Meta analysis of the risk of air pollution in children with allergic rhinitis / 中国耳鼻咽喉头颈外科

OBJECTIVE To carry out a meta analysis on the results of all conducted studies to present valid information about the impact of air pollution exposure on the risk of allergic rhinitis in children. METHODS PubMed, Science, Google Scholar and MDPI database were searched up to January 1, 2012 to July 1, 2017, including the observational studies about air pollution and children with allergic rhinitis. Combie cross-sectional study evaluation tool and NOS scale were used to evaluate the quality of literature. The odds ratio of representative air pollutants(NO2, SO2, PM10) exposed to the risk of allergic rhinitis in children and it 95％ confidence interval as effects, and based on the heterogeneity analysis and publication bias test of Review Manager 5.3 software. The effects were analyzed by fixed or random effects model. RESULTS Finally, 6 studies were included in the meta analysis (4 cross-sectional studies, 2 cohort studies). The results showed that exposure to nitrogen dioxide increased the risk of allergic rhinitis(OR=1.22, 95％CI[1.04, 1.42], P=0.01), exposing tosulfur dioxideincreased the risk of allergic rhinitis(OR=1.06, 95％CI[0.96, 1.18], P=0.23), and PM10 increased the risk of allergic rhinitis(OR=1.13, 95％CI[1.04, 1.23], P=0, 004). CONCLUSION Air pollution is a risk factor for allergic rhinitis in children, and the risk of allergic rhinitis will be increase when exposed to NO2 and PM10.

Observation of systemic adverse reactions by specific immunotherapy and analysis of risk factors in allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

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

Clinical analysis of 258 cases of nasal-sinus benign and malignant tumors / 重庆医学

Objective To analyze the clinical features of 258 cases of nasal-sinus benign and malignant tumors to improve the accuracy of clinical diagnosis.Methods The clinical data of 258 patients with nasal-sinus tumor confirmed by pathology were retrospectively analyzed and the clinic differences between benign and malignant tumors were compared.Results The clinic manifestations of sinonasal neoplasm were varied.The incidences of epistaxis or blood in the tears,headache,facial numbness or pain,eye pain or epiphora were significantly higher in the benign tumors group than in the malignant tumors group (P＜0.05).Among 196 patients undergoing surgery,the coincidence rates of preoperative and postoperative paraffin sections were similar in the two groups (P＞0.05).Among 63 surgical patients with malignant tumors,the coincidence rate of 232 incised-margin frozen sections and postoperative paraffin sections was 98.70％ (229/232).Among 34 cases,the coincidence rate of frozen sections and postoperative paraffin sections was 91.18％0 (31/34),in which 6 cases were immediately intraoperative frozen,and 66.67％ (4/6) of the cases that changed into malignancy from benignity were not consistent with the preoperative diagnosis of paraffin sections.Conclusion The sinonasal tumors are lacking specificity in clinical manifestations,but rapid intraoperative frozen section examination is helpful to improve the diagnosis rate;continuously frozen pathological examination should be performed in malignant tumor margins.

Comparison of curriculum and degree conferment in higher medical education between Germany and China / 中华医学教育探索杂志

The higher medical education in China starts late and needs further exploration and improvement.While in Germany,it is elite education with a long history.Compared with China,in curriculum setting,Sociology,Medical health security,Humanities and Social Sciences and Organ system classification courses are more emphasized,and in terms of degree,it only has Doctor degree but with higher quality in Germany.Higher medical education in China will also take the path of the elite education.We can learn from the German medical education development experience and pay attention to solving the lack of the curriculum by supplementing social medicine and medical health security,increase the autonomy of the instructors in the training process,strengthen the medical students' social responsibility,and improve the quality of higher medical education in China.

The role of interleukin-2 pathway in pathogenesis of nasal polyps / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the expression of Interleukin2 (IL-2) signaling pathway related factors and Treg cell in nasal tissue of nasal polyps, so that to investigate the possible mechanism of IL-2 signaling pathway in the progress of nasal polyps and the correlation between IL-2 pathway and Treg cell.@*METHOD@#Thirty patients were enrolled for study, including the patients with nasal polyps and those with only deviated nasal septum as normal control. The nasal polyps tissue and the turbinate mucosa of the patients were collected during surgery. The expression levels of IL-2 and IL-2R were measured by means of ELISA. The level of pSTAT5 was evaluated by Western blot. We measured the level of Foxp3 mRNA in the tissue by real-time PCR, and the proportion of Treg cells was evaluated by flow cytometry. Finally. we analyzed the correlation between IL-2 pathway related factors and Treg cells in nasal polyps.@*RESULT@#The expression levels of IL-2. IL-2R and pSTAT5 were significantly decreased in the nasal polyps compared with normal control (P < 0.05), and the level of Foxp3 mRNA and proportion of Treg cells in patients with nasal polyps were significantly lower than in normal control (P < 0.05). Moreover, there was positive correlation between the levels of IL-2 pathway related factors and the levels of Foxp3 mRNA and Treg cells proportion in nasal polyps.@*CONCLUSION@#The activated state of IL-2 signaling pathway got changed in nasal polyps tissue, the level of which was positively correlated with the expression of Treg cells, indicating that the IL-2 signaling pathway may play a crucial role in the development of nasal polyps, and the decreased level of Treg cells in nasal polyps may result from the downregulation of IL-2 signaling pathway.

Expression and role of IL-17 in nasal polyposis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the expression of interleukin-17 (IL-17) in nasal polyps from both atopic and nonatopic patients, and its associations with histological features of polyps tissue.@*METHOD@#Thirty patients with nasal polyps (NP) were included and divided into atopic and nonatopic groups according to the skin prick test. Histological characteristics were assessed by eosinophilic infiltration with HE staining. IL-17 expression in polyps tissue was detected by ELISA and RT-PCR.@*RESULT@#Eosinophilic infiltration was significantly higher in atopic NP patients than in nonatopic NP patients (P < 0.01). IL-17 protein and IL-17 mRNA levels were significantly upregulated in both atopic (P < 0.01) and nonatopic (P < 0.05) patients compared with controls. Furthermore, IL-17 levels were significantly higher in the atopic group than in nonatopic group. Significantly positive correlations were found between IL-17 levels and eosinophilic infiltration in NP patients.@*CONCLUSION@#These results indicated that expression of IL-17 was significantly upregulated in NP patients and was especially higher in atopic NP patients, suggesting that IL-17 may play an important role in the pathogenesis of NP and atopy may contribute to NP by stimulating the production of IL-17.

Association analysis of IL-23R polymorphisms in allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Polymorphism of interleukin-23 receptor (IL-23R) gene was found being related with the susceptibility to several immune-related diseases. For the terminal differentiation of IL-17-producing effecter T-helper cells in vivo, the IL-23R gene is very important. As proved recently, Th17 cells might have a great influence to the pathogenesis of allergic airways disease. Our intention was paid to find any association between the polymorphisms in the IL-23R gene and allergic rhinitis(AR) in Chinese population.@*METHOD@#A group of patients was involved in a case-control comparison, consisted of 239 AR patients and 271 control Chinese subjects. The study claimed to take some blood samples for DNA extraction and select 3 single-nucleotide polymorphisms in IL-23R individually genotyped by the PCR-RFLP method.@*RESULT@#Comparison with the controls, a great growing prevalence of the homozygous rs7517847 GG genotype and G allele appeared in AR patients (P < 0.05, respectively). Besides, a great increased frequency of the GGA haplotypes was presented in AR patients in comparison with the controls (P < 0.05).@*CONCLUSION@#The results demonstrated a important association pattern between polymorphisms in IL-23R and AR in Chinese population. Between rs7517847 in an SNP of IL-23R and AR, a great association was identified.

The correlations of chronic rhinonasal diseases and chronic obstructive pulmonary disease / 临床耳鼻咽喉头颈外科杂志

Chronic rhinonasal diseases and chronic obstructive pulmonary disease (COPD) cause impairment to the quality of life, increase the hospitalization and mortality. But we know little about the relationship between chronic rhinonasal disease (such as rhinitis, sinusitis, nasal polyps and so on) and COPD. This review aimed to reveal the correlation of rhinonasal disease and COPD, as in epidemiology, mechanism, clinical presents, treatment and so on.

Application of European position paper on rhinosinusitis and nasal polyps in clinical teaching for Otorhinolaryngology postgraduates / 中华医学教育探索杂志

Rhinosinusitis is a popular disease in otorhinolaryngology.A guideline document,European position paper on rhinosinusitis and nasal polyps (EPOS) developed on the basis of evidencebased medicine was used in clinical teaching.Theoretical teaching was promoted by reading and understanding EPOS.Meanwhile,EPOS was used in clinical practices of preclinical ward round,case analysis and independent bed charge,which laid a solid foundation to help otorhinolaryngology postgraduates fully grasp the theoretical knowledge of rhinosinusitis and nasal polyps,improve clinical practice abilities and develop standardized philosophy of diagnosis and treatment finally.

The expression of Treg/Th17 cells related transcription factors and cytokines in PBMCs and plasma in patients with allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the changes of Treg/Th17 cells related transcription factors (FOXP3, RORC) and cytokines (TGF-beta, IL-17) in the peripheral blood in patients with allergic rhinitis.@*METHOD@#Use visual analogue scale (VAS) to assess the allergic rhinitis severity of patients. Eighteen patients with allergic rhinitis and 12 healthy control subjects were consecutively enrolled. Peripheral blood samples were obtained from all patients and healthy control subjects (after prick test). The mRNA expressions of key transcription factors (RORC, FOXP3) in PBMCs were measured by RT-PCR, and the concentrations of TGF-beta, IL-17 in plasma were measured by ELISA.@*RESULT@#Patients with moderate/severe persistent rhinitis have a VAS of 8.5 +/- 0.8, and total patients have a VAS of 6.2 +/- 1.6. Compared with healthy control subjects, the mRNA expressions of FOXP3 and the concentrations of TGF-beta in plasma were significantly lower in patients with allergic rhinitis (P < 0.01) while the mRNA expressions of RORC and the concentrations of IL-17 in plasma were significantly higher in allergic rhinitis group (P < 0.01).@*CONCLUSION@#The imbalance of Treg/Th17 cells existed in allergic rhinitis patients, which may contribute to the proceeding of allergic rhinitis.

The role of TGF-beta activation on different pathological phenotypes in chronic rhinosinusitis / 临床耳鼻咽喉头颈外科杂志

Transforming growth factor-beta (TGF-beta) as a main switch has a crucial role in chronic rhinosinusitis (CRS) subtypes. The physiological functions of the secreted inactive TGF-beta are precisely regulated by suppressing factors, such as latency-associated peptide (LAP), latent TGF-beta-binding protein (LTBP) and fibrillin, as well as activating factors, such as integrins, proteases and thrombospondin-1. With progress in understanding the factors responsible for regulating TGF-beta functions, it has been revealed that the dysregulation of TGF-beta activation is closely associated with lung fibrosis and chronic obstructive pulmonary disease. Since the imbalance between TGF beta-regulating factors may be one of the main reasons for different phenotypes of CRS, we reviewed the advancement in the research of TGF-beta activation and its role in CRS pathogenesis, to provide insight into the CRS investigation in human.

Epidemiological features of allergic rhinitis in four major cities in Western China / 华中科技大学学报（医学）（英德文版）

Allergic rhinitis (AR), with an increasing uptrend of the prevalence in many developed and developing countries, is a global health problem that affects people of all ages and ethnic groups. However, data on the prevalence of self-reported AR in western China are rare. This study investigated the epidemiological features of self-reported AR in western China. In the cross-sectional, population-based study, a validated questionnaire survey on self-reported AR was carried out in 4 major cities in western China by multistage, stratified and cluster sampling, from January to December 2008. The total prevalence rate was 34.3%, with 32.3% (Chongqing), 34.3% (Chengdu), 37.9% (Urumqi), 30.3% (Nanning), respectively. The prevalence presented to increase with age before 30 years old while decrease with age after 30 years old, and the highest prevalence was in 19-30 years group in Chongqing, Chengdu and Nanning which significantly showed "persistent and moderate-severe" type (P<0.0001); In Urumqi, there wasn't a significant increasing or decreasing trend of prevalence rate with age but with an "intermittent and mild"predominance (P<0.0001). There were no distinct sexual differences in prevalence rates in the 4 cities. The morbidity was positively related to monthly average temperature and sunshine (r=0.76645, P=0.0036; r=0.67303, P=0.0165), but negatively associated with relative humidity (r=-0.64391, P=0.0238) in Urumqi. Interestingly, the monthly morbidity was negatively associate with average temperature, sunshine and precipitation in Nanning (r=-0.81997, P=0.0011; r=-0.60787, P=0.0360; r=-0.59443, P=0.0415). Self-reported AR is becoming common in western China with a rapid development in recent years, affecting about three persons out of ten. The climatic factors may have an indirect impact on the prevalence rate through the effects on the local allergens.

Serum levels of IL-12, IL-4 and pathologic changes by scanning electron microscope of nasal mucous inflammation / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The serum levels of interleukin-4, interleukin-12 will be detected to elucidate and compare the involvement of Th1 and Th2 cells and the surface structures of nasal mucosa will also be observed in patients with allergic rhinitis (AR), chronic rhinosinusitis with nasal polyps (CRSwNP), chronic rhinosinusitis without nasal polyps (CRSsNP) and nasal septal deviation (NSD) to obtain the characteristics and regularity of pathological changes.@*METHOD@#The serum levels of interleukin-4, interleukin-12 were detected by enzyme linked immunosorbent assay method. Four pieces of nasal mucosa on lateral side of middle turbinate were sampled from four patients and observed by scanning electron microscope.@*RESULT@#The levels of interleukin-4 in AR and NSD groups were significantly higher than the healthy controls (P 0.05). There were two points of regularity with different degrees in our observations: (1) disoriented and absence of cilium; (2) the cellular separations at cell junctions were obvious, even with cells lost.@*CONCLUSION@#There was an immunologic deviation towards Th2 pattern in patients with NSD the same as AR. Both Th1 and Th2 with hyperactivity participated in chronic inflammatory process of CRSwNP and CRSsNP. The pathological changes of ciliated columnar epithelium in patients with the four types of rhinitis, suggest that a comprehensive treatment including antral irrigations, multiple antibiotics, topical steroid sprays, or antihistamines, as well as nasal surgery to correct nasal deformities should be adopted, which can effectively prevent the development and expanding of the nasal mucosa inflammation.

Analysis on quality of life and personality characteristics of allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To probe into both the quality of life and personality characteristics of allergic rhinitis (AR) patients.@*METHOD@#AR patients were investigated by questionnaires of SRF-36, EPQ, SAS, SDS, then the influencing factors were analyzed by multiple regression analysis.@*RESULT@#People suffered from AR were influenced on quality of life, especially on role-physical, general health, role-emotional; there was no obviously difference on personality characteristics; however, anxiety tendency but no depressive emotion was observed.@*CONCLUSION@#In order to seek better treatment under new medical model, we should put emphasis on the quality of life and personality characteristics of AR patients.

The effect of short hairpin RNA and DNAzyme gene therapy on latent membrane protein-1 expression in nasopharyngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the inhibitory effects of short hairpin RNA (pshLMP1) combined with DNAzyme or alone on latent membrane protein-1 (LMP1)expression in HNE1 cell lines.@*METHOD@#The pshLMP1 and DNAzymes were co-transfected with pEGFP-N1-1158 (a expression vector encoding LMP1 and EGFP fusion protein) into HNE1 cells, divided into 4 groups as positive control, RNA interference, combining and DNAzyme groups. The green fluorescence were analyzed and then the mRNA and protein of LMP1 gene were detected.@*RESULT@#The HNE1 cells expressing green fluorescence in combining group were significantly less than that in RNA interference group (P < 0.01); The inhibition efficiency of green fluorescence in combining group were 86. 31% Wp 88.88% ,which were higher than that in RNA interference group with 75.15%. The detection of LMP1 mRNA and proteins showed that combining group had a higher inhibition ability.@*CONCLUSION@#Combining gene therapy with pshLMP1 and DNAzyme is superior to pshLMP1 alone to inhibit LMP1 gene expression.

Effect of intra nasally applied fluticasone propionate and levocabastine on the expression of aquaporin 5 in nasal mucosa of rat with experimental allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the expression and distribution of aquaporin 5 (AQP5) in allergic rhinitis (AR) treated by fluticasone propionate and levocabastine.@*METHOD@#Forty Wistar rats were divided randomly into AR (n=30) and control groups (n=10). After AR models were established, the AR rats were divided evenly into F group, L group and AR control group. Three groups were treated respectively for 28 days, then the expression of AQP5 in nasal mucous membrane were detected by immunohistochemistry assay.@*RESULT@#The distribution of AQP5 was consistent in all groups. The expression of AQP5 in F group was significantly different from L group and AR group (P0.05). The expression of AQP5 in L group was significantly different from that in control group (P<0.05).@*CONCLUSION@#High expressions of AQP5 in rat with AR indicated the positive correlation between AQP5 and AR. AQP5 might be one of pathological factors of AR concerned with glands excessive secretion and tissue edema. Glucocorticoid can down-regulate the expression of AQP5, but H1-receptor antagonist can not reduce the expression of AQP5.

Effect of intra nasally applied fluticasone propionate and levocabastine on the expression of aquaporin 5 in nasal mucosa of rat with experimental allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the expression and distribution of aquaporin 5(AQP5) in allergic rhinitis(AR)treated by fluticasone propionate and levocabastine.Method:Forty Wister rats were divided randomly into AR(n=30) and control groups(n=10). After AR models were established, the AR rats were divided evenly into F group, L group and AR control group.Three groups were treated respectively for 28 days, then the expression of AQP5 in nasal mucous membrane were detected by immumohistochemistry assay.Result:The distribution of AQP5 was consistent in all groups. The expression of AQP5 in F group was significantly different from L group and AR group (P 0.05). The expression of AQP5 in L group was significantly different from that in control group(P<0.05).Conclusion:High expressions of AQP5 in rat with AR indicated the positive correlation between AQP5 and AR. AQP5 might be one of pathological factors of AR concered with gland's excessive secretion and tissue edema. Glucocorticoid can down-regulate the expression of AQP5,but H1-receptor antagonist can not reduce the expression of AQP5.

Analysis of EBV-LMP1 gene mutation in plasma of patients with nasopharyngeal carcinoma in Chongqing / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To detect and analyze the EBV-LMP1 gene N terminus XhoI-site mutation and C terminus 30 bp deletion in plasma of patients with nasopharyngeal carcinoma (NPC) in Chongqing of China.@*METHOD@#DNA extraction and PCR amplification was used in plasma of 48 NPC patients and 40 control non-NPC cases from Chongqing of China. All the PCR production of N terminus was digested by enzyme XhoI, then segregated in 8% PAGE. All- the PCR production of C terminus was segregated in 8% PAGE too. Compared with B95-8 cell, some of the PCR production were sequenced and analyzed with software.@*RESULT@#LMP1 was amplified successfully from 48 of 48 NPC cases (100%) and from 38 of 40 non-NPC cases (95%) by PCR, but none of LMP1 XhoI-site mutation and none of 30 bp deletion was found by digesting, segregating and Sequencing.@*CONCLUSION@#EBV-LMP1 gene N terminus XhoI-site and C terminus 30 bp deletion have no mutation in plasma of NPC or non-NPC cases in Chongqing of China. The precise relationship of EBV-LMP1 gene mutation or deletion with NPC pathogenesis needs further investigation.

High glucose concentration incseases the MAPK and TGF?_2 expression in cultured P38 human umbilical vein endothelial cells / 基础医学与临床

Objective To examine the effects of glucose on the expression of P38 MAPK and TGF?2 in cultured human umbilical vein endothelial cells.Methods Human umbilical vein endothelial cells(HUVECs)were incubated in a culture medium with 11.2 mmol/L,16.8 mmol/L and 33.6 mmol/L glucose concentrations for 24 h,48 h and 72 h respectively.The expression P38 MAPK and TGF?2 was measured by RT-PCR and Western-blot.Results When D-glucose concentrations rose,HUVECs exposed to high glucose concentration(11.2 mmol/L,16.8 mmol/L and 33.6 mmol/L)showd increase in cell expression of P38 MAPK and TGF?2 after 48 h and 72 h exposure as compared with those cultured in medium of low glucose concentration(5.6 mmol/L).ConclusionHigh concentration of glucose can arrest the proliferative response.Even a short-term exposure of endothelial cells(ECs)to high glucose concentration may lead to their activation associated with increased expression of P38 MAPK and TGF?2.High Glucose Concentration on P38 MAPK and TGF?2 expression may participate the pathogenesy of diabetic retinopathy.

Survey on the epidemiological features of allergic rhinitis at out-patient in western area of China / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the epidemic features of allergic rhinitis at out-patient in western area of China(Chengdu in Sichuan province, Chongqing, Urumchi in Xinjiang province, Nanning in Guangxi province). METHODS A questionnaire survey on AR, rhinology examination and skin prick test were carried out among 2267 AR patients at out-patient, from Mar. 2005 to Dec. 2006. RESULTS The incidence rate of sneezing、runny nose、stuffy nose、itchy nose were 88%, 89.19%, 85.58%, 83.58% respectively. 43.80% of AR patients had inherent predisposition that 25.50% had hereditary AR and 13.45% had hereditary asthma. 46.98% of AR patients had other allergic diseases, among them 10.50% combined with asthma. According to the classification criteria of Haikou in 1997 and ARIA in 2001, there were mainly seasonal AR and mild intermittent AR in Urumchi area, while perennial AR and moderate-severe persistent AR in other areas. There was a significant impairment in Quality of life that 50% were always upset and 40% didn't sleep well and more than 10% had emotional affections. CONCLUSION We had got epidemic data such as characteristics of clinical presentation of AR at out-patient in western of China. Strategy of prevention and treatment of AR should be worked out according to the epidemic feature of AR.