摘要： 鼻眶血管瘤是一种常见的成人良性眶内病变，复发性病例在传统手术治疗后仍面临较高的复发风险及并发症。本报告介绍了一例21岁男性患者，先后接受多次手术治疗后血管瘤复发，且伴随严重鼻出血，手术已无法进一步控制病情。采用抗血管生成药物贝伐单抗进行非手术治疗，显著缩小了肿瘤，并有效控制了症状。经过两年的随访观察，患者肿瘤未出现复发，且无严重不良反应。本案例表明，贝伐单抗可作为复发性鼻眶血管瘤的一种安全且有效的非手术治疗选择，为该类难治性血管瘤的治疗提供了新的方向。

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Introduction: Nasopharyngeal cancer (NPC) is a multifaceted disease characterized by genetic and epigenetic modifications. While Epstein–Barr virus (EBV) infection is a known risk factor, recent studies highlight the significant role of DNA methylation in NPC pathogenesis. Aberrant methylation, particularly at CpG sites, can silence tumour suppressor genes, promoting uncontrolled cell growth. This study aims to analyse the methylation patterns in Indonesian NPC patients through whole-epigenome sequencing.

Methods: Seven clinical nasopharyngeal cancer samples were collected and confirmed histopathologically. DNA was extracted, sequenced using Oxford Nanopore technology, and aligned to the GRCh38 human reference genome. Methylation analysis was performed using modkit and statistical analysis with R software. Enriched pathways and processes were identified using ClusterProfiler in R, and gene overlap analysis was conducted.

Results: The analysis identified both globally hypermethylated and hypomethylated NPC samples. Key tumour suppressor genes, such as PRKCB, PLCB3, ITGB3, EPHA2, PLCE1, PRKCD, CDKN2A, CDKN2B, RPS6KA2, ERBB4, LRRC4, AKT1, PPP2R5C, and STK11 were frequently hypermethylated and confirmed to have lower expression in an independent NPC transcriptome cohort, suggesting their role in NPC carcinogenesis. Enriched KEGG pathways included PI3K-Akt signalling, ECM–receptor interaction, and focal adhesion. The presence of EBV DNA was confirmed in all samples, implicating its role in influencing methylation patterns.

Discussion: This study provides comprehensive insights into the epigenetic landscape of NPC, underscoring the role of CpG methylation in tumour suppressor gene silencing. These findings pave the way for targeted therapies and highlight the need for region-specific approaches in NPC management.

Keywords: nasopharyngeal cancer, epigenome, methylation, Epstein–Barr virus, whole-genome sequencing

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Purpose: Chronic suppurative otitis media (CSOM) is a prominent contributor to preventable hearing loss globally. Probiotic therapy has attracted research interest in human infectious and inflammatory disease. As the most prevalent probiotic, the role of Lactobacillus in CSOM remains poorly defined. This study aimed to investigate the antipathogenic effects and underlying mechanism of Lactobacillus on CSOM.

Methods: RNA sequencing of granulation of middle ear cavity from CSOM patients and lavage fluid of middle ear from normal volunteer was conducted. Human middle ear epithelial cells (HMEEC) and rats infected with Bacillus cereus (B. cereus) and Staphylococcus aureus (S. aureus) were used for CSOM constructing. Western blot, qPCR and Vybrant™ Alexa Fluor™ 488 lipid raft labeling were performed to explore the possible molecular mechanism by which lipid raft linker (RFTN1) regulates lipid raft/toll-like receptor 4 (TLR4). ELISA and HE staining was utilized to evaluate the effect of Lactobacillus on the progression of CSOM in vivo.

Results: Based on RNA Sequence analysis, a total of 3646 differentially expressed genes (1620 up-regulated and 2026 down-regulated) were identified in CSOM. RFTN1 was highly expressed in CSOM. Inhibition of RFTN1 not only reduced the inflammatory response of CSOM but also suppressed the formation of lipid rafts. Further investigation revealed that RFTN1 inhibition could reduce the expression of TLR4, which also localizes to the lipid rafts. TLR4 responds to RFTN1-mediated inflammatory responses in CSOM. We treated the CSOM model with Lactobacillus, which has great potential for alleviating the inflammatory response, and found that Lactobacillus attenuated the development of CSOM by reducing RFTN1 and TLR4 expression.

Conclusion: In conclusion, these findings suggest a crucial role for Lactobacillus in alleviating CSOM progression and uncovered the molecular mechanism involving Lactobacillus-regulated inhibition of the RFTN1-lipid raft-TLR4 signaling pathway under CSOM conditions.

Keywords: CSOM, Lactobacillus, RFTN1, TLR4, S. aureus, B. cereus

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摘要：

目的 构建和验证鲍曼不动杆菌血流感染患者死亡风险的预测模型，为鲍曼不动杆菌血流感染患者的临床决策和管理提供帮助。

方法 收集广东省第二中医院2011年1月至2023年12月连续13年病区收治的鲍曼不动杆菌血流感染患者的相关人口学资料及临床资料资料，根据收治时间将2011年1月-2020年12月收治的160例患者定为训练组，2021年1月-2023年12月收治的46例患者定为验证组。利用LASSO回归分析以及多因素COX回归确定鲍曼不动杆菌血流感染患者死亡的独立危险因素，并根据COX回归结果构建列线图预测模型。对预测模型使用受试者工作特征(ROC)曲线的曲线下面积(AUC)、标准曲线及决策曲线分析(DCA)进行区分度准确度评价。

结果 合并感染性休克、中性粒细胞/淋巴细胞比例升高、低血红蛋白及低血小板计数是鲍曼不动杆菌血流感染患者死亡的独立危险因素。通过这四个因素构建的模型，测试组及验证组在预测7天、14天、28天死亡情况ROC曲线的AUC均不低于0.850，两组在7天时死亡风险预测模型ROC曲线的AUC最高，分别为0.907和0.886。两组校准曲线显示，7天、14天、28天不同时间点准曲线围绕45°斜线摆动，实际风险与预测的风险之间具有良好的相关性。临床决策曲线显示，模型具有较强的辨别能力当概率在10%-70%之间时，净收益较高。

结论 感染性休克、NLR、HGB 和 PLT 是影响鲍曼不动杆菌血流感染患者 28 天死亡率的独立风险因素，这些变量方便易得，临床实践中可密切监测鲍曼不动杆菌血流感染患者的这些指标，并及时采取干预措施以改善预后。

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目的： 脓毒症是一种与急性器官功能障碍相关的危及生命的疾病。铁是多细胞生物和几乎所有微生物必需的微量元素，在脓毒症中的作用得到了更多的认识。本研究的目的是探讨盲肠结扎穿刺（CLP）诱导的脓毒症小鼠铁代谢的变化以及hepcidin预处理对CLP诱导的脓毒症小鼠血清炎症标志物水平和肝脏铁代谢的影响。

方法： 通过腹腔注射生理盐水、CLP（腹膜炎模型）或腹腔注射hepcidin（100 μg）处理C57BL/6小鼠。实验动物分为4组：对照组、模型组（CLP）、hepcidin预处理组（CLP +hepcidin-2h、CLP+hepcidin-24h）， CLP术后6、12、24h采血，安乐死取肝。

结果： ELISA检测显示，hepcidin预处理，尤其是提前2 h （p<0.01）可使CLP诱导的脓毒症小鼠血清hepcidin、TNF-a、IL-6升高；CLP脓毒症小鼠血清铁含量降低（P<0.01），肝脏铁含量升高（P<0.01）；Hepcidin预处理降低CLP脓毒症小鼠6、12 h血清铁（P<0.05）和6、12、24 h肝铁浓度（P<0.01）。Western blot结果显示，CLP和CLP+hepcidin脓毒症小鼠肝铁吸收相关蛋白转铁蛋白受体-2 （TFR2）、ZRT/ IRT样蛋白14 （ZIP14）、二价铁转运蛋白-1 （DMT1）升高（P<0.01），而铁输出蛋白膜铁转运蛋白（ferroportin, SLC40A1）降低（P<0.01）。与CLP组比较，CLP+ hepcidin-2 h组的蛋白表达差异较CLP+ hepcidin-24 h组更明显。

结论： Hepcidin具有促炎作用；Hepcidin通过影响铁吸收和铁输出相关蛋白的表达，加剧了败血症中铁代谢失衡。

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目的： 肺隐球菌病是肺部的真菌感染，对于有多种合并症，如肥胖、2型糖尿病和肝硬化的患者，其治疗是一种挑战。氟康唑是用来治疗肺隐球菌病的一线治疗药物，但缺乏在肥胖合并多种并发症患者中使用的经验。

方法： 本文报告了一例45岁男性患者肺隐球菌病的诊治过程。该患者肥胖，2型糖尿病，合并肝硬化。病人入院前有两周的抗真菌治疗史，但咳嗽咯血并未改善，治疗失败。入院后，患者使用指南推荐的常规剂量氟康唑，但疗效仍不满意，患者咳嗽、咯血、发热仍未缓解。在此期间，又发现患者还有肝硬化和2型糖尿病，血糖控制不佳。综合考虑合并症以及患者体重113kg，重新调整了氟康唑给药方案，最后患者肺部感染控制，且无明显不良反应。

结果： 肥胖患者可以根据瘦体重来计算氟康唑给药剂量。本例患者估算后给予800mg负荷剂量氟康唑，症状改善明显。两周后，病情缓解，调整给药剂量为600mg直至肺部感染病灶吸收。

结论： 本例说明氟康唑用于肺隐球菌病治疗应考虑合并症风险。如果必要，给药剂量应根据体重调整，推荐用瘦体重优化给药剂量。另外，注意监测患者肝肾功能。

关键词： 肺隐球菌病，氟康唑，抗真菌治疗，剂量优化，肥胖，瘦体重。

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Background: Recent advancements in nanomedicine and nanotechnology have expanded the scope of multifunctional nanostructures, offering innovative solutions for targeted drug delivery and diagnostic agents in oncology and nuclear medicine. Nanoparticles, particularly those derived from natural sources, hold immense potential in overcoming biological barriers to enhance therapeutic efficacy and diagnostic accuracy. Papain, a natural plant protease derived from Carica papaya, emerges as a promising candidate for green nanotechnology-based applications due to its diverse medicinal properties, including anticancer properties.

Purpose: This study presents a novel approach in nanomedicine and oncology, exploring the potential of green nanotechnology by developing and evaluating technetium-99m radiolabeled papain nanoparticles (99mTc-P-NPs) for imaging breast tumors. The study aimed to investigate the efficacy and specificity of these nanoparticles in breast cancer models through preclinical in vitro and in vivo assessments.

Methods: Papain nanoparticles (P-NPs) were synthesized using a radiation-driven method and underwent thorough characterization, including size, surface morphology, surface charge, and cytotoxicity assessment. Subsequently, P-NPs were radiolabeled with technetium-99m (99mTc), and in vitro and in vivo studies were conducted to evaluate cellular uptake at tumor sites, along with biodistribution, SPECT/CT imaging, autoradiography, and immunohistochemistry assays, using breast cancer models.

Results: The synthesized P-NPs exhibited a size mean diameter of 9.3 ±  1.9 nm and a spherical shape. The in vitro cytotoxic activity of native papain and P-NPs showed low cytotoxicity in HUVEC, MDA-MB231, and 4T1 cells. The achieved radiochemical yield was 94.2 ± 3.1% that were sufficiently stable (≥ 90%) for 6 h. The tumor uptake achieved in the 4T1 model was 2.49 ± 0.32% IA/g at 2 h and 1.51 ± 0.20% IA/g at 6 h. In the spontaneous breast cancer model, 1.19 ± 0.20% IA/g at 2 h and 0.86 ± 0.31% IA/g at 6 h. SPECT/CT imaging has shown substantial tumor uptake of the new nanoradiopharmaceutical and clear tumor visualization. 99mTc-P-NPs exhibited a high affinity to tumoral cells confirmed by ex vivo autoradiography and immunohistochemistry assays.

Conclusion: The findings underscore the potential of green nanotechnology-driven papain nanoparticles as promising agents for molecular imaging of breast and other tumors through SPECT/CT imaging. The results represent a substantial step forward in the application of papain nanoparticles as carriers of diagnostic and therapeutic radionuclides to deliver diagnostic/therapeutic payloads site-specifically to tumor sites for the development of a new generation of nanoradiopharmaceuticals.

Keywords: papain nanoparticle, protein nanoparticle, enzymatic nanoparticle, imaging probe, nanoradiopharmaceuticals

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Purpose: Biofilms are one of the main threats related to bacteria. Owing to their complex structure, in which bacteria are embedded in the extracellular matrix, they are extremely challenging to eradicate, especially since they can inhabit both biotic and abiotic surfaces. This study aimed to create an effective antibiofilm nanofilm based on graphene oxide-metal nanoparticles (GOM-NPs).

Methods: To create nanofilms, physicochemical analysis was performed, including zeta potential (Zp) (and the nanocomposites stability in time) and size distribution measurements, scanning transmission electron microscopy (STEM), energy dispersive X-ray analysis (EDX), and atomic force microscopy (AFM) of the nanofilm surfaces. During biological analysis, reactive oxygen species (ROS) and antioxidant capacity were measured in planktonic cells treated with the nanocomposites. Thereafter, biofilm formation was checked via crystal violet staining, biofilm thickness was assessed by confocal microscopy using double fluorescent staining, and biofilm structure was analyzed by scanning electron microscopy.

Results: The results showed that two of the three nanocomposites were effective in reducing biofilm formation (GOAg and GOZnO), although the nanofilms were characterized by the roughest surface, indicating that high surface roughness is unfavorable for biofilm formation by the tested bacterial species (Staphylococcus aureus (ATCC 25923), Salmonella enterica (ATCC 13076), Pseudomonas aeruginosa (ATCC 27853)).

Conclusion: The performed analysis indicated that graphene oxide may be a platform for metal nanoparticles that enhances their properties (eg colloidal stability, which is maintained over time). Nanocomposites based on graphene oxide with silver nanoparticles and other types of nanocomposites with zinc oxide were effective against biofilms, contributing to changes throughout the biofilm structure, causing a significant reduction in the thickness of the structure, and affecting cell distribution. A nanocomposite consisting of graphene oxide with copper nanoparticles inhibited the biofilm, but to a lesser extent.

Keywords: biofilm, graphene oxide, metal nanoparticles, nanocomposites, nanofilms

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Introduction: Efficient extraction of DNA from biological fluids is crucial for applications in molecular biology, forensic science, and clinical diagnostics. However, traditional DNA extraction methods often require costly reagents and lengthy procedures. This study aims to optimize the binding buffer composition for DNA extraction using polyethyleneimine-coated iron oxide nanoparticles (PEI-IONPs), which offer the dual benefits of magnetic separation and high DNA-binding efficiency.

Methods: The effects of three key binding buffer components—polyethylene glycol (PEG-6000), sodium chloride (NaCl), and pH—on DNA adsorption efficiency were systematically evaluated. Blood samples were treated with PEI-IONPs under various conditions, and DNA concentration, yield, and purity were quantified. Nanoparticle functionalization was confirmed through characterization, and DNA quality was validated via agarose gel electrophoresis.

Results: The optimized binding buffer composition consisted of a PEG-6000 concentration of 30%, NaCl concentration of 0M, and pH of 4, which yielded the highest DNA concentration (34 ± 1.2 ng/μL), yield (6.8 ± 0.2 μg), and purity (A260/A280 ratio of 1.81). These conditions significantly improved DNA recovery compared to suboptimal buffer compositions.

Conclusion: The findings highlighted the critical role of binding buffer composition in maximizing DNA recovery. The use of optimized PEI-IONPs provided a rapid and efficient method for DNA extraction, supporting its potential for applications in scientific and clinical research. Future studies should explore the robustness of these optimized conditions across diverse biological fluids and extraction settings.

Keywords: polyethyleneimine, nanoparticles, DNA, TEM, FTIR, blood

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郑周数1, 闫露露2,3, 丁璐1, 张英慧1, 王梅红1,杨一晖1, 吴军华3, 陈长水3, 唐鸣1, 李海波2,3

1 耳鼻咽喉头颈外科，宁波大学附属妇女儿童医院，宁波，中国

2 出生缺陷预防综合防治中心，宁波大学附属妇女儿童医院，宁波，中国

3 宁波市胚胎源性疾病防治重点实验室，宁波大学附属妇女儿童医院，宁波，中国

通讯作者：李海波：出生缺陷综合防治中心，宁波大学附属妇女儿童医院，海曙区柳汀街339号，宁波，中国，Email:lihaibo-775@163.com；

唐鸣：耳鼻咽喉头颈外科，宁波大学附属妇女儿童医院，海曙区柳汀街339号，宁波，中国，Email:tmtm-50@163.com。

【摘要】介绍 综合征型耳聋（SHL）具有特征性的临床表型，同时也具有高度的遗传异质性和表型外显的多样性。现已报道的SHL有400余种，大部分为常染色体显性遗传。 方法 14个家系中发现11种不同类型的SHL，先证者年龄从5到78个月不等。回顾性分析全外显子组测序（WES）结果、听力学特征、中耳内耳影像学表现及其他系统性的临床表型特征。结果 14例SHL患者中有2例为瓦登伯格综合征（Waardenburg Syndrome)，2例鳃耳肾综合征(Branchio-Oto-Renal Syndrome)，2例CHARGE综合征，1例鸟面综合征(Treacher Collins Syndrome)、Kleefstra综合征、Muenke综合征、条纹状骨病伴颅骨硬化症(Osteopathia Striata with Cranial Sclerosis)、Ayme-Gripp综合征、Tatton-Brown-Rahman综合征、Stickler综合征、拇指和脚趾镫骨关节强直症(Stapes Ankylosis with Broad Thumbs and Toes)。本研究的10个变异位点为首次报道。 讨论 新生儿听力筛查体系结合全外显子组测序可以在婴幼儿早期阶段诊断综合征型耳聋；扩充不同年龄段基因变异谱和表型特征数据可以有效指导临床治疗决策的制定；综合征型耳聋的听力损失程度和系统临床表型存在异质性和可变性，需要经过长期的医学随访。

【关键词】综合征型耳聋；全外显子组测序；新生儿听力筛查；表型-基因型关联

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Objective: We evaluate whether next-generation sequencing (NGS)-based preimplantation genetic testing for aneuploidy (PGT-A) improves the cumulative pregnancy outcomes of patients with unexplained recurrent implantation failure (uRIF) as compared to conventional in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI).

Patients and Methods: This was a retrospective cohort study (2015– 2022). A total of 705 couples diagnosed with uRIF were included in the study. 229 women transferred blastocysts based on morphological grading (IVF/ICSI) and 476 couples opted for PGT-A to screen blastocysts by NGS. Women were further stratified according to age at retrieval (< 38 years and ≥ 38 years). The primary outcome was the cumulative live-birth rate after all the embryos were transferred in a single oocyte retrieval or until achieving a live birth. Confounders were adjusted using binary logistic regression models.

Results: Cumulative live-birth rate was similar between the IVF/ICSI group and the PGT-A group after stratified by age: IVF/ICSI vs PGT-A in the < 38 years subgroup (49.7% vs 57.7%, adjusted OR (95% CI) = 1.25 (0.84– 1.84), P = 0.270) and in the ≥ 38 years subgroup (14.0% vs 19.5%, adjusted OR (95% CI) = 1.09 (0.41– 2.92), P = 0.866), respectively. Nonetheless, the PGT group had a lower first-time biochemical pregnancy loss rate (17.0% vs 8.7%, P = 0.034) and a higher cumulative good birth outcome rate (35.2% vs 46.4%, P = 0.014) than the IVF/ICSI group in the < 38 years subgroup. Other pregnancy outcomes after the initial embryo transfer and multiple transfers following a single oocyte retrieval were all similar between groups.

Conclusion: Our results showed no evidence of favorable effects of PGT-A treatment on improving the cumulative live birth rate in uRIF couples regardless of maternal age. Use of PGT-A in the < 38 years uRIF patients would help to decrease the first-time biochemical pregnancy loss and increase the cumulative good birth outcome.

Keywords: preimplantation genetic testing for aneuploidy, unexplained recurrent implantation failure, cumulative live-birth rate, cumulative good birth outcome

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Background: Congenital sucrase isomaltase deficiency (CSID) is in general a very rare disease. However, 2– 3% of the Greenlandic population are homozygous (HO) carriers of an Arctic-specific loss-of-function (LoF) variant in the sucrase-isomaltase (SI) encoding gene, causing CSID. The condition is characterized by gastrointestinal symptoms such as stomachache, diarrhea, and weight loss when consuming sucrose, the most common dietary sugar. However, the awareness of the condition in the population and the healthcare system seems to be limited, potentially leading to a higher healthcare burden. Hence, we aimed to investigate whether HO-carriers visit the healthcare system more with gastrointestinal symptoms compared to the control groups by using registry data.

Methods: We performed a case–control study identifying cases and controls using genotype information from the 1999– 2001 and 2005– 2010 Greenlandic health population cohorts. The cases were defined as HO LoF SI-carriers and controls were defined as non-carriers and were matched (1:1) on sex, age, place of residence, and European genetic admixture. We used electronic medical records to assess the number of electronic medical record contacts (EMRc) related to gastrointestinal symptoms and the number of gastrointestinal-related diagnostic procedures.

Results: A total of 80 HO-carriers and 80 non-carriers were included. The HO-carriers had 19% more EMRc related to gastrointestinal symptoms (IRR, 1.19, 95% CI [1.02;1.40], p=0.02) and had a 41% higher incidence of gastrointestinal related diagnostic procedures compared to controls (IRR, 1.41, 95% CI [1.05– 1.92], p=0.02). Only one HO-carrier was aware of the condition according to the electronic medical records.

Conclusion: HO-carriers of the LoF SI-variant had both significantly more gastrointestinal-related EMRc and significantly more diagnostic procedures conducted due to gastrointestinal symptoms. Only one HO-carrier was aware of the condition. Given the high prevalence of HO-carriers in the Greenlandic population, we anticipate that diagnosing more patients with CSID and providing dietary advice could potentially reduce symptom burden and healthcare visits among HO-carriers.

Keywords: Inuit, genetic metabolism, sucrase-isomaltase, Greenland, congenital sucrase-isomaltase deficiency, loss-of-function variant

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Abstract: Dexmedetomidine is a selective and potent α2-adrenoceptor agonist used for sedation, analgesia, and anxiolysis, with minimal respiratory depression; therefore, it is widely used in clinical practice. Transient hypertension has been reported to be an indication for the use of dexmedetomidine. The authors report three female patients who experienced hypertensive crisis when used atropine to treat bradycardia caused by dexmedetomidine. The transient hypertension is a relatively common side effect of dexmedetomidine, hypertensive crisis seen with coadministration of atropine is much less frequently reported. This is the first report to describe the use of atropine to treat bradycardia induced by dexmedetomidine, which may cause severe hypertension in female patients. They discuss the reason for and treatment of hypertension caused by administration of atropine and dexmedetomidine together and review the relevant literature.

Keywords: dexmedetomidine, atropine, bradycardia, hypertension

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Introduction: Iberdomide, a novel cereblon modulator (CELMoD®), is currently under clinical investigation for hematology indications. To evaluate the influence of hepatic impairment on the pharmacokinetics (PK) of iberdomide and its major active metabolite M12, a phase 1, multicenter, open-label study was conducted in healthy subjects and subjects with mild, moderate, and severe hepatic impairment.

Methods: Forty subjects were enrolled in the study and divided into five groups based on hepatic function. 1 mg iberdomide was administered and plasma samples were collected to evaluate the pharmacokinetics of iberdomide and M12.

Results: After a single dose of iberdomide (1 mg), mean iberdomide Cmax (maximum observed concentration) and AUC (area under the concentration-time curve) exposure were generally comparable between hepatic impairment (HI) subjects (severe, moderate and mild) and their respective matched normal controls. Mean Cmax and AUC exposure of the metabolite M12 were generally comparable between mild HI and matched normal subjects. However, mean Cmax of the M12 was 30% and 65% lower and AUC was 57% and 63% lower in moderate and severe HI subjects as compared to their respective matched normal controls. However, given the relatively low M12 exposure as compared to its parent drug, the observed differences were not considered clinically meaningful.

Conclusion: In summary, 1 mg single oral dose of iberdomide was generally well-tolerated. HI (mild, moderate or severe) had no clinically relevant impact on iberdomide PK and therefore, no dose adjustment is warranted.

Keywords: hepatic impairment, iberdomide, pharmacokinetics

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Abstract: Hypotension during kidney transplantation can be common. Vasopressor use during these procedures is often avoided, with a fear of decreasing renal perfusion in the transplanted kidney. However, adequate perfusion for the rest of the body is also necessary, and given that these patients often have underlying hypertension or other comorbid conditions, an appropriate mean arterial pressure (MAP) has to be maintained. Intramuscular injections of ephedrine have been studied in the anesthesiology literature in a variety of case types, and it is seen as a safe and effective method to boost MAP. We present a case series of three patients who underwent renal transplantation and who received an intramuscular injection of ephedrine for hypotension control. The medication worked well for increasing blood pressures without apparent side effects. All three patients were followed for more than one year, and all patients had good graft function at the end of that time period. This series shows that while further research is necessary in this arena, intramuscular ephedrine may have a place in the management of persistent hypotension in the operating room during kidney transplantation.

Keywords: kidney transplant, hypotension, general anesthesia, intramuscular ephedrine, perfusion pressure

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