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Objective:To explore the risk factors influencing the prognosis for patients with hepatocellular carcinoma (HCC) recurrence after liver transplantation and summarize the relevant diagnostic and therapeutic experiences.Methods:The clinicopathological features with diagnosis and treatment plan of 102 recurrent HCC patients fulfilling the Fudan Criteria were compared for survival rate (univariate analysis) and independent prognostic indicators were obtained by Cox multivariate analysis.Results:The 1/3/5-year overall survival rates were 92.2%, 48.6% and 34.6% and the 1/3/5-year survival rates with tumor were 63.2%, 31.0% and 16.7% respectively. Cox regression analysis indicated that patient age, whether tumor can be surgically resected or not and personalized diagnostic & therapeutic plan based upon targeted therapy were independent prognostic factors affecting the overall survival rates and survival rates with tumor.Conclusions:Although HCC recurrence and metastasis after liver transplantation seriously influence patient prognosis, satisfactory outcomes may be obtained for some patients through active, effective and precise managements.
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<p><b>BACKGROUND</b>Patients on hemodialysis have a high-mortality risk. This study analyzed factors associated with death in patients on maintenance hemodialysis (MHD). While some studies used baseline data of MHD patients, this study used the most recent data obtained from patients just prior to either a primary endpoint or the end of the study period to find the characteristics of patients preceding death.</p><p><b>METHODS</b>Participants were selected from 16 blood purification centers in China from January 2012 to December 2014. Patients' data were collected retrospectively. Based on survival status, the participants were divided into two groups: survival group and the death group. Logistic regression analysis was performed to determine factors associated with all-cause mortality.</p><p><b>RESULTS</b>In total, 4104 patients (57.58% male, median age 59 years) were included. Compared with the survival group, the death group had more men and more patients with diabetic nephropathy (DN) and hypertensive nephropathy. The patients preceding death also had lower levels of diastolic blood pressure, hemoglobin, serum albumin, serum calcium, serum phosphate, Kt/V, and higher age. Multivariate analysis revealed that male sex (odd ratio [OR]: 1.437, 95% confidence interval [CI]: 1.094-1.886), age (OR: 1.046, 95% CI: 1.036-1.057), and presence of DN (OR: 1.837, 95% CI: 1.322-2.552) were the risk factors associated with mortality. High serum calcium (OR: 0.585, 95% CI: 0.346-0.989), hemoglobin (OR: 0.974, 95% CI: 0.967-0.981), albumin (OR: 0.939, 95% CI: 0.915-0.963) levels, and dialysis with noncuffed catheter (OR: 0.165, 95% CI: 0.070-0.386) were protective factors based on a multivariate analysis.</p><p><b>CONCLUSIONS</b>Hemodialysis patients preceding death had lower hemoglobin, albumin, and serum calcium levels. Multivariate analysis showed that male sex, age, DN, low hemoglobin, low albumin, and low serum calcium were associated with death in hemodialysis patients.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , China , Multivariate Analysis , Renal Dialysis , Mortality , Retrospective Studies , Risk FactorsABSTRACT
Objective To investigate the effect of 3‐dimensonal conformal radiotherapy (3D‐CRT ) combined with dendritic cell‐cytokine induced kill (DC‐CIK) cell in the treatment of recurrent small cell lung carcinoma (SCLC) in high altitude regions ,and its influence on VEGF and NSE .Methods Eighty‐five patients with recurrent SCLC in the tumor radiotherapy department of the Qinghai Provincial Fifth People′s Hospital from May 2012 to April 2014 were selected and divided into the control group(41 cases) and observation group(44 cases) according to the random number table .The two groups were respectively treated by 3D‐CRT treat‐ment and 3D‐CRT combined with DC‐CIK treatment cell .The curative effect ,incidence rate of adverse reactions ,levels of VEGF and NSE ,changes of liver and renal function indexes in the two groups were compared before and after treatment .Results The ef‐fective rate and sickness control rate of the observation group were 65 .9% and 79 .5% respectively ,which were higher than those in the control group ,and the differences were statistically significant (P0 .05) .The levels of liver and renal function indexes had no statistically significant differences between before and after treatment(P>0 .05) .Conclusion 3D‐CRT combined with DC‐CIK cell in the treatment of recurrent SCLC in high altitude regions has more obvious curative effect ,moreover has no obvious influence on radiotherapeutic adverse reactions ,and liver and renal functions .
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Idiopathic pulmonary fibrosis ( IPF) is a kind of Interstitial lung disease with cause unknown,which is aggressive for its increasing prevalence and high morbidity and mortality.At present the pathogenesis of IPF is not entirely clear, but cells and cel-lular interactions play a decisive role on the alveolar inflammation and fibrosis results.We review IPF related cells of interest ( immune competent cells and fibroblast, fibrocyte, myofibroblast, endothelial and alveolar epithelial cells) , to summarize cells and cellular in-teractions in the pathogenesis of IPF,and discuss new research directions and therapeutic targets.
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<p><b>OBJECTIVE</b>To explore the effect of polydatin on the growth of TGF-β₁induced humanalveolar epithelium A549 cells and the mechanism of polydatin for inhibiting the process of epithelial-mesenchymal transition (EMT).</p><p><b>METHODS</b>A549 cells in vitro cultured were randomly divided into five groups, i.e., the blank group, the control group, the low dose polydatin group, the middle dose polydatin group, the high dose polydatin group. Common culture fluid was added in A549 cells of the blank group. Five ng/mLTGF-β₁contained culture fluid was added in A549 cells of the control group. 50, 100, and 150 μmol/mL of polydatin plus 5 ng/mL TGF-β₁contained culture fluid was added in A549 cells of low, middle, and high dosepolydatin groups, respectively. Morphological changes were observed and recorded at different time points. The optimal concentration of polydatin was determined by MTT method. Protein and mRNA expressions of E-cad epithelial cell marker) and Vimentin (mesenchymal cell marker) were detected by Western blot and Real-time PCR.</p><p><b>RESULTS</b>Under inverted phase contrast microscope, A549 cells turned from previous pebble shape to fusiform shape after intervened by polydatin and TGF-β1. The intercellular space was enlargedand the intercellular connection became loose. These phenomena were more obviously seen in the control group. A549 cells were more satiated in low, middle, and high dose polydatin groups than in the control group. The EMT inhibition was most obviously seen in the middle dose polydatin group at 48 h. Protein and mRNA expressions of E-cad showed an overall descending tendency after intervened by polydatin and TGF-β1 (P < 0.05). But compared with the control group, protein and mRNA expressions of E-cad were down-regulated in a lesser amplitude in each intervened group. Besides, the tendency was more obviously seen at 48 h than at 24 h. Protein and mRNA expressions of Vimentin showed an overall up-regulating tendency. But compared with the control group, protein and mRNA expressions of Vimentin were down-regulated in a lesser amplitude in each intervened group. Besides, the tendency was more obviously seen at 48 h than at 24 h (P < 0.05). CONCLUSIONS Polydatin could inhibit TGF-β1 induced EMT process of A549 cells time- and dose-dependently. It also played roles in inhibiting pulmonary fibrosis.</p>
Subject(s)
Humans , Cadherins , Metabolism , Cell Line , Epithelial Cells , Epithelial-Mesenchymal Transition , Glucosides , Pharmacology , Stilbenes , Pharmacology , Transforming Growth Factor beta1 , Pharmacology , Vimentin , MetabolismABSTRACT
[Objective] To investigate the relationship between the body constitution and the syndromes of the bronchiectasis patients and provide the basis for the clinical treatment.[Methods] Col ected 80 out-patients and in-patients of bronchiectasis in the first affiliated hospital of Zhejiang Chinese Medical University from May 2011 to March 2012. Al patients met with the inclusion criteria, adopted the standardization of physical scale for physical identifica-tion and dialectical type and analyzed the relationship between constitution and syndrome.[Results] ①The gentleness type, qi-deficiency type and yin-defi-ciency type were more popular in the bronchiectasis, fol owed by the phlegm-wet type, wetness-heat type, yang-deficiency type and qi-depression type. The special inherited type and blood-stasis type were very rare. ②The syndrome of phlegm heat obstructing lung was the top one in the Chinese tradi-tional medical syndromes(48.75%).The frequency of liver-fire attacking lung syndrome, hyperactivity of fire due to yin deficiency syndrome and qi-yin de-ficiency syndrome were 21.25%, 18.75% and 11.25% respectively. ③From different body constitution distribution of TCM syndromes in patients with bronchiectasis, it could be found:gentleness type, qi-deficiency type, yang-deficiency type, phlegm-wet type and wetness-heat type were most presented as phlegm-heat stasis lung syndrome. Patients with qi-deficiency type were most presented as qi-yin deficiency syndrome .Patients with Yin deficiency type were always performed as hyperactivity of fire due to yin-deficiency syndrome. Patients with lung qi-stasis type were liver-fire invading lung syn-drome.[Conclusion] Phlegm-heat stasis syndrome was the main syndrome in patients with bronchiectasis. It conformed to the pathological characteristics of deficiency essence with virtual reality. Different body constitutions decided the different traditional Chinese medical syndromes after the disease onset.
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BACKGROUND: High-dose remifentanil-based anesthesia is associated with opioid-induced hyperalgesia (OIH) and postanesthetic shivering (PAS). These effects can be prevented by N-methyl-d-aspartate (NMDA) receptor antagonists. This study aimed to investigate correlations between OIH and PAS caused by high-dose remifentanil and the effects of low-dose ketamine on OIH and PAS. METHODS: Seventy-five patients scheduled for single-port laparoscopic gynecologic surgery were randomly allocated into three groups, each of which received intraoperative remifentanil: group L at 0.1 microg/kg/min; group H at 0.3 microg/kg/min; and group HK at 0.3 microg/kg/min plus 0.25 mg/kg ketamine just before incision, followed by a continuous infusion of 5 microg/kg/min ketamine until skin closure. RESULTS: PAS, postoperative tactile pain threshold, and the extent of hyperalgesia in group H were significantly different (P < 0.05) than in the other two groups. PAS was significantly correlated with OIH, including mechanically evoked pain such as postoperative tactile pain threshold (r = -0.529, P = 0.01) (r = -0.458, P = 0.021) and the extent of hyperalgesia (r = 0.537, P = 0.002) (r = 0.384, P = 0.031), respectively, in group H and group HK. Notably, both groups were treated with high-dose remifentanil. Tympanic membrane temperature, time to first postoperative analgesic requirement, postoperative pain scores, analgesic consumption, and cumulative patient-controlled analgesia volume containing morphine were comparable in all three groups. CONCLUSIONS: OIH, including the enhanced perception of pain, and PAS were both associated with high-dose remifentanil, were significantly correlated and were attenuated by a low dose of ketamine. This suggests that a common mechanism in part mediated through activation of the central glutamatergic system (e.g., NMDA receptors), underlies the two effects caused by high doses of remifentanil.
Subject(s)
Female , Humans , Analgesia, Patient-Controlled , Anesthesia , Gynecologic Surgical Procedures , Hyperalgesia , Ketamine , Morphine , N-Methylaspartate , Pain Threshold , Pain, Postoperative , Shivering , Skin , Tympanic MembraneABSTRACT
Hyaluronidase is a protein enzyme extracted from goat or ovine testis. It breaks down hyaluronic acid in connective tissues, thereby reducing swelling and edema and increasing drug penetration into tissues after injection. Because of these properties, it is being increasingly used in the field of pain management. The most frequently reported hyaluronidase-induced complications are allergic reactions, and are usually reported in cases involving eye surgery. However, there are only a few cases of allergic reactions reported in the field of pain management. Here, we report a case involving a 52-year-old patient diagnosed with an allergic reaction after receiving epidural administration of hyaluronidase. A literature review and comparison of our case with similar cases suggested the potential mechanisms underlying these allergic reactions and emphasized the importance of considering the possibility of these reactions in patients receiving hyaluronidase during the course of pain management procedures.
Subject(s)
Humans , Middle Aged , Connective Tissue , Edema , Goats , Hyaluronic Acid , Hyaluronoglucosaminidase , Hypersensitivity , Injections, Epidural , Pain Management , TestisABSTRACT
BACKGROUND: Opioids not only exert an antinociceptive effect, but also modulate central N-methyl-D-aspartate (NMDA) receptors, resulting in hyperalgesia and acute opioid tolerance. This study was aimed to investigate the effect of the NMDA receptor antagonist, magnesium in preventing remifentanil-induced hyperalgesia. METHODS: For this study, 75 patients scheduled for robot-assisted laparoscopic prostatectomy were randomly allocated into three groups of patients whose incision sites were infiltrated: Group M, with 25% magnesium sulfate 80 mg/kg; Group S, with the same volume of saline under remifentanil-based anesthesia, and Group D, with the same volume of saline under desflurane based anesthesia. All three groups were infiltrated into incision sites after pneumoperitoneum. Intraoperative evaluation included mean remifentanil dose, and postoperative evaluation included pain severity at time intervals of 30 min, 6, 12, 24 and 36 hours, time to first postoperative analgesic requirement, and analgesic dosage required during 24 hours. RESULTS: Mean remifentanil doses during the intraoperative periods in group M were significantly lower than those in group S (P < 0.001). The time to first postoperative analgesic requirement in postoperative period in groups M and D was significantly longer than that in group S (P < 0.001). Visual analog scale scores for pain in groups M and D were significantly lower than those in group S for 12 hours after operation. CONCLUSIONS: A relatively high dose and continuous infusion of remifentanil were associated with opioid induced hyperalgesia. Wound infiltration with magnesium sulfate decreased opioid consumption and reduces opioid induced hyperalgesia.
Subject(s)
Humans , Analgesics, Opioid , Anesthesia , Hyperalgesia , Intraoperative Period , Isoflurane , Magnesium , Magnesium Sulfate , N-Methylaspartate , Piperidines , Pneumoperitoneum , Postoperative Period , ProstatectomyABSTRACT
<p><b>OBJECTIVE</b>To develop an UPLC method for the determination of leonurine in traditional Chinese medicines.</p><p><b>METHOD</b>An Acquity UPLC BEH C18 column (2.1 mm x 100 mm) with 1.7 microm particle size was used. The mobile phase was composed of methanol and ammonium formate buffer (pH 4.0) in gradient mode. The flow rate was 0.3 mL x min(-1) and the chromatograpic run time was 18 min for one sample.</p><p><b>RESULT</b>The results showed that there was significant difference in the content of leonurine in the leonurus products from different pharmaceutical companies. The leonurine content in those products is in the range of 45.6-193 microg x g(-1).</p><p><b>CONCLUSION</b>The method is simple, reproducible and reliable. It can be used to control the quality of related drugs.</p>
Subject(s)
Chromatography, High Pressure Liquid , Methods , Drugs, Chinese Herbal , Gallic Acid , Leonurus , ChemistryABSTRACT
BACKGROUND: Early oral intake (EOI) associated with early recovery of normal bowel function has been shown to be an important determinant for improving patients' satisfaction. We investigated the tolerability of EOI and its effects on the recovery of bowel function after epidural anesthesia. METHODS: A prospective randomized trial of patients undergoing lower extremities surgery under epidural anesthesia was performed. A liquid drink was given to 150 patients in the EOI group 1 hours after surgery, and to 150 patients in the delayed oral intake (DOI) group 8 hours after surgery. We recorded presence of bowel sounds immediately after operation, symptoms of ileus, time to the first flatus, time to the first defecation, degree of appetite before the first meal, and patients' satisfaction. RESULTS: There was no significant difference in the presence of immediate postoperative bowel sounds, the degree of appetite before the first meal, mild ileus, and severe ileus between groups. Time to the first flatus and time to the first defecation in the EOI group were shorter than those of the DOI group. The patients' satisfaction in the EOI group was higher than that of the DOI group. CONCLUSIONS: For uncomplicated patients undergoing lower extremities under epidural anesthesia, beginning oral hydration as early as 1 hour after the operation is safe and well tolerated and resulting in faster recovery of bowel function and higher patients' satisfaction.
Subject(s)
Humans , Anesthesia, Epidural , Appetite , Defecation , Flatulence , Ileus , Lower Extremity , Meals , Prospective StudiesABSTRACT
BACKGROUND: Opioid tolerance may involve activation of the N-methyl-D-aspartate (NMDA) system. The possible involvement of the NMDA system suggests that one of the NMDA receptor antagonists, magnesium may be a useful adjunct to opioids for the treatment of postoperative pain following remifentanil infusion. METHODS: For this study, 70 patients scheduled for major abdominal surgery under remifentanil-based anesthesia were randomly allocated into groups that received either magnesium sulfate (group M) or saline (group C) intravenously. The patients in the group M received 25% magnesium sulfate at a dose of 50 mg/kg in 100 ml of saline, and those in the group C received an equal volume of saline prior to the induction of anesthesia. In addition, patients in both groups received 10 mg/kg/h infusion of either magnesium sulfate (group M) or an equal volume of saline (group C) until the end of surgery. Pain was assessed using a visual analog scale at 30 min, and 6, 12, 24, and 36 hours after operation. The time to the first use of postoperative analgesic and cumulative analgesic consumption in both groups were also evaluated. RESULTS: The visual analog scale scores for pain and cumulative analgesic consumption were significantly lower in the group M than in the group C. The time to the first use of postoperative analgesic was significantly shorter in group C than in the group M. CONCLUSIONS: Use of the NMDA-receptor antagonist, magnesium sulfate as an adjuvant analgesic reduced postoperative pain in patients undergoing major abdominal surgery under remifentanil-based anesthesia.
Subject(s)
Humans , Analgesics, Opioid , Anesthesia , Magnesium , Magnesium Sulfate , N-Methylaspartate , Pain, Postoperative , PiperidinesABSTRACT
BACKGROUND: The use of regional local anesthetics or opioids during laparoscopic cholecystectomy (LC), in combination with general anesthesia, has been investigated in several interventional studies. METHODS: We studied a total of 240 (n = 60, each) patients who were undergoing LC, and they received local infiltration and intraperitoneal instillation with normal saline or 0.25% levobupivacaine 60 ml. Group R (S) received infiltration of normal saline 20 ml before incision and at the end of surgery and then 40 ml intraperitoneal instillation after removal of the gall bladder under remifentanil-based anesthesia. Group R (L) received 0.25% levobupivacaine instead of normal saline in the same method like group R (S). Group S (S) received the same method as group R (S) under sevoflurane based anesthesia in place of remifentanil. Group S (L) received 0.25% levobupivacaine instead of normal saline with the same method as group S (S). Pain was assessed on a visual analog scale at 1, 6, 12 and 24 hours after operation. RESULTS: The pain intensity of Group R (L) was significantly lower than that of group R (S), and the the incisional pain of group S (L) was significantly lower than that of group S (S) in the first six hours. The time delay to first operative analgesics in group R (S) and group S (S) was significantly shorter than that of group R (L) and group S (L). CONCLUSIONS: Infiltration and instillation of levobupivacaine reduced the postoperative pain and remifentanil did not increase the pain severity and opioid requirement when performing the LC.
Subject(s)
Humans , Analgesics , Analgesics, Opioid , Anesthesia , Anesthesia, General , Anesthetics, Local , Bupivacaine , Cholecystectomy, Laparoscopic , Hypogonadism , Methyl Ethers , Mitochondrial Diseases , Ophthalmoplegia , Pain, Postoperative , Piperidines , Surgical Instruments , Urinary BladderABSTRACT
<p><b>OBJECTIVE</b>To investigate the association of MspI polymorphism of Cytochrome P4501A1 (CYP1A1) gene and smoking to the susceptibility to coronary artery disease (CAD).</p><p><b>METHODS</b>The genotypes of CYP1A1 MspI site were detected using the methods of polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) in 349 cases with CAD and 404 non-CAD as controls. CAD diagnosis was confirmed by coronary angiograms. Genetic risk of CYP1A1 genotypes was analyzed by smoking index (SI).</p><p><b>RESULTS</b>The frequency of the predominant homozygotes TT, heterozygotes TC and the rare homozygotes CC in CAD group were not different with that of the controls (chi(2) = 3.224, P = 0.200). But in the smokers, the frequency of CC in CAD group was higher than that of non-CAD group (P = 0.002), while its odds ratio was 3.142 [95% confidence interval (CI) 1.481 - 6.668]. The odds ratio of genotype CC and heterozygote TC was 2.215 (95% CI 1.087 - 4.510) in the low dose cigarette smoking group, and was 1.407 (95% CI 0.709 - 2.791) in the high dose cigarette smoking group.</p><p><b>CONCLUSION</b>Both MspI polymorphism of CYP1A1 gene and smoking exposure promote the development of CAD.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Coronary Artery Disease , Genetics , Cytochrome P-450 CYP1A1 , Genetics , Gene Frequency , Genetic Predisposition to Disease , Genotype , Polymorphism, Genetic , Smoking , GeneticsABSTRACT
Charcot-Marie-Tooth disease, which is also known as hereditary motor and sensory neuropathy, is a heterogenous group of inherited diseases of the peripheral nerve. The spectrum of severity varies from asymptomatic individuals to those with severe limb abnormalities requiring corrective surgery. We report two brothers who had previously been diagnosed with Charcot-Marie- Tooth disease 3 years earlier and were scheduled to undergo a correction osteotomy of both feet under general anesthesia. General anesthesia was induced with propofol 2 mg/kg, rocuronium 0.8 mg/kg and was maintained with O2-N2O-Sevoflurane. The younger brother showed no delay in recovery of the neuromuscular blockade but the elder brother showed a delay.
Subject(s)
Humans , Anesthesia, General , Charcot-Marie-Tooth Disease , Extremities , Foot , Hereditary Sensory and Motor Neuropathy , Neuromuscular Blockade , Osteotomy , Peripheral Nerves , Propofol , Siblings , Tooth DiseasesABSTRACT
BACKGROUND: Induction with propofol has a high incidence of pain, as well as postoperative nausea and vomiting (PONV). The aim of this study was to assess the effect of a course of dexamethasone on the pain, postoperative nausea and vomiting associated with a Propofol injection, in patients undergoing otolaryngology-head and neck surgery. METHODS: One hundred twenty adults, 20-60 years of age, ASA physical status I or II, were allocated to one of two groups. Either dexamethasone 5 ml (8 mg) or saline 5 ml was administered intravenously to each group. After 60 seconds, propofol was injected into the patients' hand veins over a 30 second period and the patient was asked questions regarding the injection pain after 10 seconds. Postoperative nausea, vomiting and post-tonsilectomy pain were recorded in the recovery room (1 h after surgery) and in the hospitalization area (6 h after surgery). RESULTS: The severity and incidence of pain at the time of the propofol injection, PONV, and the level of post-tonsillectomy pain were significantly lower in the dexamethasone group than in the control group. CONCLUSIONS: The prophylactic intravenous administration of 8 mg dexamethasone is effective in reducing the severity of pain after a propofol injection and after the tonsillectomy, and decreased the incidence of PONV.
Subject(s)
Adult , Humans , Administration, Intravenous , Dexamethasone , Hand , Hospitalization , Incidence , Nausea , Neck , Pain, Postoperative , Postoperative Nausea and Vomiting , Propofol , Recovery Room , Tonsillectomy , Veins , VomitingABSTRACT
Phantom limb pain is a painful sensation from an absent limb. The onset of pain is generally early, with 75% of patients developing pain within the first few days after amputation. The frequency and duration of attacks tend to be reduced with time, although the prevalence and intensity remain constant. We report here a case of a 38-year-old man who exhibited the signs and symptoms of phantom limb pain due to the above-knee amputations of both legs. He was not responded to opioid therapy and a continuous intravenous infusion of ketamine, an N-methyl-D-aspatate receptor antagonist, reduced his severe pain.
Subject(s)
Adult , Humans , Amputation, Surgical , Extremities , Infusions, Intravenous , Ketamine , Leg , Phantom Limb , Prevalence , SensationABSTRACT
Transient global amnesia is characterized by a sudden inability to form new memories (anterograde amnesia) that usually last for minutes to several hours but never longer than 24 hours. and there are no other focal neurologic signs or symptoms. Retrograde amnesia from a few hours to many years may also be associated with this condition. We report a case of a 56-year-old female patient who experienced transient global amnesia in the recovery room after general anesthesia. She repeated the same queries several times to persons nearby and appeared perplexed. A detailed neurologic examination was otherwise entirely normal. Her symptoms resolved completely the next day.