Allergen-specific immunotherapy（AIT） remains the only therapeutic approach with the potential to modify the natural course of allergic rhinitis（AR）. Nevertheless, considerable inter-individual variability exists in patients'responses to AIT. To facilitate more reliable assessment of treatment efficacy, the China Rhinopathy Research Cooperation Group（CRRCG） convened young and middle-aged nasal experts in China to formulate the present consensus. The recommended subjective outcome measures for AIT comprise symptom scores, medication scores, combined symptom and medication scores, quality-of-life assessments, evaluation of disease control, and assessment of comorbidities. Objective indicators may supplement these measures. Currently available objective approaches include skin prick testing, nasal provocation testing, and allergen exposure chambers. However, these methods remain constrained by practical limitations and are not yet appropriate for routine implementation in clinical efficacy evaluation. In addition, several biomarkers, including sIgE and the sIgE/tIgE ratio, sIgG4, serum IgE-blocking activity, IgA, cytokines and chemokines, as well as immune cell surface molecules and their functional activity, have been shown to have associations with AIT outcomes. While these biomarkers may complement subjective assessments, they are subject to significant limitations. Consequently, large-scale multicenter trials and real-world evidence are required to strengthen the evidence base. The present consensus underscores the necessity of integrating patients'subjective experiences with objective testing throughout the treatment process, thereby providing a more comprehensive and accurate framework for efficacy evaluation. Looking forward, future investigations should prioritize the incorporation of multi-omics data and artificial intelligence methodologies, which hold promise for overcoming current limitations in assessment strategies and for advancing both the standardization and personalization of AIT.
Humans ; Allergens/immunology* ; China ; Consensus ; Desensitization, Immunologic ; Immunoglobulin E ; Quality of Life ; Rhinitis, Allergic/therapy* ; Treatment Outcome ; East Asian People

The current document is based on a consensus reached by a panel of experts from the Chinese Society of Allergy and the Chinese Society of Otorhinolaryngology-Head and Neck Surgery, Rhinology Group. Chronic rhinosinusitis (CRS) affects approximately 8% of Chinese adults. The inflammatory and remodeling mechanisms of CRS in the Chinese population differ from those observed in the populations of European descent. Recently, precision medicine has been used to treat inflammation by targeting key biomarkers that are involved in the process. However, there are no CRS guidelines or a consensus available from China that can be shared with the international academia. The guidelines presented in this paper cover the epidemiology, economic burden, genetics and epigenetics, mechanisms, phenotypes and endotypes, diagnosis and differential diagnosis, management, and the current status of CRS in China. These guidelines—with a focus on China—will improve the abilities of clinical and medical staff during the treatment of CRS. Additionally, they will help international agencies in improving the verification of CRS endotypes, mapping of eosinophilic shifts, the identification of suitable biomarkers for endotyping, and predicting responses to therapies. In conclusion, these guidelines will help select therapies, such as pharmacotherapy, surgical approaches and innovative biotherapeutics, which are tailored to each of the individual CRS endotypes.
Adult ; Asian Continental Ancestry Group ; Biomarkers ; China ; Consensus ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Eosinophils ; Epidemiology ; Epigenomics ; Genetics ; Humans ; Hypersensitivity ; Inflammation ; International Agencies ; Medical Staff ; Neck ; Phenotype ; Precision Medicine

Objective To investigate the value of iFlow color-coding technique in quantitative real-time analysis of hemodynamic changes after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) . Methods A total of 31 patients who were diagnosed with HCC in Shanghai Fifth People's Hospital from December 2015 to January 2017 were enrolled. No patient underwent surgical operation or ablation. All patients underwent TACE with the same contrast agent, high-pressure injector parameters, and place of angiographic catheter. The iFlow technique was used to generate two-dimensional color-coded images and time-density curve (TDC) before and after surgery and measure the opening of the angiographic catheter and the time to peak (TTP) of the starting and ending points of the major tumor feeding arteries, as well as the ratio of the areas under the curve (AUC) of TDC of tumor tissue and the opening of the angiographic catheter. The paired t-test was used for comparison of continuous data between groups. Results TTP of the major tumor feeding arteries was 4.64 ± 0. 49 s before TACE and 5. 97 ± 0. 84 s after TACE (t = 11. 57, P ＜ 0. 01), and there was a significant difference in AUC between the tumor tissue and the opening of the angiographic catheter (0. 53 ± 0. 15 vs 0. 16 ± 0. 12, t = 25. 85, P ＜ 0. 01) . There was no significant difference in TTP between the opening of the angiographic catheter and the major tumor feeding arteries before and after TACE (P＞ 0. 05) .Before TACE, the TDC of tumor feeding arteries had a shape of"rapid increase-rapid reduction"with relatively high slope and peak value, while after TACE, the TDC had a shape of "increase-flat-reduction"with reductions in slope and peak value. Conclusion The iFlow technique can perform real-time measurement of TTP and TDC of the region of interest and helps with quantitative evaluation of hemodynamic changes in HCC. Therefore, it can provide objective quantitative indices for evaluating the degree of tumor embolism.

Objective To investigate the application value of CT perfusion imaging (CTPI) combined with CT angiography (CTA) for determination and diagnosis of transient ischemic attack (TIA).Methods Totally 50 TIA patients from April 2014 to April 2016 in the neurology department of some hospital underwent examinations by CT scan,CTPI and CTA in time,and the values of cerebral blood volume (CBV),cerebral blood flow (CBF),mean transit time (MTT) and time to peak (TTP) were calculated at the uninjured and injured sides of the areas of interest.The relationship between cerebral blood perfusion and cerebral angiostenosis of the TIA patient was analyzed.Results The 50 patients had the values of CBF and CBV at the injured sides lower while the ones of MTI and TTP higher than those at the uninjured sides (P＜0.05).The numbers of the abnormal cerebral blood perfusion patients found by CT scan,CTPI and CTA were 28 (56.00％),45 (90.00％) and 38 (76.00％) respectively,who were confirmed clinically simultaneously.There were significant differences between the TIA positive result rates by CT scan,CTPI and CTA (P＜0.05).Conclusion Carotid artery hypoperfusion is one of the pathogeneses of TIA,and positive rate by CTPI is closely related to the conditions of TIA.CTPI combined with CTA contributes to the diagnosis of TIA,and can be used for its individualized treatment.

Objective To explore the mixed mucinous breast carcinomas(MMBC)and pure mucinous breast carcinomas(PMBC) imaging features,and evaluate the diagnostic value of ultrasound,X-ray and MRI for mucinous breast carcinoma(MBC).Methods Totally 48 cases of MBC proved by postoperative pathology were analyzed retrospectively.Manifestations of ultrasonography,X-ray and MRI of MMBC and PMBC were summarized,and diagnostic values of three methods were compared.Results Most PMBC showed regular shaped (round,oval or lobulated)mass with clear edge,but most MMBC showed irregular shaped mass with unclear edge in three imaging examinations.On sonogram,MBC mainly showed mixed cystic-solid echo,most PMBC showed low blood signal with rear echo enhancement,and most MMBC showed rich blood signal with various rear echo.On MRI,MBC usually demonstrated high or strongly high signal intensity on T2 WI.On DCE-MRI,PMBC was mainly characterized by rim enhancement with persistent enhancement pattern, and MMBC was exhibited more heterogeneous or rim enhancement with plateau enhancement pattern.Three imaging methods were no significant difference in the accuracy of diagnosis between PMBC and MMBC.There was no statistical significance in three imaging methods.Conclusion PMBC and MMBC with different the appearances of ultrasonography,X-ray and MRI have some characteristics.Fully aware of imaging features can not only identify two types of MBC,but also reduce missed diagnosis and misdiagnosis of MBC.

Diffusion-weighted magnetic resonance imaging (DW-MRI) is a functional imaging technique which can exhibit the diffusion characteristics of water molecules in vivo and thus indirectly reflect cellular density, the integrity of cell membrane, and capillary perfusion. The main applications of DW-MRI in hepatic lesions, especially in hepatocellular carcinoma, staging of liver fibrosis, and monitoring of tumor therapy, are described. Although this technique, which can be applied without need for contrast agent, is still insufficient, it will have broad application prospects with the development of software and hardware.

Objective To determine the optimal volume proportion of iodize d oil (Lipiodol)-ethanol mixture by comparing the clinical efficacy of transhepatic arterial embolization-ablation therapy using different volume proportion of Lipiodol-ethanol mixture in treating experimental rabbit models with VX 2 liver cancer. Methods VX2 tumor was implanted in eighteen adult male New Zealand white rabbits. The 18 VX 2 rabbit models were randomly and equally divided into the following six groups according to the Lipiodol-ethanol volume ratio ∶ group A (3 ∶ 1), group B (2 ∶ 1), group C (1 ∶ 1), group D (1 ∶ 2), group E (1 ∶ 3) and group F (1 ∶ 4). One week after the treatment, all the rabbits were sacrificed and their livers were removed and sent for pathologic examination. The tumor growth rate, the microvascular density, the apoptosis index (AI) of tumor tissues and the injury of the hepatic tissue adjacent to the tumor were evaluated. Results After the treatment, the tumor’s size was increased in group A, E and F. The tumor growth rate of group A was significantly higher than that of the other five groups , and the difference was statistically significant (P<0.05). The tumor’s size of groups B, C and D was decreased, although the difference was not significant when compared with the tumor’s size of groups E and F (P > 0.05). The proportion of ethanol in Lipiodol ∶ethanol mixture bore a negative relationship to the microvascular density counts (R2= 0.840, F = 89.432, P < 0.001). AI of group A was strikingly lower than that of groups C, D, E and F (P < 0.05). The difference in AI between group A and group B was not significant (P > 0.05), while the difference in AI between group B and group C or between group B and group F was statistically significant (P<0.05), and no significant difference in AI existed between each other among other groups (P > 0.05). The injury extent of the hepatic tissue adjacent to the tumor in group A and B was remarkably milder than that of other groups (P < 0.05). Conclusion When considered in terms of safety, the optimal volume proportion of Lipiodol-ethanol mixture should be 2 ∶ 1. Successful super-selective catheterization of the tumor feeding artery, strict and close fluoroscopic monitoring of the injection and proper increase in the proportion of ethanol can definitely improve the therapeutic efficacy.

Objective To investigate the CT manifestations of gastric carcinoma invasion to lesser omentum and to assess the im-pact of lesser omentum on the spreading of gastric carcinoma.Methods We retrospectively reviewed CT findings in 48 patients with gastric carcinoma and lesser omentum involved for primary tumor and the lesser omentum abnormalities.The influence of lesser o-mentum on the extension of gastric carcinoma as well as the accompanied ascites were also analyzed.Results CT manifestations of lesser omentum involvement in gastric carcinoma included the following items:① direct infiltration (35.4%,1 7/48),which was mainly shown as increased density of fatty tissue and the development of mass within the lesser omentum,including spreading into the liver through the lesser omentum directly in two cases;② omental seeding (25.0%,12/48),including smudged appearance (1 1 cases)and omental caking (1 case);③ metastasis of lymph nodes (64.6%,31/48),including enlargement and increase of lymph nodes (27 cases)and cystic mass (4 cases).Ascites was found in 1 1 patients and fluid collection in the lesser sac was shown in 3 of these 1 1 patients.The lesser omentum forms the anterior wall of the lesser sac and separates the fluid collection in the lesser sac from the ascites in the greater peritoneal cavity.Ascites was associated with the omental seeding statistically.Conclusion CT scan is helpful for detecting lesser omentum invasion by gastric carcinoma.The imaging features consist of mass sign,enlargement of lymph nodes,smudged andcakingappearance,and so on.Lesser omentum may also play a certain role in both the extension of gastric carcinoma and the compartmentalization of ascites due to gastric carcinoma.

Magnetic resonance diffusion-weighted imaging (MR-DWI) is a functional technology at the molecular level.Compared to other imaging exams (such as DSA,CT,US),DWI is non invasive,has no radiation,and objective.Thus,it is widely accepted in clinical settings.As a means to assess the therapeutic efficacy of intervention,DWI has a promising prospect.In this article,we review the application of MR-DWI in evaluating the therapeutic efficacy of hepatocellular carcinoma intervention.

Objective To study the impact of preprocedure intravenous urography (IVU) on the extracorporeal shock wave lithotripsy(ESWL) for proximal ureteral stones.Methods One hundred patients with solitary radiopaque proximal ureteral stones on plain radiographs and no severe hydronephrosis on ultrasonographic examination were allocated randomly to two treatment groups.IVU group (n=50) had IVU before the start of ESWL,whereas patients in control group (n=50) underwent ESWL without IVU.Postop- erative success,the stone-free rates and complications were evaluated in both groups. Results Seven patients in IVU group were excluded from the study. The success rate [95.3%(41/43) in IVU group vs 94.0% (47/50) in control group],stone-free rate [83.7% (36/43)vs 86.0% (43/50)] and complication rate[27.9% (12/43 ) vs 26.0% (13/50)]were similar in two groups (P＞0.05).Conclusions It is not necessary to obtain an IVU for patients who have solitary radiopaque proximal ureteral calculi on plain radiographs with no severe hydronephrosis on uhrasonographie examination before scheduling them for ESWL,thus minimizing the cost,avoiding exposure to contrast medium,and reducing radiation exposure.