[Microglia differential genes and their functions in paraquat-induced Parkinson's disease-like in mice's brains based on single-cell RNA sequencing].

Objective: To analyze the differential genes and related signaling pathways of microglia subpopulations in Parkinson's disease (PD) -like mouse brains induced by paraquat (PQ) based on single-cell RNA sequencing, and provide clues to elucidate the mechanism of PQ-induced PD-like changes in the brain of animals. Methods: In September 2021, six male 6-week-old C57BL/6 mice were randomly divided into control group and experimental group (three mice in each group) . The mice were injected with saline, 10.0 mg/kg PQ intraperitoneally, once every three days, and 10 consecutive injections were used for modeling. After infection, the brains of mice were taken and 10×Genomics single-cell RNA sequencing was performed. Microglia subpopulations were screened based on gene expression characteristics, and Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed. The differential genes of microglia subpopulations between the experimental group and control group were further screened, and functional enrichment analysis was performed using bioinformatics tools. Mouse microglia (BV2 cells) were treated with 0, 60, 90 µmol/L PQ solution, respectively. And real-time fluorescence quantitative PCR experiments were conducted to validate the expressions of differential genes hexokinase 2 (Hk2) , ATPase H+ Transporting V0 Subunit B (Atp6v0b) and Neuregulin 1 (Nrg1) . Results: Cluster 7 and Cluster 20 were identified as microglia subpopulations based on the signature genes inositol polyphosphate-5-phosphatase d, Inpp5d (Inpp5d) and transforming growth factor beta receptor 1 (Tgfbr1) , and they reflected the microglia-activated M2 phenotype. The bioinformatics analysis showed that the characteristic genes of identified microglia subpopulations were enriched in endocytosis. In terms of molecular function, it mainly enriched in transmembrane receptor protein kinase activity and cytokine binding. The up-regulated genes of Cluster 7 were mainly enriched in lysosomal pathway, endocytosis pathway, and down-regulated genes were mainly enriched in neurodegenerative disease and other signaling pathways. The up-regulated genes of Cluster 20 were mainly enriched in signaling pathways related to PD, and down-regulated genes were mainly enriched in cyclic adenosine 3', 5'-monophosphate (cAMP) signaling pathways, neurological development, synaptic function and other signaling pathways. The results of real-time fluorescence quantitative PCR showed that the expressions of Hk2 mRNA and Atp6v0b mRNA increased and the expression of Nrg1 mRNA decreased in the 90 µmol/L PQ-treated BV2 cells compared with the 0 µmol/L, and the differences were statistically significant (P<0.05) . Conclusion: Microglia are activated in the PQ-induced PD-like mouse model and polarized toward the M2 phenotype. And their functions are associated with lysosomal (endocytosis) , synaptic functions and the regulation of PD-related pathways.

[Safety and feasibility of robotic-assisted thoracoscopic day surgery for pulmonary nodules: a retrospective analysis based on propensity score matching].

Objective: To evaluate the safety and feasibility of robotic-assisted thoracoscopic day surgery for pulmonary nodules. Methods: Clinical data of 523 patients with pulmonary nodule underwent robotic-assisted thoracoscopic surgery in the Department of Thoracic Surgery, Xiangya Hospital, Central South University from January 2021 to June 2022 were retrospectively analyzed, which including 223 males and 300 females, aged from 19 to 72 (54.0±11.7) years. Those patients were divided into the day surgery group (DSG) and inpatient surgery group (ISG) according to perioperative management methods. Propensity score matching (PSM) (1∶2) was performed according to the general baseline information, T stage of the tumor, surgery approach, and tumor position, and a total of 178 patients were finally included. Clinical outcomes of DSG were observed. The differences in incidence of postoperative complications, treatment-related costs and resource consumption between DSG and ISG were compared. Subgroup analysis was performed according to surgery method to evaluate the difference between DSG and ISG in lobectomy and sublobectomy. Results: In 81 cases DSG, eight patients were transferred to thoracic surgery ward, and the day surgery discharge rate was 90% (73/81). There was no statistically significant difference in incidence of postoperative complications between DSG and ISG (P=0.612). The length of stay after surgery, period of chest draining, average hospital cost, and drug cost of DSG were statistically significant lower than ISG, ((2.19±0.84) vs (4.74±1.81) days, (1.70±0.65) vs (3.45±1.85) days, (6.64±0.74) vs (8.29±0.97)×104 CNY, (0.35±0.07) vs (0.69±0.18)×104 CNY), respectively(all P<0.05). The drainage volume and VAS score at discharge in DSG and ISG group were(220.47±120.02) ml and(242.21±129.96) ml, 1.68±0.79 and 1.64±0.91, respectively, with no statistically significant difference (P>0.05). In subgroup analysis, there was no statistically significant difference in incidence of postoperative complications, drainage volume after surgery and VAS score at discharge between DSG and ISG both for lobectomy and sublobectomy patients. And the results of the length of stay after surgery, period of chest draining, and drug cost in DSG were also significantly lower than ISG (P<0.05). Conclusions: Robotic-assisted thoracoscopic day surgery for pulmonary nodule is safe and feasible, with the advantage of short length of stay after surgery, short period of chest draining, less average hospital cost and drug cost. There is no difference in incidence of postoperative complications between DSG and ISG.

[Effects of different doses of glucocorticoids on minimally invasive procedures in pain patients with type 2 diabetes].

Objective: To investigate the effects of different doses of glucocorticoids on minimally invasive procedures in patients with type 2 diabetes mellitus (T2DM), and optimize the clinical pathways of minimally invasive procedures. Methods: The clinical data of 284 patients with T2DM who received minially invasive procedures from the Department of Pain Medicine, West China Hospital, Sichuan University from May 2017 to May 2020 were retrospectively reviewed. The patients were divided into two groups according to the main diagnostic types: spine-related group (n=148) and herpes zoster group (n=136). According to the cumulative dose of glucocorticoids (GCs) per unit body surface area during the hospitalization, patients were further divided into three subgroups: low-dose group (GCs<3.5 mg/m2), medium-dose group (3.5 mg/m2 ≤GCs<7 mg/m2), and high-dose group (GCs≥7 mg/m2). The clinical characteristics of the patients in different subgroups of the two diseases groups were compared. The effects of the glucocorticoids on the pain intensity, blood glucose, length of hospital stay (LOS) and total hospitalization cost were compared among the 3 subgroups of the two diseases groups. Results: There were no significant differences in the age, gender, height, weight, visual analog scale (VAS) and fasting blood glucose before procedures between the two groups (all P>0.05). The VAS score of the low-dose group from the spine-related group was 4.5±1.6, which was higher than that of the medium-dose group (3.5±1.3) (P=0.004). VAS score was 4.3±1.3 in the medium-dose group and 4.4±1.6 in the high-dose group from the herpes zoster group, which were higher than that in the low-dose group (3.5±0.9) (P=0.006). In terms of blood glucose, the impact on the fasting blood glucose before and after the procedures in the low-dose group from the spine-related group was less than that in the medium dose group (P=0.013). In the herpes zoster group, the blood glucose of the low-dose group was (11±5) mmol/L, which had less influence on the blood glucose fluctuation during the hospitalization than that in the high-dose group [(15±5) mmol/L] (P<0.05). The LOS and hospitalization cost in the low-dose group from the spine-related group were (9±4) d and (10 583±4 851) yuan, respectively, which were less than those in the medium-dose group [(11±3) d and (15 202±7 418) yuan] and high-dose group [(13±6) d and (18 100±4 138) yuan] (all P<0.05); however, there was no significant difference among different subgroups in the herpes zoster group (all P>0.05). Conclusion: When used in the patients with T2DM undergoing minimally invasive procedures for spine-related diseases, low-dose glucocorticoids can obtain more clinical benefit than high dose, and high dose can lead to raised blood glucose, prolong the LOS, and increase the hospitalization cost.

[The analysis of structural magnetic resonance imaging manifestation of hippocampus based on voxel and spherical harmonic surface morphometry in mesial temporal lobe epilepsy].

Objective: To compare the hippocampal volume and local surface morphology changes in patients with mesial temporal lobe (mTLE) using the voxel-based morphometry and spherical harmonic methods respectively. Methods: A total of 66 patients (31 males and 35 females, age range from 17 to 48 (28±8) years) with mTLE and 80 age-and gender-matched controls (38 males and 42 females, age range from 19 to 46 (27±7) years) were retrospectively collected from July 2009 to February 2019 at Jinling hospital.. High resolution structural MRI of the whole brain, three-dimensional T1-weighted data(3DT1) were acquired from each subject. The changes of hippocampal volume and surface morphology were evaluated between mTLE groups and controls for observing the hippocampal atrophy pattern by using voxel-based morphometry and spherical harmonic shape descriptions point distribution model respectively. Pearson correlation analysis was conducted for observing the relationship between the morphological changes of hippocampus and disease duration. Results: Compared with the controls, hippocampal volume on the affected side in patients with mTLE was significantly reduced (Z-score:-1.55±0.57 vs 0.38±0.58, P<0.001) and negatively correlated with disease duration (r=-0.297, P=0.016). Furthermore, surface morphology analysis subtly showed that the atrophy of the affected hippocampus in patients with mTLE mainly located in the head, mesial lateral part and posterior tail of the hippocampus. Their displacement values were negatively correlated with disease duration (r=-0.336, P=0.006) and positively associated with the hippocampal grey matter volume (r=0.336, P=0.006). Conclusions: Voxel-based morphometry analysis reveals a global reduction in hippocampal volume, while the morphological measurement method based on surface shape can describe the local morphological changes of hippocampal atrophy.

[Initial exploration of transfusion-free liver transplantation].

Objective: To evaluate the effect of transfusion-free techniques on the prognosis of liver transplant patients. Methods: The recipients of adult liver transplantation at Tianjin First Central Hospital from August to December 2019 were included in the clinical observation. Liver transplantation without allogeneic blood transfusion was performed through anesthesia management techniques such as acute hemodilution or phlebotomy without volume replacement,maintaining decreased baseline central venous pressure and cell saver. According to the actual results,the patients were divided into two groups: transfusion-free group(n=21) and allogeneic transfusion group(n=28). There were 13 males and 8 females aged of (56.3±11.6) years in the transfusion-free group;and there were 16 males and 12 females aged (54.3±14.2)years in the allogeneic transfusion group. The transplant recipients who had not adopted transfusion management strategy from January to July 2019 were included as control group(27 males and 13 females,aged of (58.9±14.1)years). The clinical data of patients in perioperative period were collected to compare whether there were differences in the recovery of liver function and early complications among the three groups, one-way ANOVA test, rank-sum test, and χ2 test were used for data analysis. Results: The amount of intraoperative blood loss in both the transfusion-free group and the transfusion group was less than that in the control group((454.2±271.3)ml vs.(673.6±333.4)ml vs.(890.3±346.7)ml;q=-6.342,-5.286,both P<0.05).The duration of stay in ICU of the transfusion-free group was less than that of the transfusion group and control group((36.4±9.1)hours vs.(44.3±14.9)hours vs.(58.2±21.1)hours;q=-4.432,-3.824,both P<0.05).The mean ALT level at 7 days after operation was significantly lower in the transfusion-free group than in the control group((56.8±32.1)U/L vs.(89.6±45.6)U/L;q=-3.358,P<0.05). Conclusions: The improvement of multi-disciplinary transfusion management technology aimed at transfusion-free liver transplantation can effectively reduce intraoperative hemorrhage and help to avoid surgical transfusion. Transfusion-free liver transplantation is beneficial to the early postoperative recovery,and its long-term clinical significance is worthy of further clinical research.

Greater variability in lipid measurements associated with cardiovascular disease and mortality: A 10-year diabetes cohort study.

AIM: To examine the associations between variability in lipids and the risk of cardiovascular disease (CVD) and mortality in patients with type 2 diabetes based on low-density lipoprotein-cholesterol (LDL-C), the total cholesterol (TC) to high-density lipoprotein-cholesterol (HDL-C) ratio and triglycerides (TG). MATERIALS AND METHODS: A retrospective cohort study included 125 047 primary care patients with type 2 diabetes aged 45-84 years without CVD during 2008-2012. The variability of LDL-C, TC to HDL-C and TG was determined using the standard deviation of variables in a mixed effects model to minimize regression dilution bias. The associations between variability in lipids and CVD and mortality risk were assessed by Cox regression. Subgroup analyses based on patients' baseline characteristics were also conducted. RESULTS: A total of 19 913 CVD events and 15 329 mortalities were recorded after a median follow-up period of 77.5 months (0.8 million person-years), suggesting a positive linear relationship between variability in lipids and the risk of CVD and mortality. Each unit increase in the variability of LDL-C (mmol/L), the TC to HDL-C ratio and TG (mmol/L) was associated with a 27% (HR: 1.27 [95% CI: 1.20-1.34]), 31% (HR:1.31 [95% CI: 1.25-1.38]) and 9% (HR: 1.09 [95% CI: 1.04-1.15]) increase in the risk of composite endpoint of CVD and mortality, respectively. Age-specific effects were also found when comparing LDL-C variability, with patients aged 45-54 years (HR: 1.70 [95% CI: 1.42-2.02]) exhibiting a 53% increased risk for the composite endpoints than those aged 75-84 years (HR: 1.11 [95% CI: 1.01-1.23]). Similar age effects were observed for both the TC to HDL-C ratio and TG variability. Significant associations remained consistent among most of the subgroups. CONCLUSIONS: Variability in respective lipids are significant factors in predicting CVD and mortality in primary care patients with type 2 diabetes, with the strongest effects related to LDL-C and the TC to HDL-C ratio and most significant in the younger age group of patients aged 45-54 years. Further study is warranted to confirm these findings.

[Magnetic resonance imaging morphological study of the effects of juvenile febrile convulsions on the brain structure of medial temporal lobe epilepsy].

Objective: To investigate the effect of febrile convulsions on gray matter volume (GMV) in medial temporal lobe epilepsy (mTLE) and its correlation with disease duration. Methods: A retrospective study was conducted to collect 41 mTLE patients with a history of febrile convulsions (mTLE-FC), 42 mTLE patients with no initial precipitating injury (mTLE-noIPI), and 42 normal and age and sex matched normal controls. High-resolution T1-weighted (T(1)WI) whole brain MR scans were performed on all subjects. Voxel-based morphometry were used to obtain GMV brain maps, and the GMV differences between the three groups of subjects were compared (P<0.01, GRF corrected). Finally, Spearmen rank correlation analysis was used to explore the correlation between GMV changes and the course of disease. Results: Compared with the normal control subjects, each mTLE group showed extensive GMV reduction, mainly in the affected hippocampus, thalamus, temporal lobe, and bilateral cerebellum. Further analysis found that mTLE-FC group had more significant reductions in GMV than the mTLE-noIPI group in the affected hippocampus, amygdala, inferior temporal gyrus, contralateral hippocampus, para hippocampus, and inner cingulate gyrus. At the same time, the affected amygdala and hippocampal GMV in the mTLE-FC group was significantly negatively related to the course of disease (r=-0.381, P=0.014), while the mTLE-noIPI group had no downward trend (r=0.081, P=0.611). The atrophic trend of the affected amygdala and hippocampus in patients with mTLE-FC was significantly greater than that in patients with mTLE-noIPI (P=0.029, permutation test). Conclusions: There is extensive damage to the gray matter structure of bilateral cerebral hemispheres, mainly in the hippocampus, in mTLE patients. The brain damage of mTLE patients with a history of juvenile fever convulsions is more extensive and serious, and the trend of progressive exacerbation with the course of the disease is more obvious, suggesting mTLE associated with juvenile fever convulsions may have different pathophysiological mechanisms.

Clinical efficacy of tacrolimus for treating myasthenia gravis and its influence on lymphocyte subsets.

BACKGROUND: This study aimed to determine the clinical efficacy and effects of tacrolimus in treating myasthenia gravis (MG). METHODS: A total of 45 outpatients and inpatients were divided into a tacrolimus group (n=15) and non-tacrolimus group (n=30): those in the former group were treated with 3mg/day of tacrolimus for 24 weeks, while those in the latter (control) group took other immunosuppressants (prednisone, azathioprine combined with prednisone). Each group was evaluated at weeks 4, 8, 12, 16, 20 and 24 by Myasthenia Gravis Foundation of America Quantitative Myasthenia Gravis (MGFA-QMG) Test, activities of daily living (ADL) profiles, and manual muscle (MMT) and fatigue tests. Dynamic changes in CD4+CD25+high cells were tested by flow cytometry. Inflammatory cytokines were also evaluated in the tacrolimus group. RESULTS: Efficacy index scores decreased significantly compared with baseline at every test week in both groups (P<0.01), although improvements were more evident with than without tacrolimus treatment (F=9.312, P<0.01 vs. F=24.551, P<0.01 and F=10.710, P<0.01). At week 24, peripheral blood CD4+CD25+high T cells with tacrolimus decreased significantly (P<0.01), but increased significantly without tacrolimus (P<0.01). During treatment, CD19+BAFF-R B cells in peripheral blood decreased in both groups (P<0.05). Interferon (IFN)-γ concentrations in peripheral blood also diminished significantly with tacrolimus (P<0.01). CONCLUSION: A relatively low dose of tacrolimus can affect multiple immune-system targets and, thus, can treat MG effectively in terms of both clinical symptoms and immunological responses.

[The mechanism and role of autologous peritoneum transplantation to enterocystoplasty in porcine model].

Objective: To explore the pathological mechanism and role of autologous peritoneum transplantation onenterocystoplasty in porcine model. Methods: Randomly, four experimental female swine were chosen, and each of their body weight was 28-33 kg. By intravenous anesthesia, the transplantation of autologous peritoneum for bladder reconstruction operation was carried out (to transplant the peritoneum onto an ileum segment of which the mucosa and submucosa had been removed. These flaps were used to mend and augment the bladder by suturing the edge of detective bladders). After removal of ureteral catheters and balloon catheter at day 5 respectively, their voiding behaviors were monitored, and respectively 2 swine were euthanized at week 3/6 for routine pathology, immunohistochemistry, and electron microscopic examinations. Results: Four swine underwent reconstruction, but none died for complications such as peritonitis, ileus and urinary fistula. The length of ileum was 35 cm, and the area of peritoneum was 15 cm×10 cm. Voiding behaviorsof the swine were normal, with clear urine after removal of their catheters. At autopsy, reconstructed bladders were healthy. Pathological examination showed the neobladder had been covered by continuous urothelium while the peritoneum disappeared without ileal mucosa regrowth or residual. Scanning electron microscope showed that the transitional cells of neobladder of swine were complete and orderly, and urothelium around suture border was continuous withoutmalposition. Conclusions: In porcine model, autologous peritoneal transplantation witnessed no immune rejection response for itself, which was replaced by crawling transitional epithelium around anastomosis, rather than by metaplasia.

Hydration prevents chronic hyperglycaemic patients from neurological deterioration post-ischaemic stroke.

OBJECTIVES: To determine whether chronic hyperglycaemia predisposes patients to dehydration, which may promote neurological deterioration, and to investigate whether dehydration control improves functional outcome. PATIENTS AND METHODS: This study included 355 patients hospitalized with acute ischaemic stroke and diabetes mellitus who fulfilled the glycaemic gap ≤0. We used the following cut-offs: (i) no chronic hyperglycaemia (glycated haemoglobin A1c [HbA1c] < 7%) and (ii) chronic hyperglycaemia (HbA1c ≥ 7%). The chronic hyperglycaemic patients were randomly divided into the control group and the hydration group. Hydration therapy was only initiated in the hydration group. The blood urea nitrogen (BUN)/creatinine (Cr) ratio was used as an indicator of dehydration. Stroke severity on admission and discharge was assessed by means of National Institutes of Health Stroke Scale (NIHSS). RESULTS: The mean baseline BUN/Cr ratios were higher in the control group and hydration group than in the no chronic hyperglycaemia group. The mean BUN/Cr ratio decreased from 91.22 ± 29.95 on the first day to 77.03 ± 18.23 on the third day (P < .001) in the hydration group. On the third day after admission, there was no significant difference in the BUN/Cr ratio between the hydration group and the no chronic hyperglycaemia group (P = .831). Moreover, neurological deterioration was highest in the control group (33.6%, 36/107), followed by the hydration group (10.5%, 11/105) and the no chronic hyperglycaemia group (5.6%, 8/143). CONCLUSIONS: Chronic hyperglycaemia was associated with the admission NIHSS score and neurological deterioration after excluding the effect of stress hyperglycaemia. Furthermore, hydration therapy may help prevent neurological deterioration.

[A comparison of clinical characteristics between 2 pedigrees of multiple endocrine neoplasia type 2A with different RET mutations].

Multiple endocrine neoplasia type 2A (MEN2A) is a hereditary syndrome. Here, two different RET proto-oncogen mutation were identified from family members of two MEN2A pedigrees by genetic screening. One RET mutations were found at codons 1893 and 1895 in exon 11 (1893-1895delCGA) from pedigree 1, which is a novel mutation, the other occurs at codon 634 (Cys634Arg) in exon 11 from pedigree 2. However, the clinical characteristics were similar in the patients of the two pedigrees. All the patients were in middle-age at onset. Most of them were firstly diagnosed with bilateral adrenal pheochromocytoma with different degrees of thyroid abnormalities (elevated serum calcitonin with or without thyroid mass, or had been diagnosed with medullary thyroid carcinoma). Some family members were with elevated serum parathyroid hormone but with no other evidences for hyperparathyroidism.

[The altered topology of brain structural network in patients with acute stress response after traffic accident].

Objective: To explore the changes of brain activities in traffic accident survivors with acute stress response (ASR) within a week by using complex networks analysis method based on graph-theory, and to find out the alteration of topological properties in structural brain network. Method: From January, 2013 to February, 2016, twenty traffic accidents survivors with acute stress disorders (Acute Stress Disorder Interview, ASDI>3)and twenty healthy controls underwent the 3T diffusion tensor imaging (DTI) magnetic resonance imaging scan in Nanjing General Hospital.The graph-theory analysis method was used to compare the structural brain network properties and nodal features between ASR survivors and controls.Statistical analyses were also performed by including anxiety and depression as covariates to evaluate their effect.In additional, Pearson correlation was performed between abnormal parametric values and clinical indices. Results: (1) The brain structural networks had small-world properties in both groups; (2) while compared with healthy controls, patients with ASR showed increased weighted connectivity strength (Si, 1.36±0.47 vs 0.92±0.38, P=0.008) and nodal betweenness centrality (BCi, 20±15 vs 7±6, P=0.002) in left triangular part of inferior frontal (IFG triang_L), increased Si in orbital part of inferior frontal gyrus (1.10±0.31 vs 0.77±0.30, P=0.004) and obviously decreased Si in left caudate (0.75±0.24 vs 1.04±0.35, P=0.004); (3) furthermore, the inclusion of anxiety and depression as covariates abolished nodal parameters differences in IFG triang_L, left caudate, thalamus and inferior temporal gyrus. Conclusions: The brain structure network in ASR patients has small world properties.But nodal parameters change obviously in some nodes compared with healthy controls and mainly locate in prefrontal lobe and striatum. High levels of anxiety and depression in ASR patients may partly account for these alterations.

[Dose optimization of lipid infusionin treatment of patients with acute dexmedetomidinepoisoning].

OBJECTIVE: To optimize the dose of lipid infusion in treatment of patients with acute dexmedetomidinepoisoning, in order to further guide the rational use of medication in clinical practice. METHODS: A total of 80 patients with acute dexmedetomidinepoisoning were admitted in this study from January 2012 to October 2014 at our hospital and divided into three groups based on the intensity of poisoning, including: slight poisoning (28 cases), moderate poisoning (32 cases) and severe poisoning (20 cases). Patients in each group were given 10% lipid infusion or 20% lipid infusion for treatment.Stable blood dexmedetomidineconcentrations of patients in pre-treatment and at different time points after treatment (pre-treatment and 0.5, 1, 2, 5, 10, 20 h after treatment) and the length of hospital stay, awake time in each group were investigated and compared.Ramsay sedation scores were recorded and compared in different time points (0.5 h before treatment and 2, 5, 20 h after treatment) in each group for different treatments.Side effects and complications were recorded, and follow-up was conducted during 1-3 d post discharge to record the recovery condition in patients. RESULTS: In each group, patients receiving 20% lipid infusion waked earlier than those receiving 10% lipid infusion.And the hospitalization duration for patients receiving 20% lipid infusion was significantly shorter than those receiving 10% lipid infusion [(4.6±1.6) h vs (6.7±2.0) h, (2.6±0.4) d vs (4.0±0.6) d, P<0.05]. The Ramsay sedation scores were significantly lower for patients receiving 20% lipid infusion than those receiving 10% lipid infusionat 2 h and 5 h after treatment in each group [(3.4±0.3) vs (4.7±0.4), (2.6±0.3) h vs (3.5±0.3) h, P<0.05]. The stable plasma concentrations of dexmedetomidine were gradually reduced after the treatment, and which were lower when compared with the theoretical metabolic concentration.What's more, the plasma concentrationsat 1 h, 2 h and 5 h after treatment were significantly lower for patientsreceiving 20% lipid infusion than those receiving 10% lipid infusion in each group (P>0.05). All patients in our study were cured and discharged without severe side effects and complications, and follow-ups showed that no patients showed evidence of rebound phenomenon. CONCLUSIONS: Different concentrations of lipid infusionare safe and effective in relieving the intensity of dexmedetomidinepoisoning, and promoting the clinical recovery.What's more, the therapeutic efficacy of 20% lipid infusion is greater than 10% lipid infusion.

[Study of functional connectivity density mapping in patients with acute stress response by using resting-state functional MRI after traffic accident].

Objective: To explore the changes of brain activity in traffic accident survivors with acute stress response within a week by using functional connectivity density (FCD) method. Method: A total of 20 traffic accidents survivors with acute stress disorders (acute stress disorder interview >3) and twenty healthy controls from Nanjing Jinling Hospital underwent the 3.0 T resting-state functional magnetic resonance imaging scan from January 2013 to February 2016. Functional connectivity density mapping was used to compare the brain functional connective networks between acute stress response survivors and controls. In additional, Pearson correlation was performed between abnormal short, long-range FCD values and clinical indices. Results: (1) Compared with controls, patients with acute stress response showed decreased short-range FCD in left ventromedial prefrontal cortex (-0.815±0.264 vs-0.468±0.615, t=-2.198, P<0.05), left hippocampal and parahippocampal gyri (-1.212±0.135 vs-0.887±0.234), t=-5.070, all P<0.05), and increased short-range FCD in right precentral gyrus(0.428±0.256 vs 0.016±0.298, t=4.456, P<0.05), left inferior parietal and superior parietal lobes (0.623±0.290 vs 0.143±0.300, t=4.878, allP<0.05); (2)compared with normal controls, ASR patients showed increased long-range FCD in left precuneus (0.502±0.400 vs-0.042±0.253, t=4.879, P<0.05); (3)the HAMA score of patients positively correlated with short-range FCD value of the left vmPFC (r=0.50, P<0.05). Conclusion: The long-and short-range functional connectivity in frontal-limbic system is widely changed in survivors with acute stress response, especially the short-range FCD change more significantly, and partly correlated with the severity of their stress symptoms.

[Value of the albumin to globulin ratio in predicting severity and prognosis in myasthenia gravis patients].

OBJECTIVE: To assess the predictive value of the albumin to globulin ratio (AGR) in evaluation of disease severity and prognosis in myasthenia gravis patients. METHODS: A total of 135 myasthenia gravis (MG) patients were enrolled between February 2009 and March 2015. The AGR was detected on the first day of hospitalization and ranked from lowest to highest, and the patients were divided into three equal tertiles according to the AGR values, which were T1 (AGR <1.34), T2 (1.34≤AGR≤1.53) and T3 (AGR>1.53). The Kaplan-Meier curve was used to evaluate the prognostic value of AGR. Cox model analysis was used to evaluate the relevant factors. Multivariate Logistic regression analysis was used to find the predictors of myasthenia crisis during hospitalization. RESULTS: The median length of hospital stay for each tertile was: for the T1 21 days (15-35.5), T2 18 days (14-27.5), and T3 16 days (12-22.5) (P<0.01), and Kaplan-Meier curves showed significant difference among the three groups. In the univariate model, serum albumin, creatinine, AGR and MGFA clinical classification were related to prognosis of myasthenia gravis. At the multivariate Cox regression analysis, the AGR (P<0.001) and MGFA clinical classification (P<0.001) were independent predictive factors of disease severity and prognosis in myasthenia gravis patients. Respectively, the hazard ratio (HR) were 4.655 (95% CI: 2.355-9.202) and 0.596 (95% CI: 0.492-0.723). Multivariate Logistic regression analysis showed the AGR (P<0.001) and MGFA clinical classification were related to myasthenia crisis. CONCLUSION: The AGR may represent a simple, potentially useful predictive biomarker for evaluating the disease severity and prognosis of patients with myasthenia gravis.

[Application of rabbit monoclonal antibody GCET2 in diagnosis of diffuse large B cell lymphoma].

Objective: To prepare a rabbit monoclonal antibody GCET2 and to investigate its diagnostic value in the workup of diffuse large B-cell lymphoma (DLBCL). Methods: GCET2 rabbit monoclonal antibody was developed by using RabMAb® technology, and its specificity was confirmed by ELISA, Western blot, immunohistochemistry (IHC) and flow cytometry. A panel of immunomarkers including GCET2, CD10, bcl-6, MUM1, GCET1, FOXP1, Ki-67 and CMYC was evaluated in 81 cases of DLBCLs, 5 cases of follicular lymphomas (FL) and 2 cases of Burkitt's lymphomas. Results: Rabbit monoclonal GCET2 antibody (clone EP316) was developed with specificity for normal germinal center B-cells (GCB) and GCB origined lymphomas. In 81 cases of DLBCL, the positive rate of GCET2 was 43.2%(35/81), which was significantly higher than that of other germinal center markers. Moreover, among 81 DLBCLs, the proportions of high CMYC expression in GCET2 negative and positive groups were 15.2% (7/46) and 2.8% (1/35), respectively. Conclusion: GCET2 is a sensitive immunohistochemical marker for GCB derived lymphomas. Combined with other biomarkers, it may improve the diagnostic sensitivity of GCB-DLBCL.