A 56-year-old female patient of Han nationality presented with generalized erythema and vesicles for 6 days,as well as high fever for 2 days.Twenty days prior to hospitalization,the patient received surgical treatment combined with oral methazolamide and glucocorticoids for glaucoma.The patient had a history of allergy to sulfanilamides.On admission,the patient presented with generalized erythema,vesicles and occasional erosions with bilateral eyelid and oral involvement.Nikolsky's sign was positive.Wheezing sound was heard over the right lung.Genetic testing showed that HLA-B5901 allele was positive.The patient was diagnosed with methazolamide-induced toxic epidermal necrolysis (TEN) complicated by pneumonia,and managed with immunoglobulin (25 g/day,5 days),glucocorticoids (the largest dose equivalent to methylprednisolone 160 mg/day),fresh plasma,antibiotics,as well as other supporting and symptomatic treatments.The condition was controlled after 2 weeks,and the patient was cured and discharged from hospital after 25 days.The fact that the patient carried HLA-B5901 allele suggests that HLA-B5901 is strongly correlated with methazolamide-induced TEN or Stevens-Johnson syndrome in Chinese descendants or Han population,besides in Japanese and Korean descendants.

Objective To evaluate the efficacy of clemastine fumarate in antagonizing atracuriuminduced release of histamine in the patients undergoing surgery under general anesthesia.Methods Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 21-59 yr,with body mass index of 17-26 kg/m2,scheduled for elective modified radical mastectomy,were divided into 2 groups (n=40 each) using a random number table:control group (group C) and clemastine fumarat group (group CF).Clemastine fumarate 2 mg was injected intramuscularly at 20 min before induction of anesthesia.Anesthesia was induced with iv midazolam 0.1 mg/kg,etomidate 0.3 mg/kg,fentanyl 4-6 μg/kg and atracurium 0.8 mg/kg.The patients were mechanically ventilated after insertion of the larygeal mask airway.Anesthesia was maintained with inhalation of 2％ sevoflurane.Before administration of clemastine fumarate,at 20 min after administration,immediately before administration of atracurium,and at 2,5,10 and 20 min after administration of atracurium,arterial blood samples were taken for determination of plasma histamine concentrations,and the peak airway pressure and degree of cutaneous color were recorded.The development of histaminemia and adverse cardiovascular events was assessed.Steward recovery scores and Ramsay sedation scores were recorded at 10 min after removal of the laryngeal mask airway.Results The incidence of histaminemia was 60％ and 8％ in C and CF groups,respectively.Compared with group C,the plasma histamine concentrations,incidence of histaminemia,degree of cutaneous color,and incidence of hypotension and tachycardia were significantly decreased (P＜0.05),and no significant change was found in the peak airway pressure,Steward recovery scores and Ramsay sedation scores in group CF (P＞0.05).Conclusion For atracurium-induced release of histamine in the patients undergoing surgery under general anesthesia,clemastine fumarate 2 mg injected intramuscularly before operation can not only antagonize histamine at H1 level,but also reduce histamine release,and exerts no influence on recovery from anesthesia and produces good antihistamine efficacy.

Objective To evaluate the effect of ulinastatin on acute kidney injury in the pediatric patients undergoing living-donor liver transplantation (LDLT).Methods Forty pediatric patients with congenital biliary atresia,aged 5-14 months,weighing 5.5-10.0 kg,of American Society of Anesthesiologists physical status Ⅲ or Ⅳ,scheduled for elective LDLT,were divided into either control group (group C,n=20) or ulinastatin group (group U,n=20) using a random number table.Ulinastatin 20 000 U/kg was diluted to 10 000 U/ml in normal saline and then intravenously infused in 2 parts (1/2 was given immediately before skin incision;1/2 at 5 min before portal vein declamping) in group U.The equal volume of normal saline was given instead of ulinastatin at the same time points in group C.Immediately before skin incision (To,baseline),at 30 min of anhepatic period (T1),at 1 h of neohepatic period (T2),at the end of surgery (T3) and at 24 h after surgery (T4),blood samples from the central vein and urine specimens were collected for determination of creatinine (Cr) and blood urea nitrogen (BUN) concentrations in serum (by colorimetric assay) and β2-microglobulin (β2-MG) concentrations in serum and urine (using immunoturbidimetric method).The urine volume,requirement for dopamine and diuretics and occurrence of adverse cardiovascular events (hypotension,myocardial ischemia,ventricular premature beat)were recorded during surgery.The changing rates of Cr,BUN and β2-MG concentrations in serum and β2-MG concentrations in urine were calculated at T1-4.Results Compared with group C,the urine volume was significantly increased,Cr and β2-MG concentrations in serum,β2-MG concentrations in urine and the changing rates were decreased at T2-4,serum BUN concentrations and the changing rates were decreased at T3,4 (P＜0.05 or 0.01),and no significant changes were found in the incidence of adverse cardiovascular events or requirement for dopamine and diureitcs in group C (P＞0.05).Conclusion Ulinastatin can attenuate acute kidney injury in the pediatric patients undergoing LDLT.

Objective To evaluate the role of necroptosis in intestinal injury induced by autologous orthotopic liver transplantation ( AOLT) in rats. Methods Twenty-four SPF adult male Sprague-Dawley rats, aged 10-12 weeks, weighing 250-280 g, were divided into 3 groups ( n=8 each) using a random number table method: sham operation group ( group S) , AOLT group ( group T) and necroptosis inhibitor necrostatin-1 group ( group N) . Necrostatin-11. 0 mg∕kg and the equal volume of dimethyl sulfoxide ( DM-SO) were intraperitoneally injected at 30 min before surgery in N and T groups, respectively. Blood samples were collected from the inferior vena cava at 6 h after opening the portal vein ( at 6 h after the end of surgery in group S) for determination of serum diamine oxidase ( DAO) , D-lactic acid ( D-LA) and intestinal fatty acid binding protein ( I-FABP ) concentrations by enzyme-linked immunosorbent assay. Rats were sacrificed after blood sampling, and the intestine was removed for examination of the pathological changes ( with a light microscope ) and for determination of malondialdehyde ( MDA ) contents and superoxide dismutase ( SOD) activities ( using a spectrophotometer) , and the expression of receptor-interacting protein kinase-1 ( RIPK1) , RIPK3 and mixed lineage kinase domain-like protein ( MLKL) in intestinal tissues ( by Western blot) . Intestinal damage was assessed and scored using Chiu' s scoring system. Results Compared with group S, the serum DAO, D-LA and I-FABP concentrations, MDA content and Chiu's score were signifi-cantly increased, SOD activity was decreased, and the expression of RIPK1, RIPK3 and MLKL was up-regulated in group T ( P<0. 05) . Compared with group T, the serum DAO, D-LA and I-FABP concentra-tions, MDA content and Chiu's score were significantly decreased, the SOD activity was increased, and the expression of RIPK1, RIPK3 and MLKL was down-regulated in group N ( P<0. 05) . Conclusion Ne-croptosis is involved in the pathophysiological process of intestinal injury induced by AOLT in rats.

Objective To investigate the changes of hemodynamics and cardiac function in pediatric living donor liver transplantation (LDLT).Methods 50 cases of pediatric living donor liver transplantation in our hospital from January 2016 to January 2017 were collected.The hemodynamics was monitored by Mostcare with the radial artery.Acquisition of heart rate (HR),mean arterial pressure (MAP),peripheral vascular resistance index (SVR/SVRI),stroke volume / stroke index (SV/SVI),cardiac output (CO/CI),cardiac index / stroke volume variability (SVV),dp/dtmax (cardiac contractility),cardiac cycle efficiency (CCE) at the moment of the start of operation(T0),before occlusion of the inferior vena cava (T1),immediately after occlusion of the inferior vena cava (T2),anhepatic phase 30 min (T3),immediately after reperfusion(T4),neohepatic phase 5 min (T5),30 min (T6) and 60 min (T7).Results There were no significantly hemodynamic fluctuations before occlusion of the portal vein.At T3,the increased of MAP,CI,SVRI (T3 vs T0,P＜0.05),while CCE decreased significantly (T3 vs T0,P＜0.05);MAP,SVRI,lower HR,CI and dp/dtmax have different degrees of liver T4,but the change was not significant.SVV fluctuated in the anhepatic phase at 11％ ～ 15％,maintained in the new liver stage at 12％ ～ 15％,but fluctuated slightly.Conclusion Mostcare can be used to monitor the hemodynamic and cardiac function changes in pediatric living donor liver transplantation,but the reasons for the change of the monitoring indicators and the significance of guiding the perioperative treatment need to be further studied.

Objective To investigate the effects of ulinastatin preconditioning combined with postconditioning on kidney injury of pediatric patients undergoing living donor liver transplantation (LDLT) and the underlying mechanism.Methods Forty pediatric patients with biliary atresia,scheduled for LDLT,were randomly divided into two groups (n =20 each):the ulinastatin group and the control group using a random number table.Ulinastatin (20 000 U/kg) was diluted into 10 000 U/mL with normal saline,and it was then injected intravenously in 2 parts (1/2 was given before skin incision;1/2 at 5 min before portal vein declamping) in the ulinastatin group.In the control group,the equal volume of normal saline was given instead of ulinastatin.Blood samples and urine specimens were taken from the central vein immediately before skin incision (T0,baseline),at 30 min of anhepatic period (T1),at 1 h of neohepatic period (T2),at the end of surgery (T3),and 24 h after surgery (T4) for the determination.The concentrations of serum and urine β2-microglobulin (β2-MG) were measured using an immunonephelometric method.The levels of serum TNF-α,IL-6 and IL-18 were measured using an ELISA method.The serum concentrations of creatinine (Cr) and blood urea nitrogen (BUN) were measured using a colorimetry method.Results The serum Cr,BUN,β2-MG and urine β2-MG concentrations were higher at T2-4 than at T0 in the two groups (P＜0.05 or 0.01).As compared with the control group,the serum Cr,BUN,β2-MG and urine β2-MG concentrations were significantly decreased in the ulinastatin group (P＜0.05 or 0.01).The serum levels of TNF-α,IL-6 and IL-18 were higher at T2 4 than at T0 in the two groups (P＜0.05 or 0.01).As compared with the control group,the serum levels of TNF-α,IL-6,and IL-18 were significantly decreased in the ulinastatin group (P＜0.05 or 0.01).Conclusion Ulinastatin preconditioning combined with postconditioning can alleviate kidney injury in pediatric patients undergoing LDLT to some extent,which may be related to inhibiting the excessive release of inflammatory factors.

【Objective】 To establish a predictive model for patients with hemorrhage after CT-guided coaxial core needle lung biopsy （CCNB） based on logistic regression. 【Methods】 A total of 489 patients who had undergone CCNB were retrospectively recruited. The potential risk factors of hemorrhage after lung biopsy were analyzed by univariate and multivariate logistic regression， through which we screened the independent risk factors and established a prediction model for hemorrhage. We evaluated the discrimination， calibration and clinical usefulness of the model. 【Results】 There were 141 cases （42.6%） of hemorrhage in the development group and 66 cases （41.8%） of hemorrhage in the validation group； there was no case of severe hemorrhage or hemothorax. Multivariate logistic regression analysis showed that fibrinogen degradation products， pulmonary interstitial fibrosis， largest diameter and puncture depth were independent predictive factors of hemorrhage. Hemorrhage prediction model was established and presented in the form of a nomogram. Discrimination of the model： the AUC was 0.837 in the development group and 0.777 in the validation group. The calibration curve showed good agreement between predicted probability and actual probability of hemorrhage. The unreliability test yielded a P value of 0.849 in the development group and 0.147 in the validation group. The DCA curve showed that the hemorrhage predictive model could increase the benefit of patients. 【Conclusion】 The predictive model of hemorrhage in patients after CCNB based on logistic regression can be used in clinical practice.

【Objective】 To analyze the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) in Xi’an so as to investigate the relationship between the dynamic changes of lymphocytes and the disease progression. 【Methods】 We retrospectively analyzed the clinical data of 15 patients with COVID-19 in The First Affiliated Hospital of Xi’an Jiaotong University from January 22 to February 16, 2020. 【Results】 Among the 15 patients with COVID-19, 8 were males and 7 were females, aged from 22 to 89 years. There were 12 ordinary cases (80%), 1 severe case (6.67%), and 2 critical cases(13.33%). There were 6 groups of family clusters.Most of the patients (14/15, 93.3%) had fever of different degrees. The average time from illness onset to admission was 2.80±1.66 days, and the average time from illness onset to diagnosis was 2.83±2.29 days. The main accompanying symptoms were dry cough (8/15, 53.33%) and shortness of breath (4/15, 26.67%). Nine patients (60%) who had low lymphocyte counts at admission, including of all of the critically ill patients (1 severe case and 2 critical cases) and 6 (6/12, 50%) ordinary patients. Lymphocyte counts in the ordinary cases increased gradually, but fluctuated in the severely ill patients. They were always at low level, or even decreased overall in critical cases. 【Conclusion】 In Xi’an City, COVID-19 mostly occurred in family clusters. Lymphocyte counts were reduced in most patients, especially in critically ill (severe and critical) ones. The lymphocyte count at admission and its kinetics during therapy may be an important predictor for the severity and prognosis of the disease.