Effects of dezocine-remifentanil intravenous anaesthesia on perioperative signs, serum TNF-alpha and IL-6 in liver cancer patients undergoing radiofrequency ablation

Objective: To analyse the impact of dezocine-remifentanil intravenous anaesthesia on perioperative signs, serum tumour necrosis factor-alpha [TNF-alpha], and interleukin-6 [IL-6] in liver cancer patients undergoing radiofrequency ablation [RFA]

Study Design: An experimental study

Place And Duration Of Study: Renmin Hospital of Wuhan University, Wuhan, China, from January 2017 to February 2018

Methodology: Eighty patients with small hepatocellular carcinoma [SHCC] were selected as the research object. They were divided into Group A and Group B with the random number table method, with 40 cases in each group. Group A were given dezocine-remifentanil intravenous anaesthesia and Group B were given midazolam-remifentanil intravenous anaesthesia. Patients' situations in the surgery were compared between the two groups. Changes in heart rate [HR], mean arterial pressure [MAP] and blood oxygen saturation [SpO₂] were recorded before the surgery [T₀], at 5 minutes after the RFA [T₁] and at the end of the RFA [T₂]. Levels of tumour necrosis factor-alpha; [TNF-alpha;] and interleukin-6 [IL-6] on the 1² day after the RFA were compared between the two groups

Results: The wake-up time in Group A was shorter than Group B [p<0.001], and the VAS pain score in Group A was lower than Group B [p<0.001]. At T₁, the MAP in Group A was higher than Group B [p<0.001]. There was no significant difference in MAP between the two groups at T₀ and T₂ [p=0.881, 0.696, respectively]. At T₁ and T₂, the HR in Group A was lower than Group B [all p<0.001]. There was no significant difference in HR between the two groups at T₀ [p=0.684]. There was no significant difference in SpO₂ between the two groups at T₀, T₁ and T₂ [p=0.654, 0.884 and 0.798, respectively]. On the 1st day after the RFA, the level of TNF-alpha;, IL-6 in Group A were lower than those of Group B [all p<0.001]. There was no significant difference in the incidence of intraoperative complications between the two groups [p=0.644]

Conclusion: Compared with midazolam-remifentanil intravenous anaesthesia, the dezocine-remifentanil method has a better analgesic effect, shorter wake-up time, and can effectively regulate the expression of inflammatory cytokines TNF-alpha; and IL-6. However, the effect of remifentanil on the respiratory function is dose-dependent. Therefore, respiratory cycle monitoring and management should be strengthened during the surgery

The expression of GABA(A) receptor alpha1 and GABA(B) receptor 1 in medulla oblongata solitary nucleus and ambiguous nucleus in the cases of tramadol intoxication / 法医学杂志

OBJECTIVE@#To observe the expression of GABA(A) receptor alpha1 (GABA(A)alpha1) and GABA(B) receptor 1 (GABA(B)1) in human medulla oblongata solitary nucleus and ambiguous nucleus due to tramadol-induced death.@*METHODS@#GABA(A)alpha1 and GABA(B)1 were detected by immunohistochemical SP method in tramadol-induced death group and control group. All results were evaluated by images analysis system.@*RESULTS@#Low expression of GABA(A)alpha1 and GABA(B)1 were detected in solitary nucleus and ambiguous nucleus in the control brain tissue. In cases of tramadol-induced death, the expression of GABA(A)alpha1 and GABA(B)1 significantly increased.@*CONCLUSION@#The mechanism of tramadol intoxication death could be caused by respiratory depression induced by over-expression of GABA(A)alpha1 and GABA(B)1 in medulla oblongata solitary nucleus and ambiguous nucleus.

Tramadol intoxication and its toxicological effect / 法医学杂志

Tramadol is a centrally acting analgesic with a dual mode of action. Its analgesic efficacy is attributed to its partial affinity for the mu-opiate receptor and its inhibition of norepinephrine and serotonin reuptake. Acting in a synergistic manner and being more efficacious, tramadol is used worldwide for the treatment of moderate to severe acute or chronic pain. Abuse and dependence of tramadol as well as tramadol-related deaths have been increasingly reported, either ingested alone or taken in combination with other potentially interacting drugs. The possible toxic effect of tramadol was reviewed from aspects of its analgesic mechanisms, adverse effect, dependence, and abuse.

An investigation on the transmission routes and early diagnosis of intrauterine infection induced by hepatitis B virus / 中华肝脏病杂志

<p><b>OBJECTIVES</b>To analyze the relationship between the fetus infection and HBV M, HBV DNA in amniotic fluid, umbilical cord blood, maternal blood and placenta, and to explore the mechanism of vertical transmission of HBV.</p><p><b>METHODS</b>Immunonetric assay and nucleic acid amplification hybri-comb were used. Both HBV M and HBV DNA were detected in amniotic fluid, vein blood, umbilical cord blood for each of 65 HBV-positive women in their different gestational periods, while immunohistochemical analysis was carried out on the tissue of placenta, liver, lung or heart from each abortive fetus/dead infant in the case.</p><p><b>RESULTS</b>For all of the 65 HBsAg-positive women in their different gestational periods, the detected positive rate of HBsAg was 21.50% in amniotic fluid, and 20.00% in umbilical blood. The positive rate of HBsAg, HBeAg, Anti-HBc and HBV DNA detected in blood, amniotic fluid and umbilical blood was 6.15%. The cases with positive HBsAg, Anti-HBe, Anti-HBc and negative HBV DNA were in a percentage of 13.85%. Immunohistochemical analysis on placentas after birth/abortion as well as the tissues of livers, lungs, hearts of the fetuses/dead infants in 4 cases of pregnant women with positive HBsAg, HBeAg, Anti-HBc or HBV DNA in blood, amniotic fluid or umbilical blood showed that HBsAg, HBcAg positive cells in the scope could be seen in every layer of the tissue of placenta, in the hepatic/pulmonary tissue, but not in the cardiac tissue.</p><p><b>CONCLUSION</b>The infection in amniotic fluid or placenta relates to HBV infection in fetus; intrauterine HBV may result in infection in organs such as blood, liver, or lung of a fetus; infection in the amniotic fluid may be another key route of the intrauterine infection of fetus, and the detection on HBV M or HBV DNA in amniotic may be used as one of diagnostic proofs of HBV infection of fetus in its early stage.</p>