Enhanced Recovery After Surgery in Patients With Hepatocellular Carcinoma Undergoing Laparoscopic Hepatectomy

Objective: To compare the effectiveness and safety of enhanced recovery after surgery (ERAS) in patients with hepatocellular carcinoma (HCC) undergoing laparoscopic hepatectomy.Methods: From September 2016 to June 2019, 282 patients were enrolled, and ERAS was implemented since March 2018. All indicators related to surgery, liver function, and postoperative outcomes were included in the analysis. Propensity score matching (PSM) identified 174 patients for further comparison.Results: After PSM, the clinicopathological baselines were well-matched. The group showed significantly less intraoperative blood loss (100.00 [100.00–200.00] vs. 200.00 [100.00–300.00] ml, P = 0.001), fewer days before abdominal drainage tube removal (4.00 [3.00–4.00] days vs. 4.00 [3.00–5.00] days, P = 0.023), shorter hospital stay after surgery (6.00 [5.00–6.00] days vs. 6.00 [6.00–7.00] days, P < 0.001), and reduced postoperative morbidity (18.39 vs. 34.48%, P = 0.026). The proportion of patients with a pain score ≥ 4 was significantly lower in the ERAS group within the first 2 days after surgery (1.15 vs. 13.79% and 8.05 vs. 26.44%, P = 0.002 and P = 0.001, respectively). Pringle maneuver was performed more frequently in the ERAS group (70.11 vs. 18.39%, P < 0.001), and a significantly higher postoperative alanine aminotransferase level was also observed (183.40 [122.85–253.70] vs. 136.20 [82.93–263.40] U/l, P = 0.026). The 2-year recurrence-free survival was similar between the two groups (72 vs. 71%, P = 0.946).Conclusions: ERAS programs are feasible and safe and do not influence mid-term recurrence in HCC patients undergoing laparoscopic hepatectomy.

Anticoagulant rodenticide ingestion: Who will develop coagulopathy?

Introduction: Development of coagulopathy after anticoagulant rodenticide ingestion varies among patients. This study aimed to identify factors that were associated with coagulopathy after anticoagulant rodenticide ingestion. Methods: This was a retrospective cohort study, conducted in the Hong Kong Poison Information Centre. All patients who reported rodenticide exposure and presented to the Accident and Emergency Department from 1 January 2010 to 31 December 2019 were recruited. Coagulopathy was defined as International Normalized Ratio of 1.3 or above. Results: One hundred sixty-nine patients were included in the final analysis. The median age was 44 years old. Forty-nine patients developed coagulopathy (International Normalized Ratio ⩾1.3). Univariate analysis (at p < 0.05) showed that age (p = 0.003), ingestion of first-generation anticoagulant rodenticide (p = 0.017), ingestion of more than one pack (p < 0.001), intentional ingestion (p = 0.002), hypoalbuminemia (p < 0.001), elevated alanine aminotransferase level (p = 0.041) and abnormal estimated glomerular filtration rate (p = 0.005) on presentation, and co-ingestion with paracetamol (p = 0.018) were associated with coagulopathy after anticoagulant rodenticide ingestion. Among these, ingestion of more than one pack (p < 0.001; odds ratio = 19.8; 95% confidence interval = 6.78–65.7), ingestion of first-generation anticoagulant rodenticide (p = 0.006; odds ratio = 5.2; 95% confidence interval = 1.96–15.2), hypoalbuminemia (p < 0.001; odds ratio = 22.4; 95% confidence interval = 6.17–99.0) and elevated alanine aminotransferase level on presentation (p = 0.039; odds ratio = 7.11; 95% confidence interval = 1.58–33.1) were statistically significant in the multivariate analysis. Conclusion: Ingestion of more than one pack and ingestion of first-generation anticoagulant rodenticides were significantly associated with the development of coagulopathy after anticoagulant rodenticide ingestion. Patients who developed hypoalbuminemia or elevated alanine aminotransferase level as a result of anticoagulant rodenticide ingestion were also significantly associated with the development of coagulopathy.

Comparative Assessment of Liver Function During the Intensive Phase of Treatment of Respiratory Tuberculosis Patients Treated with First Line and Reserve Drugs

The objective: to compare liver function of respiratory tuberculosis patients during the intensive phase of treatment with first line drugs (chemotherapy regimen 1) and reserve drugs (chemotherapy regimens 4 and 5).Subjects and Methods: Data of 144 respiratory tuberculosis patients were analyzed, those patients were divided into 2 groups. Group 1 included 67 patients receiving chemotherapy regimen 1 and Group 2 included 77 patients treated with chemotherapy regimens 4 or 5. During the first 3 months of treatment, the frequency and severity of changes in the liver function were assessed.Conclusion: in patients with chronic viral hepatitis, parenchymal liver damage is more frequent and it improves slower. Transaminase levels returned to normal levels more frequently and rapidly with chemotherapy regimen 1, whereas with chemotherapy regimens 4 and 5, reduction of alanine aminotransferase level was observed only from the 2nd month of treatment.

Transforming Growth Factor -β Level Might Be An Independent Factor Related to Occurrence of Chronic Hepatitis B

To investigate association between immune cell-related cytokines and development of chronic hepatitis B (CHB). Patients with chronic hepatitis B virus (HBV) infection in immune tolerance (IT, n=30) and hepatitis B envelope antigen (HBeAg) positive CHB (n=250) were enrolled in the study. HBV virus, serological indicators, and plasma cytokine levels were detected at the time of enrollment. The results showed that there were significant differences in median age of patients (27 vs. 31y), alanine aminotransferase level (ALT, 29.85 vs 234.70 U/L), alanine aminotransferase level (AST, 23.40 vs. 114.90 U/L), HBsAg level (4.79 vs. 3.88 log10 IU/ml), HBeAg (1606.36 vs. 862.47 S/CO) and HBV DNA load (8.17 vs 6.71 log10 IU/ml) between IT and CHB groups (all P<0.01). The median values of Fms-like tyrosine kinase 3 ligand (FLT3-L), interferon-γ (IFN-γ), interleukin- 17A (IL-17A) and transforming growth factor- beta (TGF-β1) in IT group were significantly higher than those in CHB group (FLT3-L: 41.62 vs. 27.47 pg/ml; IFN-γ: 42.48 vs. 33.18 pg/ml; IL-17A: 15.66 vs. 8.90 pg/ml; TGF-β1: 4921.50 vs. 2234 pg/ml. All P<0.01). The median values of IFN-a2, TGF-β3 and IL-10 levels in IT group were significantly lower than those in CHB group (IFN-α2: 15.24 vs. 35.78 pg/ml, P=0.000; TGF-β3: 131.69 vs. 162.61 pg/ml, P=0.025; IL-10: 5.02 vs. 7.9 pg/ml, P=0.012). The multivariate logistic regression analysis indicated that TGF-β 1 (OR=0.999, 95% CI 0.999-1.000, P<0.001) and TGF-β2 levels (OR=1.008, 95%CI 1.004-1.012, P <0.001) were significantly associated with the incidence of CHB. The results suggest that TGF-β level might be an independent factor related to the occurrence of CHB.

Presentation and Outcome of Acute Necrotizing Encephalopathy of Childhood: A 10-Year Single-Center Retrospective Study From Hong Kong

Acute necrotizing encephalopathy (ANE) is a rare disease in childhood. We reviewed the 10-year data from a local pediatric department, reported the clinical characteristics, laboratory tests, neuroimaging findings, and outcome of the acute necrotizing encephalopathy cases and identified the potential factors affecting the outcome. Eight episodes of acute necrotizing encephalopathy among 7 patients were recorded, in which all of them had an initial presentation of fever and seizure. We identified that acute necrotizing encephalopathy patients with a severe score of Glasgow Coma Scale (GCS) on presentation, brainstem involvement in magnetic resonance imaging (MRI) of the brain, and higher MR imaging scores were associated with worse outcome. Association of outcome with acute necrotizing encephalopathy severity score, platelet count, and serum alanine aminotransferase level did not reach a statistically significant level. These results highlight the importance of combined clinical, laboratory, and neuroimaging findings in determining the prognostic outcome of acute necrotizing encephalopathy patients.

The Frequency of Parenchimatous Lesions in Patients with Traumatic Retroperitoneal Hematoma

Objective: The retroperitoneum represent the anatomical region with the highest mortality rates, in which lesions in this region need special relevance. The aim of this study is to find out the frequency of different parenchimatous injuries related to different zones.Methods: In this retrospective study, all cases who presented to the emergency room and/or admitted to our center with retroperitoneal hematoma (RPH) complicated with parenchimatous lesions from January 2016 to December 2019 were included (4-years data). Data collected included age, hematoma zones, the production mechanisms, mortality, surgical interventions, parenchymatous lesions, complications and biochemical and hematological analysis (e.g. hemoglobin (Hb), hematocrit (Ht), platelets (PLT), leukocytes (Leu), aspartate aminotransferase level (AST), alanine aminotransferase level (ALT) and creatinine (Cr). All RPHs were diagnosed using computed tomography scan.Results: A total number of 119 RPH cases with parenchimatous lesions were included with a mean age of 45.56±2.52. The most common type of RPH was located in lateral zone (zone II) with 65 cases, followed by pelvic zone (zone III) with 36 cases. The main production mechanism for parenchimatous lesions was by road accident (n=57). The highest prevalence of parenchimatous lesions was seen in both lung and splenic lesions (n=54), followed by liver lesion (n=36) and kidney lesions (n=11), without any statistical significance. The complications showed a statistical significance when 2016 year was compare with 2018 (p=0.013). Regarding the biochemical and hematological analysis, a statistical significance was seen at PLT (when 2016 was compared with 2017, p=0.03 and 2018, p=0.008). Only 67 patients were treated by surgical interventions, and the highest mortality was registered in 2019 (n=11).Conclusion: There is a lack of evidence in the frequency of different parenchimatous lesions in RPH cases. We conclude on the basis of our study that mandatory exploration of zone II and III haematoma in parenchimatous lesions should be early diagnosed in order to reduce the morbidity and mortality of the patients.

Safety and feasibility of laparoscopy technology in right hemihepatectomy

Laparoscopic hepatectomy (LH) has been accepted widely owing to its advantages as a minimally invasive surgery; however, laparoscopic right hemihepatectomy (LRH) has rarely been reported. We aimed to compare the benefits and drawbacks of LRH and open approaches. Between January 2014 and October 2017, 85 patients with tumor and hepatolithiasis who underwent LRH (n = 30) and open right hemihepatectomy (ORH) (n = 55) were enrolled in this study. For tumors, LRH showed significantly better results with respect to blood loss (P = 0.024) and duration of hospital stay (P = 0.008) than ORH, while hospital expenses (P = 0.031) and bile leakage rate (P = 0.012) were higher with LRH. However, the operative time and rate of other complications were not significantly different between the two groups. However, for hepatolithiasis, there was less blood loss (P = 0.015) and longer operative time (P = 0.036) with LRH than with ORH. There were no significant difference between LRH and ORH in terms of hospital stay, hospital expenses, and complication rate (P > 0.05). Moreover, the postoperative white blood cell count, alanine aminotransferase level, aspartate aminotransferase level, and total bilirubin were not significantly different in both types of patients (P > 0.05). Our results suggest the safety and feasibility of laparoscopy technology for right hemihepatectomy in both tumor and hepatolithiasis patients.

1443. N-Acetyl Cysteine Coadministration in Prevention of Amphotericin--Induced Electrolytes Imbalances in Children

Background Amphotericin B (AmB) can cause electrolyte abnormalities, including hypokalemia, hypomagnesemia, hypernatremia, and metabolic acidosis; and most important, acute renal failure. Methods We conducted a randomized prospective cohort study from March 2012 to February 2018 at Hacettepe University Ihsan Doğramacı Children Hospital to children receiving AmB. Results A total of 87 patients including 37 patients with NAC and 50 patients without NAC received liposomal amphotericin B during the study period.Serum creatinine, blood urea nitrogen, phosphorus were not different statistically in both groups during the study period. Serum sodium, potassium, calcium, phosphorus, magnesium values taken on third day of AmB treatment were not statistically different in both groups. Mean serum magnesium value was higher in NAC received group on the seventh day of AmB treatment; 1.97 ± 0.33 and 1.69 ± 0.46, respectively, it was statistically significant (P = 0.025). Mean serum magnesium value was also statistically significantly higher in NAC received group on the 14th day of treatment; 1.93 ± 0.20 and 1.72 ± 0.247, respectively, in both groups (P = 0.01). Mean serum sodium values on the 14th day of AmB treatment were also statistically different between 2 groups; 136.7 ± 3.7 and 140.04 ± 5.1, respectively (P = 0.005). Serum sodium values on the 14th day of AmB treatment was in more normal limits in NAC received group. Serum alanine aminotransferase level was significantly lower in NAC received group (P = 0.02). Serum aspartate aminotransferase level was significantly lower in NAC received group (P = 0.007). Nineteen of 37 (51.4%) patients who received NAC concomitantly with AmB and 44 of 50 patients (88%) who received AmB without NAC supplemented with potassium due to hypokalemia (P < 0.001). Two of NAC received 37 patients (5.4%) and 10 of NAC not received 50 patients (20%) died. Mortality was found 2.3 times more in NAC not-received group. Conclusion Co-treatment with oral NAC once daily in children during AmB treatment course was significantly effective in preventing or ameliorating different features of its nephrotoxicity including hypokalemia, hypomagnesemia, and renal potassium as well as magnesium wasting Disclosures All authors: No reported disclosures.