Risk factors for hemodynamic instability during laparoscopic resection of pheochromocytoma.

BACKGROUND: Laparoscopic adrenalectomy for pheochromocytoma is associated with high risk of intraoperative hemodynamic instability. Our study aimed to identify predictive factors for hemodynamic instability during laparoscopic resection of pheochromocytoma. METHODS: Between January 2011 and December 2021, 136 patients underwent unilateral laparoscopic adrenalectomy for pheochromocytoma. The patients were divided into 2 groups depending on the presence or absence of hemodynamic instability during surgery. Intraoperative hemodynamic parameters were compared between the 2 groups. Patient demographic characteristics and preoperative evaluations were assessed for their prognostic relevance with respect to intraoperative hemodynamic instability via both univariate analysis and multivariate logistic regression analysis. RESULTS: There was greater blood pressure fluctuations and higher maximum blood pressure and heart rate in the hemodynamic instability group. More patients need intraoperative administration of vasoactive drugs in the hemodynamic instability group. In the univariate analysis, presence of coronary artery disease, tumour size, and previous hypertension history were significantly associated with intraoperative hemodynamic instability. The multivariate logistic regression analysis showed that tumour size and previous hypertension history were independent risk factors for intraoperative hemodynamic instability. CONCLUSION: Tumour size and previous hypertension history were associated with hemodynamic instability during laparoscopic resection of pheochromocytoma.

[Spatial Distribution and Risk Assessment of Heavy Metals in Sediments of the Ruxi Tributary of the Three Gorges Reservoir].

Sediment column and soil samples collected from 12 sampling sites in four regions of the Ruxi River, a typical tributary of the Three Gorges Reservoir, were analyzed for eight selected heavy metals including Cr, Ni, Cu, Mn, Zn, Cd, Pb, and Hg to evaluate their spatial and vertical distribution, source, and biological toxic effects. The results showed that the average concentrations of heavy metals were (79.60±11.87), (41.340±4.999), (32.69±8.70), (823.34±125.76), (122.11±22.82), (0.393±0.140), and (29.122±6.811) mg·kg-1 for Cr, Ni, Cu, Mn, Zn, Cd, and Pb, respectively, and (74.84±39.50) µg·kg-1 for Hg, all of which exceeded the sediment background values of the Yangtze River. A spatial trend of decreasing metal concentrations was observed from the reach influenced by the human activities of Ruxi town to the backwater zone and then to the natural river reach. Moreover, in the backwater zone, the heavy metals in sediments and soil along the river were significantly lower than those in sediments, indicating that the sediments and soil were not one primary source for these metals in backwater zone sediment. From the vertical distribution of sediment, in addition to Pb, the highest level of metals was observed at 8 cm in the reach influenced by human activities, and their concentrations decreased with sediment depth in the backwater zone and natural river beach. Significant correlation was found between all the heavy metals (P<0.01, except Ni), indicating a potential homology of these metals in the Ruxi River. Evaluation results of the geoaccumulation index reveal that there exists light to partial moderate Cd and Zn pollution in the Ruxi River. The evaluation of biotoxicity effects showed that Ni was likely to have toxic effects on organisms with a probability of 10% to 75%, and Cd, Zn, Hg, Cu, Pb, and Cr are likely to have biotoxic effects at<10% probability. The combined effect values of multiple metals indicated that the risk of adverse effects was between low and lower medium in the sediments of the Ruxi River.

[Distribution Characteristics and Risk Assessment of Heavy Metals in the Sediments of the Estuary of the Tributaries in the Three Gorges Reservoir, SW China].

To investigate the pollution status of sediments at the junction of the Three Gorges Reservoir area, sediment samples were collected over four seasons from the junction of the estuary located at a tributary of the Ruxi River and the Yangtze River. The content of eight heavy metals (HMs), including Cr, Zn, Mn, Ni, Cu, As, Cd, and Pb, in sediments was determined by ICP-MS. The results showed the average levels of investigated HMs (in mg·kg-1) were Cr (45.24), Zn (46.46), Mn (406.14), Ni (20.885), Cu (12.49), As (7.02), Cd (0.253), and Pb (11.042). The distribution analysis indicated that the levels of HMs at the river mouth were higher than that of the tributaries of the middle reaches and the two sections nearby. The seasonal distribution shows that the heavy metal content in the spring sediment is higher than in summer, autumn and winter. In addition, the correlation analysis indicated that the eight HMs possessed similar homologous characteristics and had common exogenous inputs. The assessment of the Geo Accumulation Index showed slight Cd pollution in the estuary of Ruxi River, and the Potential Ecological Risk index showed that Cd presented moderate ecological risks. The toxic effect of benthonic organisms was possibly correlated to Ni contamination at the intersection of the tributary and main stream, which was supported by the evidence from the sediment quality criteria. In conclusion, the rating of ecological risk at the mouth of the Ruxi River tributary is slight.

[Icaritin Reverses Multidrug Resistance of Multiple Myeloma Cell Line KM3/BTZ].

OBJECTIVE: To investigate the reversing effect of icaritin on multidrug resistance of multiple myeloma cell lines KM3/BTZ and its underlying mechanism. METHODS: KM3/BTZ cells were established by a gradually ascending gradient induction of bortezomib (BTZ). The sensitivities of KM3 and KM3/BTZ cells to 7 chemotherapeutic drugs, the inhibition and reversal effects of icaritin on proliferation and drug-resistance of KM3/BTZ cells were analyzed by MTT. The apoptosis was analyzed by flow cytometry, and the expression of Par-4, HSP27 and P-gp were detected by Western blot. RESULTS: KM3/BTZ cells were not only resistant to BTZ, but also to other 6 chemotherapeutic drugs. The resistance index (RI) to BTZ was 17.84, and higher than that of other chemotherapeutic drugs. Icaritin inhibited the proliferation and induced the apoptosis of KM3/BTZ cells. The IC50 value of BTZ decreased from 0.345 µg/ml to 0.149 µg/ml, and the reversal index was 2.38 (P<0.05). The expression of Par-4 protein increased in a concentration-dependent manner, while the expression of HSP27 and P-gp were down-regulated. CONCLUSION: Icaritin can inhibit cell proliferation and induce apoptosis of KM3/BTZ cells, moreover, can effectively reverse the multidrug resistance of KM3/BTZ cells. The mechanism may be related with down-regulation of HSP27 and P-gp expression, and up-regulation of Par-4 expression.