Volume 94  ·   Issue 16  ·  2014

Bronchial asthma (asthma for short) is one of the most common chronic respiratory diseases. Its treatment not only consumes a lot of health resources in various countries, but also causes a serious socioeconomic burden due to the loss of labor force. With the accelerating industrialization and urbanization, environmental pollution and changes in climate and ecological environment, the prevalence of asthma is increasing at a rate of almost 50% every 10 years^[1]。 It is estimated that there are about 300 million asthma patients worldwide, and the corresponding disease burden accounts for about 1% of all diseases worldwide, disability-adjusted life years (DALYs), which is equivalent to that of diabetes patients^[2]。 The disease burden of asthma is an important indicator to study the impact of asthma on society. There are a lot of studies on the burden of asthma in western developed countries, but China is lacking in this aspect. In recent years, with the rapid development of China's economy, people's lifestyle, diet and living environment have changed significantly, and the prevalence of asthma caused by this has also increased significantly. The results of the 2010 asthma epidemiological survey in Beijing showed that the prevalence of asthma among people over 14 years old in this area was 1.19%^[3]Approximately 150% higher than 10 years ago^[4]Based on this, it is estimated that there are about 200,000 asthmatics over the age of 14 in Beijing, and the annual medical expenses are about 600 million yuan. It is estimated that the number of asthma patients in China is about 30 million, and the annual medical expenses are about 90 billion yuan. Therefore, it is urgent to study the burden of asthma disease in China, which will be beneficial to formulate relevant health policies nationwide and provide reference for rational utilization of health resources.

Bronchial asthma (asthma for short) is a chronic respiratory diseases presented by reversible airway obstruction secondary to allergic inflammation and excessive contraction of bronchial smooth muscle^[1]。 Currently, based on the knowledge of the pathogenesis of asthma, anti-inflammatory drugs [mainly inhaled glucocorticoids (ICS)] and bronchodilators [mainly inhaled long-acting beta₂Agonists (LABAs)] have been widely used in the treatment of asthma.

Bronchial asthma (asthma for short) is a chronic airway inflammatory disease caused by the interaction between susceptible individuals and environmental factors. Various inhalants in the environment, such as allergens and pollutants, play an important role in the pathogenesis of asthma. Recent studies have shown that environmental factors affect patients' genes, which in turn affect their immune response to various inhalants, resulting in mucosal congestion and edema, increased mucus secretion, bronchoconstriction and other airway inflammatory reactions and airway hyperresponsiveness, resulting in asthma symptoms^[1]。

To explore the role and mechanism of signal molecule high mobility group box protein 1 (HMGB1) mediated by Toll-like receptor 2 (TLR2) in a murine asthma model.

Fourteen specific pathogen free (SPF) female C₅₇ and TLR2^-/- mice each were randomly divided into 4 groups of C₅₇ control, C₅₇ asthma, TLR2^-/- control and TLR2^-/- asthma (n=7 each). The animals were sensitized and challenged with ovalbumin (OVA) for asthmatic modeling. The same amount of normal saline was used in the control group. The supernatant of bronchoalveolar lavage fluid (BALF) was collected for detecting the level of HMGB1 by enzyme-linked immunosorbent assay (ELISA). And the expression of HMGB1 in lung tissue was detected by Western blot and immunohistochemistry.

Asthmatic murine model was successfully established. The level of HMGB1 in the BALF of C₅₇ asthma group was significantly higher than that in C₅₇ control, TLR2^-/- asthma and TLR2^-/- control groups ((59.0±13.9) vs (42.3±1.6), (47.5±2.3), (42.4±1.4) ng/L; P=0.001, 0.001, 0.037). The results of immunohistochemistry showed that the marker of HMGB1 in lung tissue was less than those in the C₅₇ control and TLR2^-/- control groups. However, the C₅₇ asthma and TLR2^-/- asthma groups were obviously more and they were located in airway epithelium. Western blot showed that the expression of HMGB1 was significantly higher in C₅₇ asthma group than that in the C₅₇ control, TLR2^-/- asthma and TLR2^-/- control groups (0.92±0.29 vs 0.18±0.09, 0.31±0.16, 0.21±0.14; P=0.007, 0.022, 0.009).

HMGB1 promotes the airway inflammation mediated by TLR2. And it may participate in the pathogenesis of asthma.

To explore the dynamic changes of airway hyperresponsiveness (AHR) in children with cough variant asthma (CVA).

A prospective observational study was conducted at the Children′s Hospital of Soochow University from April 2012 to March 2013. A total of 36 patients were diagnosed as CVA. According to the integral dose of histamine resulting in a 20% (PD20) fall in forced expiratory volume in 1 s (FEV₁), the severity of CVA was graded. Corresponding treatment was administered and the dynamic changes of airway hyperresponsiveness were followed for 0, 1 and 6 months.

Among them, 14 patients suffered from CVA only while another 22 cases had CVA plus upper airway cough syndrome (UACS). PD20 of CVA and CVA+ UACS groups were (0.46±0.26) and (0.58±0.34) mg respectively. No statistically significance existed between two groups (t=-0.880, P>0.05). According to the value of PD20, AHR in CVA patients was classified into four degrees of severe, moderate, mild and very mild. Initially there were moderate (n=8), mild (n=21) and very mild (n=5). At 1 month follow-up, moderate (n=1), mild (n=28) and borderline (n=7); At 6 month, moderate (n=2), mild (n=20) and very mild (n=7). And 4 cases turned negative and another 3 cases became lost. Cough symptom score and PD20 showed no significant correlation (r=-0.086, P>0.05).

AHR in CVA patients is predominantly mild and very mild. And it decreases rapidly mostly during initial treatment phase. The proportion of conversion from CVA into negative and typical bronchial asthma is relatively low.

To survey the risk factors of asthma among the people aged over 14 years in China.

Home visits for completing epidemiological questionnaires in accordance with stratified cluster random sampling survey were conducted in 8 provinces (cities) of China residents aged over 14 years from February 2010 to August 2011. Asthma was diagnosed based upon case history, clinical signs and lung function test. The SPSS 12.0 software was used for statistic analyses for the epidemiological status of asthma.

Sampling population was composed of 180 099 subjects. Among 164 215 valid questionnaires, there were 79 692 males and 84 523 females, 2 034 had asthma. The overall prevalence rate was 1.2% (2 034/164 215). Correlation analyses showed that the risk factors were smoking (OR=1.697, 95%CI: 1.547-1.861), breast feeding (OR=0.801, 95%CI: 0.670-0.959), genetics (OR & 95% CI >1, asthma ( OR=10.440, 95%CI: 8.991-12.112)), complications (OR & 95% CI >1), body mass index (compared with normal weight, overweight ( OR=1.360, 95%CI: 1.212-1.531), obesity (OR=10.631, 95%CI: 9.570-11.801)) and petting (OR & 95% CI >1).

Among Chinese asthmatics aged over 14, their risk factors include host (genetics & obesity) and environmental (smoking, breastfeeding, complications & pets) factors.

To explore the clinical effect and toxicity of (cisplatin, etoposide, ifosfamide & dexamethasone) DECP combination chemotherapy in the treatment of relapsing and refractory multiple myeloma(MM)with extramedullary plasmacytomas.

A total of 20 relapsed and refractory MM patients with extramedullary plasmacytomas treated with DECP regimen from May 2005 to May 2013 were analyzed retrospectively. DECP protocols included cisplatin 20 mg/m², Day 1-3; etoposide 100 mg/d, Day 1-3; ifosfamide 500 mg·m^-2·d^-1, Day 1-4; dexamethasone 20 mg/d, Day 1-4. Efficacy was evaluated after 2 therapeutic cycles.

After 2 therapeutic cycles, the objective response rate (ORR) was 55%(11/20). After 3 therapeutic cycles, the ORR was 7/12. Seven patients completed 4 cycles with an ORR of 4/7. Two patients had finished 6 cycles and continued to maintain partial remission. The most common adverse events included gastrointestinal reaction and myelosuppression. The median follow-up time was 30(12-80)months. The median time of overall survival (OS) was 30(9-121)months. The 1-year OS was 73%, 2-year OS 28% and 3-year OS 21%.

The DECP chemotherapy is both effective and safe in the treatment of relapsed and refractory MM patients with extramedullary plasmacytomas.

To explore the correlation of serum adropin level with coronary artery disease (CAD).

According to coronary angiography, 356 consecutive patients with chest complaints from January 2011 to July 2012 were divided into 2 groups of CAD (n=264, with CAD) and control (n=92, without CAD). The serum adropin level and other CAD related metabolic parameters were measured and SYNTAX score was calculated.

Serum adropin level was significantly lower in group CAD than that in control group ((56±15) vs(83±10)ng/L, P<0.01). Serum adropin levels in high, mild, low SYNTAX score group were (60±22), (56±12), (54±10) ng/L respectively, and there was no significant difference among 3 groups(P=0.116). Multivariate regression analysis revealed that adropin was an independent risk factor for CAD (OR=0.849, 95%CI: 0.817-0.882, P<0.01).

Lower serum adropin level is significantly associated with CAD. Thus it indicates a possible role of adropin in the prevention of CAD.

To characterize the differential diagnostic characteristics and the surgical treatment efficacy of pulmonary artery sarcoma (PAS).

From November 2001 to January 2014, 19 PAS patients were diagnosed and 14 of them underwent surgery at Beijing Anzhen Hospital. And their data were retrospectively reviewed.

All 19 patients underwent pulmonary artery computed tomography angiography (CTA) scan. All showed a filling defect within the lumen of pulmonary artery with a sign of wall eclipsing. And 14 of them had pulmonary artery sarcoma confirmed through postoperative histopathological examination while another 5 patients were confirmed to have FDG abnormal high intake mass shadow on Positron emission tomography-computed tomography (PET-CT) scan. Fourteen patients underwent surgery, including pulmonary endarterectomy (n=12) and pneumonectomy (n=2), and another five had no indication for operation and died shortly. No perioperative death occurred for surgical patients. Five non-surgical patients survived(20.3±11.2)days after discharge. And 14 postoperative patients survived (16.8±3.8) months. The difference between two groups reached statistical significance (P=0.000). The survival difference between two surgical procedures and between two pathological classifications did not reach statistical significance. Nine patients did not while another 5 received adjuvant radiotherapy and chemotherapy. Their average survivals were (12.3±3.2) and (22.8±4.3) months respectively. And the inter-group difference reached statistical significance (P=0.000).

The sign of wall eclipsing on pulmonary artery CTA scan is pathognomonic for PAS. Radical surgical resection provides a longer survival than non-surgery and adjuvant chemotherapy may further extend survival.

To systematically explore the prevalence of human papillomavirus (HPV) in laryngeal cancer (LC) in Chinese and evaluate the association between HPV infection and laryngeal cancer risk.

The databases both in English and Chinese were searched. And the studies met the inclusion criteria were included. The prevalence of HPV in LC group and in subgroups, stratified by publishing years and sample storage methods, were analyzed by the R 3.0 software respectively. The cancer risk of HPV infection was estimated by odds ratio (OR) generated by comparisons with the control group.

The overall prevalence of HPV was 32% [95% confidence interval (CI): 22%-44%] and the prevalence of high-risk HPV-16/18 and low-risk HPV-6/11 was 30% (95%CI: 24%-37%) and 12% (95%CI: 9%-17%) respectively in Chinese LC patients. The HPV-16/18 infection rate was 24% (95%CI: 15%-35%) in the subgroup between 1992 and 2000 and 32% (95%CI: 24%-41%) in the subgroup from 2001 to 2012 respectively. And no significant difference existed between two subgroups (P=0.07). The HPV-16/18 infection rate in formalin-fixed paraffin-embedded sample cohort was not significantly different from the fresh-frozen sample cohort [31% (95%CI: 24%-39%) and 28% (95%CI: 18%-42%); P=0.06]. Meta-analysis showed the overall HPV infection rate in the LC group was significantly higher than in the control group (OR=15.87 (95%CI: 9.25-27.24); P<0.01). Moreover, as compared with the control group, the patients in the LC group had a higher infection rate of HPV-16/18 (OR=8.07 (95%CI: 5.67-11.48); P<0.01).

HPV infection rates in Chinese LC patients stay at a relatively high level and tend to increase over time. And HPV infection may increase LC risk in Chinese.

To explore the correlation between CD133 and proliferative marker Ki-67 in primary retroperitoneal leiomyosarcoma and evaluate their prognostic values.

A total of 50 primary retroperitoneal leiomyosarcoma samples were collected at our hospital from January 2000 to December 2012. There were 9 males and 41 females. All samples were analyzed for CD133 and Ki-67 protein expression by PV6000 immunohistochemistry. Their median age was 49 (27-75) years. All cases were successfully followed up.

CD133 expression was detected in 74.00% (37/50) of primary retroperitoneal leiomyosarcoma samples. The CD133-positive rates of histological gradesⅠ& Ⅱprimary leiomyosarcoma were 7/13 and 76.70% (23/30) respectively. All grade Ⅲ samples(n=7)were CD133 positive. And the expression of CD133 had a positive correlation with tumor size, mitotic counts and histological grade (χ²=4.925, 4.525, 10.080; P=0.026, 0.033, 0.013). The survival time of CD133-positive patients with M(Q_1,Q₃)was 32(17, 56)months versus 44(26, 65)months for those negative ones. The expression of Ki-67 was detected in 84.00% (42/50) of primary retroperitoneal leiomyosarcoma samples and its expression showed a positive correlation with mitotic counts. The expressions of CD133 and Ki-67 were positively correlated in primary retroperitoneal leiomyosarcomas (P=0.009). Log-rank test showed that positive expressions of CD133 and Ki-67 and 5-year patient survival rate were correlated (P=0.021, 0.049). Multivariate analysis showed that CD133 and mitotic counts were independent prognostic indicators for primary retroperitoneal leiomyosarcomas (HR=2.040, 2.422; P=0.000, 0.018).

CD133 plays an important role in the progression of primary retroperitoneal leiomyosarcomas so that it may be used as a marker for patient prognosis. Combined detection of CD133 and Ki-67 has a prognostic value in patients with primary retroperitoneal leiomyosarcoma.

To analyze the prognostic factors and long-term surgical efficacies of rectal neuroendocrine neoplasm (NEN).

The clinical and pathological data of 141 patients with rectal NENs treated between January 1999 and November 2012 were retrospectively analyzed. The Kaplan-Meier method was used to calculate survival time and Cox regression to analyze the clinicopathological factors correlating with patient prognosis.

The overall 1, 3 and 5-year survival rates were 95.4%, 87.0% and 82.8% respectively. According to the criteria of WHO classification (2010) and staging system about rectal NEN, there were grade 1(G1)(n=76, 79.2%), grade 2(G2) (n=12, 12.5%), neuroendocrine carcinoma(NEC) (n=7, 7.3%) and mixed adenoneuroendocrine carcinoma(n=1, 1.0%), the 1, 3 and 5-year survival rates were 98.6%, 43.7%, 0% and 100.0% respectively. There were stage Ⅰ(n=71, 74.0%), stage Ⅱ(n=5, 5.2%), stage Ⅲ (n=12, 12.5%)and stage Ⅳ(n=8, 8.3%). The 1, 3 and 5-year survival rates were 97.7%, 75.0%, 57.1% and 25.0% respectively. Univariate analysis showed that tumor diameter, histological grade, lymph node metastasis, distant metastasis, radical surgery and muscular layer invasion significantly affected the postoperative survival. And Cox multivariate analysis indicated that tumor diameter and histological grade were independent prognostic factors.

Rectal NENs vary significantly in their prognoses. However, radical surgery offers satisfactory long-term survival rates. An optimal surgical approach should be selected based on tumor size. And more radical surgery should be performed for neuroendocrine tumors >2 cm.

To explore the outcomes of different recurrence patterns and recurrence-related factors after hepatectomy in patients with colorectal liver metastases (CRLM).

The outcomes of different recurrence patterns and recurrence-related factors for surgical resection of CRLMs was reviewed retrospectively.

A total of 152 postoperative recurrent cases were included between 2000 and 2013. The median overall survival was 28.9 months and 5-year survival 22.1% for the entire group. The median disease-free survival was 7.6 months. Among them, 60 patients had disease recurrence within 6 months after hepatectomy (early recurrence) and their median overall survival was 19.4 months versus 35.1 months (n=92) for those with a disease-free interval of over 6 months (P=0.000). Repeat resection was associated with better outcomes, but different patterns of recurrence were not. Lymph node metastases of primary tumor, number of metastases and efficacy of neo-adjuvant chemotherapy (NACT) were independently associated with recurrence.

Recurrence after hepatectomy of CRLMs is affected by lymph node metastases of primary tumor, number of metastases and efficacy of NACT. Additional survival advantage may be achieved by resection of recurrent disease.

To evaluate the diagnostic feasibility of mutation analysis and prenatal genetic diagnosis genetic analysis of IL2RG gene in two families with a birth history of X-linked severe combined immunodeficiency (X-SCID).

Blood samples of a male infant patient of X-SCID and his mother in family 1 and the parents of another deceased child with X-SCID in family 2 from January 2012 to February 2013 were collected. Eight exons comprising IL2RG open reading frame and their exon/intron boundaries were analyzed by bi-directional direct sequencing of polymerase chain reaction (PCR) products. Prenatal genetic diagnoses were performed by chorionic villus sampling after the genotypes of maternal probands were identified in family 1.

Two mutations of IL2RG gene were identified in these two families. The c. 361-363delGAG (p. E121del) mutation was identified in family 1. The c. 510-511insGAACT (p. W173X) mutation appeared in family 2. The two mutations of c. 361-363delGAG (p. E121del) and c. 510-511insGAACT (p. W173X) were novel. The two novel mutations were absent in 100 normal controls. The pregnancy in family 1 continued and the infant showed no symptom of X-SCID at 1 year after birth. The aunt (Ⅱ-3) of proband in family 1 was not a carrier. The female fetus in family 1 had no mutation.

Two novel mutations of c. 361-363delGAG(p. E121del) and c. 510-511insGAACT(p. W173X) in IL2RG gene may be a major cause of disease in two families with X-SCID. And direct sequencing of IL2RG gene provides genetic counseling, prenatal diagnosis and carrier screening for families with X-SCID.

To explore the HIRA gene sequences of 3′UTR region and elucidate the role of 3′UTR region of HIRA gene in the pathogenesis of tetralogy of Fallot (TOF).

Patients of TOF were confirmed by cardiac catheterization or surgery between April 2007 and December 2012 at our hospital. Mutations and single nucleotide polymorphisms (SNPs) were screened in 278 unrelated probands with isolated TOF and 515 controls. Target Scan was used to predict micro RNAs with possible combinations with 3′UTR region of HIRA gene. Dual-luciferase assay and real-time PCR were performed to detect the inhibition activity of micro RNAs on target genes. And χ ² and t tests were used to analyze the results.

Statistically significant change occurred in the alleleic frequencies of existing SNPs (rs: 117447448) between TOF patients and control group (11.5%(32/278) vs 4.9%(25/515), P=0.001). The combining site of miR328 was predicted to be 10 bp upstream of SNP site. MiR328 was expressed in heart and it was related with myocardial infarction and atrial fibrillation. Dual-luciferase assay showed a decreased level of luciferase after co-transfection with miR328 (0.012 5±0.000 6 vs 0.019 6±0.003 8, P=0.034). So was the expression of HIRA (1.039 6±0.077 2 vs 1.608 7±0.274 9, P=0.037). However, the luciferase level was not affected by SNP (rs: 117447448) (P=0.380).

The SNP (rs: 117447448) of 3′UTR region of HIRA gene is related with TOF. HIRA is the target gene of miR328. Although SNP (rs: 117447448) is not a major site of target gene HIRA for micro RNA328, it provides an important clue to in-depth studies of 3′UTR region of HIRA gene in the pathogenesis of TOF.

To employ RNA interference technology to silence transforming growth factor-β₁ (TGF-β₁) gene to examine the gene silencing effects of RNAi on the expression of vascular endothelial growth factor (VEGF) in human bladder cancer cell lines (EJ).

The TGF-β₁ gene-specific siRNA expression vector was constructed. And the most efficiently suppressed target sequences were screened through reverse transcription-polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA). The samples were divided into 3 groups of EJ, control (TGF-β₁) and recombinant plasmid (TGF-β₁ siRNA expression vector). And the expression level of VEGF protein was detected by Western blot.

TGF-β₁ gene-specific siRNA expression vector was constructed successfully. TGF-β₁ relative mRNA expression was 0.92±0.19 and the protein expression level (50±6) pg/ml. The protein expression level of EJ group after transfection was (0.86±0.18) pg/ml, control group (1.15±0.29) pg/ml and recombinant plasmid group (0.45±0.16) pg/ml(both P<0.05).

An inhibition of TGF-β₁ gene down-regulates the expression of VEGF. And TGF-β₁ may regulate angiogenesis of bladder tumor through an induction of VEGF gene expression.

To observe the activity change of astrocyte in related nucleus caused by acute pulpitis in rats.

Rat acute pulpitis model was induced by lipopolysaccharides (LPS). And, according to processing time, a total of 30 rats were divided into 5 groups of control, 6, 12, 24 and 48 h. Immunohistochemistry and Western blot were employed to detect the dynamic expression of glial fibrillary acidic protein (GFAP) in spinal nucleus of trigeminal nerve (Vc).

The relative gray value of ipsilateral Vc GFAP expression in experimental groups was 153±11 at 12 h. And it significantly increased versus the control group (100±4)(P<0.05). The relative gray value of GFAP was 198±12 at 24 h and was 231±9 at 48 h. And they significantly increased versus the control group (bothP<0.01). Their expressions were time-dependent.

In this acute pulpitis model, activated glial cells are probably involved in the processes of pulpitis and hyperalgesia.

To explore the effects of Chinese herbal medicine radix rehmanniae, radix arnebiae and cortex moutan on the proliferation of HaCaT cells and explore their potential curative mechanisms.

The main monomers of catalpol, l-shikonin and paeonol were extracted. And 10 ng/ml keratinocyte growth factor (KGF) was used to induce HaCaT cell to build an in vitro model of hyperproliferation of epidermal keratinocytes. CCK-8 assay and flow cytometry were applied to examine the effects of herbal monomers on cell proliferation and cell cycle.

Both l-shikonin (≥10^-6 mol/L) and paeonol (≥1.88×10^-4 mol/L) inhibited cell proliferation while catalpol(≥10^-6 mol/L)enhanced cell proliferation. L-shikonin (≥10^-6 mol/L) and paeonol (≥1.88×10^-4 mol/L) inhibited the HaCaT cell during S and G₂M phases while catalpol (≥10^-6 mol/L) enhanced HaCaT cell during S phase but not G₂M phase.

L-shikonin and paeonol inhibits the proliferation of HaCaT cells while catalpol has opposite effects.

To explore the effects of adenosine on hMLH1 methylation of human colorectal cancer cells.

The SW480 cells were treated with adenosine at the concentrations of 0, 1.5, 3.0, 4.5 mmol/L for 72 h. The hMLH1 methylation levels of CpG islands were detected by bisulfite sequencing polymerase chain reaction (BSP), hMLH1 mRNA expression levels by reverse transcription-polymerase chain reaction (RT-PCR), the expression levels of hMLH1 protein by Western blot and the apoptotic rates by flow cytometry (FCM). The cells were treated with adenosine at the concentrations of 0, 1.5, 3.0, 4.5 mmol/L for 24, 48, 72, 96 h. And their proliferation rates were detected by methyl thiazolyl tetrazolium (MTT).

After a 72 h treatment of adenosine, the hMLH1 promoter methylation levels of 1.5, 3.0 and 4.5 mmol/L groups were 65%±4%, 45%±11% and 16%±4% respectively and were all significantly lower than that of the control group (80%±4%, all P<0.01). The mRNA expression levels, hMLH1 protein expression levels and apoptotic rates were all significantly higher than that of the control group (0.230±0.032, 0.359±0.029 and 0.570±0.019 vs 0.079±0.010; 0.353±0.016, 0.654±0.018 and 0.854±0.014 vs 0.126±0.016; 11.9%±0.6%, 20.0%±1.8% and 35.8%±1.8% vs 3.9%±1.4%, allP<0.01). MTT showed that the proliferation rates of SW480 cells were lower than that of the control group and a time-dosage dependence existed (allP<0.05).

Adenosine can reverse the abnormal methylation of hMLH1 CpG island and promote the expression of hMLH1 so as to restrain the proliferation and promote the apoptosis of colocectal cancer cells.

Bronchial asthma (abbreviated as asthma) is a common chronic airway disease that seriously endangers human health. Epidemiological surveys show that asthma patients have a higher probability of developing mood disorders than the general population; Mood disorders play an important role in the predisposition, onset and outcome of asthma^[1,2]。 A 2004 global survey of asthma control levels involving 29 countries showed that only 5% of asthma patients were able to achieve complete control, and the level of asthma control remained unsatisfactory^[3]。 Some scholars believe that ignoring psychological and behavioral factors may be an important reason for unsatisfactory treatment of asthma^[4]。 The research progress of asthma and mood disorders is summarized as follows.

A 12-year-old male was seen on 24 October 2010 due to left knee injury for 33 days. 33 days before the visit, the child suddenly felt pain and swelling in his left knee after jumping up and landing while playing basketball, and was unable to move. The local hospital diagnosed it as "avulsion fracture of the lower pole of the left patella without obvious displacement" on X-ray film (Figure 1), external application and oral administration of traditional Chinese medicine for promoting blood circulation, removing blood stasis, reducing swelling and relieving pain, intravenous drip for anti-inflammatory, reducing swelling and relieving pain, and external fixation of the left knee in a slightly flexed position with a tray. Half a month after the injury, the X-ray film was reviewed: "The left patella was fractured with a small amount of callus growth" (Figure 2)。 Later, Bayi Orthopedic Hospital of Chengdu Military Region sought treatment. Physical examination: swelling of the left knee, tenderness of the patella, and limited flexion and extension of the left knee joint. X-ray showed: "Left patella lower pole cuff fracture, patella displaced upward, lower cuff fracture fragment obviously ossified and with a large amount of callus growth, but not connected to the lower margin of patella" (Figure 3)。 Open reduction and wire internal fixation were given. After 1 year follow-up, the knee function of the child basically returned to normal.