Prognostic impact of clinical course-specific mRNA expression profiles in the serum of perioperative patients with esophageal cancer in the ICU: a case control study.

BACKGROUND: We previously reported that measuring circulating serum mRNAs using quantitative one-step real-time RT-PCR was clinically useful for detecting malignancies and determining prognosis. The aim of our study was to find crucial serum mRNA biomarkers in esophageal cancer that would provide prognostic information for post-esophagectomy patients in the critical care setting. METHODS: We measured serum mRNA levels of 11 inflammatory-related genes in 27 post-esophagectomy patients admitted to the intensive care unit (ICU). We tracked these levels chronologically, perioperatively and postoperatively, until the two-week mark, investigating their clinical and prognostic significance as compared with clinical parameters. Furthermore, we investigated whether gene expression can accurately predict clinical outcome and prognosis. RESULTS: Circulating mRNAs in postoperative esophagectomy patients had gene-specific expression profiles that varied with the clinical phase of their treatment. Multivariate regression analysis showed that upregulation of IL-6, VWF and TGF-ß1 mRNA in the intraoperative phase (p = 0.016, 0.0021 and 0.009) and NAMPT and MUC1 mRNA on postoperative day 3 (p < 0.01) were independent factors of mortality in the first year of follow-up. Duration of ventilator dependence (DVD) and ICU stay were independent factors of poor prognosis (p < 0.05). Therapeutic use of Sivelestat (Elaspol®, Ono Pharmaceutical Co., Ltd.) significantly correlated with MUC1 and NAMPT mRNA expression (p = 0.048 and 0.045). IL-6 mRNA correlated with hypercytokinemia and recovery from hypercytokinemia (sensitivity 80.9%) and was a significant biomarker in predicting the onset of severe inflammatory diseases. CONCLUSION: Chronological tracking of postoperative mRNA levels of inflammatory-related genes in esophageal cancer patients may facilitate early institution of pharamacologic therapy, prediction of treatment response, and prognostication during ICU management in the perioperative period.

[Effects of concentration and dosage of lidocaine on preventing the pain on injection of propofol].

Although it is well-known that 2% lidocaine has an effective action for preventing propofol-induced pain, it has been unclear whether or not lidocaine of the concentration below 2% has the effective action similar to 2% lidocaine. One-hundred and thirty-two patients were randomly assigned to one of the six groups according to concentration and dosage of lidocaine administered at the time of the initiation of propofol infusion. Groups I and II received 1 ml and 2 ml of 1% lidocaine, respectively; Groups III and IV were given 1 ml and 2 ml of 0.5% lidocaine, respectively; Group V received 2 ml of 2% lidocaine; Group VI was administered 1 ml of normal saline as a control. There were no significant differences in patients' profiles and alterations of hemodynamics during anesthetic induction among the six groups. Number of patients complaining of a pain during induction was more in Group VI with significance (P < 0.0001) and number of patients complaining of uncomfortableness was also more with significance (P < 0.0001). Incidence of propofol-induced pain and degree of satisfaction with anesthetic induction were similar among the groups receiving lidocaine. Even 0.5% lidocaine may have the same effective action as 2% lidocaine for preventing the pain on injection of propofol.