Clinical Observation of Venetoclax Combined with Demethylating Agents on the Treatment of Relapsed/Refractory Acute Myeloid Leukemia / 中国实验血液学杂志

OBJECTIVE@#To investigate the efficacy and safety of venetoclax (VEN) combined with demethylating agents (HMA) in the treatment of relapsed/refractory acute myeloid leukemia (R/R AML).@*METHODS@#The clinical data of 26 adult R/R AML patients who received the combination of VEN with azacitidine (AZA) or decitabine (DAC) in Huai'an Second People's Hospital from February 2019 to November 2021 were retrospectively analyzed. The treatment response, adverse events as well as survival were observed, and the factors of influencing the efficacy and survival were explored.@*RESULTS@#The overall response rate (ORR) of 26 patients was 57.7% (15 cases), including 13 cases of complete response (CR) and CR with incomplete count recovery (CRi) and 2 cases of partial response (PR). Among the 13 patients who got CR/CRi, 7 cases achieved CRm (minimal residual disease negative CR) and 6 cases did not, with statistically significant differences in overall survival (OS) and event-free survival (EFS) between the two groups (P=0.044, 0.036). The median OS of all the patients was 6.6 (0.5-15.6) months, and median EFS was 3.4 (0.5-9.9) months. There were 13 patients in the relapse group and refractory group, respectively, with response rate of 84.6% and 30.8% (P=0.015). The survival analysis showed that the relapse group had a better OS than the refractory group (P=0.026), but there was no significant difference in EFS (P=0.069). Sixteen patients who treated for 1-2 cycles and 10 patients who treated for more than 3 cycles achieved response rates of 37.5% and 90.0%, respectively (P=0.014), and patients treated for more cycles had superior OS and EFS (both P<0.01). Adverse effects were mainly bone marrow suppression, complicated by various degrees of infection, bleeding, and gastrointestinal discomfort was common, but these could be all tolerated by patients.@*CONCLUSION@#VEN combined with HMA is an effective salvage therapy for patients with R/R AML and is well tolerated by patients. Achieving minimal residual disease negativity is able to improve long-term survival of patients.

Clinical study of 19 cases of steroid-refractory gastrointestinal acute graft-versus-host disease after allogeneic hematopoietic stem cell transplantation with fecal microbiota transplantation / 中华血液学杂志

Objective: To investigate the clinical efficacy of fecal microbiota transplantation (FMT) for treating steroid-refractory gastrointestinal acute graft-versus-host disease (GI-aGVHD) . Methods: This analysis included 29 patients with hematology who developed steroid-refractory GI-aGVHD after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in Huaian Hospital Affiliated to Xuzhou Medical University from March 2017 to March 2022. Among them, 19 patients underwent FMT treatment (the FMT group) and 10 patients did not (the control group). The efficacy and safety of FMT were assessed, as well as the changes in intestinal microbiota abundance, lymphocyte subpopulation ratio, peripheral blood inflammatory cytokines, and GVHD biomarkers before and after FMT treatment. Results: ① Complete remission of clinical symptoms after FMT was achieved by 13 (68.4%) patients and 2 (20.0%) controls, with a statistically significant difference (P<0.05). Intestinal microbiota diversity increased and gradually recovered to normal levels after FMT and FMT-related infections did not occur. ②The proportion of CD3(+) and CD8(+) cells in the FMT group after treatment decreased compared with the control group, and the ratio of CD4(+), regulatory T cells (Treg), and CD4(+)/CD8(+) cells increased (all P< 0.05). The interleukin (IL) -6 concentration in the FMT group was lower than that in the control group [4.15 (1.91-5.71) ng/L vs 6.82 (2.40-8.91) ng/L, P=0.040], and the IL-10 concentration in the FMT group was higher than that in the control group [12.11 (5.69-20.36) ng/L vs 7.51 (4.10-9.58) ng/L, P=0.024]. Islet-derived protein 3α (REG3α) was significantly increased in patients with GI-aGVHD, and the REG3α level in the FMT group was lower than that in the control group after treatment [30.70 (10.50-105.00) μg/L vs 74.35 (33.50-139.50) μg/L, P=0.021]. Conclusion: FMT is a safe and effective method for the treatment of steroid-refractory GI-aGVHD by restoring intestinal microbiota diversity, regulating inflammatory cytokines, and upregulating Treg cells.

Clinical Study on Dialectical Treatment of Modified Xiangsha Liu Junzitang to Diabetes Gastroparesis with Weakness Syndrome of Spleen and Stomach / 中国实验方剂学杂志

Objective:This study aims to investigate the clinical efficacy of Modified Xiangsha Liu Junzitang in the treatment of diabetic gastroparesis （DGP） and its influence on gastrointestinal hormones and oxidative stress. Method:In this study， 128 patients were randomly divided into control group （64 cases） and observation group （64 cases） . Patients in two groups took domperidone tablets orally 30 minutes before meals， 10 mg/time， 3 times/day. Patients in control group took Shenling Baizhusan San， 6 g/time， twice a day. Patients in observation group were prescribed addition and subtraction therapy of Modified Xiangsha Liu Junzitang， 1 dose/day. The course of treatment for both groups was 4 weeks. Before and after treatment， scores of gastroparesis cardinal symptom index （GCSI）， and gastric emptying test and electrogastrogram were noted. Before the treatment， scores of traditional Chinese medicine （TCM） syndrome and health survey summary were graded（SF-36）. The levels of gastrin （GAS）， motilin （MTL）， vasoactive intestinal peptide （VIP）， somatostatin （SS）， superoxide dismutase （SOD）， reactive oxygen species （ROS） and malondialdehyde （MDA） were measured before and after treatment. And adverse reactions during treatment were recorded. Result:The scores of postprandial abdominal distension/early satiety， nausea and vomiting， abdominal distention and the total scores of GCSI in the observation group were lower than those in control group （<italic>P</italic><0.01）. The gastric emptying rate in observation group was higher than that in control group （<italic>P</italic><0.01）， and the score of TCM syndromes was lower than that of control group （<italic>P</italic><0.01）. The scores of SF-36 in observation group were higher than those in control group （<italic>P</italic><0.01）. The frequency of gastric electricity and gastric electric vibration before and after the meal in observation group were higher than that in control group （<italic>P</italic><0.01）. The levels of GAS， MTL， VIP， ROS and MDA in observation group were lower than those in control group （<italic>P</italic><0.01）， while the levels of SS and SOD were higher than that of control group （<italic>P</italic><0.01）. The total effective rate in observation group was 93.75% （60/64）， which was higher than 79.69% （51/64） （<italic>χ</italic>²=5.494， <italic>P</italic><0.05） in control group （<italic>P</italic><0.01）. And no adverse reactions were found in the clinical observation. Conclusion:Modified Xiangsha Liu Junzitang combined with prokinetic drugs in the treatment of DGP patients can reduce the clinical symptoms of DGP， enhance gastrointestinal motility， improve the gastric emptying rate， improve the quality of life， regulate the level of gastrointestinal hormones， and reduce the damage of autonomic nerve caused by oxidative stress， with good comprehensive clinical effect and safety in application.

The Clinical Features of Metabolic Syndrome in Receptors of Hematopoietic Stem Cells / 中国实验血液学杂志

OBJECTIVE@#To evaluate the incidence and clinical characteristics of metabolic syndrome (MS) within one year after hematopoietic stem cell transplantation (HSCT) in order to screen the risk factors for HSCT-MS, provide early intervention and improve the long-term quality of survival of patients.@*METHODS@#The clinical follow-up data of 64 HSCT patients (survival time > 1 year) who received HSCT in our center from January 2007 to August 2018 were collected. Among them, 50 cases were allogeneic hematopoietic stem cell transplantation (allo-HSCT) and 14 cases were autologous hematopoietic stem cell transplantation (auto-HSCT). The changes of MS-related indexes and clinical characteristics before and 1, 3, 6 and 12 months after HSCT were analyzed retrospectively.@*RESULTS@#In allo-HSCT group, 14 cases were diagnosed as MS before operation, including high-density lipoprotein cholesterol (hypo-HDL-C)> hyper triglycerides（hyper-TG）> hyper fasting glucose（hyper-FBG）> abdominal obesity (AO) > hypertension. The preoperative diagnosis of MS in the auto-HSCT group was 5 cases, in the order of hyper-FBG> hyper-TG> AO> hypo-HDL-C> hypertension. Incidence of MS at 1, 3, 6 and 12 months after transplantation: 19, 26, 24 and 20 cases in the allo-HSCT group, respectively; auto-HSCT group were 7, 7, 6 and 6 cases, respectively. Hyper-TG and hypo-HDL-C were prominent in both groups.@*CONCLUSION@#The incidence of HSCT-MS is significantly higher within 1 year after HSCT. Regardless of allo-HSCT and auto-HSCT, the prevention and control of HSCT-MS is emphasized as an important guarantee to improve the long-term survival quality of HSCT patients.

Construction and Identification of Leukemia Cell Line Stably Expressing CD123 and CLL-1 / 中国实验血液学杂志

OBJECTIVE@#To construct an acute myeloid leukemia cell line stably expressing CD123-CLL1 so as to provide an "in vitro" model for studying the role of CD123 and CLL-1 in leukemia and the treatment targeting CD123 and CLL-1.@*METHODS@#The recombinant plasmid of lentivirus was constructed by synthesizing CD123 and CLL-1 sequences and PCR homologous recombination. The lentivirus vector was packaged by three-plasmid packaging system. After collecting the supernatant of lentivirus, the virus titer was determined by quantitative PCR. K562 leukemia cells were collected and transtected with virus supernatant. Leukemia cell line stably expressing the target gene were screened by purinomycin. The expression levels of CD123 and CLL-1 were detected by RT-PCR and flow cytometry.@*RESULTS@#The lentiviral vector was successfully constructed, and identified by agarose gel electrophoresis and gene sequencing, then the virus titer of the supernatant was up to 5.81×10@*CONCLUSION@#Lentiviral vector expressing CD123-CLL1 has been successfully constructed, and K562 leukemia cell line stably expressing CD123 and CLL-1 has been successfully obtained.

Effect of Transcranial Direct Current Stimulation on Upper Limb Motor Function for Patients with Stroke / 中国康复理论与实践

Objective:To explore the effect of transcranial direct current stimulation on upper limb motor function for stroke patients. Methods:From December, 2017 to December, 2019, 50 first stroke patients in rehabilitation medicine department within six months were randomly divided into control group (n = 25) and experimental group (n = 25). All the patients accepted upper limbs routine rehabilitation and upper limb robot assisted training, while the experimental group accepted transcranial direct current stimulation in addition, for two weeks. They were evaluated with Reconn upper limb rehabilitation robot evaluation system, simple Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Carroll Upper Extremity Function Test (UEFT) and modified Barthel Index (MBI). Results:There was no significant difference in all the scores between two groups before treatment (|t| < 2.954, P > 0.05). All the scores improved after treatment (|t| > 7.551, P < 0.001), and improved more in the experimental group than in the control group (|t| > 2.639, P < 0.05). Conclusions:Transcranial direct current stimulation can further improve the upper limb motor function and activities of daily living for stroke patients.

Investigation on Rehabilitation Therapists Practitioners under Medical-Exercise Integration in China / 中国康复理论与实践

Objective:To investigate the integration of medicine and exercise in China in rehabilitation therapists practitioners. Methods:From May to June, 2019, rehabilitation therapists in provincial and municipal medical institutions, health management centers and rehabilitation institutions nationwide were surveyed with Wenjuanxing online questionnaires, which included basic information, geographical distribution, nature of work units, occupational characteristics, educational background, years of working and awareness of exercise prescriptions. Results:A total of 2935 rehabilitation-related employees were involved, which included 1387 male and 1548 female in 31 provinces. In all the respondents, 1505 of them (51.28%) worked in tertiary hospitals and 1015 (34.58%) in secondary hospitals; 2182 (74.34%) worked on physical therapy, 947 (32.27%) on occupational therapy, 553 (18.84%) on speech therapy, 141 (4.80%) on rehabilitation engineering, and 846 (28.82%) on exercise rehabilitation; 2218 (75.57%) were with junior title and 592 (20.17%) with intermediate title; 24 (0.82%) were with secondary school education, 724 (24.67%) with junior college degree, 2011 (68.52%) with bachelor's degree, and 160 (5.99%) with master's degree or above; 785 (26.75%) fully understood, 1025 (34.92%) understood and 1009 (34.38%) basically understood the concept of exercise prescription. Conclusion:Rehabilitation therapy is widely spread in China, however, the geographical distribution is uneven. Rehabilitation related practitioners are diversified in professional direction, and full-time job is not top-notch. The level of education is generally low, and talent cultivation needs to be strengthened. The integration of medicine and exercise is developing, and exercise prescriptions are widely available. It is necessary to cultivate a considerable number of high-quality professionals to coordinate the integrated development of medicine and exercise, to improve the quality of rehabilitation services and promote the development of medicine and exercise integration.

Characteristics and research status of injuries on surface vessels induced by underwater explosion / 第二军医大学学报

Warships undergo accelerated motion when attacked by underwater explosion in the naval battles, resulting in severe damage of the warship personnel, which is termed as ship shock injury. The ship shock injury is the main factor that causes the loss of fighting capacity of personnel on warships. A great number of studies on ship shock injury have been made at home and abroad. In this paper, we reviewed and analyzed the history, research methods, injury mechanisms and characteristics, and protection and treatment measures of ship shock injury, pointing out the shortcomings of current research and proposing research direction in future. We hoped this paper can help to deepen the understanding of naval surgeons on ship shock injury and provide a reference for the prevention and treatment of ship shock injury.

Visual-spatial neglect after right-hemisphere stroke: behavioral and electrophysiological evidence / 中华医学杂志(英文版)

Background:@#Visual-spatial neglect (VSN) is a neuropsychological syndrome, and right-hemisphere stroke is the most common cause. The pathogenetic mechanism of VSN remains unclear. This study aimed to investigate the behavioral and event-related potential (ERP) changes in patients with or without VSN after right-hemisphere stroke.@*Methods:@#Eleven patients with VSN with right-hemisphere stroke (VSN group) and 11 patients with non-VSN with righthemisphere stroke (non-VSN group) were recruited along with one control group of 11 age- and gender-matched healthy participants. The visual-spatial function was evaluated using behavioral tests, and ERP examinations were performed.@*Results:@#The response times in the VSN and non-VSN groups were both prolonged compared with those of normal controls (P < 0.001). In response to either valid or invalid cues in the left side, the accuracy in the VSN group was lower than that in the non-VSN group (P < 0.001), and the accuracy in the non-VSN group was lower than that in controls (P < 0.05). The P1 latency in the VSN group was significantly longer than that in the control group (F[2, 30] = 5.494, P = 0.009), and the N1 amplitude in the VSN group was significantly lower than that in the control group (F[2, 30] = 4.343, P = 0.022). When responding to right targets, the lefthemisphere P300 amplitude in the VSN group was significantly lower than that in the control group (F[2, 30] = 4.255, P = 0.025). With either left or right stimuli, the bilateral-hemisphere P300 latencies in the VSN and non-VSN groups were both significantly prolonged (all P < 0.05), while the P300 latency did not differ significantly between the VSN and non-VSN groups (all P > 0.05).@*Conclusions:@#Visual-spatial attention function is impaired after right-hemisphere stroke, and clinicians should be aware of the subclinical VSN. Our findings provide neuroelectrophysiological evidence for the lateralization of VSN.

Visual-spatial neglect after right-hemisphere stroke: behavioral and electrophysiological evidence / 中华医学杂志(英文版)

BACKGROUND@#Visual-spatial neglect (VSN) is a neuropsychological syndrome, and right-hemisphere stroke is the most common cause. The pathogenetic mechanism of VSN remains unclear. This study aimed to investigate the behavioral and event-related potential (ERP) changes in patients with or without VSN after right-hemisphere stroke.@*METHODS@#Eleven patients with VSN with right-hemisphere stroke (VSN group) and 11 patients with non-VSN with right-hemisphere stroke (non-VSN group) were recruited along with one control group of 11 age- and gender-matched healthy participants. The visual-spatial function was evaluated using behavioral tests, and ERP examinations were performed.@*RESULTS@#The response times in the VSN and non-VSN groups were both prolonged compared with those of normal controls (P  0.05).@*CONCLUSIONS@#Visual-spatial attention function is impaired after right-hemisphere stroke, and clinicians should be aware of the subclinical VSN. Our findings provide neuroelectrophysiological evidence for the lateralization of VSN.

Advance in Physical Therapy for Motor Function Rehabilitation of Patients with Parkinson's Disease(review) / 中国康复理论与实践

@#Physical therapy is a feasible treatment for patients with Parkinson's disease besides drugs and surgical treatment,and it helps to optimize the therapeutic effect and alleviate the complications caused by drugs and surgery.This article summa-rized the application of physical therapy in improving the motor function rehabilitation of patients with Parkinson's dis-ease from several aspects,including the possible mechanisms,the rehabilitation methods of motor function,the intensity and time of treatment,and the limitation of physical therapy.

Comparison of Cookgas and Fastrach intubating laryngeal mask airway with fiberoptic bronchoscope in anticipated difficult airway management / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the clinical effectiveness of fiberoptic bronchoscope (FOB)-guided intubation through the Cookgas intubating laryngeal airway(CILA)and the Fastrach intubating laryngeal mask airway (FT-LMA) in the management of anticipated difficult airways.</p><p><b>METHODS</b>Sixty patients with all three difficult intubation criterion (thyromental distance<60 mm, interincisor distance<35 mm, and Mallampati class 3 or 4) undergoing elective plastic surgery under general anesthesia were randomly allocated into CILA group (n=30) and FT-LMA group (n=30). After anesthesia being induced and CILA or FT-LMA being inserted, the patients were treated with FOB-guided intubation through CILA or FT-LMA. The success of the intubating laryngeal airway(ILA)insertion and FOB-guided intubation, the number of attempts, and the duration of the successful attempt were recorded.</p><p><b>RESULTS</b>The ILA was inserted successfully in 30 patients from CILA group and 27 patients from FT-LMA group. Three failed cases in FT-LMA group were inserted successfully with CILA. In CILA group, the first FOB-guided intubation attempt succeeded in 26 patients, and 4 cases were intubated at the second attempt. In 27 patients of FT-LMA group, 20 cases were intubated successfully at the first attempt, 4 cases at the second attempt, and 3 cases failed; of these three failed patients, two patients were intubated smoothly with FOB through CILA at the first attempt, one was intubated by FOB via CILA at the second attempt. The duration of FT-LMA insertion [(35.3±12.8)s] was significantly longer when compared with CILA [(23.9±17.5)s] (P<0.05). However, the duration of FOB-guided intubation through CILA and FT-LMA [(48.6±13.5)s vs.(53.2±14.2)s] and the time of ILA removal [(40.4±10.2)s vs. (38.5±11.3)s] were not significantly different between these two groups (P>0.05). The adverse events during and after intubtion were not significantly different between these two groups.</p><p><b>CONCLUSIONS</b>FOB-guided intubation through CILA and FT-LMA is safe and feasible for the management of anticipated difficult airways. However, in patients with severe scar contracture of face and neck and those with huge expander in neck, the CILA insertion and FOB-guided intubation via CILA is superior to FT-LMA.</p>

The significance of change of Th22 cells in patients with acute lymphoblastic leukemia / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the proportion of Th22 cells in peripheral blood of patients with acute lymphoblastic leukemia (ALL) and evaluate its significance.</p><p><b>METHODS</b>The proportions of Th22 cells in peripheral blood of B-ALL and T-ALL patients before therapy (group 1), B-ALL and T-ALL patients in complete remission (ALL-CR, group 2) and healthy donors (group 3) were evaluated by flow cytometry. The cytokines IL-22, TGF-β, TNF-α and IL-6 in peripheral blood of each group were measured by enzyme-linked immunosorbent assay (ELISA). The levels of IL-22 mRNA in peripheral blood mononuclear cells of each group were examined by reverse transcription-PCR (RT-PCR).</p><p><b>RESULTS</b>The percentages of Th22 cells and the levels of IL-22, TNF-α, IL-6 and IL-22 mRNA in B-ALL and T-ALL patients before therapy were (0.44 ± 0.10)%, (10.9 ± 3.4) ng/L, (110.7 ± 26.5) ng/L, (60.2 ± 13.8) ng/L, 0.17 ± 0.04 and (0.46 ± 0.11)%, (11.2 ± 3.5) ng/L, (114.6 ± 27.0) ng/L, (58.7 ± 12.4) ng/L, 0.19 ± 0.04, respectively; Which in B-ALL and T-ALL patients in complete remission were(0.59 ± 0.15)%, (14.3 ± 4.1) ng/L, (142.5 ± 32.7) ng/L, (83.7 ± 18.9) ng/L, 0.25 ± 0.06 and(0.60 ± 0.15)%, (14.6 ± 4.3) ng/L, (140.4 ± 31.4) ng/L, (81.4 ± 18.2) ng/L, 0.26 ± 0.06, significantly lower than those in healthy donors \[(1.24 ± 0.31)%, (19.7 ± 6.6) ng/L, (238.3 ± 50.4) ng/L, (138.0 ± 27.1) ng/L, 0.49 ± 0.09\] (P < 0.01). The percentages of Th22 cells and the levels of IL-22, TNF-α, IL-6 and IL-22 mRNA in group l were lower than those in group 2 (P < 0.05), there was not significant difference between B-ALL and T-ALL (P > 0.05). But the levels of TGF-β in B-ALL and T-ALL patients before therapy \[(30.6 ± 8.2) ng/L, (31.4 ± 8.8) ng/L\] and in complete remission \[(24.2 ± 5.8) ng/L, (25.1 ± 6.1) ng/L\] were significantly higher than those in group 3\[(9.6 ± 2.8) ng/L\] (P < 0.01). However, the level of TGF-β in group 1 was higher than that of group 2 (P < 0.05), there was not significant difference between B-ALL and T-ALL (P > 0.05).</p><p><b>CONCLUSION</b>Both the number and function of Th22 cells reduced in ALL patients. Th22 cells might be negatively correlated with ALL progression. The lower levels of TNF-α and IL-6, and overexpression of TGF-β in ALL patients might suppress the differentiation of Th22 cells.</p>

Regulations of function and maturation of plasmacytoid dendritic cells from primary immune thrombocytopenia patients by triptolide / 中华血液学杂志

<p><b>OBJECTIVE</b>To explore the mechanism of immunomodulatory activity of triptolide on primary immune thrombocytopenia (ITP)patients-derived plasmacytoid dendritic cells (pDCs).</p><p><b>METHODS</b>pDCs in peripheral blood of ITP patients before therapy (group 1), ITP patients in complete response (ITP-CR, group 2) and healthy donors (group 3) were sorted by flow cytometry, then incubated with triptolide at 0, 5, 10 or 30 µg/L. After 24 hours, we collected the supernatants and then detected the concentrations of IFN-α, IL-6 and TNF-α using ELISA. After 5 days, the cultured cells were collected and CD11c, CD80 and CD86 expressions of myeloid dendritic cells (mDCs) were analyzed by flow cytometry, the morphology of mDC was observed by light microscope and electron microscope.</p><p><b>RESULTS</b>After incubation with triptolide at 10 µg/L, the levels of IFN-α, IL-6 and TNF-α in group 1 \[(451.32 ± 85.77) ng/L, (105.68 ± 23.85) ng/L and (135.78 ± 30.62) ng/L\] and group 2 \[(391.71 ± 72.49) ng/L, (84.73 ± 17.77) ng/L and (108.16 ± 23.21) ng/L\] were significantly higher than those in group 3 \[(335.51 ± 67.54) ng/L, (73.62 ± 21.82) ng/L and (95.58 ± 32.85) ng/L\] (all P < 0.05); the levels of IFN-α, IL-6 and TNF-α in group 1 were significantly higher than those in group 2 (all P < 0.05) in a dose-dependent manner (P < 0.05). CD11c, CD80 and CD86 expressions of mDC in group1 and group 2 were significantly higher than those in group 3 (all P < 0.05); CD11c, CD80 and CD86 expressions of mDC in group 1 were significantly higher than those in group 2 (all P < 0.05) also in a dose-dependent manner (all P < 0.05). Triptolide could inhibit pDCs from differentiation into mDCs, the latter displayed more immature morphology than untreated-pDCs.</p><p><b>CONCLUSION</b>Triptolide could decrease the immune function of pDCs from ITP, inhibit pDCs from differentiation and maturation.</p>

Induction of tracheal intubation without muscle relaxant by target controlled infusion of propofol combined with remifentanil in children / 中国医学科学院学报

<p><b>OBJECTIVE</b>To observe the safety and feasibility of tracheal intubation by target-controlled infusion of propofol and remifentanil without muscle relaxant in children.</p><p><b>METHODS</b>Totally 100 4-10-year-old pediatric patients (ASA1) who had been scheduled for plastic surgery were equally divided into remifentanil group and control group through computer-generated randomized grouping. In all patients, five minutes after intravenous administration of atropine 0.01 mg/kg and midazolam 0.1 mg/kg, propofol was infused at the targeted effect-site concentration (Ce of 6 μg/ml. When the intended target Ce of propofol was reached, the remifentanil group began to be infused with remifentanil at a Ce of 5 ng/ml, and normal saline (0.1 ml/kg) was injected simultaneously. In the control group remifentanil was replaced by normal saline and rocuronium (0.8 mg/kg) was injected together with the normal saline. After the equilibration of plasma and the Ce of remifentanil were reached, tracheal intubation was attempted. The complications during the induction and tracheal intubation were recorded. The intubating conditions were assessed using a five-point scoring system based on ease of laryngoscopy, vocal cords position, coughing, jaw relaxation and limb movement.</p><p><b>RESULTS</b>The success rate of tracheal intubation was in 90% in remifentanil group and 98% in the control group (P=0.122).CONCLUSION Target-controlled infusion of propofol and remifentanil at Ce of 6 μg/ml and 5 ng/ml is feasible for the induction and tracheal intubation without muscle relaxant in children.</p>

Study on the clinical characteristics of 32 patients with mixed phenotype acute leukemia / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the clinical and biological characteristics and prognosis of mixed phenotype acute leukemia (MPAL).</p><p><b>METHODS</b>Thirty two patients were diagnosed as MPAL by bone marrow examination, immunophenotyping, cytogenetic and molecular assay and were treated with combined chemotherapy regimens for both acute lymphoblastic and acute myeloid leukemia. Two cases were received allogeneic hematopoietic stem cell transplantation (allo-HSCT).</p><p><b>RESULTS</b>(1) The incidence of MPAL in acute leukemias was 2.6%. There were 16 cases (50.0%) of mixed myeloid and B-lymphoid (M/B), 14(43.8%) myeloid and T-lymphoid (M/T), one each (3.1%) of trilineage (M/B/T) and B- and T-lymphoid (B/T) phenotype. (2) The positive rates of CD34 and HLA-DR were 87.5% and 62.5%, respectively. (3) Abnormal karyotypes were detected in 70.0% of 30 MPAL patients, which were structural and numerical abnormalities including t(9;22), 11q23 and complex karyotypes. (4) The total complete remission (CR) rate was 75.0% and the overall survival (OS) and disease-free survival (DFS) at 2 years were 14.8% and 14.2% respectively. The CR rates for M/B and M/T cases were 75.0% and 71.4% respectively. No statistical difference was observed in OS and DFS between M/B and M/T cases.</p><p><b>CONCLUSIONS</b>MPAL is a rare type of acute leukemia with a high heterogeneity. The unfavorable indicators of MPAL may be factors such as abnormal karyotypes, high expression of CD34 and extramedullary infiltration. Combined regimens and more intensive therapy including allo-HSCT might contribute to improving survival.</p>

Construction and immunogenicity of a recombinant adenovirus co-expressing the E2 protein of classical swine fever virus and the porcine interleukin 2 in rabbits / 病毒学报

To construct a recombinant adenovirus co-expressing the E2 protein of classical swine fever virus (CSFV) and the porcine interleukin 2 (pIL-2), the CSFV E2 gene and pIL-2 gene were amplified respectively from the plasmids pMD19-T-E2 and pMD19-T-pIL-2 by PCR. E2-pIL-2 fusion gene was obtained by using 5 consecutive glycine codons as a linker and cloned into the adenoviral shuttle plasmid AdTrack. The AdTrack-E2-pIL-2 was linearized and transformed into E. coli BJ5183 with the backbone plasmid AdEasy1. The resultant recombinant plasmid AdEasy-E2-pIL-2 was transfected into the 293 cells where the recombinant adenovirus rAd-E2-pIL-2 was produced. The immunogenicity of rAd-E2-pIL-2 was evaluated in rabbits. The results of RT-PCR and Western-blotting showed that rAd-E2-pIL-2 could carry and express E2 and pIL-2 proteins. The titer of the rAd-E2-pIL-2 was 10(8.12) PFU/mL. After immunized with rAd-E2pIL-2, The injected rabbits developed a high level of CSFV specific antibodies. Regular fever was not detected in the rAd-E2-pIL-2-immunized rabbits upon challenge with CSFV C stain, and specific lymphoproliferative responses to the CSFV was detected in the lymphocytes from the immunized rabbits. In conclusion, rAd-E2-pIL-2 was constructed successfully and it could be an attractive vaccine candidate against CSFV.

Application of the fibreoptic intubating laryngeal mask airway CTrach in face and neck scar contracture patients / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the feasibility of the fibreoptic intubating laryngeal mask airway (LMA) CTrach (CTrach) in anticipated difficult airway caused by face and neck scar contracture.</p><p><b>METHODS</b>Totally 33 patients undergoing selective face and neck scar plastic surgery and requiring general anesthesia were enrolled in our study. After anesthesia induction, the CTrach was inserted and the viewer was attached, which allowed fibreoptic visualization of the larynx before and during passage of the tracheal tube through the vocal cords. The duration and the success rates of CTrach insertion, tracheal intubation, and CTrach removal were recorded. The view of glottis on viewer and the adjusting maneuvers for improving the laryngeal view were recorded. Noninvasive blood pressures and heart rates were recorded before and after anesthesia induction and at CTrach insertion, tracheal intubation, and CTrach removal.</p><p><b>RESULTS</b>The CTrach was successfully inserted in all patients, among whom 4 patients succeeded at the second attempt. The full view of glottis were shown in 10 patients, while partial view and no view of glottis were shown in 8 and 15 patients, respectively. The good view of glottis was achieved by adjusting manoeuvres. Tracheal intubation via the CTrach was successful in 27 patients at the first attempt and in 6 patients at the second attempt. Hemodynamic changes during the performance with the CTrach were minimal.</p><p><b>CONCLUSIONS</b>The CTrach can be easily inserted, with clear view and high success rate of tracheal intubation. Therefore, it is an effective way to resolve difficulty intubation caused by face and neck scar contracture.</p>

Effect of remifentanil preconditioning on myocardial ischemia-reperfusion injury / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the delayed cardioprotection induced by remifentanil in intact rat ischemia-reperfusion (I/R) models.</p><p><b>METHODS</b>Totally 42 adult male Wistar rats weighing 200-300 g were randomly divided into 7 groups (n = 6 in each group): In Group I, rats were injected with normal saline via tail vein, performed with the regimen of 3 x 5-min intravenous (i.v.) infusion at a rate of 0.1 ml x kg(-1) min(-1) 24 h before I/R; In Group II, rats were treated according to the same experimental protocols as in Group I except receiving additional naloxone (0.1 mg/kg) 10 minutes before normal saline pretreatment; In Groups III, IV, V, and VI, rats were treated with remifentanil via tail vein, performed with the regime of 3 x 5-min i.v. infusion at a rate of 2 microg x kg(-1) x min(-1) 12 h, 24 h, 48 h, and 72 h before I/R; In Group VII, the rats were treated according to the same experimental protocols as in Group IV except that they received additional naloxone (0.1 mg/kg) 10 minutes before remifentanil pretreatment. Heart rate (HR), mean arterial pressure (MAP), and a lead II electrocardiogram were continuously monitored during IR process. To determine plasma concentration of creatine kinase myocardial isoenzyme-MB (CK-MB), arterial blood samples were obtained immediately before ischemia, and at the end of ischemia and reperfusion. After a 120-min reperfusion, heart was removed for the measurement of myocardial infarct size. Infarct size (IS) was expressed as percentage of the area at risk.</p><p><b>RESULTS</b>HR, MAP, and rate-pressure product were not significantly different at each time points among all groups (P > 0.05). Compared with Group I, plasma concentrations of CK-MB at the end of ischemia and reperfusion and myocardial infarct size were significantly lower in Groups IV and V (P < 0.05). Compared with Group IV, plasma concentrations of CK-MB at the end of ischemia and reperfusion were significantly higher and myocardial infarct size was significantly larger in Group VII (P < 0.05).</p><p><b>CONCLUSION</b>Remifentanil preconditioning induces delayed cardioprotection in intact rat ischemia-reperfusion model, which may be triggered via opioid receptors.</p>

Median effective dose of remifentanil for awake laryngoscopy and intubation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Awake intubation requires an anesthetic management that provides sufficient patient safety and comfort, adequate intubating conditions, and stable hemodynamics. In this prospective clinical study, our aim was to determine the median effective dose (ED(50)) of remifentanil in combination with midazolam and airway topical anesthesia for awake laryngoscopy and intubation.</p><p><b>METHODS</b>Thirty-six female adult patients, scheduled for elective plastic surgery under general anesthesia requiring orotracheal intubation were included in this study. Ten minutes after intravenous administration of midazolam 0.1 mg/kg, patients were assigned to receive remifentanil in bolus, followed by a continuous infusion. The bolus dose and infusion rate of remifentanil were adjusted by a modified Dixon's up-and-down method. Patient's reaction score at laryngoscopy and an Observer's Assessment of Alertness/Sedation Scale (OAA/S) were used to determine whether the remifentanil dosage regimen was accepted. During laryngoscopy, 2% lidocaine was sprayed into the airway to provide the topical anesthesia. ED(50) of remifentanil was calculated by the modified Dixon up-and-down method, and the probit analysis was then used to confirm the results obtained from the modified Dixon's up-and-down method. In the patients who were scored as "accept", patient's OAA/S and reaction scores at different observed points, intubating condition score and patient's tolerance to the endotracheal tube after intubation were evaluated and recorded. Blood pressure and heart rate at different measuring points were also noted.</p><p><b>RESULTS</b>ED(50) of remifentanil for awake laryngoscopy and intubation obtained by the modified Dixon's up-and-down method was (0.62 +/- 0.02) microg/kg. Using probit analysis, ED(50) and ED(95) of remifentanil were 0.63 microg/kg (95% CI, 0.54 - 0.70) and 0.83 microg/kg (95% CI, 0.73 - 2.59), respectively. Nineteen patients who were scored as "accept" had an OAA/S of > 15 and tolerated well laryngoscopy without significant discomfort or gagging. The mean intubating condition score was 1.8 +/- 0.8. The endotracheal tube was well tolerated. During awake laryngoscopy and intubation, blood pressure and heart rate were also kept stable. The postoperative follow up showed that no patient recalled discomfort and pain for airway manipulation.</p><p><b>CONCLUSIONS</b>When combined with midazolam 0.1 mg/kg and airway topical anesthesia, ED(50) of remifentanil for successful awake laryngoscopy and intubation is 0.62 microg/kg in bolus followed by continuous infusion of 0.062 microg*kg(-1)*min(-1). This sedation and analgesia regimen can provide patient safety and comfort, ensure adequate intubating conditions, maintain hemodynamic stability, and prevent negative recall of the airway procedure.</p>