Effectiveness of Simplified Airway Risk Index score in predicting difficult airway in Chinese patients / 中华麻醉学杂志

Objective:To evaluate the effectiveness of Simplified Airway Risk Index (SARI) score in predicting difficult airway in Chinese patients.Methods:One thousand and three hundred patients of both sexes, aged 18-90 yr, with American Society of Anesthesiologists physical status Ⅰ-Ⅲ, undergoing tracheal intubation with the laryngoscope under general anaesthesia, were enrolled in this study.SARI scores (including 7 evaluation items: mouth opening, thyromental distance, Mallampati classification, neck mobility, mandibular protrusion, body weight, and history of difficulty in tracheal intubation) were determined before anesthesia induction.The receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the effectiveness of SARI scores in predicting difficult tracheal intubation and difficult laryngoscopy.Results:The AUC and 95% confidence interval of the SARI score, mouth opening, modified Mallampati classification and thyromental distance in predicting difficult tracheal intubation were 0.91 (0.89-0.93), 0.84 (0.82-0.86), 0.81 (0.79-0.83) and 0.83 (0.80-0.85), respectively.The AUC and 95% confidence interval of the SARI score, mouth opening, modified Mallampati classification and thyromental distance in predicting difficult laryngoscopy were 0.90 (0.88-0.91), 0.79 (0.76-0.81), 0.76 (0.74-0.78) and 0.73 (0.70-0.75), respectively.The AUC of SARI scores in predicting difficult tracheal intubation and difficult laryngoscopy was significantly larger than that of the mouth opening, modified Mallampati classification and thyromental distance ( P<0.05). Conclusion:The SARI score produces better efficacy in predicting tracheal intubation and difficult laryngoscopy in Chinese patients.

Effect of the LEMON method in predicting patients with difficult airway / 临床麻醉学杂志

Objective To evaluate the effect of the LEMON method in predicting difficult air-way.Methods A total of 1 528 patients scheduled for elective surgery requiring tracheal intubation under general anaesthesia,680 males and 848 females,aged 18-83 years,ASA physical status Ⅰ orⅡ,were enrolled in the study.We used the LEMON method to assess airway conditions before an-aesthesia and recorded the scores.The primary end point was difficult tracheal intubation.The sec-ondary end point was difficult laryngoscopy.Receiver operating characteristic (ROC)curve analysis and the area under the curve (AUC)were used to evaluate the clinical effect of the LEMON mothod. Results There were 37 cases with difficult tracheal intubation and 106 cases with difficult laryngosco-py.The incidence of difficult tracheal intubation and difficult laryngoscopy were 2.4% and 6.9%,re-spectively.The area under the curve of the LEMON method for predicting difficult laryngoscopy and difficult tracheal intubation were 0.884 (95% CI 0.867-0.899)and 0.934 (95% CI 0.921-0.946), respectively.Conclusion The LEMON method has good clinical effect in predicting difficult airway.

Accuracy of Wilson risk score in predicting difficult tracheal intubation / 中华麻醉学杂志

Objective To evaluate the efficacy of Wilson risk score in predicting difficult tracheal intubation. Methods American Society of Anesthesiologists physical statusⅠ-Ⅲ patients of both sexes, aged≥18 yr, undergoing elective surgery with general anesthesia, were enrolled in the study. All the pa-tients were evaluated by the special researchers for assessment of the preoperative airway. The assessment i-tems included the Wilson risk score ( 5 risk factors: weight, jaw movement, head and neck movement, mandible receding, buck teeth), modified Mallampati classification, thyromental distance, inter-incisor distance, etc. After the airway assessment was completed, anesthesia induction was conducted, and tra-cheal intubation was performed after 3 min of pressure ventilation under the mask. The primary outcome was difficult tracheal intubation. The receiver operating characteristic curve and area under the curve ( AUC) were used to analyze the efficacy of the corresponding parameters in diagnosing difficult tracheal intubation. The optimal predictive cut-off value and corresponding sensitivity and specificity of the parameters were de-termined by using the Youden index. Results A total of 1544 patients were enrolled in this study, and difficult intubation was found in 37 cases. The analysis of receiver operating characteristic curve showed that the AUC of the modified Mallampati classification was 0. 65, and the AUC of the thyromental distance was 0. 81, and the AUC of the Wilson risk score was 0. 91. Compared with the modified Mallampati classifica-tion and thyromental distance, the AUC of Wilson risk score was significantly increased when used for pre-dicting difficult tracheal intubation (P<0. 05). Compared with the inter-incisor distance, no significant change was found in the AUC of Wilson risk score in predicting difficult tracheal intubation ( P>0. 05) . The optimal predictive cut-off value of the Wilson risk score was more than 1, which was determined by the Youden index. Conclusion Wilson risk score provides better efficacy than the modified Mallampati classi-fication and thyromental distance in predicting difficult tracheal intubation.

Effect of morphine exposure in late pregnancy on expression of NR2B in nucleus accumbens of off-spring rats / 中华麻醉学杂志

Objective To evaluate the effect of morphine exposure in the late pregnancy on the expression of 2B subunit-containing N-methyl-D-aspartate receptor (NR2B) in the nucleus accumbens of offspring rats.Methods Forty-eight Sprague-Dawley rats at 14 days of gestation,aged 16-20 weeks,weighing 400-600 g,were equally and randomly divided into control group (group C) and morphine group (group M).In group M,morphine was administered subcutaneously twice a day (9:00 a.m.and 5:00 p.m.) in the initial dose of 2 mg/kg followed by daily increment of 1 mg/kg until 6 mg/kg.The equal volume of normal saline was given instead of morphine in group C.Fifty offspring rats with similar body weight were selected from the two groups,and conventionally fed for 8 weeks.Thirty offspring rats were further selected,morphine 3 mg/kg was injected subcutaneously for 7 consecutive days,and then the rats underwent the conditioned place preference test to monitor the effect.The time spent in drug-paired side (gray area) was recorded at 24 h after the test.Ten offspring rats selected were sacrificed after the test,and the brain was removed.The nucleus accumbens was isolated for detection of the expression of NR2B by immunohistochemistry and Western blot.Results Compared with group M,the time spent in drug-paired side (gray area) was significantly prolonged,and the expression of NR2B in the nucleus accumbens was up-regulated in group C (P＜0.05).Conclusion The mechanism by which morphine exposure in the late pregnancy causes susceptibility to morphine addiction is associated with up-regulation of NR2B expression in the nucleus accumbens of offspring rats.

Value of hyomental distance measured when the hyoid is located using ultrasound in predicting difficult airway / 中华麻醉学杂志

Objective To evaluate the value of hyomental distance (HMD) measured when the byoid was located using ultrasound in predicting the difficult airway.Methods Two hundred and thirteen patients of both sexes,aged 18-64 yr,with body mass index of 14-34 kg/m2,with interincisor distance ＞3 cm,with atlanto-axial joint mobility ＞ 90°,of Mallampati class Ⅰ-Ⅳ,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,scheduled for elective surgery requiring endotracheal intubation under general anesthesia,were enrolled in the study.The HMD was measured by fingers (finger breaths in width,HMDf) and by rulers (HMDr) when the hyoid was located artificially and when the hyoid was viewed on ultrasound (HMDu) before anesthesia induction.After anesthesia induction,the difficult airway was defined as Cormack-Lehane grade 3 or 4 assessed under direct laryngoscope during intubation.The hyoid viewed on ultrasound was considered as the criterion,and the error rate was calculated when the hyoid was located artificially.Youden Index was used to determine the optimal value in predicting difficult airway,and the specificity and sensitivity of HMDf,HMDr and HMDu in predicting difficult airway were calculated based on this criterion.Results The error rate was 18.8％ when the hyoid was located artificially.The specificity and sensitivity of HMDu in predicting difficult airway were 64.6％ and 91.5％,respectively.The specificity and sensitivity of HMDr in predicting difficult airway were 62.5％ and 84.8％,respectively.The specificity and sensitivity of HMDf in predicting difficult airway was 29.2％ and 98.2％,respectively.Conclusion The HMD measured when the hyoid is located using ultrasound can accurately predict the difficult airway.

Effects of biological rhythm disturbance on sedation induced by propofol in rats / 中华麻醉学杂志

Objective To evaluate the effects of biological rhythm disturbance on sedation induced by propofol in rats.Methods Thirty-two adult male Sprague-Dawley rats,weighing 180-220 g,were randomly divided into 4 groups (n =8 each) using a random number table:circadian rhythm + administration during night-time group (group CN),circadian rhythm + administration during day-time group (group CD),biological rhythm+administration during night-time group (group BN),and biological rhythm+administration during day-time group (group BD).In CN and CD groups,the rats were fed for 2 weeks in the experimental boxes in a 12 (7:00-19:00):12 h (19:00-7:00) light:dark cycle.While the rats were fed for 2 weeks in the experimental boxes in a 24 h light cycle.Propofol 75 mg/kg was intraperitoneally injected at 14:00 in CN and BN groups,or at 22:00 in CD and BD groups.The duration of loss of righting reflex was recorded.At 20 min after recovery of righting reflex,the cognitive function was assessed.The latency of passive avoidance was measured at 6,12,24 and 48 h after training.Results Compared with group CN,the duration of loss of righting reflex was significantly shortened,and the latency of passive avoidance was prolonged at 12 and 24 h after training in group CD,and the duration of loss of righting reflex and latency of passive avoidance at 12 and 24 h after training were shortened in group BN.Compared with group CD,no significant change was found in the duration of loss of righting reflex,and the latency of passive avoidance was significantly shortened at 24 h after training in group BD.There was no significant change between BN group and BD group in the duration of loss of righting reflex and latency of passive avoidance.Conclusion Biological rhythm disturbance can counteract circadian rhythmproduced effects on sedation induced by propofol in rats.

The exPression of forkhead box 2 in invasive ductal carcinoma of breast and the relationshiP with delta-like Ligand 4 / 中国综合临床

Objective To study the expression of forkhead box 2(FOXC2)and delta-like liGand 4 (DLL4)in invasive ductal carcinoma(IDC)of breast and the clinical siGnificance. Methods The expression of FOXC2 and DLL4 in l22 cases of IDC(Grade Ⅰ33,Grade Ⅱ40,GradeⅢ 49)were observed by tissue chip and immunohistochemistry. The relationship of the expression with clinicopatholoGical characteristics and between FOXC2 and DLL4 were statistically analyzed. PCR experiment was performed in normal breast tissue,ductal carcinoma in situ(DCIS)IDC Grade Ⅰ,Grade Ⅱ and Grade Ⅲ(l0 cases respectively). Results The positive rate of FOXC2 and DLL4 in IDC was 77. 87% and 74. 59% respectively. A hiGher expression was observed in GradeⅢ than in GradeⅠand Ⅱ( P<0. 05 ). The expression of FOXC2 was related to the neGative expression of ER. The expression of DLL4 was related to the tumour size,clinical staGe and lymph node metastasis( P<0. 05). The RCR of FOXC2 and DLL4 were Gradually increased in normal breast tissue,DCIS,IDC GradeⅠ, Grade Ⅱ and Grade Ⅲ(P<0. 05). Moreover the expression of FOXC2 was related to the expression of DLL4(r=0. 233,P=0. 0l0). Conclusion FOXC2 and DLL4 miGht toGether have influence on the proGression and outcome of breast carcinoma,and could be important markers of proGnosis. DLL4 miGht be reGulated by variety of factors includinG FOXC2 at the same time.

Clinical significance and expression of Skp2, p27 and p21 in Ovarian Serous Cystadenocarcinomas / 中国综合临床

ObjectiveTo investigate the correlation of Skp2,p27kiP1 and p21WAF1 expression with the clinicopathological features of ovarian serous cystadenocarcinomas.Methods Expressions of Skp2 ,p27kiP1 and p21WAF1 were examined by immunohistochemical staining in 124 epithelial ovarian tumors (25 serous cystadenomas, 19 borderline serous cystadenomas, and 80 serous cystadenocarcinomas) Results(1) The expression of Skp2 in serous cystadenocarcinomas (47.5％)was significantly higher than that in borderline serous cystadenomas (0％)and serous cystadenomas (0％)(P ＜ 0.001) .The p27kiP1 expression in serous cystadenocarcinomas (35.0％) was significantly lower than that in borderline serous cystadenomas(73.7％)and serous cystadenomas (80.0％) .The p21WAF1 staining frequency in serous cystadenocarcinomas (38.8％)was significantly lower than in borderline serous cystadenomas (73.7％)and serous cystadenomas (80.0％) .(2) The Skp2 protein expression in serous cystadenocarcinomas was positively correlated with clinicopathological stage,histological differentiation degree and lymph node metastasis of the tumors.The p27kiP1, p21WAF1 protein expression in serous cystadenocarcinomas was reversely correlated with clinicopathological stage and histological differentiation degree of the tumors(Ps ＜ 0.05) .(3) The Skp2 protein expression in serous cystadenocarcinomas was reversely correlated with that of p27kiP1 , p21WAF1.Conclusion The Skp2 protein expression in serous cystadenocarcinomas was increased and positively correlated with the clinicopathological features of ovarian serous cystadenocarcinomas.Skp2 protein expression was reversely correlated with p27kip1 ,p21WAF1.Skp2 protein expression may play an important role in the development and progression of serous cystadenocarcinomas.

Expression of CD151 in Human Atherosclerotic Artery and Its Implication / 华中科技大学学报（医学）（英德文版）

To investigate the expression of CD151 in human atherosclerosed artery and explore its clinical implications, Western blot and immunohistochemical techniques were used to determine the protein expression of CD151 in arterial tissues with atherosclerosis taken from 36 patients, including 26 cases who received bypass operation for peripheral artery atherosclerosis and 6 cases who died from coronary heart disease. The expression of CD151 in normal artery tissues from 15 healthy organ donators were also measured to serve as control. The results showed that expression of CD151 protein in atherosclerotic arteries was significantly higher than that in normal artery. In ath erosclerotic arteries, CD151 expression was localized in vascular smooth muscle cells (VSMCs) in all tunica media and in partial subintima, while in normal artery, sparse expression was found in tunica media near adventitia. It is concluded that high CD151 protein expression in artery is associated with atherosclerosis and CD151 plays an important role in the atherosclerosis related to VSMC. The expression of CD151 in human atherosclerotic artery depends on the extent of atherosclerotic dam age, it's independent of risk factors.