[Effects of lateral and medial points of thoracic paravertebral nerve block by ultrasound for rapid recovery after laparoscopic cholecystectomy]

Objective: To investigate the effects of ultrasound-guided lateral and medial point blocks of thoracic paravertebral space on the rapid recovery of laparoscopic cholecystectomy. Methods: A total of 90 patients of either sex, aged 18-67 years, weighted 45.10-91.80 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing elective laparoscopic cholecystectomy were divided into two groups (n=45) using a random number table: lateral point group of thoracic paravertebral space (group A) and medial point group of thoracic paravertebral space (group B). Ultrasound-guided thoracic paravertebral nerve block was performed before induction of general anesthesia. The puncture point of group A was positioned as the intercostal block of the thoracic paravertebral space of the right side of T(6)-T(11), and the puncture point of the group B was positioned as the thoracic paravertebral body of the right side of T(6)-T(11) thoracic paravertebral space. The thoracic paravertebral block was performed with 2 ml of 0.75% ropivacaine per injection for a total of 10 ml. The visual analog scale (VAS) scores of resting pain and active pain at 4, 8, 12 and 24 h after operation were observed. The anus recovery time after surgery and perioperative hypotension were also recorded. Results: The blood pressures in group A were significantly higher than those in group B at 4, 8, 12 and 24 h after operation, which were(73±7) vs (70±7), (78±7) vs (74±7),(82±7) vs (79±7),and (87±7) vs (83±7) mmHg,and the differences were statistically significant (t=2.29, 2.54, 2.33, 2.37, all P<0.05). The VAS scores of resting pain and active pain in group A were significantly higher than those in group B, and the differences were statistically significant (Z=-2.29, -2.51, -2.21, -2.39, -2.53, -2.25, -2.30, -2.24, all P<0.05). The postoperative anal exhaust recovery time of the patients in group A was (21.8±1.9) min that was obvious lower than that in group B which was (22.7±1.9) min with statistically significant difference (t=2.12, P<0.05). There was no significant difference in the incidence of postoperative dizziness, nausea, vomiting, and pruritus (χ(2)=0.28, 0.72, 0.45, 0.21,all P>0.05). Conclusions: In the procedure of thoracic paravertebral block under the guidance of ultrasound, the closer blocking points are to the central axis of the spine, the better the postoperative analgesic effect, but the more obvious the postoperative blood pressure reduction and the longer the anal recovery exhaust time. The further away from the central axis of the spine, the more analgesic effect decreases, but the blood pressure decreases and the anal recovery time is relatively rapid.

[Morphological classification of acute isolated pontine infarction and it's clinical relevance]

Objective: To investigate a diffusion weighted imaging (DWI)-based morphological classification for acute isolated pontine infarcts (AIPI) and to assess differences in clinical characteristics, risk factors and functional outcomes among the different morphologies. Methods: All participants from SMART cohort with DWI-proven AIPI were included and categorized into 3 groups: basilar artery branch disease (BABD) group, small artery disease (SAD) group and large-artery-occlusive disease (LAOD) group, according to lesion extent of the transverse axial plane and basilar artery atherosclerosis severity. The clinical characteristics, vascular risk factors and 6-month's functional outcome was analyzed among 3 groups. Results: Of the 1 129 patients enrolled, 175 had AIPI. BABD was the most frequent subtype of AIPI (46.3%), followed by SAD (36.0%) and LAOD (17.7%). Neurological impairment on admission was more severe in the LAOD and BABD group than SAD group (P<0.001). In terms of risk factors, the percentage of hypertension was significant different among three groups (P<0.05). The average National Institute of Health stroke scale was 3.49 for SAD group, 5.93 for LAOD group, 5.97 for BABD group, and the differences were significant (P<0.001). The Poor outcome (mRS>2) was found in only 13.7% of patients at 6-month post-stroke and there was no difference among 3 groups. Conclusions: According to the morphological classification, BABD is the most frequent subtype of AIPI. The differences of the clinical characteristics and risk factors among three groups indicate that differences observed in morphology might have distinct pathophysiologic mechanisms. AIPI can be reliably classified based on morphology using clinical magnetic resonance images.

[Prevalence and risk factors of perivascular space in the population of Shunyi Study]

Objective: To investigate the prevalence on imaging, topographic distribution and risk factors of perivascular space (PVS) in community population. Methods: This study was based on the population of Shunyi Study in China from June 2013 to September 2016. One thousand two hundred and thirty-two stroke free participants older than 35 years, who completed cerebral MRI, were included. Cardiovascular risk factors were assessed by interview, physical examination and blood sample tests. PVS were evaluated on high-resolution 3-dimensional-T1WI, T2WI and FLAIR sequences. On T1WI, PVS were detected according to 3D imaging criteria. The number and anatomic location of large PVS (≥3 mm) were recorded. And severity of PVS was then semiquantitatively graded in both white matter (WM) and basal ganglia (BG). Associations between risk factors and PVS were analyzed by multinominal Logistic regression models and adjusted for age, gender and relevant confounders. Results: Perivascular spaces were observed in the BG or WM in every subject, aged (55±10) years and 37.3% male. Large PVS were detected in 19.0% (460/1 232) of participants. Severity of PVS was found to be strongly associated with age in both basal ganglia (severe versus mild: OR=1.81; 95%CI 1.45-2.27, P<0.01) and white matter (OR=1.39; 95%CI 1.13-1.71, P<0.01), and the proportion of subjects with hypercholesterolemia decreased with the severity of PVS in BG (OR=0.58, P=0.01) . The present of large PVS was found to be associated with age(present versus absent: OR=1.03, 95%CI 1.02-1.05, P<0.01) and ApoE ε4 carrier genotype(OR=1.53, 95%CI 1.01-2.23, P=0.04). Conclusions: Perivascular spaces are always detected in the BG or WM in elderly people, and large PVS are also prevalent in community-based population. The risk factors are different due to distribution and size, and may depend on anatomic or pathologic characteristics.

Abstract P6-20-05: Therapeutic targeting of BRCA1 and TP53 mutant breast cancer through mutant p53 reactivation

Triple negative breast cancer (TNBC) is an aggressive subset for which novel therapeutic approaches are needed. A significant proportion of TNBC patients harbor either germline or somatic mutations in BRCA1, or epigenetic silencing of BRCA1, which renders them deficient in DNA repair. Virtually all BRCA1 deficient breast cancers harbor mutations in TP53 suggesting that inactivation of p53 is a requirement for tumor progression in the setting of BRCA1 deficiency. Due to this dependency, we hypothesized that restoring wild type p53 function in BRCA1 deficient breast cancer would be therapeutic. The majority of TP53 mutations are missense, which generate a defective protein that potentially can be targeted with small molecules. Zinc Metallochaperones (ZMCs) are a new class of anti-cancer drugs that reactivate a class of zinc deficient mutant TP53 alleles by restoring zinc binding. Using ZMC1 in human breast cancer cell lines expressing the zinc deficient p53R175H, we demonstrate that loss of BRCA1 sensitizes cells to mutant p53 reactivation. Using genetically engineered murine mammary tumor models with Brca1 deficiency, we demonstrate that ZMC1 significantly improves survival in mice bearing tumors harboring the zinc deficient Trp53R172H allele but not the Trp53 null allele. We synthesized a novel formulation of ZMC1 (Zn-1), in which the drug is made in complex with zinc to improve zinc delivery, and demonstrate that Zn-1 has increased efficacy over ZMC1. Furthermore, we show that ZMC1 plus olaparib is a highly effective combination for tumors expressing the p53R172H mutant. In conclusion, we have validated preclinically a novel therapeutic approach for BRCA1 deficient breast cancer through reactivation of mutant p53.

Citation Format: Na B, Yu X, Wither T, Gilleran J, Yao M, Foo TK, Chen C, Moore D, Xia B, Lin Y, Kimball D, Ganesan S, Carpizo D. Therapeutic targeting of BRCA1 and TP53 mutant breast cancer through mutant p53 reactivation [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-20-05.

Abstract P4-14-14: Clinicopathological features and endocrine therapy mode of ER low expression (1%-9%) breast cancer patients in China

Purpose: Since 2010, ASCO/CAP recommended that ER be considered positive if ≥1% tumor cells with positive nuclear staining by immunohistochemistry (IHC) in breast cancer. ASCO/CAP also recommended considering endocrine therapy (ET) in ER positive patients. However, most breast cancers are either ER negative or ER strongly positive (≥10%), and tumors with low ER (1-9%) expression are rare. Up to now, the effect of ET is controversial for these patients with ER 1-9% and unfortunately, we know little about the clinical information of this subgroup. In this study, we analyzed the clinicopathological characteristics and ET mode of patients with low ER expression. We sought to figure out whether the ASCO/CAP guidelines affect clinical ET decision in China and Which features are important considerations for doctors to choose ET. We also evaluated the efficacy of ET in these patients. Methods: Patients diagnosed stage I-III primary invasive breast cancer with ER low expression (1-9%) between January 2008 and December 2016 were retrospectively identified from six hospitals in China. Result: 457 patients (2.7%) had low expression of ER (1-9%) of 17216 patients. Mean age at diagnosis was 49 years. 288 patients (49.9%)were younger than 50 years old. 254 patients (55.6%) had stage II disease and 37 patients (8.1%) had lymphovascular invasion (LVI). 260 patients (56.9%) were HER2 positive; 408 patients had PR negative or low expression; 327 patients' (71.6%) Ki-67 status were &gt; 20%. 388 patients (85%) received chemotherapy. Of those 388 patients, 90% patients received anthracycline combined with taxol chemotherapy regimens. 170 patients (37.2%)received ET. Before 2010, only 25.7% patients with low ER expression received ET. The proportion of ET increased after the 2010 ASCO/CAP guideline was published. In 2013, 50% patients received ET. The rate of ET was totally different in six hospitals. 55% patients received ET in the hospital with highest rate, while only 4% patients received ET in the hospital with lowest rate. Using the univariate logistic regression analysis of ET, ER expression, PR expression, Ki-67 status and LVI were associated with the rate of ET. But after adjustment for other covariates, only ER level was significantly associated with the rate of ET. Compared to patients with ER&lt;5% tumors, patients with ER≥5% tumors had a significantly higher probability of ET rate (OR, 2.882; 95% CI: 1.928-4.308; P &lt; 0.001). Median follow time was 30 months. The 5-year RFS rate was 85%. Younger age and positive lymph nodes were associated with worse RFS. Survival rate did not differ significantly between patients with or without ET (without ER vs with ET: OR, 0.870; 95% CI: 0.508-1.448; p=0.61). Conclusions: 2010 ACSO/CAP recommendation indeed result in an increase of ET rate for patients with 1%-9% ER positive. But these patients do not appear to benefit from ET. Prospective studies are needed for these patients and we need more accurate way to evaluate ER levels, which associate with endocrine response.

Citation Format: Fu P, Wang S, Yao M, Xiang A, Li J, Wang H, Geng C, Jin F, Yin Y, Huang X, Jiang Z. Clinicopathological features and endocrine therapy mode of ER low expression (1%-9%) breast cancer patients in China [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-14-14.

[Expression and distribution of programmed death receptor 1 and T cell immunoglobulin mucin 3 in breast cancer microenvironment and its relationship with clinicopathological features]

Objective: To explore the expression and distribution of programmed death receptor 1 (PD-1) and T-cell immunoglobulin mucin 3 (TIM-3) in breast cancer microenvironment and analyze the their correlation with the clinicopathological features. Methods: The specimens of tumor tissue and adjacent tissues from 30 patients with infiltrative breast cancer who were diagnosed as breast cancer from June 2016 to May 2017 in The First Hospital of Jiaxing were collected, and the specimen were divided into two parts along the center. After embedding and cryosectioning, the expression and distribution of PD-1 and TIM-3 protein in tumor tissues were observed by immunofluorescence staining. Another part of the specimen was cut and digested, and non-continuous density gradient centrifugation was used to extract tumor-infiltrating lymphocytes (TILs), real-time quantitative PCR (qRT-PCR) was used to detect the mRNA expression of PD-1 and TIM-3 in TILs. Meanwhile, the protein expression was determined by Western blotting. The relationship between the expression of PD-1 and TIM-3 and pathological parameters of breast cancer was analyzed with correlation analysis. Results: Immunofluorescence results showed that more PD-1 and TIM-3 positive cells were observed in the tumor tissues compared with the tumor-adjacent tissues. The qRT-PCR showed that the expression of PD-1 and TIM-3 mRNA in TILs were both significantly higher than those in paracancerous tissues (3.09±0.38 vs 1.26±0.23, 3.42±0.31 vs 1.57±0.29, t=4.16, 4.37, both P<0.05). At the protein level, the expression of PD-1 and TIM-3 in tumor tissue lymphocytes(0.66±0.08, 0.80±0.11) was significantly higher than those in cancerous tissues(0.10±0.01, 0.26±0.02) (t=6.79, 4.57, both P<0.05). There were significant differences in the expression of PD-1, TIM-3 mRNA in the TILs between the different tumor histological grades, tumor sizes, lymph node metastasis (t=2.22-2.99, all P<0.05). Correlation analysis showed that there was a significant positive correlation between the expression of PD-1 and TIM-3 in tumor tissues (r=0.616, P<0.01). Conclusions: In the breast cancer microenvironment, PD-1, TIM-3-mediated signaling pathway plays an important role in the occurrence and development of breast cancer, it provides a new basis for the combination therapy of breast cancer.

A Flexible All-in-One Lithium-Sulfur Battery

The recent boom in flexible and wearable electronic devices has increased the demand for flexible energy storage devices. The flexible lithium-sulfur (Li-S) battery is considered to be a promising candidate due to its high energy density and low cost. Herein, a flexible Li-S battery was fabricated based on an all-in-one integrated configuration, where a multiwalled carbon nanotubes/sulfur (MWCNTs/S) cathode, MWCNTs/manganese dioxide (MnO₂) interlayer, polypropylene (PP) separator, and Li anode were integrated together by combining blade coating with vacuum evaporation methods. Each component of the all-in-one structure can be seamlessly connected with the neighboring layers. Such an optimal interfacial connection can effectively enhance electron- and/or load-transfer capacity by avoiding the relative displacement or detachment between two neighboring components at bending strain. Therefore, the flexible all-in-one Li-S batteries display fast electrochemical kinetics and have stable electrochemical performance under different bending states.

[Clinical application of computed tomography angiography and three-dimensional reconstruction in repairing high-voltage electrical burn wounds in necks, shoulders, axillas, and upper arms with tissue flaps]

Objective: To explore the application value of computed tomography angiography (CTA) and three-dimensional reconstruction in repairing high-voltage electrical burn wounds in necks, shoulders, axillas, and upper arms with tissue flaps. Methods: From December 2014 to December 2018, 12 patients with high-voltage electrical burns in necks, shoulders, axillas, and upper arms were hospitalized. The size of wounds ranged from 13 cm×10 cm to 32 cm×15 cm after complete debridement. Before tissue flap repair, the subclavian artery-axillary artery-brachial artery and their branches were examined by CTA. The main target vessels and their branches were conducted by three-dimensional reconstruction, and the development of the axis vessels for the tissue flaps planning to dissect and their branches were observed. For wounds in upper arms, amputation stump bone exposed wounds, and wounds in axillas and the anterior, the latissimus dorsi myocutaneous flap is the first choice for repair, if the thoracodorsal artery and internal and external branches are well developed according to CTA examination. Latissimus dorsi myocutaneous flaps were used in 6 patients with the area of myocutaneous flap ranging from 16 cm×12 cm to 32 cm×17 cm. All the donor sites were covered by split-thickness skin graft of thighs. For large wounds in occiputs, necks, and scapulas, the contralateral lower trapezius myocutaneous flap is the first choice for repair, if the superficial descending branch and deep branch of the contralateral transverse cervical artery are well developed according to CTA examination. For small wounds in necks and scapulas, the ipsilateral lower trapezius myocutaneous flap can be used for repair, if the superficial descending branch of the ipsilateral transverse cervical artery is well developed according to CTA examination. Lower trapezius myocutaneous flaps were used in 4 patients with the area of myocutaneous flap ranging from 18 cm×12 cm to 25 cm×17 cm. The donor site of one patient was sutured directly and the donor site of the other 3 patients was covered by split-thickness skin graft of thighs. For wounds in the posteromedial side of upper arms and the anterior side of axillas, the lateral thoracic skin flaps can be used for repair, if the latissimus dorsi myocutaneous flap can not be utilized for reasons of back burn or no muscle is needed for dead space, when the blood supply of side chest skin is reliable according to CTA examination. Lateral thoracic skin flaps were used in 2 patients with the area of skin flap ranging from 16 cm×12 cm to 17 cm×14 cm. The donor site of one patient was sutured directly and the donor site of the other one patient was covered by split-thickness skin graft of thigh. Results: During the operation of tissue flap repair in 12 patients, the orientation and starting position of the axis vessels were consistent with those observed by CTA examination before operation. All the tissue flaps survived after operation. During follow-up of 1 to 24 months, the patients were satisfied with no serious scar contracture affecting the function nor secondary infection or chronic ulcer. Conclusions: CTA and its three-dimensional reconstruction technique can clearly reconstruct the subclavian artery-axillary artery-brachial artery and their branches before repair of high-voltage burn wounds in necks, shoulders, axillas, and upper arms. It can be used to observe whether the vessels are embolized or not and the starting position and orientation of blood vessels, which can provide an important reference for the selection of tissue flap transplantion.

[A study of the relations of foramen rotundum structure direction and the approach of percutaneous puncturing of radiofrequency thermocoagulation for treating V2 of primary trigeminal neuralgia]

Objective: To investigate the relations of foramen rotundum structure direction and surrounding structure systematically in order to choose the best approach of percutaneous puncturing of radiofrequency thermocoagulation for treating V2 of primary trigeminal neuralgia. Methods: A total of 122 patients with V2 of primary trigeminal neuralgia for radiofrequency thermocoagulation were enrolled from August 2012 to May 2017 at the First Hospital of Jiaxing. CT scan images were observed retrospectively, to find the inside and outside of the foramen rotundum. The direction of foramen rotundum were recorded and the best approach of puncturing were analyzed. Results: The images were divided into four quadrants with the semi - coronal CT scan plane of the lower margin of the zygomatic arch and the outer edge of foramen rotundum for horizontal axis, and the sagittal plane for the vertical axis. In 122 cases, foramen rotundum direction in outer upper quadrant were 77 cases(63.1%), and in outer under quadrant were 22 cases(18.0%), and in inner upper quadrant were 19 cases(15.6%), and in inner under quadrant were 4 cases(3.3%). Conclusion: The most common foramen rotundum direction is in outer upper quadrant, so the best approach of percutaneous puncturing of radiofrequency thermocoagulation for treating V2 of primary trigeminal neuralgia is the upper side against zygomatic and the inner side against the wall of maxillary sinus.

[Clinical application of high mobility group box nuclear protein 1 subcomponent in the progression of liver cancer]

The biological functions of high-mobility group (HMG) proteins include regulation of DNA replication, transcription, recombination and repair. According to molecular weight, sequence alignment and DNA structural characteristics, HMG proteins are subdivided into three superfamilies (HMGA, HMGB and HMGN). Recently, HMGB family members (HMGB1, HMGB2, HMGB3, and HMGB4) found to interact with hepatitis B or C virus. Therefore, activation of relevant signaling molecules to regulate transcription of genes related to hepatocellular carcinoma as a mediator of inflammation promoting HCC progression has attracted considerable attentions. This article focuses on the clinical application of the expression of HMGB family members in the process of HCC progression.

[Abnormal expression of angiopoietin-2 associated with invasion, metastasis and prognosis of lung cancer]

Objective: To investigate the relationship between abnormal angiopoietin-2 (Ang-2) expression and invasion/metastasis of lung cancer. Methods: Totally 122 cases of postoperative primary lung cancer tissues and their paracancerous tissues from Jan. 2009 to Dec. 2010 were collected from Affiliated Hospital of Nantong University and Ang-2 expression was analyzed by immunohistochemistry. At the cellular level, the protein and mRNA levels of Ang-2 in lung epithelial cell line Beas-2B and four lung cancer cell lines (SPCA-1, NCI-1650, A549 and NCI-H1975) were observed. The most effective Ang-2-shRNA for Ang-2 transcription was screened and transfected into A 549 lung cancer cells. The Ang-2 expression, Ang-2 gene transcription, cell proliferation, invasion/metastasis, and epithelial-mesenchymal transition (EMT) abilities of lung cancer cells were analyzed by Western blotting, fluorescent quantitative reverse transcriptase PCR, Cell Counting Kit-8 assay, and Transwell cell models for exploring the relationship between Ang-2 expression and invasion/metastasis of lung cancer. Results: The higher Ang-2 expression levels in lung cancerous tissues were closely related to tumor diameter (P=0.008), differentiating degree (P=0.033), TNM stage (P=0.025) and 5-year survival rate (P<0.001). According to the Kaplan-Meier survival curves, the 5-year survival rate of patients with higher expression levels of Ang-2 (16.1%) was significantly poorer than that of patients with lower Ang-2 (80.0%, P<0.001). Significant difference of 5-year survival rate was found in patients with different Ang-2 levels at TNM stage Ⅰ(P<0.001), but not at stage Ⅱ, Ⅲ and Ⅳ. Among Beas-2B and four lung cancer cell lines, the protein and mRNA levels of Ang-2 in A549 cells were the highest. After Ang-2-shRNA-1 plasmid successfully transfected into A549 cells, cell proliferation rate was significantly lower than that in the shRNA-negative or blank group at a time-dependent manner. The significant decrease of the invasion, migration and EMT abilities were also found in A549 cells after transfection of Ang-2 shRNA. Conclusion: Abnormal expression of Ang-2 is closely related to invasion, migration and prognosis of lung cancer, and interfering the activation of Ang-2 would be a novel molecular-targeted therapy for lung cancer.

[Study on the application of dexmedetomidine combined with remifentanil in dressing change of conscious patients with non-intubation in burn intensive care unit]

Objective: To observe the analgesic and sedative effect and safety of application of dexmedetomidine combined with remifentanil in dressing change of conscious patients with non-intubation in burn intensive care unit. Methods: Forty patients conforming to the study criteria hospitalized in our burn intensive care unit from April 2015 to April 2017 were selected. Prospective, randomized, and double-blind method was used for the design. Patients were divided into dexmedetomidine group and dexmedetomidine+ remifentanil group according to the random number table, with 20 cases in each group. Patients in the two groups were respectively given corresponding drugs during dressing change. The frequency and time of dressing change, Verbal Rating Scale (VRS) score of patients during dressing change (at drug administration for 25 minutes) and after dressing change (25 min after dressing change), Ramsay Sedation Score (RSS) during dressing change, satisfaction level for anesthesia of the patients and physicians after dressing change, dosage of remifentanil, and various adverse effects during and after dressing change were recorded. The heart rate, mean arterial blood pressure (MAP), respiratory rate, and pulse oxygen saturation (SpO₂) before drug administration and at 10, 15, and 25 minutes after drug administration were also recorded. Data were processed with analysis of variance for repeated measurement, t test, chi-square test, and Fisher's exact probability test. Results: (1) Totally 38 patients completed the trial. There were no statistically significant differences between patients in two groups in gender, American Association of Anesthesiologist Grading, age, weight, and total burn area (χ²=0.230, 0.146, t=0.224, 0.351, 0.367, P>0.05). (2) The frequency of dressing change of patients in two groups were both 48 times. The time of dressing change and VRS scores during dressing change of patients in two groups were similar (t=0.821, 1.522, P>0.05). The VRS score of patients in dexmedetomidine+ remifentanil group after dressing change was (3.1±0.4) points, obviously lower than (3.8±0.8) points in remifentanil group (t=2.213, P<0.05). The RSS, satisfaction level scores for anesthesia of the patients and physicians after dressing change in dexmedetomidine+ remifentanil group were (3.13±0.32), (3.44±0.41), and (3.13±0.25) points, respectively, obviously better than (1.82±0.24), (2.71±0.23), (2.53±0.41) points in remifentanil group (t=2.226, 2.684, 7.702, P<0.01). The dosage of remifentanil of patients in dexmedetomidine+ remifentanil group was (282±19) μg, obviously less than (340±31) μg in remifentanil group (t=9.896, P<0.01). There were no statistically significant differences between patients in two groups in rates of respiratory inhibition and hypotension (χ²=0.211, 0.154, P>0.05). Compared with those in remifentanil group, the rates of nausea, vomiting, and other gastrointestinal symptoms of patients in dexmedetomidine+ remifentanil group were obviously reduced (P<0.05), but the rate of bradycardia was obviously increased (χ²=6.008, P<0.05). (3) There were no statistically significant differences between patients in two groups in heart rate, MAP, respiratory frequency, and SpO₂ before drug administration (t=0.444, 0.892, 1.059, 1.039, P>0.05). The heart rates of patients in dexmedetomidine+ remifentanil group at 10, 15, and 25 minutes after drug administration were (83±11), (78±10), and (82±14) times per minute, respectively, significantly lower than (95±10), (87±12), and (89±12) times per minute in remifentanil group (t=5.592, 3.992, 2.630, P<0.05 or P<0.01). The MAP of patients in dexmedetomidine+ remifentanil group at 15 and 25 minutes after drug administration were (69.4±3.1) and (73.8±2.2) mmHg (1 mmHg=0.133 kPa), respectively, significantly lower than (75.4±3.0) and (78.1±3.5) mmHg in remifentanil group (t=9.181, 7.206, P<0.01). There were no statistically significant differences between patients in two groups in respiratory frequency at each time point after drug administration (t=1.489, 1.862, 1.963, P>0.05). The SpO₂ of patients in dexmedetomidine+ remifentanil group at 15 minutes after drug administration was 0.972±0.018, obviously lower than 0.979±0.015 in remifentanil group (t=2.070, P<0.05). Conclusions: Application of remifentanil with small dosage has effective analgesia for conscious burn patients with non-intubation during dressing changes, however, adverse effects such as nausea and vomiting are likely to occur. Remifentanil combined with dexmedetomidine not only guarantee the analgesic effect, but also reduce the dosage of analgesics, improve the sedative effect and satisfaction of the patients for anesthesia, and reduce various adverse effects. However, it will increase the incidence of bradycardia and has some inhibition effect on circulation at the same time.

Ex Vivo Generation of Donor Antigen-Specific Immunomodulatory Cells: A Comparison Study of Anti-CD80/86 mAbs and CTLA4-lg Costimulatory Blockade

Adoptive transfer of alloantigen-specific immunomodulatory cells generated ex vivo with anti-CD80/CD86 mAbs (2D10.4/IT2.2) holds promise for operational tolerance after transplantation. However, good manufacturing practice is required to allow widespread clinical application. Belatacept, a clinically approved cytotoxic T-lymphocyte antigen 4-immunoglobulin that also binds CD80/CD86, could be an alternative agent for 2D10.4/IT2.2. With the goal of generating an optimal cell treatment with clinically approved reagents, we evaluated the donor-specific immunomodulatory effects of belatacept- and 2D10.4/IT2.2-generated immunomodulatory cells. Immunomodulatory cells were generated by coculturing responder human peripheral blood mononuclear cells (PBMCs) (50 × 10⁶ cells) with irradiated donor PBMCs (20 × 10⁶ cells) from eight human leukocyte antigen-mismatched responder–donor pairs in the presence of either 2D10.4/IT2.2 (3 μg/10⁶ cells) or belatacept (40 μg/10⁶ cells). After 14 days of coculture, the frequencies of CD4⁺ T cells, CD8⁺ T cells, and natural killer cells as well as interferon gamma (IFN-γ) production in the 2D10.4/IT2.2- and belatacept-treated groups were lower than those in the control group. The percentage of CD19⁺ B cells was higher in the 2D10.4/IT2.2- and belatacept-treated groups than in the control group. The frequency of CD4⁺CD25⁺CD127^lowFOXP3⁺ T cells increased from 4.1±1.0% (preculture) to 7.1±2.6% and 7.3±2.6% (day 14) in the 2D10.4/IT2.2- and belatacept-treated groups, respectively (p<0.05). Concurrently, delta-2 FOXP3 mRNA expression increased significantly. Compared with cells derived from the no-antibody treated control group, cells generated from both the 2D10.4/IT2.2- and belatacept-treated groups produced lower IFN-γ and higher interleukin-10 levels in response to donor-antigens, as detected by enzyme-linked immunospot. Most importantly, 2D10.4/IT2.2- and belatacept-generated cells effectively impeded the proliferative responses of freshly isolated responder PBMCs against donor-antigens. Our results indicate that belatacept-generated donor-specific immunomodulatory cells possess comparable phenotypes and immunomodulatory efficacies to those generated with 2D10.4/IT2.2. We suggest that belatacept could be used for ex vivo generation of clinical grade alloantigen-specific immunomodulatory cells for tolerance induction after transplantation.

[Clinical effects of a combination treatment with narrow-spectrum intense pulsed light and fractional carbon dioxide laser on hypertrophic scar pruritus]

Objective: To observe the effects of a combination treatment with narrow-spectrum intense pulsed light and fractional carbon dioxide laser on hypertrophic scar pruritus in clinic. Methods: A prospective randomized controlled study was conducted. A total of 90 patients with hypertrophic scars conforming to the inclusion criteria who were hospitalized in our ward from March to December 2017 were divided into combination treatment group and control group according to the random number table, with 45 patients in each group. For scar pruritus, patients in control group were treated twice by narrow-spectrum intense pulsed light with a one-month interval, while patients in combination treatment group were firstly treated by narrow-spectrum intense pulsed light combined with fractional carbon dioxide laser once, and with narrow-spectrum intense pulsed light once one month later. Before and 3 months after treatment, scar pruritus was evaluated by the Visual Analogue Scale and the Four-item Itch Questionnaire, and the improvement of scar was assessed by photography. Three months after treatment, the treatment satisfaction of scar pruritus was self-rated by patients. Meanwhile, adverse effects were recorded during the procedures and follow-up periods. Data were processed with Chi-square test, paired t test, Wilcoxon rank-sum test, and Fisher's exact probability test. Results: Before treatment, there was no statistically significant difference in scar pruritus degree evaluated by the Visual Analogue Scale and score distribution of scar pruritus location, extent, frequency, and sleep effect of the Four-item Itch Questionnaire between patients of two groups (Z=-1.08, -0.91, -0.03, -0.69, -1.49, P>0.05). Three months after treatment, there was reducing degree of scar pruritus of patients evaluated by the Visual Analogue Scale in control group or combination treatment group compared with before treatment within the same group (Z=-1.98, -4.65, P<0.05 or P<0.01), while the latter was more obvious than the former (Z=-2.14, P<0.05). There were reducing scores of scar pruritus extent and frequency of patients in control group, along with location, extent, frequency, and sleep effect of patients in combination treatment group compared with those before treatment within the same group (Z=-2.33, -2.34, -3.53, -4.96, -3.32, -4.84, P<0.05 or P<0.01). However, scores of scar pruritus location and sleep effect of patients in control group were similar to those before treatment within the same group (Z=-0.58, -1.34, P>0.05). The scores of scar pruritus location, extent, frequency, and sleep effect of patients were obviously lower in combination treatment group compared with control group (Z=-2.09, -2.69, -1.99, -2.23, P<0.05 or P<0.01). It was much better of scar improvement of patients in combination treatment group compared with control group (Z=-4.00, P<0.01). The percentages of treatment satisfaction of scar pruritus of patients with 0, 1%-25%, 26%-50%, 51%-75%, 76%-100% were 0, 2.2% (1/45), 17.8% (8/45), 48.9% (22/45), and 31.1% (14/45) respectively in combination treatment group, which were obviously better than 0, 11.1% (5/45), 53.3% (24/45), 28.9% (13/45), and 6.7% (3/45) in control group (Z=-4.42, P<0.01). During the treatment and follow-up periods, the adverse effect ratio of patients in control group was 6.7% (3/45), similar to 2.2% (1/45) of combination treatment group (P>0.05). Conclusions: The combination of narrow-spectrum intense pulsed light and fractional carbon dioxide laser can greatly reduce pruritus, improve effect of scar treatment, and bring higher patient satisfaction compared with narrow-spectrum intense pulsed light alone in treating hypertrophic scar pruritus. Clinical trial registration: Chinese Clinical Trial Registry, ChiCTR-ONH-17012350.