Asthma is a chronic airway disease characterized by airway inflammation and airway remodeling. Chronic airway inflammation can be involved in airway remodeling in asthmatic patients by incuding epithelial-mesenchymal transition (EMT).Bromodomain-containing protein 4 (BRD4) is a key transcriptional regulator in mammals,and many evidences have shown that BRD4 plays a pivotal role in airway remodeling via nuclear factor-κB/RelA signaling pathway. This review summarizes the recent advances in the role of BRD4 in regulating EMT,with an attempt to elucidate the molecular mechanisms of asthma and inform the prevention and control of asthma.

Objective To explore the underlying mechanism of respiratory syncytial virus-related asthma .Methods Totally 30 sprague-dawley rats were randomly divided into control group ,respiratory syncytial virus (RSV) group ,and anti-NGF group ,with 10 in each group .RSV infection model was established by nasal drip once a week .In anti-NGF antibody intervention group ,each rat was given intraperitoneal injection of anti-NGF for 3 h before identical RSV infection .transmission electron microscopy(TEM) were performed to observe the ultramicro-structure changes in adrenal medullary cell .The concentrations of adrenaline and NGF in serum were measured by ELISA .The NGF expression was assayed by immunohistochemistry .The expression difference of neurofilament protein mRNA was detected by RT-PCR .Results (1) Electron microscope showed ,medullary cells riched in mitochondria ,Chro-maffin granule concentration decreased obviously ,and membrane could saw clubbing phenomenon of neurite outgrowth clearly in RSV infection group .Meanwhile ,NGF expression was significantly increased in RSV infection group .(2) ELISA results showed that the concentrations of NGF in the RSV group was significantly increased compared with control group and anti-NGF group(P<0 .05) ,while the concentrations of NGF showed no difference between control group and anti-NGF group(P> 0 .05) .Compared with control group ,the adrenaline concentration of RSV group and anti-NGF group was significantly decreased(P<0 .01) ,and the adrenaline concentration of RSV group was significantly decreased compared with anti-NGF antibody group(P<0 .05) .(3) NF-LmRNA expression was significantly increased in RSV group .However ,compared with control group ,the NF-LmRNA expression was significantly decreased in anti-NGF group .(4) RT-PCR results show that ,Compared with control group ,adrenal medullary cells NF-LmRNA expression of RSV group and the anti-NGF group was significantly increased .Compared with RSV group ,NF-LmRNA adrenal medulla cells in Anti-NGF group was significantly decreased .Conclusion RSV infection may induce the adrenal medullary cell differentiation to nerve cell by over-expressed NGF ,and result in the decrease of adrenaline in serum to involve in asthma progression .

Objective: To discuss the role of clinical pharmacists played in the pharmaceutical care for osteomyelitis patients. Methods:Clinical pharmacists participated in the treatment for a special patient with osteomyelitis. Taking the disease features, medi-cal history, adverse drug reactions into account, clinical pharmacists provided consultant opinions for establishing and adjusting the ap-propriate therapeutic regimens and individualized pharmaceutical care. Results:The drug treatment regimens for the patient were safe, effective and rational. By the individualized pharmaceutical care, clinical pharmacists were able to find the problems in the drug treat-ment and implement the efficient solutions. Conclusion: Clinical pharmacists show their own advantages in individual pharmaceutical care, and play an important role in improving the rational drug use.

Objective To evaluate the prevalence rate of pulmonary malignant disease in people at high risk of lung cancer through low-dose multi-slice spiral CT. Methods 1 200 symptom-free volunteers were under low-dose spiral CT scans in an on-going screening study. The people tested aged 40 or older regardless of their gender or smoking history. Low-dose CT scans were performed with Iightspeed Plus multi-slice scanner using spiral mode, 120 kV,30 mAs. Results Calcified nodules were detected in 32 participants and non-calcified nodules were detected in 18 participants by low-dose CT,in which 3 were vicious ones,including 1 non-solid lesion and 2 solid lesions. The detection rate of lung cancer was 0. 25%. Conclusion Low-dose multi-slice spiral CT was effective in detecting, classifying and defining lung nodules,and furthermore would make it possible to find lung cancer at earlier stage.

Objective To evaluate the effectiveness of water jet debridement combined with negative pressure wound therapy (NPWT) for the treatment of early infection after fracture internal fixation.Methods The study cohort included 6 men and one woman with an average age of 43.6 years (range,from 36 to 58 years) who had presented with early infection after fracture internal fixation from October 2013 to March 2015.All the patients sustained closed fractures initially.The wound debridement was done within 3 to 5 days after the infection was confirmed.The length and depth of an incision was determined by the methylene staining range.Water jet was used to eliminate the dying tissues thoroughly from a shallower layer to a deeper layer while the internal fixator was retained.The wound was closed by full thickness sutures in a sparse fashion for drainage.Sensitive antibiotics were systematically administered for all the patients.The NPWT device was kept for 5 days.Results All the wounds healed uneventfully after an average of 18 days (range,from 10 to 25 days).The mean follow-up time was 12 months (range,from 8 to 24 months).No antibiotics were used during follow-up.There were no local or systematical symptoms like new sinus,broken wound or fever.Bony callus formed at the fracture sites after an average of 4.3 months (range,from 2.5 to 8.0 months) and no fracture nonunion happened.All the fractures healed after an average of 10.1 months (range,from 5.5 to 16.0 months).All the patients were satisfied with their treatment outcomes.Conclusion Since water jet provides simple,rapid and radical debridement while NPWT simplifies operative procedures and promotes wound healing,combination of the two can be an effective treatment for early infection after fracture internal fixation.

Object To analyze reasons of complications induced by the clavicle hook plate in treatment of acute distal clavicle fractures and acute acromioclavicular joint dislocations,and to investigate corresponding solutions.Methods Seventy nine clavicle hook plates were facilitated in the treatment of acuteb distal clavicle fractures (47 cases) and acute high grade acromioclavicular joint dislocations (32 cases) from May 2006 to May 2009.There were 51 males and 28 females,with an average age of 42.6 years(range,15 to 78 years).Seventy eight patients underwent plate removal operation.Forty patients agreed to accept the CT examination to evaluate the acromion erosion around the plates.Among them,7 patients received further CT examination 3 months after the removal surgery.The shoulder function was evaluated by the constant scores at the final follow-up.Results All patients were followed up for at least one year (range,12 to 30 months).The mean duration for retaining the hook plate was 8.3 months with the mean Constant scores 92 points in the acute distal clavicle group; 7.2 months with the mean Constant scores 95 points in the acute acromioclavicular joint dislocation group.There were 8 kinds,totally 105 complications happened in 78 patients (98.7％).The complications were classified into four groups: (1) Due to the specific working mechanism of the plate(88/105,83.8％);(2) Due to the iatrogenic errors(12/105,11.4 ％);(3) Due to insufficiency design of the plate(3/105,2.9％);(4) Due to the etiology of the injury itself(2/105,1.9％).Conclusion The complication rate is unexpected higher.Most complications are unavoidable due to specific working mechanism of the plate.The patients should be well informed about this preoperatively in order to avoid the possible legal trouble.The iatrogenic errors can be avoided with proper indications and improved surgical techniques.The design of the plate needs to be improved,and the hook plate should be removed as early as possible.

ObjectiveToinvestigatetheriskfactorsforunfavorableoutcomeinpatientswithminor ischemic stroke. Methods Patients with minor ischemic stroke were enroled prospectively. The modified Rankin Scale ( mRS ) w as used to assess the clinical outcome at day 90 after onset, and mRS 0-2 w as defined as favorable outcome. The demographic data, vascular risk factors, clinical data, imaging data, stroke etiologic subtypes, laboratory test results, and treatment methods in the favorable outcome group and unfavorable outcome group w ere compared. Multivariate logistic regression analysis w as used to identify the independent risk factors for early poor outcome in patients w ith minor ischemic stroke. Results A total of 516 patients with minor ischemic stroke were enroled. At day 90 after onset, 90 patients (17.44%) had unfavorable outcome and 426 (82.56%) had favorable outcome. Multivariate logistic regression analysis showed that age (odds ratio [OR] 1.045, 95% confidence interval [CI] 1.017-1.074; P=0.002), heart diseases (OR 2.021, 95%CI 1.063-3.841; P=0.032), baseline National Institutes of Health Stroke Scale (NIHSS) score (OR 1.662, 95%CI 1.177-2.347; P=0.004), limb movement disorder ( OR 2.430, 95%CI 1.010-5.850; P=0.048), ataxia (OR 2.929, 95%CI 1.188-7.221;P=0.020), early neurological deterioration ( OR 50.994, 95%CI 17.659-147.258; P<0.001), infarct diameter ( OR 1.279, 95%CI 1.075-1.521; P=0.005), non-responsible vascular stenosis ( OR 2.518, 95%CI 1.145-5.536;P=0.022), and large artery atherosclerotic stroke ( OR 2.010, 95%CI 1.009-4.003; P=0.047) w ere the independent risk factors for unfavorable outcome in minor ischemic stroke. Conclusions The early poor outcome of minor ischemic stroke is closely associated w ith age, heart diseases, baseline NIHSS score, limb movement disorder, ataxia, early neurological deterioration, infarct diameter, non-responsible vascular stenosis, and large artery atherosclerotic stroke. The relevant examinations need to be improved early, the etiologic subtype should be identified, and the correct clinical treatment should be guided.

Objective To investigate the treatment effect of proximal femoral nail antirotation (PFNA) on unstable femoral intertrochanterie fractures in the elderly. Methods A retrospective stud- y was done on 65 patients with unstable femoral intertrochanteric fractures, who were treated with PFNA from December 2005 to October 2006 and followed up for at least half a year. There were 22 males and 43 females, at age range of 67-97 (mean 78.5 years). All the operations were carried out within a week af- ter fractures. The data of operation time, operative blood loss, complications, bone healing time and hip function scores were recorded for evaluating treatment outcomes. Results All the patients were fol- lowed up for 6-18 months (average 10.5 months). The operation lasted for (29.6±7.5) minutes, with mean blood loss of (150.5±40.2) ml and bone healing time of (9.1±2.2) weeks. All patients ob- tained satisfactory treatment results, except for 3 patients with proximal thigh pain, 2 with pulmonary in- fection occurred and 1 with thrombs of lower limb vein. Harris post trauma hip function score was (88.5 ± 6.3) points. Conclusion PFNA is an effective way for femoral unstable intertrochanteric fractures in the elderly, for it is characterized by short operation time, less blood loss and stable fixation.

Objective To explore the operative techniques for AO/OTA type 31-A3.1 and 31-A3.2 intertrochanteric fractures fixed with intrameduallary nail.Methods Seventy-four cases of unstable intertrochanteric fracture (AO/OTA type 31-A3.1 and 31-A3.2) from January 2007 to December 2010 were analyzed retrospectively.There were 33 males and 41 females,aged from 36-87 years (mean,71 years).The right hip was involved in 34 patients and the left in 40 patients.The mechanism of injury was traffic injuries in 27 cases,fall damage in 43 cases,injury by falling in 3 case and crush injury in 6 cases.Percutaneous joystick technique,Homann retractor technique,clamp technique and mini-incision was applied to aid reduction during the surgery.All cases were fixed with proximal intrameduallary nail.Clinical and radiographic outcomes were recorded.The postoperative hip function was evaluated using Harris score.Results With the aid of C-arm,closed reduction was performed in 73 cases.Only one patient experienced open reduction because of failure of closed reduction.Sixty-five cases were followed up for 8 to 23 months (mean,14.5 months).Bone union was observed in all cases with the average time of 7.4 months (range,8-23).The operation time,blood loss,the frequency of X-ray exposure was 75±4 minutes,135±5 ml and 24±3 times,respectively.At final follow-up,29 cases were classified as excellent,31 as good,and 5 as fair.The mean Harris hip score was 91.4 points (range,87-95).The overall rate of excellent or good result was 92.3％.Conclusion It is difficult to perform close reduction for unstable intertrochanteric hip fracture (AO/OTA type 31-A3.1and 31-A3.2),especially in relatively young patients.Special operative skills are necessary in some cases.

ObjectiveTo evaluate the technique and clinical outcomes of supra-acetabular external fixation in treating pelvic fractures associated with injuries of abdominal organs.MethodsThere were 17 cases of pelvic fractures associated with injuries of abdominal organs.Nine were males and 8 were females,with the average age of 42 years(range,21-75 years).The injury was caused by traffic accident in 9 cases,fall-down from height in 4,and crush by heavy objects in 6.According to Tile classification of pelvic fractures,7 were type B1,3 were type B2,2 were type B3,4 were type C1 and 1 was type C2.Fifteen cases suffered with hemorrhagic shock,2 with perineal injury and 12 with fractures of the limbs.All patients were treated with supra-acetabular external fixation and the outcomes were evaluated by Cole's clinical scoring,Matta and Tornetta's radiographic standards.ResultsAll 17 cases were followed up with the mean period of 6.5 months (range,2-18 months).The average time of operation was 15 min (range,9-25 min).The mean blood loss was 17 ml(range,5-25 ml).All fractures healed and the mean healing period was 9.2 weeks (range,8-12 weeks).Three had transient palsy of lateral femoral cutaneous nerve.Five had soft tissue infection while the bony structures were not involved.According to Cole's scoring for pelvic fractures,15 cases were excellent,1 case was good and 1 case was fair,with the good-excellent rate of 94.12％.According to Matta and Tornetta's standards of fracture reduction,12 were excellent,3 were good and 2 were fair,with the good-excellent rate of 88.24％.ConclusionSupra-acetabular external fixation is a minimal invasive and convenient method for treating pelvic fractures with abdominal organs injury which is mechanically stronger than traditional external fixation via iliac crest.