Anhui Provincial Hospital Research Articles

The prevalence and risk factors for serositis in patients with systemic lupus erythematosus: a cross-sectional study.

This study aims to estimate the prevalence of serositis and identify risk factors for serositis in a large cohort of systemic lupus erythematosus (SLE) patients. A cross-sectional study was conducted based on the medical records of patients hospitalized with SLE at the First Affiliated Hospital of Anhui Medical University and Anhui Provincial Hospital. Patients were diagnosed with serositis when they presented with symptoms and signs of pleuritis or/and pericarditis. We explored factors associated with the generation and quantity of serositis by using binary and ordinal logistic regression analysis. Among the 1668 lupus patients, 298 have serositis. Active lupus disease, fever (≥38°C) and high D-dimer were all significantly associated with the generation and quantity of serositis. Male gender was independent significant risk factor for pleuritis but not for pericarditis, while low complement C4 and high erythrocyte sedimentation rate (ESR) were risk factors for pericarditis rather than for pleuritis. The possible prevalence of serositis in patients with SLE was 17.9%. The significant associations of active lupus disease, fever (≥38°C) and high D-dimer with serositis suggest that higher disease activity and hypercoagulability may both contribute to the generation and development of serositis in SLE. The risk factors for pleuritis and pericarditis in SLE are similar but not identical.

Patients with Hematologic Malignancies Can Benefit More from Allele-Level HLA Matching Than Antigen-Level after Single Unit Umbilical Cord Blood transplantation: a Retrospective Single Center Clinical Analysis

Introduction:The increasing number of unrelated umbilical cord blood (UCB) has been used as an alternative graft because greater degrees of donor-recipient HLA mismatch are tolerated. Generally, lower resolutionHLA typing (antigen-level) for HLA-A and -B and at the allele level for HLA-DRB1 is used to select UCB units; HLA-C and -DQB1 are not typically considered. A few studies have suggested that HLA-matching based upon allelic typing for 8 HLA loci(HLA-A, -B, -C and -DRB1 )should be taken into account when searching UCB units; and the NMDP also encourages extended high-resolution typing of umbilical cord blood units to facilitate further study of the impact of HLA. Nevertheless, few studies have taken into consideration that if HLA-matching based upon allelic typing for 10 loci (HLA-A, -B, -C,-DRB1 and -DQB1) can benefit more patients than traditional HLA typing method (antigen-level for HLA-A,-B and allele-level for HLA-DRB1). In this study, we aim to compare the clinical outcomes between patients using allele-level HLA typing and those using traditional HLA typing method, such as engraftment, relapse and survival after unrelated cord blood transplantation (UCBT).Patients and methods: 309 patients with hematologic malignancies who underwent UCBT in Anhui Provincial Hospital from May 2008 to December 2015 were analyzed. All patients received a single UCB unit after intensified myeloablative conditioning regimens and a combination of cyclosporine A (CsA) and mycophenolate mofetil (MMF) was given for graft-versus-host disease (GVHD) prophylaxis. Of 309 patients at enrollment, 95 patients used traditional HLA typing method (antigen level for HLA-A,-B and allele level for HLA-DRB1, at least 4/6 HLA loci matching must be met) and 214 patients used allele-level HLA typing method (allele-level for HLA-A,-B,-C,-DRB1 and -DQB1, at least 5/10 HLA loci matching must be met). The follow-up assessment was conducted before May, 31, 2016.Results: Patients using allele-level HLA typing method had a statistically significant higher cumulative incidence of platelet engraftment (P=0.039), and the risk of grades 2-4 acute GVHD was statistically significant lower than patients using traditional HLA typing method (P=0.01). The risk of transplant-related mortality (TRM) by 1 year was also lower than patients using traditional HLA typing method (P=0.043), while there was no increase in the risk of relapse (P=0.338). Conclusion: Using allele-level HLA typing method when searching UCB units (at least 5/10 HLA loci matching must be met) can improve the engraftment of platelet, reduce the risk of grades 2-4 acute GVHD and TRM, which can take the place of traditional HLA typing method to search UCB units. DisclosuresNo relevant conflicts of interest to declare.

Rapid B-Cell Recovery Is Predictive of Graft-Versus-Host Disease-Free Survival, Few Infectious Events, and Good Quality-of-Life after Cord Blood Transplantation Using Myeloablative Regimen without Antithymocyte Globulin

Background:The severity of complications of transplantation is governed mainly by the status of immune reconstitution. Compared to other stem cell sources, cord blood transplantation (CBT) is characterized by an impairment of early T cell immune reconstitution but rapid B-cell neogenesis. In this study, we investigated the kinetics of early B-cell immune reconstitution and its relation with clinical outcome after CBT using myeloablative regimens without antithymocyte globulin (ATG).Methods:(1) Between July 2011 and Feb. 2016, 199 patients with malignant hematological diseases who received an unrelated CBT at Anhui provincial hospital were included in this study. The patients received myeloablative conditioning without ATG and cyclosporin A (CSA) and mycophenolate mofetile as graft-versus-host disease (GVHD) prophylaxis in CBT protocols. (2) Dynamic monitoring of blood cells and lymphocyte recovery after CBT. (3)Lymphocyte subsets were assessed by flow-cytometry after fluorochrome-conjugated monoclonal antibodies for T-cells (CD3, CD4, and CD8), B-cells (CD19), and NK-cells (CD56, CD16). Immunoglobulin levels were measured by immunoturbidimetry assay. These analyses were done approximately at 1-6, 9, 12, 18 and 24 months post-transplantation.(4)The relationship between immune reconstitution and clinical outcome was analyzed.Results: (1) From 1 month after CBT, the absolute monocyte count (AMC) and absolute lymphocyte count (ALC) sustained to increase until month 18, the median ALC, CD3+-cell, CD3+CD4+-cell, and CD3+CD8+-cell counts achieved normal at month 2, 3, 5, and 2, respectively. The median NK-cell counts achieved normal at month 1 after CBT. (2) Early B-cell recovery was delayed with gradual increase in the number of cells, starting around month 3 after CBT. The median CD19+-cell count at days 30, 60 and 90 was 1/µl, 2/µl, and 7/µl, respectively. The median CD19+-cell count reached normal at month 5, the counts continue to increase beyond the normal range until month 18 post CBT. The median serum IgM, IgG and IgA levels reached the normal range at month 3, 4, and 9 after CBT, respectively. (3)Thirty-one cases died of severe infection and the median time of death from infection was 91 days after CBT (range, 31-413 days). By assessment of the rate of readmission within 30 days of hospital discharge, the patients with lower counts of CD19+ population after CBT has been associated with a higher readmission rates because of infectious episodes and GVHD. Onset of B-cell robust recovery ,which characterized by CD19+-cell count greater than 45/µl at month 3, 90/µl at month 4, and 280/µl at month 6, the patients’ subsequently readmission-rate was decreased significantly. The 30-day readmission rate was 6.9%,11% and 24% after CBT when the patients achieved robust B-cell recovery at month 3, 4, and 6, respectively.Assessment of B-cell counts within 83 graft samples, 32 of 83 patients had robust B cell recovery at month 3 who received comparable total B-cell and naive B-cell numbers in the grafts. The patients with or without rapid B-cell recovery showing a similar relapse rate (18.56% vs 15.34%, respectively). The 3-year probabilities of overall survival (OS) and disease-free survival (DFS) were 59%, respectively. Conclusion: Patients with rapid B-cell recovery are less likely to develop post-transplant GVHD, infections, and readmitted to hospital. The CD19+ B-cell counts may serve as useful predictor of GVHD-free survival, the 30-day readmission rate and quality-of-life after CBT. DisclosuresNo relevant conflicts of interest to declare.

Intensified Myeloablative Conditioning Regimen without Antithymocytic (ATG) Results in Superior Patient Outcome Compared to Myeloablative Conditioning Regimen for Single-Unit Umbilical Cord Blood Transplantation in Hematological Malignancies

The superiority and safety of strengthening conditioning regimen for single- unit unrelated cord blood transplantation (sUCBT) in hematological malignancies remain controversial. We retrospectively analyzed the clinical data of 251 hematological malignancies undergoing sUCBT from Apr 2000 to Dec 2014 at Department of hematology in Anhui Provincial Hospital. Out of the 251 patients, 216 received the intensified myeloablative conditioning regimen (IMCR), and 35 received the myeloablative conditioning regimen (MCR). We evaluated the effect of IMCR without using Antithymocyte globulin (ATG) on patient outcomes. The cumulative incidence of myeloid and platelet engraftment of the IMCR group was significantly higher than that in the MCR group (96.98% vs. 82.81%, 85.89% vs. 51.79%, P=0.000 and 0.003, respectively). Corresponding incidences of transplantation-related mortality (TRM) by 180 days in the IMCR group and the MCR group were 19.50% vs. 41.67% (P=0.003), respectively. There were no differences in the incidence of grade II to IV acute GVHD (aGVDH), grade III to IV aGVHD and 2-year cumulative incidence of relapse. Up to Dec. 2015, with a median follow-up of 30 months, the estimated 3-year overall survival and disease- free survival in the IMCR group were both significantly higher than that of the MCR group (64.8% vs. 35.5%, 61.6% vs. 35.5%, P=0.000 and 0.001, respectively). This study is the first to show the superiority of intensified myeloablative regimen to conventional myeloablative regimen.A large-scale prospective study was needed.(A)(B) [Display omitted] [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Hypoalbuminemia: a risk factor for acute kidney injury development and progression to chronic kidney disease in critically ill patients.

The increased likelihood of poor outcomes in critically ill patients with hypoalbuminemia is well recognized. However, hypoalbuminemia remains poorly defined as an independent predictor of acute kidney injury (AKI) and stage 4 chronic kidney diseases (CKD4). The aim of this study was to assess the role of hypoalbuminemia as an independent risk factor for AKI and CKD4 in critically ill patients. A retrospective cohort study. General intensive care unit (ICU) at Anhui Provincial Hospital, PR China. None. We screened patients admitted to the ICU at Anhui Provincial Hospital between January 1, 2008, and October 31, 2011, and included those aged >18years with available records of serum albumin (SA), baseline serum creatinine, and outcome data. The exclusion criteria were: (1) patients with known AKI and CKD stage 4, 5 before ICU admission; (2) patients lost to follow-up; and (3) patients without research authorization. A total of 588 patients with available data were enrolled in the study, and 62 patients with preexisting CKD stage 4 and CKD stage 5 and 115 with preexisting AKI were excluded. Thirty patients were lost to follow-up. Ultimately, 381 patients were analyzed, 233 (61.2%) of whom developed AKI. Patients with low SA were significantly more likely than those with normal SA (p=0.0003) to develop AKI, and to progress from AKI to CKD4 (p=0.0229). More patients in the AKI group than in the non-AKI group had risk factors such as hypotension, mechanical ventilation (MV), proteinuria, sepsis, nephrotoxin exposure, and high-risk surgery (p<0.01). The difference in duration of MV, ICU days, ICU mortality, hospital days, and hospital mortality between the AKI and non-AKI groups was also significant (p<0.01). Logistic regression showed that hypoalbuminemia was significantly associated with AKI and CKD4 [odds ratio (OR) 1.810, 95% confidence interval (CI) 1.102-2.992, and OR 2.494, 95% CI 1.231-5.295, respectively]. After 4years of follow-up, Kaplan-Meier analysis showed that survival in hypoalbuminemia patients was significantly shorter than in patients with normal SA (p=0.0393). In the Cox proportional hazard model, hypoalbuminemia was an independent predictor of long-term mortality (hazard ratio 1.5, 95% CI 1.042-2.183, p=0.0291). Hypoalbuminemia in critically ill patients is independently associated with an increased risk of development of AKI and AKI progressing to CKD4.

Direct anterior approach versus posterolateral approach for total hip arthroplasty in the lateral decubitus position

Objective: To compare the clinical efficacy of the direct anterior approach (DAA) and the posterolateral approach (PLA) for total hip arthroplasty (THA) in the lateral decubitus position. Methods: From July to December, 2014, 104 patients randomly divided into two equal groups of the DAA group and the PLA group underwent unilateral primary THA procedures.All procedures were performed by the same surgeon in the Department of Orthopaedics, the Affiliated Anhui Provincial Hospital of Anhui Medical University.General data, perioperative index, postoperative function and radiological evaluation were recorded and statistically analyzed. Results: The patients had an average follow-up of 14 (range, 10-16) months.No significant differences were detected with respect to the operation time, incision length, preoperative Hb concentration and transfusion rate between two groups (P> 0.05 for all comparisons). However, there were significant differences associated with the intraoperative bleeding, postoperative drainage and postoperative Hb concentration in the two groups(P<0.05 for all comparisons). The DAA group showed significant superior outcomes compared with the PLA group in the Harris hip scores [(83.6±7.1) vs (79.8±6.6), P<0.05], WOMAC[ (28.9±6.1) vs (36.1±6.9), P<0.001], and VAS pain scores[ (2.2±0.9) vs (2.9±1.1), P<0.05]at 1 month after surgery. No differences were seen between the study groups in the evaluation of radiography and the incidence of adverse event (P> 0.05 for all comparisons). Conclusions: Compared with the posterolateral approach, the present study shows the exciting results in patients underwent the DAA THA in the lateral decubitus position at early follow-up.The advantages of THA using the DAA include less operative trauma, alleviation of postoperative pain, and faster postoperative rehabilitation. It is a safe, reliable and effective surgery approach.

Short-term outcomes of minimally invasive Sweet esophagectomy for Siewert type Ⅱ esophagogastric junction adenocarcinoma

Objective: To describe the technique for minimally invasive Sweet esophagectomy and to evaluate the feasibility, safety and the short-term clinical outcomes of this approach in the treatment of Siewert type Ⅱ esophagogastric junction adenocarcinoma. Methods: The clinical data of 122 patients with Siewert type Ⅱ esophagogastric junction adenocarcinoma who received Sweet esophagectomy between October 2013 and June 2015 in Department of Thoracic Surgery, Anhui Provincial Hospital Affiliated with Anhui Medical University was analyzed retrospectively. The study group consisted of 87 men and 35 women, and the ages ranged from 48 to 78 years (median: 67 years). Of those 122 patients, 47 underwent minimally invasive approach and 75 underwent open left transthoracic sweet esophagectomy. This study included 16 stage Ⅰa patients, 35 stage Ⅰb patients, 32 stage Ⅱa patients, 28 stage Ⅱb patients, and 11 stage Ⅲa patients. The clinicopathologic factors, operational factors and postoperative complications of the two groups were compared by t test and χ2 test. Results: The two groups were similar in terms of gender, age, American Society of Anesthesiologists grade, preoperative staging and incidence of comorbidities (P>0.05). The minimally invasive approach was associated with significant increase in the number of total lymph nodes dissected or the stations of the total lymph nodes dissected (18.1±2.7 vs. 15.0±2.5, t= 6.612, P=0.001; 8.9±1.1 vs. 6.7±1.2, t=9.960, P=0.003), significant decrease in surgical blood loss ((88±32) ml vs. (120±34) ml, t=5.052, P=0.001), chest tube duration ((8±4) d vs. (10±4) d, t=3.110, P=0.002) and postoperative stay ((9±5) d vs. (12±4) d, t=3.167, P=0.002) relative to the open approach. The postoperative in-hospital mortality and total morbidity did not differ between the two groups (P>0.05). The minimally invasive approach was associated with significantly fewer respiratory complications than the open approach (8.5% vs. 22.7%, χ2=4.063, P=0.044). Conclusion: Minimally invasive technique for Siewert type Ⅱ esophagogastric junction adenocarcinoma can be safely and effectively performed for intrathoracic anastomosis with favorable early outcomes.

Prognostic value of FDG PET-CT metabolic parameters before treatment in patients with esophageal cancer receiving radiotherapy

Objective To investigate the prognostic value of metabolic parameters, maximum standard uptake value (SUVmax), metabolic tumour volume (MTV), total lesion glycolysis (TLG), and PET tumor length(PTL), in primary lesions of esophageal cancer on FDG PET-CT imaging in patients receiving radiotherapy or combined radiotherapy. Methods A total of 55 patients with stage Ⅰ-IV esophageal cancer who received PET-CT radiotherapy localization in our hospital from 2006 to 2012 were enrolled. The association of sex, age, primary lesion, TNM stage, SUVmax, MTV, TLG, PTL, and therapeutic methods with the patient's prognosis was analyzed. The receiver operating characteristic curve was used to determine the cut-off values of SUVmax, MTV, TLG, and PTL, and the patients were divided into higher-value group and lower-value group. The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used for survival difference analysis. Results The median overall survival (OS) time for all patients was 19.1 months (95% CI 8.1-30.1), and the 1-, 2-, 3-, and 4-year OS rates were 59%, 45%, 35%, and 26%, respectively. The group with lower values of SUVmax(<11.4), MTV (<8.27 cm3), TLG (<35.21), and PTL (<5.8 cm) had better prognosis than those with higher values (P=0.002, 0.021, 0.044, and 0.000). Conclusions SUVmax, MTV, TLG, and PTL before treatment have certain values in predicting the prognosis of patients with esophageal cancer. Risk stratification can be performed for these patients before radiotherapy according to these parameters, in order to develop individualized treatment regimens and improve prognosis. Key words: Tomography, positron-emission; Fluorodeoxyglucose; Tomography, X-ray computed; Esophageal neoplasms/radiotherapy; Prognosis

Pathogens and clinical characteristics of bacterial infection in hematology department between 2010 and 2014

目的分析2010年1月至2014年12月血液科不同病房住院患者细菌感染的病原学分布特点、耐药情况及临床特点。方法采用Kirby-Bauer纸片扩散法进行药敏试验，采用WHONET5.6软件进行细菌菌株及耐药性分析；采用SPSS 17.0及R3.0统计软件对临床数据进行统计分析。结果2 843例患者共送检标本3 312份，其中596例患者共培养出634株（19.14%）阳性菌株，其中血液来源488株（76.97%）。革兰阴性菌427株（67.35%），大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌分列前3位，是主要的病原菌，对亚胺培南耐药率分别为0.8%、11.8%、3.3%；大肠埃希菌及肺炎克雷伯菌中产超广谱β内酰胺酶菌株分别占83.9％及75.0%。革兰阳性菌207株（32.65%），主要为凝固酶阴性葡萄球菌、肠球菌及链球菌。凝固酶阴性的葡萄球菌中耐甲氧西林的菌株占65.9%；未发现对万古霉素、利奈唑胺、替加环素耐药的葡萄球菌及肠球菌。结论血液科细菌感染发生率高，血流感染常见，病原菌以革兰阴性菌为主，不同病房细菌分布存在差异。

Endovascular treatment of irregular and complicated intracranial aneurysms with coils by double microcatheter technique

Objectives To summarize the preliminary experience of endovascular treatment of irregular and complicated intracranial aneurysms with double microcatheter technique and to investigate the feasibility of its application. Methods From January 2012 to May 2015, the clinical data of 37 patients with irregular and complicated intracranial aneurysm admitted to the Department of Neurosurgery, Anhui Provincial Hospital were analyzed retrospectively. All 37 patients were treated endovascularly by using double microcatheter technique, 33 of them were treated with double microcatheter technique alone and 4 were treated with stent-assisted double microcatheter technique. Prognosis of patients were evaluated by the Glasgow outcome scale (GOS). The follow-up time after procedure was 6 months. Results Immediate angiography after procedure in 37 patients revealed that the aneurysms of 35 patients were densely embolized and 2 were near-totally embolized. All patients recovered well (GOS grade V), no complications and deaths occurred. After 6 months, 24 patients were followed up by DSA, and it revealed that the parent arteries were patent, and no recurrence of aneurysms was found. Thirteen patients were lost to follow-up. Conclusion The efficacy of double microcatheter technique for the treatment of irregular and complicated intracranial aneurysms is good and it has feasibility. Key words: Intracranial aneurysm; Double microcatheter technique; Endovascular procedures

Alteration of parahippocampal gyrus functional connectivity in the role of memory disorder after concussion: a fMRI study

Objective To investigate the alteration of functional connectivity and its significance in post-concussion syndrome (PCS) patients with memory disorders using resting-state functional magnetic resonance imaging (rs-fMRI). Methods From September 2014 to April 2015, 28 PCS patients with memory disorders admitted to the Department of Neurosurgery, Anhui Provincial Hospital, Anhui Medical University and 28 health controls (HC) recruited in the same period were studied. The RS-fMRI data were collected and processed. The left and right parahippocampal gyri were used as the regions of interest (ROI) to make functional connectivity with the whole brain and were analyzed in order to obtain the altered brain areas of hippocampal gyrus and whole brain functional connectivity in patients with PCS. Results The functional connectivity of the left parahippocampal gyrus and bilateral prefrontal lobe, bilateral temporal lobe, right precuneus, and right precentral gyrus reduced (all P<0.05), and the functional connectivity with the bilateral occipital lobe, bilateral lingual lobe, and left superior parietal lobule enhanced (all P<0.05). The functional connectivity of the right parahippocampal gyrus, right inferior frontal gyrus, bilateral temporal lobe, and bilateral occipital lobe reduced (all P<0.05), and the functional connectivity with the bilateral middle frontal gyrus, left inferior frontal gyrus, right orbital frontal gyrus, left inferior temporal gyrus, left middle occipital lobe, bilateral angular gyrus, right lingual lobe, and left parietal lobule enhanced (all P<0.05). Conclusion In resting state, the abnormality of function connectivity of the parahippocampal gyrus in patients with PCS may be one of the reasons for resulting in memory impairment in patients with PCS. Key words: Post-concussion syndrome; Parahippocampal gyrus; Functional connectivity; Functional magnetic resonance imaging

睡眠障碍伴焦虑躯体化症状的临床研究

目的：探讨睡眠障碍伴焦虑躯体化症状患者的临床特点，为此类患者的诊断提供有价值的线。方法：选取2015年7月至2016年3月在安徽省立医院神经内科门诊就诊睡眠障碍的患者并发放问卷121份进行躯体化症状调查，剔除资料不完整的问卷，共收回有效问卷104份，对问卷资料进行分析。结果：104例睡眠障碍伴焦虑躯体化症状的问卷量表中处于重度心理情绪问题的占48.1%，SSS ≥ 38分有72名，焦虑抑郁情绪检出率为69.2%。性别因素对躯体化症状有影响，躯体化症状总分越高，焦虑程度越高，躯体化症状与焦虑状态有一定的相关性。结论：综合医院医生应该重视以睡眠障碍伴焦虑躯体化症状为主要表现的患者，及时发现和规范治疗，以提高诊疗水平。 Objective: Provide valuable clues for the diagnosis of the patients to investigate the clinical cha-racteristics of patients having sleep disorder with anxiety somatic symptoms. Methods: Select the 121 of the patients in neurology clinic from July 2015 to March 2016 in Anhui Provincial Hospital. Among them, 104 questionnaires are valid. Among the 104 cases of the patients with sleep disorders, those who are in severe psychological and emotional issues account for 48.1%; 72 patients score higher than 38 in the scale of SSS, and the rate of anxiety and depression detection is 69.2%. The gender factors have an impact on somatic symptoms, and the higher the somatic symptoms scores, the higher the degree of anxiety, so the somatic symptoms have something to do with the anxiety states. Conclusion: General Hospital doctors should pay attention to the patients having sleep disorder with anxiety and somatic symptoms, and give them timely detection and standardized treatment to improve the level of diagnosis and treatment.

Bispectral index-guided fast track anesthesia by sevoflurane infusion combined with dexmedetomidine for intracranial aneurysm embolization: study protocol for a multi-center parallel randomized controlled trial

Background: After intracranial aneurysm embolization, rapid recovery from general anesthesia is necessary for timely monitoring of adverse events. Fast-track anesthesia using a balanced technique or combination of drugs at their minimum required dosages is preferred for these neurosurgical patients. However, fast-track anesthesia is still limited by a lack of standardization and quality control standards. Methods/Design: A multi-center, parallel, randomized controlled clinical trial will be conducted at Anhui Provincial Hospital and Renmin Hospital of Wuhan University, China. One hundred and twenty patients with intracranial aneurysm will be randomly assigned to a normal saline group and a dexmedetomidine group. General anesthesia will be induced intravenously with propofol. Additionally, either 1.0 μg/kg dexmedetomidine or normal saline will be delivered completely within 10 minutes before anesthesia induction. Once anesthesia has begun, dexmedetomidine (0.3 μg/kg per hour) or normal saline will be continuously infused. Intraoperatively, anesthesia will be maintained with 2-3% sevoflurane. Primary outcomes will be anesthesia time, operative time, time from the end of anesthesia until recovering spontaneous breathing, time until eye opening on command, and time until orientation to time and place. Secondary outcomes will be dose of sevoflurane, Visual Analogue Scale score, and bispectral index. Discussion: In this trial, we will assess the clinical efficacy of sevoflurane anesthesia with dexmedetomidine as a fast track anesthesia for intracranial aneurysm embolization. Trial registration: This protocol was registered at Chinese Clinical Trial Registry (identifier: ChiCTR-IPR-16008113) on 17 March 2016. Ethics: Written approval for this trial has been obtained from the Ethics Committee of the Anhui Provincial Hospital of China (approval No. 2015-31). This study will be performed in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association. Informed consent: Prior to the trial, participants and their family members will be informed of the risks and benefits of this trial. Written informed consent will be obtained from each participant.

Effects of lung protective ventilation on pulmonary function, inflammation, and oxidative stress in patients undergoing craniotomy: study protocol for a multi-center, randomized, parallel, controlled trial

Background: Conventional mechanical ventilation often leads to lung inflammatory responses and oxidative stress, influencing a patient's prognosis. Lung protective ventilation has been widely used during one-lung ventilation and abdominal surgeries as it can reduce lung tissue injury and improve systemic oxygenation. However, there are few reports on its use during craniotomy. Methods/Design: This multi-center, randomized, parallel, controlled trial will be performed at Anhui Provincial Hospital (Southern District), and the Renmin Hospital of Wuhan University, China. Sixty patients scheduled to undergo craniotomy and meeting our eligibility criteria will be randomly allocated to undergo either lung protective ventilation (6 mL/kg tidal volume, 10 cmH 2 O positive end-expiratory pressure, respiratory frequency 15 breaths/min; n = 30) or conventional mechanical ventilation (10 mL/kg tidal volume, respiratory frequency 12 breaths/min; n = 30). All patients will be evaluated from just prior to surgery (at changing of the ventilation mode) to immediately after extubation. The primary outcome measure will be dynamic lung compliance. The secondary outcome measures will be respiratory index, mean airway pressure, plateau pressure, alveolar and plasma markers of inflammation, and oxidative stress. Discussion: The outcomes will reveal the effects of a protective ventilation strategy using low tidal volumes and the use of positive end-expiratory pressure on respiratory status, postoperative pulmonary and systemic inflammation, and oxidative stress in patients undergoing craniotomy. This will provide objective evidence for the safety of protective ventilation during craniotomy. Trial registration: This trial was registered at Chinese Clinical Trial Registry (registration number: ChiCTR-IPR-16008029) on 1 March 2016. Ethics: The study protocol was approved by the Ethics Committee of Anhui Provincial Hospital, China (approval number: 2014-59) on 27 November 2014 and will be performed in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association. Informed consent: Written informed consent will be obtained from participants or their guardians.

Postoperative sedation by intranasal dexmedetomidine in patients with hypertensive cerebral hemorrhage: study protocol for a randomized parallel-cohort controlled trial

Background: Cerebral hemorrhage is often complicated by conscious disturbance and restlessness regardless of the size or location of the hemorrhage, and sedation is often necessary. Dexmedetomidine has dose-dependent sedative, anxiolytic and analgesic effects. It is suited to patients undergoing mechanical ventilation for traumatic brain injury; however, its sedative effects cannot easily be controlled in patients breathing spontaneously. We will investigate the safety and efficacy of postoperative intranasal dexmedetomidine in patients undergoing craniotomy for hypertensive cerebral hemorrhage. Methods/Design: A randomized parallel-cohort controlled trial will be performed at the South District of Anhui Provincial Hospital, China. Patients with hypertensive cerebral hemorrhage will be randomly divided into groups treated with 0.9% normal saline (placebo), or dexmedetomidine 1 or 1.5 μg/kg. Study drug, either undiluted dexmedetomidine 1 or 1.5 μg/kg (dexmedetomidine group) or equal volume of 0.9% normal saline (placebo group), will be administered immediately to each naris as drops after craniotomy for evacuation of hematoma. Primary outcomes include systolic blood pressure, diastolic blood pressure, heart rate, peripheral oxygen saturation, intracranial pressure, Glasgow Coma Scale score, the level of inflammatory markers in the cerebrospinal fluid, and the levels of malondialdehyde, superoxide dismutase, 4-hydroxynonenal, neurotensin, 8-hydroxy-2'-deoxyguanosine and corticosteroid in serum. Secondary outcomes are volume of hematoma, body weight, duration of surgery, duration of anesthesia, blood loss, urine output and length of hospital stay. Discussion: The results of this trial will provide evidence for the safe and effective postoperative use of intranasal dexmedetomidine in patients with hypertensive cerebral hemorrhage who are not mechanically ventilated. Trial registration: Chinese Clinical Trial Registry (http://www.chictr.org.cn/index.aspx) identifier: ChiCTR-IPR-15006668; registered on 30 June 2015. Ethical issues: The trial was approved by Clinical Research Ethics Committee of Anhui Provincial Hospital, China (permission No. 2015 ethics No. 07).

Relaxation therapy and music therapy impact on perioperative anxiety and pain of patients with gastrointestinal cancer

Objective To explore the perioperative psychological behavior interventions for patients with postoperative anxiety and pain of gastrointestinal tumor. Methods We selected 110 patients with gastrointestinal cancer during surgical treatment from gastrointestinal surgery department of Anhui provincial hospital from April 2014 to October 2014 and divided them into experimental group (n=58) and control group (n=52). The patients of control group were used conventional care while the patients of experimental group received the psychological behavior therapy, relaxation therapy and music therapy within 72 hours after surgery for evaluation of postoperative pain and anxiety on the basis of conventional nursing, and we carried on the comparison of two groups of patients with postoperative hospital stay. Results Two groups of patients with SAI and TAI were no statistical difference at time of admitting to hospital (P>0.05) ; the SAI and TAI of the experimental group patients in postoperative one day and three days after operation are lower than those of the control group, and the difference between the two groups after surgery was statistically significant (P 0.05); NRS score of different time points after surgery within two groups showed that the experimental group NRS scores were lower than those of the control group, and the differences were statistically significant between two groups (P 0.05); the experimental group patients in hospitalization days and postoperative hospitalization days were shorter than these of the control group, the difference between the two groups have statistical significance (P<0.05). Conclusions Relaxation therapy and music therapy can significantly improve the patient′s perioperative anxiety, reduce the pain after surgery. For gastrointestinal cancer patients perioperative health of body and mind and postoperative rehabilitation, it has a positive role. Key words: Gastrointestinal tumor; Anxiety; Pain; Relaxation therapy; Music therapy

Association between the serum level of vitamin D and systemic sclerosis in a Chinese population: a case control study.

Several autoimmune diseases have been associated with reduced vitamin D levels. However, the serum level of vitamin D in Chinese systemic sclerosis (SSc) patients have not been reported. The aim of this study was to evaluate the serum levels of vitamin D in Chinese SSc patients and analyze the association between vitamin D and SSc. 25-hydroxy vitamin D 125 I RIA kit was applied to evaluate the serum levels of vitamin D in 60 SSc patients and 60 healthy controls from Anhui Provincial Hospital, China. The data of epidemiological and clinical characteristics of SSc patients were also collected. The serum levels of vitamin D were significantly lower in SSc patients than that in healthy controls (26.51 ± 6.27 vs. 36.29 ± 14.24 ng/mL, P < 0.001). The ratio of pulmonary involvement in vitamin D insufficiency patients was higher than that in normal vitamin D patients, but the difference missed statistical significance. The differences in other aspects were not statistically significant in the two groups. Serum levels of vitamin D in patients with SSc were lower than that in healthy controls. Further studies are needed to determine whether vitamin D supplement could provide some positive effects.

Property change of brain network small world in patients with post-concussion syndrome: a resting-state functional magnetic resonance imaging study

Objective To investigate the change and its significance of the property of brain network small world in patients with post-concussion syndrome. Methods A total of 24 patients at 3 months after concussion admitted to the Department of Neurosurgery, the Affiliated Anhui Provincial Hospital, Anhui Medical University from July 2013 to August to 2014 were enrolled. Twenty-one age-, gender- and education-matched volunteers recruited in the corresponding time period were used as a control group. The resting-state functional magnetic resonance imaging (MRI) data of both groups were collected. The functional brain network was constructed using the graph theory analysis. The property of brain network small world (when γ >1, λ≈ 1, and σ= γ/λ >1, the network has the property of small world) and its parameters – the changes of the clustering coefficient (Cp) and the average shortest path length (Lp) of the 2 groups were analyzed. Results In the range of sparsity 0.05 to 0.4, both the brain concussion syndrome group and the healthy control group met the property of small world (γ value, 1.871±0.253 vs. 2.178±0.178; λ value, 1.105±0.050 vs. 1.083±0.015; σvalue, 1.654±0.249 vs. 1.942±0.155), but the property of small world changed in patients with brain concussion syndrome compared with the healthy population, and there were significant difference in γ value between the 2 groups (t=3.350, P=0.030). Both the Cp value and Lp value of the brain concussion syndrome group were more than those of the healthy control group (Cp, 0.310±0.022 vs. 0.290±0.026; Lp, 4.721±3.489 vs. 3.743±1.671), however, there was only significant difference in Cp value (P<0.05). Conclusion The patients with brain concussion syndrome have the property of small world, but they had the dysfunction of local brain structure, and the whole brain network function does not change. Key words: Post-concussion syndrome; Brain functional network; Small-world property; Clustering coefficient; Average shortest path length

Analysis of hypertrophy-related factors in 82 adult patients with hypertrophic port-wine stains

Objective To analyze clinical features of and hypertrophy-related factors in patients with hypertrophic port-wine stains (PWS). Methods Patients with PWS were enrolled into this study from Anhui Provincial Hospital and the First Affiliated Hospital of Anhui Medical University between January 2010 and August 2014. Clinical features of hypertrophic PWS were investigated. The factors related to hypertrophy in PWS were analyzed by univariate and multivariate unconditional logistic regression analyses. Results A total of 262 patients with PWS were enrolled, 82 (30 males and 52 females) of whom had hypertrophic PWS with a median age of 32.5 years (range, 18-54 years). Among the 82 patients, 66 (80.48%) had plaque-like hypertrophic PWS, 9 (10.98%) had papular or nodular type, and 7 (8.54%) had mixed type; 56.10% (46/82) were aged ≥ 30 years, 41.46% (34/82) varied from 11 to 30 cm2 in lesional area, and 85.36% (70/82) showed purple lesions. There was a significant difference between patients with hypertrophic PWS and those with flat PWS in the distribution of age, lesional area and color (χ2=25.559, 10.580, 90.630, respectively, all P 0.05). Multivariate unconditional logistic regression analysis revealed that an age ≥ 30 years (OR=2.889, 95% CI: 1.459-5.721) and purple lesions (OR=19.984, 95% CI: 5.704-70.023) were factors related to skin hypertrophy in PWS. Conclusion An age ≥ 30 years and purple lesions seem to be hypertrophy-related factors in PWS. Key words: Port-wine stain; Risk factors; Causality; Hypertrophy

The correlation study between the serum cortisol and C type behaviors of perioperative patients with lung cancer

Objective To discuss the correlation between the serum cortisol level and C type behaviors of perioperative patients with lung cancer. Methods A total of 100 patients from the thoracic department of Anhui Provincial Hospital were enrolled as the study object. The general information, the serum cortisol level, the C type behavior of perioperative patients with lung cancer were investigated by using the General Information Questionnaire, Serum cortisol testing and C Type Behavior Scales. Results The serum cortisol level of 100 patients was (447.85±87.65)μg/L. The C Type Behaviors Scale showed that the scores of anxiety were significantly higher in these patients than in the norm, P <0.05, depression scores were significantly higher in these patients than in the norm, P<0.01, while the extroversion anger, reason, optimism and social support were significantly lower, P<0.01. The serum cortisol of patients was positively correlated with anxiety, depression and introversion anger of C type behaviors, r=0.215, 0.241, 0.225, P < 0.05. The serum cortisol of patients was negatively correlated with optimism and social support of C type behaviors, r=-0.223,-0.276, P<0.05. Conclusions The serum cortisol level of perioperative patients was higher than the norm, and correlated with the C type behaviors. Key words: Lung neoplasms; Perioperative nursing; Hydrocortisone; Patients; C type behaviors