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Persistent postoperative hypotension caused by subclinical empty sella syndrome after a simple surgery:A case report

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世界临床病例杂志 2023年第24期11卷 5817-5822页

作者： Kang-Mei Zhao Jia-Sheng Hu Sheng-Mei Zhu Ting-Ting Wen xiang-ming fang Department of Anesthesiology The First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhou 310003Zhejiang ProvinceChina Department of Anesthesiology Sanmen People’s HospitalSanmen 317100Zhejiang ProvinceChina

BACKGROUND Empty sella is an anatomical and radiological finding of the herniation of the subarachnoid space into the pituitary fossa leading to a flattened pituitary gland.Patients with empty sella may present with various symptoms,including headache due to intracranial hypertension and endocrine symptoms related to the specific pituitary hormones affected.Here,we report a female patient who developed persistent postoperative hypotension caused by subclinical empty sella syndrome after a simple surgery.CASE SUMMARY A 47-year-old woman underwent vocal cord polypectomy under general anesthesia with endotracheal intubation.She denied any medical history,and her vital signs were normal before the surgery.Anesthesia and surgery were uneventful.However,she developed dizziness,headache and persistent hypotension in the ward.Thus,intravenous dopamine was started to maintain normal blood pressure,which improved her symptoms.However,she remained dependent on dopamine for over 24 h without any obvious anesthesia-and surgery-related complications.An endocrine etiology was then suspected,and further examination showed a high prolactin level,a low normal adrenocorticotropic hormone level and a low cortisol level.Magnetic resonance imaging of the brain revealed an empty sella.Therefore,she was diagnosed with empty sella syndrome and secondary adrenal insufficiency.Her symptoms disappeared one week later after daily glucocorticoid supplement.CONCLUSION Endocrine etiologies such as pituitary and adrenal-related dysfunction should be considered in patients showing persistent postoperative hypotension when anesthesia-and surgery-related factors are excluded.

关键词： Empty sella syndrome Perioperative hypotension Secondary adrenal insufficiency Adrenocorticotropic hormone Cortisol Case report

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indfulness Meditation for Primary Headache Pain： A Meta-Analysis

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Chinese Medical Journal 2018年第7期131卷 829-838页

作者： Qiang Gu Jin-Chao Hou xiang-ming fang School of Medicine Zhejiang University Hangzhou Zhejiang 210029 China Department of Anesthesiology School of Medicine The First Affiliated Hospital Zhejiang University Hangzhou Zhejiang 210029 China

Background： Several studies have reported that mindfulness meditation has a potential effect in controlling headaches, such as migraine and tension-type headache; however, its role remains controversial. This review assessed the evidence regarding the effects of mindfulness meditation for primary headache pain. Methods： Only English databases （PubMed, Cochrane Central Register of Controlled Trials [the Cochrane Library], PsyclNFO, Psychology and behavioral science collection, PsyArticles, Web of Science, and Scopus） were searched from their inception to November 2016 with the keywords （＂meditation＂ or ＂mindfulness＂ or ＂vipassana＂ or ＂dzogchen＂ or ＂zen＂ or ＂integrative body-mind training＂ or ＂IBMT＂ or ＂mindfulness-based stress reduction＂ or ＂MBSR＂ or ＂＇mindfulness-based cognitive therapy＂ or ＂MBCT＂ and ＂Headache＂ or ＂Head pain＂ or ＂Cephalodynia＂ or ＂Cephalalgia＂ or ＂Hemicrania＂ or ＂Migraine＂）. Titles, abstracts, and full-text articles were screened against study inclusion criteria： controlled trials of structured meditation programs for adult patients with primary headache pain. The quality of studies included in the meta-analysis was assessed with the Yates Quality Rating Scale. The meta-analysis was conducted with Revman 5.3. Results： Ten randomized controlled trials and one controlled clinical trial with a combined study population of 315 patients were included in the study. When compared to control group data, mindfulness meditation induced significant improvement in pain intensity （standardized mean difference, -0.89; 95% confidence interval, 1.63 to 0.15; P - 0.02） and headache frequency （-0.67; - 1.24 to -0.10; P - 0.02）. In a subgroup analysis of different meditation forms, mindfulness-based stress reduction displayed a significant positive influence on pain intensity （P 〈 0.000）. Moreover, 8-week intervention had a significant positive effect （P 〈 0.000）. Conclusions： Mindfulness meditation may reduce pain intensity and is a promising treatment option tbr patients. Clinicians may consider mindfulness medi

关键词： Headache Pain Meta-Analysis Mindfulness Meditation

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Sepsis-induced immunosuppression:mechanisms,diagnosis and current treatment options

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Military Medical Research 2023年第2期10卷 242-261页

作者： Di Liu Si-Yuan Huang Jian-Hui Sun Hua-Cai Zhang Qing-Li Cai Chu Gao Li Li Ju Cao fang Xu Yong Zhou Cha-xiang Guan Sheng-Wei Jin Jin Deng xiang-ming fang Jian-Xin Jiang Ling Zeng Department of Trauma Medical Center Daping HospitalState Key Laboratory of TraumaBurns and Combined InjuryArmy Medical UniversityChongqing 400042China Department of Respiratory Disease Daping HospitalArmy Medical UniversityChongqing 400042China Department of Laboratory Medicine the First Affiliated Hospital of Chongqing Medical UniversityChongqing 400016China Department of Critical Care Medicine the First Affiliated Hospital of Chongqing Medical University400016 ChongqingChina Department of Physiology School of Basic Medicine ScienceCentral South UniversityChangsha 410078China Department of Anesthesia and Critical Care the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical UniversityZhejiang 325027 WenzhouChina Department of Emergency the Affiliated Hospital of Guizhou Medical UniversityGuizhou Medical University550001 GuiyangChina Department of Anesthesiology the First Affiliated HospitalZhejiang University School of MedicineHangzhou 310052China.

Sepsis is a common complication of combat injuries and trauma,and is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection.It is also one of the significant causes of death and increased health care costs in modern intensive care units.The use of antibiotics,fluid resuscitation,and organ support therapy have limited prognostic impact in patients with sepsis.Although its pathophysiology remains elusive,immunosuppression is now recognized as one of the major causes of septic death.Sepsis-induced immunosuppression is resulted from disruption of immune homeostasis.It is characterized by the release of antiinflammatory cytokines,abnormal death of immune effector cells,hyperproliferation of immune suppressor cells,and expression of immune checkpoints.By targeting immunosuppression,especially with immune checkpoint inhibitors,preclinical studies have demonstrated the reversal of immunocyte dysfunctions and established host resistance.Here,we comprehensively discuss recent findings on the mechanisms,regulation and biomarkers of sepsis-induced immunosuppression and highlight their implications for developing effective strategies to treat patients with septic shock.

关键词： Sepsis Immunosuppression Immune monitoring Immunomodulatory therapy

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Analysis and validation of diagnostic biomarkers and immune cell infiltration characteristics in pediatric sepsis by integrating bioinformatics and machine learning

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World Journal of Pediatrics 2023年第11期19卷 1094-1103页

作者： Wen‑Yuan Zhang Zhong‑Hua Chen Xiao‑Xia An Hui Li Hua‑Lin Zhang Shui‑Jing Wu Yu‑Qian Guo Kai Zhang Cong‑Li Zeng xiang‑ming fang Department of Anesthesiology and Intensive Care School of MedicineThe First Affiliated HospitalZhejiang UniversityQingChun Road 79Hangzhou 310003China Department of Anesthesiology Shaoxing People’s Hospital(Shaoxing HospitalZhejiang University School of Medicine)Shaoxing 312000China Department of Anesthesiology Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA

Background Pediatric sepsis is a complicated condition characterized by life-threatening organ failure resulting from a dysregulated host response to infection in children.It is associated with high rates of morbidity and mortality,and rapid detection and administration of antimicrobials have been emphasized.The objective of this study was to evaluate the diagnostic biomarkers of pediatric sepsis and the function of immune cell infiltration in the development of this illness.Methods Three gene expression datasets were available from the Gene Expression Omnibus collection.First,the differentially expressed genes(DEGs)were found with the use of the R program,and then gene set enrichment analysis was carried out.Subsequently,the DEGs were combined with the major module genes chosen using the weighted gene co-expression network.The hub genes were identified by the use of three machine-learning algorithms:random forest,support vector machine-recursive feature elimination,and least absolute shrinkage and selection operator.The receiver operating characteristic curve and nomogram model were used to verify the discrimination and efficacy of the hub genes.In addition,the inflammatory and immune status of pediatric sepsis was assessed using cell-type identification by estimating relative subsets of RNA transcripts(CIBERSORT).The relationship between the diagnostic markers and infiltrating immune cells was further studied.Results Overall,after overlapping key module genes and DEGs,we detected 402 overlapping genes.As pediatric sepsis diagnostic indicators,CYSTM1(AUC=0.988),MMP8(AUC=0.973),and CD177(AUC=0.986)were investigated and demonstrated statistically significant differences(P<0.05)and diagnostic efficacy in the validation set.As indicated by the immune cell infiltration analysis,multiple immune cells may be involved in the development of pediatric sepsis.Additionally,all diagnostic characteristics may correlate with immune cells to varying degrees.Conclusions The candidate hub genes(CD177,CYSTM1,and MMP8)were identifi

关键词： Paediatric sepsis Bioinformatics Machine-Learning Biomarkers Immune cell infiltration

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Clinical use of low-dose aspirin for elders and sensitive subjects

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World Journal of Clinical Cases 2019年第20期7卷 3168-3174页

作者： Yan Zhang xiang-ming fang Guo-Xun Chen Department of Gastroenterology Affiliated Puren Hospital of Wuhan University of Science and TechnologyWuhan 430000Hubei ProvinceChina Department of Nutrition University of Tennessee at KnoxvilleKnoxvilleTN 37996United States

The use of low-dose aspirin(LDA)has been a common preventive measure to reduce the risk of cardiovascular events.This is attributed to aspirin’s ability to inhibit platelet activation.On the other hand,the use of LDA in human subjects has been associated with the development of gastrointestinal injuries like ulcer and bleeding,especially for those sensitive subjects such as elder human subjects.This opinion review will summarize the recent clinical reports regarding the use of LDA and the development of gastrointestinal conditions in China.Based on these reports,it seems that the use of LDA is commonly associated with gastrointestinal injuries,and stopping its use leads to recovery in elderly subjects.Therefore,we would like to suggest that gastroduodenal health and conditions should be seriously taken into consideration when LDA is recommended to the elderly,or other alternative means to reduce the risk of cardiovascular events such as nutritional interventions should be suggested.

关键词： Low-dose aspirin Gastrointestinal damages Upper gastrointestinal bleeding Human subjects Chinese elders

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Sarcomatoid intrahepatic cholangiocarcinoma mimicking liver abscess: A case report

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World Journal of Clinical Cases 2020年第1期8卷 208-216页

作者： Yan Wang Jia-Lei ming Xing-Yu Ren Lu Qiu Li-Juan Zhou Shu-Dong Yang xiang-ming fang Department of Radiology The Affiliated Wuxi People’s Hospital of Nanjing Medical UniversityWuxi 214023Jiangsu ProvinceChina Department of Pathology The Affiliated Wuxi People’s Hospital of Nanjing Medical UniversityWuxi 214023Jiangsu ProvinceChina

Sarcomatoid intrahepatic cholangiocarcinoma(SICC)is an extremely rare and highly invasive malignant tumor of the liver.To our knowledge,the imaging findings of sarcomatous cholangiocarcinoma have been rarely reported;and radiological features of this tumor mimicking liver abscess have not yet been reported.CASE SUMMARY We present a case of SICC mimicking liver abscess.The patient,a 43-year-old male,complained of repeated upper right abdominal discomfort and intermittent distension over a period of one month.Radiology examination revealed a huge focal lesion in the right liver.The lesion was hypointense on computed tomography with honeycomb enhancement surrounded by enhanced peripheral areas.It showed a hypo-signal on non-contrast T1-weighted images and a hypersignal on non-contrast T2-weighted images.Radiologists diagnosed the lesion as an atypical liver abscess.The patient underwent a hepatectomy.After surgery,he survived another 2.5 mo before passing away.A search of PubMed and Google revealed 43 non-repeated cases of SICC reported in 20 published studies.The following is a short review in order to improve the diagnostic and therapeutic skills in cases of SICC.CONCLUSION This report presents the clinical and radiological features of SICC and imaging features which showed hypovascularity and progressive enhancement.SICC can present as a multilocular cyst on radiological images and it is necessary to distinguish this lesion from an atypical abscess.Simple surgical treatment is not the best treatment option for this disease.

关键词： Sarcomatoid intrahepatic cholangiocarcinoma Liver abscess Radiological features Case report

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Lateral position intubation followed by endoscopic ultrasoundguided angiotherapy in acute esophageal variceal rupture: A case report

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World Journal of Clinical Cases 2021年第2期9卷 372-378页

作者： Ting-Ting Wen Zheng-Lv Liu Min Zeng Yu Zhang Bao-Li Cheng xiang-ming fang Department of Anesthesiology The First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhou 310003Zhejiang ProvinceChina Department of Anesthesiology The Second Hospital of YinzhouNingbo 315100Zhejiang ProvinceChina

BACKGROUND Massive esophageal variceal bleeding can be catastrophic,leading to high morbidity and mortality.Patients experiencing massive esophageal variceal bleeding are at high risk of aspiration and hemorrhagic shock in acute episodes.Intubation and bleeding control are the two essential steps for resuscitation of these patients.CASE SUMMARY A 47-year-old male patient was admitted to our hospital with upper digestive tract bleeding.He was diagnosed with alcohol-induced liver cirrhosis and consequent esophagogastric varices.As he did not show a good response to somatostatin and Sengstaken-Blakemore tube placement,the patient was scheduled for endoscopic angiotherapy under anesthesia.Preoperative assessment showed an ASA physical status of III and Child-Pugh classification B.However,massive hemorrhage occurred just after induction of anesthesia.Intubation by video-guided laryngoscopy in the lateral decubitus position was attempted twice and was successful.After that,an experienced endoscopic ultrasound(EUS)specialist performed angiotherapy and occluded the culprit vessel.An ultra-thin gastroscope was then inserted into the endotracheal tube to extract the blood observed in the lobar bronchi.The patient suffered hemorrhagic shock with an estimated blood loss of 1500 mL in 20 min and remained in the intensive care unit for two days.The patient was discharged from our hospital eight days later without major complications.CONCLUSION Intubation in the lateral decubitus position and EUS-guided treatment can be lifesaving procedures in patients with massive upper gastrointestinal hemorrhage.

关键词： Intubation in the lateral position Endoscopic ultrasound Esophageal varices Angiotherapy Ultra-thin gastroendoscope Case report

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Evaluation of Endotracheal Intubation with a Flexible Fiberoptic Bronchoscope in Lateral Patient Positioning： A Prospective Randomized Controlled Trial

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Chinese Medical Journal 2016年第17期129卷 2045-2049页

作者： Hui Li Wu Wang Ya-Ping Lu Yan Wang Li-Hua Che Li-Pei Lei xiang-ming fang Department of Anesthesiology School of Medicine The First Affiliated Hospital Zhejiang University Hangzhou Zhejiang 310003 China Department of Anesthesiology Lishui Central Hospital of Zhejiang Province Lishui Zhejiang 323000 China Department of Anesthesiology Jiaxing First Hospital of Zhejiang Province Jiaxing Zhejiang 314001 China Department of Gastroenterology School of Medicine The First Affiliated Hospital Zhejiang University Hangzhou Zhejiang 310003 China

Background： There is an unmet need for a reliable method of airway randomized controlled two-center study was designed to evaluate the management for patients in the lateral position. This prospective feasibility of intubation using a flexible fiberoptic bronchoscope in the lateral position during surgery. Methods： Seventy-two patients scheduled for elective nonobstetric surgery in the lateral decubitus position requiring tracheal intubation under general anesthesia at Lishui Central Hospital of Zhejiang Province and Jiaxing First Hospital of Zhejiang Province from April I, 2015, to September 30, 2015, were enrolled in this study. Patients were randomly assigned to the supine position group （Group S, n = 38） and the lateral position group （Group L, n = 34）. Experienced anesthetists performed tracheal intubation with a fiberoptic bronchoscope after general anesthesia. The time required for intubation, intubation success rates, and hemodynamic changes was recorded. Between-group differences were assessed using the Student＇s t-test, Mann-Whitney U-test, or Chi-square test. Results： The median total time to tracheal intubation was significantly longer in Group S （140.0 [135.8, 150.0] s） compared to Group L （33.0 [24.0, 38.8] s）（P 〈 0.01）. The first-attempt intubation success rate was significantly higher in Group L （97%） compared to Group S （16%）. Hemodynamic changes immediately after intubation were more exaggerated in Group S compared to Group L （P = 0.02）. Conclusion： Endotracheal intubation with a flexible fiberoptic bronchoscope may be an effective and timesaving technique for patients in the lateral position. Trial Registration： Chinese Clinical Trial Register, ChiCTR-IIR- 16007814; http：//***/showproj.aspx？proj= 13183.

关键词： Airway Management Bronchoscope Intubation Patient Positioning

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An Appreciation for the Rabbit Ladderlike Modeling of Radiation-induced Lung Injury with High-energy X-Ray

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Chinese Medical Journal 2015年第12期128卷 1636-1642页

作者： xiang-ming fang Chun-Hong Hu Xiao-Yun Hu Xuan-Jun Yao Ping-Yan Qian Ju-Ying Zhou Jian Guo Alexander Lerner Imaging Center The First Affiliated Hospital of Soochow University Jiangsu 215006 China Imaging Center Wuxi People's Hospital Affiliated to Nanjing Medical University Jiangsu 214023 China Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions Suzhou Jiangsu 215123 China Radiotherapy Center The First Affiliated Hospital of Soochow University Jiangsu 215006 China Department of Radiology LAC+USC Medical Center University of Southern California Los Angeles CA USA

Background：To evaluate the utility of rabbit ladderlike model of radiation-induced lung injury （RILI） for the future investigation of computed tomography perfusion.Methods：A total of 72 New Zealand rabbits were randomly divided into two groups：36 rabbits in the test group were administered 25 Gy of single fractionated radiation to the whole lung of unilateral lung;36 rabbits in the control group were sham-radiated.All rabbits were subsequently sacrificed at 1,6,12,24,48,72 h,and 1,2,4,8,1 6,24 weeks after radiation,and then six specimens were extracted from the upper,middle and lower fields of the bilateral lungs.The pathological changes in these specimens were observed with light and electron microscopy;the expression of tumor necrosis factor-α （TNF-a） and transforming growth factor-βl （TGF-β1） in local lung tissue was detected by immunohistochemistry.Results：（1） Radiation-induced lung injury occurred in all rabbits in the test group.（2） Expression of TNF-a and TGF-β1 at 1 h and 48 h after radiation,demonstrated a statistically significant difference between the test and control groups （each P 〈 0.05）.（3） Evaluation by light microscopy demonstrated statistically significant differences between the two groups in the following parameters （each P 〈 0.05）：thickness of alveolar wall,density of pulmonary interstitium area （1 h after radiation）,number offibroblasts and fibrocytes in interstitium （24 h after radiation）.The test group metrics also correlated well with the time ofpostradiation.（4） Evaluation by electron microscopy demonstrated statistically significant differences in the relative amounts of collagen fibers at various time points postradiation in the test group （P 〈 0.005）,with no significant differences in the control group （P 〉 0.05）.At greater than 48 h postradiation the relative amount of collagen fibers in the test groups significantly differ from the control groups （each P 〈 0.05）,correlating well with the time postradiation （r =0.99318）.Conclusions：A consistent and reliable rabbit model of RILI can

关键词： Radiation-induced Lung Injury Radiation-induced Fibrosis Radiation Therapy Rabbit Model

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Single-lung transplantation for pulmonary alveolar microlithiasis: A case report

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World Journal of Clinical Cases 2019年第22期7卷 3851-3858页

作者： Xing-Yu Ren xiang-ming fang Jing-Yu Chen Hao Ding Yan Wang Qiu Lu Jia-Lei ming Li-Juan Zhou Hong-Wei Chen Department of Radiology Wuxi People’s Hospital-Nanjing Medical UniversityWuxi 214000Jiangsu ProvinceChina Lung Transplantation Center Wuxi People’s Hospital-Nanjing Medical UniversityWuxi 214000Jiangsu ProvinceChina

BACKGROUND Pulmonary alveolar microlithiasis(PAM)is a rare idiopathic lung disease characterized by the accumulation of innumerable microliths.Currently,effective therapeutics for PAM are not available,and the only treatment for end-stage lung disease is lung transplantation(LuTx).Further,there are few reports that focus on LuTx for the treatment of PAM,and the follow-up reports of postoperative imaging are even rarer.CASE SUMMARY A 52-year-old man presented to Shanghai Pulmonary Hospital in 2017 after experiencing shortness of breath and exacerbation.The patient was diagnosed with PAM and referred for single-LuTx(SLuTx)on March 14,2018.Preoperative imaging results from a chest X-ray demonstrated bilateral,diffuse,symmetrical,sandstorm-like radiopaque micronodules,and pneumothorax and a computed tomography scan revealed minute,calcified military nodules in both lungs.We performed a left SLuTx,and intraoperative pathology was consistent with PAM.One week after surgery,a chest X-ray revealed slight exudation of the left lung,and one month later,the left transplanted lung exhibited good dilation,mild pulmonary perfusion injury with local infection,and left pleural effusion.Fiberoptic bronchoscopy revealed left hyperplastic granulation at the left bronchial anastomosis.Multiple sputum cultures suggested the presence of Klebsiella pneumoniae and Acinetobacter baumannii.The last follow-up was conducted in April 2019;the patient recovered well.CONCLUSION This case presents the imaging findings of a patient with PAM before and after LuTx and confirms the effectiveness of LuTx for the treatment of this disease.

关键词： Pulmonary alveolar microlithiasis Lung transplantation Complications Chest X-ray Computed tomography Case report

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