[Influential factors for failure of enhanced recovery after surgery from hepatectomy for hepatocellular carcinoma and the establishment of risk prediction model].

Objective: To investigate the influential factors for failure of enhanced recovery after surgery(ERAS) from hepatectomy for hepatocellular carcinoma(HCC) patients and then to establish a risk prediction model. Methods: The relevant clinical data of 180 patients with HCC undergoing hepatectomy at Department of Hepatic Surgery, Affiliated Provincial Hospital, Anhui Medical University from January 2016 to June 2017 were analyzed retrospectively.There were 149 male patients and 31 female patients aging of (56.5±11.0)years(from 33 to 84 years old). The factors affecting postoperative failure of ERAS of HCC patients were identified by univariate and multivariate analyses, and then, all the obtained factors and their statistical values were used to establish the risk prediction model. Results: A total of 23 patients failed in the ERAS protocol(12.8%). The preoperative total bilirubin (TBIL), alanine aminotransferase(ALT) and amount of intraoperative bleeding were independent risk factors for failure of ERAS from hepatectomy(all P<0.05). The obtained risk prediction model was presented as follows: risk coefficient(R)=0.114×(TBIL)+ 0.082×(ALT)+ 0.008×(amount of intraoperative bleeding). At the cut of value of R=7.90, the area under the ROC curve of this model for predicting failure of ERAS was 0.866(95%CI: 0.788-0.945, P<0.01), with the sensitivity and specificity of 69.6% and 91.1%, respectively.External validation results indicated that the scoring system had good differential ability(area under the ROC curve=0.889, 95%CI: 0.811-0.967, P<0.01). Conclusions: Higher level of preoperative TBIL(>21 µmol/L) and ALT(>50 U/L) and the larger amount of intraoperative bleeding (more than 400 ml) are independent risk factors for failure of ERAS inpatients undergoing hepatectomy for HCC and the established prediction model may have certain value for risk assessment.

Metal induced self-assembly of designed V-shape protein into 2D wavy supramolecular nanostructure.

In order to understand and imitate the more complex bio-processes and fascinating functions in nature, protein self-assembly has been studied and has attracted more and more interest in recent years. Artificial self-assemblies of proteins have been constructed through many strategies. However, the design of complicated protein self-assemblies utilizing the special profile of building blocks remains a challenge. We herein report linear and 2D nanostructures constructed from a V shape SMAC protein and induced by metal coordination. Zigzag nanowires and wavy 2D nanostructures have been demonstrated by AFM and TEM. The zigzag nanowires can translate to a 2D nanostructure with an excess of metal ions, which reveals the step by step assembly process. Fluorescence and UV/Vis spectra have also been obtained to further study the mechanism and process of self-assembly. Upon the protein nanostructure, fluorescence resonance energy transfer (FRET) could also be detected using fluorescein modified proteins as building blocks. This article provides an approach for designing and controlling self-assembled protein nanostructures with a distinctive topological morphology.

Three-dimensional ultrasound-assisted popliteal catheter placement revealing aberrant anatomy: implications for block failure.

BACKGROUND: The current means of introducing continuous sciatic catheters include nerve stimulation, with or without catheter stimulation techniques. More recently, ultrasound has been utilized to facilitate catheter placement. METHODS: This case represents a stimulating catheter-guided continuous block facilitated by three-dimensional ultrasound, which revealed aberrant anatomy with proximal and wide bifurcation of the sciatic nerve with implications for block failure. RESULTS: Before ultrasound imaging secondary failures were attributed to catheter misplacement or dislodgement. CONCLUSION: Because of this case observation, our current practice is to use ultrasound confirmation of the bifurcation of the nerve of all popliteal catheter placements, particularly catheters placed in patients having ambulatory procedures to prevent secondary failure of catheters at home.

Update on ropivacaine.

Long-acting local anaesthetics are primarily used in the practice of anaesthesia, particularly in regional anaesthesia and analgesia. Ropivacaine is a new long-acting local anaesthetic that has been the focus of interest because of its increased cardiovascular safety compared with bupivacaine. Other advantages of ropivacaine over bupivacaine include a greater sensorimotor differential block and shorter elimination half-life (t(1/2)), with a lower potential for accumulation. The most important attribute of ropivacaine, however, is its increased margin of safety compared with bupivacaine when given in equal doses. Many post-marketing studies have focused on the comparisons of efficacy in blocks and toxicity profiles of bupivacaine versus ropivacaine. Recent animal toxicity studies confirm the results of original studies showing that ropivacaine has less cardiovascular toxicity than bupivacaine with respect to direct myocardial depression, success of resuscitation and arrhythmogenic potential when given in equal doses. Reduced cardiotoxicity may be a distinct characteristic of ropivacaine. A review of current literature suggests that, at clinically relevant doses, ropivacaine provides the lowest potential risk of cardiotoxicity for inadvertent intravascular injection. Studies are currently under way comparing ropivacaine with levobupivacaine, the latest addition to the group of long-acting local anaesthetics.

[Protective effect of ONO-1078, a leukotriene antagonist, on focal cerebral ischemia in mice].

AIM: To determine whether ONO-1078 [pranlukast, 4-oxo-8-[p-(4-phenylbutyloxy) benzoyl-amino]-2-(tetrazol-5-yl)-4H-1-benzopyran hemihydrate], a potent leukotriene antagonist, has protective effect on focal cerebral ischemia in mice. METHODS: Focal cerebral ischemia was induced by permanent middle cerebral artery (MCA) occlusion in mice. ONO-1078 (0.01, 0.05, 0.10 mg.kg-1), dexamethasone (0.5 mg.kg-1), nimodipine (0.2 mg.kg-1) or saline (control) were injected i.p. once daily for 3 days, and 30 min before MCA occlusion. Twenty-four hours after cerebral ischemia, the neurological scores were evaluated, infarct volumes and areas of the right and left cerebral hemispheres were measured by computer imaging analysis. RESULTS: ONO-1078, dexamethasone and nimodipine reduced the neurological scores. ONO-1078 and dexamethasone reduced the ratio of right/left hemisphere area, indicating inhibition of brain edema, while nimodipine showed no effect. ONO-1078 dose-dependently reduced infarct size, and dexamethasone and nimodipine showed the same effect. CONCLUSION: ONO-1078 showed protective effect on focal cerebral ischemia. This may represent a novel approach to the treatment of acute cerebral ischemia.

[Data analysis of 492 times centrifuge examination].

Objective. To sum up the experiences and to find the regularity of centrifuge examinations. Method. The data of nine years of centrifuge examination (from 1988 to 1996) of pilots who suffered from black out or LOC frequently were analyzed. Result. There were totally 492 times centrifuge examinations. First centrifuge examination included 229 pilots, 49 qualified, 180 unqualified. Second centrifuge examination included 263 pilots, 50 qualified, 213 unqualified. The pilots were all male. The average age of first centrifuge examination was 29.27 +/- 4.87 years. Average flying time was 1015.24 +/- 131.89 h. 68.7% of their plane was JJ-6 or above. Conclusion. Most pilots undergoing centrifuge examination these nine years were 26-35 year old, and had flown for 601-1200 h. The planes they flew are mostly high-performance fighter aircraft. Close attention must be paid to pilots under similar condition by the flight surgeon. It is recommended that the special equipment of G-tolerance training should be added to the fighter aircraft units.

Investigation on the effect of selenium on T lymphocyte proliferation and its mechanisms.

The effects of selenium on T lymphocyte proliferation and its mechanisms have been investigated. The results showed that selenium is able to enhance lectin-stimulated T lymphocyte proliferation, to increase the production of interleukin 2 (IL-2) by lymphocytes and interleukin 1 (IL-1) by macrophages in the presence of lectin and to augment the response of T lymphoblasts to IL-2 and that of thymocytes to IL-1. The data presented suggest that selenium may be an important modulator for immune response. Selenium might enhance IL-2 production and response through the augmentation of IL-1 production and response, thereby promoting the enhancement of the proliferation and action of T lymphocytes and other immunocompetent cells. Based on these results, we may consider using selenium as an immunological enhancement agent to enhance or recover immune functions of the organism.

Effect of tumor-derived immunosuppressive factor(s) on interleukin 2 and on expression of interleukin 2 receptor.

In this paper, we have described the effects of tumor-derived immunosuppressive factor(s) (TDSF) on interleukin 2 (IL-2) production, on IL-2 responsiveness and on the expression of IL-2 receptors. The results showed that TDSF was able to markedly inhibit the production of IL-2 from PHA-stimulated lymphocytes and IL-2-dependent proliferation of activated lymphocytes, and to partially inhibit the expression of IL-2 receptor. These results suggest that inhibiting IL-2 production and responsiveness may be a major mechanism by which TDSF inhibit T lymphocyte proliferation and other immune responses. That TDSF exerted a very potent inhibiting action on IL-2 responsiveness is especially noticeable if we consider using IL-2 as an immunotherapeutic agent. This may be an important reason why treatment of tumor with IL-2 did not yield satisfactory results so far.

Effect of insulin on the production of interleukin 2 by T lymphocytes.

The effect of insulin on interleukin 2 (IL-2) production was investigated. The results showed that insulin alone did not stimulate the resting T lymphocytes to produce IL-2, but enhanced the production of IL-2 by T lymphocytes and interleukin 1 (IL-1) by macrophages in the presence of lectin. Insulin augmented the response of T lymphocytes to IL-1 in the presence of Con A. The peak time of IL-2 production was not affected by insulin.

Biologic characteristics of an immunosuppressive factor derived from a human lung cancer cell line.

A 549, a human lung cancer cell line, spontaneously produces a tumor-derived immunosuppressive factor (TDSF) which inhibited PHA-stimulated T lymphocyte proliferation via a noncytotoxic mechanism. The inhibition increased in a dose-dependent pattern. The factor also markedly suppressed production of interleukin (IL-2) by PHA-stimulated lymphocytes and IL 2-dependent proliferation of activated lymphocytes. The fact that TDSF possessed very potent inhibitive action on IL-2 is especially noteworthy if we consider the use of IL-2 as immunotherapeutic agent. The synthesis of the factor was inhibited by mitomycin C, actinomycin D and cycloheximide, indicating that the factor is a genic product of A 549 cells. The factor is chemically a protein with a molecular weight greater than 150 KD and sensitive to extremes of pH, heating to 60 degrees C and trypsin treatment.

Investigation on the inhibitory effect of tumor-derived immunosuppressive factor(s) on T lymphocyte proliferation.

Using five tumor cell lines, the effect of tumor-derived immunosuppressive factor(s) (TDSF) on T lymphocyte proliferation and its mechanism have been investigated. It was found that TDSF markedly inhibited PHA-stimulated T lymphocyte proliferation via a noncytotoxic mechanism. The inhibition increased in dose-dependent manner and the maximum inhibition was achieved when the factor was added at the initiation of the culture. When PBMC were preincubated with supernatants of tumor cells for 24 h, washed extensively and then cocultured with freshly prepared PBMC, similar suppressive effects were observed. The above results indicated that the activation of any suppressor cell subgroup may be one of the mechanisms of immunosuppressive action of TDSF.

Biologic effects of freezing on tissues of the maxillofacial region.

An experimental study was done on the effects of freezing on various tissues of the maxillofacial region. After freezing, skin became necrotic, but the wound healed with a flat surface. Blood vessels showed injury of the endothelial cells and thrombosis in the veins. The internal wall of some arteries became thickened, and the lumen was narrowed. Paralysis of the facial nerve occurred immediately after freezing. Function usually recovered several weeks later. Cartilage and bone showed no change in shape after freezing, but the cells were destroyed. New cartilage and bone formation were seen in the later stages.