Combined use of transversus abdominis plane block and laryngeal mask airway during implementing ERAS programs for patients with primary liver cancer: a randomized controlled trial.

The incidence and mortality of primary liver cancer are very high and resection of tumor is the most crucial treatment for it. We aimed to assess the efficacy and safety of combined use of transversus abdominis plane (TAP) block and laryngeal mask airway (LMA) during implementing Enhanced Recovery After Surgery (ERAS) programs for patients with primary liver cancer. This was a prospective, evaluator-blinded, randomized, controlled parallel-arm trial. A total of 96 patients were enrolled (48 in each group). Patients in the control group received general anesthesia with endotracheal intubation, while patients in the TAP + LMA group received general anesthesia with LMA and an ultrasound-guided subcostal TAP block. The primary end-point was postoperative time of readiness for discharge. The secondary end-points were postoperative pain intensity, time to first flatus, quality of recovery (QoR), complications and overall medical cost. Postoperative time of readiness for discharge in the TAP + LMA group [7 (5-11) days] was shorter than that of the control group [8 (5-13) days, P = 0.004]. The postoperative apioid requirement and time to first flatus was lower in the TAP + LMA group [(102.8 ± 12.4) µg, (32.7 ± 5.8) h, respectively] than the control group [(135.7 ± 20.1) µg, P = 0.000; (47.2 ± 7.6) h, P = 0.000; respectively]. The QoR scores were significantly higher in the TAP + LMA group than the control group. The total cost for treatment in the TAP + LMA group [(66,608.4 ± 6,268.4) CNY] was lower than that of the control group [(84,434.0 ± 9,436.2) CNY, P = 0.000]. There was no difference in complications between these two groups. The combined usage of a TAP block and LMA is a simple, safe anesthesia method during implementing ERAS programs for patients with primary liver cancer. It can alleviate surgical stress, accelerate recovery and reduce medical cost.

Thickness measurement of frequency domain OCT on photoreceptor cell layer in diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM:To compare the outer nuclear layer ( ONL) , inner and outer segments (IS/OS), photoreceptor cell layer in healthy people and diabetic retinopathy by frequency-domain optical coherence tomography ( OCT) .·METHODS: Totally 100 eyes of 50 healthy people were selected as control group. According to conventional mydriasis for examination of fundus and fundus fluorescein angiography ( FFA ) examination, all diabetic cases were divided into 3 groups: normal retina group ( NDR ) , non - proliferative diabetic retinopathy group (NPDR), proliferative diabetic retinopathy group (PDR). Using OCT measure the thickness of ONL, IS/OS and photoreceptor cell layer of fovea and parafovea ( nasal side and temporal side) in the four groups.·RESULTS: Compared with the control group, the ONL and photoreceptor cell layer's thickness of macular fovea and temporal parafovea in NPDR group and PDR group were statistically significant(all P<0. 05). The differences between ONL and photoreceptor cell layer's thickness of macular fovea and temporal parafovea in NDR group and PDR group were not statistically significant(P>0. 05). The IS/OS of macular fovea and temporal parafovea was not significantly different among those groups (P>0. 05). The thickness of different layers of nasal parafovea were not different (P>0. 05).·CONCLUSION: The thickness of macular fovea and temporal parafovea has relation with degree of DR; the change of photoreceptor cell layer's thickness occurs mainly in ONL, but IS/OS no change; the change in temporal parafovea more obvious than in nasal parafovea. Frequency-domain OCT can quantitatively and qualitatively observe the subtle diabetic macular changes in diabetic patients with macular disease, and provides a reliable detection for the early diagnosis and treatment.