More and more studies have indicated that the relationship between vitamin D pathway and asthma,and the mechanisms include multiple abnormal aspects of vitamin D pathway leading to abnormal em-bryonic development and immune system disorders and so on. This review summarizes the relationship between vitamin D,vitamin D binding protein,vitamin D receptors,related gene polymorphisms and the immune system to describe the pathogenesis of asthma.

Objective To test the releasing property of a self-developed plastic drug delivery implant of anti-infective nano-hydroxyapatite(nano-HA)so as to provide a new local drug delivery system(LDDS)for treatment of osteomyelitis.Methods The nano-HA was used as the core carrier to load gentamicin(GM).It was coated with poly hydroxybutyrate-co-hydroxyvalerate /polyethylene glycol(PHBV/PEG)to prepare the nano-HA-PHBV/PEG-GM microspheres which were mixed with the fibrin sealant(FS)to develop a plastic implant.Then its antibacte rial and in vitro releasing properties were investigated.Results The plastic LDDS implant was found to have a fine drug delivery capability.The bacterial growth inhibition zone was found around the LDDS for 56 days in the antibacterial test.Three samples were soaked with liquid of PBS(phosphate buffered saline).The titer of GM released within the first day was 154.3 ?g/mL,and then the releasing maintained a slow level in the following days.After 49 days'releasing,the titer was 6.9 ?g/mL which was still higher than the MIC(2 ?g/mL)(minima l inhibitory concentration)of GM.Conclusion The plastic LDDS has a fine in vitro releasing property and may have a widespread application in treatment of osteomyelitis.

Objective To study the clinical value of VACORA vacuum-assisted rotation system in the treatment of benign breast lesions. Methods Under the screening of dynamic ultrasound,122 beast lesions in 93 patients diagnosed as benign lesions from ultrasound were treated with VACORA vacuum-assisted rotation system,and all the patients were examined for follow-up. Results All the lesions were totally rotated and 119 lesions demonstrated to be benign and 3 lesions were atypical hyperplasia from pathologic examination. In the benign lesions, 72 cases were demonstrated to be fibroadenoma, 39 cases were demonstrated to be fibrosis adenosis,4 cases were intraductal papilloma,2 cases were duct inflammation, 1 case was epithelial hyperplasia of the duct and 1 case was lymphode. In 8 cases,bleeding was seen along the needle tract,which was stopped after compression. Small hematoma was formed in 10 patients in the second day of follow-up, which was disappeared in the 3 to 6 months of the follow-up. And all patients had no remnant lesions in the local area and the incisions were not clear in the skin 3 to 6 months of the follow-up. Hypoechoic focuses were detected out at the original location in the 3 benign cases, which were possibly residual focuses. Conclusions Benign breast lesions could be clearly resected with VACORA rotation system under the screening of ultrasound, which is safe, minimal invasive, prosthetic, and has little complications.

Objective:To explore the clinical features of acute pancreatitis in pregnancy (APIP) and the risk factors for fetal death.Methods:The clinical data of 90 patients with APIP in the Affiliated Hospital of Southwest Medical University were retrospectively analyzed from January 2013 to June 2020. Based on the severity, the patients were classified into MAP groups ( n=41), MSAP groups ( n=33), SAP group ( n=16). According to the presence of fetal deaths, the patients were divided into fetal death group ( n=13) and fetal survival group ( n=77). The clinical characteristics and indicators of patients in each group were compared. Binary logistic regression analysis was performed on the variables with differences between groups to explore independent risk factors for fetal death. The receiver operating characteristic curves of laboratory indicators were drawn to evaluate their diagnostic efficacy. Results:Hyperlipidemia was the main cause in 90 APIP cases (42/90, 46.7%). The levels of LDH, CRP, blood glucose, D2 polymer, albumin and ApoA1, the 1-min and 5-min Apgar scores of neonates were statistically significant among MAP group, MSAP group and SAP group (all P<0.05). There were no maternal deaths in 90 cases and 13 fetal deaths (14.4%). Fetal mortality increased with the severity of APIP. APIP combined with hypertension ( OR=14.742, 95% CI 1.157-187.890, P=0.038), ketoacidosis ( OR=19.587, 95% CI 1.789-214.469, P=0.015) and CRP level ( OR=1.013, 95% CI 1.001-1.025, P=0.031) were risk factors for fetal death. ApoA1 level ( OR=0.118, 95% CI 0.021-0.664, P=0.015) was a protective factor for fetal death. The sensitivity and specificity of ApoA1 for predicting fetal death were 84.6% and 79.2%, the sensitivity and specificity of CRP for predicting fetal death were 76.9% and 84.4%, and the sensitivity and specificity of the combination of the two indicators for predicting fetal death were 100% and 67.5%. Conclusions:The severity of APIP was closely related to fetal death. Hypertension, ketoacidosis and blood level CRP were independent risk factors for fetal death, which should be paid special attention.

ObjectiveTo investigate the clinical features of severe acute hypertriglyceridemic pancreatitis (HTGP). MethodsA retrospective analysis was performed for the clinical data of 179 patients with moderate severe pancreatitis (MSAP) or severe acute pancreatitis (SAP) who were admitted to The First Affiliated Hospital of Guangxi Medical University from January 2013 to June 2016. According to the etiology, these patients were divided into severe biliogenic acute pancreatitis (biliogenic AP) group with 68 patients, severe alcoholic acute pancreatitis (alcoholic AP) group with 39 patients, severe acute HTGP group with 45 patients, and severe acute pancreatitis group with other causes (other group) with 27 patients. Related data of the patients with clear causes in the former three groups were recorded, including demographic data, blood triglyceride (TG) level on the first day of admission, cause, pancreatic necrosis, systemic complications ［acute respiratory distress syndrome (ARDS), acute renal injury, hypotension, and disseminated intravascular coagulation (DIC)］, and related clinical outcomes (admission to the intensive care unit, length of hospital stay, and mortality rate). In order to investigate the influence of TG concentration on the prognosis of AP patients, the patients were divided into normal blood lipid group with 82 patients, mild dyslipidemia group with 52 patients, moderate dyslipidemia group with 28 patients, and severe dyslipidemia group with 17 patients, according to the TG level on the first day of admission, and the incidence rates of systemic complications, pancreatic necrosis, and clinical outcomes were analyzed. The Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, the chi-square test was used for comparison of categorical data between groups, and the Spearman rank correlation test was used for correlation analysis. ResultsBiliary tract disease remained the leading cause of SAP (38%), followed by hypertriglyceridemia (25%). As for systemic complications, the HTGP group had a significantly higher incidence rate of ARDS than the biliogenic AP group and the alcoholic AP group (P=0.014 and 0022). In the groups with different TG levels, the incidence rates of ARDS and acute renal injury were positively correlated with TG level (r=0.966 and 0.982, P=0.004 and 0.019). ConclusionThe HTGP group has a higher incidence rate of ARDS than the biliogenic AP group and the alcoholic AP group, and the risk of ARDS and acute renal injury tends to increase with the increasing TG level.

BACKGROUND:The incidence of intestinal necrosis during liver transplantation is low, and most of them abandon transplantation and thus leading to death. OBJECTIVE:To retrospectively analyze the reasons which result in smal intestinal necrosis during liver transplantation, and to explore the viable treatment options. METHODS:The clinical data of 207 patients were reviewed, two patients complicated with smal intestinal necrosis during liver transplantation. Case 1 underwent liver transplantation combined with necrotic smal bowel resection. Case 2 abandoned liver transplantation, and received conservative treatment. RESULTS AND CONCLUSION:Both of the two patients had preoperative portal system thrombosis. In Case 1, there was upper gastrointestinal bleeding before transplantation, and repeated application of hemostatic drugs could increase the thrombosis and thus resulting smal intestinal necrosis. At 10 days after liver transplantation, the patients complicated with intestinal fistula and were treated with fistulation. After fistulation, the patient suffered from abdominal cavity and lung infections. At 7 days after anti-infection treatment and immunosuppressant stopped, the infections were cured. At 40 days after fistulation, the intestinal fistula was healed and the patient was discharged after rehabilitation. After fol owed-up for 2 years, the patient was stil healthy living. The Case 2 suffered with mass ascites which lead to abdominal compartment syndrome, the intestinal venous disorders lead to extensive smal bowel necrosis. At 2 days after abandon the liver transplantation, the patient was dead because of multiple organ failure. The patients who waiting for liver transplantation had preoperative portal system thrombosis, abdominal pain and abdominal distention, should be pay attention to intestinal necrosis. Patients with smal bowel necrosis during liver transplantation can be cured with liver transplantation combined with necrotic smal bowel resection.

ObjectiveTo investigate the clinical features of elderly patients with acute pancreatitis (AP) aged ≥80 years. MethodsA retrospective analysis was performed for 3642 patients with pancreatitis who were admitted to Department of Gastroenterology in The Affiliated Hospital of Southwest Medical University from January 2013 to December 2019, and according to age, they were divided into young group (aged ＜65 years) with 2955 patients, middle-aged group (aged 65-79 years) with 558 patients, and elderly group (aged ≥80 years) with 129 patients. Related clinical data were collected and analyzed, including sex, age, etiology, predisposing factors, past medical history, disease severity, complication, and clinical outcome. The independent samples one-way ANOVA-test was used for comparison of normally distributed continuous data between groups and the least significant difference t-test was used for comparison within each group; the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups; the Kruskal-Wallis H test was used for comparison of ordinal categorical variables. ResultsIn the young group, there were 1721 male patients and 1234 female patients; in the middle-aged group, there were 214 male patients and 334 female patients; in the elderly group, there were 48 male patients and 81 female patients; the middle-aged group and the elderly group had a significantly higher proportion of female patients than the young group (62.8% vs 61.6% vs 41.8%, P＜0.05). High-fat diet was the main predisposing factor for all three groups, and compared with the young group, the elderly group had a significantly lower proportion of patients with AP induced by alcohol or high-fat diet+alcohol (P＜0.05). The elderly group had a significantly higher proportion of patients with the etiology of biliary diseases than the middle-aged group and the young group (798% vs 69.2% vs 41.4%, χ2=204.127, P＜0.05), as well as a significantly lower proportion of patients with the etiology of hyperlipidemia, alcohol, or biliary diseases+hyperlipidemia (all P＜0.05). Among the 129 patients in the elderly group, 83 (64.3%) had mild AP, 23 (17.8%) had moderate-severe AP, and 23 (17.8%) had severe AP; there was a significant difference in the constituent ratio of disease severity between the elderly group and the middle-aged/young groups (H=1972.5, P＜005). The elderly group and the middle-aged group had a significantly lower proportion of patients with recurrence than the young group (both P＜0.05). There were no significant differences in local complications between the three groups (all P＞0.05), and as for systemic complications, compared with the young group, the elderly group had a significantly higher proportion of patients with pneumonia (3.9% vs 2.2%, P＜0.05), acute kidney injury (AKI) (6.2% vs 2.5%, P＜0.05), or multiple organ dysfunction syndrome (MODS) (7.8% vs 4.0%, P＜0.05). Compared with the middle-aged group and the young group, the elderly group had a significantly lower proportion of cured patients (67.4% vs 76.3% vs 820%, P＜0.05) and a significantly higher proportion of patients with improvement (23.3% vs 147%/12.7%, P＜0.05). The elderly group and the middle-aged group had a significantly higher proportion of patients withdrawn from treatment than the young group (8.5%/5.9% vs 3.4%, P＜0.05). There was 1 death in the elderly group (0.8%), 9 deaths in the middle-aged group (1.6%), and 16 deaths in the young group (0.5%), and there was no significant difference between the three groups (P＞0.05). There were no significant differences in length of hospital stay and hospital costs between the three groups (P＞0.05). ConclusionAP patients aged ≥80 years are mainly female and are often caused by biliary factors, and they are likely to develop the complications such as pneumonia, AKI, and MODS.

Background and purpose: Regional lymph node metastasis was significantly associated with the prognosis of patients with non-small cell lung cancer (NSCLC). This study was designed to compare paclitaxel liposome plus cisplatin (LP) with gemcitabine and cisplatin (GP) in patients with regional lymph node metastasis of advanced NSCLC as a ifrst-line treatment. Methods:A total of 55 patients were randomly assigned to receive either liposomal paclitaxel (175 mg/m2) and cisplatin (75 mg/m2) or gemcitabine (1 000 mg/m2) and cisplatin (75 mg/m2) every 3 weeks. Results:Objective response rate (ORR) of lung primary foci was 37.9%in the LP arm and 30.8%in the GP arm (P>0.05) and the disease control rate (DCR) was 91.3%and 80.8%respectively (P>0.05);ORR of regional metastasis lymph node was higher in the LP arm (44.8%vs 15.4%, P<0.05).There was no signiifcant difference in DCR (93.1%vs 73.1%, P=0.101), although slight trends favoring paclitaxel liposome were seen;There was signiifcant difference in median overall survival (17.0 vs 12.0 months, P<0.05). LP was associated with significantly less thrombocytopenia and gastrointestinal side effects (P<0.05), but no signiifcant difference was observed in hyphemia, leucopenia, hepatotoxicity, renal toxicity and allergic reactions (P>0.05). Conclusion: Liposomal paclitaxel plus cisplatin is superior to gemcitabine plus cisplatin with less toxicity and better tolerated, it deserves further research and clinic application for patients with regional lymph node metastasis of advanced NSCLC.

Objective To observe the effect of miR-145 on pain threshold and explore the pos-sible underlying positive role of miR-145 in rats with diabetic neuropathic pain.Methods The total of 36 rats with diabetic neuropathic pain were randomly divided into three groups respectively with nor-mal control group (group N)(n=12 for each group):diabetic neuropathic pain(DNP)group (group D),DNP-NC group (group DN)and DNP-agomiR-145 group (group agomiR-145).The rats received agomiR-145 intrathecal injection in group agomiR-145 (10 μl,1×106TU/ml),or the negative control virus in group DN (10 μl,1×106TU/ml),or equal volume of normal saline in other two groups. Paw mechanical withdrawal threshold(MWT)and paw withdrawal latency(TWL)were measured on the day before intrathecal injection and day 1,days 3,7 and 14 after intrathecal injection.On the days 14 after pain-related behavioral test,the RNA expression of miR-145 in the dorsal root ganglion (DRG)was detected using reverse transcription-quantitative polymerase chain reaction(RT-PCR)as-say and the expression of Nav 1.8 in DRG were detected by fluorescent immunofluorescence.In addi-tion,a dual luciferase activity assay was used to testify the target genes of miR-145.Results MWT and TWL were decreased at 1 d before intrathecal injectionin groups D,DN and agomiR-145 than that in group N (P<0.05).The significant increase of MWT was observed in group agomiR-145 on day 3,7,14 than those in group D and group DN (P<0.05).TWL in group agomiR-145 was increased significantly on day 7 and day 14 compared with those in groups D and DN (P<0.05).Compared with group N,miR-145 expression level in DRG in groups D and DN were significantly lower (P<0.05).In addition,the protein expression of Nav1.8 was significantly increased in group D and DN compared with that in group N (P<0.05).Compared with groups D and DN,miR-145 expression was increased significantly and the expression of Nav1.8 in DRG was decreased significantly in group agomiR-145 (P<0.05).In addition,a dual luciferase reporter assay demonstrated that miR-145 can bind with the 3'-UTR region of Nav1.8 and regulate its expression.Conclusion Intrathecal agomiR-145 can effectively attenuate neuropathic pain of DNP rats,which may be related with down-regulation of Nav1.8 in DRG..

ObjectiveTo investigate the influence of serum triglyceride (TG) level on the outcome of acute biliary pancreatitis (ABP). MethodsA retrospective analysis was performed for 249 ABP patients who were admitted to The Affiliated Hospital of Southwest Medical University from September 2018 to August 2019, and the patients were divided into normal blood lipid group(n=156) and mild(n=25), moderate(n=44), and severe(n=24) hyperlipidemia groups. The patients’ data were collected for analysis. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and the Dunn-Bonferroni test was used for further comparison between two groups. The chi-square test was used for comparison of nominal categorical variables between multiple or two groups; the Kruskal-Wallis H test was used for comparison of ordinal categorical variables between multiple groups, and the Mann-Whitney U rank sum test was used for further comparison between two groups. A multivariate logistic regression analysis was used to investigate the influencing factors for organ failure and infectious pancreatic necrosis (IPN), and the receiver operating characteristic (ROC) curve was used to evaluate the value of different indices in predicting severe acute pancreatitis (SAP). ResultsThere were significant differences in age and BISAP between four groups(χ2=25.057， 10.430, all P＜0.05) . Compared with the normal blood lipid group, the severe hyperlipidemia group had a significantly higher proportion of patients with IPN or multiple organ failure syndrome (MODS) (both P＜0.05), and the moderate hyperlipidemia group had a significantly higher proportion of patients with MODS (P＜0.05), while the severe hyperlipidemia had a significantly higher proportion of patients with systemic inflammation reaction syndrome than the other three groups (all P＜005). Compared with the normal blood lipid group, the moderate and severe hyperlipidemia groups had a significant increase in the risk of MODS (moderate hyperlipidemia group: odds ratio ［OR］=3.500, 95% confidence interval ［CI］: 1.193-10.270, P＜0.05; severe hyperlipidemia group: OR=6.167, 95%CI: 1921-19.792, P＜0.05), and after adjustment, the risk of MODS in the severe hyperlipidemia group was 3.430 times that in the normal blood lipid group (95%CI: 1.198-9.825, P=0.022). The severe hyperlipidemia group had a significant increase in the risk of IPN (OR=4.351, 95%CI: 1.719-11.008, P＜0.05), and after adjustment, the risk of IPN in the severe hyperlipidemia group was 5.819 times that in the normal blood lipid group (95%CI: 1.489-22.745, P＜0.05). Blood lipids had a good value in predicting SAP, with an area under the ROC curve of 0.626 (95%CI: 0.530-0.723, P=0.008). ConclusionCompared with the ABP patients with normal TG, ABP patients with elevated TG tend to have a younger age, more complications, and a higher mortality rate, especially those with a TG level of ＞5.65 mmol/L, and therefore, antihyperlipidemic treatment for such patients should be taken seriously to improve their survival rate and prognosis.