Clinicopathological features of olfactory carcinoma / 中华病理学杂志

Objective: To investigate the clinicopathological features and differential diagnosis of olfactory carcinoma (OC). Methods: Twenty-one cases of sinonasal tumors, including those initially diagnosed as olfactory neuroblastoma (ONB) and those with uncertain diagnosis, were collected from the Department of Pathology, the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) from January 2016 to August 2022, among which 3 cases were reclassified as OC. The clinicopathological features were investigated, and the remaining 18 cases were used as control. Results: Of the three OC patients, 2 were male and 1 was female, with an average age of 57 years ranging from 35 to 74 years. Microscopically, the tumor cells were arranged in solid, nested or lobulated patterns with occasional palisading around the solid nests. The stroma was highly vascular with focal neurofibrillary areas. There were prominent rosettes or pseudorosettes formation. The tumor cells were mainly ovoid to spindly with scant to moderate amount of cytoplasm, one or several small nucleoli, and fine chromatin content. Brisk mitotic figures were seen. In all 3 cases of OC, there were scanty atypical glands and some were ciliated. Immunohistochemically, at least one epithelial marker and neuroendocrine marker were diffusely expressed in the tumor. Some of the tumor cells were positive for p40 and p63, and the sustentacular cells showed the expression of S-100 protein. All cases tested were negative for NUT, CD99 and desmin, with intact expression of SMARCA4 (BRG1) and SMARCB1 (INI-1). Ki-67 proliferation index varied from 20% to 80%. Follow-up after 16-18 months showed no mortality with tumor recurrence from 1 patient after 16 months. Conclusion: OC is a rare sinonasal tumor with neuroepithelial differentiation, its histomorphology is diverse, and the combination of immunohistochemical markers is essential for appropriate diagnosis.

Lower Baseline LDL Cholesterol Affects All-cause Mortality in Patients with First Percutaneous Coronary Intervention / 生物医学与环境科学（英文）

OBJECTIVE@#Foreign studies have reported that coronary artery disease (CAD) patients with high baseline low-density lipoprotein cholesterol (LDL-C) may have a good prognosis, which is called the "cholesterol paradox". This study aimed to examine whether the "cholesterol paradox" also exists in the Chinese population.@*METHODS@#A total of 2,056 patients who underwent the first percutaneous coronary intervention (PCI) between 2014 and 2016 were enrolled in this retrospective cohort study and classified into two groups based on baseline LDL-C = 2.6 mmol/L (100 mg/dL). The outcomes of interest included major adverse cardiovascular events (MACE), all-cause mortality, recurrent nonfatal myocardial infarction, unexpected coronary revascularization, or any nonfatal stroke.@*RESULTS@#All-cause mortality occurred in 8 patients (0.7%) from the low-LDL-C group and 12 patients (2.4%) in the high-LDL-C group, with a significant difference between the two groups (adjusted hazard ratio: 4.030, 95% confidence interval: 1.088-14.934; P = 0.037). However, no significant differences existed for the risk of MACE or other secondary endpoints, such as unexpected revascularization, nor any nonfatal stroke in the two groups.@*CONCLUSION@#In this study, a high baseline LDL-C was not associated with a low risk of clinical outcomes in CAD patients undergoing first PCI, which suggested that the "cholesterol paradox" may be inapplicable to Chinese populations.

Effects of growth patterns and years on quality of Saposhnikoviae Radix samples / 中国中药杂志

This study aims to reveal the effects of different growth patterns and years on the quality of Saposhnikoviae Radix samples. The apparent colors of the powder samples were quantified by a colorimeter, and the total color values(E~*ab) were calculated. The content of prim-O-glucosylcimifugin, cimifugin, 4'-O-β-D-glucosyl-5-O-methylvisamminol, sec-O-glucosylhamaudol, and 3'-O-angeloylhamaudol in the samples was simultaneously determined by high performance liquid chromatography(HPLC). Cluster analysis, principal component analysis, partial least squares discriminant analysis, and Pearson correlation analysis were performed to analyze the powder chromatic values and the content of 5 components. The results showed that the E~*ab values of the samples were in the order of wild group<multiple-year-old group<one-year-old group. The content of cimifugin, sec-O-glucosylhamaudol, and 3'-O-angeloylhamaudol in the wild group was significantly higher than that in the multiple-year-old and one-year-old groups. The results of multivariate statistical analysis showed that the quality of multiple-year-old group varied greatly. The quality of the multiple-year-old samples was close to that of the wild group and better than that of the one-year-old group. The variable importance in the projection(VIP) values of b~*, 3'-O-angeloylhamaudol content, E~*ab, and L~* were all larger than 1, and that of cimifugin content was close to 1. The E~*ab value was negatively correlated with the content of prim-O-glucosylcimifugin, cimifugin, sec-O-glucosylhamaudol, and 3'-O-angeloylhamaudol, while it had no linear correlation with the 4'-O-β-D-glucosyl-5-O-methylvisamminol content. The growth patterns and years had different effects on the quality of Saposhnikoviae Radix samples. The chromatic values of Saposhnikoviae Radix and the content of 5 components can be used to evaluate the quality of Saposhnikoviae Radix, and 3'-O-angeloylhamaudol and cinmifugin can be considered as markers for the quality control of Saposhnikovia divaricata during the growing process.

Value of Intraplaque Neovascularization on Contrast-Enhanced Ultrasonography in Predicting Ischemic Stroke Recurrence in Patients With Carotid Atherosclerotic Plaque

Objective@#Patients with a history of ischemic stroke are at risk for a second ischemic stroke. This study aimed to investigate the relationship between carotid plaque enhancement on perfluorobutane microbubble contrast-enhanced ultrasonography (CEUS) and future recurrent stroke, and to determine whether plaque enhancement can contribute to risk assessment for recurrent stroke compared with the Essen Stroke Risk Score (ESRS). @*Materials and Methods@#This prospective study screened 151 patients with recent ischemic stroke and carotid atherosclerotic plaques at our hospital between August 2020 and December 2020. A total of 149 eligible patients underwent carotid CEUS, and 130 patients who were followed up for 15–27 months or until stroke recurrence were analyzed. Plaque enhancement on CEUS was investigated as a possible risk factor for stroke recurrence and as a possible adjunct to ESRS. @*Results@#During follow-up, 25 patients (19.2%) experienced recurrent stroke. Patients with plaque enhancement on CEUS had an increased risk of stroke recurrence events (22/73, 30.1%) compared to those without plaque enhancement (3/57, 5.3%), with an adjusted hazard ratio (HR) of 38.264 (95% confidence interval [CI]:14.975–97.767; P < 0.001) according to a multivariable Cox proportional hazards model analysis, indicating that the presence of carotid plaque enhancement was a significant independent predictor of recurrent stroke. When plaque enhancement was added to the ESRS, the HR for stroke recurrence in the high-risk group compared to that in the low-risk group (2.188; 95% CI, 0.025–3.388) was greater than that of the ESRS alone (1.706; 95% CI, 0.810–9.014). A net of 32.0% of the recurrence group was reclassified upward appropriately by the addition of plaque enhancement to the ESRS. @*Conclusion@#Carotid plaque enhancement was a significant and independent predictor of stroke recurrence in patients with ischemic stroke. Furthermore, the addition of plaque enhancement improved the risk stratification capability of the ESRS.

Effects of polysorbates on stability of monoclonal antibody drugs / 中国生物制品学杂志

@#Objective To evaluate the effects of various polysorbates(PS)on the stability of different types of monoclonal antibody(mAb)drugs.Methods Three types of monoclonal antibodies mAbA(IgG1 proantibody drug),mAbB(IgG1 mAb)and mAbC(IgG1 mAb with Fc N297A mutation)were used as model proteins,and different kinds or contents of PS were added into the mAb formulations respectively to investigate the influencing factors.The effects of PS on the stability of mAb drugs were evaluated comprehensively by detecting the changes of quality attributes,such as protein aggregates and insoluble particles.Results PS20 and PS80 showed no significant difference in inhibiting the formation of aggregates and charge variants in the three mAbs(P>0.05),while the addition of PS80 in mAbB and PS20 in mAbC significantly inhibited the increase of insoluble particles respectively(P<0.05);The content of PS20 showed a significant effect on the detection indexes of charge variants and insoluble particles in mAbC(P<0.05).Conclusion Different types of mAbs have different sensitivities to various kinds and contents of PS.Therefore,when designing the formulation of mAbs,it is necessary to select appropriate kinds and contents of PS to further improve the stability of mAb drugs.

Association of Increased Amygdala Activity with Stress-Induced Anxiety but not Social Avoidance Behavior in Mice / 神经科学通报·英文版

Chronic stress leads to many psychiatric disorders, including social and anxiety disorders that are associated with over-activation of neurons in the basolateral amygdala (BLA). However, not all individuals develop psychiatric diseases, many showing considerable resilience against stress exposure. Whether BLA neuronal activity is involved in regulating an individual's vulnerability to stress remains elusive. In this study, using a mouse model of chronic social defeat stress (CSDS), we divided the mice into susceptible and resilient subgroups based on their social interaction behavior. Using in vivo fiber photometry and in vitro patch-clamp recording, we showed that CSDS persistently (after 20 days of recovery from stress) increased BLA neuronal activity in all the mice regardless of their susceptible or resilient nature, although impaired social interaction behavior was only observed in susceptible mice. Increased anxiety-like behavior, on the other hand, was evident in both groups. Notably, the CSDS-induced increase of BLA neuronal activity correlated well with the heightened anxiety-like but not the social avoidance behavior in mice. These findings provide new insight to our understanding of the role of neuronal activity in the amygdala in mediating stress-related psychiatric disorders.

Efficay of different doses of remimazolam for anesthesia induction during reoperation in asthenic patients with tracheotomy / 中华麻醉学杂志

Objective:To evaluate the efficay of different doses of remimazolam for anesthesia induction during reoperation in asthenic patients with tracheotomy.Methods:One hundred and twenty patients of both sexes, aged 19-64 yr, with a modified frailty index score ≥3, of American Society of Anesthesiologists physical status Ⅳ, scheduled for reoperation after tracheotomy, were divided into 4 groups ( n=30 each)using a random number table method: propofol group (group C) and different doses of remimazolam groups (R 1, R 2 and R 3 groups). Anesthesia was induced with intravenous sufentanil 5 μg, propofol 1.5 mg/kg in group C and with remimazolam 0.1, 0.2 and 0.3 mg/kg in R 1, R 2 and R 3 groups, respectively.The tracheotomy cannula was replaced with a reinforced endotracheal intubation (ID=6.0 mm) when bispectral index value ≤ 65.Mean arterial pressure and heart rate were recorded before induction (T 0), immediately before replacement of the tube (T 1) and immediately after replacement of the tube (T 2). The onset time of anesthesia and adverse reactions such as hypotension, bradycardia and bucking during replacement of the tube, and requirement for rescue sedation were recorded. Results:Compared with group C, mean arterial pressure was significantly increased at T 1, 2 in group R 1 and group R 2, the onset time of anesthesia was significantly prolonged, the incidence of hypotension and bradycardia was decreased in R 1, R 2 and R 3 groups, and the requirement for rescue sedation in group R 1 and incidence of bucking in group R 1 and group R 2 were increased ( P<0.05 or 0.01). Compared with group R 1, heart rate at T 2 was significantly decreased, the onset time of anesthesia was shortened, and the requirement for rescue sedation and incidence of bucking were decreased in C, R 2 and R 3 groups, and the incidence of hypotension was significantly increased in group R 3 ( P<0.05 or 0.01). Compared with group R 2, the onset time of anesthesia was significantly shortened in group R 3 ( P<0.05). Conclusions:Remimazolam 0.2 mg/kg provides good efficacy when used for anesthesia induction with fewer side effects during reoperation in asthenic patients with tracheotomy.

Genotoxicity assessment of three reference chemicals in rat hepatocytes by alkaline comet assay / 上海预防医学

Objective:To establish a comet test method for detection of genotoxicity of three reference chemicals in rat liver cells. Methods:6-10 week old Sprague Dawley rats were randomly divided into 4 groups， with normal saline （0.9% NaCl solution） as negative control group. Animals in three test groups were treated， respectively， with ethyl methanesulfonate （EMS） 200 mg/kg， N-methyl-N-nitrosourea （MNU） 50 mg/kg， and D-mannitol 2 000 mg/kg. There were 10 animals in each group， 5 males and 5 females. The animals received two times （21 h interval） of test compounds through intragastric administration， and their clinical symptoms and body weight changes were recorded during the experiment. The rats were sacrificed 3 h after the last exposure. The liver was weighed， then used to prepare single-cell suspensions for the alkaline comet test which determines the average tail DNA content percentage （DNA%） of hepatocytes and other comet indicators. Results:（1） D-mannitol， EMS and MNU did not show significant toxicity in the whole animal. （2） The mean values of tail DNA content percentage （DNA%） of rat hepatocytes in EMS ［（60.07±24.69）%］ and MNU ［（41.66±22.35）%］ groups were higher than that in the negative control group ［（2.32±1.39）%］ and the difference was statistically significant （P<0.05）. The difference between D-mannitol group ［（3.06±3.30）%］ and the negative control group was not significant （P>0.05）. Conclusion:This laboratory has established a comet test method using hepatocytes from treated rats. Among three testing chemicals， EMS and MNU have displayed genotoxicity by this assay， but no genotoxicity was observed in D-mannitol treated animals.

Analysis on the concentration of chloroform and risk factors of swimming pools in Bao’an District of Shenzhen City / 上海预防医学

Objective:To investigate the concentration level of chloroform in the water of swimming pool in Baoan District of Shenzhen City，and determine the risk factors. Methods:During May and July，2019，a total of 110 water samples from 40 swimming pools were collected in Xin’an subdistrict of Bao’an District for the examination of chloroform routine indicators. In addition， 38 pipe water samples were collected for the examination of chloroform and free residual chlorine． Results:The concentration of chloroform in the swimming pools was determined to be （43.400±27.802） μg/L with the median of 37.343 μg/L. Chloroform was correlated positively with total bacterial count（P<0.05），turbidity， free chlorine residual， and PH value（P<0.01）. Conclusion:The disinfection quality of swimming pool water in Bao’an District remains low. It is necessary to determine the risk factors associated with chloroform in the swimming pool and further reduce the concentration level of disinfection by-products.

The effect on nicotine addiction of combining transcranial magnetic stimulation with smoking-related cues / 中华物理医学与康复杂志

Objective:To explore the effect of repetitive high-frequency magnetic stimulation (H-F rTMS) of the dorsolateral part of the prefrontal cortex (DLPFC) combined with smoking-related cues on nicotine addicts′ cigarette craving, the concentration of exhaled CO and sleep quality.Methods:Sixty nicotine addicts were randomly divided into groups A, B and C, each of 20. All were given H-F rTMS five times a week for two weeks, while those in groups A and B watched smoking and non-smoking pictures for ten minutes, respectively. Before and after the intervention, all of the subjects self-reported their cigarette cravings using a visual analogue scale. Exhaled CO (CO ppm) was measured and the Pittsburgh sleep quality index (PSQI) was evaluated. Results:After the intervention the average craving score, CO ppm and PSQI score had improved significantly in all three groups. The average craving score and CO ppm of group A were both significantly better than in the other two groups. Conclusions:rTMS can significantly improve cigarette craving, CO ppm and sleep quality of cigarette adicts. Viewing smoking-related pictures as an addition to rTMS can even better the effects of rTMS.

Expression of solute carrier proteins SLC35E1 and SLC35E2B in skin lesions of patients with Mycobacterium infections / 中华皮肤科杂志

Objective:To investigate the expression of solute carrier family 35 member E1 (SLC35E1) and SLC35E2B in skin lesions of patients with Mycobacterium infections. Methods:Paraffin-embedded skin tissues of 31 patients confirmedly diagnosed with Mycobacterium infections were collected from Dermatology Hospital of Southern Medical University from 2014 to 2018, including 10 cases of multibacillary leprosy, 9 of nontuberculous mycobacterial infection, 7 of cutaneous tuberculosis, and 5 of erythema induratum. Meanwhile, paraffin-embedded skin tissues of 10 healthy individuals were collected, and served as normal control group. Immunohistochemical staining was performed to determine the expression of SLC35E1 and SLC35E2B in the lesional and normal control skin specimens, and immunofluorescence staining to observe the co-expression of CD68 and S100 with SLC35E1 and SLC35E2B in the skin lesions. Results:Neither SLC35E1 nor SLC35E2B was expressed in the normal control group, but high expression of SLC35E1 and SLC35E2B was observed in the dermis of skin lesions from the patients with leprosy, nontuberculous mycobacterial infection, cutaneous tuberculosis or erythema induratum. Immunohistochemical staining showed that the expression of SLC35E1 and SLC35E2B (expressed as average optical density) was significantly higher in the multibacillary leprosy group (0.143 ± 0.010, 0.169 ± 0.004, respectively) , nontuberculous mycobacterial infection group (0.278 ± 0.015, 0.229 ± 0.088, respectively) , cutaneous tuberculosis group (0.171 ± 0.010, 0.103 ± 0.016, respectively) and erythema induratum group (0.200 ± 0.015, 0.118 ± 0.021, respectively) than in the normal control group (both 0, all P < 0.05) . Immunofluorescence staining showed co-expression of SLC35E1 and SLC35E2B with CD68 in skin lesions of the patients with leprosy, nontuberculous mycobacterial infection, cutaneous tuberculosis. Conclusion:Both SLC35E1 and SLCE2B were markedly highly expressed in skin lesions of patients with Mycobacterium infections.

Granulomatosis with polyangiitis with nasal symptoms as the first clinical manifestation: clinical analysis of 18 cases / 中华耳鼻咽喉头颈外科杂志

Objective: To analyze and summarize the diagnosis, treatment and prognosis of granulomatosis with polyangiitis (GPA) with nasal symptoms as the first clinical manifestation. Methods: The data of 18 patients of GPA with nasal mucosal symptoms as the first clinical manifestation from the Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University between 2005 and 2019 was collected, including 8 males and 10 females, aged from 5 to 68 years. Nasal endoscopy, imaging examination, laboratory examination, immunological and histopathological examination of nasal mucosa were completed. All patients were treated with glucocorticoid combined with cyclophosphamide and were followed up for 2 to 15 years. Descriptive statistical method was used for analysis. Results: All the 18 patients had the nasal mucosal symptoms as the first clinical manifestation, including nasal obstruction, running nose and epistaxis. Nasal endoscopy showed swelling, erosion, scab and bleeding of nasal mucosa, and 6 cases had nasal septal perforation. Nasal sinus CT scan showed high density shadow of sinus, as well as hyperostosis and osteosclerosis. CT imaging features of pulmonary showed nodular lesion or patchy infiltration in 12 patients and cavitation was found in 6 cases. Laboratory results showed that 13 cases were positive for anti-neutrophil cytoplasmic antibodies (ANCA), and 5 cases were negative. During follow-up period, thirteen patients were symptomatic controlled and survived; two patients died of disease progression; one patient gave up treatment and died; two patients were lost to follow-up. Conclusions: Nasal symptoms are the first clinical manifestation of GPA. Early diagnosis and early treatment with glucocorticoid combined with cyclophosphamide can effectively improve the survival rate.

Fertility and reproduction in rats with metabolic syndrome / 上海预防医学

Objective To study the effect of metabolic syndrome on the fertility and reproduction in model animals. Methods The model of"high fat diet for spontaneously hypertensive rats(SHR)"was adopted to construct the model of metabolic syndrome in rats. The metabolic syndrome model rats were used to mate with male and female 1 : 1 cage, and the mating cycle was 2 weeks. Results After the SHR rats were fed a high-fat diet for 10 weeks, 16 males and 15 females met the screening criteria for metabolic syndrome, with the modeling rates of 40% and 37.5%, respectively. In addition to the abnormal metabolism-related indicators(such as blood glucose, blood lipid and blood pressure), the male rats with metabolic syndrome mainly had decreased sperm motility(P < 0.05), increased sperm malformation rate(P < 0.01), and decreased mating rate(P < 0.05). In addition to abnormal metabolism-related indicators, the conception rate and the live fetal rate of the female rats with metabolic syndrome were slightly lower than that of the control group; however, there was no statistical difference. The mean birth weight of the litter was significantly lower than that of the control group(P < 0.05). Conclusion According to the whole process from mating to natural production, metabolic syndrome is determined to have a significant effect on the fertility and reproductive ability of rats.

Novel SNP markers on ginsenosides biosynthesis functional gene for authentication of ginseng herbs and commercial products / 中国天然药物

Panax ginseng and Panax quinquefolius have similar bioactive components and morphological characteristics, but they are known to have different medicinal values, high-sensitive and accurate method is expected to identify the sources of ginseng products and evaluate the quality, but with a huge challenge. Our established UHPLC-TOF/MS method coupled with orthogonal partial least squares discriminant analysis (OPLS-DA) model based on 18 ginsenosides was applied to discriminate the sources of raw medicinal materials in ginseng products, and nested PCR strategy was used to discover 6 novel single nucleotide polymorphism (SNP) sites in functional dammarenediol synthase (DS) gene for genetic authentication of P. ginseng and P. quinquefolius for the first time. OPLS-DA model could identify the sources of raw ginseng materials are real or not. SNP markers were applied to identify ginseng fresh samples as well as commercial products, and proved to be successful. This established molecular method can tell exact source information of adulterants, and it was highly sensitive and specific even when total DNA amount was only 0.1 ng and the adulteration was as low as 1%. Therefore, this study made an attempt at the exploration of new type SNP marker for variety authentication and function regulation at the same time, and the combination of chemical and molecular discrimination methods provided the comprehensive evaluation and authentication for the sources of ginseng herbs and products.

Clinicopathological Observation of Primary Renal Non-Hodgkin's Lymphoma--A Report of Two Cases / 中国实验血液学杂志

OBJECTIVE@#To investigate the clinicopathological and immunohistochemical features as well as diagnosis, differential diagnosis,treatment and prognosis of patients with primary renal non-hodgkin's lymphoma (PRNHL).@*METHODS@#Clinical data of 2 patients with PRNHL from January 2013 to October 2017 were retrospectively analyzed.@*RESULTS@#One of the two male patients PRNHL aged 51 years old, admitted to hospital for swelling and pain in the right waist, B-ultra sonic examination showed a very solid upper right renal space occupying lesion. CT showed the soft tissue mass of the right kidney about 10.5 cmx 8.6 cm. Preoperative diagnosis was a right kidney cancer subjected to radical surgery, and the postoperative pathological diagnosis was a right renal diffuse large B cell lymphoma (DLBCL). Expression of CD20, CD79a, Mum-1, BCL-2, BCL-6 in tumor cells was identified by inmmunohistochemistry, and Ki-67 proliferation index was 90%. Six courses of chemotherapy with R-CHOPE regimen were carried out supplemented local radiotherapy. The patients were followed up for 32 months, which were generally in good condition and stable. The another patient was 65 years old, no without obvious clinical symptoms, B-ultrasonic examination found a space occupying lesion in the left kidney. Abdomind CT scan plus enhancement showed the left kidneydisplayed uneven enhanced lesions of size 9 cm x 5 cm, the preoperative diagnosis was left kidney cancer, the pathological diagnosis was diagnosed as mall B cell lymphoma of the left kidney after the radical operation. Immunohistochemistry determined expression of CD20, CD79a, pax-5, BCL-2 in tumor cells and Ki-67 proliferation index 10%. 6 courses of chemotherapy with CHOPE regimen had been performed and followed up for 20 months, the conditions were generally good and stable.@*CONCLUSION@#PRNHL is a rare extranodal non-Hodgkin lymphoma with atypical clinical symptoms characterized by lumbar swelling pain. It is easy to be misdiagnosed as renal cell carcinoma before operation. The diagnosis depends on pathology and immunohisto-chemistry. The prognosis of 2 patients was relatively good. PRNHL should be differetiated with renal sarcomatoid cancer, nephroblastoma and other diseases. Surgical resection plus chemotherapy is recommended.

Research and application of three-dimensional printed template in endodontics / 中华口腔医学杂志

With the progress of technology, three-dimensional (3D) printing technology has become more and more widely used in stomatology. 3D printed template has played an irreplaceable role in oral implantation; at the same time, 3D printed template, which has been successfully applied to the calcified root canal negotiation, endodontic treatment of dental invaginatus, apical surgery and autotransplantation, has also provided a new concept and treatment mode for the diagnosis and therapy of endodontic diseases. This review, summarized the research and application of 3D printed template from the perspective of the treatment of endodontic deseases.

Cardiac surgery ERAS system and practical effects / 医学研究生学报

Objective Enhanced recovery after surgery (ERAS) refers to a series of evidence-based medical evidence that has been used to confirm the effective treatment measures in perioperative period, which contributes to speed up the recovery of patients. We aimed to explore the effect of preoperative ERAS for patients undergoing cardiac surgery. Methods Patients with cardiac surgery of a single-center (third-class hospital in cardiac surgery intensive care unit) were compared 6 months before the implementation of ERAS (n =704) and 6 months after implementation (n = 685), and followed up for 1 month. The primary outcomes were acute renal failure, re-intubation, stroke and 30-day mortality. The secondary outcomes included re-operation rates, bloating, wound infections and lung infections. Results After the implementation of ERAS, the mechanical ventilation time decreased significantly from the median of 6 hours to 4.5 hours (P<0.001). The ICU stay time and hospitalization time after ICU transfer were significantly shorter (P<0.001), and the incidence of adverse events, postoperative abdominal distension and lung infection was significantly lower (P<0.05). Addictionally, the hospitalization cost decreased (P<0.05), and the satisfaction increased (P<0.05). Conclusion ERAS for patients undergoing heart surgery can effectively promote their postoperative recovery, decrease postoperative complications, shorten the length of hospitalization, reduce the cost of hospitalization, then improve patients’ satisfaction. The transformation and application of ERAS in cardiac surgery has important clinical value.

Comparison of efficacy of different doses of dexmedetomidine for sedation in patients with Parkinson's disease undergoing deep brain stimulation surgery / 中华麻醉学杂志

Objective To compare the efficacy of different doses of dexmedetomidine for sedation in patients with Parkinson's disease (PD) undergoing deep brain stimulation (DBS) surgery.Methods Seventy-five patients of both sexes with PD,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,aged 48-72 yr,with body mass index of 18-24 kg/m2,undergoing elective DBS surgery,were divided into 3 groups (n =25 each) using a random number table method:different doses of dexmedetomidine groups (D1-3 groups).Dexmedetomidine was intravenously infused in a loading dose of 0.5 μg/kg at 10 min before local infiltration anesthesia with 0.25 ％ ropivacaine 10-20 ml,followed by an infusion of 0.3,0.5 and 0.8 μg · kg-1 · h-1 in D1-3 groups,respectively.The infusion of dexmedetomidine was suspended during neurological test,the patients were awakened,and dexmedetomidine was infused at 0.3,0.5 and 0.8 μg · kg-1 · h-1 until the end of the surgery after the test.Bispectral index (BIS) value was recorded immediately before anesthesia (T0),immediately after administration prior to wake-up (T1) and during neurological test (T2).The wake-up time and adverse reactions such as requirement for rescue analgesics,pulse oxygen saturation (SpO2) ＜ 90％ and snoring were recorded.Results Compared with group D1,the requirement for rescue analgesics and BIS value at T1,2 were significantly decreased in D2 and D3 groups,and the wake-up time was significantly prolonged,and the incidence of SpO2 ＜ 90％ and snoring was increased in group D3 (P＜0.05 or 0.01).Compared with group D2,the requirement for rescue analgesics and BIS value at T1 were significantly decreased,the wake-up time was prolonged,and the incidence of SpO2 ＜90％ and snoring was increased in group D3 (P＜0.05 or 0.01).Conclusion Dexmedetomidine 0.5 μg · kg-1 · h-1 can produce good sedative efficacy and safety for DBS surgery in patients with PD.

Effect of sodium valproate combined with phenytoin sodium on the epileptiform discharge and cognitive function in patients with refractory epilepsy / 新乡医学院学报

Objective To investigate the effect of sodium valproate combined with phenytoin sodium on the epileptiform discharge and cognitive function in patients with refractory epilepsy (RE).Methods A total of 213 patients with RE were selected from February 2011 to February 2015 in the Third Affiliated Hospital of Xinxiang Medical University.The patients were divided into phenytoin sodium group,sodium valproate group and combined treatment group according to the treatment methods,71 cases in each group.The patients in the phenytoin sodium group were treated with phenytoin sodium,the patients in the sodium valproate group were treated with sodium valproate,and the patients in the combined treatment group were treated with phenytoin sodium and sodium valproate.The electroencephalogram and cognitive function score of the patients in the three groups were performed before treatment and six months after treatment,and the therapeutic effect was evaluated.The improvement of electroencephalogram,cognitive function score and clinical effect were compared among the three groups.Results The total effective rate in the combined treatment group,phenytoin sodium group and sodium valproate group was 80.28％ (57/71),60.56％ (43/71) and 59.15％ (42/71) respectively,the total effective rate in the combined treatment group was significandy higher than that in the phenytoin sodium group and sodium valproate group (x2 =8.412,9.596;P ＜ 0.05),but there was no significant difference in the total effective rate between phenytoin sodium group and sodium valproate group (x2 =0.003,P ＞ 0.05).The improvement rate of electroencephalogram in the combined treatment group,phenytoin sodium group and sodium valproate group was 80.28％ (57/71),63.38％ (45/71) and 60.56％ (43/71) respectively,the improvement rate of electroencephalogram in the combined treatment group was significantly higher than that in the phenytoin sodium group and sodium valproate group(x2 =7.520,8.412;P ＜ 0.05),but there was no significant difference in the improvement rate of electroencephalogram between phenytoin sodium group and sodium valproate group (x2 =0.070,P ＞ 0.05).There was no significant difference in the scores of total intelligence quotient,language intelligence quotient and performance intelligence quotient in the three groups before treatment (P ＞ 0.05).The scores of total intelligence quotient,language intelligence quotient and performance intelligence quotient after treatment were significantly higher than those before treatment in the three groups (P ＜0.05).After treatment,the scores of total intelligence quotient,language intelligence quotient and performance intelligence quotient in the combined treatment group were significantly higher than those in the phenytoin sodium group and sodium valproate group(P ＞ 0.05);but there was no significant difference in the scores of total intelligence quotient,language intelligence quotient and performance intelligence quotient between the phenytoin sodium group and sodium valproate group (P ＞ 0.05).Conclusion Phenytoin sodium combined with sodium valproate can effectively control the epileptiform discharge,improve the cognitive function and improve the therapeutic effect in RE patients.

Molecular Analysis-Based Genetic Characterization of a Cohort of Patients with Duchenne and Becker Muscular Dystrophy in Eastern China / 中华医学杂志(英文版)

<p><b>Background</b>Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) are common X-linked recessive neuromuscular disorders caused by mutations in dystrophin gene. Multiplex polymerase chain reaction (multiplex PCR) and multiplex ligation-dependent probe amplification (MLPA) are the most common methods for detecting dystrophin gene mutations. This study aimed to contrast the two methods and discern the genetic characterization of patients with DMD/BMD in Eastern China.</p><p><b>Methods</b>We collected 121 probands, 64 mothers of probands, and 15 fetuses in our study. The dystrophin gene was detected by multiplex PCR primarily in 28 probands, and MLPA was used in multiplex PCR-negative cases subsequently. The dystrophin gene of the remaining 93 probands and 62 female potential carriers was tested by MLPA directly. In fetuses, multiplex PCR and MLPA were performed on 4 fetuses and 10 fetuses, respectively. In addition, sequencing was also performed in 4 probands with negative MLPA.</p><p><b>Results</b>We found that 61.98% of the subjects had genetic mutations including deletions (50.41%) and duplications (11.57%). There were 43.75% of mothers as carriers of the mutation. In 15 fetuses, 2 out of 7 male fetuses were found to be unhealthy and 2 out of 8 female fetuses were found to be carriers. Exons 3-26 and 45-52 have the maximum frequency in mutation regions. In the frequency of exons individually, exon 47 and exon 50 were the most common in deleted regions and exons 5, 6, and 7 were found most frequently in duplicated regions.</p><p><b>Conclusions</b>MLPA has better productivity and sensitivity than multiplex PCR. Prenatal diagnosis should be applied in DMD high-risk fetuses to reduce the disease incidence. Furthermore, it is the responsibility of physicians to inform female carriers the importance of prenatal diagnosis.</p>