Background: In June 2013, the FDA issued a Black Box Warning on synthetic colloids resulting from data indicating an increased risk of mortality, renal injury, and excess bleeding incidence in septic patients admitted...Background: In June 2013, the FDA issued a Black Box Warning on synthetic colloids resulting from data indicating an increased risk of mortality, renal injury, and excess bleeding incidence in septic patients admitted to the Intensive Care Unit (ICU), and patients undergoing coronary artery bypass graft (CABG) surgery. The purpose of this study was to compare the incidence of mortality, incidence/severity of renal injury and bleeding in septic ICU patients, and patients undergoing CABG surgery who have received hydroxyethyl starch 130/0.4 or albumin. Methods: This was a retrospective, single center, cohort study conducted at a 433 bed tertiary care hospital in Lexington, Kentucky. Computer generated lists provided patients who received hydroxyethyl starch 130/0.4 or albumin during inpatient stay as either a sepsis patient in the ICU or post coronary artery bypass graft patient. All cause mortality was the primary endpoint and secondary endpoints included overall renal dysfunction, incidence of bleeding, and overall length of stay. Results: A total of 89 patients were evaluated that received albumin or hydroxyethyl starch 130/0.4 alone with either septic ICU or CABG diagnosis codes. There was no significant difference in all cause mortality (p = 0.64). Overall renal dysfunction showed no statistically significance between the two groups (p = 0.66). There was no statistically significant difference between the albumin or HES 130/0.4 arms with respect to bleeding (TIMI Minimal p = 0.57, TIMI Minor p = 0.69, TIMI Major p = 0.35). Patient who received albumin had a statistically significant longer hospital overall length of stay (p = 0.003). Conclusion: There was no difference between HES 130/0.4 and albumin in mortality, renal dysfunction, and bleeding in septic ICU and CABG patients. Patients receiving albumin had an increased overall length of stay. These findings suggest that hydroxyethyl starch 130/0.4 may be safe in the studied patient populations;however, further investigation into specific HES agents should be conducted.展开更多
BACKGROUND Accidental dural puncture(ADP)and subsequent post-dural puncture headache(PDPH)remain common complications of epidural procedures for obstetric anesthesia and analgesia.No clear consensus exists on the best...BACKGROUND Accidental dural puncture(ADP)and subsequent post-dural puncture headache(PDPH)remain common complications of epidural procedures for obstetric anesthesia and analgesia.No clear consensus exists on the best way to prevent PDPH after ADP.CASE SUMMARY We report our findings in twenty parturients who underwent an incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch(HES)to prevent PDPH after ADP with a 16-gauge Tuohy needle during epidural procedures.ADP with a 16-gauge Tuohy needle occurred in nine parturients undergoing a cesarean section(CS)and in eleven parturients receiving labor analgesia.An epidural catheter was re-sited at the same or adjacent intervertebral space in all patients.After CS,the epidural catheter was used for postoperative pain relief over a 48-h period.After delivery in eleven cases,epidural infusion was maintained for 24 h.Thereafter,15 mL of 6%HES 130/0.4 was administered via the epidural catheter immediately prior to catheter removal.None of the parturients developed PDPH or neurologic deficits over a follow-up period of at least two months to up to one year postpartum.CONCLUSION An incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch may have great efficacy in preventing PDPH after ADP.展开更多
The position and quantity of the hydroxyethyl groups in hydroxyethyl starch (HES) were studied by GC/MS and NMR. Quantitative characterization was carried out based on the results of both methods.
Purpose: The primary aim of this study was to investigate volume effect and safety of up to 50 mL/kg BW 6% hydroxyethyl starch (HES) 130/0.4 in adult and pediatric patients undergoing major elective surgery. The need ...Purpose: The primary aim of this study was to investigate volume effect and safety of up to 50 mL/kg BW 6% hydroxyethyl starch (HES) 130/0.4 in adult and pediatric patients undergoing major elective surgery. The need to infuse human albumin may be reduced or avoided in Japan if these large doses 6% HES 130/0.4 can be infused. Methods: The study was an uncontrolled, open-labeled, multi-center trial. Fifteen adult and 5 pediatric patients undergoing major elective surgery received 6% HES 130/0.4 (Voluven®) with a maximum dose of 50 mL/kg from the start of surgery until 2 hours after the end of surgery according to a treatment algorithm. The primary efficacy endpoint was the volume effect of 6% HES 130/0.4 determined by the volume of saved albumin during the investigational period and the time course of hemodynamic stability in adult and pediatric patients. Safety parameters were fluid balance, hemodynamic and laboratory parameters ECG, local and systemic tolerance and adverse events. Results: Adult patients received a mean of 32.0 mL/kg of 6% HES 130/0.4. For 12 out of 15 adult patients an average amount of 1033.8 mL (18.6 mL/kg) albumin could be saved. The other 3 adult patients did not receive more than 1000 mL of HES 130/0.4. All pediatric patients received approximately 50 mL/kg of HES 130/0.4;for these patients an average amount of 39.9 mL/kg body weight albumin could be saved. The majority of adult patients, and all pediatric patients were hemodynamically stable at all 3 time points. The observed changes of the assessed laboratory parameters including hematological and coagulation parameters or in any other safety parameter determined did not reveal any safety concern related to the administration of 6% HES 130/0.4 up to doses of 50 mL/kg body weight. Conclusion: The study results indicate that 6% HES 130/0.4 has a reliable volume effect, could contribute to significant human albumin savings and was safe and well tolerated up to a maximum dose of 50 mL/kg body weight in adult and pediatric patients undergoing major elective surgery.展开更多
Objective:To study the effect of salvia miltiorrhiza and ligustrazine hydrochloride injection combined with hydroxyethyl starch injection on serum BNP, Hcy, MMP-2, S100B protein and hemorheology in patients with acute...Objective:To study the effect of salvia miltiorrhiza and ligustrazine hydrochloride injection combined with hydroxyethyl starch injection on serum BNP, Hcy, MMP-2, S100B protein and hemorheology in patients with acute cerebral watershed infarction.Methods:A total of 90 patientswith acute cerebral watershed infarction in our hospital from August 2014 to December 2016 were enrolled in this study. The subjects were divided into the control group (n=45) and the treatment group (n=45) randomly. The control group was treated with hydroxyethyl starch injection, the treatment group was treated withsalvia miltiorrhiza and ligustrazine hydrochloride injection combined with hydroxyethyl starch injection, and both the two groups were treated for 2 weeks. The serum BNP, Hcy, MMP-2, S100B protein and hemorheology of the two groups before and after treatments were compared.Results:There were no significantly differences of the serum BNP, Hcy, MMP-2, S100B protein and hemorheology of the two groups before treatment. The serum BNP, Hcy, MMP-2, S100B proteinlevels of the two groups after treatment were significantly lower than before treatment, and that of the treatment group after treatment were significantly lower than the control group. The PV, Lr, Mr, Hr and RE of the two groups after treatment were significantly lower than before treatment, and that of the treatment group after treatment were significantly lower than the control group.Conclusion:Salvia miltiorrhiza and ligustrazine hydrochloride injection combined with hydroxyethyl starch injectioncan significantlyimprovetheneurological function and hemorheology, reduce inflammation of the patients with acute cerebral watershed infarction, and it was worthy clinical application.展开更多
Cancer-associated fibroblasts(CAFs)play an important role in facilitating the progression of triple-negative breast cancer(TNBC)by deteriorating the tumor mechanical microenvironment(TMME).Herein,we designed a CAFs-ta...Cancer-associated fibroblasts(CAFs)play an important role in facilitating the progression of triple-negative breast cancer(TNBC)by deteriorating the tumor mechanical microenvironment(TMME).Herein,we designed a CAFs-targeting nanomedicine by conjugating doxorubicin(DOX)-loaded hydroxyethyl starch-IR780 nanoparticles(NPs)with Cys-Arg-Glu-Lys-Ala(CREKA)peptide,which had a special affinity for fibronectin overexpressed on CAFs.After systemic administration,the NPs efficiently targeted CAFs and generated hyperthermia upon light irradiation,decreasing CAFs through the combination of chemo-and photothermal-therapies.Thus,a series of changes in TMME were achieved by reducing CAFs,which further disrupted the niche of cancer stem cells(CSCs)to affect their survival.As a result,the tumor growth was significantly inhibited in 4T1 tumors.The strategy of TMME modulation and CSCs elimination through targeting and depleting CAFs provides a novel therapeutic treatment for desmoplastic solid tumors.展开更多
文摘Background: In June 2013, the FDA issued a Black Box Warning on synthetic colloids resulting from data indicating an increased risk of mortality, renal injury, and excess bleeding incidence in septic patients admitted to the Intensive Care Unit (ICU), and patients undergoing coronary artery bypass graft (CABG) surgery. The purpose of this study was to compare the incidence of mortality, incidence/severity of renal injury and bleeding in septic ICU patients, and patients undergoing CABG surgery who have received hydroxyethyl starch 130/0.4 or albumin. Methods: This was a retrospective, single center, cohort study conducted at a 433 bed tertiary care hospital in Lexington, Kentucky. Computer generated lists provided patients who received hydroxyethyl starch 130/0.4 or albumin during inpatient stay as either a sepsis patient in the ICU or post coronary artery bypass graft patient. All cause mortality was the primary endpoint and secondary endpoints included overall renal dysfunction, incidence of bleeding, and overall length of stay. Results: A total of 89 patients were evaluated that received albumin or hydroxyethyl starch 130/0.4 alone with either septic ICU or CABG diagnosis codes. There was no significant difference in all cause mortality (p = 0.64). Overall renal dysfunction showed no statistically significance between the two groups (p = 0.66). There was no statistically significant difference between the albumin or HES 130/0.4 arms with respect to bleeding (TIMI Minimal p = 0.57, TIMI Minor p = 0.69, TIMI Major p = 0.35). Patient who received albumin had a statistically significant longer hospital overall length of stay (p = 0.003). Conclusion: There was no difference between HES 130/0.4 and albumin in mortality, renal dysfunction, and bleeding in septic ICU and CABG patients. Patients receiving albumin had an increased overall length of stay. These findings suggest that hydroxyethyl starch 130/0.4 may be safe in the studied patient populations;however, further investigation into specific HES agents should be conducted.
文摘BACKGROUND Accidental dural puncture(ADP)and subsequent post-dural puncture headache(PDPH)remain common complications of epidural procedures for obstetric anesthesia and analgesia.No clear consensus exists on the best way to prevent PDPH after ADP.CASE SUMMARY We report our findings in twenty parturients who underwent an incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch(HES)to prevent PDPH after ADP with a 16-gauge Tuohy needle during epidural procedures.ADP with a 16-gauge Tuohy needle occurred in nine parturients undergoing a cesarean section(CS)and in eleven parturients receiving labor analgesia.An epidural catheter was re-sited at the same or adjacent intervertebral space in all patients.After CS,the epidural catheter was used for postoperative pain relief over a 48-h period.After delivery in eleven cases,epidural infusion was maintained for 24 h.Thereafter,15 mL of 6%HES 130/0.4 was administered via the epidural catheter immediately prior to catheter removal.None of the parturients developed PDPH or neurologic deficits over a follow-up period of at least two months to up to one year postpartum.CONCLUSION An incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch may have great efficacy in preventing PDPH after ADP.
文摘The position and quantity of the hydroxyethyl groups in hydroxyethyl starch (HES) were studied by GC/MS and NMR. Quantitative characterization was carried out based on the results of both methods.
文摘Purpose: The primary aim of this study was to investigate volume effect and safety of up to 50 mL/kg BW 6% hydroxyethyl starch (HES) 130/0.4 in adult and pediatric patients undergoing major elective surgery. The need to infuse human albumin may be reduced or avoided in Japan if these large doses 6% HES 130/0.4 can be infused. Methods: The study was an uncontrolled, open-labeled, multi-center trial. Fifteen adult and 5 pediatric patients undergoing major elective surgery received 6% HES 130/0.4 (Voluven®) with a maximum dose of 50 mL/kg from the start of surgery until 2 hours after the end of surgery according to a treatment algorithm. The primary efficacy endpoint was the volume effect of 6% HES 130/0.4 determined by the volume of saved albumin during the investigational period and the time course of hemodynamic stability in adult and pediatric patients. Safety parameters were fluid balance, hemodynamic and laboratory parameters ECG, local and systemic tolerance and adverse events. Results: Adult patients received a mean of 32.0 mL/kg of 6% HES 130/0.4. For 12 out of 15 adult patients an average amount of 1033.8 mL (18.6 mL/kg) albumin could be saved. The other 3 adult patients did not receive more than 1000 mL of HES 130/0.4. All pediatric patients received approximately 50 mL/kg of HES 130/0.4;for these patients an average amount of 39.9 mL/kg body weight albumin could be saved. The majority of adult patients, and all pediatric patients were hemodynamically stable at all 3 time points. The observed changes of the assessed laboratory parameters including hematological and coagulation parameters or in any other safety parameter determined did not reveal any safety concern related to the administration of 6% HES 130/0.4 up to doses of 50 mL/kg body weight. Conclusion: The study results indicate that 6% HES 130/0.4 has a reliable volume effect, could contribute to significant human albumin savings and was safe and well tolerated up to a maximum dose of 50 mL/kg body weight in adult and pediatric patients undergoing major elective surgery.
基金Hubei Natural Science Foundation Project Plan 2015(2015-cEV129).
文摘Objective:To study the effect of salvia miltiorrhiza and ligustrazine hydrochloride injection combined with hydroxyethyl starch injection on serum BNP, Hcy, MMP-2, S100B protein and hemorheology in patients with acute cerebral watershed infarction.Methods:A total of 90 patientswith acute cerebral watershed infarction in our hospital from August 2014 to December 2016 were enrolled in this study. The subjects were divided into the control group (n=45) and the treatment group (n=45) randomly. The control group was treated with hydroxyethyl starch injection, the treatment group was treated withsalvia miltiorrhiza and ligustrazine hydrochloride injection combined with hydroxyethyl starch injection, and both the two groups were treated for 2 weeks. The serum BNP, Hcy, MMP-2, S100B protein and hemorheology of the two groups before and after treatments were compared.Results:There were no significantly differences of the serum BNP, Hcy, MMP-2, S100B protein and hemorheology of the two groups before treatment. The serum BNP, Hcy, MMP-2, S100B proteinlevels of the two groups after treatment were significantly lower than before treatment, and that of the treatment group after treatment were significantly lower than the control group. The PV, Lr, Mr, Hr and RE of the two groups after treatment were significantly lower than before treatment, and that of the treatment group after treatment were significantly lower than the control group.Conclusion:Salvia miltiorrhiza and ligustrazine hydrochloride injection combined with hydroxyethyl starch injectioncan significantlyimprovetheneurological function and hemorheology, reduce inflammation of the patients with acute cerebral watershed infarction, and it was worthy clinical application.
基金the National Research and Development Program of China(Nos.2018YFA0208900,2020YFA0211200,and 2020YFA0710700)the National Natural Science Foundation of China(Nos.82172757 and 31972927)+2 种基金the Scientific Research Foundation of Huazhong University of Science and Technology(No.3004170130)the Program for HUST Academic Frontier Youth Team(No.2018QYTD01)the HCP Program for HUST.
文摘Cancer-associated fibroblasts(CAFs)play an important role in facilitating the progression of triple-negative breast cancer(TNBC)by deteriorating the tumor mechanical microenvironment(TMME).Herein,we designed a CAFs-targeting nanomedicine by conjugating doxorubicin(DOX)-loaded hydroxyethyl starch-IR780 nanoparticles(NPs)with Cys-Arg-Glu-Lys-Ala(CREKA)peptide,which had a special affinity for fibronectin overexpressed on CAFs.After systemic administration,the NPs efficiently targeted CAFs and generated hyperthermia upon light irradiation,decreasing CAFs through the combination of chemo-and photothermal-therapies.Thus,a series of changes in TMME were achieved by reducing CAFs,which further disrupted the niche of cancer stem cells(CSCs)to affect their survival.As a result,the tumor growth was significantly inhibited in 4T1 tumors.The strategy of TMME modulation and CSCs elimination through targeting and depleting CAFs provides a novel therapeutic treatment for desmoplastic solid tumors.