49)%] were also significantly higher than those in control mice [(0.21 ± 0.19)%, both P < 0.05]. The percentages of CD8(+)CD28(-)T cell of blood and BALF in the DXM mice were significantly lower than those in asthmatic group. The correlations between IgE (r = 0.864, P = 0.012), EOS (r = 0.804, P = 0.029) and CD8(+)CD28(-)T cell were significant. CONCLUSION: The fraction of CD8(+)CD28(-)T cell is closely correlated with the inflammation of asthmatic airway. The airway hyperresponsiveness and inflammation in asthmatic mice may be relieved by DXM through its effect of inhibiting the expression of CD8(+)CD28(-) T cell.

[Effect of polyI: C on secretion of thymic stromal lymphopoietin and airway inflammation in mice with respiratory syncytial virus-induced asthma exacerbation].

OBJECTIVE: To investigate the effects of polyinosinic-polycytidylic acid (polyI:C) on the production of thymic stromal lymphopoietin (TSLP) and airway inflammation in mice with exacerbated asthma induced by respiratory syncytial virus (RSV). METHODS: Thirty-two female BALB/c mice were randomly divided into 4 groups, namely the PBS control group, OVA group, OVA/RSV group, and OVA/RSV/polyI:C group. In the latter 3 groups, the mice were sensitized by OVA and stimulated with nebulized OVA. RSV was inoculated into the nasal cavity of the sensitized mice and polyI:C (1 mg/kg) was intramuscularly administered. The airway response to metacholine was examined, and the serum levels of IL-4, IL-5, IL-13, and IFN-γ and TSLP in the supernatants of bronchoalveolar lavage fluid (BALF) were detected using ELISA. The total BALF cells, eosinophils, lymphocytes and neutrophils were counted. The lung specimens were collected to observe the inflammation with HE staining, and immunohistochemistry was employed to determine TSLP production in the airway epithelial cells. RESULTS: The mice in RSV/OVA/polyI:C group showed a significantly lower airway responsiveness to metacholine than those in OVA/RSV group (P<0.01). Compared with OVA/RSV group, RSV/OVA/polyI:C group showed significantly lower serum levels of IL-4, IL-5, IL-13 and TSLP in BALF (P<0.05), with also lower total BALF cells, eosinophils and lymphocytes (P<0.05) and lessened infiltration of the airway inflammatory cells. Immunohistochemistry of TSLP also demonstrated a lower production of TSLP in the airway epithelial cells in RSV/OVA/polyI:C group than in OVA/RSV group. CONCLUSIONS: polyI:C can inhibit the increase in TSLP production in the airway epithelial cells after RSV infection and relieve airway inflammation in mice with RSV-induced asthma exacerbation.

[Effects of different factors on the expression of thymic stromal lymphopoietin in respiratory syncytial virus-infected human airway epithelial cells].

OBJECTIVE: To investigate the effects of different factors on the expressions of thymic stromal lymphopoietin (TSLP) in respiratory syncytial virus (RSV)-infected human airway epithelial cell line 16HBE cells. METHODS: RSV amplified by infecting Hep-2 cells was identified for its virulence. 16HBE cells were divided into six groups, namely the control group, RSV group, RSV/anti-TLR3 group, RSV/IFN-gamma group, RSV/IL-4 group and RSV/dexamethasone group with corresponding treatments. Real-time RT-PCR was used to examine the expression of TSLP mRNA in the cells 6 h after RSV infection. Western blotting was used to examine TSLP protein expression in the cells 24 h after the infection. RESULTS: The expression of TSLP mRNA in 16HBE cells 6 h after RSV infection increased by 1.63-/+0.08 folds as compared to the expression level in the control cells. The expression of TSLP mRNA was significantly decreased in RSV-infected cells treated with anti-TLR3 antibody (P=0.034) and recombinant human IFN-gamma (P<0.001), but increased with the treatment by recombinant human IL-4 (P=0.025). Dexamethasone significantly inhibited the expression of TSLP mRNA in RSV-infected cells (P<0.001). The production of TSLP protein in 16HBE cells increased by 1.9 folds (P<0.001) 24 h after RSV infection, but underwent no significant changes after treatment with anti-TLR3 antibody (P=0.114). Recombinant human IFN-gamma significantly decreased while IL-4 enhanced the expression of TSLP protein in the infected cells (P=0.020 and 0.014, respectively). Dexamethasone significantly inhibited the increment of TSLP protein expression in RSV-infected cells (P<0.001). CONCLUSIONS: RSV infection can enhance the expressions of TSLP in human airway epithelial cells. IFN-gamma, anti-TLR3 and dexamethasone can inhibit the elevation of TSLP expression induced by RSV infection, but IL-4 synergistically enhances its expression.

Analysis of risk factors associated with recurrence of nasopharyngeal angiofibroma.

OBJECTIVE: Surgical outcomes and prognostic factors were analyzed to determine what factors increase the probability of juvenile nasopharyngeal angiofibroma (JNA) recurrence. METHODS: Ninety-seven males with JNA were diagnosed and underwent surgery at Fudan University Affiliated Eye, Ear, Nose and Throat Hospital from 1997 to 2006. Clinical data were extracted from medical records and were used in the statistical analysis. RESULTS: The total recurrence rate of JNA was 39.2% after the initial surgery. A patient whose tumour staging was higher was more likely to have a recurrence than a patient whose tumour staging was lower (p = .0031). The recurrence rates in two groups (age >or= 18 years group and < 18 years group) were 26.8% and 48.2%, respectively (p = .03). The recurrence rates with tumour size < 4 cm and >or= 4 cm were 21.7% and 54.9%, respectively (p = .0008). CONCLUSION: The significant predictors of recurrence in our study were age at diagnosis, tumour size, and Radkowski classification.

[Effect of continuous femoral nerve block in analgesia and the early rehabilitation after total knee replacement].

OBJECTIVE: To evaluate the benefit and safety of continuous femoral nerve block in patients undergoing total knee arthroplasty. METHODS: From December 2008 to August 2009, 80 patients with total knee arthroplasty were randomly divided into two groups, 40 patients in each group. In group A the pain-control was dominanted by continuous femoral nerve block, there were 5 males adn 35 females with an average age of (65.0 +/- 4.2) years old; In group B the pump of vein odynolysis was used, there were 5 males and 35 females with an average age of (64.7 +/- 8.5) years old. The treatment of relieve pain continued for 3 days. The pain of visual analog scale (VAS), sleep condition, early-stage rehabilitation and adverse effects were recorded. RESULTS: The VAS scores of group A was lower than that of group B at 2, 6, 24, 36, 48, 56, 72 h after operation (P < 0.05 or P < 0.01); The sleep condition and early-stage rehabilitation of group A were better than that of group B. The complications of group B occurrenced more than group A; The analgetica of group B were used more than that of group A. CONCLUSION: The continuous femoral nerve block is an effective pain relieve method and is benefical to rehabilitation from total knee arthroplasty early.