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Erector Spinae Plane Block for Open and Laparoscopic Liver Surgery: Two Case Reports

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Open Journal of Anesthesiology 2020年第4期10卷 113-119页

作者： jimmy guan cheng lim Agnes Wanwei Huang Kwee Lian Woon Prit Anand Singh Department of Anaesthesia and Surgical Intensive Care Changi General Hospital Singapore

Epidural analgesia has long been regarded as the gold standard in abdominal surgery. However, concerns regarding risks associated with central neuraxial blockade, catheter placement and the presence of coagulopathy in patients undergoing liver resection have limited its use. Bilateral erector spinae plane blocks and catheter placement may mimic the effects of epidural analgesia by blocking both somatic and visceral pain while concomitantly avoiding central neuraxial blockade and catheter placement. We describe our experience in using the erector spinae plane block and catheter placement as part of a multimodal analgesia approach in a patient undergoing laparoscopic and another patient undergoing open liver resection. Our findings concur with previous reports which suggest that erector spinae plane blocks may be more efficacious as somatic rather than visceral analgesia. However, we conclude that further studies on factors affecting its efficacy should be conducted in view of the present lack of researched evidence.

关键词： Erector Spinae Plane Block Bilateral Erector Spinae Plane Block Laparoscopic Liver Resection Open Liver Resection ESP Block

大型激光粉末床熔融金属增材制造装备研究与探讨

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材料开发与应用 2024年第2期39卷 28-36页

作者：程锦泽关凯杨书业刘斌姜欢欢天津镭明激光科技有限公司天津300393 北京鑫精合增材制造技术有限公司北京102200

国产金属增材制造加工装备已在航空航天、军工、汽车、模具、高端医疗等先进研发制造领域获得广泛应用。伴随着大尺寸增材制造的需求逐渐增多,突破国产化大型金属增材制造装备及工艺技术的瓶颈,提高大体积、高品质金属零件增材制造成形... 详细信息

国产金属增材制造加工装备已在航空航天、军工、汽车、模具、高端医疗等先进研发制造领域获得广泛应用。伴随着大尺寸增材制造的需求逐渐增多,突破国产化大型金属增材制造装备及工艺技术的瓶颈,提高大体积、高品质金属零件增材制造成形加工的制造水平,在缓解金属增材制造成形范围、工艺质量和应用细分等方面将起到一定的促进作用。本研究结合目前大尺寸金属增材制造装备日趋广泛的市场需求,针对激光粉末床熔融金属增材制造装备的技术特点,探讨了大尺寸、多光束装备制造,以及使用成本与效率问题,并对具有“飞行打印”结构超大尺寸装备的技术思路进行了介绍。

关键词：大尺寸装备金属增材制造多光束飞行打印

Acute-on-chronic liver failure in a multi-ethnic Asian city:A comparison of patients identified by Asia-Pacific Association for the Study of the Liver and European Association for the Study of the Liver definitions

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World Journal of Hepatology 2017年第28期9卷 1133-1140页

作者： Anandraj Selva Rajoo Seng-Gee lim Wah Wah Phyo Thandar Tun Yock-Young Dan Yin-Mei Lee How-cheng Low Kieron lim Poh-Seng Tan guan-Huei Lee Yong Loo Lin School of Medicine National University of SingaporeSingapore 119077Singapore Institute of Molecular and Cell Biology ASTARSingapore 138668Singapore Division of Gastroenterology and Hepatology Department of MedicineNational University HospitalSingapore 119228Singapore Department of Hepatology Mandalay General Hospital30th StChan Aye Tharsan TownshipMandalayMyanmar

AIM To explore the applicability of the Asia-Pacific Association for the Study of the Liver(APASL) and European Association for the Study of the Liver(EASL) guidelines for acute-on-chronic liver failure(ACLF) in profiling patients and determining the *** Patients admitted to a tertiary hospital in Singapore with acute decompensation of liver disease from January 2004to July 2014 are screened for ACLF according to the APASL and EASL criteria. The patients' data(including basic demographics, information about existing chronic liver disease, information about the acute decompensation, relevant laboratory values during admission, treatment, and outcome) are retrospectively analyzed to determine the background, precipitating factors and *** A total of 458 liver patients is analyzed, and 78 patients with ACLF are identified. Sixty-three patients(80.8%) meet the APASL criteria, 64 patients(82.1%) meet the EASL criteria, and 49 patients(62.8%) fulfilled both criteria. The most common causes of acute liver injury are bacterial infections(59.0%), hepatitis B flare(29.5%), and variceal bleeding(24.4%). The common aetiologies of the underlying chronic disease included hepatitis B(43.6%), alcoholic(20.5%) and cryptogenic(11.5%) liver disease. The overall mortality rate is 61.5%. Increased age, the number of organ failures(as per CLIF-SOFA score), peak creatinine, INR, and amylase levels are associated with increased mortality or the need for liver transplantation. 14.3% of patients undergo liver transplantation with a 100% 1-year survival rate. CONCLUSION Both APASL and EASL criteria have identified ACLF patients with high three-month mortality, but those who fulfill APASL criteria alone have a better survival.

关键词： Acute-on-chronic liver failure Survival Prognosis Liver decompensation Liver cirrhosis

Risk factors for ribavirin treatment failure in Asian organ transplant recipients with chronic hepatitis E infection

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World Journal of Hepatology 2019年第6期11卷 553-561页

作者： En Xian Sarah Low Edhel Tripon Kieron lim Poh Seng Tan How cheng Low Yock Young Dan Yin Mei Lee Mark Muthiah Wai Mun Loo Calvin Jianyi Koh Wah Wah Phyo JunXiong Pang Seng Gee lim guan-Huei Lee Department of Medicine Ng Teng Fong General HospitalNational University Health SystemSingapore 609606Singapore Centre for Liver Disease Management and Transplant of Medical City Manila 1605Philippines Mount Elizabeth Medical Centre Singapore 228510Singapore Division of Gastroenterology and Hepatology National University Health SystemSingapore 119228Singapore Department of Medicine National University of SingaporeSingapore 119077Singapore Centre for Infectious Disease Epidemiology and Research National University of SingaporeSingapore 117549Singapore Department of Medicine Yong Loo Lin School of MedicineNational University of SingaporeSingapore 119228Singapore

BACKGROUND Hepatitis E virus(HEV)infection is a cause of chronic hepatitis in immunosuppressed *** virologic response rates to a 12-wk course of ribavirin therapy were reported to be>70%in the *** study describes the outcome of HEV treatment in a transplant center in *** To study the outcome of ribavirin treatment in a series of chronic HEV patients,and the cause of treatment *** We studied all of the transplant recipients who were diagnosed with HEV infection between 2012 to *** outcome of therapy and virologic relapse are monitored for three years after the end of *** Ten transplant recipients(4 liver,5 kidney,and 1 bone marrow transplantation)with positive HEV RNA were *** patients received at least 12 wk of ribavirin therapy,and the remaining patient resolved after reducing immunosuppression *** subjects had prolonged viremia that lasted more than one year,despite continuous ribavirin *** ribavirin-treated patients(44.4%)had HEV RNA relapse after achieving a virologic response by the end of *** overall failure rate is 66.7%.Being a kidney transplant recipient is the strongest risk factor for not achieving an initial sustained virologic response(0/5 treated,Chi-Square test,P<0.05).The most common side effect of ribavirin is anemia(100%)(haemoglobin reduction of 3-6.2 g/dL).Seven patients required either a blood transfusion or erythropoietin *** The sustained virologic response rate of 12-wk ribavirin therapy for HEV infection in this Asian series was lower than *** transplant recipients had a higher rate of treatment failure due to higher immunosuppression requirements and adverse effects.

关键词： Toxicity Antiviral agents Hepatitis E virus Virus classification Systemic immunity Immune responses Persistent infection

Validation of genetic variants associated with metabolic dysfunctionassociated fatty liver disease in an ethnic Chinese population

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World Journal of Hepatology 2020年第12期12卷 1228-1238页

作者： guan Huei Lee Wah Wah Phyo Wai Mun Loo Raymond Kwok Taufique Ahmed Asim Shabbir jimmy So Calvin Jianyi Koh Juanda Leo Hartono Mark Muthiah Kieron lim Poh Seng Tan Yin Mei Lee Seng Geelim Yock Young Dan Division of Gastroenterology and Hepatology Department of MedicineNational University Health SystemSingapore 119228Singapore Yong Loo Lin School of Medicine National University of SingaporeSingapore 117597Singapore Department of Medicine Khoo Teck Puat HospitalSingapore 768828Singapore Department of Surgery National University Health SystemSingapore 119228Singapore

BACKGROUND Genetic factors play an important role in the pathogenesis and development of metabolic dysfunction-associated fatty liver disease(MAFLD).AIM To study the association of single nucleotide polymorphisms(SNPs),previously identified in Western populations,with the risk of MAFLD in a Singapore Chinese population and their interactions with environmental and medical risk *** A retrospective case-control study was conducted with 72 MAFLD cases and 72 controls with no hepatic steatosis on computed tomography,magnetic resonance imaging,or controlled attenuation parameter *** were recruited from two tertiary *** alleles such as NCAN,GCKR,LYPLAL1,PNPLA3,PPP1R3B,FDFT1,COL13A1,EFCAB4B,PZP,and TM6SF2 were genotyped using the TaqMan®Predesigned SNP Genotyping *** Weight and body mass index(BMI)were 1.2-times higher in patients(70.6 kg,95%confidence interval[CI]:57.1-84.1 vs 60.8 kg,95%CI:48.5-73.1,P<0.001 and 26.9 kg,95%CI:23-40.8 vs 23.3 kg 95%CI:19-27.6,P<0.001 respectively).The prevalence of diabetes mellitus in patients was 40.3%and 20.8%in controls(P=0.011).Patients had higher mean triglycerides than controls(P<0.001).PNPLA3 GG was more likely to be associated with MAFLD(43.4%CC vs 69.7%GG,P=0.017,and 44.8%CG vs 69.7%GG,P=0.022).In multivariable analysis,hypertriglyceridemia(odds ratio[OR]:2.0495%CI:1.3-3.1,P=0.001),BMI(OR:1.295%CI:1.1-1.4,P<0.001)and PNPLA3 GG(OR:3.495%CI:1.3-9.2,P=0.014)were associated with MAFLD(area under the receiver operating characteristic curve of 0.823).CONCLUSION Among the Chinese population of Singapore,PNPLA3 homozygous GG allele is a strong predictor of MAFLD,whereas LYPLAL1,GCKR,FDFT1,COL13A1,PZP,and TM6SF2 are not significantly ***,high BMI,and PNPLA3 GG are independent predictors of MAFLD.

关键词： Single nucleotide polymorphism PNPLA3 Genotyping Metabolic dysfunction-associated fatty liver disease Non-alcoholic steatohepatitis Hypertriglyceridemia Body mass index Waist-hip ratio,Screening Hepatic steatosis

Efficacy of Autologous Cultured Fibroblast Cells as a Treatment for Patients with Facial Contour Defects: A Clinical Replication Study

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Journal of Cosmetics, Dermatological Sciences and Applications 2017年第4期7卷 306-317页

作者： Edward Charles R. Lee Kim Siea Lee Jezamine lim Jason Yip cheng Zhang Xu Zhang Han Bin To lim Sabah Medical Centre Sabah Malaysia Loh guan Lye Specialists Centre Pinang Malaysia Tissue Engineering Centre University Kebangsaan Kuala Lumpur Malaysia Astute Clinic Kuala Lumpur Malaysia Beijing Cell Technology Inc. Beijing China SB Clinical Research Malaysia

Background: The US FDA has recently approved autologous cultured fibroblast cells (ACF) as treatment for cutaneous contour defects. ACF provides an alternative to synthetic fillers or fat grafting with the significant advantage of producing longer lasting effect. Methods: This was a prospective open label single group clinical study to demonstrate the clinical efficacy of ACF that we have replicated in our lab. The study enrolled 18 patients with nasolabial folds from 2 centres in Malaysia in 2011-2012. ACF at dose of 23 or 92 million cells were injected on 3 occasions at 4 weeks interval. Efficacy at 6- and 12-month post treatment was assessed using a standardized 7-point scale which was performed by the 2 investigators as well as a panel of 7 independent evaluators. Results: We obtained a successful outcome (primary endpoint), defined as improvement in the appearance of the nasolabial fold of at least 2 points on the 7-point scale, in 33% of patients as assessed by investigators at 12-month follow-up and in 22% of patients assessed by independent evaluators. Investigators also found 78% of patients having had a 1-point improvement from baseline while independent evaluators found 83% of patients having improved by as much. Patients were uniformly (100%) satisfied with the improvement in their appearance. No treatment-related adverse event was reported. Baseline score and follow-up duration had significant effect on treatment response. The greater the baseline severity and the longer the post-treatment follow-up, the better the response to ACF. Larger dose of cells (92 million cells) has little additional effect suggesting that the 1 mL dose (23 million cells) is near optimal. Older patients showed a trend towards poorer response but this was not statistically significant. Conclusions: We have successfully replicated the laboratory method and clinical procedure to perform ACF treatment which was effective in improving the appearance of nasolabial folds in some patie

关键词： Facial Contour Defect Nasolabial Fold Wrinkle Autologous Cultured Fibroblast Cell Autologous Cell Therapy

Persisting lung pathogenesis and minimum residual virus in hamster after acute COVID-19

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Protein & Cell 2022年第1期13卷 72-77页

作者： Lunzhi Yuan Huachen Zhu Ming Zhou Jian Ma Rirong Chen Liuqin Yu Wenjia Chen Wenshan Hong Jia Wang Yao Chen Kun Wu Wangheng Hou Yali Zhang Shengxiang Ge Yixin Chen Quan Yuan Qiyi Tang Tong cheng Yi guan Ningshao Xia State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics National Institute of Diagnostics and Vaccine Development in Infectious DiseasesSchool of Life SciencesSchool of Public HealthXiamen UniversityXiamen 361000China State Key Laboratory of Emerging Infectious Diseases The University of Hong KongHong KongChina Joint Institute of Virology(Shantou University and The University of Hong Kong) Guangdong-Hongkong Joint Laboratory of Emerging Infectious DiseasesShantou UniversityShantou 515063China Department of Microbiology Howard University College of MedicineWashingtonDC 20059USA Research Unit of Frontier Technology of Structural Vaccinology Chinese Academy of Medical SciencesXiamen 361102China

Dear Editor,Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has infected more than 200 million people,causing coronavirus disease 2019(COVID-19)*** are the primary target organ of SARS-CoV-2 *** mild COVID-19 cases develop symptoms of fever,fatigue,muscle weakness,chest pain,headache and cough(Chen et al.,2020;Wang et al.,2020;Zhu et al.,2020),while severe COIVD-19 cases might have pneumonia,breathing difficulties,multiple organ failure and death(Chen et al.,2020;Wang et al.,2020;Zhu et al.,2020).Both the clinicians and researchers have largely focused on the acute phase of COVID-19,but the long-term health consequences of the COVID-19 patients after clinical recovery remain less *** clinical cohorts demonstrated that some patients discharged from hospital still experience symptoms including fatigue,muscle weakness,chest pain,cough and breathing difficulties(Carfi et al.,2020;lim et al.,2020;Huang et al.,2021).Moreover,severely impaired pulmonary diffusion capacities and abnormal chest imaging manifestations were observed in some convalescent patients(Huang et al.,2021).Surprisingly,residual virus(An et al.,2020;Yao et al.,2020;Kim et al.,2021)were detected in some convalescent patients.

关键词： acute impaired pathogenesis

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FHL1在胃癌中的表达及其临床意义

临床肿瘤学杂志 2011年第3期16卷 228-231页

作者：吴成利周洲钱建新潘军柳珂于观贞王杰军第二军医大学附属长征医院肿瘤科上海200070

目的观察肿瘤抑制因子FHL1在人胃癌组织中的表达,并探讨其与胃癌预后的关系。方法应用组织芯片技术和免疫组织化学方法检测1072例胃癌术后癌组织中FHL1的表达,并分析其与癌浸润深度、分化、分期等病理特征及预后之间的相关性。结果 FHL... 详细信息

目的观察肿瘤抑制因子FHL1在人胃癌组织中的表达,并探讨其与胃癌预后的关系。方法应用组织芯片技术和免疫组织化学方法检测1072例胃癌术后癌组织中FHL1的表达,并分析其与癌浸润深度、分化、分期等病理特征及预后之间的相关性。结果 FHL1在分化高、中和低、未分化的胃癌组织中阳性表达率分别为58.4%和24.9%(P<0.001);FHL1在T1、T2期和T3、T4期胃癌组织中的阳性表达率分别为60.3%和38.3%(P<0.001);FHL1在淋巴结转移阴性和阳性的胃癌组织中阳性表达率分别为59.0%和37.6%(P<0.001);FHL1在TNM分期中Ⅰ、Ⅱ期和Ⅲ、Ⅳ期胃癌组织中的阳性表达率分别为58.8%和35.3%(P<0.001);生存分析表明FHL1是判断胃癌患者预后的独立指标。结论 FHL1表达与人胃癌的浸润深度、组织分化、淋巴结转移、TNM分期和预后相关,并可能参与人胃癌发生发展的过程。

关键词： FHL1 胃癌组织芯片