A nomogram for preoperative prediction of lymph node metastasis in patients with intrahepatic cholangiocarcinoma based on inflammation-related markers / 中华外科杂志

Objectives: To construct a nomogram for prediction of intrahepatic cholangiocarcinoma (ICC) lymph node metastasis based on inflammation-related markers,and to conduct its clinical verification. Methods: Clinical and pathological data of 858 ICC patients who underwent radical resection were retrospectively collected at 10 domestic tertiary hospitals in China from January 2010 to December 2018. Among the 508 patients who underwent lymph node dissection,207 cases had complete variable clinical data for constructing the nomogram,including 84 males,123 females,109 patients≥60 years old,98 patients<60 years old and 69 patients were pathologically diagnosed with positive lymph nodes after surgery. Receiver operating characteristic curve was drawn to calculate the accuracy of preoperative imaging examinations to determine lymph node status,and the difference in overall survival time was compared by Log-rank test. Partial regression squares and statistically significant preoperative variables were screened by backward stepwise regression analysis. R software was applied to construct a nomogram,clinical decision curve and clinical influence curve,and Bootstrap method was used for internal verification. Moreover,retrospectively collecting clinical information of 107 ICC patients with intraoperative lymph node dissection admitted to 9 tertiary hospitals in China from January 2019 to June 2021 was for external verification to verify the accuracy of the nomogram. 80 patients with complete clinical data but without lymph node dissection were divided into lymph node metastasis high-risk group and low-risk group according to the score of the nomogram among the 858 patients. Log-rank test was used to compare the overall survival of patients with or without lymph node metastasis diagnosed by pathology. Results: The area under the curve of preoperative imaging examinations for lymph node status assessment of 440 patients was 0.615,with a false negative rate of 62.8% (113/180) and a false positive rate of 14.2% (37/260). The median survival time of 207 patients used to construct a nomogram with positive or negative postoperative pathological lymph node metastases was 18.5 months and 27.1 months,respectively (P<0.05). Five variables related to lymph node metastasis were screened out by backward stepwise regression analysis,which were combined calculi,neutrophil/lymphocyte ratio,albumin,liver capsule invasion and systemic immune inflammation index,according to which a nomogram was constructed with concordance index(C-index) of 0.737 (95%CI: 0.667 to 0.806). The C-index of external verification was 0.674 (95%CI:0.569 to 0.779). The calibration prediction curve was in good agreement with the reference curve. The results of the clinical decision curve showed that when the risk threshold of high lymph node metastasis in the nomogram was set to about 0.32,the maximum net benefit could be obtained by 0.11,and the cost/benefit ratio was 1∶2. The results of clinical influence curve showed that when the risk threshold of high lymph node metastasis in the nomogram was set to about 0.6,the probability of correctly predicting lymph node metastasis could reach more than 90%. There was no significant difference in overall survival time between patients with high/low risk of lymph node metastasis assessed by the nomogram and those with pathologically confirmed lymph node metastasis or without lymph node metastasis (Log-rank test:P=0.082 and 0.510,respectively). Conclusion: The prediction accuracy of preoperative nomogram for ICC lymph node metastasis based on inflammation-related markers is satisfactory,which can be used as a supplementary method for preoperative diagnosis of lymph node metastasis and is helpful for clinicians to make personalized decision of lymph node dissection for patients with ICC.

Survival analysis of patients with intrahepatic cholangiocarcinoma treated with adjuvant chemotherapy after radical resection based on CoxPH model and deep learning algorithm / 中华外科杂志

Objective: To establish a predictive model for survival benefit of patients with intrahepatic cholangiocarcinoma (ICC) who received adjuvant chemotherapy after radical resection. Methods: The clinical and pathological data of 249 patients with ICC who underwent radical resection and adjuvant chemotherapy at 8 hospitals in China from January 2010 to December 2018 were retrospectively collected. There were 121 males and 128 females,with 88 cases>60 years old and 161 cases≤60 years old. Feature selection was performed by univariate and multivariate Cox regression analysis. Overall survival time and survival status were used as outcome indicators,then target clinical features were selected. Patients were stratified into high-risk group and low-risk group,survival differences between the two groups were analyzed. Using the selected clinical features, the traditional CoxPH model and deep learning DeepSurv survival prediction model were constructed, and the performance of the models were evaluated according to concordance index(C-index). Results: Portal vein invasion, carcinoembryonic antigen>5 μg/L,abnormal lymphocyte count, low grade tumor pathological differentiation and positive lymph nodes>0 were independent adverse prognostic factors for overall survival in 249 patients with adjuvant chemotherapy after radical resection (all P<0.05). The survival benefit of adjuvant chemotherapy in the high-risk group was significantly lower than that in the low-risk group (P<0.05). Using the above five features, the traditional CoxPH model and the deep learning DeepSurv survival prediction model were constructed. The C-index values of the training set were 0.687 and 0.770, and the C-index values of the test set were 0.606 and 0.763,respectively. Conclusion: Compared with the traditional Cox model, the DeepSurv model can more accurately predict the survival probability of patients with ICC undergoing adjuvant chemotherapy at a certain time point, and more accurately judge the survival benefit of adjuvant chemotherapy.

Exploring the significance of chemotherapy in the perioperative application of biliary tract carcinomas / 中华外科杂志

Biliary tract cancer is extremely malignant with a poor prognosis. At the moment, the only curative method available is radical resection. Targeted and immunotherapy are currently advancing quickly, but chemotherapy still holds a key role in the perioperative management of biliary cancer. Perioperative chemotherapy aims to decrease tumor volume before surgery so that patients can have their tumors surgically removed or have a higher radical resection rate. It also aims to remove any tumor cells that remain after surgery and prevent the growth of new tumors. Chemotherapy-based combination treatment techniques have been increasingly investigated in recent years to improve perioperative care and patient survival. From the standpoint of chemotherapy regimens and clinical trial success in the perioperative phase of radical surgery, the value of chemotherapy in the perioperative period of biliary tract cancer were explored in this paper.

Outcomes of patients experiencing cardiovascular adverse events within 1 year following craniotomy for intracranial aneurysm clipping: a retrospective cohort study / 南方医科大学学报

OBJECTIVE@#To investigate the impact of postoperative serious cardiovascular adverse events (CAE) on outcomes of patients undergoing craniotomy for intracranial aneurysm clipping.@*METHODS@#This retrospective cohort study was conducted among the patients undergoing craniotomy for intracranial aneurysm clipping during the period from December, 2016 to December, 2017, who were divided into CAE group and non-CAE group according to the occurrence of Clavien-Dindo grade ≥II CAEs after the surgery. The perioperative clinical characteristics of the patients, complications and neurological functions during hospitalization, and mortality and neurological functions at 1 year postoperatively were evaluated. The primary outcome was mortality within 1 year after the surgery. The secondary outcomes were Glasgow outcome scale (GOS) score at 1 year, lengths of postoperative hospital and intensive care unit (ICU) stay, and Glasgow coma scale (GCS) score at discharge.@*RESULTS@#A total of 361 patients were enrolled in the final analysis, including 20 (5.5%) patients in CAE group and 341 in the non-CAE group. No significant differences were found in the patients' demographic characteristics, clinical history, or other postoperative adverse events between the two groups. The 1-year mortality was significantly higher in CAE group than in the non-CAE group (20.0% vs 5.6%, P=0.01). Logistics regression analysis showed that when adjusted for age, gender, emergency hospitalization, subarachnoid hemorrhage, volume of bleeding, duration of operation, aneurysm location, and preoperative history of cardiovascular disease, postoperative CAEs of Clavien-Dindo grade≥II was independently correlated with 1-year mortality rate of the patients with an adjusted odds ratio of 3.670 (95% CI: 1.037-12.992, P=0.04). The patients with CEA also had a lower GOS score at 1 year after surgery than those without CEA (P=0.002). No significant differences were found in the occurrence of other adverse events, postoperative hospital stay, ICU stay, or GCS scores at discharge between the two groups (P > 0.05).@*CONCLUSION@#Postoperative CAEs may be a risk factor for increased 1-year mortality and disability in patients undergoing craniotomy for intracranial aneurysms.

Impact of adjuvant chemotherapy on prognosis in intrahepatic cholangiocarcinoma patients underwent radical resection / 中华外科杂志

Objectives: To investigate the clinical value of adjuvant chemotherapy(ACT) in patients with intrahepatic cholangiocarcinoma(ICC) who underwent radical resection and to explore the optimal population that can benefit from ACT. Methods: A retrospective cohort study method was adopted. The clinical and pathological data of 685 patients with ICC who underwent curative intent resection in 10 Chinese hepatobiliary surgery centers from January 2010 to December 2018 were collected;There were 355 males and 330 females. The age(M(IQR)) was 58(14) years (range: 22 to 83 years). Propensity score matching(PSM) was applied to balance the differences between the adjuvant and non-adjuvant chemotherapy groups. Log-rank test was used to compare the prognosis of the two groups of patients. A Bayesian network recurrence-free survival(RFS) prediction model was constructed using the median RFS time (14 months) as the target variable, and the importance of the relevant prognostic factors was ranked according to the multistate Birnbaum importance calculation. A survival prognostic prediction table was established to analyze the population benefiting from adjuvant chemotherapy. Results: Among 685 patients,214 received ACT and 471 did not receive ACT. A total of 124 pairs of patients were included after PSM, and patients in the ACT group had better overall survival (OS) and RFS than those in the non-ACT group(OS: 32.2 months vs. 18.0 months,P=0.003;RFS:18.0 months vs. 10.0 months,P=0.001). The area under the curve of the Bayesian network RFS prediction model was 0.7124. The results of the prognostic factors in order of importance were microvascular invasion (0.158 2),perineural invasion (0.158 2),N stage (0.155 8),T stage (0.120 9), hepatic envelope invasion (0.090 3),adjuvant chemotherapy (0.072 1), tumor location (0.057 5), age (0.042 3), pathological differentiation (0.034 0), sex (0.029 3), alpha-fetoprotein (0.028 9) and preoperative jaundice (0.008 5). A survival prediction table based on the variables with importance greater than 0.1 (microvascular invasion,perineural invasion,N stage,T staging) and ACT showed that all patients benefited from ACT (increase in the probability of RFS≥14 months from 2.21% to 7.68%), with a more significant increase in the probability of RFS≥14 months after ACT in early-stage patients. Conclusion: ACT after radical resection in patients with ICC significantly prolongs the OS and RFS of patients, and the benefit of ACT is greater in early patients.

Significance of combination of targeted therapy and immunotherapy in conversion therapy of biliary tract cancer / 中华外科杂志

Biliary tract cancer has insidious onset and high degree of malignancy, and radical resection is often impossible when it is diagnosed.Conversion therapy can achieve tumor downgrading, so that patients who were initially unresectable have a chance to achieve R0 resection.However, due to the high heterogeneity and complex immune microenvironment of biliary tract cancer, conversion therapy is still in the stage of active exploration.As a new type of conversion therapy, combination of targeted therapy and immunotherapy is of great significance to effectively improve the efficiency of conversion therapy.Further exploration of combination mechanism and improvement of immune microenvironment are expected to become the future direction of combination of targeted therapy and immunotherapy.

Speculating the Conditions and Characteristics of Morbidity of "Warm Haze" Based on Pathogenic Properties of Haze and SARS / 中国中医药信息杂志

Although haze and severe acute respiratory syndrome (SARS) are different, they are not only both closely related to climate, but also take respiratory symptom as their main clinical manifestation when they play pathogenetic roles. Based on the comparative analysis of the pathogenic properties of haze and SARS, this article speculated the conditions and characteristics of the morbidity of "warm haze", a newly serious infectious disease which consists of haze combines abnormally warm climate that potentially occurs, as well as proposes related early warnings and measures in order to provide reference for TCM in preventing newly infectious diseases and inspire a new thinking of TCM in preventing diseases which consist of both climatic and environmental factors.

A novel HSF4 mutation in a Chinese family with autosomal dominant congenital cataract / 华中科技大学学报（医学）（英德文版）

This study was aimed to identify the mutation of the whole coding region of shock transcription factor 4 (HSF4) gene in a Chinese family with autosomal dominant congenital cataract (ADCC). All exons of HSF4 were amplified by PCR. Sequence analysis of PCR products was performed. Restriction fragment length polymorphism (RFLP) analysis was conducted to confirm the pathogenic mutation. The results showed that a C to T substitution occurred at nucleotide 331 in patients of this family, leading to the replacement of the amino acid arginine-111 with cysteine in exon 3. RFLP analysis showed that the amino acid change was co-segregated with all affected individuals. It was concluded that the new mutation of c.331C>T in HSF4 DNA may be responsible for the autosomal dominant congenital cataract in this family.

A novel HSF4 mutation in a Chinese family with autosomal dominant congenital cataract / 华中科技大学学报（医学）（英德文版）

This study was aimed to identify the mutation of the whole coding region of shock transcription factor 4 (HSF4) gene in a Chinese family with autosomal dominant congenital cataract (ADCC). All exons of HSF4 were amplified by PCR. Sequence analysis of PCR products was performed. Restriction fragment length polymorphism (RFLP) analysis was conducted to confirm the pathogenic mutation. The results showed that a C to T substitution occurred at nucleotide 331 in patients of this family, leading to the replacement of the amino acid arginine-111 with cysteine in exon 3. RFLP analysis showed that the amino acid change was co-segregated with all affected individuals. It was concluded that the new mutation of c.331C>T in HSF4 DNA may be responsible for the autosomal dominant congenital cataract in this family.

Construction of MHV-A59 damp-heat mouse model and analysis of the relevant indices / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the impact of inflammation, water metabolism and immune function on the establishment of a mouse model of damp-heat syndrome with MHV-A59 infection.</p><p><b>METHODS</b>Twenty-four mice were randomly divided into control group, virus group, damp-heat group and model group. The peripheral blood CD4(+) and CD8(+) lymphocytes were detected by flow cytometry, and the serum levels of IFN-γ and IL-4 were assayed by ELISA. The expressions of NF-κB and AQP4 in the liver and stomach were determined using immunohistochemistry.</p><p><b>RESULTS</b>The expression of NF-κB and CD4(+)/CD8(+) ratio in the virus and model groups were significantly higher than those in the damp-heat and control groups, while the expression of AQP4 was significantly higher in the model and damp-heat groups than in the other groups. Compared with the control group, the model group showed a significantly higher ratio of IFN-γ/IL-4.</p><p><b>CONCLUSIONS</b>MHV-A59 virus is the main cause of elevated NF-κB expression and CD4(+)/CD8(+)/ ratio, while damp-heat syndrome is responsible for increased AQP4 expression, and their synergistic effect results in increased IFN-γ/IL-4 ratio. The mouse model established using MHV-A59 virus and the damp-heat factors can mimic damp-heat syndrome described in traditional Chinese medicine theory.</p>

c.359T>C mutation of the MYH14 gene in two autosomal dominant non-syndromic hearing impairment families with common ancestor / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To identify the gene mutation for two Chinese families with autosomal dominant non-syndromic hearing impairment(NSHI).</p><p><b>METHODS</b>Two NSHI pedigrees with common ancestor were identified by clinical examination and family investigation. Linkage analysis was performed for all known NSHI loci, and all exons and exon-intron boundaries of the non-muscle myosin heavy chain 14 (MYH14) gene were amplified by PCR and sequenced.</p><p><b>RESULTS</b>The disease-causing gene of these 2 pedigrees was fine mapped to the DFNA4 locus on 19q13.33. A heterozygous transition of c. 359T>C (p.S120L) in MYH14 gene was identified. The mutation was detected in all patients but not in normal members in the two families.</p><p><b>CONCLUSION</b>It is the first report that mutation in MYH14 gene can cause dominant non-syndromic hearing impairment in Asian population, suggesting that MYH14 gene can be a disease-causing gene of Chinese patients with hearing impairment.</p>

Narcotrend for monitoring the anesthetic depth during endotracheal intubation in sevoflurane anesthesia / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the feasibility of using Narcotrend (NCT) in monitoring the anesthetic depth during endotracheal intubation in sevoflurane anesthesia.</p><p><b>METHODS</b>Thirty ASA I-II patients (aged 20-49 years) undergoing gynecologic surgery under general anesthesia with tracheal intubation were randomized into sevoflurane group (n=15) and sevoflurane plus rocuronium group (n=15). In the former group, anesthesia was induced with sevoflurane at the primary concentration of 8% till the final end expiratory concentration reaching 2 MAC(minimum alveolar concentration) for 3 min, followed then by tracheal intubation and further observation of the indicators for another 3 min. The patients in sevoflurane plus rocuronium group received identical anesthesia procedures except for the administration of intravenous injection of rocuronium (0.6 mg/kg) after the loss of eyelash reflex. The NCT, BIS and hemodynamics were recorded during the process.</p><p><b>RESULTS</b>No significant differences were noted in NCT, bispectral index (BIS), MAP and heart rate before tracheal intubation between the two groups (P>0.05). The NCT and BIS increased significantly after tracheal intubation in sevoflurane group (P<0.05), but remained below 60. No significant changes in NCT and BIS occurred during intubation in sevoflurane plus rocuronium group (P>0.05). The mean arterial pressure (MAP) and heart rate were significantly increased in both groups after tracheal intubation in comparison with those before tracheal intubation (P<0.05), but the increment in sevoflurane group was significantly greater (P<0.05).</p><p><b>CONCLUSION</b>NCT may reflect the changes of the anesthetic depth resulting from the nociceptive stimulus of tracheal intubation in sevoflurane- induced anesthesia. NCT and BIS can not serve such a purpose in combined anesthesia with sevoflurane and rocuronium.</p>

Variation and significance of NKT cell and its subset in patients with severe multiple injuries / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To observe the variation and significance of natural killer T (NKT) cells in patients with severe multiple injuries.</p><p><b>METHODS</b>Peripheral blood was drawn from 30 patients with severe multiple injuries and 20 healthy individuals. NKT cells and the subsets of NKT cells were stained and analyzed on fluorescence activated cell sorter (FACS) using Cellquest software. The level of IL-4 and IFN-gamma in blood serum was detected by ELISA.</p><p><b>RESULTS</b>The proportion of NKT cells was significantly increased. CD4+ NKT cells was increased (t equal to -3.11, P less than 0.01) and CD4+CD8+NKT (double negative NKT, DN NKT) cells decreased in patients with severe multiple injuries compared with healthy controls (t equal to 2.99, P less than 0.01). There was a positive correlation between the proportion of NKT cells and injury severity score (ISS) by Spearman correlation analysis (r equal to 0.70, P less than 0. 01). The level of IFN-gamma was significantly decreased and the level of IL-4 significantly increased in patients with severe multiple injuries.</p><p><b>CONCLUSIONS</b>We demonstrate that human NKT cells are increased in trauma patients. Most significantly, there is an association between ISS and NKT cells. The increased CD4+NKT cells may contribute to the reduction of Th1 cytokine production and the growth of Th2 cytokine production, leading to the suppression of immunity after injury.</p>

Treatment of focal bone defect in postoperative nonunion with autologous red bone marrow injection / 中国骨伤

<p><b>OBJECTIVE</b>To observe the clinical effect of autologous red bone marrow injection in treating focal bone defect in postoperative nonunion.</p><p><b>METHODS</b>Thirteen patients with focal bone defect in postoperative nonunion (7 cases in tibia, 2 cases in femur, 4 cases in humerus), including 8 males and 5 females with the mean age of 32.5-years-old (ranging from 15 to 60 years). The bone defects were treated with autologous red bone marrow injection (1 time per 2 weeks, 5 times in total) and the X-rays of AP and LP were observed.</p><p><b>RESULTS</b>Thirteen patients were followed up from 6 to 12 months with an average of 7.5 months. According to results of X-ray pictures, 13 cases obtained bone defect recovered completely, and the average time of union was 4 months.</p><p><b>CONCLUSION</b>Autologous red bone marrow injection has ascendancy such as less wound and clear clinical effect, which can accelerate bone healing and promotes functional recovery of limb. It is a good method to treat focal bone defect in postoperative nonunion.</p>

Analysis of emergency treatment in 4519 patients with multiple injuries / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the clinical manifestations, treatment, complications, and prognosis of patients with multiple injuries.</p><p><b>METHOD</b>The clinical data, including the causes of injury, treatment, complications, causes of death, and mortality rate, of 4519 patients were retrospectively analyzed.</p><p><b>RESULTS</b>The major causes of injury were road traffic injury (2410 cases, 53.33%), violence injury (747 cases, 16.53%), and high falling injury (575 cases, 12.72%). The main involved positions included head (2247 cases, 18.71%), abdominal region and pelvis (2118 cases, 17.64%), and thoracic region (1853 cases, 15.43%). The major complications were shock (1497 cases, 33.13%). The main cause of death was sepsis with multiple organ dysfunction syndrome/failure (28 cases, 82.35%) after multiple injuries, significant higher than other causes in the same period (P<0.01).</p><p><b>CONCLUSIONS</b>The multiple injuries have various causes of disease, and were complicated with their diverse clinical manifestations, numerous complications, and high mortalities. Further research on the integrated rescue mortality is required.</p>

The analysis of HLA-A, B and DRB1 allelic polymorphism in Han race population in Lanzhou region of China / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the HLA-A, B and DRB1 allele polymorphism of the Han race population in Lanzhou area.</p><p><b>METHODS</b>Polymerase chain reaction-sequence specific primer was used to detect HLA-A, B and DRB1 alleles in 200 unrelated healthy Han individuals from Lanzhou region, Northwest China, and the results were compared with those of Han populations in North, South and Northwest China, and Hui, Uigur and Tibetan population in China.</p><p><b>RESULTS</b>Fourteen of alleles were detected and identified for HLA-A; 32 for HLA-B; and 13 for HLA-DRB1. HLA- A*01, A*02,A*11,A*24, A*30, A*31, A*33; HLA- B*13, B*15, B*40, B*44, B*46, B*51, B*58, B*60; HLA- DRB1*04,. DRB1*07, DRB1*08, DRB1*09, DRB1*11, DRB1*12, DRB1*14 and DRB1*15 were the most common alleles. The frequencies of HLA-A, B and DRB1 genes of Lanzhou Han race were close to that of North China Hans and Hui population in Northwest China, and a little different to that of South China Hans. The HLA-DRB1 alleles were significantly different to those of Uigur and Tibetan race population of China.</p><p><b>CONCLUSION</b>The allelic polymorphism of HLA-A,B and DRB1 loci of Han race population in Lanzhou area was between North and South Han race of China, close to Northwest China Hui, and markedly different to Northwest China Uigur and Tibetan race populations.</p>

Two novel missense mutations of GATA4 gene in Chinese patients with sporadic congenital heart defects / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To identify mutations in GATA4 gene in Chinese patients with sporadic congenital heart defects (CHD).</p><p><b>METHODS</b>Single stranded conformation polymorphism (SSCP) analysis was performed to screen for mutations in all six exons and exon-intron boundaries of GATA4 in 31 individuals with CHD. Direct DNA sequencing was used to identify the specific mutations.</p><p><b>RESULTS</b>Two novel missense mutations, V267M in exon 4, V380M in exon 6, and one polymorphism in intron 6 of GATA4 were identified.</p><p><b>CONCLUSION</b>The above identified two novel GATA4 mutations associated with CHD in Chinese patients. This suggests that the transcription factor GATA4 may play an important role in cardiogenesis.</p>

Auditory evoked potentials index for monitoring the depth of desflurane anesthesia in the elderly / 中南大学学报(医学版)

OBJECTIVE@#To observe the changes of auditory evoked potentials (AEP) index, mean arterial blood pressure (MAP) and heart rate (HR) undergoing desflurane anesthesia in the elderly and to evaluate the use of AEP index for monitoring the depth of desflurane anesthesia in the elderly.@*METHODS@#Forty patients classified as ASA physical status I-III undergoing general anesthesia were divided into 2 groups with 20 patients in each group: Group elderly (> or =65 years) and Group youth (18-55 years). Anesthesia was induced with propofol and vecuronium. After the endotracheal intubation, the lungs were ventilated with desflurane in oxygen. End-tidal concentration of desflurane was maintained at 0.6 MAC, 1.0 MAC and 1.3 MAC for 20 min, respectively. The changes of MAP, HR and AEP index were recorded simultaneously.@*RESULTS@#During the anesthesia of desflurane, MAP decreased significantly compared with those at preanesthesia in both groups. And HR decreased significantly compared with those at preanesthesia only in Group elderly (P 0.05). During the anesthesia of desflurane, AEP index decreased significantly compared with those at preanesthesia in both groups (P 0.05). At the same concentration of desflurane, AEP index in the Group elderly were less than those in Group youth (P < 0.05). AEP index correlated with the end-tidal desflurane concentration significantly. The coefficient of product-moment correlation (r) were -0.983 and -0.980, respectively in Group elderly and Group youth (P < 0.05).@*CONCLUSION@#AEP index correlates well with the end-tidal desflurane concentration which is valuable for monitoring the depth of desflurane anesthesia in the elderly. AEP index can show the different depth of anesthesia at the same end-tidal desflurane concentration between the elderly and youth.

Apoptosis of psoriatic keratinocytes and the severity of patients' condition / 中南大学学报(医学版)

OBJECTIVE@#To investigate the correlation between the apoptosis of psoriatic keratinocytes (KCs) in the psoriatic lesions and patient's condition.@*METHODS@#Thirty patients with psoriasis were included. Activated caspase-3 was examined by colorimetric method in skin biopsy specimens. The apoptotic KCs were detected with terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) assay in skin biopsy specimens. The severities of 26 patients with psoriasis vulgaris (PV) were assessed using the PASI scoring system and the severities of psoriatic lesions.@*RESULTS@#Apoptotic indexes (AI) were higher in the pustular psoriatic lesions than those in the vulgaris psoriatic lesions (P0.05). The severities of psoriatic lesions were positively correlated to AI or the expression of activated caspase-3 in PV lesions (P<0.05).@*CONCLUSION@#The amount of apoptotic KCs may be related to varied types, stages of psoriasis, and severities of psoriatic lesions.

Clinical study on bispectral index in monitoring the depth of desflurane anesthesia in the elderly / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the values of bispectral index (BIS) in mornitoring the depth of desflurane anesthesia in the elderly by observing the changes of BIS at various end-tidal desflurane concentrations.@*METHODS@#BIS was used to monitor the depth of desflurane anesthesia in the elderly without surgery stimulation. Forty ASA physical status I approximately III patients undergoing general anesthesia were divided into 2 groups with 20 in each group:Group Elderly ( > or =65 years) and Group Youth ( 18 approximately 55 years). Anesthesia was induced with propofol 2. 0 mg/kg and vecuronium 0. 1 mg/kg including the endotracheal topical anesthesia with 2% lidocaine. After the desflurane in oxygen, each concentration of desflurane was maintained for 20 minutes. The changes of mean arterial blood pressure (MAP), heart rate (HR) and BIS were recorded simultaneously. The timepoints setting for observation were: preanesthesia, 2 minutes after the anesthesia, endotracheal intubation, 2 minutes after the intubation, and end-tidal concentration of desflurane at 0. 6 MAC, 1.0 MAC and 1. 3 MAC.@*RESULTS@#During anesthesia of desflurane, MAP and HR did not change significantly in the 2 groups with increasing end-tidal desflurane concentration from 0. 6 MAC to 1. 3 MAC (P > 0.05). BIS decreased significantly than that at preanesthesia in the 2 groups during anesthesia of desflurane ( P 0. 05 ). In general, BIS highly correlated with the end-tidal desflurane concentration. The coefficient of product-moment correlation (r) between BIS and the end-tidal desflurane concentration was -0. 996 and -0. 946 in Group Elderly and Youth (P < 0. 05 ).@*CONCLUSION@#BIS highly correlates with the end-tidal desflurane concentration which is used to evaluate the depth of desflurane anesthesia in the elderly and youth. There is different depth of anesthesia by BIS in the elderly or youth at the same end-tidal desflurane concentration.