AIM: To observe the effects of ketamine on preventing the increase of postoperative morphine requirement induced by fentanyl.METHODS: Sixty women undergoing total abdominal hysterectomy by spinal anaesthesia were assigned to 4 groups consisting of placebo(normal saline,C),fentanyl(3 bolus of 1 ?g/kg,at 15 min intervals,F),ketamine(infusion of 15 ?g?kg-1?min-1 ketamine from the skin incision until 20 min before the end of the surgery,K),ketamine and fentanyl(infusion of 15 ?g?kg-1?min-1 ketamine from the skin incision until 20 min before the end of the surgery plus 3 bolus of 1 ?g/kg fentanyl,at 15-min intervals,FK).The cumulative morphine consumption,pain score,and adverse effects(nausea, vomiting,hallucination,dizziness and itching) were recorded at 1,3,6,12,24,48 h postoperatively.RESULTS: There were no significant differences in age,weight,duration of surgery and the post-operative sensory block time.The cumulative morphine consumption in group F was significantly higher than those in group C at 3,6,12 h postoperatively(P

Objective:To explore the etiology, clinical diagnosis and treatment strategy of Lesch Nyhan syndrome.Methods:We retrospectively analyzed 2 patients with severe dyskinesia, mental retardation and complicated renal calculi who were admitted to the first people's Hospital of Zhengzhou in August 2019. Case 1, male, 9 years old, had multiple urinary calculi for 1 year. The patient came to the local hospital because double multiple kidney stones and bladder stonesa year ago. The patient had been treated with transurethral holmium laser lithotripsy for bladder stones. The results of infrared spectrum showed that the bladder stone was anhydrous uric acid stone. A week ago, color Doppler ultrasound showed multiple kidney stones and bladder stones. The patient was underdeveloped, mentally retarded and had a full-term cesarean section. There was no history of hypoxia, asphyxia and rescue of the patient. He had the following clinical manifestations: In the waking state, he was no language response to any stimulation. The nasolabial fold on the right was shallow and the corner of the mouth was oblique to the left. He lost the large movements such as lifting head, sitting alone, standing. The trunk showed torsion spasticity, limb muscle strength 2-3, limbs showing spastic hypertonia, limb joints stiff, hands showing fist-like, no involuntary movement and muscle fasciculation. The biceps reflex and knee tendon reflex were not elicited, and the pathological reflex was positive. Serum uric acid was 517 μmol/L. The Case 2 came from the same family, male, 6 years old, had the similar symptoms to his elder brother case 1. The family members complained on behalf of the child about intermittent fever for more than 2 years. The imaging examination of case 2 revealed kidney stones. Serum uric acid was 373 μmol/L. Whole Exome Sequencing and Sanger Sequencing were used to find the genetic causes of the two siblings. The NCBI-Homologene database was used to find the homologous sequence of the human HPRT1 gene, and the human HPRT1 gene sequence was compared with other species to analyze the protein conservation. The online website PredictProtein (http: //www.predactprotein) was used to predict the two-dimensional structure of the HPRT1 gene. The reported cases were summarized and same with the treatment plan.Results:A De novo mutation [c.571T>G(p.Tyr191Asp)] was found in the HPRT1 gene of the child, which was inherited from the mother. Lesch Nyhan syndrome can be diagnosed by the results of gene examination combined with clinical manifestations. The amino acid Tyr at the 191 position and the amino acids before and after it were highly conserved. Amino acid 191 was involved in the β-strand of the protein. We treated the patients with the lowest dose of allopurinol and children's conventional dose of potassium sodium bicitrate granules, and low purine diet. After 3 months of treatment, the serum uric acid was decreased, and the urinary calculi did not increase significantly.Conclusions:Combining with the clinical manifestations of children, HPRT1 gene might be the cause of pediatric disease and the two siblings could be diagnosed as Lesch-Nyhan syndrome. For such patients, the lowest dose of allopurinol and children's conventional dose of potassium sodium hydrogen citrate granule combined with diet could be more effective.

OBJECTIVE: To investigate the correlation between plasma cytokine levels and liver functions in patients with occupational medicamentosa-like dermatitis due to trichloroethylene(OMDT). METHODS: A total of 22 OMDT patients were selected as research subjects using judgment sampling method. Blood samples were collected from patients on the 1 st, 2 nd, 3 rd, 4 th, and 5 th week of admission and the day of hospital discharge. The automatic biochemical instrument was used for detecting the index of serum liver function. The levels of cytokines including tumor necrosis factor-α(TNF-α), interferon-γ(IFN-γ), interleukin(IL)-5, IL-6, and IL-10 in plasma were measured by enzyme-linked immunosorbent assay. The Spearman correlation analysis was performed to analyze the correlation between cytokines and liver function in 15 patients with exfoliative dermatitis. RESULTS: The levels of alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin(TBIL), direct bilirubin(DBIL), glutamyl transpeptidase(GGT), and total bile acid(TBA) of OMDT patients on the 1 st week of admission increased(P<0.05), while total protein(TP) and albumin(ALB) decreased(P<0.05) compared with the results at discharge(a stage of recovery). The correlation analysis results of patients with exfoliative dermatitis showed that: the levels of TNF-α, IFN-γ and IL-6 were negatively correlated with the levels of TP and ALB respectively(P<0.05), the level of IL-5 was negatively correlated with TBIL(P<0.05), and the level of IL-10 was negatively correlated with ALB(P<0.05) in the 1 st week. The level of IL-6 was positively correlated with ALT(P<0.05) in the 2 nd week. The level of TNF-α was positively correlated with TBIL(P<0.05), the level of IL-10 was positively correlated with AST(P<0.05) in the 3 rd week. The levels of TNF-α and IL-10 were positively correlated with AST and ALT respectively(P<0.05), the level of IFN-γ was positively correlated with AST(P<0.05) in the 4 th week. The levels of IL-6 and IL-10 were positively correlated with ALT and GGT(P<0.05), and the levels of TNF-α and IFN-γ were positively correlated with AST(P<0.05) in the 5 th week. The level of TNF-α was negatively correlated with DBIL(P<0.05) and was positively correlated with TBA(P<0.05) at discharge.CONCLUSION:s Patients with OMDT are frequently accompanied with severe liver function damage at the early stage. The level of plasma cytokines(TNF-α, IFN-γ, IL-6 and IL-10) might correlate with the severity of liver dysfunction.

Objective To study the clinical features,diagnosis and treatment in the neonates of Kasabach-Merritt phenomenn (KMP).Method To analyze retrospectively the data collected from the 9 neonates of Kasabach-Merritt phenomenon in our neonatal intensive care unit from January 2016 to March 2017.The data of their clinical presentation,imaging findings,treatment and outcomes were analyzed.Result Among the 9 cases,there were 6 males and 3 females,with onset age of 0 ～ 14 d.The hemangiomas were located over the body surface of the neck,back,trunk and limbs in 4 cases.The others were located in the deep organs in 5 cases.2 cases were found hepatic hemangiomas by fetal ultrasound and 3 cases had symptoms of poor response,dyspnea and nasal bleeding with occult onset.All the 9 cases had thrombocytopenia,and the average platelet count was 24.0 × 109/L.The imaging findings showed the changes of hemangiomas,and among them,3 cases were associated with arteriovenous fistula.In one case,the biopsy pathology diagnosis was Kaposiform hemangioendothelioma.Among 8 cases which was treated,2 cases had systemic medication,2 cases had interventional embolization and 4 cases were treated with combined therapy (interventional embolization together with medication),including 1 case of definitive surgical treatment.Finally 7 cases improved,1 case with severe thrombocytopenia and coagulation disorders did not improve and treatment abandoned and 1 case died before treatment.Conclusion The symptomatology of KMP is various,which is related to the location of the lesion.The imaging studies are helpful to diagnosis.Massive hemorrhage and multiple organ dysfunction can be fatal.The treatments are different among cases,for most cases with proper treatment the prognosis are good.

Objective:To study the genetic profiles and clinical characteristics of neonatal-onset genetic epilepsy.Methods:From July 2016 to May 2021, patients with neonatal-onset genetic epilepsy admitted to our hospital and received second-generation genetic sequencing were enrolled in this study. According to the types of genetic variations, the patients were assigned into ion channel group and non-ion channel group. Clinical characteristics, treatments and prognosis of the two groups were compared.Results:A total of 36 patients with identified genetic variations were enrolled, involving 15 epilepsy-related genes. KCNQ2, SCN2A and STXBP1 were the most common pathogenic genes. 20 cases (55.6%) were in the ion channel group and 16 cases (44.4%) in the non-ion channel group. No significant differences existed in their general status, seizure types, EEG characteristics, treatments and outcomes between the two groups ( P>0.05). Among all 36 cases, the age of onset ranged from 10 min to 24 d after birth and 28 cases (78.8%) developed epilepsy within 1 week after birth. Developmental and epileptic encephalopathies were diagnosed in 20 patients. 7 patients were diagnosed with self-limited neonatal epilepsy, 2 were pyridoxine dependence, 2 were Zellweger syndrome and 1 case of self-limited familial neonatal-infantile epilepsy, Turner type mental retardation with epilepsy, PURA syndrome, Rett syndrome and 22q11.2 deletion syndrome, each. The patients received antiepileptic drugs including phenobarbital, levetiracetam, oxcarbazepine, topiramate, valproic acid, benzodiazepines (nizepam/clonazepam /clobazam/midazolam), lacosamide and lamotrigine. 5 patients died after giving up treatment. 31 patients were followed up for 6 to 50 months. 22 cases (71.0%) were controlled at 1- to 35-month-old including 21 cases (56.7%) with developmental delay. 6 cases (19.4%) had ineffective seizure control and 3 cases (9.7%) showed reduced seizures, all with varying degrees of developmental delay. Conclusions:Neonatal-onset epilepsy is correlated with multiple genes. KCNQ2, SCN2A, STXBP1 are the common pathogenic genes with multiple variants of KCNQ2 gene. Most patients have seizures within 1 week after birth. More than half of patients have ion channel related gene variations. Sodium channel blockers have certain effects as treatment.

Objective:To analyze the risk factors of recurrence and canceration for premalignant vocal fold lesions after surgery, and to provide a reasonable basis for preoperative evaluation and postoperative follow-up. Methods:This study retrospective analyzed the relationship between clinicopathological factors and clinical outcome（recurrence, canceration, recurrence-free survival, and canceration-free survival） in 148 patients undergoing surgical treatment in Chongqing General Hospital from 2014 to 2017. Results:The five-year overall recurrence rate was 14.86% and the overall recurrence rate was 8.78%. Univariate analysis showed that smoking index, laryngopharyngeal reflux and lesion range were significantly associated with recurrence（P<0.05）, and smoking index and lesion range were significantly associated with canceration（P<0.05）. Multivariate logistic regression analysis showed that smoking index ≥600 and laryngopharyngeal reflux were independent risk factors for recurrence（P<0.05）, and smoking index ≥600 and lesion range ≥1/2 vocal cord were independent risk factors for canceration（P<0.05）. The mean carcinogenesis interval for the postoperative smoking cessation group was significantly longer（P<0.05）. Conclusion:Excessive smoking, laryngopharyngeal reflux and a wide range of lesions may be related to postoperative recurrence or malignant progression of precancerous lesions in the vocal cord, and further large-scale multi-center prospective randomized controlled studies are needed to clarify the effects of the above factors on recurrence and malignant changes in the future.
Humans ; Vocal Cords/pathology* ; Retrospective Studies ; Laryngopharyngeal Reflux/complications* ; Prospective Studies ; Precancerous Conditions/pathology* ; Risk Factors

OBJECTIVE: To analysis the dynamic change of cytokines in patients with occupational trichloroethylene-induced medicamentosa-like dermatitis(OMDT) at the initial stage of treatment. METHODS: Twenty-two cases of early onset OMDT with no glucocorticoid treatment history were selected as the research subjects by judgment sampling method. Blood samples were collected on the 1 st, 2 nd, 3 rd, 4 th and 5 th weeks after admission and on the day of hospital discharge. The levels of tumor necrosis factor-α(TNF-α), interferon-γ(IFN-γ), interleukin(IL)-5, IL-6 and IL-10 in plasma samples were measured by the enzyme linked immunosorbent assay. RESULTS: The five cytokines in patients with exfoliative dermatitis showed an increasing trend at the initial stage of treatment. Among them, the levels of TNF-α, IL-5 and IL-10 reached a peak and then dropped rapidly to form a plateau, and the levels of IFN-γ and IL-6 were slightly increased and the duration of increase was shorter than that of other cytokines. The levels of TNF-α, IFN-γ, IL-5 and IL-6 in patients with erythema multiforme remained within the detection limits in the detection process. Only a few patients showed a short-term increase, the IL-10 level showed a slight increase at the initial stage and then decreased to the plateau stage. The levels of TNF-α, IFN-γ and IL-6 in patients with bullous epidermal necrolysis increased rapidly at the initial detection stage for a short period of time, and then decreased sharply. The level of IL-5 remained at the detection limit, and the IL-10 level showed alternative rising and falling pattern. Part of the dynamic change of cytokines in patients with exfoliative dermatitis and bullous epidermal necrolysis was similar. CONCLUSION: The levels of TNF-α, IFN-γ, IL-5, IL-6, and IL-10 in OMDT patients changed with the progression of the disease at the early treatment stage, and the degree of change was related to the type of rash. Among them, the levels of TNF-α and IL-10 showed dynamic changes due to the progression of the disease, which could be considered as effect biomarkers to evaluate the severity and progression of the disease, and provide a reference for the rational treatment of patients.