Difficult-to-treat asthma is a complex disease with poor response to high-dose inhaled corticosteroids plus a second controller or need high levels of treatment to maintain control.Difficult-to-treat asthma represents a significant clinical challenge and a heavy medical burden due to its heterogeneity.Identification of the phenotypes and endotypes in difficult-to-treat asthma is very helpful for individualized therapy.This review summarizes the latest studies on the classification of difficult-to-treat asthma in order to provide evidence for the diagnosis and treatment of difficult-to-treat asthma in children.

Objective The aim of the study was to investigate the effects of inflammation on the biological be-haviors of the VF -MSCs and provide the theoretic basis for the repair of the vocal folds which were damaged by in-flammation .Methods The inflammatory vocal fold tissues and normal vocal fold tissues were respectively derived from the vocal cord polyp and normal tissues of the hypopharyngeal carcinoma patients .The HE staining ,masson trichrome staining and elastin van gieson (EVG) staining were performed to detect the effects of inflammation on the collagenous fiber and elastic fibers of the vocal fold lamina propria .The cell colony formation analysis and MTT cell growth curve were used to detect the effects of inflammation on the proliferation of VF -MSCs .The effects of in-flammation on the multi-directional differentiation of VF -MSCs were evaluated by inducing the VF -MSCs to dif-ferentiate into osteoblasts and lipoblasts .Results The results of masson trichrome staining and EVG staining showed that in the inflammatory vocal fold lamina propria collagen fibers became thicker and the amount of collagen fibers increased ,while elastic fibers became thinner and the amount of elastic fibers decreased .Compared with the vocal fold mesenchymal stem cell (VF-MSCs) in normal vocal folds ,VF-MSCs in inflammatory vocal folds pro-liferated more significantly ,but the osteogenic differentiation and adipogenic differentiation of VF -MSCs in inflammatory vocal folds were restrained .Conclusion Inflammation enhanced the compressive resistance ,abated the elasticity , and restrained the multi -directional differentiation of VF -MSCs .

85%of IRAB were resistant to the rest 12 antibacterials except polymyxin B,cefoperazone/sulbactam and minocycline.CONCLUSIONS It should be exactly detect and control IRAB due to extremely severity about hospital infections and multidrug resistantce.

Patients with advanced lung cancer should be given proper hospice care .Doctors should not only practice protective medicine on the foundation of laws and regulations , informing the patients about their conditions tactfully , but also try their best to provide the patients with optimal therapeutic strategies , taking the patient's physi-cal tolerance, economy, etc.into account and achieving the goal of humanized and individualized therapy .Mean-while, the construction of professional medical -nursing institution is in urgent need .Only providing general nurs-ing in multiple aspects of illness , mental health , social functions , can we relieve the pain both physically and men-tally, and improve the patient's quality of their terminal times .

Objective To study the effects of steaming Orange Magnoliavine Fruit with vinegar on the lignan metabolism in rats.Methods The rats were fed with same amount of extracts:Orange Magnoliavine Fruit before and after steaming processing with vinegar. Then plasma samples were collected at different times and determined contents of schisantherin A and deoxyschizandrin by HPLC to draw drug concentration in blood-time curve. The pharmacokinetic parameters were calculated with DAS2.0 analysis software.Results Pharmacokinetic model of schisantherin A and deoxyschizandrin in rats accorded with one compartment model. Plasma concentration in rats under the condition of Orange Magnoliavine Fruit samples before and after steaming processing with vinegar was:Tmax of schisantherin A was determined with (4.250±1.523), (5.750±1.784)h respectively, Cmax with (2.197±0.995), (2.815±0.842)μg/mL respectively, T1/2 with (2.654±0.377), (3.504±0.856)h respectively. Tmax of deoxyschizandrin was determined with (3.250±1.836), (4.250±1.471)h respectively, Cmax with (1.922±0.773), (2.307±0.602)μg/mL, T1/2 with (2.111±1.185), (3.242±2.126)h. Orange Magnoliavine Fruit before and after steaming processing with vinegar exhibited differences in pharmacokinetic parameters in rats.Conclusion The pharmacokinetic parameters of schisantherin A and deoxyschizandrin showed that the steaming processing with vinegar on Orange Magnoliavine Fruit can slow down lignan metabolism in vivo.

Objective To compare the intelligence quotient (IQ) between children with Asperger syndrome (AS) and children with attention deficit hyperactivity disorder (ADHD) in order to provide reliable evidence for differential diagnosis.Methods The intelligence of 141 children with AS,154 children with ADHD and 102 normal control (NC) children aged 6-13 years old examined by the China-Wechsler Intelligence Scale for Children was analyzed,and the diagnoses of AS and ADHD was made according to the Fourth edition of the Diagnostic and Statistical Manual of Mental Disorder.Results The proportions of children at low level of IQ (borderline and mental retardation range) in children with AS and with ADHD group were both significantly higher than those of NC group.The proportions of children at top level of IQ (superior and very superior range) in ADHD group were significantly lower than those of AS and NC groups.In the AS group,higher proportions of verbal IQ (VIQ) at top level and performance IQ (PIQ) at low level were found.The average VIQ,PIQ and full IQ (FIQ) of the AS,ADHD and NC groups were (102.55 ± 17.27,91.31 ± 16.01,97.10 ± 15.88),(95.39 ±13.49,94.16 ± 12.92,94.40 ± 12.78) and (104.06 ± 13.66,103.05 ±11.80,103.91 ± 12.92),respectively.The VIQ,PIQ and FIQ in ADHD group were lower than those in NC group significantly(P ＜ 0.01);compared with NC group,the PIQ and FIQ in AS group were significantly lower (P ＜ 0.01),while the VIQ was not significantly different(P ＞0.05).The AS and ADHD group scored both lower than the NC groupin the subtests ofcomprehension, coding, picture completion andpicture arrangement (P ＜ 0.01).The difference values between VIQ and PIQ in the AS,ADHD and TD group were(11.23 ± 17.29),(1.23 ± 13.10) and (1.00 ± 10.91),respectively,among which only the value in AS group was statistically significant (P ＜ 0.01) but not in ADHD and NC group(P ＞0.05).The proportion of children having a VIQ-PIQ difference value more than 15 in AS group was 54.60％ (77/141 cases),which was significantly higher than that in ADHD [22.07％ (34/154 cases)] and NC groups [13.72％ (14/102 cases)] (P ＜ 0.01),while the latter 2 value had no statistical difference (P ＞ 0.05).The differences among scores on the three Kaufman factors were significant in AS group (P ＜ 0.01) but not in ADHD and NC groups(P ＞ 0.05).Conclusions Compared with ADHD and normal control children,there are some unique intelligence profiles in children with AS,which show VIQ and PIQ separation,imbalance intelligence structure as well as strengths and weaknesses coexisting.Furthermore,children with ADHD and AS children share common features in some subtests scores.

Objective To evaluate the effects of peptide-based enteral nutrition (PBEN) on inflammatory response and immune function in rats with intestinal mucositis.Methods 48 Sprague-Dawley male rats were randomly divided into 6 groups (all n =8):basal feed group (BFG),PBEN group (PBENG),intact protein enteral nutrition group (IPENG),methotrexate (MTX) + BFG,MTX + PBENG,and MTX + IPENG.The rats in MTX + BFG,MTX + PENG,and MTX + IPENG were intraperitoneal injected with MTX 10 mg/kg on day 0 and day 6 to induce sustained intestinal injury.From day 1,BFG and MTX + BFG were fed with basal feed,PBENG and MTX + PBENG with PBEN,IPENG and MTX + IPENG with IPEN.The daily energy intake of each rat was 1.80 kJ/g body weight.All the rats were sacrificed on day 11.The pathological changes of intestinal tissue were observed with HE staining,the levels of tissue myeloperoxidase (MPO),nitric oxide (NO),inducible nitric oxide synthase (iNOS),the thymus index and spleen gland index of intestinal tissue were measured using colorimetry,and the serum levels of immunoglobulins IgG,IgA,and IgM were determined with enzyme-linked immunosorbent assay.Results There were no significant differences among BFG,PBENG,and IPENG in each index.Serious injury of intestinal mucosa was observed in MTX groups.Significant differences were noted in all indexes between MTX + BFG and BFG (all P ＜0.05).The mucosal damage score (Chiu score) and the level of MPO and iNOS in MTX + PBENG were significantly lower than those in MTX + BFG [2.3 ± 0.69vs.2.96 ± 0.75,P =0.003 ; (2.30 ± 0.42) U/g tissue vs.(2.98 ± 0.23) U/g tissue,P =0.040 ; (0.37 ±0.06) U/mg prot vs.(0.44 ±0.10) U/rag prot,P =0.030] ; the serum levels of IgG and IgA were significantly higher than those in MTX + BFG (P =0.015,P =0.021) ; however,the levels of NO and IgM were not significantly different between the 2 groups (P =0.597,P =0.160).There were no statistically significant differences between MTX + IPENG and MTX + BFG in terms of the indexes (all P ＞ 0.05).Conclusion PBEN can reduce the inflammation response and improve the immune function in intestinal mucositis rat.

Objective To establish a rat model of persistent intestinal mucosal injury.Methods The rat model of persistent intestinal mucosal injury was induced by intraperitoneal injection of methotrexate.The food intake and body weight of all the rats were recorded.Pathological changes were observed using HE staining, the level of D-lactate and diam-ine oxidase in plasma, and myeloperoxidase and malondiadehyde in the intestinal tissue were measured by biochemistry. Results After modeling, the rat body weight and food intake were decreased.On day 4, the scores of mucosal damage, the levels of plasma D-lactate, DAO, MPO and MDA were significantly increased (P<0.05).On day 5, the intestinal damages of rats began to restore, and there was no significant difference among groups on day 6.The symptoms after the secondary injection were similar to those after the first injection, and the rats recovered gradually at day 12.Conclusions Intestinal mucosal injury in rats induced by 20 mg/kg MTX is an acute injury process, the course only lasts for 4-5 days. Intermittent injections twice of 10 mg/kg MTX can cause persistent intestinal mucosal injury in rats.This persistent injury model is more suitable for nutritional therapy evaluation in medium-and long-term studies of nutritional therapy.

Objective:To study the influence factors of laser therapy in the treatment of temporomandibular disorders(TMD)pain. Methods:1 20 cases of TMD were treated by MDC-500 semiconductor laser therapy.VAS was valued after each treatment.The cor-relation of the VAS varians following treatment with gender and age was analysed by two way AHOVA of the repeated measurement data.Results:1 1 4 cases completed the treatment and follow-up.After each treatment the VAS decreased(P <0.001 ),in females decreased more than in males(P <0.05).There was no significant difference between age groups(P =0.208).Conclusion:Laser therapy can ease TMD pain,and is more effective for female patients.

Radiolabeled monoclonal antibodies can specifically bind to tumor-associated antigens.On this immune basis,RIT and RII have therefore been used in the diagnosis and treatment of cancer.Many RIT and RII pharmaceuticals were applied in trials of preclinical and clinical phases,and excellent results had been achieved.This paper reviews on the current status of RIT and RII pharmaceuticals.