Clinical Study on Safety and Efficacy of MicrowaveAblation for Primary Hyperparathyroidism

Objective@#To evaluate the safety, feasibility, and efficacy of microwave ablation (MWA) for the treatment of primaryhyperparathyroidism (PHPT). @*Materials and Methods@#This study enrolled 67 PHPT patients (22 men, 45 women; mean age, 56.0 ± 16.3 years; range, 18–83 years) from January 2015 to December 2018. The laboratory data, including the serum intact parathyroid hormone (iPTH),calcium, phosphorus, and alkaline phosphatase (ALP) levels, were evaluated before MWA and again 2 hours, 1 day, 7 days, 1month, 3 months, 6 months, 12 months, 18 months, and 24 months after. @*Results@#Complete ablation was achieved with all 72 hyperplastic parathyroid glands found on the 67 patients enrolled, 64 ofwhom were treated in one session and 3 were treated over two sessions. The technical success rate was 100%. The medianfollow-up time was 13.6 months (range, 10.0–31.1 months). The clinical success rate was 89.4%. The volume reduction ratewas 79.4% at 6 months. Compared to pre-MWA, the serum iPTH, calcium, phosphorus, and ALP levels had significantlyimproved 6 months post-MWA (iPTH, 157.3 pg/mL vs. 39.2 pg/mL; calcium, 2.75 ± 0.25 mmol/L vs. 2.34 ± 0.15 mmol/L;phosphorus, 0.86 ± 0.20 mmol/L vs. 1.12 ± 0.22 mmol/L; ALP, 79 U/L vs. 54 U/L, respectively; all, p < 0.01). Hoarseness wasa major complication in 4 patients (6.0%), but it improved spontaneously within 2–3 months. @*Conclusion@#MWA is safe, feasible, and effective for the treatment of PHPT.

Protective Effect of Ulinastatin against Activation of Tourniquet-Induced Platelet Mitochondria Apoptotic Signaling / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To investigate the protective effect of ulinastatin against the activation of tourniquet-induced platelet mitochondria apoptotic signaling.</p><p><b>METHOD</b>44 patients with unilateral lower limb operation and tourniquet application were randomly divided into normal saline group and ulinastatin group, and were treated with normal saline and ulinastatin respectively. 12 patents with unilateral lower limb operation but without tourniquet application were enrolled in control group. Lipid hydroperoxide (LPO) in serum was detected by LPO assay kit, the content of ATP was examined by fluorescein-luciferase assay kit; the change of mitochondrial membrane potential (Δ ψm) was detected by JC-1 mitochondrial membrane potential kit; the content of cytoplasmic cytochrome C was examined by Cytochrome C ELISA kit; Caspase-3 activity was detected by Caspase-3 fluorometric assay kit.</p><p><b>RESULTS</b>As compared with control group, the patients in normal saline group exhibited significant platelet mitochondrial dysfunction which characterized by low ATP level and low mitochondrial membrane potential (Δ ψm) (P < 0.05). Tourniquet application resulted in the activation of the mitochondria apoptotic signaling in platelet, displaying increase in the serum LPO level, release of mitochondrial cytochrome C into the cytoplasm, and activation of caspase-3 (P < 0.05). These alterations above-mentioned were obviously improved by ulinastatin treatment (P < 0.05).</p><p><b>CONCLUSION</b>Tourniquet induces platelet mitochondrial dysfunction and mitochondria-dependent apoptotic signaling activation, which can be improved by ulinastatin treatment.</p>

Effect of mean arterial pressure on arterial to end-tidal CO₂partial pressure difference during one-lung ventilation / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the effect of different mean arterial pressures (MAP) on arterial to end-tidal CO₂partial pressure difference [(Pa-et)CO₂] and the intrapulmonary shunt (Qs/Qt) in patients undergoing thoracic surgery during one-lung ventilation (OLV).</p><p><b>METHODS</b>Forty-two patients undergoing right-sided pulmonary lobectomy were allocated into group A with fluctuation of MAP (at 20 min after OLV) within ± 10% of the baseline (n=22) and group B with lowered MAP by 30% of the baseline (n=20). Arterial and venous blood gas analyses were recorded to calculate [(Pa-et)CO₂] and Qs/Qt at 20 min after induction with two-lung ventilation (T₁), 20 min after OLV (T₂), 30 min after recovery of normal blood pressure (T₃), and 20 min after recovery of two-lung ventilation (T₄).</p><p><b>RESULTS</b>PetCO₂and PaCO₂were well correlated during two-lung ventilation and OLV in group A (P<0.05). In group B, [(Pa-et)CO₂] at T₂was significantly higher than that in group A, but PetCO₂was still correlated with PaCO₂(P<0.05). Qs/Qt increased more obviously in group B than in group A in T₂(P<0.05). Bo obvious correlation was found between the [(Pa-et)CO₂] and Qs/Qt during OLV.</p><p><b>CONCLUSION</b>PetCO₂reflects the dynamic changes of PaCO₂under normal blood pressure during OLV. In the hypotension period, when [(Pa-et)CO₂] increases and the correlation coefficient between PetCO₂and PaCO₂lowers, PetCO₂may not accurately reflect the changes of PaCO₂and blood gas analysis is warranted.</p>

Bispectral index monitoring prevent awareness during total intravenous anesthesia: a prospective, randomized, double-blinded, multi-center controlled trial / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Awareness is a serious complication of general anesthesia. In China, the incidence of intraoperative awareness was 1% in patients undergoing total intravenous anesthesia (TIVA). In this study, we compared the incidence of awareness between Bispectral index (BIS)-guided and routine TIVA protocol and evaluated the effect of BIS on preventing awareness.</p><p><b>METHODS</b>A prospective, randomized, double-blinded, multicenter controlled trial was performed. Patients (≥ 18 years of age) undergoing TIVA were randomly divided into BIS-guided group (Group A, BIS was monitored and recommended to maintain between 40 - 60) and control group (Group B, BIS was monitored but the screen was covered). The intraoperative BIS values were downloaded and the BIS trends of confirmed awareness cases were analyzed to determine whether light anesthesia existed.</p><p><b>RESULTS</b>Of the total 5228 patients, 2919 patients were assigned to Group A and 2309 to Group B. Four cases of confirmed awareness (0.14%) were reported in the BIS-guided group and 15 (0.65%) in the control group (P = 0.002, OR = 0.21, 95% confidence intervals: 0.07 - 0.63). The incidence of possible awareness (0.14% vs. 0.26%, P = 0.485) and dreaming (3.1% vs. 3.1%, P = 0.986) was comparable between BIS-guided group and the control group. Among the 19 confirmed awareness cases, intraoperative BIS trends of six cases were downloaded and identified. Five of them showed signs of light anesthesia as BIS > 60 and lasted 19 - 106 minutes, whereas one case had a stable BIS trend and the values were within 60 during the operation. Another five awareness cases were reviewed for anesthesia procedures, of which improper light anesthesia were confirmed.</p><p><b>CONCLUSIONS</b>BIS-guided TIVA (BIS was recommended to maintain between 40 - 60) decreased the risk of awareness compared with routine TIVA. The main reason for awareness was light anesthesia.</p>

A proteomic study of peripheral blood mononuclear cells in patients undergoing cardiopulmonary bypass / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To explore the effect of cardiopulmonary bypass (CPB) on the profile of protein expression in peripheral blood mononuclear cells (PBMCs).</p><p><b>METHODS</b>Eleven patients undergoing cardiac surgery under cardiopulmonary bypass were enrolled in the study. Peripheral blood samples were collected before CPB (T0), 1 h after CPB (T1) and at the end of operation (T2), and PBMCs were obtained by gradient centrifugation. The profile of protein expression was analyzed using 2-D gel electrophoresis (2-DE) and mass spectrometry. The candidate proteins were further identified by Western blotting.</p><p><b>RESULT</b>Compared to protein profile at T0, 12 protein spots were identified to be up-regulated in PBMCs at T1 (P <0.05), among which S100A9 reached the peak level at T1 and decreased after operation,but not returned to its initial level.</p><p><b>CONCLUSION</b>Results indicate that 12 proteins are likely to be involved in CPB, however, their roles need to be elucidated.</p>

Effects of hypertonic sodium chloride hydroxyethyl starch 40 injection in treatment of acute intracranial hypertension complicated by hemorrhagic shock in dogs / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the effect of hypertonic sodium chloride hydroxyethyl starch 40 injection (HSH) in treatment of acute intracranial hypertension complicated by hemorrhagic shock in dogs, and explore the mechanism of the effects of HSH.</p><p><b>METHODS</b>Twenty dogs were randomized into 4 equal groups, namely the 7.5% NaCl (HS) group, Ringer-Lactates solution (RL) group, hydroxyethyl strarch (HES) group, and HSH group. Canine models of acute intracranial hypertension complicated by hemorrhagic shock were established by epidural balloon inflation with saline and rapid discharge of the arterial blood. One hour after the induced shock, the dogs were given HS (6 ml/kg), RL of 3-fold volume of blood loss, HES of equivalent volume of blood loss, and HSH 8 ml/kg in the 4 groups, respectively. During the shock and resuscitationperiod, the intracranial pressure (ICP), mean arterial pressure (MAP) and cerebral perfusion pressure (CPP) of the dogs were monitored, and the serum sodium level and plasma osmolality were measured at 30 min, 1 h and 4 h after the resuscitation.</p><p><b>RESULTS</b>All dogs had similar MAP, CPP, and ICP before resuscitation (P>0.05). After resuscitation, the MAP was significantly improved (P<0.01), but the dogs in HSH group exhibited the fastest response; with the exception of the dogs in HS group to have significantly decreased MAP 2 h after resuscitation (P<0.01), all the other dogs maintained the MAP for 4 h. The CPP was also significantly increased after resuscitation (P<0.01), and in HS group, CPP decreased significantly after 2 h (P<0.01), and HSH group maintained the high CPP after 4 h. The ICP was increased significantly in RL and HES groups after resuscitation (P<0.01), reaching the peak level at 1 and 3 h, respectively, but in HS and HSH groups, the ICP decreased significantly to the lowest level at 1 h (P<0.01) which was maintained for 4 h. After resuscitation, the plasma sodium and plasma osmolality were significantly increased in HSH and HS groups.</p><p><b>CONCLUSION</b>In dogs with acute intracranial hypertension and hemorrhagic shock, HSH can effectively resuscitate hemorrhagic shock and decrease ICP, and the effect is longer-lasting than that of HS.</p>