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The present study aims to investigate the risk factors for urosepsis and the diagnostic and prognostic values of the bone morphogenetic protein endothelial cell precursor-derived regulator (BMPER) in patients with urosepsis following ureteroscopic lithotripsy. A total of 305 patients with unilateral ureteral obstruction caused by calculi were included in the study. Patients were divided into three groups, namely, high, medium, and low perfusion pressure groups. The serum C-reactive protein, procalcitonin, lactate (LAC), and BMPER were measured after operation. A logistic regression model was used to assess the risk factors for postoperative urosepsis. The relationships of BMPER with laboratory parameters were explored with a multiple linear regression model. Receiver operating characteristic (ROC) curves were used to diagnosis urosepsis. The cumulative incidence of the adverse events after operation was calculated and compared by log-rank test. Forty-five patients (14.8%) had an episode of urosepsis after operation. Irrigation pressure was an independent risk factor for urosepsis. LAC and sequential organ failure assessment (SOFA) were associated with BMPER after operation. The area under curve value of BMPER for urosepsis was 0.829 (95% confidence interval [CI], 0.773 to 0.884). Uroseptic patients with higher BMPER concentration exhibited more adverse outcome. BMPER possesses valuable discriminative capacity for urosepsis and is a strong predictor of adverse outcome in patients with urosepsis.

Context: Ursolic acid (UA; 3β-hydroxy-urs-12-en-28-oic acid), one of the pentacyclic triterpenoids found in various plants and herbs, possesses some beneficial effects under pathological conditions, including combating hepatic fibrosis. Objective: This study investigates the effects of UA on renal tubulointerstitial fibrosis in vivo and in vitro. Materials and methods: In vivo, 24 male C57BL6 mice were divided into four groups. Eighteen mice were subjected to unilateral ureteral obstruction (UUO) and the remaining six sham-operated mice served as control. UUO mice received either vehicle or UA (50 or 100 mg/kg) by gastric gavage for 6 days. In vitro, HK-2 cells were treated with 10 or 50 μM UA and 10 ng/mL recombinant human transforming growth factor-β1 (TGF-β1). The molecular mechanisms of fibrosis were investigated. Results: UUO induced marked interstitial collagen I and fibronectin deposition and epithelial-mesenchymal transition (EMT), as evidenced by increased α-smooth muscle actin (α-SMA) and decreased E-cadherin. However, UA treatment significantly reduced collagen I and fibronectin accumulation in the fibrotic kidney. UA treatment also decreased α-SMA and preserved E-cadherin in vivo. In vitro, TGF-β1-treated HK-2 cells demonstrated elevated α-SMA, snail1, slug, TGF-β1, and p-smad3, as well as diminished E-cadherin. UA pretreatment prevented E-cadherin loss and diminished α-SMA expression in HK-2 cells. UA downregulated mRNA expression of snail1 and slug. UA also lowered TGF-β1 protein expression and p-Smad3 in HK-2 cells. Conclusions: UA attenuated renal tubulointerstitial fibrosis by inhibiting EMT, and such inhibition may be achieved by decreasing profibrotic factors. UA may be a novel therapeutic agent for renal fibrosis.

Objective To evaluate long-term functional and survival outcomes of patients with glioma after intraoperative neurophysiologic monitoring (IONM) application. Methods A total of 856 patients with glioma, who underwent tumor resection between October 2010 and March 2016, were included in this retrospective cohort study. All patients were stratified into IONM (439 patients) and non-IONM groups (417 patients). The primary outcome measured was overall survival (OS), and the secondary outcome measured was rate of late neurologic deficits. Analyses were performed using univariate tests and multivariate logistic regression and Cox proportional hazard model. Results The 2 cohorts were well balanced with respect to baseline characteristics. Univariate survival analysis showed longer OS in the IONM group than that in the non-IONM group (P = 0.036), especially in patients with high-grade astrocytic tumor (P = 0.034). The IONM group showed a lower rate of neurologic deficits than did the non-IONM group. Multivariate analysis showed that IONM was a favorable factor of OS (odds ratio, 0.776; P = 0.046) and late neurologic function (odds ratio, 0.583; P = 0.039). Dominant hemispheric and eloquent location of glioma had no association with OS. Conclusions Application of IONM is beneficial to long-term functional and oncologic outcomes of patients with glioma.

Background Self-harm (SH) is an emerging problem among Chinese adolescents. The present study aimed to measure the prevalence of SH behaviours and to explore the relationship between childhood adversity and different SH subtypes among Chinese adolescents. Methods A total of 5726 middle school students were randomly selected in three cities of Anhui province, China, using a stratified cluster sampling method. SH was categorized into five subtypes (highly lethal self-harm, less lethal self-harm with visible tissue damage, self-harm without visible tissue damage, self-harmful behaviours with latency damage and psychological self-harm). Multivariate logistic regression was used to explore the relationships between childhood adversity and different subtypes of adolescent SH. Results The prevalence rates of highly lethal self-harm, less lethal self-harm with visible tissue damage, self-harm without visible tissue damage, self-harmful behaviours with latency damage and psychological self-harm were 6.1, 20.4, 32.0, 20.0 and 23.0%, respectively. Childhood sexual abuse and physical peer victimization were associated with each SH subtype with adjusted odds ratios (AORs) ranging from 1.23 to 1.76. Highly lethal self-harm was associated with childhood physical peer victimization, sexual abuse, emotional abuse, and emotional neglect. The less lethal SH subtypes (i.e., less lethal self-harm with visible tissue damage, self-harm without visible tissue damage, self-harmful behaviours with latency damage and psychological self-harm) were associated with childhood peer victimization, family life stress event scores and childhood sexual abuse. Conclusions A high prevalence of SH exists among Chinese adolescents. The association of childhood adversity with SH merits serious attention in both future research and preventive interventions. Electronic supplementary material The online version of this article (10.1186/s12888-018-1607-0) contains supplementary material, which is available to authorized users.

Background Dihydroquercetin (DHQ) is an antifibrotic agent. However, whether DHQ can prevent renal fibrosis remains unknown. Purpose : This study aimed to investigate the effects of DHQ on tubulointerstitial fibrosis and its underlying mechanisms in unilateral ureteral obstruction (UUO) mice in vivo and NRK-49F cells in vitro. Methods In vivo, UUO mice received vehicle or DHQ treatment. In vitro, NRK-49F cells were pretreated with DHQ and exposed to transforming growth factor-β1 (TGF-β1). Changes in fibroblast activation, collagen synthesis, oxidative stress, and related signaling pathways were assessed by immunohistochemical staining, Western blot analysis, real-time reverse transcription-PCR, and fluorescence microscopy. Results UUO induced tubular atrophy, inflammation, fibroblast differentiation into myofibroblast, and collagen deposition, whereas DHQ ameliorated these effects. UUO also resulted in decreased levels of nuclear factor-erythroid-2-related factor 2 (Nrf2), catalase, and heme oxygenase-1, but increased H2O2 and malondialdehyde levels. DHQ treatment corrected these changes. In vitro, the intracellular Nrf2 level of NRK-49F exposed to TGF-β1 decreased. However, DHQ rescued intracellular Nrf2 level and promoted nuclear translocation of Nrf2. DHQ scavenged TGF-β1-induced accumulation of reactive oxygen species, inhibited TGF-β1-induced Smad3 phosphorylation, and prevented TGF-β1-induced fibroblast activation and collagen synthesis in NRK-49F. Nrf2 knockdown could suppress the DHQ-mediated inhibitory effects on oxidative stress, Smad3 phosphorylation, fibroblast activation, and collagen deposition. Furthermore, DHQ ameliorated established renal fibrosis in UUO mice. Conclusions DHQ posed remarkable preventive and therapeutic effects on UUO-induced renal fibrosis and suppressed fibroblast activation by reducing oxidative stress and Smad3 phosphorylation via Nrf2 signaling. This study provided a mechanistic basis for the clinical application of DHQ in renal fibrosis treatment.

Cardiac resynchronization therapy (CRT) is a standard treatment for selected patients with chronic heart failure (HF). However, up to 30%-50% of patients still do not respond to CRT.Our aim was to identify the predictive value of an S wave in lead VThe CLBBB definition included the Strauss left bundle branch block criteria and the absence of q waves in leads I, VOf 181 patients with left bundle branch block-like pattern, 112 patients with CLBBB were included into 3 groups: 54 in the T-CLBBB group, 32 in the VAn S wave in lead V

Using ECG-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), we sought to develop and validate a new method to recommend left ventricular (LV) lead positions in order to improve volumetric response and long-term prognosis after cardiac resynchronization therapy (CRT). Seventy-nine patients received gated SPECT MPI at baseline, and echocardiography at baseline and follow-up. The volumetric response referred to a reduction of ≥ 15% in LV end-systolic volume 6 months after CRT. After excluding apical, septal, and scarred segments, there were three levels of recommended segments: (1) the optimal recommendation: the latest contracting viable segment; (2) the 2nd recommendation: the late contracting viable segments whose contraction delays were within 10° of the optimal recommendation; and (3) the 3rd recommendation: the viable segments adjacent to the optimal recommendation when there was no late contracting viable segment. After excluding 11 patients whose LV lead was placed in apical or scarred segments, 75.6% of the patients concordant to recommended LV segments (n = 41) responded to CRT while 51.9% of those with non-recommended LV lead locations (n = 27) were responders (P = .043). Response rates were 76.9%, 76.9% , and 73.3% (P = .967), respectively, when LV lead was implanted in the optimal recommendation (n = 13), the 2nd recommendation (n = 13), and the 3rd recommendation (n = 15). LV leads placed at recommended segments reduced composite events of all-cause mortality or heart failure (HF) rehospitalization compared with pacing at non-recommended segments (log-rank χ2 = 5.623, P = .018). Pacing in the recommended LV lead segments identified on gated SPECT MPI was associated with improved volumetric response to CRT and long-term prognosis.

Objective To evaluate the clinical application of 3-T intraoperative magnetic resonance imaging (iMRI), awake craniotomy, multimodal functional mapping, and intraoperative neurophysiologic monitoring (IONM) for resection of dominant-sided insular gliomas. Methods From March 2011 to June 2013, 30 gliomas involving the dominant insular lobe were resected in the IMRIS 3.0-T iMRI integrated neurosurgical suite. For 20 patients, awake craniotomy with cortical electrical stimulation mapping was performed to locate the language areas. For 10 patients who were not suitable for awake surgery, general anesthesia and functional navigation were performed. Diffusion tensor imaging tractography-based navigation, continuous motor evoked potential monitoring, and subcortical electrical stimulation mapping were applied to localize and monitor the motor pathway in all cases. iMRI was used to assess the extent of resection. The results of intraoperative imaging, IONM, and the surgical consequences were analyzed. Results Intraoperative imaging revealed residual tumor in 26 cases and led to further resection in 9 cases. As a result, the median extent of resection was increased from 90% to 93% ( P = 0.008) in all cases, and from 88% to 92% ( P = 0.018) in low-grade gliomas. The use of iMRI also resulted in an increase in the percentage of gross and near total resection from 53% to 77% ( P = 0.016). The rates of permanent language and motor deficits resulting from tumor removal were 11% and 7.1%, respectively. Conclusions The combination of iMRI, awake craniotomy, multimodal brain mapping, and IONM tailored for each patient permits the maximal safe resection of dominant-sided insular glioma.

Previous research has revealed associations between childhood maltreatment (CM) and adverse health behaviors. However, little is known about the relationship between CM and adolescent murderous ideation and behaviors. A total of 5726 middle and high school students completed the Childhood Trauma Questionnaire-Short Form and the Murderous Ideation and Behaviors Questionnaire. The findings revealed that the prevalence rates for murderous ideation, plans, preparation, and attempts were 9.9%, 2.8%, 1.3%, and 0.6%, respectively. The results of multinomial logistic regression models indicated that adolescents who experienced CM were more likely to exhibit murderous ideation and behaviors, with adjusted odds ratios (AORs) ranging from 2.55 to 22.31. Additionally, a significant dose-response relationship was found between the number of CM types experienced and murderous ideation and behaviors (AORs ranging from 1.52 to 2.45). The odds of participants who had experienced three or five types of CM were significantly associated with murderous ideation and behaviors, with AORs ranging from 4.55 to 28.30 and from 5.26 to 85.45, respectively. The findings highlighted that adolescents who engaged in murderous ideation and behaviors were more likely to have a personal history of CM and revealed a dose-response relationship between the number of CM types and murderous ideation and behaviors.

The cAMP responsive element binding protein 1 (CREB1) is a ubiquitous transcription factor that contributes to the regulation of gluconeogenesis. The mechanisms of the CREB1 function remain largely unknown. In this study, we aimed to explore genetic variations in CREB1 promoter region and determine whether these loci affect transcriptional activity and risk on type 2 diabetes (T2D). Three polymorphisms were identified and designated as MU1, MU2 and MU3, respectively. Genotypic distribution analysis revealed that MU1 genotypes presented similar distribution between T2D and healthy controls (P > 0.05), while the MU2 and MU3 showed significant differences (P

Chronic rhinosinusitis (CRS) is characterized by inflammation of the mucosa of the nose and paranasal sinuses with a duration of at least 12 consecutive weeks and is a common otorhinolaryngologic disease that is frequently encountered in everyday practice (1). Although CRS is not a life-threatening disease, not all patients are cured or achieve control of their symptoms, even with maximal medical management or surgical intervention. The symptoms in CRS patients with (CRSwNP) and without nasal polyps (CRSsNP) are considerably overlapping, while patients with CRSwNP have higher symptom scores and more nasal symptoms (2). Patients with CRSwNP are particularly recalcitrant to usual therapies, and this type of CRS is increasingly prevalent (3). The persistent symptoms can result in facial pain/headache, impairments in general health, vitality and social functioning, stress disorders and other problems that affect patients’ lives and work (4–7). The European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) group proposed clear guidelines for a symptom-based definition of rhinosinusitis that has been validated and accepted in epidemiological studies (1,8,9). The European postal survey of 57 128 adults in 12 countries reported that the overall prevalence of EP3OS-defined CRS was 10.9% and ranged from 6.9% to 27.1% in 19 centres (10). A recent survey reported a prevalence of EP3OS-defined CRS of 5.51% in Sao Paulo, Brazil (11). Some authors have used the data from the National Population Health Survey to estimate the prevalence of CRS and found prevalences of 6.95% in Korea (12) and 5.7% among female and 3.4% among male Canadians (13). The 2012 National Health Interview Survey of 34 525 adults found that 12% of adults have been told by a doctor or other health professional that they have sinusitis, and these self-reported doctor-diagnosed prevalences of sinusitis were 15% and 9% among males and females, respectively. The vital health statistic data revealed that CRS is more prevalent than other common chronic respiratory diseases, such as chronic obstructive pulmonary disease (3%) and asthma (8%) (14). Based on this high prevalence, some studies in the USA have claimed that CRS poses an enormous health and economic burden to individuals, the community and society (15). When accounting for the entire population into account, the health burden of CRS is speculated to be huge in Asia; nevertheless, little is known about the actual situation. A survey of 4554 Danes reported a CRS prevalence of 7.8% compared to the overall prevalence of 10.9% in 19 European centres (10,16). The National Health Interview Survey of US adults revealed a decreasing trend in CRS from 16% in 1997 to 14% in 2006 and 12% in 2012 (14,17,18). The literature suggests that the prevalence and patterns of CRS might vary by region and population and change over time due to environmental changes and the development of health care. The previous epidemiological data regarding CRS are mainly from western studies, and little is known regarding the potential socio-economic disparities. In Asia, large-scale epidemiological studies are required to update information about the prevalence of CRS, and such studies would provide information for the assessment of the disease burden and the development and promotion of public health policies associated with CRS. We conducted a cross-sectional investigation in seven major Chinese cities. This study aimed to provide a better understanding of the epidemiological characteristics of CRS, including its prevalence and associations with socio-economic factors and tobacco smoke.

Objective: To evaluate the regulatory effect of corticosteroid on occludin expression in polyp tissues of chronic rhinosinusitis with nasal polyps (CRSwNP) patients and in vitro. Methods: Twenty CRSwNP patients were enrolled and subjected to prednisone (30 mg/day for 14 days). The expression of occludin in polyp tissues was examined before and after treatment using immunohistochemical staining and quantitative reverse transcription polymerase chain reaction. Moreover, the expression of occludin in polyp-derived epithelial cells (PECs) and human bronchial epithelial cells (BECs) was examined using Western blot analysis in the presence of corticosteroid and/or MKP-1 siRNA, respectively. Results: mRNA and protein expression of occludin in polyp tissues was significantly upregulated after prednisone administration (p < 0.05). Corticosteroids significantly increased MKP-1 and occludin expression in cultured PECs (p < 0.05), and MKP-1 siRNA significantly decreased occludin expression in cultured BECs (p < 0.05). Conclusion: Our findings suggest that corticosteroid can promote epithelial occludin expression in nasal polyps through a MKP-1-dependent pathway. i 2014 S. Karger AG, Basel

Background The prevalence of bronchial asthma (BA) and the underlying risk factors in patients with allergic rhinitis (AR) in China are largely unknown. Thus, this study is designed to assess the BA comorbidity in AR patients in two cities (Guangzhou and Zhuhai) of southern China and to determine the risk factors of BA in these AR patients. Methods We performed a cross-sectional, hospital-based survey in two modernized cities in southern China. The BA prevalence was evaluated in 1931 AR patients. Participants were asked to complete a questionnaire containing specific items for AR and BA. A logistic regression analysis was used to assess the risk factors of BA comorbidity in AR patients. Results The prevalence of concomitant BA in AR patients is 5.33% (103/1931). Most of the participants (98.4%) were sensitized to more than one allergen, and the most common sensitization was to house-dust mites. The strongest risk factor of BA determined by a multiple logistic regression analysis was a duration of AR of >5 years (adjusted odds ratio [OR], 8.67; 95% confidence interval [CI], 3.74–20.06), followed by smoking (adjusted OR, 7.21; 95% CI, 1.86–8.23) and self-medication with antibiotics (adjusted OR, 6.35; 95% CI, 3.43–11.78). Conclusion Our findings suggested the risk factors of concomitant BA in AR patients may be helpful to establish preventive strategies.

Aims The present study was to assess the accuracy of automatic atrial and ventricular capture management (ACM and VCM) in determining pacing threshold and the performance of a second-generation automatic atrioventricular (AV) interval extension algorithm for reducing unnecessary ventricular pacing. Methods and results A total of 398 patients at 32 centres who received an EnPulse dual-chamber pacing/dual-chamber adaptive rate pacing pacemaker (Medtronic, Minneapolis, MN, USA) were enrolled. The last amplitude thresholds as measured by ACM and VCM prior to the 6-month follow-up were compared with manually measured thresholds. Device diagnostics were used to evaluate ACM and VCM and the percentage of ventricular pacing with and without the AV extension algorithm. Modelling was performed to assess longevity gains relating to the use of automaticity features. Atrial and ventricular capture management performed accurately and reliably provided complete capture management in 97% of studied patients. The AV interval extension algorithm reduced the median per cent of right ventricular pacing in patients with sinus node dysfunction from 99.7 to 1.5% at 6-month follow-up and in patients with intermittent AV block (excluding persistent 3° AV block) from 99.9 to 50.2%. On the basis of validated modelling, estimated device longevity could potentially be extended by 1.9 years through the use of the capture management and AV interval extension features. Conclusion Both ACM and VCM features reliably measured thresholds in nearly all patients; the AV extension algorithm significantly reduced ventricular pacing; and the use of pacemaker automaticity features potentially extends device longevity.

Background Real-world data of the subcutaneous immunotherapy (SCIT) with semi-depot house-dust mite (HDM) allergen extract (a HDM allergen extract that contains a 50%-50% mixture of Dermatophagoides pteronyssinus and Dermatophagoides farina) for allergic rhinitis and asthma was unavailable in China until recently. Aim To investigate the effectiveness and safety of a HDM-SCIT for allergic rhinitis and asthma in Chinese patients. Methods A multicenter, single-arm, open-label, self-controlled study. Chinese patients with allergic rhinitis or allergic asthma and with a history of symptoms from HDM exposure were included and received allergen-specific immunotherapy for 1 year by subcutaneous injection of HDM-SCIT. The primary outcome measure was the percentage of patients with an improvement in symptom severity assessed at 12 months after initiation of the treatment. The occurrence of adverse events and compliance of treatment were also evaluated. Results A total of 272 outpatients were included for effectiveness analysis. The subject-evaluated improvement rate in the visual analog scale (VAS) was 76.1% and 71.3% at 6 and 12 months, respectively; corresponding values for investigator-evaluated VAS were 77.9% and 71.7%, respectively (p < 0.0001). Symptom score changes were -2.43 and -3.79 at 6 and 12 months, respectively (both p < 0.0001); the VAS improvement rate and symptom score change did not differ significantly between children and adolescents and/or adults. Good injection schedule adherence was found in 98.8% of the patients. No study drug–related serious adverse events or serious systemic allergic reactions occurred. Conclusion HDM-SCIT was safe and effective in the treatment of allergic rhinitis and asthma in a Chinese population, with good compliance.

Background Chronic rhinosinusitis (CRS) is defined as a condition of inflammation in the paranasal sinus mucosa persisting for more than 12 weeks. We previously reported that the prevalence of CRS was about 8 % in China. Here, we aim to investigate the occupational and environmental risk factors associated with CRS. Methods Data were collected from seven Chinese cities: Urumqi, Changchun, Beijing, Wuhan, Chengdu, Huaian and Guangzhou. CRS was diagnosed according to the European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) document. Participants were asked to complete a standardized questionnaire, which was developed by the Global Allergy and Asthma European Network (GA2LEN) project and covered sociodemographic characteristics, CRS-related symptoms and occupational and environmental exposures. We evaluated the association between CRS and various occupational and environmental factors using odds ratios (ORs) and 95 % confidence intervals (95 % CIs). Results The total study population consisted of 10,633 subjects, 850 (7.99 %) of whom were defined as having CRS according to the EP3OS criteria. We found that there were significant associations between occupational and environmental factors and CRS. Specifically, having a clearance-related job, occupational exposure to dust, occupational exposure to poisonous gas, a pet at home or carpet at home or at the workplace were risk factors for CRS. Additionally, the method used to keep warm in winter, the duration of time spent using air conditioning in summer and the frequency of exposure to mouldy or damp environments were significantly different in subjects with and without CRS. Conclusions Our data showed that some occupational and environmental exposures are strongly associated with CRS, which aids in understanding the epidemiology of CRS.

There is still insufficient understanding of the underlying processes that contribute to internalizing problems of early maturing adolescents. The purpose of this study is to examine the longitudinal pattern of early maturation and its effects on morning cortisol and depressive symptoms among a general population of adolescent cohort aged 8-11 years old at baseline (boys=424, girls=288). Results suggest newly-onset early maturation boys have 3-times more likely to have depressive symptoms at 1-year follow-up (adjusted odds ratio=3.197, 95% confidence interval=1.595-6.405); while in girls, stable early maturation individuals are more than 4 times as likely to have depressive symptoms (adjusted odds ratio=4.566, 95% confidence interval=1.882-11.077). Morning cortisol has moderating effects in the association of depressive symptoms with newly-onset early maturation in boys and stable early maturation in girls. These findings possibly explain current inconsistent results regarding association between earlier maturation and risk of depression in adolescents. Further longitudinal studies are needed to explore HPG-HPA interactions in adolescence, which may be critical to understanding the heightened susceptibility of mental health problems.

Objectives/Hypothesis: The aim of this article was to describe our surgical technique for the treatment of nasal septal perforations with diameters of 1 to 2 cm. Study Design: Retrospective clinical research. Methods: We reviewed 13 patients with moderate nasal septal perforations (1–2 cm diameter) treated with a sandwich technique (bone or cartilage and quadriceps fascia graft as an interposition graft) by an endoscope-assisted intranasal approach from January 2008 to June 2011. Follow-up periods were 3 months. Results: Thirteen patients were treated with the sandwich technique. Twelve cases (92.3%) were completely healed. One case received incomplete closures without any postoperative symptoms. All patients were found not to have any complications after surgery. Conclusions: The transnasal endoscopic sandwich technique for repairing moderate nasal septal perforation (1–2 cm) has a high success rate and is easy to perform. Laryngoscope, 2012

Background: MicroRNAs (miRNAs) are known to regulate the inflammatory response in various cell types. However, the ability of miRNAs to modulate dendritic cells (DCs) function for allergen immunotherapy is unclear. Objective: To assess the role of miR-23b in the regulation of ovalbumin (OVA)-induced DC differentiation and function and to investigate the related molecular mechanisms. Methods: Bone marrow-derived dendritic cells (BMDCs) were generated from murine bone marrow progenitor cells and subsequently stimulated with OVA to examine the profile of miRNA expression. After transfection with miR-23b reagents, DCs were evaluated for endocytic ability, surface marker expression, cytokine secretion and CD4+ T-cell differentiation. The possible roles of the Notch and NF-κB signalling pathways were also evaluated. Human monocyte-derived dendritic cells (MDDCs) were similarly evaluated as well. Results: Significant upregulation of miR-23b was observed in BMDCs pulsed with OVA. Following miR-23b transfection, BMDCs showed decreased OVA uptake, increased IL-10 production, decreased IL-12 production and an enhanced capacity to promote FoxP3+ CD4+ T regulatory cells (Tregs) differentiation. In addition, inactivation of the Notch1 and NF-κB signalling pathways were observed. Conversely, inhibition of miR-23b in BMDCs resulted in the opposite effects. In human MDDCs, miRNA23b transfection similarly increased IL-10 and decreased IL-12 production, and that treated human MDDCs induced increased FoxP3+ CD4+ T cells. Conclusion: Our findings provide evidence that miR-23b is capable of inducing tolerogenic DC activity and Treg responses in vitro through the inhibition of the Notch1 and NF-κB signalling pathways; thus, miR-23b might represent a therapeutic target for the management of allergic diseases.

Background Connexin (Cx) 26 plays a key role in maintaining the integrity of tight junctions. However, the expression and modulation of Cx26 in allergic rhinitis (AR) has not been well understood. Methods We detected the expression of Cx26 in house-dust mite (HDM)–sensitized AR patients and investigated the Cx26 production and modulation in primary human nasal epithelial cells (HNECs) and BEAS-2B cells after treatment with the allergen Der p 1 from Dermatophagoides pteronyssinus. Results We found that the mRNA and protein levels of Cx26 were significantly down-regulated in AR patients compared with the control. Der p 1 was found to induce protease-activated receptor 2 (PAR2) expression and suppress Cx26 production significantly in vitro. PAR2 siRNA was shown to prevent the suppression of Cx26 induced by Der p 1 in BEAS-2B cells. Conclusion The suppression of Cx26 in HDM-sensitized AR patients is related to a PAR2-mediated pathway and might serve during the initiation and maintenance of AR. Targeting the PAR2-mediated Cx26 suppression may be a potential means of preventing allergic sensitization.

This 8-week, randomized, double-blind, parallel-group study compared the efficacy and safety of aliskiren with ramipril in Asian patients with mild to moderate hypertension. Following a 2- to 3-week placebo run-in period, patients with mean sitting diastolic blood pressure (msDBP) ⩾95 and

BACKGROUND Thymosin β4 was recently demonstrated to be a potential stimulator of angiogenesis and arteriogenesis in both in-vivo and in-vitro studies. Little is known about the relationship between serum thymosin β4 levels and the extent of coronary collaterals in patients with coronary artery disease. HYPOTHESIS Serum thymosin β4 independently predicts the formation of coronary collaterals in patients with coronary artery disease. MATERIALS AND METHODS A total of 190 consecutive patients who underwent coronary angiography were divided into two groups according to coronary angiograms and collateral formation: the poor collateral group consisting of 103 patients with at least more than or equal to one coronary stenosis of greater than or equal to 75% without visible collateral circulation, and the good collateral group consisting of 87 patients with at least more than or equal to one coronary stenosis of greater than or equal to 75% with well-developed collateral circulation. Collateral score was analyzed using the Cohen-Rentrop classification. RESULTS Serum thymosin β4 levels were 1024.50 ± 516.92 ng/ml and 1373.00 ± 1082.88 ng/ml for patients in the poor collateral group and the good collateral group, respectively. Serum thymosin β4 levels in the good collateral group were significantly higher than those in the poor collateral group (P

To get a better cosmetic effect, and to avoid even a small incision and scar in the anterior neck zone, we adapted gasless endoscopic thyroidectomy via anterior chest approach. From June 2004 to June 2008, 219 patients with thyroid diseases underwent gasless endoscopic thyroidectomy via anterior chest approach. The clinical and pathologic characteristics of patients, the type of operation, operative time, length of postoperative hospital stay, and postoperative complications were analyzed retrospectively. All 219 operations were successfully performed endoscopically. Only three patients showed temporary paralysis of the recurrent laryngeal nerve (RLN), and all of them recovered within 1–3 months after the surgery. One patient showed permanent paralysis of the RLN, one patient developed a postoperative seroma, and one patient suffered a tracheal injury. There were no injuries to the superior laryngeal nerve or any hypoparathyroidism. No further complications, such as irritating cough, tetany, and emphysema developed after the operation. Because of the anterior chest wall approach, none of the patients had a surgical scar on the neck and all were satisfied with the cosmetic effect. Gasless endoscopic thyroid surgery through anterior chest approach is a feasible and safe method. This technique had better cosmetic results and could constitute a new treatment modality for patients with benign tumors and can also be an effective alternative treatment for the selected patients with thyroid cancer.

To investigate the responses of nasal airway and autonomic nervous system (ANS) under controlled nasal breathings. Ten healthy volunteers, aged between 21 and 37 years, were enrolled. The participants breathed either through bilateral nostrils (BNB) or unilaterally through the left nostril (UNB) at 0.25 Hz for 5 min. The electrocardiography was simultaneously recorded and the ANS activities were evaluated using heart rate variability analysis. Nasal airway resistance and related factors were measured by rhinomanometry. The results showed that the mean heartbeat interval during UNB was significantly greater than during BNB. The sympathetic modulation decreased significantly during UNB. The correlations between nasal airway resistance and mean heartbeat interval were significant for both UNB and BNB. The increase of heartbeat intervals during UNB was associated with the decrease of cardiac sympathetic activities. The changes of ANS activities and nasal airway resistance during UNB are similar to the changes caused by a prolonged lying.

OBJECTIVE In-vivo studies have shown that hyaluronan (HA) can promote angiogenesis and arteriogenesis, which results in accelerated collateral development. This study is aimed at investigating the association between plasma HA levels and the extent of coronary collaterals, in patients with coronary artery disease. METHODS A total of 253 consecutive patients, who underwent coronary angiography, were divided into three groups according to coronary angiograms: normal group, 81 patients with normal coronary angiographic findings; poor collateral group, 98 patients with at least one coronary stenosis of at least 75%, but without visible collateral circulation; good collateral group, 74 patients with at least one coronary stenosis of at least 75% with well-developed collateral circulation. Plasma HA levels were measured by radioimmunoassay. The correlation between HA levels and the extent of coronary collaterals according to the Cohen-Rentrop classification was calculated by cumulative logits models. RESULTS Plasma HA levels were 43.71+/-2.91, 61.77+/-4.10, and 131.97+/-11.76 ng/ml, for patients in the normal, poor collateral, and good collateral groups, respectively. The good collateral group had significantly higher plasma HA levels than the poor collateral (P

Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the upper airway and is tightly linked with airway hyperresponsiveness (AHR) and asthma. However, the surrogate biomarkers for indicating AHR and asthma in patients with CRSwNP remain elusive. Objective To investigate the surrogate biomarkers for indicating AHR and asthma in patients with CRSwNP. Methods In this study, sinonasal tissues were collected from 42 patients with CRSwNP (asthma, n = 17; asymptomatic AHR, n = 11; non-AHR, n = 14), 11 patients with chronic rhinosinusitis without nasal polyps (CRSsNP), and 13 controls. The protein and messenger RNA levels of interleukin (IL) 25 and other cytokines in nasal polyp (NP) and control sinonasal tissues were determined by quantitative real-time polymerase chain reaction and multiplex immunoassay, respectively. Multivariate logistic regression and receiver operating characteristic curve analysis were performed to assess the clinical relevance of IL-25. Results We found that the protein and messenger RNA levels of IL-25 were significantly increased in NP tissues compared with the control sinonasal tissues from patients with CRSwNP, patients with CRSsNP, and controls. Multivariate logistic regression revealed that the nasal IL-25 protein level and nasal and blood eosinophil counts were independent risk factors for AHR in patients with CRSwNP. According to receiver operating characteristic curve analysis, nasal tissue IL-25 had a sensitivity of 91.4% and a specificity of 62.8% (area under the curve, 0.845) at the cutoff level of 5 pg/μL for indicating AHR in this CRSwNP cohort. Conclusion Our findings indicated that IL-25 was significantly increased in NP tissues and may be considered as the molecular indicator for AHR in patients with CRSwNP. Trial Registration ClinicalTrials.gov Identifier: NCT02110654.

Activated mTOR was implicated to play a role in the carcinogenesis of nasopharyngeal carcinoma (NPC). However, the mechanism of activated mTOR/Complex1(mTORC1) signaling pathway in NPC development has not been well established. In this study, we correlated the expression of mTORC1 signal molecules and Cyclin D1 in NPC. We also investigated the effect of blocking mTORC1 signal with rapamycin and mTOR siRNA on Cyclin D1 expression in CNE-2 cells, as well as cell apoptosis and viability. We found a positive association of mTORC1 signal molecules and Cyclin D1 in NPC. Also, we found blockage mTORC1 inhibited Cyclin D1 expression in CNE-2 cells and enhanced cell apoptosis. Our results suggested that mTORC1 signal pathway might be a potential target for NPC therapy.

Summary Background The pathogenesis of nasal polyps is still unclear. There is increasing evidence indicating that Staphylococcal aureus (S. aureus) is associated with the formation of nasal polyps, but the mechanism has not been well documented to date. Methods We stimulated cultured nasal polyps and turbinate tissues with Staphylococcal exotoxin B (SEB), detected the expression of pro-inflammatory cytokines (IL-2, IL-6, and IL-8) and T cell cytokines (IFN-γ, IL-4, IL-5, IL-10, and IL-17) in the supernatants, and evaluated mRNA expression (T-bet, GATA-3, Foxp3, and RORγt) and frequencies of CD4+CD25+ T regulatory cells (Tregs) in nasal tissues. We also evaluated the effects of blocking IL-6 with monoclonal antibodies to T cell profiles in cultured nasal tissues stimulated by SEB. Results Levels of IL-6, IFN-γ and IL-4 increased significantly in SEB-stimulated nasal polyps. Meanwhile, mRNA expressions of T-bet and GATA-3 were significantly up-regulated, while Foxp3 was inhibited and the frequencies of CD4+CD25+ Tregs were decreased after SEB stimulation. After blocking IL-6, the levels of IL-10 and Foxp3 mRNA, as well as the frequencies of CD4+CD25+ Tregs, were significantly increased, while IFN-γ and IL-4 production and the mRNA expression of T-bet and GATA-3 were significantly inhibited. Conclusions SEB is able to modulate pro-inflammatory factors, T-helper type 1/Th2 profiles and suppress Treg activity in cultured nasal polyps, which were rescued by blocking IL-6 activity. Therefore, IL-6 is essential for SEB-induced Treg insufficiency in nasal polyps.

Conclusion: mometasone furoate nasal spray (MFNS) can reduce the symptoms and improve quality of life in Chinese patients with moderate to severe allergic rhinitis (AR). Objective: To evaluate the effects of MF on symptoms and quality of life in Chinese patients with moderate to severe AR. Patients and methods: In a multicenter and open-label study, 500 patients with moderate to severe AR were enrolled and received MFNS 200 µg once daily. We visited the patients four times (at baseline, and week 1, 2, and 4) to record symptom scores and the influence of AR on daytime activities and quality of sleep. The Mini Rhinoconjunctivitis Quality of Life Questionnaire (Mini-RQLQ) and the Nocturnal Rhinoconjunctivitis Quality of Life Questionnaire (NRQLQ) were used in this study. Results: Compared with the baseline, MFNS significantly reduced the total and individual symptom scores and nocturnal sleep and daytime activities scores at week 1, 2, and 4 according to the Mini-RQLQ and NRQLQ.

The pathogenesis of chronic rhinosinusitis (CRS) with nasal polyps(NP) is still poorly understood. To evaluate the role of Foxp3+ T regulatory cells (Tregs) in the pathogenesis and management of NP, we investigated the location and expression of Foxp3 in NP before and after treatment with intranasal steroid. NP specimens were obtained from 14 patients with NP before and after intranasal administration of mometasone (50 microg/day for 4 weeks). Foxp3 was detected by double immunofluorescence stain, quantitative reverse transcriptase polymerase chain reaction (RT-PCR), flow cytometry and western blot. The concentration of interleukin(IL)-10 in supernatants of homogenized tissue was measured by enzyme-linked immunosorbent assay (ELISA). We found that Foxp3 and IL-10 were downregulated in NP compared to the control mucosa (P

Background: Allergic rhinitis (AR) is a common disease and its prevalence is increasing worldwide. Data on the current prevalence of AR in China, one of the biggest countries in the world, with a population of around 1.3 billion citizens, are scarce. The aim of this study was to investigate the prevalence of self-reported AR in Chinese citizens. Methods: In a cross-sectional, population-based study, telephone interviews were conducted in 11 major cities in China after sampling target telephone numbers through the approach of random digital dialing. The questions for the telephone interviews were based on validated questionnaires. Results: A total of 38,203 telephone interviews were conducted from September 2004 to May 2005. The response rate was 63.7%. After adjustment for age and gender, the self-reported prevalence of AR was lowest in Beijing (8.7%) and highest in Urumqi (24.1%). Among the subjects with self-reported AR, 25.6% were diagnosed with persistent AR and 74.4% suffered from intermittent AR. Less than half of the subjects with self-reported AR had presented at a health clinic. In 37.3% AR had previously been diagnosed by physicians, and 33.1% of subjects with self-reported AR had been treated. Comorbidities reported were asthma (9.2%), rhinosinusitis (13.3%) and atopic dermatitis (16.4%). Conclusions: This study demonstrates that the self-reported prevalence of AR in 11 cities across Mainland China has wide variations, ranging from 20%; 26% of the self-reported AR subjects were classified as suffering from persistent AR.

Objective To determine the molecular mechanisms of hypertonic saline on nasal disorders. Methods Primary human nasal epithelial cells (HNECs) were treated with 0.9 and 3% saline for 12 h. CLC-3 was detected in HNECs by immunohistochemistry, reverse transcriptase-polymerase chain reaction (RT-PCR) and western blotting. Results Positive expression of CLC-3 was detected in HNECs in all subjects by immunohistochemistry. The relative density of CLC-3 mRNA was 0.22 ± 0.09 and 0.12 ± 0.05 in HNECs treated with 3 and 0.9% saline, respectively. The effect of 3% saline on the expression of CLC-3 in HNECs was observed in a time-dependent manner. Conclusions Hypertonic saline decreases the nasal edema and influences the mucocilliary function through the fluid secretion in vitro and may be associated with the upregulation of CLC-3.

SUMMARY 1 The leucocyte-mediated inflammatory response plays a pivotal role in ischaemia–reperfusion injury. P-Selectin and CD11b are important mediators for the recruitment of leucocytes into the endothelium. However, the time-course of changes in P-selectin and CD11b expression during reperfusion is not defined. Magnesium has been shown to have a protective role in reperfusion injury, but the mechanism of its action is not yet clear. 2 In the present study, 90 male Sprague-Dawley rats were randomized into three groups, namely a sham-operated group, an IR group (subjected to 45 min of coronary occlusion followed by reperfusion for up to 6 h) and an MgSO4-treated group, which received an infusion of MgSO4 starting 30 min before occlusion and continuing until the onset of reperfusion. The expression of P-selectin on platelets and CD11b on leucocytes, endothelial P-selectin on cardiac microvessels and P-selectin mRNA in myocardial tissue were measured by flow cytometry, immunohistochemistry and reverse transcription–polymerase chain reaction, respectively, at different time points during reperfusion. The degree of myocardial necrosis and arrhythmia was assessed. 3 The present study shows that P-selectin expression on platelets and cardiac microvessels, P-selectin mRNA in myocardial tissue and CD11b expression on leucocytes in the IR group were significantly upregulated compared with the sham-operated group in a time-dependent manner during reperfusion. Treatment with MgSO4 attenuated the upregulation of P-selectin expression, in addition to inhibiting myocardial necrosis and arrhythmia, but had no effect on CD11b expression on leucocytes. 4 These results suggest that the expression of P-selectin and CD11b is upregulated after reperfusion and magnesium pretreatment plays a cardioprotective role in ischaemia–reperfusion injury, possibly by inhibiting the upregulation of P-selectin expression.

To examine the role of atorvastatin on volume-overload-induced heart failure and to test the hypothesis that atorvastatin inhibits MMP-2 and 9 expression in heart failure with non-ischemic etiology.Arteriovenous (AV) fistula-treated rats were administered with atorvastatin (3 mg/kg/d) or vehicle for 17 weeks. Ventricular hypertrophy and heart failure were assessed by echocardiography, B-type natriuretic peptide BNP mRNA level and morphological measurement. MMP-2, 9 expression were measured by Western blot and zymography.Atorvastatin decreased left ventricular end diastolic diameter from 6.86+/-0.51 mm to 6.28+/-0.37 mm (P0.05), increased fractioning shortening from 41.4%+/-4.5% to 52.7%+/-4.2% (P0.01), decreased ratio of BNP/GAPDH mRNA level from 0.43+/-0.03 to 0.27+/-0.03 (P0.05). Similar data were observed for morphological measurement. Protein expression and enzyme activity of MMP-2 and 9 in the left ventricle tissue were significantly increased 18 weeks after surgery and atorvastatin also prevented those changes.Left ventricular remodeling induced by AV fistula was profoundly changed by atorvastatin treatment. Hypertrophy was attenuated and global function was improved. These positive effects of atorvastatin on heart failure were associated with decreased MMP-2 and 9 protein expression and enzyme activity.

Cysteinyl leukotriene (LT) has been proposed in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP). This study sought to examine the expression of the LT receptor (LTR) in CRSwNP patients and evaluate the potential role of LTR antagonist (LTRA) in the management of eosinophilic CRSwNP (ECRS) patients.Nasal polyps and uncinate process tissues were collected from 18 ECRS patients, 13 non-eosinophilic CRSwNP (non-ECRS) patients, and 16 control subjects. The messenger RNA (mRNA) and protein expression of LTR (cysteinyl leukotriene receptor 1 [CysLT1R] and cysteinyl leukotriene receptor 2 [CysLT2R]) was examined using quantitative reverse-transcription polymerase chain reaction (qRT-PCR), immunohistochemistry, and Western blot analysis. Moreover, the effects of LTRA and steroids on total nasal symptom scores (TNSS) of uncontrolled ECRS patients were evaluated.The mRNA and protein expression of CysLT1R and CysLT2R was significantly increased in polyp tissues compared with healthy controls (p0.05). Compared with the non-ECRS subset, the ECRS subset showed significantly increased expression of CysLT1R and CysLT2R, as well as leukotriene C4 (LTC4) and leukotriene D4 (LTC4) levels (p0.05). Moreover, combined LTRA and steroids significantly decreased TNSS more than steroids alone in uncontrolled ECRS patients (p0.01).Our findings indicate that LTR was differentially expressed between ECRS and non-ECRS patients, and that LTRA may be used as an additional therapy for ECRS patients.

Aims To study three atypical glioneuronal tumours (GNTs), in order to shed light on the clinical and pathological features of this diverse tumour group. Methods and results Clinical and neuropathological data for each case were retrospectively reviewed. Case 1 involved a 17-year-old boy with left leg movement difficulty. A mass lesion in the basal ganglia was detected radiologically; histopathological features included neurocytic/perivascular rosettes and a pilocytic astrocytoma component. Case 2 involved a 33-year-old man with intractable epilepsy. His left parietal lobe contained a cyst-like mass, resembling dysembryoplastic neuroepithelial tumour and rosette-forming glioneuronal tumour of the fourth ventricle microscopically. Case 3 involved a 21-year-old woman with a mass lesion in the mesencephalic tegmentum extending to the third and fourth ventricles and the suprasellar region. The lesion contained perivascular/neurocytic rosettes and an oligodendroglioma-like component. None of the tumours expressed an isocitrate dehydrogenase I mutation of the R132H type or contained a 1p/19q deletion, a BRAFV600E mutation, or KIAA1549–BRAF fusion. Conclusions We describe three GNTs with atypical histopathology and locations. Additional cases and molecular studies are needed to better understand the biological nature of GNTs and to refine their classification system.

Recent evidence has suggested that miRNA is implicated in the immune response of allergic and inflammatory diseases. However, little is known about its role in the mechanism that underlies the establishment of pro-allergic DCs in allergic rhinitis is not fully understood. This study assessed whether and how microRNA (miR)-106b regulates the pro-allergic properties of DCs upon allergen stimulation in vitro. Bone marrow-derived dendritic cells (BMDCs) were generated and stimulated with ovalbumin (OVA) to identify the miRNA expression profile. After transfection with miR-106b mimics and inhibitors OVA-activated BMDCs were further evaluated for surface marker expression using flow cytometry, cytokine production using ELISA and subsequent effects on Th2 cell polarisation using flow cytometry. Moreover, the upstream controllers and potential target proteins of miR-106b were examined in a western blot analysis. Results showed that MiR-106b expression was significantly inhibited in activated BMDCs upon OVA stimulation (p

Clipping and bypass surgery are common therapeutic options for the management of giant internal carotid artery (ICA) aneurysms. However, potential ischemic risks may be exaggerated by prolonged temporary occlusion (PTO) during the surgery. Monitoring motor-evoked potentials (MEPs) is a sensitive technique for detecting potential ischemia intraoperatively. This preliminary study was designed to evaluate the effectiveness of applying MEP monitoring during giant ICA aneurysm surgery using PTO. From July 2009 to July 2012, 11 patients with giant ICA aneurysms who could not pass the preoperative hemodynamic evaluations were enrolled in this study. MEP monitoring was utilized intraoperatively in all cases. Clipping was performed if there were no significant MEP changes under PTO. A variant extracranial-to-intracranial (EC-IC) bypass was performed if there was reproducible loss of MEP signals after PTO or unclippable anatomic features. Five patients underwent clipping alone and six underwent bypass. There were no significant differences in baseline clinical data between the two groups. The overall percentage of patients with good outcomes (Glasgow Outcome Score ≥4) improved from 72.7 % (8/11) postoperatively to 90.9 % (10/11) after 26.0 ± 9.5 months of follow-up. There were no significant differences between the clipping and bypass groups regarding short- and long-term outcomes (p = 0.545 and p = 1.000). MEP monitoring is useful for evaluating the safety of PTO, surgical strategy, and outcomes of giant ICA aneurysm surgery. Direct clipping during safe PTO under intraoperative MEP monitoring is applicable for giant ICA aneurysms. Its use achieved favorable outcomes by indicating the need for bypass surgery.

Oxidative stress is characteristic of chronic airway inflammatory diseases such as asthma, chronic obstructive pulmonary disease and chronic rhinosinusitis with nasal polyps (CRSwNP). Heme oxygenase (HO)-1 has been proposed to be a cytoprotective enzyme against oxidative stress in CRSwNP. However, the expression and regulation of HO-1 in eosinophilic CRSwNP (ECRS) and non-eosinophilic CRSwNP (non-ECRS) subsets has not been well documented.Nasal polyps and uncinate process tissues were enrolled from 40 CRSwNP patients (ECRS, 17; non-ECRS, 23) and 20 control subjects, respectively. The messenger RNA (mRNA) and protein expression of HO-1 was examined using qRT-PCR, immunohistochemistry, and Western blot staining. Moreover, the stimulatory effects of several cytokines (interferon γ [IFN-γ], interleukin [IL]-5, and IL-13, etc.) on HO-1 mRNA expression in cultured nasal explants were evaluated.The mRNA and protein expression of HO-1 was significantly increased in polyp tissues compared with healthy controls (p0.05), and the non-ECRS subset showed significantly increased HO-1 expression compared with the ECRS subset (p0.05). Moreover, in cultured nasal explant, HO-1 mRNA was significantly upregulated in the presence of IFN-γ, IL-27, IL-5, IL-13, and IL-17A, but was significantly inhibited by transforming growth factor β1 (TGF-β1) (p0.05).Our findings indicate that HO-1 was differentially expressed and regulated in ECRS and non-ECRS patients.

A growing body of literature suggests that cytokines play an important part in the pathogenesis of chronic nasal sinusitis. However, the mechanism by which the expression of cytokines in chronic nasal sinusitis is upregulated has not been well documented. The present study investigated the role of nuclear factor-kappa B (NF-κB) activation in upregulating the expression of interleukin-5, -6 and -8 (IL-5, IL-6 and IL-8). We titrated the levels of IL-5, IL-6 and IL-8 in nasal mucosa in 52 cases of chronic nasal sinusitis and 12 normal subjects using enzyme-linked immunosorbent assay. According to whether allergic rhinitis was associated or not, we subdivided the patients into the AR group (with allergic rhinitis) and the NAR group (without allergic rhinitis). Semi-quantitative reverse transcription-polymerase chain reaction and immunohistochemical staining were used to evaluate expression and activation of NF-κB P50 and P65 subunits in nasal mucosa. The correlation between activities of P50 and P65 and cytokines expression was analysed. Our results showed that IL-5, IL-6 and IL-8 in both the AR and NAR groups were strikingly elevated in comparison with the control group (all p p p p p p p p

Objective Thromboembolic complications commonly occur in radiofrequency (RF) ablation procedures. Endothelial injury is believed to be induced during the process of RF ablation and to be involved in the mechanisms of thromboembolism. In this study, we gave further information about endothelial injury and also investiged the possible reasons for endothelial dysfunction during RF. Methods and results Plasma levels of nitric oxide (NO), a biomarker of endothelial injury and some antioxidants and oxidants: beta-carotene (beta-CAR), lipoperoxide (LPO), superoxide dismutase (SOD), vitamin C (VC) and vitamin E (VE) were measured in 44 patients who underwent radiofrequency catheter ablation. Plasma NO concentration decreased significantly from 433.27 +/- 59.93 nmol/L to 407.13 +/- 52.32 nmol/L during RF ablation. Levels of beta-CAR, LPO, SOD,VC and VE were not significantly different. The decrease of plasma NO level was significantly correlated with ablation duration and cumulative ablation energy but had no significant correlation with overall procedure time, output ablation energy, ablation temperature and age of the patients. Conclusions Radiofrequency catheter ablation induced endothelial injury but had no effect on oxidative stress. Radiofrequency energy was the main factor that caused endothelial injury during RF ablation.

Insulation defects in the leads are a common complication in implantable cardioverter-defibrillators (ICDs). Although the new multilumen leads have significantly reduced the incidence of insulation defects, they have introduced the new and rare problem of outer-insulation abrasions. In this report, we present the case of a 53-year-old man with dilated cardiomyopathy who was found to have an outer-insulation abrasion on fluoroscopy 3 years after the implantation of an ICD. Several electrical storms experienced by the patient were considered to be responsible for the abrasions; results of routine evaluations were normal. A CRT-D device was finally implanted.

Background Although the prevalence of aspirin-exacerbated respiratory disease (AERD) in western populations is high, AERD is rather rare in China, and few related studies have been published to date. Methods We performed a prospective cohort investigation on the incidence of AERD in patients with chronic rhinosinusitis (CRS) in southern China. A literature search of the China Academic Journal Network Publishing Database was conducted to obtain an overview of the incidence of AERD in the Chinese population, and previous studies on the incidence of AERD were reviewed. Results We found 2 patients with aspirin hypersensitivity among 351 consecutive CRS (309 with nasal polyps [NPs]) patients, suggesting a rate of 0.57% in the CRS population. Forty-five articles about AERD were obtained by Chinese-language literature searches. In total, 346 cases of AERD were reported during the past 30 years. Conclusion Given the large population of NPs in China, the prevalence of AERD is very low, and this may be related to the reduced levels of nasal tissue eosinophilia and subsequent low asthma comorbidity.

Aims The present study was to assess the reduction of right ventricular pacing (RVP) by pacemaker algorithms of Managed Ventricular Pacing (MVP) and Search AV+ (SAV+) interval over a period of 12 months. Methods and results A total of 385 patients indicated for a dual-chamber pacemaker (DC-PM) were enrolled in the prospective, randomized COMPARE study at 29 centres in China between June 2009 and April 2011. Patients implanted with DC-PMs were randomized in a 1 : 1 ratio to the MVP group or the SAV+ group. The percentage of VP (%VP) was obtained from the device diagnostic data at 1-, 6-, and 12-month follow-ups and was expressed as the median %VP over all beats in patients with sinus node dysfunction (SND) and atrioventricular block (AVB) excluding persistent third-degree AVB. Of 385 enrolled patients, 253 had SND and 72 had AVB. The %VP in the MVP group was significantly lower than that in the SAV+ group at 1-, 6-, and 12-month follow-ups, respectively. At 12-month follow-up, the median %VP in SND patients was 0.20% in the MVP group and 1.4% in the SAV+ group ( P < 0.0001) and the median %VP in AVB patients was 11.8% in the MVP group and 98.1% in the SAV+ group ( P < 0.001). There was no statistical difference in %VP from 1- to 12-month follow-up. A trend in the correlation between %VP and AT/AF burden was observed. Conclusion Over 12-month follow-up, the %VP was lower for MVP than SAV+ in patients with either SND or AVB. The sustainable %VP reduction has potential implications in reducing the development of heart failure and/or atrial arrhythmia morbidity.

Objective: Asthma is one of the most common chronic diseases and associated with significant morbidity and mortality. However, few data on occupational and environmental risk factors of asthma are available, particularly in Asian adults. Based on a national cross-sectional survey, we assessed the prevalence and risk factors of asthma in Chinese adults. Methods: A total of 9974 participants aged 15 years and over in seven Chinese cities were selected using a stratified four-stage random sampling. All participants were interviewed face-to-face in their homes using a standardized self-administered questionnaire. Multivariate logistic regression analyses were adopted to determine various risk factors for asthma. Results: The prevalence of self-reported lifetime asthma was 2.46% among the entire adult population, 3.02% among males and 1.93% among females. The prevalence varied by age group, ethnicity, marital status, education, and floor space per person (p < 0.05). After adjusting for socio-demographic variables and smoking, we found independent occupational and environmental determinants of asthma, including a clearance-related job (OR = 2.28, 95%CI: 1.07–4.89), occupational exposure to industrial or occupational poisonous gas (OR = 4.21, 95%CI: 2.43–7.30), having large amounts of carpet in the workplace (OR = 2.61, 95%CI: 1.20–5.69) and using coal for cooking (OR = 2.65, 95%CI: 1.26–5.57). Conclusions: Asthma is a serious public health problem in China. Our study provides important updated information on the prevalence of asthma and its associated risk factors, which may help us better understand the epidemiology of asthma and prevent this disorder.

Background Motor evoked potential (MEP) monitoring has been widely used in brain or spine surgery to recognize potential damage of the pyramidal motor system. However, its ability to detect ischemic injury during middle cerebral artery (MCA) aneurysm surgery remains unclear. A prospective cohort study was designed to evaluate MEP changes during MCA aneurysm surgery. Methods From January 2009 to August 2011, 89 patients underwent MCA aneurysm surgery and were prospectively divided into 2 groups: MEP monitoring group and control group. Based on an amplitude decrement of >50% or loss, a 2-stage warning criterion of MEP changes was established. Concomitant somatosensory evoked potential changes were also recorded. MEP changes occurred in 15 patients, and various methods were used to avoid continued brain ischemia. Indocyanine green angiography and Doppler ultrasonography were performed if needed. A head computed tomography scan was performed immediately and the day after the operation. Results At discharge, neither motor status nor Glasgow Coma Scale score was significantly different between the 2 groups. However, at the latest follow-up (mean, 31.9 months), motor status of the patients in the monitoring group was better ( P = 0.037). MEP monitoring was identified as an independent prognostic factor for motor outcome in long-term results by multivariate analysis ( P = 0.042). Both wave loss and >50% amplitude decrement of MEP monitoring showed good predictive value when used as part of a 2-stage warning criterion. Conclusions MEP monitoring is reliable for evaluation of the ischemic status of the pyramidal motor system during MCA aneurysm surgery and can improve surgical outcomes when used appropriately.

MUC5B immunohistochemical staining was a valuable method for identifying fungi in fungal ball sinusitis, especially in distinguishing aspergillus and mucor. Combined infection with Aspergillus and Mucor fungi was the most common pattern in fungal ball sinusitis.To assess the value of MUC5B immunohistochemical staining in identifying fungi in fungal ball sinusitis by comparing it with conventional Grocott methenamine silver (GMS) staining.GMS staining and MUC5B immunohistochemical staining were used to identify fungi in mucopurulent cheesy or clay-like tissues from sinuses in 180 fungal ball sinusitis patients, and the examination results were compared.In 180 samples of fungal ball sinusitis, GMS staining showed Aspergillus in 130, Mucor in 88, and Candida albicans in 6, while MUC5B immunohistochemical staining identified Aspergillus in 166, Mucor in 172, and Candida albicans in 16. The fungal detection rate for MUC5B immunohistochemical staining was markedly greater than that for GMS staining (p0.01). This implies that MUC5B immunohistochemical staining was more sensitive than GMS staining in identifying fungi in fungal ball sinusitis. Mixed infection of Aspergillus and Mucor was present in 146 of 180 patients (81.1%).

Objectives/Hypothesis The aims of this study were to evaluate the efficacy of functional endoscopic sinus surgery (FESS)–oriented multimodality treatment in chronic rhinosinusitis (CRS) patients with asthma and its impact on asthma. Study Design Prospective, nonrandomized cohort. Methods Twenty-seven CRS patients with asthma who underwent FESS with postoperative topical corticosteroid spray were evaluated preoperatively; 25 of them were evaluated 1 year and 3 years postoperatively. CRS was evaluated by visual analogue scale, clinical control of CRS, and objective measurement endoscopy Lund-Kennedy scores. Asthma was assessed by subjective asthma control test and asthma control level, also by objective antiasthma medication use and pulmonary function tests. Results VAS scores of general symptoms (8.09 ± 0.87 preoperatively) were significantly improved at 1 year (2.94 ± 2.21) and 3 years (3.77 ± 2.16) postoperation (P = .000). No difference in these items was found between 1 year and 3 years (P = .463). Endoscopy Lund-Kennedy scores at 1 year (4.34 ± 3.09) and 3 years (5.80 ± 3.38) postoperatively were significantly better (9.33 ± 2.03 preoperatively, P = .000), and there was no difference between 1 year and 3 years of follow-up (P > .05). Significantly, asthma control level improved postoperatively (P = .025). However, antiasthma drug and pulmonary function showed no significant change postoperatively (P > .05). Conclusions FESS-oriented multimodality treatment improves CRS with asthma significantly and persistently. Asthma control level improved. Antiasthma medication use and pulmonary function remained stable. Level of Evidence 4. Laryngoscope, 124:24–28, 2014

This study was focused on the clinical effects of topical steroid for chronic rhinosinusitis (CRS) in Chinese adults.The CRS patients were randomly selected in the department of otorhinolaryngology, first affiliated hospital of Sun Yat-sen university between november 2010 and December 2011. Thirty-four CRS patients with polyps (CRSwNP) or CRS without polyps (CRSsNP), no prior surgeries were included. These patients were prescribed to use budesonide nasal spay for three months. Evaluation included visual analog score (VAS), sino-nasal outcome test-20(SNOT-20), CT scan (Lund-Mackay score). SPSS 16.0 software was used to analyze the data.Four patients were lost to follow up, while the other 30 patients finished the 3-months' follow up. Except for smelling disturbance which was not statistically changed (t = 0.902, P0.05), VAS for nasal blockage (baseline: 4.84 ± 3.15, after treatment: 2.26 ± 2.27), rhinorrhea (baseline: 6.03 ± 2.93, after treatment: 1.96 ± 2.23), headache (baseline: 1.68 ± 2.66, after treatment: 0.42 ± 0.95), facial pressure (baseline: 2.04 ± 2.97, after treatment: 0.58 ± 1.42) and general symptom (baseline: 6.00 ± 2.75, after treatment: 2.71 ± 1.90) were statistically decreased (t value was 4.386, 6.740, 2.445, 2.980, 6.989, respectively, all P0.05). VAS of nasal blockage, rhinorrhea and general symptom were statistically decreased after one-month's treatment (all P0.05), but no statistical improvements were observed between first, second and the third month (all P0.05). SNOT-20 was significantly decreased after treatment (t = 3.687, P0.01). 22.2% patients were cured on CT scan.Topical steroid improves objective symptoms and quality of life in CRS patients. Some of the patients can be cured in CT scores. The symptoms improvements begin from the first month, but do not change during the latter two months.

A B S T R A C T Objective: To evaluate the clinical efficacy of sublingual immunotherapy (SLIT) with house-dust mite (HDM) extract and to examine the change of biomarkers (TIM-1, IL-5 and IL-10) after 6-month SLIT in children with allergic rhinitis (AR). Methods: One hundred and sixteen HDM-sensitized children with persistent AR were enrolled to assess the clinical efficacy of SLIT by determining the individual nasal symptom score (INSS) and total nasal symptom scores (TNSS) after 6-month SLIT. Moreover, the mRNA expression of TIM-1, IL-5 and IL-10 in peripheral blood mononuclear cells (PBMCs) was examined in 16 well-controlled and 12 uncontrolled AR patients using quantitative reverse transcription polymerase chain reaction (qRT-PCR). Results: After 6-month SLIT, both TNSS and INSS scores were significantly decreased compared with the baseline value (p < 0.01). The rates for well-controlled, partly controlled and uncontrolled children were 43.1%, 32.8% and 24.1%, respectively. Accordingly, the mRNA levels of TIM-1 and IL-5 decreased significantly and IL-10 mRNA level increased significantly compared with the baseline value in wellcontrolled children (p < 0.05). Conclusion: Our findings suggest SLIT with HDM extract is effective and safe for AR children and TIM-1 may be considered as an indicator for evaluating the clinical efficacy of SLIT.