Efficacy and Safety of Decitabine Combined with Modified CAG Regimen in Patients Aged ≥ 70 Years with Newly Diagnosed Acute Myeloid Leukemia / 中国实验血液学杂志

OBJECTIVE@#To evaluate the clinical efficacy and safety of decitabine combined with modified CAG regimen (D-CAG regimen) in patients aged ≥70 years with newly diagnosed acute myeloid leukemia (AML).@*METHODS@#The clinical data of 59 AML patients (≥70 years old) who were newly diagnosed and treated in the Hematology Department of the First Affiliated Hospital of Nanjing Medical University from November 2010 to June 2021 were retrospectively analyzed.@*RESULTS@#Among the 59 AML patients, 28 were males and 31 were females, with a median age of 74 (70-86) years. The complete remission (CR) rate was 69.4% (34/49), and the median duration of CR was 10.7 (0.6-125.4) months after 2 courses of D-CAG treatment. According to the British Medical Research Council (MRC) classification, there was only one patient in the favorable-risk group, and the CR rate was 71.8% (28/39) in the intermediate-risk group, and 55.6% (5/9) in the adverse-risk group, respectively. There was no statistical difference in the CR rate between the intermediate-risk and adverse-risk group. Referring to ELN 2017 genetic risk classification, CR rate was 88.2% (15/17) in the favorable-risk group, 45.5% (5/11) in the intermediate-risk group, and 66.7% (14/21) in the adverse-risk group. There was no significant difference in CR rate between the favorable-risk and adverse-risk categories, but both were significantly higher than that in the intermediate-risk group (P <0.05). Next-generation sequencing (NGS) analysis showed that 11 gene mutations with a frequency of more than 10%, including TET2 mutation (35.6%), ASXL1 mutation (30.5%), NPM1 mutation (28.8%), FLT3-ITD mutation (27.1%), DNMT3A mutation (22.0%), IDH1 mutation (15.3%), CEBPA single mutation (13.6%), TP53 mutation (13.6%), IDH2 mutation (11.9%), RUNX1 mutation (11.9%), and NRAS mutation (10.2%). There were no statistical differences in mutation frequency of these 11 genes between CR group and non-CR group. Compared with normal karyotypes, patients with complex karyotypes were more likely to develop TP53 mutations (P <0.001), while FLT3-ITD and DNMT3A mutations were more likely to occur in patients with normal karyotypes (P =0.04, P =0.047). The median follow-up, overall survival (OS), and event-free survival (EFS) of all the patients was 11.7 (1.5-128.2) months, 12.3 (1.5-128.2) months, and 8.5 (1.5-128.2) months, respectively. The median OS and EFS of CR patients were 19.8 and 13.3 months, respectively, which were significantly longer than 6.4 and 5.7 months in patients experiencing treatment failure (P < 0.001, P =0.009). In regard to genes with mutation frequency >10%, there were no statistical differences in CR rate, median OS, and median EFS between mutated and wild-type patients by Chi-square test and survival analysis. Univariate analysis showed that age, hemoglobin, lactate dehydrogenase, cytogenetics and CR were factors affecting prognosis, while multivariate analysis showed that only CR failure was an independent adverse prognostic factor for OS. The major adverse reactions to D-CAG regimen were grade 3-4 myelosuppression, pulmonary infection, and fever (infection focus was not identified).@*CONCLUSION@#D-CAG regimen is safe and effective in the treatment of AML patients ≥70 years old, and can partially improve the prognosis of elderly and high-risk patients.

Investigation on the growth factor regulatory network of dermal fibroblasts in mouse full-thickness skin defect wounds based on single-cell RNA sequencing / 中华烧伤杂志

Objective: To explore the heterogeneity and growth factor regulatory network of dermal fibroblasts (dFbs) in mouse full-thickness skin defect wounds based on single-cell RNA sequencing. Methods: The experimental research methods were adopted. The normal skin tissue from 5 healthy 8-week-old male C57BL/6 mice (the same mouse age, sex, and strain below) was harvested, and the wound tissue of another 5 mice with full-thickness skin defect on the back was harvested on post injury day (PID) 7. The cell suspension was obtained by digesting the tissue with collagenase D and DNase Ⅰ, sequencing library was constructed using 10x Genomics platform, and single-cell RNA sequencing was performed by Illumina Novaseq6000 sequencer. The gene expression matrices of cells in the two kinds of tissue were obtained by analysis of Seurat 3.0 program of software R4.1.1, and two-dimensional tSNE plots classified by cell group, cell source, and gene labeling of major cells in skin were used for visual display. According to the existing literature and the CellMarker database searching, the expression of marker genes in the gene expression matrices of cells in the two kinds of tissue was analyzed, and each cell group was numbered and defined. The gene expression matrices and cell clustering information were introduced into CellChat 1.1.3 program of software R4.1.1 to analyze the intercellular communication in the two kinds of tissue and the intercellular communication involving vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), epidermal growth factor (EGF), and fibroblast growth factor (FGF) signal pathways in the wound tissue, the relative contribution of each pair of FGF subtypes and FGF receptor (FGFR) subtypes (hereinafter referred to as FGF ligand receptor pairs) to FGF signal network in the two kinds of tissue, and the intercellular communication in the signal pathway of FGF ligand receptor pairs with the top 2 relative contributions in the two kinds of tissue. The normal skin tissue from one healthy mouse was harvested, and the wound tissue of one mouse with full-thickness skin defect on the back was harvested on PID 7. The multiple immunofluorescence staining was performed to detect the expression and distribution of FGF7 protein and its co-localized expression with dipeptidyl peptidase 4 (DPP4), stem cell antigen 1 (SCA1), smooth muscle actin (SMA), and PDGF receptor α (PDGFRα) protein. Results: Both the normal skin tissue of healthy mice and the wound tissue of full-thickness skin defected mice on PID 7 contained 25 cell groups, but the numbers of cells in each cell group between the two kinds of tissue were different. Genes PDGFRα, platelet endothelial cell adhesion molecule 1, lymphatic endothelial hyaluronic acid receptor 1, receptor protein tyrosine phosphatase C, keratin 10, and keratin 79 all had distinct distributions on two-dimensional tSNE plots, indicating specific cell groups respectively. The 25 cell groups were numbered by C0-C24 and divided into 9 dFb subgroups and 16 non-dFb groups. dFb subgroups included C0 as interstitial progenitor cells, C5 as adipose precursor cells, and C13 as contractile muscle cells related fibroblasts, etc. Non-dFb group included C3 as neutrophils, C8 as T cells, and C18 as erythrocytes, etc. Compared with that of the normal skin tissue of healthy mice, the intercellular communication in the wound tissue of full-thickness skin defected mice on PID 7 was more and denser, and the top 3 cell groups in intercellular communication intensity were dFb subgroups C0, C1, and C2, of which all communicated with other cell groups in the wound tissue. In the wound tissue of full-thickness skin defected mice on PID 7, VEGF signals were mainly sent by the dFb subgroup C0 and received by vascular related cell groups C19 and C21, PDGF signals were mainly sent by peripheral cells C14 and received by multiple dFb subgroups, EGF signals were mainly sent by keratinocyte subgroups C9 and C11 and received by the dFb subgroup C0, and the main sender and receiver of FGF signals were the dFb subgroup C6. In the relative contribution rank of FGF ligand receptor pairs to FGF signal network in the normal skin tissue of healthy mice and the wound tissue of full-thickness skin defected mice on PID 7, FGF7-FGFR1 was the top 1, and FGF7-FGFR2 or FGF10-FGFR1 was in the second place, respectively; compared with those in the normal skin tissue, there was more intercellular communication in FGF7-FGFR1 signal pathway, while the intercellular communication in FGF7-FGFR2 and FGF10-FGFR1 signal pathways decreased slightly or did not change significantly in the wound tissue; the intercellular communication in FGF7-FGFR1 signal pathway in the wound tissue was stronger than that in FGF7-FGFR2 or FGF10-FGFR1 signal pathway; in the two kinds of tissue, FGF7 signal was mainly sent by dFb subgroups C0, C1, and C2, and received by dFb subgroups C6 and C7. Compared with that in the normal skin tissue of healthy mouse, the expression of FGF7 protein was higher in the wound tissue of full-thickness skin defected mouse on PID 7; in the normal skin tissue, FGF7 protein was mainly expressed in the skin interstitium and also expressed in the white adipose tissue near the dermis layer; in the two kinds of tissue, FGF7 protein was co-localized with DPP4 and SCA1 proteins and expressed in the skin interstitium, co-localized with PDGFRα protein and expressed in dFbs, but was not co-localized with SMA protein, with more co-localized expression of FGF7 in the wound tissue than that in the normal skin tissue. Conclusions: In the process of wound healing of mouse full-thickness skin defect wound, dFbs are highly heterogeneous, act as potential major secretory or receiving cell populations of a variety of growth factors, and have a close and complex relationship with the growth factor signal pathways. FGF7-FGFR1 signal pathway is the main FGF signal pathway in the process of wound healing, which targets and regulates multiple dFb subgroups.

Albumin-to-Fibrinogen Ratio as an Independent Prognostic Parameter in Untreated Chronic Lymphocytic Leukemia: A Retrospective Study of 191 Cases / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Chronic lymphocytic leukemia (CLL) is one of the most frequent type of B-cell chronic lymphoproliferative disorders and chronic inflammation takes part in the development of CLL. However, there has been no valid immune biomarker to predict the prognosis of untreated CLL patients. MATERIALS AND METHODS: In this retrospective study, we analyzed the clinical correlations and prognostic value of albumin-to-fibrinogen ratio (AFR) detected at diagnosis in 191 CLL patients. RESULTS: The cut-off value of AFR was 9.7 calculated by X-tile. Patients who were more than 65 years old were often accompanied by low level of AFR (p < 0.001). Survival analysis showed that patients with low level of AFR had shorter overall survival (OS) than patients with high level of AFR (p < 0.001). Multivariate analysis illustrated that AFR had a negative impact on OS (p=0.003) and was independent of parameters involved in CLL international prognostic index and other prognostic markers such as CD38 and ZAP-70. CONCLUSION: These data provide a comprehensive view of AFR and shows that AFR at diagnosis is an adverse prognostic factor in untreated CLL patients.

Discussion of development and validation of dissolution methods for solid oral dosage forms / 药学学报

It is generally assumed that study of in vitro dissolution can reveal the in vivo behavior and bioavailability of a drug. The dissolution test indisputably plays a vital role in the research and development of pharmaceutical preparations as well as routine quality control of approved drugs. In order to develop an ideal dissolution method, the physicochemical properties of drug and the characteristics of its dosage form should be considered, and a proper dissolution condition be established to simulate the in vivo dissolution behavior of drugs. The new dissolution method should have the required characteristics of accuracy and durability, but also could distinguish pharmaceutic preparations with different quality. In recent years, there have been more and more reports on the establishment and verification of dissolution methods for oral solid dosage forms. However, there is very few review articles on the topic. According to the latest guidelines by domestic and foreign drug organizations, this review paper is prepared to summarize the most important skills and progress in the development of dissolution methods for oral solid preparations. The aim is to provide a reference for the development and validation of new dissolution methods.

Direct Detection of Di-2-ethylhexy Phthalate in Environmental Water Sample Based on Extractive Electrospray Ionization Mass Spectrometry / 分析化学

The environmental organic pollutant of di-2-ethylhexy phthalate ( DEHP ) was analyzed by extractive electrospray ionization mass spectrometry ( EESI-MS ). Effect of some important experimental conditions were investigated systematically, including the electrospray voltage, temperature of ion-transport tube, sample injection rate and extractant composition. Under the optimal conditions, a method for rapid detection of DEHP in water sample was established. DEHP levels in different samples with complex matrixes were measured, including landfill leachate, urban sewage and lake water. The results showed that DEHP in water samples could be ionized by EESI source and obtained the molecule ion (m/ z 391. 28) at the positive detection mode, and then CID experiment were performed to obtain the secondary fragment ions m/ z 279. 26, 167. 12 and 149. 11. The intensity of characteristic peak m/ z 149. 11 possessed a good linearity with the concentration of DEHP in the range of 5-1000 μg / L with the correlation coefficient of R2 = 0. 9991, and the detection limit (LOD) of 0. 21 μg / L. The recoveries of DEHP at three spiked levels (8, 80, 400 μg / L) were 96. 2％ - 111. 2％ , with RSDs of 5. 6％ - 11. 8％ . With the developed EESI-MS method, the concentrations of DEHP in landfill leachate, urban sewage and Yan lake water were 556. 5, 275. 3 and 37. 8 μg / L, respectively. The EESI-MS method possessed many advantages such as no requirement of sample pretreatment, fast analysis speed ( about 3 min per sample), simple operation and high sensitivity, thus providing a new mass spectrometric method for rapid detection of phthalate esters.

In vivo Breath Analysis by Extractive Electrospray Ionization-Mass Spectrometry for Investigation of Metabolic Responses to Traditional Chinese Medicine Massages / 分析化学

Traditional Chinese Medicine massage is a kind of physiotherapy which affects on specific parts of the body surface by means of training to regulate the function of the body to achieve the therapeutic effect. In this work,under positive detection model, the chemical fingerprint of exhaled breath from volunteers before and after receiving Traditional Chinese Medicine massage within m/z 50-1000 were detected by extractive electrospray ionization-mass spectrometry (EESI-MS). And through high resolution mass spectrometry analysis, the metabolites such as epinephrine (m/z 184. 0889), 3-(3-hydroxyphenyl) propionic acid (m/z 167.0615) and L-tryptophan (m/z 205. 0933) were successfully identified. Besides, chemical fingerprints of volunteers before and after receiving Traditional Chinese Medicine massage under different health condition were clearly differentiated via partial least squares discrimination analysis (PLS-DA). The results showed that Traditional Chinese Medicine massage could significantly change the metabolic process of volunteers. Moreover, it further indicated that the established method could provide a real time fashion to follow metabolic changes caused by Traditional Chinese Medicine massage.

Experimental evaluation of isopentane as submucosal injection agent for endoscopic submucosal dissection / 医学研究生学报

Objective At present,there are a wide range of clinical submucosal injection agents. However,no consensus has been reached on what kind of submucosal injections to use. This study aims to evaluate the feasibility,effectiveness and safety of isopentane as a submucosal injection agent and further provide an evidence for clinical application. Methods Fresh in vitro porcine stomach(In vitro time < 6 h)was used to be submucosal injected with isotonic saline(control group)and isopentane(isopentane group)in 37℃ water bath. We evaluated the injection volume and uplift effect of both submucosal injection agents when the uplift height was 1.5 cm;A 2 cm diameter of mucous uplift was made by isotonic saline or isopentane and then dissected by electrical knife. The opera-tion time was evaluated;20 μL of isotonic saline or isopentane was submucosal injected in living rat stomach. The mucosal uplift height was measured. 1 hour after injection,uplift site(2 mm diameter)was completely dissected by sterile scalpel,bleeding volume was measured within 10 minutes,and the pathological examination of the uplift site was carried out. Results The same height of mucous uplift(1.5 cm)can be achieved by less isopentane[(0.14± 0.07)mL]compared with isotonic saline[(13.65± 4.60)mL],the difference is statistically significant(P<0.01). Isopentane had better uplifting persistency in 5,10,15,20,30,45,60 min(P<0.01).The initial mean uplift area in control group was[(18.10±6.22)cm2],and mean uplift area after 60 min was[(24.24±7.19) cm2],the difference is statistically significant(P=0.03). While isopentane group had a relatively stable uplift area,the mean uplift area was comparable between control group and isopentane group at 0 and 60 min[(22.93± 8.16)cm2vs(21.70± 7.86)cm2,P=0.71]. Similarly,average dissection time was shorter in isopentane group[(3.22±0.53)min]compared with control group[(9.60± 1.98)min](P<0.01). The mucosal thickness variation before and after injection was much more significant in isopentane group than that in control group[(1.34±0.30)mm vs(0.28±0.16)mm,P=0.000]. Conclusion Isopentane submucosal injection can main-tain the effective mucosal uplift height,which is in favor of subsequent endoscopic mucosal resection and has no damage to the tissue. Isopentane is expected to be a new submucosal injection agent.

Outcomesi n 334 cases of Millions of Poor Cataar ct Patients'Extraction Project in Shanxi Province / 国际眼科杂志(Guoji Yanke Zazhi)

Abstract?AIM: To evaluate the visual acuity, visual function, q uality of lfi e, and cost/effectiveness of cataract surgery in patients with low soc ioeconomics tatus ( LSES ) who received government subsidies for free cataract surgery.?METHODS: Retrospectively, 334 eyes of 334 patient s were reviewed. Visual function and quality of l ife questionnaires we re available in 83 patie nts. The cost/effectiveness of cataract surgery was analyzed in 225 patients with LSES and 12 0 patients who rec eived standard cataract surgery. Mutl iple linear regression anal ysis and logistic regression analysis were used to assess the factors affecting the postoperative visual acuity.?RESULTS: At 1wk postoperatively, uncorrected visual acuity ( UCVA ) was improved significantly compared to these preoperait vely (P<0.50 ), 235 eyes (70.4%) had UCVA of 20/40 or better, and 16 eyes (4.8%) had UC VA wor se than 20/400. Multiple linear regresis on ana lysis revealed that other ocular diseases and cataract classification wer e factors contributing to po stop erative UC VA. Logistic regression analysis showed that low preoperative visual ac uti y and other ocular diseases were risk factors of postopera tive low vision, and the odds ratio (95%confidence int erval) values were 6.5 (2.8-14.8) and 1.3 (1.0-1.6), respe ctively.Visual fun ction and quality of life were significantly improved after the surgery. Th e cost/effetc iveness of c ataract su rgery in patients with LSES was lower than that in standard cataract patients.?CONCLUSION: Visual acuity and visual function were significantly better after the surgery in catara ct patients wti h LSES, and the operation cost was low.Quality of life in these patients was significantly improved.

Research and investigation in medicine of Baima Tibetan in Pingwu Sichuan / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate and collect medicinal resources and methods of prevention and treatment of diseases in Baima Tibetan of Pingwu Sichuan in order to rescue and protect the ethenological medicine.</p><p><b>METHOD</b>Through visiting, field survey in four ethnic townships of Baima Tibetan in Pingwu Sichuan as well as referring literatures to collect information and data analysis of them the investigation was carried out.</p><p><b>RESULT</b>The investigation area showed rich medical resources. Rheumatism, stomach disease, pharyngitis and trauma are local common diseases which caused by local climate, diet and life style and so on. The Baima Tibetan are good at using local herb singly and simply to treat disease, using cold water medicine and powder snuffing are their own characters.</p><p><b>CONCLUSION</b>It is an extremely urgent issue to rescue Baima Tibetan medicine which is disappearing by the influence of the Han nationality culture.</p>

Coverage on cataract surgery among adults aged 40 or above in a multiethnic rural district of high altitude area in Gongshan county, Yunnan province, China / 中华流行病学杂志

Objective To estimate the prevalence of cataract and its surgical coverage rate together with the burden related to bilateral cataract-blindness,among adults aged 40 or above in Gongshan county of Yunnan province and to evaluate the current cataract status and the efficacy of local cataract prevention program.Methods Cluster sampling was used.The protocol consisted of personal interview,pilot study,visual acuity checking,measuring the intraocular pressure; slit lamp microscopy and the fundus of the eye examination etc.Cataract was graded clinically using the Lens Opacity Classification System (LOCS) ]Ⅲ.Bilateral cataract-blindness burden,bilateral cataractblindness burden and cataract surgical coverage rate were calculated respectively,using two different criteria.Odds ratios (OR) were compared among different groups regarding age,gender,education,ethnic group and altitude of living area.Results Among the 1236 eligible residents,1116 (90.3％)were enrolled in the present study.The prevalence of cataract was 23.8％ among adults aged 40 or order.When the bilateral best refractive vision ＜3/60 was defined as the blindness criterion,the bilateral cataract-blindness burden showed as 1.3％,and cataract blindness surgical coverage rate was 50.0％.When the bilateral presenting vision ＜ 6/60 was defined as the blindness criterion,the bilateral cataract-blindness burden was 25.0％,and cataract blindness surgical coverage rate was 12.9％.The cataract surgical coverage rates were much lower and the bilateral cataract-blindness burden much higher in women,illiterates,living in high altitude areas and those who were aged 70 or above.Conclusion Cataract blindness was a serious public health problem in aged individuals and illiteracy in the residents of the studied areas.Poor prevention programs on cataract called for urgent action to be taken.

Pleomorphism of the myelin-like bodies in the hepatocytes of patients with Dubin-Johnson syndrome complicated with chronic hepatitis B / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To explore characteristics of the myelin-like bodies in the hepatocytes of patients with Dubin-Johnson syndrome (DJS) complicated with chronic hepatitis B (CHB).</p><p><b>METHODS</b>11 cases of DJS complicated with CHB and 5 cases DJS without CHB were studied clinicopathologically. The hepatocyte ultrastructure was observed with transmission electron microscope and taken photos. The data were compared and analyzed using Fisher's Exact Test.</p><p><b>RESULTS</b>Deposition of myelin-like bodies can be observed in the hepatocytes of DJS patients with CHB but can not in DJS patients without CHB. The morphology of pigment varys. The electron density and volume of pigment in DJS patients with CHB can be classified into five types: brights (2/11,18.2%), reticulation (1/11, 9.1%), punctiform (6/11, 54.5%), abnormity (1/11, 9.1%) and primary type (1/11, 9.1%). The myelin-like bodies in the hepatocytes of patients with DJS are high density and round with membrance (we named it as primary type) (5/5, 100%).</p><p><b>CONCLUSIONS</b>The myelin-like bodies in the hepatocytes of DJS patients with CHB possess special pleomorphism and may have important diagnostic value.</p>

Platelet-derived growth factor-BB inhibited p21(WAF1) expression partially through transforming growth factor-beta signalling system in vascular smooth muscle cell / 中华心血管病杂志

<p><b>OBJECTIVE</b>To assess if the modulating effect of platelet-derived growth factor (PDGF)-BB on p21(WAF1) was mediated by upregulating transforming growth factor (TGF)-beta(1) expression in vascular smooth muscle cells (VSMC).</p><p><b>METHODS</b>TGF-beta(1) mRNA and protein expressions were measured by reverse transcription-PCR and ELISA, the protein expressions of p21(WAF1) and the downstream TGF-beta signalling including TGF-beta type I receptor (ALK-5 in VSMC), Smurf2, pSmad2/3, Smad4, Smad7 were detected by Western blot.</p><p><b>RESULTS</b>PDGF-BB significantly upregulated the expressions of TGF-beta(1) at mRNA (0.79-fold) and protein (1.98-fold) levels in VSMC, significantly inhibited the expression of p21(WAF1) (-67 +/- 12)%, and enhanced the expressions of ALK-5, pSmad2/3, Smad4, Smurf2 protein by 1.21-fold, 0.95-fold, 0.69-fold and 2.55-fold respectively, inhibited Smad7 expression (-65 +/- 9)%, these alterations were partially restored by anti-TGF-beta(1) neutralizing antibody.</p><p><b>CONCLUSIONS</b>These findings suggested that PDGF-BB inhibited p21(WAF1) expression in VSMC partially through upregulating TGF-beta(1) expression via PDGF-BB and TGF-beta signalling pathways.</p>

Effect of isoflurane preconditioning on the nuclear factor kappa B activity of leukocytes in patients undergoing cardiac valve replacement with cardiopulmonary bypass / 中华麻醉学杂志

Objective To investigate the effect of isoflurane preconditioning on the nuclear factor kappa B (NF-kB)activity of leukocytes in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Twenty ASAⅡorⅢpatients of both sexes aged 20-60 yrs undergoing cardiac valve replacement under CPB were randomly divided into 2 groups(n=10 each):control group(C)and isoflurane preconditioning group(I).Anesthesia was induced with midazolam 0.08-0.12 mg?kg~(-1),fentanyl 5-10?g?kg~(-1) and vecuronium 0.1 mg?kg~(-1).The patients were mechanically ventilated(FiO_2=100%)after tracheal intubation.Anesthesia was maintained with intermittent i.v.boluses of fentanyl and midazolam in group C or with 2 MAC isoflurane and intermittent i.v.boluses of fentanyl and midazolam in group I before CPB.Systolic BP was kept between 90-120 mm Hg,diastolic BP between 50-80 mm Hg and HR between 60-90 bpm in both groups. Isoflurane was discontinued at the initiation of CPB.Arterial blood samples were taken after tracheal intubation and before inhalation of isoflurane(T_0)at 30 min(T_1),1 h(T_2)and 2 h(T_3)after aortic unclamping for determination of NF-kB activity of leukocytes using electrophoretic mobility shift assay(EMSA).The amount of fentanyl,midazolam,dopamine and sodium nitroprusside(SNP)consumed during operation and the rate of recovery of spontaneous heart beat in both groups were recorded.Results The NF-kB activity was significantly increased after aortic unclamping in C group but there was no significant difference in NF-kB activity before CPB (T_0)and after aortic unclamping(T_(1-3))in I group.The NF-kB activity was significant lower at T_(1-3) in group I than in group C.The total amount of fentanyl consumed was 40-60?g?kg~(-1) in C group and 20-30?g?kg~(-1) in group I. Significantly less amount of dopamine was used in group I than in group C.There was no significant difference in SNP consumption between the 2 groups.The rate of recovery of spontaneous heart beat was significantly higher in group I than in group C(P＜0.01).The amount of dopamine consumed was positively correlated with the highest level of NF-kB activity in both group[r=0.962 in group C;r=0.908 in group I(P＜0.01)].Conclusion Isoflurane preconditioning can attenuate the NF-kB activity of leulocytes in patients undergoing cardiac valve replacement under CPB.