The purpose of this review is to explain the relationship between chronic rhinosinusitis (CRS) and lower respiratory tract inflammation, especially asthma and introduce the new advances in the treatment of CRS patient with asthma. We also introduce our treatment strategy for these patients, including surgery technique and perioperative management.
Asthma ; pathology ; Chronic Disease ; Humans ; Inflammation ; pathology ; Otolaryngology ; methods ; Respiratory System ; physiopathology ; Sinusitis ; physiopathology

Objective To investigate the PCR-based evaluation of prednisolone-induced relapse of asymptomatic Toxoplasma gondii infection and the therapeutic efficacy of azithromycin.Methods A total of 36 of female ICR mice,about 20 g,were randomly divided into 6 groups:contrast group (C),prednisolone group (P),infection group(I),infection plus prednisolone group (IP),infection plus azithromycin group(IA),infection plus prednisolone and azithromycin group (IPA).The infection group (I),infection plus prednisolone group(IP),infection plus azithromycin group(IA),infection plus prednisolone and azithromycin group (IPA)were challenged at week 0 with 10 cysts of Toxoplasma gondii Prugniaud strain per injection intraperitoneally.The prcdnisolone group (P),infection plus prednisolone group (IP) infection plus prednisolone and azithromycin group (IPA)were injectied with prednisolone 1 mg into hind medial subcutaneous every day from the 6th week to 7th week.The infection plus azithromycin group(IA),infection plus prednisolone and azithromycin group (IPA) were injectied with azithromycin 250 mg/kg intraperitoneally every day from the 6th week to 7th week.The serum samples were collected and DNAs extracted at week 0,1,2,3,4,5,6 and 7 for amplification of Toxoplasma gondii of specific B1 gene by PCR.All the mice were sacrificed 7 weeks after the challenge to calculate the number of cysts in brain tissues.Results Compared with the primer of AF146527 gene,the primer of B1 gene was more sensitive and specific.The method of PCR could amplify the productions of specific B1 gene Toxoplasma gondii 5 weeks before the challenge,while it could not amplified 5 weeks after the challenge.All the mice of the IP group were dead 2 weeks after the injection of prednisolone (week 7),and the only two mice of the IPA group were dead at the same time (P <0.05),respectively.Compared with the I group,IA group and IPZ group,the number of cysts in brain tissues of the IP group significantly increased (P <0.01).Conclusions B1 as target gene is more suitable for diagnosis of Toxoplasma gondii infection by PCR.Prednisolone could induce the relapse of asymptomatic Toxoplasma gondii infection of mice and the mice are finally dead.Azithromycin is effective but it can not completely cure the Toxoplasma gondii infection.

Objective To investigate the expression and clinical significance of α-actinin-1 protein (ACTN1) in prostate cancer (PCa) and prostatic hyperplasia (BPH). Methods The clinical data of patients with PCa or BPH treated in our school affiliated hospital were collected between January 2007—October 2014, according to certain criteria. Immunohistochemistry method was used to detect the expression of ACTN1 in 30 samples of PCa and 30 samples of BPH tissues. Western blot assay was used to detect the relative expression of ACTN1 in 18 samples of PCa and 20 samples of BPH tissues in two groups. Results The result of immunohistochemistry showed that the positive expression rates of ACTN1 were 76.7%and 20%in PCa and BPH groups respectively. The difference was statistically significant (P<0.01). Western blot assay showed that the relative expression of ACTN1was significantly higher in PCa group (0.591±0.182) than that in BPH group (0.037 ± 0.052, P < 0.05). There was no significant difference in expression level of ACTN1 between different age groups. There was no significant difference in serum prostate specific antigen (PSA) level between patients with or without bone metastasis, and patients with or without lymph node metastasis (P > 0.05). There were significant differences in ACTN1 levels between different Gleason score and T staging groups (P<0.05). Conclusion The expression ofα-actinin-1 is significantly higher in PCa tissues than that in BPH tissues. There is the relationship between expression of ACTN1, Gleason scores and T staging.

Objective:To improve the diagnosis of anti-synthetase antibody syndrome(ASS) by analyzing the clinical features of 6 patients.Methods:Six cases of ASS with complete data were included in this study as they were diagnosed or other CTD during the period of hospitalization in Wuxi People's Hospital from January 2016 to February 2020. Their clinical and laboratory characteristics, and follow-up information were analyzed. Features and changes in the course of disease were analyzed.Results:Four out of 6 patients were females, with age of disease onset as 34-72 years, and an interval of 4-59 months from the first diagnosis to the diagnosis of ASS. The first diagnosis was Sjogren's syndrome (SS) in 2 cases, rheumatoid arthritis (RA) in 1 case, mixed connective tissue disease (MCTD) in 1 case, systemic sclerosis (SSc) in 1 case, and undifferentiated connective tissue disease (UCTD) in 1 case. At the first diagnosis, 5 cases had dry cough and/or dyspnea, followed by fever (4 cases), arthritis and Raynaud's phenomenon (3 cases). Anti-nuclear antibody(ANA), which was more common in cytoplasmic type, and anti-SSA/52 000 antibody were mostly positive(5 cases). The presence of non-specific interstitial pneumonia (NSIP) pattern (6 cases) in high resolution CT(HRCT) was found at the initial diagnosis. During follow-up, patients developed repeated liver function or muscle enzyme abnor-malities (3 cases), mechanic's hand (MH) (3 cases), and lung interstitial disease progression (4 cases). The myositis antibodies were found to be positive.Conclusion:ASS can occur in the course of or at the same time as other CTDs. ASS should be considered in patients with interstitiallung disease (ILD) (especially NSIP pattern) in HRCT, and/or positive of cytoplasmic type ANA and/or anti-SSA/52 000 antibodies At the same time, if repeated liver function or muscle enzyme abnormalities, new onset of MH, and lung interstitial disease progresses during treatment, consideration may be given to the possibility of complicated ASS. Myositis-specific antibodies are helpful in the diagnosis of ASS.

Objective To explore the clinical characteristics and prognostic indicators that classify patients with systemic lupus erythematosus (SLE) at risk of in-hospital mortality.Methods Medical records of 1611 SLE patients admitted between 1999-2009 were collected from 26 centers across Jiangsu province,and patients were divided into two groups based on the outcomes.The suspected risk factors of poor outcomes were selected and then analyzed by chi-square test,independent-samples t test,Wilcoxon rank sum test and Logistic regression.Results Among the 1 611 enrolled patients,91 patients were in the death group (5.6％) and 1 520 patients in the control group (94.4％).The duration of disease [28(4,60) m vs 12(2,47) m,Z=-3.290,P＜0.05),the rate of male/female (13.2％ vs 7.1％,x2=4.606,P＜0.05),as well as the occurrence rateof seizure (8.8％ vs 1.7％,x2=17.550,P＜0.05),psychosis (41.8％ vs 23.8％,x2=14.809,P＜0.05),lupus headache (19.8％ vs 6.0％,x22=-25.898,P＜0.05),alopecia (47.3％ vs 30.3％,x2=11.541,P＜0.05),pericarditis (35.2％ vs 22.0％,x2=8.408,P＜0.05),myocarditis (4.4％ vs 1.0％,x2=5.885,P＜0.05),fever (55.0％ vs 28.5％,x2=28.632,P＜0.05),decreased hemoglobin levels (60.9％ vs 44.8％,x2=8.603,P＜0.05),urinary casts (24.2％ vs 12.2％,x2=10.884,P＜0.05),hematuria (51.7％ vs 37.8％,x2=6.988,P＜0.05),decreased estimate glomerular filtration rate (eGFR)levels (27.6％ vs 11.0％,x2=18.12,P＜0.05),and elevated glutamic-oxaloacetic transaminase (AST) levels (30.2％ vs 17.9％,x2=8.176,P＜0.05) were higher in the death group.The frequency of arthritis (34.3％ vs 18.7％,x2=9.459,P＜0.05),proteinuria (31.6％ vs 14.3％,x2=12.169,P＜0.05),elevated erythrocyte sedimentation rate (ESR) levels (80.4％ vs 71.8％,x2=4.192,P＜0.05),decreased complement levels (44.2％ vs 17.6％,x2=24.881,P＜0.05) and anti-dsDNA antibodies positivity rate (39.7％ vs 23.1％,x2=9.963,P＜0.05) were higher in the control group.Logistic regression analysis showed seizure [OR =4.035,95％ CI(1.338,12.164),P＜0.05],lupus headache [OR=3.026,95％CI (1.406,6.511),P＜0.05],decreased hemoglobin (Hb) levels [OR =2.116,95％ CI(1.139,3.934),P＜0.05],decreased eGFR levels [OR =2.159,95％ CI(1.0 11,4.610),P＜0.05] and fever [OR=2.567,95％CI (1.422,4.634),P＜0.05] were positively correlated with in-hospital mortality,with elevated ESR levels [OR=0.418,95％CI (0.218,0.802),P＜0.05] and decreased complement levels [OR=0.328,95％CI (0.120,0.894),P＜0.05] negatively correlated (P＜0.05).Conclusion The results sugest that seizure,lupus headache,decreased Hb levels,decreased eGFR levels and fever are the most important predictors of in-hospital mortality.Clinicians should pay more attention to these symptoms in admission.

ObjectiveTo investigate the association of complement C3 with clinical and serological features of patients with systemic lupus erythematosus.MethodsData was collected by the same methods in the past ten years in fifteen hospitals in Jiangsu Province and then data weres summarized for retrospective analysis.Clinical and laboratory data were selected and then analyzed by Chi-square test,Wilcoxon rank sum test and Logistic regression.ResultsOne thousand four hundred and five patients were investigated.One thousand and forty two had low serum complement C3 level.In this case control study,hospitalization age,disease course,admission times,pleurisy,gastrointestinal involvement,general lymphadenopathy/hepatosplenomegaly,white blood cell count, haemoglobin level,platelet count, serum C-reactive protein level,serum albumin level,serum creatinine level,Urine protein quantification,anti-nuclear antibodies (ANA),anti-dsDNAantibodies, anti-SmantibodiesandSLEDAIscore were possible factors associatedwith complement C3 reduction(P＜0.05).Logistic regression analysis showed that CRP (OR=0.396,0.254-0.617,P=0.000),ANA (OR=2.907,1.267-6.670,P=0.012),urine protein level(OR=1.702,1.043-2.779,P=0.033) and SLEDAI score (OR-0.930, 0.886-0.975,P-0.003) were correlated with complement C3 reduction.Conclusion Complement C3 level is valuable for lupus flare assessment.The complement C3 reduction is a risk factor for renal impairment.

Objective:To investigate the clinical characteristics and treatment of Beh?et′s disease complicated with cardiac valve involvement.Methods:We searched the wanfang medical database and Medline database to reviewed the domestic and foreign literature reports on cardiac Beh?et′s disease and analyzed their clinical features and therapeutic strategies. Chi-squared test was used for data analysis.Results:It was shown that Beh?et′s disease with cardiac valve involvement mainly affect men. The male to female ratio was 3.86∶1 in China and 2.50∶1 in foreign patients( χ2=1.32, P=0.251). The preoperative diagnosis rate was not high(60.3% in China, 57.1% abroad) ( χ2=0.13, P=0.716). Aortic valve and perivalvular lesions were the most common involved sites, of which aortic regurgitation was the most frequenty occurred, followed by mitral valve lesions. Glucocorticoids was still the main means treatment for medical(93/235 in China, 28/420 abroad), cyclophosphamide was more widely used in China(28/235), azathioprine was more widely used in foreign countries (12/42). Aortic replacement (AVR) was the mainly surgical approach, followed by artificial aortic valve replacement and left ventricular outflow tract plasty (Bentall).The incidence of postoperative perivalvular leakage or valve prolapse was higher with AVR than with Bentall(AVR 76.3%/Bentall 21.8% at home, χ2=32.60, P<0.001, AVR 71.4%/Bentall 0 abroad, χ2=13.84, P<0.001). Conclusions:Cardiac valve involvement is a severe complication of Beh?et′s disease. Heart involvement are more common, and the preoperative diagnosis rate is lower in China. The incidence of perivalve leakage (PVL) or valve prolapse (PD) after operation is higher with AVR than with Bentall surgery.The Bentall operation could improve prognosis and the postoperative complications abroad are lower than domestic.

Objectives: . Despite the efficacy of surgical treatments, the high rate of recurrence in juvenile nasopharyngeal angiofibroma (JNA) after surgery remains an unresolved problem. The present study comprehensively analyzed the risk factors and characteristics of JNA recurrence, providing clinical guidance for reducing recurrence. Methods: . A total of 123 patients who underwent surgery for JNA between 1997 and 2019 at a single hospital were analyzed retrospectively. Univariate and multivariate analyses were used to assess the clinical risk factors for the recurrence of JNA. The relapse-free survival and annual cumulative recurrence rates were analyzed for subgroups defined according to clinical parameters. Results: . After screening, 78 of the 123 patients were included in the present study. The main risk factors associated with JNA recurrence included the year of diagnosis, tumor size, sphenoid bone invasion, Radkowski stage, surgical approach, and intraoperative bleeding. Importantly, the surgical approach and sphenoid bone invasion were independent prognostic factors affecting recurrence. Patients who underwent endoscopic surgery without sphenoid bone invasion exhibited longer relapse-free survival. In the present study, the overall cumulative recurrence rate of JNA was 38.7%, and recurrence occurred mainly in the first year after the initial surgery. Conclusion . Endoscopic surgery achieved better relapse-free survival in JNA patients, and patients with sphenoid bone invasion should be carefully explored to avoid residual JNA. The recurrence rate of JNA differed among subgroups defined based on clinical parameters and was highest in the first year after surgery. Computed tomography or magnetic resonance imaging, along with close follow-up, should be performed strictly within 1 year after the primary operation.

Objective:To investigate the clinical, treatment responses and outcomes of SLE patients with lupus podocytopathy (LP).Methods:Seven hospitalized cases in Wuxi people's hospital were diagnosed with LP based on the renal biopsy study during January 2011 to May 2019. Their clinical, immunological and pathological features, treatment responses and prognosis were analyzed.Results:Six cases were women. The mean onset age was (33±12), and the mean duration of systemic lupus erythematosus (SLE) was (69±64) months. Among these patients, 3 cases were initially diagnosed of SLE, and 6 with kidney damage caused by SLE. Six cases presented as nephrotic syndrome (NS) in which 2 cases were complicated with acute kidney injury(AKI). The extrarenal manifestations were not parallel to the renal manifestations as the positive rate of autoantibody and the incidence of hypocomplementemia were both low. After treatments with glucocorticoids and immunosuppressants, renal disease of 6 cases was improved. During follow-up, 2 cases developed renal disease recurrence.Conclusion:LP tends to occur in women in reproductive age, and NS or AKI is the main clinical manifestations. Renal manifestations are not parallel to extra-renal manifestations. Glucocorticoids and immunosuppressive therapy is sensitive, and some patients may relapse after treatment.

Objective:To explore the effect of leptin on B cells in patients with systemic lupus erythematosus (SLE).Methods:Peripheral blood mononuclear cells (PBMCs) were isolated from SLE patients, and then CD19 + B cells were purified with magnetic bead sorting method. PBMCs or purified B cells were cultured with recombinant leptin at 0, 100, 250 ng/ml for 3 or 5 days. The frequencies of plasma cells, follicular helper T (Tfh) cells and peripheral helper T (Tph) cells, as well as activation markers (CD80, CD86) and leptin receptor and the proliferation of B cells were determined with flow cytometry. The concentrations of antibodies and cytokines were examined with enzyme-linked immunosorbnent assay (ELISA). Data were analyzed with t test and analysis of variance (ANOVA). Results:Increased levels of leptin were positively correlated with systematic lupus erythematosus disease activity index (SLEDAI) and the frequency of plasma cells in SLE patients. Leptin receptor could be detected on SLE B cells, and recombinant leptin elevated the levels of its receptor on CD19 + B cells [(7.8±1.3)% vs (6.1±0.9)%, t=3.36, P=0.006]. Leptin enhanced the expression of CD80 [(21±4)% vs (19±4)%, t=2.84, P=0.004] and CD86 [(22±4)% vs (19±4)%, t=4.92, P=0.004] on SLE B cells in vitro. It also promoted B cells to differentiate into plasma cells [(7.6±1.5)% vs (5.2±1.3)%, t=6.42, P=0.025]. There was no statistical significant difference of the effect of leptin on B cell proliferation. Leptin also increased the levels of antibodies [IgG: (62±3) ng/ml vs (45±4) ng/ml, t=7.75, P<0.001; IgM: (112±24) ng/ml vs (56±18) ng/ml, t=5.38, P<0.001] and inflammatory cytokines [IL-6: (24±5) pg/ml vs (20±5) pg/ml, t=4.09, P=0.002; TNF-α: (19.1±3.8) pg/ml vs (14.1±2.9) pg/ml, t=3.38, P=0.006; IL-10: (24±5) pg/ml vs (20±5) pg/ml, t=4.09, P=0.002] secreted by B cells. In addition, leptin significantly upregulated the frequencies of Tfh cells[(2.82±0.49)% vs (1.28±0.20)%, t=4.56, P=0.001] and Tph cells [(4.5±0.5)% vs (3.4±0.4)%, t=3.88, P=0.003]. Conclusion:Leptin could directly promote the activation, differentiation and secretory capacity of B cells by binding to its receptor, and also modulate B cell responses indirectly via enhancement of Tfh and Tph cells, which may be involved in the pathogenesis of SLE.