右美托咪定混合低浓度罗哌卡因用于腹横肌平面阻滞的有效性及安全性

目的观察右美托咪定混合低浓度罗哌卡因用于腹横肌平面阻滞的有效性及安全性。方法选择在全身麻醉下行腹腔镜结直肠癌根治术患者60例,所有患者术毕送麻醉恢复室(PACU)后在超声引导下行双侧腹横肌平面阻滞。采用随机数字表法,分成3组:0.19%罗哌卡因+生理盐水(19R组)、0.19%罗哌卡因+50μg右美托咪定(19RD组)及0.25%罗哌卡因+生理盐水(25R组),每组分别于两侧腹横肌平面注射药液各30 ml。所有患者术后均使用舒芬太尼静脉自控镇痛(PCIA)。比较3组患者术后2(T1)、4(T2)、8(T3)、12(T4)及24 h(T5)的Ramsay镇静评分、静息及咳嗽时疼痛评分(VAS评分);记录术后3组患者第1次需求PCIA距离手术结束时间(T);24 h镇痛泵PCIA请求与给药次数;不良反应发生的例数、术后镇痛满意度评分及发生局部麻醉药中毒的症状的例数。结果 3组患者不同时点的Ramsay镇静评分比较差异无统计学意义(P>0.05);与25R组比较,19R组静息时VAS评分在T1、T2、T3及T4时较高,19R组咳嗽时VAS评分在T1、T2及T3时较高,两组比较,差异有统计学意义(P<0.05)。19R组患者第1次镇痛泵PCIA请求距离手术结束时间(T)(16.9±13.1)h较25R组的(26.1±15.5)h缩短,差异有统计学意义(P<0.05);19R组患者24 h舒芬太尼PCIA总消耗量(V)、PCIA给药次数(D1)与PCIA请求次数(D2)与25R组比较,差异有统计学意义(P<0.05),19R组均高于25R组;19R组患者镇痛满意度评分与25R组比较,差异有统计学意义(P<0.05),19R组低于25R组;而19RD组与25R组比较,差异无统计学意义(P>0.05)。3组均未见腹横肌平面阻滞穿刺引起的不良反应或局部麻醉药中毒症状。结论超声引导下50μg右美托咪定混合低浓度(0.19%)罗哌卡因可安全有效地用于腹横肌平面阻滞,达到与0.25%罗哌卡因相当的镇痛效果,对腹腔镜结直肠癌根治术患者能提供有效镇痛,并能减少局部麻醉药中毒的风险。

Functional changes of the heart and lung in perioperative period of orthotopic liver transplantation

Objective: To investigate the variation of functions ofthe heart and lung during orthotopic liver transplan-tation (OLT).Methods: Pulmonary artery cannula and right radialartery cannula were indewelled before anaesthesiaand the parameters of hemodynamics in different pe-riods were monitored. Analysis of variance was usedto reveal the variation among the groups. T hypothe-sis test in paired data was used to compare the preop-erative parameters with those in each period duringoperation and after operation respectively, and tocompare the parameters immediately after operationwith those in each period after operation respective-ly.Results: During the operation, heart rate increased,but blood pressure decreased significantly at the be-ginning of no-liver period, increased again in a shortperiod and then increased progressively 12 h after op-eration. Pulmonary artery pressure (PAP) increasedfrom before the no-liver period to 60 h after opera-tion. Pulmonary wedge pressure changed in accord-ance with the variation of PAP. Cardiac output wasmaintained at a high-output level from before opera-tion to 60 h after operation. Systemic vascular resist-ance (SVR) was within the normal limits before op-eration, whereas pulmonary vascular resistance(PVR) was lower than normal. In the no-liver peri-od during the operation, SVR decreased significant-ly. Both SVR and PVR increased progressively andreturned to normal postoperatively.Conclusions: The patients undergoing OLT have ahigh cardiac output and Iow resistance obstacle be-fore and during the operation, and will recover grad-ually after operation. Monitoring hemodynamicsduring the peri-operative period is of significance inthe prevention and treatment of pneumonedema andcardiac functional insufficiency.

Clinical experience in liver transplantation from an organ transplantation center in China

Objective: To sum up the experience in liver trans-plantation in a period of ten years at a single center.Methods: We retrospectively reviewed the clinical re-cords of 120 patients receiving liver transplantationfrom April 1993 to October 2002. The patients’ cli-nical characteristics, surgical techniques, complica-tions and survival were compared in the phases of1993-1997 (phase Ⅰ), 1999 (phase Ⅱ), and 2000-2002 (phase Ⅲ).Results: Malignant liver diseases were major indica-tions for liver transplantation in phase Ⅰ(100%) andⅡ(53. 3%), but decreased markedly in percentagein phase Ⅲ(34. 0%). When compared with recipi-ents in phase Ⅰ and Ⅱ, the survival of recipients withbenign liver diseases in phase Ⅲ was significantly im-proved with the 3-month, 6-month and 1-year sur-vival rates of 85. 7%, 84. 5% and 83. 1%, respec-tively. For patients with malignant liver diseases, the3-month, 6-month and 1-year survival rates were87. 4%, 81. 1% and 46. 0%, respectively. The rein-fection rate of hepatitis B virus was 24% 12 monthsafter transplantation. With technical refinements,the incidence of postransplantation vascular compli-cations has significantly decreased from 29. 4% inphase Ⅰ and Ⅱ to 4. 9% in phase Ⅲ. Biliary compli-cations remained one of the major obstacles to long-term survival. No reno-venous bypass was applied inphase Ⅲ, providing a promising outcome.Conclusion: Strict selection of potential recipients,technical refinement, appropriate management ofvascular and biliary complications, and prophylaxisof recurrences of hepatitis B and malignant liver dis-eases are important to obtain long-term survival ofpatients receiving liver transplantation in China.

Transplantation Expression of 4-1BB molecule on peripheral blood T cells in liver transplanted patients and its clinical implication

OBJECTIVE: To investigate the gene expression of 4-1BB in peripheral blood mononuclear cells(PBMCs) and its possible significance in clinical liver transplantation.METHODS: Reverse transcription-polymerase chain reaction (RT-PCR) was used to determine the geneexpression of 4-1BB in PBMCs from 22 patients receiving liver transplantation, 13 patients with primaryliver carcinoma (PLC), and 12 healthy controls. To determine whether 4-1BB molecule is also expressedon the surface of CD4^+ and CD8^+ T cell, flow cytometry was used to analyse the phenotype of T cellsubsets from the blood of liver transplantation patients.RESULTS: 4-1BB mRNA was detected in PBMCs from stable survivors after liver transplantation, butalmost not deteeted in PBMCs from PLC patients and healthy controls. Meanwhile, 4-1BB was almost notexpressed on the surface of CD4^+ and CD8^+ T cells in healthy controls and PLC patients. A low level of4-1BB expression, however, was found on the surface of CD4^+ and CD8^+ T cells from the stablesurvivors after liver transplantation.CONCLUSIONS: This study demonstrates that although patients are stable after liver transplantation,effector T-cells can also be activated through the signal of 4-1BB molecule and persistent irmmune responseto grafts. Blockage of 4-1BB/4-1BBL pathway may benefitially reduce the clinical dosage ofimmunosuppressive agents and prolong the survival of grafts.

Biomarkers for hepatocellular carcinoma based on body fluids and feces

Novel non-/minimally-invasive and effective approaches are urgently needed to supplement and improve current strategies for diagnosis and management of hepatocellular carcinoma(HCC).Overwhelming evidence from published studies on HCC has documented that multiple molecular biomarkers detected in body fluids and feces can be utilized in early-diagnosis,predicting responses to specific therapies,evaluating prognosis before or after therapy,as well as serving as novel therapeutic targets.Detection and analysis of proteins,metabolites,circulating nucleic acids,circulating tumor cells,and extracellular vesicles in body fluids(e.g.,blood and urine)and gut microbiota(e.g.,in feces)have excellent capabilities to improve different aspects of management of HCC.Numerous studies have been devoted in identifying more promising candidate biomarkers and therapeutic targets for diagnosis,treatment,and monitoring responses of HCC to conventional therapies,most of which may improve diagnosis and management of HCC in the future.This review aimed to summarize recent advances in utilizing these biomarkers in HCC and discuss their clinical significance.

Living related liver transplantation for an infant with biliary atresia

Objective: To sum up the preliminary experience inliving related liver transplantation (LRLT).Methods: A 9-month-old male infant with biliaryatresia (BA) who had undergone an unsuccessfulKasai operation was defined as a candidate for LR-LT. The donor was his 30-year-old mother. Her la-teral lobe of the left liver was transplanted into theinfant’s body as the graft. The left branches of theportal vein, left hepatic artery and left hepatic veinof the graft were end-to-end anastomosed to the por-tal vein, hepatic artery proper and hepatic vein ofthe recipient respectively. Biliary drainage was re-established via Roux-en-Y operation.Results: The donor retained her liver function within2 weeks after the operation. Steroid and FK506 wereprescribed in immunosuppressive therapy for the re-cipient. The blood bilirubin level of the infant de-creased to normal 2 weeks after operation. No acuterejection occurred. Biliary leakage in the early peri-od after the transplantation was controlled by drain-age, and E. coli infection was effectively treated withantibiotics. The donor and recipient are in satisfacto-ry condition to the present.Conclusion: LRLT is advisable for children with bili-ary atresia.

Early diagnosis and therapeutic strategies for hepatocellular carcinoma:From bench to bedside

Hepatocellular carcinoma(HCC)is the fourth leading cause of cancer-related deaths worldwide.The prognosis of patients with HCC remains poor largely due to the late diagnosis and lack of effective treatments.Despite being widely used,alpha-fetoprotein serology and ultrasonography have limited diagnostic performance for early-stage HCC.The emergence of omics strategies has contributed to significant advances in the development of non-invasive biomarkers for the early diagnosis of HCC including proteins,metabolites,circulating tumor deoxyribonucleic acid,and circulating non-coding ribonucleic acid.Early diagnosis is beneficial to patients as it increases the proportion who can be treated with curative treatment,thus prolonging survival outcomes.Currently,multiple clinical trials involving locoregional,systemic therapies,and combinations of these modalities are changing therapeutic strategies for different stage HCC.Success in several preclinical trials that involve immunotherapeutic innovations has created the potential to complement and enforce other treatment strategies in the future.This review summarizes the most recent advances in noninvasive early molecular detection,current therapy strategies,and potential immunotherapeutic innovations of HCC.

Prophylaxis and treatment of hepatitis B virus reinfection following liver transplantation

Objectives: To prevent and early diagnose hepatitis Bvirus reinfection and recurrent hepatitis B followingliver transplantation, and to discuss the further treat-ment of recurrent hepatitis B.Methods: Liver transplantation recipients receivedlamivudine for prophylaxis of HBV reinfection. Viro-logical and biochemical data, serum HBV-DNA, andimmunohistological staining for HBsAg and HBcAg inliver biopsy specimens were tested in due time.Results: Five patients with hepatitis B virus reinfectionand two patients with hepatitis B recurrence were ob-served after liver transplantation. One patient with re-current hepatitis B developed chronic severe hepatitisB despite treatment. One patient improved after a se-ries of treatment.Conclusions: Hepatitis B virus reinfection or recurrenthepatitis B following liver transplantation occurs most-ly 6-12 months after operation. The diagnosis of hepa-titis B recurrence should be taken into account whenliver biochemical data becomes poor during this pe-riod. The treatment for recurrent hepatitis B after liv-er transplantation includes increased dosage of lamivu-dine, application of famciclovir, and other liver pro-tection measures.

A long follow-up of a patient with bilateral retinoblastoma who underwent globe-preserving therapy and had metastasis after 72mo

Dear Editor,I am Dr.Yi Zhang,from the Department of Pediatrics,Beijing Tongren Hospital,Capital Medical University,Beijing,China.I would like to describe the metastasis in the left parotid and cervical lymph nodes of a patient with bilateral retinoblastoma 72mo after the initial

Natural killer/T-cell lymphoma with intracranial infiltration and Epstein-Barr virus infection: A case report

BACKGROUND Because of atypical clinical symptoms,lymphoma is easily confused with infectious diseases.Extranodal nasal-type natural killer/T-cell lymphoma(NKTL)is more common,and there are few cases of eyelid site onset and intracranial infiltration,which increases the difficulty of diagnosis.This disease usually has a very poor prognosis and there are few reports of recovery.CASE SUMMARY A 3-year-old boy was admitted to our hospital due to an initial misdiagnosis of"eyelid cellulitis"and failed antibiotic treatment.He was characterized by fever,right eyeball bulging,convulsions,and abnormal liver function.His blood Epstein-Barr virus(EBV)DNA was positive(8.798×10^4 copies/mL),and remained positive for about half a year.The cranial imaging examination suggested a space-occupying lesion in the right eyelid,with the right temporal lobe and meninges involved.The boy underwent ocular mass resection.The pathological diagnosis was NKTL.He was diagnosed as having NKTL with intracranial infiltration,combined with chronic active EBV infection(CAEBV).Then he underwent systemic chemotherapy and intrathecal injection.The boy suffered from abnormal blood coagulation,oral mucositis,diarrhea,liver damage,and severe bone marrow suppression but survived.Finally,the tumor was completely relieved and his blood EBV-DNA level turned negative.The current follow-up has been more than 2 years and his condition is stable.CONCLUSION This case suggests that chemotherapy combined with intrathecal injection may have a good effect on intracranial infiltrating lymphoma and CAEBV,which deserves further study and discussion.

Study on the relationship between the expression of NFκB1 and LncRNA-PACER in peripheral blood mononuclear cells of patients with pulmonary tuberculosis

Objective: To investigate the expression relationship between nuclear transcription factor kappa B1 (NFκB1) and long non-coding RNA PACER (LncRNA-PACER) in peripheral blood mononuclear cells (PBMCs) of patients with pulmonary tuberculosis. Methods: From February 2018 to March 2019, 40 patients with pulmonary tuberculosis (tuberculosis group) and 40 healthy persons (control group) were collected, the levels of TNF-α, IL-6 and IL-8 in serum were detected by enzyme-linked immunosorbent assay (ELISA);the expressions of LncRNA-PACER and NFκB1 mRNAs in PBMCs were detected by real-time fluorescence quantitative PCR;Western blot was used to detect the expressions of NFκB1 and COX 2 in PBMCs;Pearson method was used to analyze the expressions of LncRNA-PACER and NFκB1 in PBMCs of patients with pulmonary tuberculosis, and the expressions of LncRNA-PACER and NFκB1 in PBMCs of patients with pulmonary tuberculosis were analyzed. Results: Compared with the control group, the expressions of TNF-α, IL-6 and IL-8 in the serum of patients with pulmonary tuberculosis was significantly increased (P<0.05), and the expressions of LncRNA-PACER, NFκB1 mRNAs, proteins and COX-2 protein in PBMCs were significantly increased (P<0.05). The expressions of LncRNA-PACER and NFκB1 proteins in PBMCs were related to the number of pulmonary lesions and pulmonary cavity (P<0.05), and there was a positive correlation between the expression of LncRNA-PACER and the expression of NFκB1 mRNA in PBMCs of patients with pulmonary tuberculosis (r = 0.873, P<0.05). Conclusions: The expressions of NFκB1 and LncRNA-PACER in PBMCs of patients with pulmonary tuberculosis are significantly increased, they are positively correlated and both of them are related to the occurrence and development of pulmonary tuberculosis.

Clinical analysis of 2790 children with retinoblastoma: a single-center experience in China

Background In this study,we aimed to analyze the clinical characteristics and prognosis of children with retinoblastoma(RB)in a single center in China with a large sample collection spanning 17 years.Methods The clinical data of 2790 children with RB treated in Beijing Tongren Hospital from 2005 to 2021 were collected,and a retrospective analysis was conducted.Results The median age of the participants was 28.3 months.There were 3624 affected eyes,12.4%of which were in groups A–C,67.1%in groups D–E and 16.2%were not specified.The primary symptom observed in most cases was a white pupil,accounting for 66.5%,followed by strabismus(12.8%).The median follow-up time was 59.7 months.The enucleation rate was 71.3%(703/986)in a single left eye and 72.5%(702/968)in a single right eye.The overall survival(OS)rate was 95.8%(2444/2552)because 237 patients dropped out,and 109 died.Kaplan‒Meier survival analysis showed that the median survival time(MST)was 125.92 months[95%confidence interval(CI)=124.83–127.01].Cox multivariate survival analysis showed that trilateral RB(P=0.017),metastasis site(P=0.001),and combined distant tissue metastasis(P=0.001)were independent prognostic factors for RB.The OS of 44 cases of familial RB was 93.2%(41/44),with an MST of 80.62 months(95%CI=67.70–93.54).Conclusions The timing of eye protection treatment and enucleation should be comprehensively judged to avoid worsening prognosis due to operation time delay.More importantly,the promotion and popularization of diagnosis and treatment technologies are necessary to further improve RB prognosis.

Report of seven children with undifferentiated embryonal sarcoma of the liver

Undifferentiated embryonal sarcoma of the liver (UESL) very rarely presents clinically.Approximately 1% to 4% of all solid tumors in children are malignant liver tumors,and UESL accounts for 9% to 15% of the liver tumor.The onset of UESL usually occurs at 6 to 10 years of age and there is no obvious difference based on sex.[1] The first symptoms of UESL are abdominal distention and abdominal pain without jaundice,while a physical examination commonly reveals no positive vital signs except the palpable liver tumor.[1] The serum alphafetoprotein (AFP) test is not sensitive for UESL.[2] Preoperative diagnosis of UESL is very difficult.

Dual liver transplantation

Reperfusion is the key strategy in acute ST-segment elevation myocardial infarction(STEMI) care,and it is time-dependent.Shortening the time from symptom to reperfusion and choosing the optimal reperfusion strategy for STEMI patients are great challenges in practice.We need to improve upon the problems of low reperfusion rate,non-standardized treatment,and economic burden in STEMI care.This article briefly reviews the current status of reperfusion strategy in STEMI care,and also introduces what we will do to bridge the gap between the guidelines and implementation in the clinical setting through the upcoming China STEMI early reperfusion program.

Perfect prognosis of a boy with alveolar rhabdomyosarcoma of the nasal wing treated with brachytherapy and chemotherapy

To the Editor:Alveolar rhabdomyosarcoma(ARMS)of nasalwingwith distant metastasis has a very poor prognosis.Because it is difficult to achieve complete surgical excision of the primary site of the nasal wing,distant metastasis is not easy to control.Here,we present an unusual case of a 29-month-old boy with ARMS in the left nasal wing accompanied by bone metastasis who was treated with systemic chemotherapy as well as 125I interstitial brachytherapy,and this special multidisciplinary management resulted in a perfect prognosis and mild long-term side effects.