Association between airborne particulate matter（PM 2.5） concentration and the incidence of allergic rhinitis in Shanghai / 临床耳鼻咽喉头颈外科杂志

Objective:To explore the impact of PM 2.5 concentration in Shanghai on the incidence of allergic rhinitis（AR） in the population, and provide strategies for early warning and prevention of AR. Methods:Collect daily average concentrations of atmospheric pollutants monitored in Shanghai from January 1, 2017 to December 31, 2019, and clinical data of AR patients from five hospitals in Shanghai during the same period. We used a time-series analysis additive Poisson regression model to analyze the correlation between PM 2.5 levels and outpatient attendance for AR patients. Results:During the study period, a total of 56 500 AR patients were included, and the daily average concentration of PM 2.5 was（35.28±23.07）μg/m³. There is a correlation between the concentration of PM 2.5 and the number of outpatient attendance for AR cases. There is a positive correlation between the daily average number of outpatient for AR and levels of PM 2.5 air pollution（（P<0.05）） . We found that every 10 μg/m³ increase in PM 2.5, the impact of on the number of AR visits was statistically significant on the same day, the first day behind, and the second day behind, with the strongest impact being the exposure on the same day. Every 10 μg/m³ increases in PM 2.5, the number of outpatient visits increased by 0.526% on the same day（95%CI 1.000 50-1.010 04）. Conclusion:The atmospheric PM 2.5 concentration in Shanghai is positively correlated with the number of outpatient for AR, and PM 2.5 exposure is an independent factor in the onset of AR. This provides an important theoretical basis for AR.

Analysis of differential gene expressions of inflammatory and repair-related factors in chronic refractory wounds in clinic / 中华烧伤杂志

Objective@#To compare the tissue morphology and gene expressions of inflammatory and repair-related factors in chronic refractory wound tissue including pressure ulcers and diabetic feet.@*Methods@#During August 2016 to September 2017, 10 samples of prepuce were collected after circumcision of 10 urological patients [all male, aged (38±4) years old] admitted in the First Affiliated Hospital of Nanchang University and included in normal skin group, samples of tissue around the edge of wounds with blood supply were collected from 9 heat or electric burn patients [6 male patients, 3 female patients, aged (51±8) years old], 13 pressure ulcer patients [9 male patients, 4 female patients, aged (51±14) years old] and 10 diabetic foot patients [8 male patients, 2 female patients, aged (61±10) years old] during the operations. The samples were divided into burn wound group (9 samples), pressure ulcer group (13 samples), and diabetic foot group (10 samples). Ten slices were taken from pressure ulcer group and diabetic foot group respectively, and 5 slices in each group were used to observe the tissue morphology and expressions of Ki67 and CD31 of wounds respectively with immunofluorescence method. Ten samples from normal skin group, 9 samples from burn wound group, 13 samples from pressure ulcer group, and 10 samples from diabetic foot group were collected for analysis of mRNA expressions of vascular endothelial growth factor 192 (VEGF192), transforming growth factor β (TGF-β), vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1) , interleukin-1β (IL-1β), IL-6, and tumor necrosis factor α (TNF-α) by real time fluorescent quantitative reverse transcription polymerase chain reaction. Data were processed with Mann-Whitney U test and Kruskal-Wallis rank-sum test.@*Results@#(1) The expression level of Ki67 in diabetic foot group (390±100) was higher than that of pressure ulcer group (182±14, Z=-2.611, P<0.01). (2) Although there were a large number of vascular endothelial cells (CD31 positive cells) in wounds of diabetic foot group, their distribution was disordered and failed to form intact lumen. There were less vascular endothelial cells in wounds of pressure ulcer group than those of diabetic foot group, but the complete lumen was formed. (3) The mRNA expression levels of VEGF192 in wounds of burn wound group, pressure ulcer group, and diabetic foot group were significantly lower than the level in normal skin group (H=13.72, 30.50, 15.20, P<0.05 or P<0.01), and the level was the lowest in pressure ulcer group. The mRNA expression level of VEGF192 in wounds of pressure ulcer group was significantly lower than that of diabetic foot group (H=15.30, P<0.01). Compared with that of normal skin group, the mRNA expression level of TGF-β in wounds of burn wound group showed no significant difference (H=-9.50, P>0.05), while the mRNA expression levels of TGF-β in wounds of pressure ulcer group and diabetic foot group were significantly decreased (H=18.04, 14.50, P<0.01). The mRNA expression level of TGF-β in wounds of pressure ulcer group was similar to that of diabetic foot group (H=3.54, P>0.05). (4) Compared with those of normal skin group, the mRNA expression levels of VCAM-1 in wounds of burn wound group and pressure ulcer group were significantly increased (H=-22.50, -11.50, P<0.05 or P<0.01), and there was no significant difference in the mRNA expression level of VCAM-1 in wounds of diabetic foot group (H=10.00, P>0.05); the mRNA expression level of ICAM-1 in wounds of burn wound group showed no significant difference (H=-9.50, P>0.05), and the levels of ICAM-1 in wounds of pressure ulcer group and diabetic foot group were significantly decreased (H=16.50, 16.50, P<0.01). The mRNA expression level of VCAM-1 in wounds of pressure ulcer group was significantly higher than that of diabetic foot group (H=-21.50, P<0.01), the mRNA expression level of ICAM-1 in wounds of pressure ulcer group was similar to that of diabetic foot group (H=0, P>0.05). (5) Compared with those of normal skin group, except for the mRNA expression level of IL-1β in wounds of diabetic foot group showed no significant difference (H=-10.00, P>0.05), the mRNA expression levels of IL-1β in wounds of burn wound group and pressure ulcer group were significantly increased (H=-32.50, -21.50, P<0.01); the mRNA expression levels of IL-6 were significantly increased in wounds of burn wound group, pressure ulcer group, and diabetic foot group (H=-17.50, -30.50, -11.80, P<0.05 or P<0.01); except for the mRNA expression level of TNF-α in wounds of burn wound group showed no significant difference (H=-9.50, P>0.05), the mRNA expression levels of TNF-α in wounds of pressure ulcer group and diabetic foot group were significantly decreased (H=18.04, 14.50, P<0.01). The mRNA expression levels of IL-1β and TNF-α in wounds of pressure ulcer group were significantly lower than those of burn wound group (H=11.00, 27.54, P<0.05 or P<0.01), while the mRNA expression level of IL-6 was significantly higher (H=-13.00, P<0.05). The mRNA expression levels of IL-1β and TNF-α in wounds of diabetic foot group were significantly lower than those of burn wound group (H=22.50, 24.00, P<0.01), while the mRNA expression level of IL-6 showed no significant difference (H=5.70, P>0.05).@*Conclusions@#The phenotypes of diabetic foot and pressure ulcer vary from the expressions levels of proliferating cell nuclear antigen and blood vessels forming ability to the expression levels of growth factors, cell adhesion factors, and inflammatory cytokines.

Chinese Society of Allergy Guidelines for Diagnosis and Treatment of Allergic Rhinitis

Allergic rhinitis (AR) is a global health problem that causes major illnesses and disabilities worldwide. Epidemiologic studies have demonstrated that the prevalence of AR has increased progressively over the last few decades in more developed countries and currently affects up to 40% of the population worldwide. Likewise, a rising trend of AR has also been observed over the last 2–3 decades in developing countries including China, with the prevalence of AR varying widely in these countries. A survey of self-reported AR over a 6-year period in the general Chinese adult population reported that the standardized prevalence of adult AR increased from 11.1% in 2005 to 17.6% in 2011. An increasing number of original articles and imporclinical trials on the epidemiology, pathophysiologic mechanisms, diagnosis, management and comorbidities of AR in Chinese subjects have been published in international peer-reviewed journals over the past 2 decades, and substantially added to our understanding of this disease as a global problem. Although guidelines for the diagnosis and treatment of AR in Chinese subjects have also been published, they have not been translated into English and therefore not generally accessible for reference to non-Chinese speaking international medical communities. Moreover, methods for the diagnosis and treatment of AR in China have not been standardized entirely and some patients are still treated according to regional preferences. Thus, the present guidelines have been developed by the Chinese Society of Allergy to be accessible to both national and international medical communities involved in the management of AR patients. These guidelines have been prepared in line with existing international guidelines to provide evidence-based recommendations for the diagnosis and management of AR in China.

Experimental study on dendritic cells modified by dust mite allergen gene in the treatment of allergic rhinitis in mouse / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the therapeutic effects of dendritic cells (DC) modified by the dust-mite-allergen(Der p1) gene on mouse model of allergic rhinitis (AR).@*Methods@#DC modified by the Der p1 gene (Der p1-DC) were prepared.Using random number table, 24 Balb\c mice were divided into four groups: immature DC (imDC)/AR group, dexamethasone/AR group, Der p1-DC/AR group and control group, with 6 mice in each group.AR mouse model was built with Der p1 and the mouse model of AR was established.The AR mice were respectively given by abdominal injection of Der p1-DC, imDC and dexamethasone.Normal control mice were treated with physiologic saline.ELISA method was used for determining the content of IgE, IgG1and histamine in blood.The relative expression of mRNA of IL-4 and IL-13 on nasal mucosa with protein was analyzed by RT-PCR and Westen blot methods.All the data were statistically analyzed by SPSS 19.0 statistical software, and the variance analysis was used in multiple groups of average samples.@*Results@#The contents of IgE, IgG1 and histamine in the mice of Der p1-DC/AR group were lower than those in imDC/AR group ((0.560±0.110) OD 450 nm vs (1.150±0.280) OD 450 nm, (0.690±0.054) OD 450 nm vs (0.920±0.125) OD 450 nm, (4 145±670) pg/ml vs (7 685±669) pg/ml, t value was 4.80, 4.14, 9.16, respectively, all P<0.05), and the expression of IL-4 and IL-13 on nasal mucosa in Der p1-DC/AR group was remarkedly lower than those in imDC/AR group (0.41±0.25 vs 1.59±1.02, 0.26±0.01 vs 1.10±0.09, t value was 2.75, 22.72, respectively, all P<0.05). There was no statistically significant difference between the mice treated with Der p1-DC and dexamethasone group.@*Conclusions@#The results showed that Der p1-DC could reduce inflammation in AR mice and decrease the expression of IL-4 and IL-13. It suggested that Der p1-DC can be used in the immunotherapy of AR mouse.

Effect of hydrogen-rich saline on the CD4+ CD25+ Foxp3+ Treg cells of allergic rhinitis guinea pigs model / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the effect of hydrogen-rich saline on the CD4+ CD25+ Foxp3+ Treg cells in a guinea pig model of allergic rhinitis (AR) and investigate the underling anti-inflammatory mechanism.@*Methods@#Using random number table, eighteen guinea pigs were divided into three groups (control group/AR group/HRS group, n=6 of each group). AR guinea pig model was built with ovalbumin and aluminum. The guinea pigs were injected with hydrogen-rich saline (HRS group) for ten days after sensitation. And control group was injected with equal normal saline at the same time. Number of sneezes, degree of runny nose and nasal rubbing movements were scored. Peripheral blood eosinophil count was recorded. The content of interleukin 10(IL-10) and transforming growth factor β (TGF-β) in the serum were detected by enzyme-linked immunosorbent assay (ELISA). Immunohistochemical method was taken to detect IL-10 and TGF-β in nasal mucosa. The proportion of CD4+ CD25+ Foxp3+ T cells in the CD4+ T cells of spleen and peripheral blood were determined with flow cytometry. SPSS 17.0 software was used to analyze the data.@*Results@#There was significant difference in symptom scores among them. The scores of AR group preceded control group, and HRS could decrease the scores of AR ((6.29±1.79) vs (1.01±0.71), (4.50±0.84) vs (6.29±1.79), F=24.725, all P<0.05). The highest number of eosinophils in the peripheral blood belonged to control group, and the number of eosinophils were dramatically reduced after HRS administration ((0.41±0.05)×109/L vs (0.25±0.03 )×109/L, (0.32±0.03)×109/L vs (0.41±0.05)×109/L, F=70.05, all P<0.05). The content of IL-10 and TGF-β in control group is peak ((86.88±17.17) pg/ml, (598.28±72.70) pg/ml, respectively), and compared with AR group, HRS also increased the expression of IL-10 and TGF-β of peripheral blood ((72.54±11.75) pg/ml vs (53.49±10.07) pg/ml, (530.23±57.15) pg/ml vs (482.69±65.96) pg/ml, F value was 28.357, 14.128, respectively, all P<0.05). The proportion of CD4+ CD25+ Foxp3+ Treg cells in controls exceeded HRS group and AR group (1.81%±0.10%, 1.29%±0.74%, respectively), and HRS treatment increased the ratio of CD4+ CD25+ Foxp3+ Treg cells than AR group of peripheral blood ((1.50%±0.11%) vs (1.15%±0.11%), F=168.96, P<0.05). But there was no significant diferences in splene tissue ((1.01%±0.08%) vs (0.98%±0.09%), F=97.381, P>0.05).@*Conclusion@#Both the number and the cytokine secretion of CD4+ CD25+ Foxp3+ Treg cells are decreased in AR group, HRS may inhibit inflammatory response and ameliorate AR via improving the number and the cytokine secretion.

The effect of dendritic cells on allergic rhinitis in sublingual therapy / 临床耳鼻咽喉头颈外科杂志

Dendritic cells (DCs) is known as the most potential and professional antigen presenting cells (APC), it mainly involves in the cellular immunity and T cell dependent humoral immunity, which plays a key role in the immune response and is one of the most hot areas in immunology in recent years. DCs plays a key role in allergic rhinitis (AR) and is one of the most important mechanism of AR treating by sublingual immunotherapy (SLIT). This article reviewed the mechanism of the role of DCs in AR and AR treating by SLIT.

Early compliance and efficacy of sublingual immunotherapy in patients with allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The study aimed to investigate the efficacy and adverse effects of sublingual immunotherapy (SLIT) of dust mite drops to allergic rhinitis with mite allergy. The compliance and satisfaction of SLIT were also assessed.@*METHOD@#One hundred and three patients of allergic rhinitis sensitive to dust mites were treated with SLIT for 6 months or more. The symptom questionnaire,including items on rhinorrhea, sneezing, nasal obstruction, itchy nose, olfactory disturbance, eye discomfort and sleep disturbance were obtained before and 6 months after SLIT. The patients' satisfaction and adverse effects were also investigated.@*RESULT@#Seventy-five of the 103 patients insist on SLIT for more than 6 months and completed the questionnaire. The duration of receiving SLIT was 9.8 months on average (range from 6 to 13 months). The satisfaction rate was 89.3%. The drop-out rate of SLIT was 31.0%.@*CONCLUSION@#The subjective symptoms were improved with SLIT in patients with allergic rhinitis sensitive to dust mites. The drop out rate was high despite of the symptomatic improvement.

Content of CD4+ CD25+ regulatory T cells in peripheral blood lymphocytes in patients with allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the change of CD4- CD25 regulatory T cells (Tregs) of peripheral blood in allergic rhinitis (AR) patients.@*METHOD@#T lymphocytes of twenty AR patients and eight healthy subjects were separated and the flow cytometry was used to measure the percentage of CD4+ CD25+ Treg.@*RESULT@#Compared with control group, the percentage of Treg and CD4- CD25high Tregs of AR patients was decreased significantly (P < 0.05).@*CONCLUSION@#The proportion of CD4+ CD25+ Tregs decreased in AR patients conspicuously, which might be one of the pathogenesis of AR.

Application of mucoperiosteal flap of nasal septum to repair defect of fossa orbitalis, hard palate and the anterior skull base / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the neoplasia of fossa orbitalis, hard palate and the anterior skull base defect by making use of mucoperiosteal flap of nasal septum.@*METHOD@#A retrospective study was reviewed in 12 patients with tumors in nasal cavity and nasal sinuses. According to tumor character and range, by partial or total maxillectomy and ethmoidectomy, fossa orbitalis, hard palate and the anterior skull base defects were repaired synchronously on the heels of resection of the tumors which damaged fossa orbitalis, hard palate and the anterior skull base.@*RESULT@#Among the 12 patients there were 5 patients with the destructions on ethmoidal horizontal plate, 2 patients with the destructions on hanging wall of ethmoid, 1 patient with the destruction on hanging wall of fossa orbitalis, 1 patient with the destruction on medial wall of fossa orbitalis and on floor of orbit respectively, 2 patients with the destructions on hard palate and all the destructions were repaired following detection synchronously. There were no complications of surgical death, cerebrospinal fluid leaks, encephalomeningocele.@*CONCLUSION@#During the operation of tumor in nasal cavity and/or nasal sinuses when defect of fossa orbitalis, hard palate and anterior skull base were found and the defects need repair, we can take advantages of mucoperiosteal flap of nasal septum to perform the transplantation of mucoperiosteal flap in order to avoid forming local defect.

Different expression of histamine H4 receptor in nasal mucosa in allergic rhinitis patients / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To observe expression and distribution of histamine H4 receptor in nasal mucosa in normal people and allergic rhinitis patients,and understand role of histamine H4 receptor in allergic rhinitis.@*METHOD@#Select normal people and allergic rhinitis patients each 10, take the nasal mucosa, detect expression and distribution of histamine H4 receptor at proteins and transcription level respectively by immunohistochemical method and RT-PCR, and compared.@*RESULT@#Histamine H4 receptor at proteins and transcription level were found in normal nasal mucosa (25 509 +/- 6 441, 0.42 +/- 0.08), increased significantly in nasal mucosa of allergic rhinitis patients (49 676 +/- 8 541, 0.69 +/- 0.11, P < 0.05), which in structural cells and immune cells.@*CONCLUSION@#Histamine H4 receptors exist in normal nasal mucosa, its express significantly enhance, flew histamine H4 receptor may be mediated histamine in pathogenesis of allergic rhinitis ,who is one of the ligands of histamine.

Study on the expression of Eotaxin and the role of histamine in allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the expression of Eotaxin and the effect of histamine in allergic rhinitis model (AR), and aim to explore the pathogenesis of AR.@*METHOD@#The AR models were established by application of ovum albumin in rats. The expression of Eotaxin in nasal mucosa, serum and nasal cavity lavage fluid, were observed before and after treatment of histamine or its antagonist by immunochemistry, RT-PCR and ELISA technique.@*RESULT@#The expression of Eotaxin in nasal lavage fluid and nasal mucosa increased after treatment of histamine (P < 0.05). Contrarily, the expression of Eotaxin in nasal lavage fluid, nasal mucosa and serum decreased after treatment of the antagonist of histamine.@*CONCLUSION@#Both histamine and its receptor can involve in the pathogenesis of AR by affecting the expression of Eotaxin.

Study on the expression of Eotaxin and the role of histamine in allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

Objective: To explore the expression of Eotaxin and the effect of histamine in allergic rhinitis model (AR),and aim to explore the pathogenesis of AR. Method:The AR models were established by applicating of ovain albumin in rats. The expression of Eotaxin in nosal mucosa,serum and nasal cavity lavage fluid,were observed before and after treatment of histamine or its antagonist by immunochemistry,RT-PCR and ELISA technique. Result:The expression of Eotaxin in nasal lavage fluid and nasal mueosa increased after treatment of histamine(P＜0.05). Contrarily,the expression of Eotaxin in nasal lavage fluid,nasal mucosa and serum decreased after treatment of the antagonist of histamine. Conclusion:Both histamine and its receptor can involve in the pathogenesis of AR by affecting the expression of Eotaxin.

The role of hydrogen sulfide and cystathionine-gamma-lyase in allergic rhinitis guinea pigs / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the change of endogenous hydrogen sulfide (hydrogen sulfide, H2S) and its rate-limiting enzyme Cystathionine-gamma-lyase (CSE) in allergic rhinitis through guinea pigs with intervention treatment.@*METHOD@#Twenty-four guinea pigs were divide into 4 groups at random, one group were models of allergic rhinitis (AR) which were established by using ovalbumin, the second group were treated with NaHS after sensitized, the third group were treated with Propargylglycine (PPG) which was suppression of CSE after sensitized, and the last group were treated with saline for control. The concentration of eotaxin of nasal lavage and H2S in plasma were recorded, and then the expression of CSE in nasal mucosa was determined by real-time fluorescence RT-PCR.@*RESULT@#The concentration of eotaxin in nasal lavage of sensitized group were higher than those of control (P < 0.01), and concentration of H2S in plasma and expression of CSE in nasal mucosa were lower than control (P < 0.05). The concentration of eotaxin decreased when treated with NaHS and increased when treated with PGG (P < 0.05). Level of H2S in plasma and expression of CSE increased when treated with NaHS and decreased when treated with PGG (P < 0.05), and the level of H2S was positive linear correlate with the expression of CSE.@*CONCLUSION@#Endogenous H2S perhaps plays a significant role in the pathogenesis of allergic rhinitis, and it was mainly regulated by CSE.