Optimal central venous pressure during partial hepatectomy for hepatocellular carcinoma

BACKGROUND:Low central venous pressure(CVP) affects hemodynamic stability and tissue perfusion.This prospective study aimed to evaluate the optimal CVP during partial hepatectomy for hepatocellular carcinoma(HCC).METHODS:Ninety-seven patients who underwent partial hepatectomy for HCC had their CVP controlled at a level of 0 to 5 mmHg during hepatic parenchymal transection.The systolic blood pressure(SBP) was maintained,if possible,at 90 mmHg or higher.Hepatitis B surface antigen was positive in 90 patients(92.8%) and cirrhosis in 84 patients(86.6%).Pringle maneuver was used routinely in these patients with clamp/unclamp cycles of 15/5 minutes.The average clamp time was 21.4±8.0 minutes.These patients were divided into 5 groups based on the CVP:group A:0-1 mmHg;B:1.1-2 mmHg;C:2.1-3 mmHg;D:3.1-4 mmHg and E:4.1-5 mmHg.The blood loss per transection area during hepatic parenchymal transection and the arterial blood gas before and after liver transection were analyzed.RESULTS:With active fluid load,a constant SBP ≥90 mmHg which was considered as optimal was maintained in 18.6% in group A(95% CI:10.8%-26.3%);39.2% in group B(95% CI:29.5%-48.9%);72.2% in group C(95% CI:63.2%-81.1%);89.7% in group D(95% CI:83.6%-95.7%);and 100% in group E(95% CI:100%-100%).The blood loss per transection area during hepatic parenchymal transection decreased with a decrease in CVP.Compared to groups D and E,blood loss in groups A,B and C was significantly less(analysis of variance test,P【0.05).Compared with the baseline,the blood oxygenation decreased significantly when the CVP was reduced.Base excess and HCO 3-in groups A and B were significantly decreased compared with those in groups C,D and E(P【0.05).CONCLUSION:In consideration of blood loss,SBP,base excess and HCO 3-,a CVP of 2.1-3 mmHg was optimal in patients undergoing partial hepatectomy for HCC.

Genome-wide association study reveals novel loci for adult type 1 diabetes in a 5-year nested case-control study

BACKGROUND Type 1 diabetes(T1D)is a severe and prevalent metabolic disease.Due to its high heredity,an increasing number of genome-wide association studies have been performed,most of which were from hospital-based case-control studies with a relatively small sample size.The association of single nucleotide polymorphisms(SNPs)and T1D has been less studied and is less understood in natural cohorts.AIM To investigate the significant variants of T1D,which could be potential biomarkers for T1D prediction or even therapy.METHODS A genome-wide association study(GWAS)of adult T1D was performed in a nested case-control study(785 cases vs 804 controls)from a larger 5-year cohort study in Suzhou,China.Potential harmful or protective SNPs were evaluated for T1D.Subsequent expression and splicing quantitative trait loci(eQTL and sQTL)analyses were carried out to identify target genes modulated by these SNPs.RESULTS A harmful SNP for T1D,rs3117017[odds ratio(OR)=3.202,95%confidence interval(CI):2.296-4.466,P=9.33×10-4]and three protective SNPs rs55846421(0.113,0.081-0.156,1.76×10-9),rs75836320(0.283,0.205-0.392,1.07×10-4),rs362071(0.568,0.495-0.651,1.66×10-4)were identified.Twenty-two genes were further identified as potential candidates for T1D onset.CONCLUSION We identified a potential genetic basis of T1D,both protective and harmful,using a GWAS in a larger nested case-control study of a Chinese population.