Volume 99 ·  Issue 16 ·  2019

The pathophysiological mechanism, prevention management and drug treatment of special asthma are different from those of common asthma, and they are not fully understood in clinic. This paper briefly reviews some existing problems and new understandings in the diagnosis and treatment of asthma in special cases at present, and expounds the particularities of management of pregnancy asthma, elderly asthma, perioperative asthma, occupational asthma and exercise asthma, so as to arouse the attention of respiratory specialists to asthma in special cases and improve the overall control level of asthma.

Old age is the second peak period of asthma onset. Due to the decline of physiological function, complications and retardation of sensation in the elderly, there are particularities in the diagnosis and treatment of asthma in the elderly. For elderly asthma, more attention should be paid to the collection of detailed medical history, special objective examination and judgment thresholds suitable for such patients should be developed to reduce the missed diagnosis rate and misdiagnosis rate as much as possible, and relatively personalized management strategies should be formulated taking into account comorbidities and pharmacokinetics to improve their prognosis and quality of life.

Although the status of asthma control in China has been greatly improved at present. The rate of acute asthma attacks due to surgery is also not high. However, if an asthma attack or bronchospasm occurs during surgery, it may lead to serious consequences. Therefore, it is necessary to pay attention to the perioperative management of asthma, so that asthma patients can successfully receive surgical treatment. The key to perioperative management of asthma is preoperative assessment and pretreatment with appropriate medications. If an asthma attack occurs intraoperatively or postoperatively, the principles for its management are the same as recommended in the asthma guidelines.

To analyze bronchiectasis in hospitalized asthmatic patients in the past 10 years in a single center.

The clinical data of all asthmatic patients, who were hospitalized in the Center of Respiratory Medicine and Allergic Diseases, the General Hospital of Northern Military District from January 1, 2008 to December 31, 2017, was retrospectively collected and analyzed. The data of hospitalized asthmatic patients, hospitalized asthmatic patients with bronchiectasis and hospitalized asthmatic patients with acute exacerbation of bronchiectasis in the past 10 years and the trends of 10 consecutive years were analyzed. According to whether or not co-existing with bronchiectasis, asthmatic patients were divided into asthmatic patients with bronchiectasis group and asthmatic patients without bronchiectasis group, then the general condition, symptoms, characteristics and comorbidities of the two groups were analyzed and the risk factors of bronchiectasis in asthmatic patients were also analyzed. According to the number of hospitalizations, asthmatic patients with bronchiectasis group was divided into hospitalization ≥ 2 times group and single-time group; according to the causes of hospitalization, asthmatic patients with bronchiectasis group was divided into asthmatic patients hospitalized for acute exacerbation of bronchiectasis group, hospitalized for acute asthmatic attack group and hospitalized for acute exacerbation of other comorbidities group. Then the reasons for different hospitalization times and the clinical characteristics, comorbidities and risk factors of asthmatic patients hospitalized for acute exacerbation of bronchiectasis group were analyzed.

A total of 2 207 cases of hospitalized asthmatic patients were included, of which 434 cases (19.7%) were classified into asthmatic patients with bronchiectasis group over the 10-year study period. The lowest percentage of asthmatic patients with bronchiectasis group over the total hospitalized asthmatic patients was observed in the year 2008 (8.2%, 17/207), and there was significant difference in the comparison of the 2008 and 2011 through 2017 (all P<0.05). The most common risk factor of asthmatic patients with bronchiectasis group was hemoptysis, followed by wet rales on physical examination, phlegm, cough, shortness of breath after activity, T>37 ℃, co-existing with emphysema, hospitalization≥ 14 d (OR=13.75, 2.638, 2.156, 1.957, 1.828, 1.351, 1.383, 1.351). In asthmatic patients with bronchiectasis group, there were 181 cases (41.7%) in ≥2 times group, 253 cases (58.3%) in single-time group; when the reason for hospitalization was analyzed by grouping single-time versus ≥2 times, the reason of acute asthmatic attack: the number of cases in ≥2 times group (45.9%, 83/181) was similar to the single-time group (46.2%, 117/253); the reason of acute exacerbation of bronchiectasis: the number of cases in ≥2 time groups (47.0%, 85/181) was higher than the single-time group (40.3%, 102/253); but there was no significant difference between the two groups (P>0.05). The reason of acute exacerbation of other comorbidities: the number of cases in ≥2 times group was significantly lower than single-time group [13 cases (7.2%) vs 34 cases (13.4%), P<0.05]. The frequencies of symptoms of fever, cough, phlegm, hemoptysis, shortness of breath after activity, wet rales on physical examination, hospitalization ≥ 14 d, non-invasive mechanical ventilation, co-existing with emphysema, heart function insufficiency and cor pulmonale in asthmatic patients hospitalized for acute exacerbation of bronchiectasis group was higher than hospitalized for acute asthmatic attack group (all P<0.05). Hospital costs in asthmatic patients with bronchiectasis group was higher than asthmatic patients without bronchiectasis group [RMB 11 264 (8 035, 17 161) vs 9 337 (5 916, 15 151) yuan]; asthmatic patients hospitalized for acute exacerbation of bronchiectasis group was higher than hospitalized for acute asthmatic attack group [RMB 13 101 (8 931, 20 118) vs 10 076 (7 136, 14 659) yuan] (bothP<0.05).

Asthmatic patients with bronchiectasis have an increased trend of hospitalization. In asthmatic patients hospitalized for acute exacerbation of bronchiectasis, the symptoms of fever, hemoptysis, cough and sputum were more frequently seen than those in asthmatic patients hospitalized for acute asthmatic attack, and the former have more serious condition, longer hospitalization and increased costs.

To improve the understanding of Eosinophilic granulomatosis with polyangiitis (EGPA).

A total of 30 EGPA patients from the China-Japan Friendship Hospital between August 2005 and April 2017 were included, and a systematic retrospective study about clinical manifestations, laboratory findings, imaging features, pathology and so on was conducted.

There were 9 males and 21 females. Mean age was (44.5±13.9) years at diagnosis. Among these patients, 26 (86.7%) had asthma, duration was 45.0 (20.0, 78.7) months, and 15 (50.0%) had asthma as their first symptom. Rhinitis/nasosinusitis occurred in 27 (90.0%), skin lesions in 13 (43.3%), neuropathy in 10 (33.3%), heart disease in 8 (26.7%), renal involvement in 3 (10.0%) and gastro-intestinal manifestations in 3 (10.0%) of the patients. Peripheral blood eosinophil>10% accounted for 23/30 (76.7%). There were 3 patients (10.0%) who had positive anti-neutrophil antibody, and the pattern by immunofluorescence was mainly perinuclear. Migratory infiltrates often observed on the chest radiograph, and the main presentation was ground-glass opacity, amounting for 21/30 (70.0%). The pathological manifestations were extravascular eosinophilic tissue infiltration, necrotizing vasculitis, and extravascular granulomas, and the latter two of which were fewer.

The manifestations of EGPA are individual, complex, with a lack of pathognomonic symptoms, and female predominated.

To summarize the clinical features of allergic bronchopulmonary aspergillosis (ABPA) and analyze the common causes of missed diagnosis.

The clinical data of patients with ABPA who were admitted into Qilu Hospital of Shandong University from October 2014 to November 2017 were retrospectively analyzed, including baseline data, eosinophil count in peripheral blood, serum total IgE, A. fumigates-specific antibody (sIgE, sIgG and sIgM), pulmonary function tests and chest CT, etc. Then the correlations between serum total IgE, sIgE and forced expiratory volume in one second (FEV₁) as percentage of predicted value (FEV₁%pred) was conducted, as well as that between serum total IgE, sIgE and FEV₁/forced vital capacity (FEV₁/FVC). The clinical features of the patients were summarized and the causes of missed diagnosis were analyzed.

There were 46 patients with ABPA (21 males and 25 females, 48.3±13.2 years old) in total. Only 2 cases (4.3%) were diagnosed after the first symptom onset, and 44 cases (95.7%) were treated repeatedly for many years before being diagnosed. The misdiagnoses were asthma (26 cases, 56.5%), bronchiectasis (13 cases, 28.3%), pneumonia (4 cases, 8.7%), pulmonary tuberculosis (3 cases, 6.5%), and lung cancer (4 cases, 8.7%). Common symptoms of ABPA included cough, expectoration, wheezing, chest tightness, fever, weight loss, chest pain, etc. Peripheral blood eosinophil count increased in 37 patients (80.4%). Serum total IgE in 37 patients (80.4%) were higher than 1 000 U/ml, and 9 cases (19.6%) were less than 1 000 U/ml. The positive rate of sIgE, sIgG and sIgM was 100.0%, 89.1% and 54.3%, respectively. All patients underwent pulmonary function tests and 35 cases (76.1%) had obstructive ventilation dysfunction, 5 cases (10.9%) with mixed ventilation dysfunction, 5 cases (10.9%) were normal and 1 case (2.2%) with restrictive ventilation dysfunction. All patients underwent Chest CT examination, 28 cases (60.9%) showed bronchiectasis, 8 cases (17.4%) manifested mucus plugs (among them, 4 cases with high-attenuation mucus) and 10 cases (21.7%) had other atypical imaging. Serum total IgE and sIgE had no correlations with FEV₁%pred and FEV₁/FVC.

ABPA is characterized by recurrent episodes of wheezing, fleeting pulmonary opacities and bronchiectasis. The main reasons of misdiagnosis in ABPA patients were: atypical symptoms, variety of predisposing diseases, early atypical imaging changes, limitations and misunderstandings of screening indicators, interference with tumor markers, and the presence of pulmonary aspergillus overlap syndrome. The severity of asthma attacks is not related to the degree of fungal sensitization.

To investigate the clinical and laboratory features of Phytosterolemia with hematological abnormalities.

A retrospective study was performed on 20 patients with phytosterolemia admitted to the hematology department of the First Affiliated Hospital of Suzhou University during 2004—2017. History of patients was collected and the platelet counts, lipidomic analysis of plasma and osmotic fragility of erythrocytes were carried out. The erythrocyte and platelet morphology was examined by light microscope. Phytosterol levels in serum were measured by high performance liquid chromatography method. All of ABCG5/8 exons and intron-exon boundaries were amplified by PCR and directly sequenced to identify mutations.

All patients had been misdiagnosed as immune thrombocytopenia (ITP), or Evans syndrome with a mean delay of 21 years between symptom onset and accuracy diagnosis. The clinical manifestations of the patients were variable, but most of them presented with thrombocytopenia, anemia, splenomegaly from early ages, and xanthomas. Other major features were also observed, such as impaired liver functions (9 cases), premature atherosclerosis (5 cases) and/or arthritis (4 cases). Interestingly, all patients displayed an increased osmotic fragility of red cells and unique blood film features: large unequal platelets surrounded by a circle of vacuoles and various abnormal erythrocyte shapes, especially stomatocyte. Serum levels of the sitosterol and stigmasterol in the patients were remarkably elevated up to 331.05(276.00, 670.20)mg/L and 244.60(193.78,399.40)mg/L, about 10 and 24 times higher than those of normal subjects. There were 14 mutations in ABCG5/8 genes found in the patients. Among them, 2/3 of the mutations were in ABCG5 gene, including p.(E22X), p.(R446X),g.ISV7+3G>A, p.(R446X), p.(R419H), g.ISV7+3G>A, p.(G90E), p.(R389H) and g.7+2G>A), and 1/3 in ABCG8 gene involving p.(M614-K628del), p.(E25X), p.(L86P fs X185), p.(R263Q), p.(E500D fs X604) and p.(G674R) mutation. The ABCG5 p.(R446X) mutation was found in 3 separate families.

The phenomena of thrombocytopenia/ stomatocyte/splenomegaly represents a special clinical manifestations of phytosterolemia, and distinct changes of blood cell morphology are the typical characters. Plasma plant sterols and ABCG5/ABCG8 genes should be analyzed when such hematologic abnormalities are unexplained.

To summarize the efficacy and safety of the combination of rituximab and ATG as induction therapy in highly sensitized kidney transplant recipients.

Clinical data of patients who received kidney transplantation from donation after cardiac death(DCD) in Organ Transplant Center of Second Affiliated Hospital of Guangzhou Medical University from January 1st 2015 to December 31th 2016 was retrospectively analyzed. Highly sensitized patients with over 30% active panel reactive antibody (PRA>30%) received rituximab, while non-sensitized recipients as controlled group. All selected patients were observed in the renal function, urine protein, hemogram and the variation of PRA at each time point. Acute rejection, infection required hospitalization, delayed graft function(DGF), primary nonfunction (PNF), graft dysfunction, the mortality rate of patients with good allograft function and the graft survival rate were also observed.

46 groups of patients were selected into highly-sensitized group and non-sensitized group. In both groups, there was no statistical difference in the renal function, urine protein and WBC (all P>0.05). Highly sensitized recipients at day 7 and day 14 following the surgery, had a significantly lower percentage of lymphocyte counts and lymphocyte proportion compared to other groups, with statistical differences(all P<0.05). Both groups had a similar incidence of DGF(2.2%) and no occurrence of PNF. 19.5% of highly sensitized recipients experienced acute rejection and 13% in control group. More specifically, no statistical difference was noted in the rate of infection required hospitalization(30.4% vs 22.2%), graft loss(2.2% vs 0) and the mortality rate of patients with good allograft function(4.3% vs 2.2%)(all P>0.05). The graft survival rate was 97.8% in the highly-sensitized group, while 100% in the control group. And the rate of patient survival in these two groups was 95.7% and 97.8%, with no statistical differences(all P>0.05).

Immune-induction therapy that combines Rituximab with ATG can significantly inhibit lymphocyte proliferation. It is effective and safe in treating hypersensitive patients. The survival rate of human/kidney of hypersensitive patients in the short and medium term is comparable to those with low immune risk.

To investigate the effect of the derepression of chemokine receptor-7 (CXCR7) in prostatic tissues from patients with Castration Resistant Prostate Cancer (CRPC) on the resistance to enzalutamide (Enza).

During the period of January 2015 to December 2017 all CRPC cases who underwent radical radiotherapy or androgen deprivation therapy (ADT) were evaluated. After prostatic puncture biopsy, the tissues were treated for immunostaining with CXCR7. Cox proportional hazard modeling and Kaplan-Meier analysis were used to determine PSA Progression-Free Survival (PSAP-FS) and Clinical or Radiographic Progression-Free Survival (CRP-FS) in the cohort. At last, PSA response rates and progression outcomes in CXCR7 negative cases and CXCR7 positive cases were analyzed.

Total 39 CRPC patients were enrolled in this study. And 23 cases derepress CXCR7, 16 cases negatively express CXCR7. The median follow-up duration was 12 months (range: 6-18) in the cohort. Chi-square analysis confirmed that PSA response rates after Enza treatment were significantly associated with CXCR7 derepression (χ²=22.129, P=0.000 06). Compared with CXCR7 positive expression group, CXCR7 negative expression group displayed improved median PSAP-FS (4.4 mon vs 11.7 mon, P=0.040 8) and CRP-FS (5.2 mon vs 13.1 mon, P=0.036 2) after Enza treatment.

Derepression of CXCR7 in CRPC patients may be associated with resistance to enzalutamide. This protein may be novel target for treatment of CRPC.

To investigate the effect of estrogen level on Budd Chiari syndrome related hepatocellular carcinoma.

Immunohistochemical method was used to detect estrogen receptor-α and estrogen receptor-β expression in 38 cases of Budd Chiari syndrome related hepatocellular carcinoma and 50 cases of HBV related hepatocellular carcinoma.Hepatoma cells of Budd Chiari syndrome related hepatocellular carcinoma were exposed to different concentrations of Estrogen for 48 hours. Tetrazolium bromide (MTT) colorimetry was used to analyze cell proliferation activities; cell cycle was analyzed by flow cytometry (FCM); cell apoptosis was analyzed by flow cytometry (FCM) and Casepase-3 activity was measured after induced by adriamycin(ADM).

The positive rate of estrogen receptor-α expression in the tissues of Budd Chiari syndrome related hepatocellular carcinoma was 71.05%, which was higher than that (32%)in HBV related hepatocellular carcinoma tissue evidently (P<0.01). The positive rate of estrogen receptor-β expression in the tissues of Budd Chiari syndrome related hepatocellular carcinoma was 68.4%, which was higher than that (26%)in HBV related hepatocellular carcinoma tissue evidently (P<0.01). With the concentrations of estrogen increasing, MTT Assays showed that estrogen level increased the cell proliferation activities of Budd Chiari syndrome related hepatocellular carcinoma. The number of cells at stage S and G2/M were significantly increased and cells at stage G0/G1 were reduced with the increasing concentrations of estrogen. After being incubated under the different concentrations of estrogen for 48 h, the apoptosis rates decreased gradually and the Casepase-3 activity was significantly reduced with the increasing concentration of estrogen.

Estrogenreceptor expression may have an important influence on hepatocellular carcinoma cell biology difference between Budd Chiari syndrome related hepatocellular carcinoma and HBV related hepatocellular carcinoma. Estrogen level can promote cell proliferation and cell cycle, and inhibit the apoptosis of hepatoma cells of Budd Chiari syndrome related hepatocellular carcinoma in vitro, and these effects were increased with the increasing of estrogen level.

To summarize the etiologies of bilateral adrenal lesions and the changes of the disease profile in hospitalized patients.

Bilateral adrenal lesion screening was conducted in all patients admitted to Peking University Third Hospital from 1994 to 2017. The etiologies and disease profiles of bilateral adrenal lesions were retrospectively analyzed.

A total of 260 patients with bilateral adrenal lesions were included in the study. There were 146 males and 114 females with a mean age of (55.4±16.2) years. The most common adrenal lesion was bilateral adrenal hyperplasia (75 cases, 28.8%), followed by bilateral adrenal adenomas (71 cases, 27.3%), metastatic carcinoma (51 cases, 19.6%), discordant bilateral adrenal lesions (27 cases, 10.4%), bilateral pheochromocytomas (13 cases, 5.0%), and others. The clear data of endocrine function evaluation could be found in 184 patients. Among them, 111 cases (60.3%) were nonfunctioning lessions, 34 cases (18.5%) with primary aldosteronism, 15 cases (8.1%) with pheochromocytoma, 13 cases (7.1%) with congenital adrenal hyperplasia, 6 cases (3.3%) with primary hypoadrenocorticism, and 5 cases (2.7%) with Cushing syndrome. Using every 8 years as a period of time, the number of hospitalized patients with bilateral adrenal lesions increased with years in three periods (8, 41 and 211 cases, respectively).

The most common cause of bilateral adrenal lesions is adrenal hyperplasia in the hospitalized patients. More than half of bilateral adrenal lesions are nonfunctioning. In functional bilateral lesions, primary aldosteronism and pheochromocytoma account for a large proportion.

To explore the effect and mechanism of bamboo leaf flavonoids on depression in type 2 diabetic rats.

The streptozotocin (STZ) was used to induce the depression model of type 2 diabetic rats. Eight weeks old male Sprague-Dawley (SD) rats were randomly divided into 5 groups: the normal control group (n=8), the model group (n=9), the bamboo leaf flavonoid group (n=9), the solvent control group (n=9) and the bamboo leaf flavonoid normal control group (n=8). Rats of the bamboo leaf flavonoid group and the bamboo leaf flavonoid normal control group were treated with intragastric administration of bamboo leaf flavonoids (200 mg·kg^-1·d^-1) for 12 weeks. Tail suspension test (TST) and forced swimming test (FST) were used to measure the level of depression. Nissl staining was used to detect the survival amount of hippocampus neurons. The levels of interleukin-1β (IL-1β) and interleukin-6 (IL-6) were detected by enzyme-linked immunosorbent assay (ELISA). The expression levels of receptor of advanced glycation endproducts (RAGE), phosphorylated signal protein P38 (p-P38), cleaved caspase-3 and the nuclear factor-κB (NF-κB) were detected by Western blotting.

Compared with the normal control group, the TST and FST immobility time of the model group rats increased [(206±13) s vs (101±9) s, (192±24) s vs (98±8) s, both P<0.01]. Furthermore, the injury of hippocampal neurons was more severe, and the boundary was unclear. The nissl bodies were scarce or disappeared, and nuclear pyknosis was observed. The levels of hippocampal CA3 IL-1β and IL-6 elevated [(31.78±4.12) pg/ml vs (9.26±3.52) pg/ml, (49.15±3.47) pg/ml vs (19.63±2.18) pg/ml, bothP<0.01]. The Western blotting showed that the expressions of RAGE, p-P38, cleaved caspase-3 enhanced and NF-κB nuclear translocation increased (allP<0.05). After bamboo leaf flavonoids treatment (for 12 weeks), compared with the model group, the immobility time of TST and FST reduced in the bamboo leaf flavonoid group [(152±11) s vs (206±13) s, (110±19) s vs (192±24) s, P<0.01], and hippocampal neuronal injury alleviated. In addition, the concentrations of IL-1β and IL-6 decreased [(21.79±3.95) pg/ml vs (31.78±4.12) pg/ml, (34.68±4.28) pg/ml vs (49.15±3.47) pg/ml, bothP<0.01] and the expressions of RAGE, p-P38, nuclear NF-κB, cleaved caspase-3 up-regulated in the bamboo leaf flavonoid group.

Bamboo leaf flavonoids can effectively improve depression in diabetic rats through decreasing hippocampal neuronal injury and the release of inflammatory factors, and inhibiting RAGE/P38/NF-κB signaling pathway.

To investigate the impact of TNF-related apoptosis-inducing ligand (TRAIL) gene knock-out (TRAIL^-/-) on Th17 cells in the mice colitis induced by dextran sulphate sodium (DSS).

Mice were randomly assigned to 4 subgroups: wild type (WT), TRAIL^-/-, WT colitis and TRAIL^-/-colitis (n=6/group). Colitis was induced by oral administration of 3.5% DSS for 7 consecutive days. The severity of colitis in each mouse was scored both clinically and histopathologically. Flow cytometry was performed to assess Th17 cell population in peripheral blood mononuclear cells (PBMC) and mesenteric lymph nodes (MLN). The expression levels of Th17 cell markers interleukin (IL)-17A and retinoic acid-related orphan receptor (ROR)-γt in PBMC and MLN were also examined using a quantitative polymerase chain reaction method.

Compared with WT group, WT colitis group displayed elevated CD4⁺IL-17A⁺ Th17 cells (0.29±0.07 vs 0.08±0.03, 1.20±0.36 vs 0.40±0.11, both P<0.05) and enhanced mRNA expression of IL-17A and ROR-γt in PBMC and MLN (IL-17A: 2.43±0.87 vs 0.37±0.19, 5.03±1.77 vs 1.05±0.48, bothP<0.05; ROR-γt: 2.49±0.48 vs 0.93±0.47, 23.75±7.60 vs 1.31±0.90, bothP<0.05). After the DSS administration, TRAIL^-/- group developed more severe colitis than WT group, mainly manifesting higher disease activity index, reduction of colon length and increased infiltration of inflammatory cells. In addition, TRAIL^-/- colitis group exhibited increased proportion of CD4⁺ IL-17A⁺ Th17 cells (0.57±0.22 vs 0.29±0.07, P<0.001; 2.92±0.98 vs 1.20±0.36, P<0.000 1) as well as enhanced mRNA expression of IL-17A and ROR-γt in PBMC and MLN when compared with WT colitis group (IL-17A: 4.10±1.96 vs 2.43±0.87, 15.88±2.86 vs 5.03±1.77, bothP<0.05; ROR-γt: 4.05±0.62 vs 2.49±0.48, 69.61±10.48 vs 23.75±7.60, bothP<0.05).

TRAIL deficiency not only promots the number and activity of Th17 cells in PBMC and in MLN, but also aggravats DSS-induced colitis in mice.

To investigate the pathological characters of urothelial barrier in prostatic ducts of elderly male SD rats.

Ten elderly male SD rats were anesthetized with chloral hydrate and then took the bladder, prostatic urethra and prostate tissues for serial pathological sections and HE staining. Immunohistochemical method was used to detect the expression of the Cytokeratin 7 (CK7), Cytokeratin 20 (CK20), Uroplakin Ⅲ (UP Ⅲ), Zonula occludens-1 (ZO-1) and Occludin in issues, and to make densitometric analysis (IA) on immunohistochemical results of each antibody.

HE staining observed that urothelial umbrella cells exist in the bladder, prostatic urethra and proximal prostatic duct. Immunohistochemical method showed the CK7, UPⅢ, ZO-1 and Occludin were positive in bladder, prostatic urethra and prostatic duct, while CK20 was negative. CK7 and UPⅢ were positive in the proximal prostatic duct, and negative in the bottom of the ductal acinar lumen; ZO-1 and Occludin were positive in prostatic duct. The IOD/Area values of CK7 and UP Ⅲ, in bladder, prostatic urethra, proximal prostatic duct, the middle of prostatic duct and bottom of the ductal acinar lumen, were 0.16, 0.13, 0.06, 0.05, 0.00 and 0.17, 0.16, 0.08, 0.05, 0.00(P<0.05,respectively). The expression of ZO-1 and Occludin in bladder (0.14 and 0.13) were higher than those in other tissues (0.11-0.12 and 0.09-0.10, P<0.05); the expression of ZO-1 and Occludin, which in proximal prostatic duct to the middle of prostatic duct and bottom of the ductal acinar lumen, had no significant difference (0.12-0.11 and 0.09-0.09, P>0.05). The IA values of CK20 were extremely low (0.00-0.01, P>0.05).

Urothelial barriers partially exist in the prostatic ducts of elderly male SD rats, and with the prostatic ducts gradually extending to the bottom of acinar lumen, the urothelial barriers disappear. The results lay a foundation for further study on the repair of urinary epithelial barrier after prostatectomy.

The patient had hemolytic anemia and thrombocytopenia at a young age, which improved after splenectomy. The posterior blood smear showed oral red blood cells and giant platelets, and the fragility of red blood cells increased. Multiple periarticular subcutaneous masses, pathologically confirmed as xanthomas; Non-specific chronic hepatic impairment, improved after treatment with ursodeoxycholic acid capsules; Recent atrial fibrillation, possible myocardial involvement. Based on the above clinical findings, combined with the suspicion of phytosterolemia due to the suspected marriage of the patient's parents, further examination revealed a significant increase in blood phytosterol, and the homozygous mutation of ABCG8 gene was analyzed by gene analysis, and the diagnosis was clear. Phytosterolemia is an extremely rare autosomal recessive disease. It is hoped that this article can enhance clinicians' understanding of this disease.

Asthma is a heterogeneous disease characterized by chronic airway inflammation presented by repeated respiratory symptoms and reversible limitation of expiratory airflow. Correct disease self-management methods and effective asthma action plan can improve the status of asthma control and achieve the overall asthma control goal. This article reviews the main contents of self-management and asthma action plan of asthma patients.

Precision medicine is a new disease treatment and prevention concept that comprehensively considers everyone's genes, environment and lifestyle. The background of the development of precision medicine is the rapid development of human genomics research. Recent advances in genetics and human genomics have greatly promoted the precise diagnosis and precise treatment of various types of diabetes. The development of diabetes precision medicine should be based on existing evidence-based medicine standards, and efforts should be made to apply medical big data for improvement. This paper presents a review on this important topic.

Immune aging is not a complete decline of the immune system, but rather a process of rebuilding the immune system, the end result of the body's continuous adaptation. Immune aging can cause lymphatic system and cell dysfunction, increase the occurrence of infection, tumor and other diseases in the elderly, and seriously affect their physical health and quality of life. This article summarizes the current situation of immune senescence in the elderly, aiming at better prevention of senile diseases, improving the quality of life and prolonging the life of the elderly.