BACKGROUND Transarterial chemoembolization(TACE)is the first-line treatment for patients with unresectable liver cancer;however,TACE is associated with postembolization pain.AIM To analyze the risk factors for acute a...BACKGROUND Transarterial chemoembolization(TACE)is the first-line treatment for patients with unresectable liver cancer;however,TACE is associated with postembolization pain.AIM To analyze the risk factors for acute abdominal pain after TACE and establish a predictive model for postembolization pain.METHODS From January 2018 to September 2018,all patients with liver cancer who underwent TACE at our hospital were included.General characteristics;clinical,imaging,and procedural data;and postembolization pain were analyzed.Postembolization pain was defined as acute moderate-to-severe abdominal pain within 24 h after TACE.Logistic regression and a classification and regression tree were used to develop a predictive model.Receiver operating characteristic curve analysis was used to examine the efficacy of the predictive model.RESULTS We analyzed 522 patients who underwent a total of 582 TACE procedures.Ninety-seven(16.70%)episodes of severe pain occurred.A predictive model built based on the dataset from classification and regression tree analysis identified known invasion of blood vessels as the strongest predictor of subsequent performance,followed by history of TACE,method of TACE,and history of abdominal pain after TACE.The area under the receiver operating characteristic curve was 0.736[95%confidence interval(CI):0.682-0.789],the sensitivity was 73.2%,the specificity was 65.6%,and the negative predictive value was 92.4%.Logistic regression produced similar results by identifying age[odds ratio(OR)=0.971;95%CI:0.951-0.992;P=0.007),history of TACE(OR=0.378;95%CI:0.189-0.757;P=0.007),history of abdominal pain after TACE(OR=6.288;95%CI:2.963-13.342;P<0.001),tumor size(OR=1.978;95%CI:1.175-3.330;P=0.01),multiple tumors(OR=2.164;95%CI:1.243-3.769;P=0.006),invasion of blood vessels(OR=1.756;95%CI:1.045-2.950;P=0.034),and TACE with drug-eluting beads(DEBTACE)(OR=2.05;95%CI:1.260-3.334;P=0.004)as independent predictive factors for postembolization pain.CONCLUSION Blood vessel invasion,TACE history,TACE with drug-eluting beads,and history of abdominal pain after TACE are predictors of acute moderate-to-severe pain.The predictive model may help medical staff to manage pain.展开更多
Objective： The intoxications caused by 2,4-dinitrophenol （2,4-DNP）, even death, have been frequently reported in recent years. This study aims to investigate the dynamic changes of plasma toxin concentration and ex...Objective： The intoxications caused by 2,4-dinitrophenol （2,4-DNP）, even death, have been frequently reported in recent years. This study aims to investigate the dynamic changes of plasma toxin concentration and explore the clinical value of resin hemoperfusion （HP） in the treatment of patients with acute 2,4-DNP poisoning. Methods We reported 16 cases of acute 2,4-DNP poisoning through occupational exposure due to ignoring the risk of poisoning. The blood samples were collected from the 14 survivors. According to the different treatments of resin HP, the survivors were divided into routine HP （n=5） and intensive HP （n=9） groups. Ultra high performance liquid chromatography/ tandem mass spectroscopy （UPLC-MS/MS） was used to detect the 2,4-DNP concentration in plasma in this study. Results： The 14 survivors recovered very well after treatment. The initial plasma 2,4-DNP concentrations （C1） of survivors ranged from 0.25 to 41.88 pg/ml （mean （12.56＋13.93） pg/ml）. A positive correlation existed between initial plasma 2,4-DNP concentration （C1） and temperature. The elimination of 2,4-DNP was slow and persistent, and the total clearance rates of plasma toxin from the 1st to 3rd day （R3）, the 3rd to 7th day （R3-7）, and the 1st to 7th day （RT）, were only （53.03±14.04）%, （55.25±10.50）%, and （78.29±10.22）%, respectively. The plasma toxin was cleared up to 25 d after poisoning in most of the patients. The R3, R3-7, and R7 in the intensive HP group were all apparently higher than those in the routine HP group, with statistical significance （P〈0.05）. Simultaneously, the elimination half-life （tl/2） of 2,4-DNP in the intensive HP group was apparently shorter than that in the routine HP group, with statistical significance （P〈0.05）. Conclusions： The clinicians should be aware of this slow and persistent process in the elimination of plasma 2,4-DNP. Higher initial plasma toxin concentration resulted in a more severe fever for the patient. According to the limited data, longer and more frequent resin HP may accelerate to eliminate the poison.展开更多
基金Supported by Medical Health Science and Technology Project of Zhejiang Provincial Health Commission,China,No.2020372769.
文摘BACKGROUND Transarterial chemoembolization(TACE)is the first-line treatment for patients with unresectable liver cancer;however,TACE is associated with postembolization pain.AIM To analyze the risk factors for acute abdominal pain after TACE and establish a predictive model for postembolization pain.METHODS From January 2018 to September 2018,all patients with liver cancer who underwent TACE at our hospital were included.General characteristics;clinical,imaging,and procedural data;and postembolization pain were analyzed.Postembolization pain was defined as acute moderate-to-severe abdominal pain within 24 h after TACE.Logistic regression and a classification and regression tree were used to develop a predictive model.Receiver operating characteristic curve analysis was used to examine the efficacy of the predictive model.RESULTS We analyzed 522 patients who underwent a total of 582 TACE procedures.Ninety-seven(16.70%)episodes of severe pain occurred.A predictive model built based on the dataset from classification and regression tree analysis identified known invasion of blood vessels as the strongest predictor of subsequent performance,followed by history of TACE,method of TACE,and history of abdominal pain after TACE.The area under the receiver operating characteristic curve was 0.736[95%confidence interval(CI):0.682-0.789],the sensitivity was 73.2%,the specificity was 65.6%,and the negative predictive value was 92.4%.Logistic regression produced similar results by identifying age[odds ratio(OR)=0.971;95%CI:0.951-0.992;P=0.007),history of TACE(OR=0.378;95%CI:0.189-0.757;P=0.007),history of abdominal pain after TACE(OR=6.288;95%CI:2.963-13.342;P<0.001),tumor size(OR=1.978;95%CI:1.175-3.330;P=0.01),multiple tumors(OR=2.164;95%CI:1.243-3.769;P=0.006),invasion of blood vessels(OR=1.756;95%CI:1.045-2.950;P=0.034),and TACE with drug-eluting beads(DEBTACE)(OR=2.05;95%CI:1.260-3.334;P=0.004)as independent predictive factors for postembolization pain.CONCLUSION Blood vessel invasion,TACE history,TACE with drug-eluting beads,and history of abdominal pain after TACE are predictors of acute moderate-to-severe pain.The predictive model may help medical staff to manage pain.
文摘Objective： The intoxications caused by 2,4-dinitrophenol （2,4-DNP）, even death, have been frequently reported in recent years. This study aims to investigate the dynamic changes of plasma toxin concentration and explore the clinical value of resin hemoperfusion （HP） in the treatment of patients with acute 2,4-DNP poisoning. Methods We reported 16 cases of acute 2,4-DNP poisoning through occupational exposure due to ignoring the risk of poisoning. The blood samples were collected from the 14 survivors. According to the different treatments of resin HP, the survivors were divided into routine HP （n=5） and intensive HP （n=9） groups. Ultra high performance liquid chromatography/ tandem mass spectroscopy （UPLC-MS/MS） was used to detect the 2,4-DNP concentration in plasma in this study. Results： The 14 survivors recovered very well after treatment. The initial plasma 2,4-DNP concentrations （C1） of survivors ranged from 0.25 to 41.88 pg/ml （mean （12.56＋13.93） pg/ml）. A positive correlation existed between initial plasma 2,4-DNP concentration （C1） and temperature. The elimination of 2,4-DNP was slow and persistent, and the total clearance rates of plasma toxin from the 1st to 3rd day （R3）, the 3rd to 7th day （R3-7）, and the 1st to 7th day （RT）, were only （53.03±14.04）%, （55.25±10.50）%, and （78.29±10.22）%, respectively. The plasma toxin was cleared up to 25 d after poisoning in most of the patients. The R3, R3-7, and R7 in the intensive HP group were all apparently higher than those in the routine HP group, with statistical significance （P〈0.05）. Simultaneously, the elimination half-life （tl/2） of 2,4-DNP in the intensive HP group was apparently shorter than that in the routine HP group, with statistical significance （P〈0.05）. Conclusions： The clinicians should be aware of this slow and persistent process in the elimination of plasma 2,4-DNP. Higher initial plasma toxin concentration resulted in a more severe fever for the patient. According to the limited data, longer and more frequent resin HP may accelerate to eliminate the poison.
