Abnormal liver biochemical parameters in pregnancy during the epidemic of coronavirus disease 2019 / 临床肝胆病杂志

ObjectiveTo investigate the differences in abnormal liver biochemical parameters in pregnant patients during the epidemic or non-epidemic period of coronavirus disease 2019 （COVID-19）. MethodsA retrospective analysis was performed for 539 pregnant women who were discharged from Department of Obstetrics， Peking University First Hospital， from October 2017 to March 2022 and had at least one abnormal liver biochemical parameter among alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， gamma-glutamyl transpeptidase （GGT）， total bilirubin （TBil）， and total bile acid. The patients in the epidemic period of COVID-19 and those in the non-epidemic period of COVID-19 were compared in terms of etiology， coagulation parameters， aminotransferases， bile acid， and renal function. The independent samples t-test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups. ResultsAmong the patients discharged from Department of Obstetrics during the non-epidemic period of COVID-19， 262 had abnormal liver biochemical parameters， accounting for 1.46%， while 277 patients had abnormal liver biochemical parameters during the epidemic period of COVID-19， accounting for 1.73% among the patients discharged from Department of Obstetrics during the same period of time， and there was a significant difference between these two groups （χ2=3.947， P=0.047）. The etiological analysis of the patients with abnormal liver biochemical parameters during the two periods showed that there was no difference in the proportion of patients with four pregnancy-specific liver diseases （hyperemesis gravidarum， preeclampsia and eclampsia， intrahepatic cholestasis of pregnancy， and acute fatty liver of pregnancy）. As for the patients with abnormal liver biochemical parameters in pregnancy， there was no significant difference in the proportion of patients with normal creatinine and stimated glomerular filtration rate （eGFR） between the epidemic period and the non-epidemic period （86.78% vs 87.90%， χ2=0.141， P=0.708）. The patients with ALT≥5×upper limit of normal accounted for 7.94% in the epidemic period of COVID-19 and 9.54% in the non-epidemic period （χ2=0.433， P=0.511）， and the patients with severe cholestasis accounted for 7.75% in the epidemic period of COVID-19 and 9.27% in the non-epidemic period （χ2=0.392， P=0.531）. The proportion of patients with obstetric bleeding during the epidemic period of COVID-19 was significantly lower than that during the non-epidemic period （14.61% vs 24.19%， χ2=489.334， P<0.001）. ConclusionThere is no difference in the proportion of patients with pregnancy-specific liver diseases among the patients with abnormal liver biochemical parameters in pregnancy between the epidemic period and the non-epidemic period of COVID-19， and there is no change in the proportion of patients with normal creatinine and eGFR among these patients in the epidemic period of COVID-19.

Research progress in the surgical treatment of hilar cholangiocarcinoma / 中华肝胆外科杂志

Hilar cholangiocarcinoma (HCCA) is a type of bile duct cancer with insidious onset and poor prognosis. Surgical resection is the only potentially curative treatment. The selection of surgical approaches and prognosis assessment depend on different classification systems and preoperative imaging results. This article reviews the progress in classification systems, imaging modalities, biliary drainage techniques, postoperative adjuvant therapy, future liver remnant insufficiency treatment, liver transplantation and resection extent for HCCA.

Application of antifungal agents in special populations / 中华皮肤科杂志

Antifungal agents have shown good efficacy and tolerability in the general population. However, the antifungal treatment remains a great challenge in some special populations due to their special conditions, such as children, the elderly, pregnant women and patients with hepatic insufficiency. This review summarizes recommendations for the use of common antifungal agents in the above special populations.

Research advances in coronavirus disease 2019-related liver injury / 临床肝胆病杂志

The coronavirus disease 2019 (COVID-19) pandemic has brought great threats and challenges to global public health and has changed the priorities of medical resource allocation. A considerable proportion of patients with liver injury is observed during the clinical diagnosis and treatment of COVID-19, especially in those with a severe or critical illness. This article summarizes the epidemiology, mechanism, clinical features, and treatment of liver injury caused by COVID-19, in order to help clinicians with decision making and treatment optimization.

Clinical features of patients with severe acute respiratory syndrome coronavirus 2 Delta variant infection and abnormal liver function in Guangdong Province, China / 临床肝胆病杂志

Objective To investigate the clinical features of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant infection and abnormal liver function in Guangdong Province, China. Methods The patients with SARS-CoV-2 Delta variant infection who belonged to the same chain of transmission in Guangdong Province (Guangzhou and Foshan) and were admitted to Guangzhou Eighth People's Hospital, Guangzhou Medical University from May 21 to June 18, 2021 were enrolled in this study, and the judgment criteria for liver function were alanine aminotransferase (male/female) > 50/40 U/L, aspartate aminotransferase > 40 U/L, total bilirubin > 26 μmol/L, gamma-glutamyl transpeptidase > 60 U/L, and alkaline phosphatase (ALK) > 125 U/L. Abnormality in any one item of the above criteria was defined as abnormal liver function, and such patients were included in analysis (the patients, aged < 18 years, who had a mild or moderate increase in ALP alone were not included in analysis). Clinical data were compared between the patients with normal liver function and those with abnormal liver function, and the etiology and prognosis of abnormal liver function were analyzed. The Mann-Whitney U test was used for comparison of continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. Results Among the 166 patients with SARS-CoV-2 Delta variant infection, 32 (19.3%) had abnormal liver function with mild-to-moderate increases in liver function parameters, and compared with the normal liver function group, the abnormal liver function group had a significantly higher proportion of critical patients ( χ 2 =38.689, P < 0.001) and significantly higher age and inflammatory cytokines [C-reactive protein type, serum amyloid A, and interleukin-6 (IL-6)](all P < 0.05). Among the 32 patients with abnormal liver function, 13 patients had abnormal liver function on admission (defined as primary group), while 19 patients had normal liver function on admission but were found to have abnormal liver function by reexamination after treatment (defined as secondary group). For the primary group, the evidence of abnormal liver function was not found for 3 patients (3/13, 23.1%), and the possibility of toxic liver injury directly associated with SARS-CoV-2 infection was considered. Among the 19 patients in the secondary group, 9 (47.4%) had mild/common type and 10 (52.6%) had critical type, and all critical patients had the evidence of liver injury indirectly caused by the significant increases in C-reactive protein type, serum amyloid A, and IL-6 and hypoxemia; the evidence of abnormal liver function was not found for only 1 patient (1/19, 5.3%), and the possibility of toxic liver injury directly associated with SARS-CoV-2 infection was considered. All 32 patients with abnormal liver function had [JP2]significant reductions in liver function parameters after treatment including liver protection. Conclusion As for the patients with SARS-CoV-2 Delta variant infection who belong to the same chain of transmission in Guangdong Province, the critical patients show a significantly higher proportion of patients with abnormal liver function than the patients with other clinical types, and other factors except SARS-CoV-2 infection and indirect injury caused by SARS-CoV-2 infection are the main cause of liver injury.

Breviario de guías y metas del paciente crítico hospitalizado en Medicina Interna / Breviary of guidelines and goals of critical hospitalized patients in Internal Medicine

Los pacientes en estado crítico presentan disfunción fisiológica que provoca inestabilidad en órganos y sistemas del cuerpo, con desenlaces fatales y lesiones irreversibles o incluso la muerte. En los servicios de Medicina Interna de los hospitales de México, en especial en los públicos, hay pacientes críticos con múltiples patologías que requieren vigilancia en el cumplimiento de diversas metas de su tratamiento. Se presenta un compendio de las guías y metas de patologías críticas con mayor prevalencia en los servicios de Medicina Interna, las cuales son necesarias para guiar el tratamiento.

Patients with critical illness develop physiological dysfunction which provokes multi-organ system failure and triggers fatal outcomes and irreversible injuries or even death. Inside Internal Medicine services of Mexican hospitals, especially in public hospitals, there is a considerable number of critically ill patients with multiple pathologies who require surveillance to reach clinical goals of their treatment. We present a summary of guidelines and goals of the most prevalent critical diseases inside Internal Medicine services, which are necessary to guide treatments.

Avaliação da mortalidade no pós-operatório de fraturas de fêmur em idosos com comorbidades prévias / Evaluation of postoperative mortality of femoral fractures in elderly with previous comorbidities

Introdução: Queda é o acidente que ocorre com maior frequência no idoso, sendo a principal causa de morte naqueles com mais de 65 anos. As fraturas do quadril ocupam um papel de grande importância, gerando grande problema de ordem clínica envolvendo pacientes e familiares e de ordem econômica para a sociedade. Objetivo: Coletar dados de questionário da admissão e correlacionar a presença de comorbidades prévias a mortalidade em 30 dias do pós-cirurgia. Métodos: Estudo retrospectivo observacional não randomizado com 216 pacientes com fraturas cirúrgicas do quadril com 61 anos ou mais de idade atendidos no setor de emergência do Centro Hospitalar São Lucas na cidade de Niterói, RJ, no período de 30/03/2016 a 20/03/2018. Resultados: A incidência de óbito após a cirurgia do quadril é igual a 6,9% no primeiro mês. O paciente com fratura no quadril tem comorbidades cardiovasculares (75,9%). O óbito está associado à comorbidade hepática em 13,3% e ao baixo peso em 33,3%. O fato de ter duas ou mais comorbidades não está significativamente associado ao óbito. Conclusão: As comorbidades hepáticas, o baixo peso e a presença de disfunções cardiovasculares são importantes preditores prognósticos na mortalidade do paciente com mais de 61 anos após cirurgia de fratura do fêmur no primeiro mês. (AU)

Introduction: Falls are the leading cause of accidents and death in those aged 65 and above. The high incidence of these injuries impact patients, their families and it represents an economic problem for society. Objective: Collect data from the admission survey and correlate previous comorbidities to mortality in 30 days after surgery. Methods: Retrospective observational non-randomized study. 216 patients were included, aged 61 years or older, who were admitted at the emergency department of the Centro Hospitalar São Lucas in Niterói city, Rio de Janeiro. All the participants were candidates of hip fracture surgery between 03/30/2016 and 03/20/2018. Results: The mortality after hip surgery was 6.9% in the first month. Patients who underwent hip surgery had, previously, cardiovascular diseases (75.9%). Death was associated with liver comorbidity in 13.3% and low weight in 33.3%. The fact of having two or more comorbidities was not associated with death. Conclusion: Liver and cardiovascular diseases and low weight are important prognostic predictors in mortality of patients over 61 years of age after femoral fracture surgery in the first month. (AU)

Chanarin-Dorfman syndrome: the first case reported in China / 中华皮肤科杂志

Objective:To detect gene mutations and make a diagnosis in a family with ichthyosis accompanied by liver injury.Methods:Clinical data were collected from the proband, and genomic DNA was extracted from peripheral blood samples from the proband and his parents. Exome sequencing was performed in the proband by using a gene panel targeting hereditary skin diseases to identify mutation sites, and then the candidate mutation site was verified by PCR and Sanger sequencing in the family members. Results of peripheral blood smear examination and other auxiliary examinations were collected from the proband and his parents and analyzed.Results:The proband presented with generalized dry skin and tiny white scales on the lower limbs, accompanied by elevated transaminase levels, mild sensorineural hearing loss in both ears and fatty liver. Exome sequencing revealed a homozygous mutation c.933dupA in exon 6 of the ABHD5 gene encoding CGI-58 protein in the peripheral blood genomic DNA of the proband, resulting in a frameshift mutation p.R312Tfs*45 in the amino acid sequence. Heterozygous mutations at this site were identified in his father and mother. The mutation cosegregated with the disease phenotype in the family. The peripheral blood smear examination of the proband showed lipid vacuoles in neutrophils, which were called Jordan anomaly. Conclusion:The diagnosis of Chanarin-Dorfman syndrome was made in the proband based on the presentation of ichthyosis-like skin lesions and abnormal liver function, as well as the homozygous mutation in the ABHD5 gene and Jordan anomaly in peripheral blood smears.

Efficacy of early versus delayed laparoscopic cholecystectomy in the treatment of acute calculous cholecystitis combined with abnormal liver function / 中国基层医药

Objective:To investigate the efficacy of early versus delayed laparoscopic cholecystectomy (LC) in the treatment of acute calculous cholecystitis complicated by abnormal liver function. Methods:A total of 106 patients with acute calculous cholecystitis complicated by abnormal liver function who received LC in Nanjing Drum Tower Hospital, Nanjing University Medical School, China between February 2018 and February 2020 were included in this study. They were assigned to receive laparoscopic cholecystectomy either within 72 hours after disease onset (early group, n = 51) or 72 hours after disease onset (delayed group, n = 51). Perioperative indexes, complications, immune function and liver function were compared between the two groups. Results:Intraoperative blood loss in the early group was less than that in the delayed group [(63.11 ± 8.18) mL vs. (92.39 ± 7.23) mL, t = 19.558, P < 0.001]. Operative time, time to anal exhaust and length of hospital stay in the early group were (49.53 ± 6.33) minutes, (23.24 ± 4.65) hours and (6.38 ± 1.23) days in the early group were significantly shorter than those in the delayed group [(63.24 ± 5.42) minutes, (32.88 ± 5.78) hours, (8.34 ± 1.54) days, t = 12.004, 9.415, 7.204, all P < 0.001]. There was no significant difference in the rate of conversion to open cholecystectomy during LC between the two groups ( χ2 = 0.877, P > 0.05). There was no significant difference in the incidence of complications between early and delayed groups [11.76% (6/51) vs. 7.27% (4/55), χ2 = 0.625, P > 0.05]. On day 3 after surgery, the proportion of CD 3+ cells and the ratio of CD 4+/CD 8+ cells in the early group were (37.81 ± 4.29) % and (1.32 ± 0.29), respectively, which were significantly higher than those in the delayed group [(32.56 ± 5.26) %, 1.21 ± 0.23, t = 5.605, 6.379, both P < 0.001]. Total bilirubin, alanine aminotransferase and alkaline phosphatase levels in the early group were (21.05 ± 5.16) μmol/L, (71.58 ± 9.36) U/L and (175.73 ± 19.64) U/L, respectively, which were significantly lower than those in the delayed group [(27.81 ± 5.14) μmol/L, (82.54 ± 12.35) U/L, (214.62 ± 20.58) U/L, t = 6.921, 7.893, 9.865, all P < 0.001]. On day 5 after surgery, total bilirubin, alanine aminotransferase and alkaline phosphatase levels in the early group were (14.63 ± 4.58) μmol/L, (42.13 ± 8.24) U/L, (137.72 ± 17.62) U/L, respectively, which were significantly lower than those in the delayed group [(18.67 ± 6.45) μmol/L, (59.64 ± 11.29) U/L, (162.76 ± 18.39) U/L, t = 3.692, 8.265, 7.462, all P < 0.001]. Conclusion:Early LC for treatment of acute calculous cholecystitis complicated by abnormal liver function can effectively promote the recovery of liver function, mitigate immune injury, improve perioperative indicators, and dose not increase the incidence of complications.

Value of Fractalkine and soluble CD40 ligand in bile in predicting liver injury after liver transplantation / 临床肝胆病杂志

Objective To investigate the value of cytokines in bile combined with clinical indices in predicting the degree of liver injury after liver transplantation. MethodsA total of 16 patients undergoing liver transplantation who were hospitalized in Center of Organ Transplantation, The Affiliated Hospital of Qingdao University, from January to December 2018 were enrolled, and according to the level of alanine aminotransferase (ALT) on day 1 after surgery, the patients were divided into mild liver injury (ALT ＜500 U/L) group with 10 patients and severe liver injury (ALT ＞500 U/L) group with 6 patients. Bile samples were collected on days 1, 3, 5, and 7 after surgery, and MILLIPLEX assay was used to measure the levels of 17 cytokines. R software was used to perform principal component analysis (PCA) of bile cytokines and clinical indices and gene ontology (GO) enrichment analysis of bile cytokines. The two-independent-samples t-test was used for comparison of normally distributed continuous data between two groups; The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. A Spearman correlation analysis was performed to evaluate the correlation between clinical indices and bile cytokines. ROC curve analysis was used to evaluate the predictive value of cytokines in bile and clinical indices for liver injury after liver transplantation. ResultsCompared with the mild liver injury group, the severe liver injury group had significantly higher expression levels of bile Fractalkine (Z=-2.828, P=0.003), soluble CD40 ligand (sCD40L) (Z=-2.850, P=0.008), interleukin-4 (Z=-2.398, P=0.017), CXCL10 (Z=-2.475, P=0.023), and macrophage inflammatory protein-1α (Z=-1844, P=0.043). The correlation analysis showed that on day 1 after liver transplantation, aspartate aminotransferase, ALT, and lactate dehydrogenase were positively correlated with the levels of several cytokines in bile (all P＜0.05). The area under the ROC curve of Fractalkine, sCD40L and AST were 0.933 (0.812-1.000), 0.833 (0.589-1.000) and 0.917 (0.779-1.000), respectively, suggesting that AST and Fractalkine and sCD40L in bile on the first day after liver transplantation have significant predictive value for liver injury. The results of PCA showed that bile cytokines combined with clinical indices on day 1 after liver transplantation could better distinguish the patients with mild liver injury from those with severe liver injury. GO analysis showed that bile cytokines were associated with positive feedback regulation of external stimulus, cell chemotaxis, receptor ligand activity, cytokine activity, and cytokine-cytokine receptor interaction. ConclusionFractalkine and sCD40L in bile can predict the degree of liver injury after liver transplantation.

The assay of voriconazole in plasma from patients with hepatic insufficiency by UPLC-MS/MS / 药学实践杂志

Objective To establish an UPLC-MS/MS method of voriconazole assay in human plasma for clinical therapeutic drug monitoring. Methods The plasma samples were treated with methanol to precipitate protein and the supernatants were assayed by UPLC-MS/MS. The chromatographic column was InertSustain C18 HP (3.0 mm×100 mm, 3 μm) with the mobile phase of water and acetonitrile solution (15:85) at 35 ℃ and 0.3 ml/min flow rate. ESI was used for Mass Spectrum in positive ion MRM mode with target ions m/z: 350.9/282.2(voriconazole) and m/z: 307.0/238.0(fluconazole). Results The linear range of voriconazole was 0.1–20 μg/ml (r=0.999 5）. The lower limit of quantitation was 0.1 μg/ml. The extraction recovery was higher than 90%. RSDs of inter-day and intra-day were all lower than 10%. The plasma concentrations measured by this method were in the range of 0.97 to 18.7 μg/ml from 10 patients with hepatic insufficiency who were treated with voriconazole. Conclusion The established method was fast, accurate and sensitive。It can be applied for the therapeutic drug monitoring of voriconazole，and provided a good base for rationalized medication treatment in patients with hepatic insufficiency.

Features of liver injury in adolescents and adults with infectious mononucleosis: A single-center retrospective clinical study of 274 cases / 临床肝胆病杂志

ObjectiveTo investigate the features of liver injury and related influencing factors in adolescents and adults with infectious mononucleosis (IM). MethodsA retrospective analysis was performed to investigate the features of liver injury in adolescents and adults with IM who were hospitalized in Peking University First Hospital from January 2005 to December 31 2018, and the patients were divided into subgroups based on age, Epstein-Barr virus (EBV) DNA level, and presence or absence of jaundice or infection with cytomegalovirus or hepatitis E virus (HEV). The t-test was used for comparison of continuous data meeting analytical conditions between two groups, and the Mann-Whitney U test was used for comparison of continuous data which did not meet analytical conditions between two groups; the chi-square test was used for comparison of categorical data between two groups, and the Fisher’s exact test was used for comparison of categorical data which did not meet the analytical conditions of the chi-square test. A logistic regression analysis was used for multivariate analysis. ResultsA total of 274 patients were enrolled, with 154 male patients (56.2%) and 120 female patients (43.8%), and the mean age of onset was 22.3±67 years. The incidence rate of liver injury ［defined as alanine aminotransferase (ALT) ＞50 U/L and/or aspartate aminotransferase (AST)＞40 U/L］ was 97.4% (267/274), and that of jaundice was 27.6% (74/268). The patients, aged ≥20 years, tended to have a higher level of gamma-glutamyl transpeptidase (GGT) (Z=2.070, P=0.038). Serum EBV DNA was measured for 167 patients, among whom 90 had positive results and 77 had negative results. The positive serum EBV DNA group had significantly higher levels of GGT (Z=3.005, P=0.003) and lactate dehydrogenase (Z=2.162, P=0.031) than the negative serum EBV DNA group. The patients with cytomegalovirus infection tended to have a higher level of alkaline phosphatase (Z=2.351, P=0.019), and the patients with HEV infection presented with a higher level of GGT (Z=1.988, P=0.047). AST (odds ratio ［OR］=1.006, 95% confidence interval ［CI］: 1.002-1.010, P=0.005) and ALP (OR=1.012, 95%CI: 1.005-1.020, P=0.001) were independent risk factors for jaundice. ConclusionThere is a high incidence rate of liver injury in adolescents and adults with IM, and the patients with an older age or positive serum EBV DNA tend to have more severe liver injury.

Gd-BOPTA-enhanced MRI evaluation of liver function in patients with cirrhosis / 中国医学影像技术

Objective: To investigate the relationship between liver function parameters and liver parenchymal relative enhancement (RE) at hepatocyte phase with gadobenate dimeglumine (Gd-BOPTA)-enhanced MRI, and to clarify clinical predictive factors affecting liver parenchymal RE.Methods: Data of 238 patients underwent abdominal Gd-BOPTA-enhanced MRI were retrospectively analyzed and classified into 4 groups, i.e. normal liver function group (NLF group) and liver cirrhosis Child-Pugh A, B and C group (LCA, LCB and LCC groups). Liver parenchymal RE at hepatocyte phase was calculated, and the relationship between liver parenchyma RE and liver function parameters were analyzed, then clarified clinical predictive factors affecting liver parenchymal RE. Results: Liver parenchyma RE of hepatocyte phase were negatively correlated with the changes of total bilirubin (TB), prothrombin time (PT), international normalized ratio (INR), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and Child-Pugh classification (all P<0.01),but positively correlated with albumin (Alb) and cholinesterase (ChE) (both P<0.01). Liver parenchyma RE at hepatocyte phase in NLF group were significantly higher than that in LCA,LCB and LCC groups (all P<0.001), respectively, and lower in patients with ascites than in those without ascites (P<0.001). Compared with LCB and LCC groups, liver parenchyma RE at hepatocyte phase in LCA group were significantly higher (both P<0.001), and predicted factors of liver parenchymal RE in hepatocyte stage included TB, Alb, ALP, and presence of ascites. Conclusion: There are significant correlations of liver parenchyma RE and liver functional parameters in liver cirrhosis, predictive factors of liver parenchymal RE in hepatocyte stage with Gd-BOPTA-enhanced MRI include TB, Alb, ALP and presence of ascites.

Liver injury in coronavirus disease 2019 / 临床肝胆病杂志

At present, coronavirus disease 2019 (COVID-19) caused by 2019 novel coronavirus (2019-nCoV) infection has spread rapidly in China and more than 70 countries around the world and thus become a public health event of international concern. In addition to fever and respiratory symptoms, varying degrees of liver injury is also observed after 2019-nCoV infection. This article reviews the clinical features, pathology, pathogenic mechanism, and therapeutic strategies of liver injury associated with COVID-19, hoping to provide a reference for clinical decision-making on the prevention and treatment of COVID-19.

Effect of remifentanil on MACBAR of sevoflurane in patients with hepatic dysfunction undergoing laparoscopic surgery / 中华麻醉学杂志

Objective@#To evaluate the effect of remifentanil on the minimum alveolar concentration of sevoflurane required to blunt the adrenergic response (MACBAR) in the patients with hepatic dysfunction undergoing laparoscopic surgery.@*Methods@#The patients, aged 18-64 yr, with body mass index < 30 kg/m2, undergoing elective laparoscopic hepatobiliary surgery, were selected.Patients with normal liver function were selected as control group (C group), and patients with liver dysfunction (Child-Pugh grade B) were selected as test group and divided into 3 subgroups by a random number table method: no remifentanil group (R0 group) and different target plasma concentrations of remifentanil groups (R1 group and R2 group). Anesthesia was induced by intravenously injecting propofol 2-3 mg/kg, remifentanil 2 μg/kg and cisatracurium 0.15 mg/kg.After endotracheal intubation, mechanical ventilation was performed.The end-tidal sevoflurane concentration was adjusted to the preset concentration in each group and maintained at the level for 20 min before the pneumoperitoneum was established.Anesthesia was maintained as follows: remifentanil was not used in C group and R0 group, and the target plasma concentration of remifentanil was 1 and 2 ng/ml in group R1 and group R2, respectively, and sevoflurane was inhaled.The MACBAR of sevoflurane was determined using the sequential method.The initial end-tidal sevoflurane concentrations were 5.0%, 4.6%, 2.6% and 2.4% in group C, group R0, group R1 and group R2, respectively.MAP and HR were recorded and blood samples were collected before and after pneumoperitoneum, and the plasma epinephrine and norepinephrine concentrations were measured by enzyme-linked immunosorbent assay, and the difference in MAP and HR before and after pneumoperitoneum was calculated.@*Results@#A total of 14 cases in group C, 19 cases in group R0, 19 cases in group R1 and 15 cases in group R2 completed the study.Compared with group C, the MACBAR of sevoflurane and plasma adrenergic concentration before and after pneumoperitoneum were significantly decreased (P<0.05), and no significant change was found the other parameters in group R0 (P>0.05). Compared with group R0, the MACBAR of sevoflurane was significantly decreased in group R1 and group R2, and HR before and after pneumoperitoneum and the difference were significantly decreased in group R2(P<0.05). The MACBAR of sevoflurane was significantly lower in group R2 than in group R1 (P<0.05).@*Conclusion@#Remifentanil can decrease the MACBAR of sevoflurane and enhance the efficacy in inhibiting the stress responses in the patients with hepatic dysfunction undergoing laparoscopic surgery.

Effect of remifentanil on MACBAR of sevoflurane in patients with hepatic dysfunction undergoing lap-aroscopic surgery / 中华麻醉学杂志

Objective To evaluate the effect of remifentanil on the minimum alveolar concentration of sevoflurane required to blunt the adrenergic response(MACBAR)in the patients with hepatic dysfunction undergoing laparoscopic surgery.Methods The patients,aged 18-64 yr,with body mass index ＜ 30 kg/m2,undergoing elective laparoscopic hepatobiliary surgery,were selected.Patients with normal liver function were selected as control group(C group),and patients with liver dysfunction(Child-Pugh grade B)were selected as test group and divided into 3 subgroups by a random number table method: no remifen-tanil group(R0 group)and different target plasma concentrations of remifentanil groups(R1 group and R2 group).Anesthesia was induced by intravenously injecting propofol 2-3 mg/kg,remifentanil 2 μg/kg and cisatracurium 0.15 mg/kg.After endotracheal intubation,mechanical ventilation was performed.The end-tidal sevoflurane concentration was adjusted to the preset concentration in each group and maintained at the level for 20 min before the pneumoperitoneum was established.Anesthesia was maintained as follows:remifentanil was not used in C group and R0 group,and the target plasma concentration of remifentanil was 1 and 2 ng/ml in group R1 and group R2,respectively,and sevoflurane was inhaled.The MACBAR of sevoflurane was determined using the sequential method.The initial end-tidal sevoflurane concentrations were 5.0％,4.6％,2.6％and 2.4％in group C,group R0,group R1 and group R2,respectively.MAP and HR were recorded and blood samples were collected before and after pneumoperitoneum,and the plas-ma epinephrine and norepinephrine concentrations were measured by enzyme-linked immunosorbent assay,and the difference in MAP and HR before and after pneumoperitoneum was calculated.Results A total of 14 cases in group C,19 cases in group R0,19 cases in group R1 and 15 cases in group R2 completed the study.Compared with group C,the MACBAR of sevoflurane and plasma adrenergic concentration before and after pneumoperitoneum were significantly decreased(P＜0.05),and no significant change was found the other parameters in group R0(P>0.05).Compared with group R0,the MACBAR of sevoflurane was signifi-cantly decreased in group R1 and group R2,and HR before and after pneumoperitoneum and the difference were significantly decreased in group R2(P＜0.05).The MACBAR of sevoflurane was significantly lower in group R2 than in group R1(P＜0.05).Conclusion Remifentanil can decrease the MACBAR of sevoflurane and enhance the efficacy in inhibiting the stress responses in the patients with hepatic dysfunction undergo-ing laparoscopic surgery.

Association of blood lipids and albumin-bilirubin index with disease progression in patients with chronic hepatitis B virus infection / 临床肝胆病杂志

ObjectiveTo investigate the value of blood lipid indices and albumin-bilirubin index (ALBI) in evaluating the progression of chronic hepatitis B virus (HBV) infection. MethodsA total of 184 patients with chronic HBV infection who visited The Second Affiliated Hospital of Anhui Medical University from June 2016 to June 2017 were enrolled, and according to the stage of the disease, they were divided into ASC group (74 HBV carriers), CHB group (70 patients with chronic hepatitis B), and LC group (40 patients with compensated cirrhosis). A total of 50 healthy individuals were enrolled as health control (HC) group. Blood lipid indices and liver function parameters were measured, and the changes in blood lipid indices and ALBI during the progression of chronic HBV infection were analyzed. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the Dunnett method was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between groups; Pearson correlation analysis was used to investigate correlation. Results There were significant differences between the ASC, CHB, LC, and HC groups in blood lipid indices of cholesterol (CHO), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A (APOA), and apolipoprotein B (F=12.075, 19.559, 6.554, 9.392, and 5.458, all P＜0.001), and the LC group had significantly greater reductions in the above indices compared with the other three groups (all P＜0.05). There was a significant difference in ALBI between the four groups (F=49.225, P＜0.001); the LC group had a significantly higher ALBI than the other three groups (all P＜005), and the ASC and CHB groups had a significantly higher ALBI than the HC group (both P＜0.05). CHO, HDL-C, LDL-C, and APOA were negatively correlated with ALBI (all P＜0.05), among which CHO and HDL-C had the strongest correlation with ALBI (r=-0.310 and -0.266, both P＜0.001). ConclusionIn patients with chronic HBV infection, blood lipid indices and ALBI can reflect the degree of liver function damage, especially in patients with liver cirrhosis.

Association of blood lipids and albumin-bilirubin index with disease progression in patients with chronic hepatitis B virus infection / 临床肝胆病杂志

ObjectiveTo investigate the value of blood lipid indices and albumin-bilirubin index (ALBI) in evaluating the progression of chronic hepatitis B virus (HBV) infection. MethodsA total of 184 patients with chronic HBV infection who visited The Second Affiliated Hospital of Anhui Medical University from June 2016 to June 2017 were enrolled, and according to the stage of the disease, they were divided into ASC group (74 HBV carriers), CHB group (70 patients with chronic hepatitis B), and LC group (40 patients with compensated cirrhosis). A total of 50 healthy individuals were enrolled as health control (HC) group. Blood lipid indices and liver function parameters were measured, and the changes in blood lipid indices and ALBI during the progression of chronic HBV infection were analyzed. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the Dunnett method was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between groups; Pearson correlation analysis was used to investigate correlation. Results There were significant differences between the ASC, CHB, LC, and HC groups in blood lipid indices of cholesterol (CHO), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A (APOA), and apolipoprotein B (F=12.075, 19.559, 6.554, 9.392, and 5.458, all P＜0.001), and the LC group had significantly greater reductions in the above indices compared with the other three groups (all P＜0.05). There was a significant difference in ALBI between the four groups (F=49.225, P＜0.001); the LC group had a significantly higher ALBI than the other three groups (all P＜005), and the ASC and CHB groups had a significantly higher ALBI than the HC group (both P＜0.05). CHO, HDL-C, LDL-C, and APOA were negatively correlated with ALBI (all P＜0.05), among which CHO and HDL-C had the strongest correlation with ALBI (r=-0.310 and -0.266, both P＜0.001). ConclusionIn patients with chronic HBV infection, blood lipid indices and ALBI can reflect the degree of liver function damage, especially in patients with liver cirrhosis.

Preoperative detection of liver functional reserve in patients with hilar cholangiocarcinoma using the indocyanine green retention test / 中华肝胆外科杂志

Objective To study the use of preoperative indocyanine green retention test at 15 minutes (ICG R15) in the prediction of liver functional reserve in patients with hilar cholangiocarcinoma (HCCA).Methods The clinical data of 62 patients with HCCA treated in our department from March 2016 to March 2018 was reviewed.The relationship between preoperative ICG R15 and postoperative hepatic insufficiency was analyzed.The relationship between preoperative ICG R15 and Child-Pugh scoring was also studied.Univariate analysis was used to evaluate the risk factors of postoperative liver dysfunction.Logistic regression was used to assess the independent risk factors of postoperative liver dysfunction.The regression equation between independent risk factors and postoperative liver dysfunction was established.Results Among the 62 patients,ICG R15 was less than 10.0％ in 26 patients,between 10.0％ and 19.0％ in 17 patients,between 20.0％ and 29.0％ in 9 patients,between 30.0％ and 39.0％ in 5 patients,and over 40.0％ in 5 patients.There were 29 patients with a Child-Pugh A grading and 33 patients with a Child-Pugh B grading in the preoperative evaluation of liver function.The Wilcoxon W rank sum test was used to compare the preoperative ICG R15 in patients with Child-Pugh grading A and B separately.The ICG R15 in Child-Pugh grading A patients was significantly lower than those in Child-Pugh B grading patients (P ＜0.05).There were no significant differences in age,gender,history of previous liver diseases,duration of operation,and intraoperative blood loss (P ＞ 0.05) between the normal liver function group and the liver dysfunction group.However,there was a significant difference in the preoperative ICG R15 and preoperative bilirubin levels (P ＜ 0.05) between the two groups.The preoperative ICG R15 and preoperative bilirubin levels were significant risk factors of postoperative hepatic insufficiency.Regression analysis suggested that preoperative ICG R15 level was an independent risk factor of postoperative hepatic insufficiency (P ＜ 0.05).A regression equation:logit(P) =0.185 × preoperative ICG R15-3.152 could be constructed.Conclusions ICG R15 is an ideal clinical indicator for evaluation of preoperative liver functional reserve in patients with HCCA.It predicted the recovery of postoperative liver function.

Efecto de la administración de vitamina K en las complicaciones asociadas con enfermedad hepática crónica terminal / Effect of the administration of vitamin K on the complications associated with end stage liver disease

Resumen ANTECEDENTES La administración de vitamina K se restringe a situaciones, como antídoto de los antagonistas de vitamina K y enfermedad hemorrágica del recién nacido, pero debido a su papel en la hemostasia, su administración se ha extendido al tratamiento de otras enfermedades, como la enfermedad hepática crónica. OBJETIVO Identificar la eficacia de adicionar vitamina K al tratamiento de los pacientes con insuficiencia hepática terminal con algún estado de descompensación. MATERIAL Y MÉTODO Estudio de casos y controles retrospectivo realizado en el periodo 2016-2017 en pacientes con enfermedad hepática crónica estadio Child-Pugh C durante un episodio de descompensación. La vitamina K (bisulfito sódico de menadiona) se administró a dosis de 10 mg vía intramuscular cada 12 h durante tres días. RESULTADOS Se estudiaron 60 pacientes, 30 recibieron vitamina K, en caso de un evento hemorrágico se administró en conjunto terapia de sustitución con plasma fresco congelado y crioprecipitados. La media de edad fue de 60 (25-86) años, todos los casos eran del género masculino. La principal causa de complicación fue la hemorragia (85%). Cinco casos (8.3%) fallecieron por reactivación de la hemorragia. Administrar vitamina K no acortó las pruebas de coagulación (TP, TTPa, INR) ni mostró beneficio en la mortalidad. Sólo la trombosis como la encefalopatía mostró asociación con la mortalidad. CONCLUSIÓN La adición de vitamina K no influye en las complicaciones en pacientes con enfermedad hepática terminal.

Abstract BACKGROUND The administration of vitamin K are restricted to situations such as an antidote for vitamin K antagonists and hemorrhagic disease of the newborn, but due to its role in hemostasis, its use has been extended to other diseases, such as terminal chronic liver disease. OBJECTIVE To identify the efficacy of adding vitamin K to the management of patients with terminal hepatic insufficiency with some state of decompensation. MATERIAL AND METHOD A retrospective case-control study was done between 2016-2017 in patients with Child-Pugh C chronic liver disease during an episode of decompensation. Vitamin K (menadione sodium bisulfite) was administered at a dose of 10 mg intramuscular every 12 h for three days. RESULTS A total of 60 patients were studied, 30 received vitamin K, in the case of a hemorrhagic event, replacement therapy with fresh frozen plasma and cryoprecipitates were administered together. The mean age was 60 (25-86) years; all were male. Hemorrhage (85%) was the main cause of complication. Five cases (8.3%) died due to reactivation of the hemorrhage. The administration of vitamin K did not shorten the coagulation tests (TP, aPTT, INR) nor showed a mortality benefit. Only thrombosis such as encephalopathy showed an association on mortality. CONCLUSION The addition of vitamin K does not influence the complications in patients with terminal liver disease.