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 To study the method based on gradient vector flow (GVF) and particle swarm optimization (PSO) for realizing multimodal medical image registration and improving its accuracy. Methods In view of three major components of image registration, i.e. the feature space, the similarity metric and the search strategy, a novel method was proposed with three improvements. Firstly, the GVF field was employed as the feature space. Then three similarity metrics were proposed based on GVF field. Finally, an improved PSO combined with crossover mechanism of genetic algorithm was utilized to search for the optimal transformation of two images. Results With 54 times of experiments on both simulated and real medical images, it was demonstrated that this method accurately registered the multimodal medical images to be superior to the method based on PSO of pixels, and the Walsh transform method. Conclusion The method based on GVF and PSO is effective for multimodal medical image registration.

Objective To evaluate the diagnostic value of DCE-MRI and breast MR reporting and data system(BI-RADS-MR)in differentiation of breast lesions. Methods Seventy-five patients with 75 pathological-confirmed breast lesions underwent DCE-MRI before treatment and DCE-MRI quantitative analysis. Two senior doc-tors assessed the imaging features blindly by BI-RADS-MR. The pathology results were set as a gold standard. The receiver operating characteristic curve(ROC)interpretation of two physician′s curve analysis was used to evaluate the sensitivity,specificity of BI-RADS classification. Results According to the BI-RADS MR score,38 breast cancer patients were rated as 1 case in grade Ⅰ,0 case in grade Ⅱ,4 cases in gradeⅢ,13 cases in gradeⅣ,20 cases in grade V;37 breast benign tumors were rated as 17 cases in grade Ⅰ,5 cases in grade Ⅱ,12 cases in gradeⅢ,3 cases in gradeⅣandⅤ0 cases. The statistical difference of Tpeak,S max,K1 between benign and malig-nant breast tumors were significant(P<0.05). On ROC,the area under the curve was 0.940,95%confidence in-terval was from 0.887 to 0.994. The sensitivity of BI-RADS in the diagnosis of breast cancer was 94.59%and speci-ficity was 92.11%. Conclusion DCE-MRI combined with BI-RADS-MR classification in diagnosis of benign and malignant breast tumors has an important value and can improve diagnosis and differential diagnosis level.

[ABSTRACT]OBJECTIVETo investigate the species distribution of the common inhaled allergens among the primary and middle school students in Beijing.METHODSA total of 1280 students who were randomly selected underwent 20 kinds of common allergen skin prick test. Skin prick test were positive in 495 students.RESULTS49.3% of the Beijing primary and secondary school students were positive for more than four kinds of allergens. The dust mites and fall pollen allergens were positive at the same time in 37.4% of the allergen positive students. The commonest three allergens were D. farina, D. pteronginus and Large seed fleabane pollen in urban area, and were dermatophagoides farinae, willow tree pollen and Large seed fleabane pollen in suburban area. The positive rate of skin prick test decreased with age.CONCLUSIONThe dust mites and fall pollen are the most important allergens in primary and middle school students in Beijing.

Objective To investigate the relationship between the content of stromal cell-derived factor-1 (SDF-1) in myocardium in different period of myocardial infarction and left ventricular function.Methods Twenty three Chinese miniature pigs were randomly divided into the experimental group and the control group.The swines in experimental group were prepared as acute myocardial infarction model by ligating anterior descending coronary artery and were randomly divided into 6 subgroups according to the different time points after infarction.The left ventricular end-diastolic diameter (LVDd),left ventricular ejection fraction (LVEF) and left ventricular fraction shortening (LVFS) were measured respectively.Global circumferential strain (GCS) and global radial strain (GRS) of left ventricle were measured.The content of SDF-1 were also measured by real-time quantitative PCR.Results Compared with the control group,SDF-1 levels were significantly elevated,and LVEF,LVFS,GCS and GRS were reduced.However,LVDd were significantly increased.The content of SDF-1 and GCS has a negative correlation (r =-0.580,P =0.000).Conclusions The content of SDF-1 in myocardial tissue have a certain relationship with GCS of left ventricular myocardium.

Objective To establish a simple and rapid method for the determination of 1,3-dideoxygalactonojirimycin in Bombycis Faeces, a potent glucosidase inihibitor, by HPLC. Methods A RP-HPLC method with fluorescence detection has been developed. Results The HPLC method developed in this research has a good reliability including accuracy and precision. The detection limit was less than 72 ng. Conclusion This method is sufficiently sensitive for determining 1,3-dideoxygalactonojirimycin in Bombycis Faeces and other related products.

[ABSTRACT]OBJECTIVETo investigate the prevalence of allergic rhinitis in Beijing primary and middle school students.METHODSStratified cluster sampling was conducted with the school as a unit. The investigated subjects included the 7 to 15 years old students from the primary and middle school in Beijing Dongcheng District and Changping District. The epidemiological investigation was carried out using the designed allergic rhinitis questionnaire. Allergen skin prick test was performed in students randomly selected from those who participated the questionnaire survey. The results were statistically analyzed.RESULTS1. The self-reported prevalence of allergic rhinitis was 49.68% in Beijing primary and middle school students. 2. Self-reported prevalence increased with age going up. 3. City center self-reported prevalence was higher than that in suburb areas. 4. The confirmed prevalence of allergic rhinitis in Beijing primary and middle school students was 21.09%, in which, the male prevalence rate was 24.83% and the female prevalence rate was 14.11%. 5. The 5.14% of the students with allergic rhinitis were combined with asthma.CONCLUSIONThe self-reported and confirmed prevalence of allergic rhinitis in Beijing primary and middle school students was 49.68% and 21.09% respectively.

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.

Objective To compare the clinical effects of proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) in the treatment of intertrochanteric fractures in elderly patients.And provide a reasonable basis for clinical treatment of elderly patients with intertrochanteric fractures.Methods The clinical and follow-up records of 58 elderly patients with intertrochanteric fractures treated by PFNA and DHS were retrospectively reviewed.For times of operation,blood loss in operation,length of incision,incidents of complication and Harris's hip functional standard score were compared and analyzed.Results PFNA group operation time[(59.61 ± 8.27)min],amount of bleeding[(234.51 ± 38.80)ml] were both better than the DHS group of[(83.54 ± 11.12)min and (446.57 ±54.01) ml] respectively.There were significant differences (t =9.80,18.10,all P ＜ 0.05).The satisfactory rate was 92.8％ in PFNA group,higher than the DHS group's 83.3 ％ (x2 =6.18,P ＜ 0.05).There was significant difference between two groups in the incident of complication,DHS group was higher.Conclusion PFNA internal fixation with a minimally invasive,fixed solid and recovery fast,is the better internal fixation in the treatment of elderly intertrochanteric fracture patients.

Objective To observe the relationship between liver steatosis in rats with long-term high-caloric and high-fat diet and the expression of angiotensinogen(AGT)、uncoupling protein 2(UCP-2)and transforming growth factorβ1(TGFβ1).Then angiotensin-converting enzyme inhibitor(ACEI)and angiotensin Ⅱ receptor blocker(ARB)drugs were given to investigate whether rennin-angiotensin system (RAS)blockade can mitigate the liver steatosis and to probe its mechanisms.Methotis Forty male Wistar rats were divided into normal control group(NC group,n=10),high-calorie and high-fat fed group(HF group,n=10),ARB treated group(AR group,n=10)and ACEI treated group(AE group,n=10).Rats were fed with high-calorie and high-fat diet and given RAS inhibitor drugs(valsartan 40mg/kg to the AR group and perindopril 4 mg/kg to the AE group)for eight weeks.Serum TG,free fatty acids(FFAs) lever and the fat content in liver were then measured with biochemical tests;insulin resistance was evaluated with euglycemic hyperinsulinemia clamp technique,the expression of UCP-2 and TGFβI in liver tissue were examind with immunohistochemical staining and AGT mRNA,UCP-2 mRNA and TGFβ1 mRNA were tested with RT-PCR.Results With the administration of RAS inhibitor drugs,following changes were observed.The levels of TG and FFAs and the fat content in liver decreased(P＜0.01 or P＜0.05),insulin resistance in high-fat fed rats was improved(P＜0.05),liver steatosis,inflammation and fibrosis were mitigated.The levels of UCP-2 decreased by 36.5%(P＜0.05)in AE group and 42.5%(P＜0.05)in AR group and TGFβ1 decreased by 37%(P＜0.05)in AE group and 41.6%(P＜0.05)in AR group as compared with the HF group with immunohistochemical staining.The expression of AGTmRNA decreased by 14.9%(P＜0.05)in AE group and 21%(P＜0.05)in AR group,UCP-2 mRNA decreased by 9%(P＜0.05)in AE group and 11%(P＜0.05)in AR group and TGFβ1 mRNA decreased by 17%(P＜0.05)in AE group and 19%(P＜0.05)in AR group as compared with the HF group with RT-PCR.Conclusions RAS blockade could improve insulin resistance,mitigate the liver injury of long term high-fat fed rats and have a protective effect on liver.The mechanism may be associated with the effects of improved insulin resistance,the interaction within RAS and the down-regulation of UCP-2 and TGFβ1 in liver tissue.