Asthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of "one-airway-one-disease," coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitization and multimorbidity, (iii) advances in mHealth for novel phenotype definitions, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches, and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut, and neuropsychiatric multimorbidities, is the "Epithelial Barrier Hypothesis." This review determined that the "one-airway-one-disease" concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme "allergic" (asthma) phenotype combining asthma, rhinitis, and conjunctivitis. Rhinitis alone and rhinitis and asthma multimorbidity represent two distinct diseases with the following differences: (i) genomic and transcriptomic background (Toll-Like Receptors and IL-17 for rhinitis alone as a local disease; IL-33 and IL-5 for allergic and non-allergic multimorbidity as a systemic disease), (ii) allergen sensitization patterns (mono- or pauci-sensitization versus polysensitization), (iii) severity of symptoms, and (iv) treatment response. In conclusion, rhinitis alone (local disease) and rhinitis with asthma multimorbidity (systemic disease) should be considered as two distinct diseases, possibly modulated by the microbiome, and may be a model for understanding the epidemics of chronic and autoimmune diseases.

The coating that combines efficient microwave absorption performance and excellent tribological properties has important research value. Herein, firstly, the ceramic precursor was coated on expanded graphite (EG) or thermally expanded reduced graphene oxide (TERGO) sheets to prevent aggregation. Then, the treated EG and TERGO were homogeneously dispersed in the ceramic matrix to prepare two types of graphene-based/ceramic coatings by plasma spraying. The microwave absorption properties and tribological properties with different load of all coatings have been systematically investigated. Remarkably, the microwave absorption properties of the TERGO/Al2O3 coating achieve wide bandwidth (reflection loss ≤ − 10 dB coved 2.8 GHz), and strong absorption (reflection loss of −35.3 dB) as the thickness of 2.1 mm. Meanwhile, the TERGO/Al2O3 coating possesses excellent tribological properties, and the coefficient of friction and wear rate were decreased by 41 and 90

Abstract Background: Currently, there are various platforms for circulating tumor cells (CTCs) detection that need further improvement. Here we performed CTCs detection with a novel automatic CTCs isolation and enrichment platform, CytoBot® 2000.Methods: We conducted a retrospective study with186 breast cancer patients and 20 healthy volunteers. Peripheral blood was obtained and the CTCs were detected immediately. The performance of CytoBot® 2000 was verified by spiking assay and clinical samples through the receiver operating characteristic (ROC) curve. The number of CTCs and CD45 positive CTCs were analyzed along with clinicopathologic features and clinical therapies. Additionally, a short-term follow-up review was presented for treatment monitoring with CTC.Results: CTCs were discovered in 119 of 137 patients (86.86%) with malignant tumors and 31 of 49 patients (63.27%) with benign carcinoid, but not in healthy group. Statistical analysis revealed that CTCs could easily distinguish malignant breast cancer from benign carcinoid (P < 0.0001). Notably, CTCs were significantly correlated with tumour progression (P = 0.0216). When the cut-off value was 2, the ROC curve estimated the sensitivity and specificity of 74.5% and 81.2%, respectively. The number of CTC was significantly associated with tumour TNM stage (P = 0.032) and tumour size (P = 0.0326). In retrospective follow-up, the majority of patients (65.22%) exhibited a reduction in CTCs enumeration because of improved treatment. Additionally, the increased proportion of CD45 positive CTCs has found during treatment with different strategies. Conclusion: The CTCs enumeration on CytoBot 2000® platform could accurately respond to the clinical diagnosis and treatment. CTCs and CD45 positive CTCs both have significance in clinical indication of cancer diagnosis and monitoring.

The retinal vascular endothelial cells can be damaged by oxidative stress even in the early stage of diabetic retinopathy (DR). This study aimed to investigate the protective effect of curcumin on the rat retinal vascular endothelial cells (RRVECs) in high glucose circumstance. The cultured RRVECs were identified and characterized by both of vWF and CD31 immunofluorescence expression. The activation of ROS/NF-κB signal pathway was examined by electrophoretic Mobility Shift Assay (EMSA), immunohistochemistry and Western blot; the apoptosis of RRVECs was tested by flow cytometry. We found that curcumin reduced the reactive oxygen species (ROS) and relieved the apoptosis in RRVECs exposed to the high glucose by flow cytometry. It was revealed that the increased activity of NF-κB and phosphorylated NF-κB in RRVECs induced by high glucose concentration was significantly suppressed by curcumin. We concluded that curcumin could suppress the oxidative stress via regulation of NF-κB signal to protect the RRVECs in DR.

Review question / Objective: To evaluate the effectiveness of acupuncture treatment of patients on UC with anxiety and depression, and provide the latest evidence-based medical evidence for it.Condition being studied: Ulcerative colitis (UC) is a chronic non-specific inflammatory disease with a yearly incidence.Studies have shown that anxiety and depression are complication of UC, and also a causative factor for recurrent episodes.Drugs for anxiety and depression have many side effects.Many previous studies have shown that acupuncture treatment is effective and safe, but without systematic reviews.This study aims to systematically study the effectiveness of acupuncture treatment for patients on UC with anxiety and depression.

Electrocardiogram (ECG) is an effective and non-invasive indicator for the detection and prevention of arrhythmia. ECG signals are susceptible to noise contamination, which can lead to errors in ECG interpretation. Therefore, ECG pretreatment is important for accurate analysis. In this paper, a method of noise reduction based on deep learning is proposed. The method is divided into two stages, and two corresponding models are formed. In the first stage, a one-dimensional U-net model is designed for ECG signal denoising to eliminate noise as much as possible. The one-dimensional DR-net model in the second stage is used to reconstruct the ECG signal and to correct the waveform distortion caused by noise removal in the first stage. In this paper, the U-net and the DR-net are constructed by the convolution method to achieve end-to-end mapping from noisy ECG signals to clean ECG signals. The ECG data used in this paper are from CPSC2018, and the noise signal is from MIT-BIH Noise Stress Test Database (NSTDB). In the experiment, the improvement in the signal-to-noise ratio SNR imp , the root mean square error decrease RMSE de , and the correlation coefficient P , are used to evaluate the performance of the network. This two-stage method is compared with FCN and U-net alone. The experimental results show that the two-stage noise reduction method can eliminate complex noise in the ECG signal while retaining the characteristic shape of the ECG signal. According to the results, we believe that the proposed method has a good application prospect in clinical practice.

The purpose of this study was to explore the risk factors for renal survival in patients with severe Lupus nephritis treated with continuous renal replacement therapy (CRRT). Two hundred and forty-seven SLE patients (male 54, female 193, median age 30.0(23-41) years requiring CRRT from January 2009 to December 2016 in Jinling Hospital were included in this study. 152(61.54%) patients achieved dialysis independence (dialysis independent group);95(38.46%) patients were on maintenance dialysis (dialysis dependent group). The multivariate COX regression analysis revealed that kidney damage course (P = 0.047, HR = 0.997),albumin level (P = 0.021, HR = 1.765), serum creatinine level (p=0.033, HR=0.684), oliguria or anuria(P=0.001, HR=0.460)were the prognostic factors for renal recovery in these patients. Renal biopsy was performed in 137patients, the CI>5 were the independent factors for the renal recovery in these patients. During a median follow-up time of 39.63(14.38,72.28) months，26(18.98%) patients in the dialysis independence group progressed into maintenance dialysis, the 1 ,5and 8 year renal survival were 94.6 % ,75.5%and 69.7%, respectively. Conclusion: About Forty percent of the patients still need renal replacement therapy, Kidney damage course,Albumin serum creatinine, Oliguria or anuria and CI>5 were the independent factor for renal survival.

Superior sulcus tumors (SSTs), a unique subgroup of locally advanced non–small-cell lung carcinoma (NSCLC), remain a great challenge for clinicians. T4 SSTs used to be a contraindication for operations, and the optimal treatment modality for T4 SS NSCLCs remains uncertain. The aim of our study is to evaluate the roles of surgical treatment and radiotherapy for patients with T4 SSTs. We used the SEER database [1973-2015] to identify patients diagnosed with T4 stage SS NSCLC (according to 7th edition AJCC staging system) between 2004 and 2015, those with M1 disease were excluded. Propensity score matching with Kaplan-Meier and Cox proportional hazards model were performed to estimate prognosis. A total of 384 patients were included (mean 66.4±11.71 years-of-age). Among them, the majority was male (59.4%) with lesions located in the left lung (52.3%) and diagnosed with IIIB stage (56.6%). 47 patients underwent cancer-directed surgery, and radiotherapy was received by 66.9% of patients. Median overall survival (OS) and lung cancer specific survival (LCSS) was 12 and 17 months, and 5-year OS, LCSS was 15.8%, 25.4%, respectively. In the matched population, the median survival outcomes were better with receipt of surgery (OS: 51.3 vs 35.1 months; p=0.049 LCSS: 67.1 vs 36.3 months; p=0.003). Multivariate Cox analysis showed that age ≧ 66 years (hazard ratio [HR] = 1.639, 95% confidence interval [CI] 1.214-2.213, p=0.001), unmarried status (HR = 1.356, 95% CI 1.023-1.798, p=0.034), tumor sized ≧ 6.0 cm (HR = 1.694, 95% CI 1.263-2.273, p<0.001) were associated with inferior OS. Cancer-directed surgery (HR = 0.537, 95% CI 0.337-0.855, p=0.009) and radiotherapy (HR = 0.644, 95% CI 0.472-0.878, p=0.006) were independent protective factors for patients with T4 superior sulcus NSCLC. However, neither adjuvant nor neoadjuvant radiotherapy was independent prognostic factor for those received surgery (p>0.05). Conversely, in the subgroup analysis, favorable impacts of radiotherapy were observed for non-surgery patients (OS: HR = 0.58, 95% CI 0.42-0.79, p<0.001; LCSS: HR = 0.55, 95% CI 0.37-0.75, p<0.001). Our study shows superior sulcus NSCLC patients with T4 stage have dismal prognosis. Surgical resection remains the optimal option for those with resectable disease. Moreover, for non-surgery tumors, the use of radiotherapy should be considered.

B7-H6 is a ligand of NKp30, which is an activating receptor of natural killer (NK) cells. High expression of B7-H6 is found in certain types of tumor cells, such as lymphoma, leukemia and gastric carcinoma. The expression of B7-H6 can be induced by inflammatory stress in healthy cells. The expression of B7-H6 is significantly correlated with distant metastasis status and post-operative prognosis in cancer patients. The effectiveness of B7-H6 modified antitumor immunotherapy strategies had been verified in tumor-bearing mice, which opened a new door to targeted therapy. In this review, we will focus on the recent development on the roles of B7-H6 in tumor immunity, as well as mechanisms involved in the regulation of B7-H6 expression.

Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) focuses on the integrated care of chronic diseases. Area 5 (Care Pathways) was initiated using chronic respiratory diseases as a model. The chronic respiratory disease action plan includes (1) AIRWAYS integrated care pathways (ICPs), (2) the joint initiative between the Reference site MACVIA-LR (Contre les MAladies Chroniques pour un VIeillissement Actif) and ARIA (Allergic Rhinitis and its Impact on Asthma), (3) Commitments for Action to the European Innovation Partnership on Active and Healthy Ageing and the AIRWAYS ICPs network. It is deployed in collaboration with the World Health Organization Global Alliance against Chronic Respiratory Diseases (GARD). The European Innovation Partnership on Active and Healthy Ageing has proposed a 5-step framework for developing an individual scaling up strategy: (1) what to scale up: (1-a) databases of good practices, (1-b) assessment of viability of the scaling up of good practices, (1-c) classification of good practices for local replication and (2) how to scale up: (2-a) facilitating partnerships for scaling up, (2-b) implementation of key success factors and lessons learnt, including emerging technologies for individualised and predictive medicine. This strategy has already been applied to the chronic respiratory disease action plan of the European Innovation Partnership on Active and Healthy Ageing.

PURPOSE:To develop a measure of medication-related quality of life (MRQoL) and to validate the measure in a hospital-based population of patients with polypharmacy.METHODS:The Medication-Related Quality of Life Scale version 1.0 (MRQoLS-v1.0) included 14 items developed on the basis of interviews with elderly patients with polypharmacy, defined as taking five or more medications simultaneously. This scale was tested in 219 outpatients (99 with polypharmacy and 120 without polypharmacy). Two measures were used to establish construct validity the Psychological Distress Checklist, for convergent validity, and the Medication Adherence Behavior Scale (MABS), for discriminant validity.RESULTS:The 14-item scale was found to be both reliable and valid. Internal consistency reliability evaluated using Cronbach's alpha for this scale was 0.91. Scores on the MRQoLS-v1.0 correlated statistically significantly and negatively with those on the Psychological Distress Checklist. Discriminant validity was demonstrated by low correlation with MABS, indicating that the MRQoLS-v1.0 measured concepts different from medication adherence. Significant differences in the MRQoLS-v1.0 between patients with polypharmacy and those without polypharmacy provided evidence for known-group validity.CONCLUSIONS:The study presents a psychometric evaluation of a measure used to assess MRQoL of patients with polypharmacy. The instrument is practical to administer in clinics and provides a valuable adjunct to the outcome measurement for patients with polypharmacy. Further research on the sensitivity of this instrument to medication change in multi-medicated patients is warranted.

B7-H4 plays an important role in tumor immune evasion. In previous studies we have found that B7-H4 can translocate to the nucleus, and the exposure to PI3K inhibitor Ly294002 affects B7-H4 subcellular distribution. In this study we report the role of PI3K/Akt pathway in the B7-H4 subcellular distribution and the effect of PI3K/Akt inhibitors on B7-H4-mediated immunoresistance. The involvement of PI3K/Akt pathway in B7-H4 subcellular distribution was evident in experiments with wortmannin, while MDM2 inhibitor nutlin-3 and the mTOR inhibitor rapamycin were used to dissect the signaling downstream of Akt. Wortmannin and rapamycin demonstrated similar effects on B7-H4 subcellular distribution. Exposure to any of these inhibitors decreased levels of membrane B7-H4 while at the same time inducing its nuclear accumulation, while exposure to nutlin-3 had no effect on B7-H4 subcellular distribution. In the T cell proliferation assay, both wortmannin and rapamycin effectively inhibited B7-H4 WT/293 cells-mediated T cell proliferation while exerting no effect on Mock/293 cells. PI3K/Akt/mTOR plays a role in B7-H4 subcellular distribution, while MDM2 does not take part in it. Moreover, we show that wortmannin and rapamycin inhibit B7-H4-mediated tumor immunoresistance through regulating B7-H4 subcellular distribution. Taken together, these results suggest that PI3K/Akt/mTOR inhibitors might be used for adjuvant therapy aimed at inhibition of immune evasion.

Several unmet needs have been identified in allergic rhinitis: identification of the time of onset of the pollen season, optimal control of rhinitis and comorbidities, patient stratification, multidisciplinary team for integrated care pathways, innovation in clinical trials and, above all, patient empowerment. MASK-rhinitis (MACVIA-ARIA Sentinel NetworK for allergic rhinitis) is a simple system centred around the patient which was devised to fill many of these gaps using Information and Communications Technology (ICT) tools and a clinical decision support system (CDSS) based on the most widely used guideline in allergic rhinitis and its asthma comorbidity (ARIA 2015 revision). It is one of the implementation systems of Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). Three tools are used for the electronic monitoring of allergic diseases: a cell phone-based daily visual analogue scale (VAS) assessment of disease control, CARAT (Control of Allergic Rhinitis and Asthma Test) and e-Allergy screening (premedical system of early diagnosis of allergy and asthma based on online tools). These tools are combined with a clinical decision support system (CDSS) and are available in many languages. An e-CRF and an e-learning tool complete MASK. MASK is flexible and other tools can be added. It appears to be an advanced, global and integrated ICT answer for many unmet needs in allergic diseases which will improve policies and standards.

Several unmet needs have been identified in allergic rhinitis: identification of the time of onset of the pollen season, optimal control of rhinitis and comorbidities, patient stratification, multidisciplinary team for integrated care pathways, innovation in clinical trials and, above all, patient empowerment. MASK-rhinitis (MACVIA-ARIA Sentinel NetworK for allergic rhinitis) is a simple system centred around the patient which was devised to fill many of these gaps using Information and Communications Technology (ICT) tools and a clinical decision support system (CDSS) based on the most widely used guideline in allergic rhinitis and its asthma comorbidity (ARIA 2015 revision). It is one of the implementation systems of Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). Three tools are used for the electronic monitoring of allergic diseases: a cell phone-based daily visual analogue scale (VAS) assessment of disease control, CARAT (Control of Allergic Rhinitis and Asthma Test) and e-Allergy screening (premedical system of early diagnosis of allergy and asthma based on online tools). These tools are combined with a clinical decision support system (CDSS) and are available in many languages. An e-CRF and an e-learning tool complete MASK. MASK is flexible and other tools can be added. It appears to be an advanced, global and integrated ICT answer for many unmet needs in allergic diseases which will improve policies and standards.

The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and will add value to existing public health knowledge by: 1) proposing a common framework of care pathways for chronic respiratory diseases, which will facilitate comparability and trans-national initiatives; 2) informing cost-effective policy development, strengthening in particular those on smoking and environmental exposure; 3) aiding risk stratification in chronic disease patients, using a common strategy; 4) having a significant impact on the health of citizens in the short term (reduction of morbidity, improvement of education in children and of work in adults) and in the long-term (healthy ageing); 5) proposing a common simulation tool to assist physicians; and 6) ultimately reducing the healthcare burden (emergency visits, avoidable hospitalisations, disability and costs) while improving quality of life. In the longer term, the incidence of disease may be reduced by innovative prevention strategies. AIRWAYSICPs was initiated by Area 5 of the Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing. All stakeholders are involved (health and social care, patients, and policy makers).

Asthma is the most common chronic lower respiratory disease in childhood throughout the world. Several guidelines and/or consensus documents are available to support medical decisions on pediatric asthma. Although there is no doubt that the use of common systematic approaches for management can considerably improve outcomes, dissemination and implementation of these are still major challenges. Consequently, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), recently formed by the EAACI, AAAAI, ACAAI, and WAO, has decided to propose an International Consensus on (ICON) Pediatric Asthma. The purpose of this document is to highlight the key messages that are common to many of the existing guidelines, while critically reviewing and commenting on any differences, thus providing a concise reference. The principles of pediatric asthma management are generally accepted. Overall, the treatment goal is disease control. To achieve this, patients and their parents should be educated to optimally manage the disease, in collaboration with healthcare professionals. Identification and avoidance of triggers is also of significant importance. Assessment and monitoring should be performed regularly to re-evaluate and fine-tune treatment. Pharmacotherapy is the cornerstone of treatment. The optimal use of medication can, in most cases, help patients control symptoms and reduce the risk for future morbidity. The management of exacerbations is a major consideration, independent of chronic treatment. There is a trend toward considering phenotype-specific treatment choices; however, this goal has not yet been achieved.