The successful treatment of systemic toxic induced paraquat poisoning by skin absorption: case reports and a literature review.

Paraquat (PQ) poisoning is life-threatening, can cause acute organ damage, and has a high mortality. However, cases of skin absorption induced by PQ poisoning are rare. This report describes a case where PQ was absorbed by the patient's skin, causing severe organ damage. Having accidentally touched PQ on his skin, the patient, whose skin festered, became damaged, red, and swollen, developed serious systemic toxic symptoms. The patient recovered after systemic treatment. Generally speaking, being poisoned by PQ through skin absorption is rare. By analyzing the reported PQ poisoning through skin absorption and by reviewing the relevant literature, this paper aims to explore successful treatments for PQ poisoning through skin absorption and to provide treatment guidance for physicians encountering such cases.

Repeated cardiac arrest caused by an air embolism during hepatic resection: A case report.

RATIONALE: Although venous air embolism (VAE) during liver operation has been reported occasionally, fatal VAE in hepatic resection is uncommon. Prompt detection of VAE by transesophageal echocardiography (TEE) is crucial for effective therapy. We describe a case of fatal VAE that caused repeated cardiac arrest during hepatic resection and was confirmed by TEE. PATIENT CONCERNS: A 51-year-old woman with a body weight of 50 kg underwent partial liver resection due to intrahepatic duct calculus. She had a 1-year history of intrahepatic duct calculus without cardiopulmonary disease. The operation was performed under general anesthesia combined with epidural block. When the inferior vena cava was compressed, the PetCO2 level decreased abruptly from 30 to 10 mmHg, followed by a decrease in SpO2 and the development of hypotension. Her heart rate increased with ST interval elevation on electrocardiography monitoring. Ephedrine and phenylephrine were administered immediately but had little effect. Cardiac arrest occurred. DIAGNOSES: Air embolism was detected by TEE. INTERVENTIONS: Resuscitation was successful although cardiac arrest occurred repeatedly. OUTCOMES: The patient returned to consciousness 6 hours postoperatively but died of multiorgan dysfunction 10 days later. LESSONS: Fatal air embolism may happen during hepatic resection. Prompt detection of VAE by TEE is crucial for effective therapy and should always be available during hepatic resection.

Perioperative Single-Donor Platelet Apheresis and Red Blood Cell Transfusion Impact on 90-Day and Overall Survival in Living Donor Liver Transplantation.

BACKGROUND:: Although many previous studies have confirmed that perioperative blood transfusion is associated with poor outcomes after liver transplantation (LT), few studies described the influence of single-donor platelet apheresis transfusion in living donor LT (LDLT). This study aimed to assess the effect of blood products on outcomes for LDLT recipients, focusing on apheresis platelets. METHODS:: This retrospective study included 126 recipients who underwent their first adult-to-adult LDLT. Twenty-four variables including consumption of blood products of 126 LDLT recipients were assessed for their link to short-term outcomes and overall survival. Kaplan-Meier survival curve and the log-rank test were used for recipient survival analysis. A multivariate Cox proportional-hazard model and a propensity score analysis were applied to adjust confounders after potential risk factors were identified by a univariate Cox analysis. RESULTS: Patients who received apheresis platelet transfusion had a lower 90-day cumulative survival (78.9% vs. 94.2%, P = 0.009), but had no significant difference in overall survival in the Cox model, compared with those without apheresis platelet transfusion. Units of apheresis platelet transfusion (hazard ratio [HR] = 3.103, 95% confidence interval [CI]: 1.720-5.600, P < 0.001) and preoperative platelet count (HR = 0.170, 95% CI: 0.040-0.730, P = 0.017) impacted 90-day survival independently. Multivariate Cox regression analysis also found that units of red blood cell (RBC) transfusion (HR = 1.036, 95% CI: 1.006-1.067, P = 0.018), recipient's age (HR = 1.045, 95% CI: 1.005-1.086, P = 0.025), and ABO blood group comparison (HR = 2.990, 95% CI: 1.341-6.669, P = 0.007) were independent risk factors for overall survival after LDLT. CONCLUSIONS:: This study suggested that apheresis platelets were only associated with early mortality but had no impact on overall survival in LDLT. Units of RBC, recipient's age, and ABO group comparison were independent predictors of long-term outcomes.

Graphene oxide regulates endoplasmic reticulum stress: autophagic pathways in nasopharyngeal carcinoma cells.

During carcinogenesis, growth, proliferation, invasion and metastasis, increasing evidence shows that autophagy and endoplasmic reticulum stress (ER stress) are regulated in nasopharyngeal carcinoma, a finding drawing more attention from physicians and scientists. As one of the carbon-based nano-materials, graphene oxide (GO) has been extensively used for its advantages, such as biocompatibility, an ultrahigh surface to volume ratio, abundant surface groups, and a special photothermal effect. The present study is designed to explore the effects of GO on autophagy and ER stress in nasopharyngeal carcinoma cells. Our findings will provide scientific bases for the clinical application of GO and the development of new analogues. GO inhibits the proliferation of HONE1 cells, promotes their apoptosis in a concentration-dependent manner and enhances the expression of the ER stress chaperone GRP78 in HONE1 cells. These results suggest that GO could affect HONE1 cells through the autophagic and ER stress pathways. Thus, GO inhibits the proliferation of nasopharyngeal carcinoma cells via the induction of cytotoxic autophagy. In addition, ER stress is also activated as an adaptive response, so blocking ER stress may enhance the sensitivity of nasopharyngeal carcinoma cells to GO.

[Risk factors of pinhole infection in the fractured lower limbs after external fixation: a case-control study].

OBJECTIVE: To investigate the risk factors of pinhole infection in the fractured lower limbs after external fixation. METHODS: The case-control study was designed. From May 2009 to May 2014, the clinical data of 272 patients with lower limb fracture treated by external fixation device were collected. All the patients were divided into two groups according to post-operative pinhole infection. There were 29 cases in the case group including 23 males and 6 females. The age of patients in case group ranged from 25 to 77 years old,with the average age of (53.41 ± 12.77) years old. There were 243 cases in control group including 217 males and 26 females. The age of patients in the control group ranged from 27 to 78 years old, with the average age of (48.71 ± 11.87) years old. There were nine risk factors observed in our study including age, gender, fixed time by external fixation device, diabetes, time in bed, smoking, operation condition of other parts in the body, infection condition of other parts in the body. RESULTS: The results of univariate analysis showed that there were statistically significant differences among age (χ² = 15.708, P < 0.001), fixed time by external fixation device (χ² = 11.940, P < 0.001), severity of the lower limb fracture (χ² =15.438, P < 0.001), diabetes (χ² = 8.519, P = 0.004) and time in bed (χ² = 7.165, P = 0.007) between case group and control group. The results of Logistic regression analysis showed that the risk factors of pinhole infection after fixed by external fixation device in the lower limb fracture were the advanced age (OR = 8.327, P < 0.001), fixed time by external fixation device (OR = 6.795, P < 0.001), diabetes (OR = 4.965, P = 0.001) and time in bed (OR = 4.864, P = 0.008). CONCLUSION: The advanced age, long fixed time, diabetes and long time in bed could increase the risk of pinhole infection after external fixation in the lower limbs with fracture.

[Anesthetic management of Stanford type A aortic dissection operation].

OBJECTIVE: To explore the anesthetic management experiences of patients with Stanford A aortic dissection undergoing surgical treatment through moderate or deep hypothermia circulatory arrest (DHCA). METHODS: From June 2008 to December 2011, a total of 77 patients undergoing surgical treatment of Stanford A aortic dissection was recruited. RESULTS: Cardiopulmonary bypass (CPB) was established under general anesthesia in all patients. The procedures included moderate hypothermia (n = 51) and DHCA (n = 26). The total surgical duration was 152 - 600 (292 ± 91) min, CPB time 38 - 310 (128 ± 43) min and aortic cross-clamp time 31 - 169 (87 ± 26) min. The time of circulatory arrest under deep hypothermia was 20 - 113 (41 ± 19) min in 26 patients. Among 77 patients, there were 5 intraoperative and 7 postoperative fatalities. The remained 65 patients were discharged postoperatively and received a regular outpatient follow-up. None of them died or required reoperation. CONCLUSION: Surgical treatment is appropriate and efficient for the patients with Stanford A aortic dissection. During surgery, the keys of preventing neurological complications are blood volume monitoring and blood protection.

The effect of nitrous oxide on intracuff pressure of the size 2 ProSeal Laryngeal Mask Airway.

STUDY OBJECTIVE: To investigate intracuff pressure changes in the ProSeal Laryngeal Mask Airway (PLMA) during 50% nitrous oxide (N2O) anesthesia. DESIGN: Prospective, randomized study. SETTING: Operating room of a university-affiliated hospital. PATIENTS: 40 ASA 1 and 2 children, aged 2 to 6 years, weighing 10-20 kg, undergoing elective inguinal herniorrhaphy with general anesthesia. INTERVENTIONS AND MEASUREMENTS: Patients were assigned to two groups (n = 20). Patients in Group A were anesthetized with 50% N(2)O in oxygen and sevoflurane, while patients in Group B were anesthetized with 50% air in oxygen and sevoflurane. PLMA cuffs were inflated with air. PLMA intracuff pressures starting from a baseline pressure of 30 mmHg were recorded using a pressure transducer for 30 minutes. The occurrence of postoperative throat discomfort was recorded. MAIN RESULTS: In Group A, who inhaled 50% N2O for 30 minutes, intracuff pressures reached 86.7 ± 10.4 mmHg, while in Group B, who inhaled 50% air for 30 minutes, intracuff pressures were 29.7 ± 1.0 mmHg. The postoperative throat complication rate in Group A was 45%, which was significantly higher than in Group B (5%). CONCLUSION: PLMA intracuff pressure increased significantly during 50% N2O anesthesia. The children's postoperative throat complication rate also was increased.

[Effect of doxycycline on inflammation-related cytokines and apoptosis in human conjunctival epithelial cells].

OBJECTIVE: To evaluate the effects of doxycycline on the regulation of intercellular adhesion molecule-1 (ICAM-1, CD54), interleukin-1beta (IL-1beta), human leukocyte antigen DR (HLA-DR) and apoptosis in human conjunctival epithelial cells. METHODS: Human primary conjunctival epithelial cells were isolated and cultured from donors and identified by immunohistochemistry. Cultured epithelial cells were treated with either 0 U/ml IFN-gamma, 300 U/ml IFN-gamma, 300 U/ml IFN-gamma with 10 microg/ml doxycycline, 300 U/ml IFN-gamma with 20 microg/ml doxycycline, 300 U/ml IFN-gamma with 40 microg/ml doxycycline or 300 U/ml IFN-gamma with 100 microg/ml dexamethasone for 24 hours. The amount of CD54, HLA-DR and IL-1beta was measured by flow cytometry and western blot analysis. Apoptosis was evaluated by flow cytometry after the cultured epithelial cells were treated for 72 hours. RESULTS: Cultured conjunctival epithelial cells can express CD54 and IL-1beta. IFN-gamma increased the amount of CD54 and IL-1beta (P < 0.01). Doxycycline and dexamethasone inhibited the IFN-gamma induced increase of express of CD54 and IL-1beta of cultured conjunctival epithelial cells, and the inhibiting effect was dependent on the concentration of doxycycline (P < 0.01). Very little HLA-DR and apoptosis were detected before and after treatment with IFN-gamma. CONCLUSION: Doxycycline can suppress the expression of inflammatory cytokine such as CD54 and IL-1beta, which suggests that doxycycline may be a potent drug for the treatment of ocular surface inflammatory disease.

Neurturin-deficient mice develop dry eye and keratoconjunctivitis sicca.

PURPOSE: Neurturin has been identified as a neurotrophic factor for parasympathetic neurons. Neurturin-deficient (NRTN(-/-)) mice have defective parasympathetic innervation of their lacrimal glands. This study was conducted to evaluate tear function and ocular surface phenotype in NRTN(-/-) mice. METHODS: Determined by tail genomic DNA PCR, 25 NRTN(-/-) mice and 17 neurturin-normal (NRTN(+/+)) mice aged 6 weeks to 4 months were evaluated. Aqueous tear production, tear fluorescein clearance and corneal sensation were serially measured. Corneal permeability to AlexaFluor dextran (AFD; Molecular Probes, Eugene, OR) was measured by a fluorometric assay at 485 nm excitation and 530 nm emission. Histology was evaluated in PAS-stained sections. Mucin and HLA class II (IA) antigen were assessed by immunofluorescent staining. Tear IL-1beta was measured by ELISA, and tear matrix metalloproteinase (MMP)-9 by zymography. Gene expression in the corneal epithelia was analyzed by semiquantitative RT-PCR. RESULTS: In comparison to that in age-matched NRTN(+/+) mice, aqueous tear production, tear fluorescein clearance, and corneal sensation were significantly reduced in NRTN(-/-) mice, whereas corneal permeability to AFD was significantly increased. Immunoreactive MUC-4 and -5AC mucin and goblet cell density (P < 0.001) in the conjunctiva of NRTN(-/-) mice were lower than in NRTN(+/+) mice. The expression of MUC-1 and -4 mRNA by the corneal epithelium was reduced in NRTN(-/-) mice. There were a significantly greater number of IA antigen-positive conjunctival epithelial cells in NRTN(-/-) mice than NRTN(+/+) mice. Tear fluid IL-1beta and MMP-9 concentrations and the expression of IL-1beta, TNF-alpha, macrophage inflammatory protein (MIP)-2, cytokine-induced neutrophil chemoattractant (KC), and MMP-9 mRNA by the corneal epithelia were significantly increased in NRTN(-/-) mice, compared with NRTN(+/+) mice. CONCLUSIONS: Neurturin-deficient mice show phenotypic changes and ocular surface inflammation that mimic human keratoconjunctivitis sicca. This model supports the importance of a functional ocular surface-central nervous system-lacrimal gland sensory-autonomic neural network in maintaining ocular surface health and homeostasis.