Volume 98  ·  Issue 18  ·  2018

At the end of 2017, the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines (3rd Edition) made a magnificent debut in Chinese version. Once again, it has attracted the attention of Chinese clinical oncology doctors. Looking back at the more than 10 years of NCCN clinical practice guidelines in China, domestic experts refer to the latest evidence-based medical evidence and timely update the recommendations of the guidelines, which has become the most important theoretical basis for guiding and standardizing the clinical diagnosis and treatment of cancer in China.

Precision medicine is a new medical model and interdisciplinary field for preventing and treating diseases. At present, the domestic definition of it is "according to the clinical information of patients and population cohort information, applying modern genetic technology, molecular imaging technology and bio-information technology, combined with the living environment and mode of patients, to achieve accurate disease classification and diagnosis, and formulate personalized disease prevention and treatment plans"^[1]。 Because the development and technology transformation of precision medicine require large-scale samples and multi-departmental participation, and the benefits of precision medicine extensively include healthy people and patient groups, it is necessary to consider health equity as an important issue when formulating precision medicine development plans and policies.

Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE), is a global healthcare problem^[1,2]。 The risk of occurrence of VTE in hospital is related to patients' hospitalization, surgery and other treatment measures, and other risk factors (such as advanced age, obesity, bed rest, comorbidities, etc.). It is often complicated by other diseases, which is an important cause of unexpected death of patients in hospital, and has become a serious problem faced by hospital administrators and clinical medical staff^[3]。 Research data at home and abroad show that 40% ~60% of patients with surgery and non-surgery are at risk of VTE, while the prevention rate of high-risk groups is very low, and the prevention rate in Asian countries is even lower^[4,5,6,7]。 Early identification of high-risk patients with VTE and timely prevention can significantly reduce the occurrence of VTE in hospitals.

Hemophagocytic syndrome (HPS), also known as hemophagocytic lymphohistiocytosis (HLH), is a critical disease in which cytotoxic T cells and natural killer (NK) cells are over-activated due to various inducements, and stimulate the activation of macrophages and secrete a large number of inflammatory cytokines. Lymphoma is one of the important causes of HLH, and its incidence increases with age. In order to improve the knowledge and understanding of lymphoma-related HLH among hematologists and oncologists and provide standardized clinical practice guidance, the Lymphoma Professional Committee of China Anti-Cancer Association organized relevant domestic experts to demonstrate, extensively solicited the opinions of domestic and foreign experts, and reached the following consensus on the diagnostic procedures, laboratory tests, diagnostic criteria and treatment principles of lymphoma-related HLH.

In recent years, with the increasing application of on-site rapid detection (POCT), a variety of different POCT devices have emerged, including handheld POCT analyzer and small desktop computers. The handheld POCT analyzer is mainly based on microfluidic chip technology, which centrally embodies the ideal of transferring the functions of the analytical laboratory to the chip, namely the Chip Laboratory (LOC), which has fast analysis speed, can perform multiple tests on a single platform, use a single-person test card, and use brand-new tubing and electrodes for each test. With the development of science and technology, handheld POCT detection platform has supplemented a variety of quality control schemes and systems, and has gradually occupied an important position in the POCT field^[1,2]。 At present, the management norms of POCT in China are basically established according to the product characteristics and quality control requirements of small desktop computers. Therefore, it is necessary to formulate more practical classification management methods according to different types of POCT equipment. The purpose of this consensus is to develop management specifications for clinical application and quality control of handheld POCT with microfluidic chip technology.

To find key microRNA (miR) associated with chronic thromboembolic pulmonary hypertension (CTEPH).

Affymetrix miR microarray data and GSE56914 data downloaded from GEO database (http: //www.ncbi.nlm.nih.gov/geo/) were obtained and integrated. The microarray data were obtained from peripheral blood samples of CTEPH patients and the matched control. Differentially expressed miRs were screened. Target genes of these miRs were searched. Then, functional enrichment analyses for these miRs were performed. After that, disease network including miRs, target genes and pathways was constructed.

Five important miRs including hsa-miR-885-5p, hsa-miR-501-5p, hsa-miR-615-3p, hsa-miR-610, and hsa-miR-346 were identified. Furthermore, hsa-miR-885-5p and hsa-miR-501-5p were significantly enriched in cell cycle pathway. Hsa-miR-615-3p was involved in cytokine-cytokine receptor interaction, axon guidance, focal adhesion and cell cycle pathway. Hsa-miR-610 was significantly enriched in focal adhesion pathway, and hsa-miR-346 was involved in cytokine-cytokine receptor interaction, axon guidance, and focal adhesion pathway.

Hsa-miR-885-5p, hsa-miR-501-5p, hsa-miR-615-3p, hsa-miR-610 and hsa-miR-346 are important miRs for the development of CTEPH.

To compare the clinical characteristics and outcomes of patients with lung cancer, gastrointestinal (GI) cancer and urologic cancer with venous thromboembolism (VTE).

From January 2003 to January 2013, 192 lung cancer, GI cancer and urologic cancer patients with VTE were retrospectively evaluated for the clinical characteristics and outcomes.

Among 192 patients, 82 cases of lung cancer, 78 cases of GI cancer, 32 cases of urologic cancer were involved. The Eastern Cooperative oncology Group Performance Status score of GI cancer group was significantly higher than those of the lung cancer and urologic cancer groups[(2.4±1.1) vs (2.0±1.4), (1.8±1.0), both P<0.05]. The proportion of smoking patients in lung cancer group was significantly higher than that in GI cancer and urologic cancer groups (79.3% vs 30.8%, 53.1%, bothP<0.05), while the proportion of operation was significantly lower than that in the latter two groups (35.4% vs 53.8%, 68.8%, bothP<0.05). Pathological types of cancer were mostly adenocarcinoma, and the proportion of adenocarcinoma in lung cancer and GI cancer groups was significantly higher than that in urologic cancer group (76.9%, 73.8% vs 37.9%, bothP<0.001). The proportion of moderately and/or poorly differentiated histodifferentiation in the first two groups was significantly higher than that of urologic cancer group (90.0%, 95.7% vs 40.0%, bothP<0.001). The proportion of patients with TNM stage Ⅲ-Ⅳ in lung cancer group was significantly higher than that of the urological cancer group (87.0% vs 64.3%,P<0.05). The incidence of VTE in lung cancer group was significantly higher than those of GI cancer and urologic cancer groups within 6 months after tumor diagnosis, chemotherapy and operation (79.3% vs 60.3%, 46.9%; 76.5% vs 48.6%, 36.4%; 92.3% vs 57.9%, 59.1%; allP<0.05). The case fatality rate within one year in lung cancer and GI cancer groups was significantly higher than that in urologic cancer group (51.2%, 52.6% vs 18.8%, bothP<0.01). The median survival time of the lung cancer and GI cancer groups was significantly shorter than that of the urological cancer group (P=0.001, 0.010, respectively).

Adenocarcinoma, advanced cancer, and poor histodifferentiation are risk factors of VTE in cancer patients. Most events of VTE occur within 6 months after a diagnosis of cancer. The prognosis of lung cancer and GI cancer complicated with VTE is worse than that of urologic cancer with VTE.

To explore the association between α-actinin-3 ( ACTN3) polymorphism and muscle strength in postmenopausal women.

Five hundred and ninety-eight postmenopausal women with an average of (62.9±7.0) years old in Dongcheng District of Beijing were included. The ACTN3 polymorphism including rs540874, rs618838 and rs2229456 were genotyped by Sequenom Mass Array to explore their associations with muscle strength. One hundred and sixty-three of them were trained with regular Tai chi movement while 271 were administered with elemental calcium 600 mg/d combined with Vitamin D 800 U/d or calcitriol 0.25 μg/d for 2 years. Association between changes of muscle strength and ACTN3 polymorphism were analyzed.

The rs540874 genotypes were found to be significantly associated with chair stand test[GG (9.02±3.85) s vs GA (9.27±4.14) s vs AA (9.68±5.00) s, P=0.015]. Right grip strength in women with G allele were likely to be higher compared with A allele, but it was not statistically significant (P=0.056). Multiple linear regression showed that the chair stand test of AA genotype was statistically longer than that of GG and GA genotype (β=2.639, 95%CI: 1.632-4.646, P=0.010). The associations between rs618838, rs2229456 genotypes and muscle strength of both lower and upper limbs were not significant (all P>0.05). In addition, muscle strength of lower limbs of patients with rs540874 genotyped with G allele, rs618838 genotyped with C allele and rs2229456 genotyped with A allele increased significantly after enhanced exercise and vitamin D supplementation (allP<0.05).

The rs540874 polymorphism of ACTN3 gene was associated with the muscle function of lower limb in postmenopausal women. The improvement of muscle strength after intervention were possibly correlated with rs540874, rs618838 and rs2229456 polymorphisms.

To study the cystic fibrosis transmembrane regulator(CFTR) genotypes and genetic characteristics of a Chinese family with Congenital bilateral absence of vas deferens(CBAVD).

Two 33/29-years-old brothers presented with CBAVD-caused obstructive azoospermia were diagnosed on the basis of scrotal palpation, analysis of semen and ultrasound tests. We extracted their genomic DNA as well as their healthy parents′ from the peripheral blood leukocytes. To identify CFTR mutations, each of the 27 exons of the CFTR gene and their flanking splice sites sequences were amplified by polymerase chain reaction(PCR) and subsequently studied with Sanger sequencing. Mutations/variations were identified and compared with the control sequence searched in the NCBI database.

Homozygous 5T mutation at the splicing site ahead of exon 10 of the CFTR gene was identified in both brothers in association with 13TG and 12TG alleles(13TG-5T/12TG-5T), one of those was inherited from the mother(13TG-5T/11TG-7T), the other was from the father(12TG-5T/12TG-7T). All of the results above had been excluded the presence of other mutations. Genetic study of this family supports that homozygous 5T mutation is associated with CBAVD. Individuals with homozygous 5T alleles are 20 times more possible to transmit this deleterious variant to the next generation than general population.

This family we analysed agrees with the previous conclusion that 5T allele is a deleterious and heritable mutation which could cause CBAVD. Considering better genetic counseling, CFTR gene detection and Preimplantation genetic diagnosis(PGD) are suggested for CBAVD couples who seek for reproductive assistance.

To analyze the clinical features of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma.

A total of 14 cases diagnosed with primary pulmonary MALT lymphoma were collected from May 2007 to May 2017 in Zhongshan Hospital, Fudan University. The clinical features, pathological characteristics, diagnosis, treatment and prognosis were retrospectively analyzed.

All 14 cases were pathologically diagnosed with primary pulmonary MALT lymphoma. The biopsy tissues were obtained through the Video-assisted Thoracoscopic Surgery (VATS) (4 cases), percutaneous puncture (2 cases), and bronchoscopy (8 cases). Cell types of these tumors were centrocyte-like cells (10 cases), lymphocytoid cells (2 cases), and monocytoid B cells (2 cases). The B cell clonality was detected by IgH cloning test in 4 cases and 3 of them were demonstrated with monoclonal strips. MALT1 breakup gene was positive in 3 out of 6 examined cases using fluorescence in situ hybridization (FISH). As for the treatment, 8 patients underwent chemotherapy, 5 patients underwent surgical resection and 1 patient abandoned treatment. Twelve patients were followed up to 9 years. The tumor recurrence occurred in 2 patients and resulted their death.

The clinical manifestations of primary pulmonary MALT lymphoma are lack of specificity. The pathology, immunohistochemistry, IgH cloning test and MALT1 breakup gene tested by FISH are the criteria for diagnosis.

By observing the clinical effect of ultrasound, fiberoptic bronchoscopy and traditional standard in positioning the general anesthesia of laryngeal mask ventilation in elderly patients, the superiority of laryngeal mask positioning with visualization technique of ultrasound and fiberoptic bronchoscope on airway management in elderly patients with general anesthesia was analyzed.

One hundred and twenty cases of elderly patients with general anesthesia of laryngeal mask ventilation from the People′s Hospital of Yuyao city from October 2016 to October 2017 were selected and randomly divided into 3 groups(n=40)according to American Society of Anesthesiologists (ASA) grading criteria Ⅰ-Ⅲ. Group A: traditional standard positioning laryngeal mask group. Group B: fiberoptic bronchoscope positioning laryngeal mask group. Group C: ultrasound positioning laryngeal mask group. The general information of sex ratio of male and female, mass, and height, and operation type, operation duration, anaesthesia duration, and modified Mallampati grade were observed and compared among the three groups. The number of successful laryngeal mask ventilation after laryngeal mask placement in 3 groups was observed, the laryngeal mask placement time (T₀) and the normal ventilation time after adjustment (T₁) in each group were recorded, and the first success rate of laryngeal mask placement, the success rate after adjusting the positioning, and the success rate of re-placement were calculated. Moreover, the mean peak airway pressure at 5 min after operation, the minimum intrathecal injection gas for minimum ventilation (V_min), the minimum laryngeal mask intravesical pressure (ICP_min), and the lowest air pressure for oral and pharyngeal leakage (OLP_min) were recorded. The airway seal pressure (OLP₆₀) and the volume of gas injection (V₆₀) when the intravesical pressure was 60 cmH₂O (1 cmH₂O=0.098 kPa) were used to record the incidence of postoperative laryngeal mask bleeding, cough, nausea and vomiting, and the incidence of pharyngalgia, odynophagia, hoarseness and other related complications after 24 hours of the operation.

There was no significant difference in general information, airway evaluation and anesthesia operation among the three groups (all P>0.05). The incidence of intraoperative laryngeal mask bleeding in group B and C was 7.9% and 2.6% respectively, the incidence of odynophagia at 24 hours after operation was 5.3% and 0 respectively, and the incidence of pharyngalgia and hoarseness was 18.4% and 7.9% respectively, less than that in group A (24.2%, 12.1% and 36.3%). The difference was statistically significant (χ²=8.900, 6.880, 9.000, P<0.05). The success rate of adjustment and positioning after the placement of laryngeal mask was 84.2% and 94.7% respectively in group B and C, higher than that in group A of 72.7%, and the difference was statistically significant (χ²=6.500, P<0.05). The lowest laryngeal mask intralaryngeal pressure for ventilation in group B and C was (35.39±4.67) cmH₂O and (32.61±3.22) cmH₂O, lower than that in group A of (39.30 ± 5.93) cmH₂O, the intralaryngeal pressure was 60 cmH₂O, and the airway seal pressure was (25.82±4.48) cmH₂O and (28.34±6.99) cmH₂O, higher than that in group A of (22.45±4.98) cmH₂O, which was significantly different (F=18.200, 9.720, P<0.05).

In elderly patients with general anesthesia, it is feasible to manage the airway by ultrasound or fiberoptic bronchoscopy with laryngeal mask. Ultrasound positioning laryngeal mask improves the accuracy of the intraoperative ventilation, and reduces the incidence of postoperative airway related complications.

To observe whether Ginkgo biloba extract (EGb761) can improve postoperative delirium in elderly patients.

Eighty elderly patients undergoing tumor surgery at Zhejiang Cancer Hospital and complicated with postoperative delirium(POD) between June 2013 and July 2016 were randomly divided into treatment group (group A) and control group (group B) according to the random number table method. Patients in group A received ginkgo biloba extract (EGb761) drops oral treatment (3 times/d, 80 mg each time) in addition to oxygen inhalation and appeasement treatment. Patients in group B underwent routine oxygen inhalation and appeasement treatment. POD assessment was performed twice between the hours of 8: 00 am and 8: 00 pm daily after the diagnosis of POD. Observed indicators include sex ratio, age, body mass index (BMI), educated level, type of surgery, anesthesia method, duration of surgery, intraoperative mean arterial blood pressure, intraoperative blood loss, type of POD, visual analogue scale (VAS) scores when diagnosis of POD, the onset time of POD, initial RASS scores, duration of POD.

A total of 80 patients with POD were enrolled, 23 patients were excluded for did not cooperate with the tests of POD or refused to participate in the study. Finally, 57 elderly patients completed the study, 29 patients in the medication group (A group) and 28 patients in the control group (B group). There was no significant difference in sex ratio, age, BMI, education level, operation type, anesthesia method, operation duration, intraoperative mean arterial pressure, intraoperative blood loss, POD type and VAS score (all P>0.05). There was no significant difference between the two groups in POD onset time and initial RASS score (allP>0.05). The duration of POD in group A and group B was 16 (16)h and 48 (35) h respectively, the difference was statistically significant (U=161.500, P<0.001).

Ginkgo biloba extract (EGb761) can shorten the course of POD in elderly patients.

To investigate the relationship between the incidence of daytime urinary incontinence(DUI)and the usage of diapers.

The stratified sampling method was used to investigate the relationship between the incidence of DUI and the usage of diapers on children from 3 to 10 years old from 30 kindergarten and primary schools in Henan Province, China. The survey was carried out in the way of anonymous questionnaire.

A total of 8 560 qualified questionnaires(96.2%) were collected and used for statistical analysis. The overall incidence of DUI was 3.52%. With the age increasing, the incidence of DUI was decreased(χ²_trend=75.690, P<0.001) from 6.06% for 3 years old children to 1.82% for 10 years old children. With the time of usage diapers increased, the rate of urination training was significantly reduced(χ²_trend=84.260, P<0.001), and the incidence of DUI was significantly increased(χ²_trend=18.824, P<0.001). With the increase of using diapers, the incidence of DUI increased (χ²_trend=9.234, P<0.01). With the delay of the starting time of urination training, the incidence of DUI was increasing( χ²_trend=9.775, P<0.01). Logistic regression analysis showed that the increase of time of using diapers(OR=1.017, 95% CI: 1.006-1.027, P<0.01)and the increase of frequency of using diapers(OR=1.290, 95% CI: 1.002-1.025, P<0.05)contribute to DUI significantly. Urination training starts from 0 to 6 months was a protective factor against DUI(OR=0.529, 95% CI: 0.345-0.811, P<0.01).

The usage of diapers is the risk factor of DUI. It′s better to start urination training earlier to help reduce the incidence of DUI in children.

To summarize the clinical manifestations, pathological features, diagnosis, and treatment of abdominal solitary fibrous tumor (SFT).

The data of clinical manifestations, pathological features, diagnosis, and treatment of 18 patients with abdominal SFT admitted to Department of General Surgery, Peking Union Medical College Hospital between January 2000 and December 2016 were retrospectively reviewed.

Abdominal mass was first presented in 14 patients. The blood routine, liver, kidney, and coagulation function were normal in all the patients. Tumor markers were abnormal in 4 cases. Most SFT showed hypoechoic mass with regular shape under ultrasound. CT findings differed among the cases. All the 18 patients underwent surgical treatment, and the diagnosis was proved by the postoperative histopathology. SFT differed in general morphology. The positive rate of Ki-67, smooth muscle actin (SMA), CD34, and S-100 was high under immunohistochemistry.

Early diagnosis of abdominal SFT is difficult, leading to a low preoperative diagnosis rate. Complete removal of the tumor is the only reliable method of radical treatment.

To improve the clinical diagnosis and treatment of primary renal lymphoma.

Clinical data of 5 cases ( 2 male cases and 3 female cases) with primary renal lymphoma was reviewed. The age of patients was 55 to 70 years old, with a mean age of 62 years. No history of glomerulonephritis or nephropathy was recorded. All the cases were unilateral, including 3 cases in the left side and 2 cases in right. The major clinical manifestations were as follows: 2 cases of left lumbar pain, 1 case of gross hematuria, 1 case of hematuria under microscope, and 1 case receiving adjuvant chemotherapy after 12 years. The physical examination was as follows: the superficial lymph nodes of 5 cases were not enlarged; the liver, spleen and abdominal mass were not palpable; 2 cases had left upper quadrant tenderness ( with no rebound pain) and left kidney percussion pain. B-ultrasound, CT or MRI examination were performed before the operation, and renal malignant neoplasm was considered. No abnormality was found in bone marrow aspiration after operation. Four cases underwent radical nephrectomy and 1 case accepted partial nephrectomy. Four cases were administered with six cycles of R-CHOP (cyclophosphamide, pirarubicin, vincristine and prednisone) associated with rituximab, and 1 case was given six cycles of CHOP.

Five cases were diagnosed as non-Hodgkin′s lymphoma, with 4 cases of diffuse large B-cell lymphoma of the kidney and 1 case of marginal zone B-cell non-Hodgkin lymphoma of mucosa-associated lymphoid tissue. The maximum diameter of the tumor was 3.5 to 10 cm, with the median diameter of 6.5 cm. The tumor was grey and white on the cutting surface, and the texture was fine. Under the microscope, the tumor cells were diffusely infiltrating, oval or polygonal, slightly larger than normal lymphocytes, with large irregular hyperchromatic nuclei. Four cases were followed up for 6 months to 2 years, with an average of 16 months. Chest X - ray and abdominal B-ultrasound were performed every 3 months, and abdominal CT or MRI scan was performed every 6 months. One case lost follow-up after 3 months. Except the case, the rest three are all alive.

Primary renal lymphoma is rare. Most of the cases reported showed rapid systemic progression and a poor prognosis. There were no distinct characteristics in B-ultrasound and CT examination. Pathological examination is the key to its diagnosis. The surgical treatment combined with systemic chemotherapy can prolong survival of patients.

To observe the expression of protein kinase B (Akt) / mammalian target of rapamycin (mTOR) induced by high phosphorus in rat vascular smooth muscle cells (VSMC) calcification model, and its modulation on the expression of core binding factor alpha 1 (Cbfα1).

Rat VSMC cells were cultured in vitro, and then divided into two groups: normal phosphorus group (Pi 1.3 mmol/L) and high phosphorus group (Pi 2.6 mmol/L). At day 7, calcium deposition was detected by Alizarin stain. The mRNA levels of Cbfα1 and osteopontin (OPN) were determined by real-time PCR. The protein expressions of p-Akt (ser473), p-mTOR (S2448), Cbfα1 and OPN were quantified by Western blot. Then, VSMC cultured with high phosphorus were treated with Akt inhibitor (Wortmannin) and mTOR inhibitor (Rapamycin) with different concentrations. After 24 h, the mRNA levels of Cbfα1 and OPN were determined and after 48 h, the protein expressions of p-Akt, p-mTOR, Cbfα1 and OPN were quantified. Also, at day 7, calcium deposition was also visualized by Alizarin stain.

After 7 days, compared with normal phosphorus group, calcium deposition was more obvious in high phosphorus group. The mRNA expressions of Cbfα1 and OPN increased significantly and the protein expressions of p-Akt, p-mTOR, Cbfα1 and OPN up-regulated significantly in high phosphorus group (allP<0.05). After treated with Wortmannin or Rapamycin for 24 h, compared with high phosphorus group, the mRNA expressions of Cbfα1 and OPN decreased significantly in high phosphorus + Wortmannin (30, 50 and 100 nmol/L) groups (allP<0.05) and high phosphorus + Rapamycin (1, 10 and 100 ng/ml) groups (allP<0.05). After treated with Wortmannin or Rapamycin for 48 h, compared with high phosphorus group, the protein expressions of p-Akt, Cbfα1 and OPN down-regulated significantly in high phosphorus + Wortmannin (30, 50 and 100 nmol/L) groups (allP<0.05). It showed a dose-dependent down-regulation of p-mTOR, Cbfα1 and OPN in high phosphorus + Rapamycin (1, 10, 100 ng/ml) groups (allP<0.05). After 7 days, compared with high phosphorus group, calcium deposition decresased significantly in high phosphorus + Wortmannin and high phosphorus + Rapamycin groups.

High phosphorus can induce VSMC calcification. Akt and mTOR are involved in VSMC calcification induced by high phosphorus through the activation of Cbfα1.

A 56-year-old male was diagnosed with pancreatic cancer with multiple lung metastases in a foreign hospital in May 2015. In June 2015, he started to receive 6 cycles of chemotherapy with gemcitabine combined with tegio and nimozumab, and the efficacy was stable. After several months of discontinuation, it was replaced with oxaliplatin combined with irinotecan and 5-fluorouracil in January 2016 for 4 cycles of chemotherapy. The efficacy was stable, and the last chemotherapy time was March 2016. The tumor did not shrink during both chemotherapy sessions, and the tumor progressed slowly between drug withdrawals. In May 2016, the patient went to our hospital after CT reexamination showed tumor progression. Patients are advised to have pancreatic cancer biopsy specimens for tumor gene testing. The sequencing results showed that the patient's tumor carried MCL1 (Myeloid cell leukemia-1) gene amplification and SPTA1 gene mutation. No gene abnormalities such as KRAS, SMAD4, CDKN2A and TP53 were found, and no fusion gene was found. In view of the fact that among the targeted drugs that have been marketed in China, only sorafenib has a certain inhibitory effect on MCL1, it is recommended that patients try the drug, but patients give up for economic reasons. The last visit date was June 1, 2016. The patient was in poor general condition and later lost to follow-up.

Bronchial asthma (asthma for short) is a common chronic airway inflammatory disease that seriously affects people's health. In the past 20 years, the incidence and mortality of asthma in children and adults have continued to increase at a rate of 20% to 50% every 10 years. The epidemiological survey of asthma prevalence and risk factors in China (CARE) shows that the prevalence of asthma among adults in China is 1.24%^[1]Of which severe asthma accounted for 5.99%^[2]； Moreover, the emergency treatment rate and hospitalization rate of severe asthma patients far exceed that of other asthma patients, which is one of the important reasons for the increase of asthma treatment cost^[3]。