Comparative Effectiveness of Two Ultrasound‐Guided Regional Block Techniques for Surgical Anesthesia in Open Unilateral Inguinal Hernia Repair

Transversus abdominis plane (TAP) and ilioinguinal/iliohypogastric (II/IH) nerve blocks have been described as analgesic adjuncts for inguinal hernia repair, but the efficacy of these techniques in providing intraoperative anesthesia, either individually or together, is not known. We designed this retrospective cohort study to test the hypothesis that combining TAP and II/IH nerve blocks (“double TAP” technique) results in greater accordance between the preoperative anesthetic plan and actual anesthetic technique provided when compared to TAP alone. Based on this study, double TAP may be preferred for patients undergoing open inguinal hernia repair who wish to avoid general anesthesia.     

Transversus abdominis plane block: A new method in renal colic pain management

In recent decades, regional plane blocks via ultrasonography have become very popular in regional anesthesia and are more commonly used in pain management. The transversus abdominis plane (TAP) block is a procedure where local anesthetics are applied to block the anterior divisions of the tenth thoracic intercostal through the first lumbar nerves (T10–L1) into the anatomic space formed amidst the internal oblique and transversus abdominis muscles located in the antero-lateral part of the abdomen wall. The most important advantage of this block method is that ultrasonographic identification is easier and its complications are fewer compared with central neuroaxial or paravertebral blocks. Here, we describe three cases where pain management in renal colic was treated with the TAP block.     

急诊阑尾切除术中超声引导腹横肌平面阻滞的镇痛效果

目的：探讨全麻急诊阑尾切除术中超声引导腹横肌平面阻滞的镇痛效果。方法全麻下接受急诊开腹阑尾切除术患者50例,采用计算机排序分为A、B组各25例,分别予以超声引导腹横肌平面阻滞和常规麻醉。观察并记录48 h内各随访时点运动与静息时的数字评分（ NRS）,使用镇痛药物辅助的病例数,患者对术后疼痛缓解自我评分以及镇痛相关并发症。结果在12 h内各时点静息与运动时的NRS评分,A组明显低于B组（ P＜0.05）,24～48 h各时点两组间比较差异无统计学意义（P ＞0.05）。 A组患者术后疼痛缓解自我评分明显高于B组（P＜0.05）。术后第一日和第二日辅助镇痛药使用率A组低于B组（ P＜0.05）。结论超声引导下腹横肌平面阻滞可以产生良好12小时左右的术后镇痛。在多模式镇痛中可能更占优势。     

Ultrasound‐Guided Transversus Abdominis Plane Catheter for Chronic Abdominal Pain

Abstract Background and Objectives: Neural blockade of the thoracolumbar nerves supplying the anterior abdominal wall through transversus abdominis plane (TAP) has been investigated for different applications mainly for the acute pain management following abdominal surgical procedures. The role of this block for chronic pain syndromes is still to be discovered, and its value in chronic abdominal pain needs to be studied. We are presenting new application of the TAP technique for management of chronic abdominal pain syndrome using the continuous infusion. Case report: We present a case of an 18‐year‐old girl who underwent an uneventful laparoscopic cholecystectomy. Postoperatively, patient complained of chronic pain at the site of the surgery. All diagnostic and imaging studies were negative for a surgical or a medical cause. Multiple interventions including epidural blocks, transcutaneous electrical neural stimulation, and celiac plexus blocks had failed to relieve the pain. After discussion with the patient about the diagnostic nature of the procedure and the likelihood of recurrence of pain, TAP block was performed on the right side with significant improvement of pain for about 24 hours. The degree of pain relief experienced by the patient was very dramatic, which encouraged us to proceed with an indwelling TAP catheter to allow for continuous infusion of a local anesthetic. The patient was sent home with the continuous infusion through a TAP catheter for 2 weeks. From the day of catheter insertion and up to 9 months of follow‐up, patient had marked improvement of her pain level as well as her functional status and ability to perform her daily activities, after which our acute pain team stopped following the patient. Conclusion: A successful TAP block confirmed the peripheral (somatic) source of the abdominal pain and provided temporary analgesia after which an indwelling catheter was inserted, which provided prolonged pain relief.     

利用PCR-SSP技术检测TAP2等位基因多态性

目的：探讨利用聚合酶链反应-序列特异性引物（PCR-SSP）技术检测TAP2等位基因多态性的方法及其可行性。方法用盐析法抽提随机健康人群DNA 样本,以PCR-SSP技术为基础,根据 TAP2*0101,TAP2*0102,TAP2*0103,TAP2*0201四种等位基因型的全序列特点,选取 TAP2mRNA 1308C-T ,1693A-G ,1951C-T等位基因上三个突变位点,使用primer5．0软件设计引物,通过PCR-SSP电泳获得等位基因不同的结果。结果根据PCR-SSP电泳结果获得的不同等位基因的格局图,清晰地得出每个个体的纯合子、杂合子情况,将TAP2所有类型完全分析清楚。结论该方法可确实有效地分型 TPA2等位基因,成本低,操作方便,适合大规模批量地进行人群调查。此技术可用于人类群体遗传学调查,为研究TAP2基因多态性与疾病的关联性提供技术平台。     

Association of TAP1/TAP2 gene polymorphism with inflammatory urogenital diseases combined with joint diseases

AIM: To study association of TAP1/TAP2 gene polymorphism with urogenital infections combined with joint lesions. MATERIALS AND METHODS: Of 139 patients examined 45 ones had inflammation caused by Chlamydia trachomatis (17 had joint disease), 42 had Mycoplasma hominis infection (joint lesions in 17 cases). Method of amplification was used on the basis of specific primers (ARMS). RESULTS: Patients infected with C. trachomatis significantly more frequently had allele TAP1-02011 and TAP2-0201 (RR = 18.5, p < 0.01 and RR = 4.61, p < 0.05, respectively). Joint lesion in patients with chlamydial infection was associated with allele TAP1-02011 (RR = 11.92, p < 0.05). In mycoplasmosis association with joint lesions there is a significant link of joint syndrome with heterogeneous combination threonine/alanine in gene TAP2 position 565 (RR = 4.22, p < 0.05). CONCLUSION: The findings can be used for predicting the joint syndrome development in patients with urogenital infection.     

用合成多肽制备抗胰蛋白酶原激活肽单克隆抗体的研究

目的 建立以合成的小分子肽胰蛋白酶原激活肽制备单克隆抗体(mAb)的技术路线。方法 以合成多肽TAP与载体KLH交联的偶联物为免疫原，免疫BALB／c小鼠，应用细胞融合技术建立能稳定分泌抗TAP mAb的杂交瘤细胞株。结果 共获得10株能稳定分泌TAP mAb的杂交瘤细胞株．经稳定性试验．对其分泌的mAb进行效价测定、中和抑制试验、特异性鉴定，均表明所制备的杂交瘤细胞株稳定性好．其所分泌的mAb效价高、特异性好。结论 利用合成多肽TAP成功制备了抗TAP单克隆抗体。     

Evaluation of Transesophageal Atrial Pacing Stethoscope in Adult Surgical Patients Under General Anesthesia

Sinus bradycardia (SB) and atrioventricular functional rhythm (AVJR) commonly cause circulatory insufficiency in anesthetized surgical patients. Treatment is usually with drugs, which can be ineffective or have adverse effects. Cardiac pacing might be preferred, but the transvenous or epicardial routes are too invasive for routine use, and transcufaneous pacing fails to preserve atrial transport function, Transesophageal atrial pacing (TAP) lacks these disadvantages, yet inavailability of inexpensive products has prevented more widespread use. Therefore, a pacing esophageal stethoscope (PES) fabricated by addition of bipolar electrodes to disposable esophageal stethoscopes routinely used for intraoperative monitoring, was evaluated in 100 anesthetized adults. TAP thresholds (10-msec pulses) and hemodynamic effects of TAP as treatment for incidental SB (< 60 beats/mm) or AVJR were determined. Minimum TAP thresholds (mean ± standard error) in 48 males were 7.3 ± 0.3 mA and in 51 females were 8.5 ± 0.4 mA. Corresponding inferior alveolar ridge-to-electrode distances were 32.5 ± 0.2 and 30.4 ± 0.2 cm. For 48 patients with SB ± 60 beats/mm (54 ± 1 beats/min), TAP (81 ± 1 ppm) produced average 15, 11, and 14 mmHg increases in systolic, diastolic, and mean arterial pressure, respectively (P < 0.001). For 11 patients with AV/R (71 ± 5 beats/mm), TAP (92 ± 3 ppm) produced average 23 and 15 mmHg increases in systolic and mean arterial pressure, respectively (P < 0.05). There were no apparent complications of TAP. TAP with a PES appears practical, safe, and effective for prophylaxis and treatment of SB or AV/R in anesthetized surgical patients.     

TAP, a novel T cell-activating protein involved in the stimulation of MHC-restricted T lymphocytes

Five mAbs have been generated and used to characterize TAP (T cell activating protein) a novel, functional murine T cell membrane antigen. The TAP molecule is a 12-kD protein that is synthesized by T cells. By antibody crossblocking, it appears to be closely associated with a 16-kD protein on the T cell membrane also identified with a novel mAb. These molecules are clearly distinct from the major well-characterized murine T cell antigens previously described. Antibody binding to TAP can result in the activation of MHC-restricted, antigen-specific inducer T cell hybridomas that is equivalent in magnitude to maximal antigen or lectin stimulation. This is a direct effect of soluble antibody and does not require accessory cells or other factors. The activating anti-TAP mAbs are also mitogenic for normal heterogeneous T lymphocytes in the presence of accessory cells or IL-1. In addition, these antibodies are observed to modulate specific immune stimulation. Thus, the activating anti-TAP mAbs synergise with antigen-specific stimulation of T cells, while a nonactivating anti-TAP mAb inhibits antigen driven activation. These observations suggest that the TAP molecule may participate in physiologic T cell activation. The possible relationship of TAP to known physiologic triggering structures, the T3-T cell receptor complex, is considered. TAP is expressed on 70% of peripheral T cells and therefore defines a major T cell subset, making it perhaps the first example of a murine subset-specific activating protein.     

The effects of 2,4,6-triaminopyrimidine (TAP) on sodium and potassium excretion by the rat kidney: comparison with amiloride.

2,4,6-Triaminopyrimidine (TAP) has been reported to be a blocker of the cation-specific paracellular conductance pathways of several epithelia. The compound is also known to inhibit sodium transport in the frog skin. Its effects on renal function were studied in clearance experiments in anesthetized rats and in isolated perfused rat kidneys and compared with the effects of amiloride. The effects of both compounds on electrical resistance of the frog gallbladder were also evaluated. Both TAP and amiloride caused modest natriuresis and a marked reduction in potassium excretion. Amiloride is approximately 1000 times more potent than TAP when compared on the basis of drug concentration in the urine. The concentrations of both substances in urine (at effective doses) correspond to concentrations reported to be effective against sodium transport in amphibian membranes. The urinary concentrations of TAP also correspond to the concentrations required to inhibit paracellular cation movement in the gallbladder. Amiloride at the level tested (10(-3) M) did not seem to influence the paracellular pathway. The results neither establish nor disprove a role of the paracellular pathway in potassium secretion. Both TAP and amiloride are secreted by the renal tubules.     

HLA class I deficiencies due to mutations in subunit 1 of the peptide transporter TAP1

The transporter associated with antigen processing (TAP), which is composed of two subunits (TAP1 and TAP2) that have different biochemical and functional properties, plays a key role in peptide loading and the cell surface expression of HLA class I molecules. Three cases of HLA class I deficiency have previously been shown to result from the absence of a functional TAP2 subunit. In the present study, we analyzed two cases displaying not only the typical lung syndrome of HLA class I deficiency but also skin lesions, and found these patients to be TAP1-deficient. This defect leads to unstable HLA class I molecules and their retention in the endoplasmic reticulum. However, the absence of TAP1 is compatible with life and does not seem to result in higher susceptibility to viral infections than TAP2 deficiency. This work also reveals that vasculitis is often observed in HLA class I-deficient patients.     

The Value of Transesophageal Atrial Pacing in Predicting the Efficacy of Antiarrhythmic Drugs in Patients with Paroxysmal Narrow QRS Complex Tachycardia

Transesophageal atrial pacing (TAP) is used in the diagnosis and treatment of paroxysmal narrow QRS complex tachycardia (NQT). The aim of this study was to assess the value of this technique in predicting the efficacy of antiarrhythmic therapy. The study group consisted of 30 consecutive patients with spontaneous NQT whose clinical tachycardia was inducible by TAP. Baseline TAP was performed off all antiarrhythmic medication and repeated during oral antiarrhythmic drug therapy. The pacing protocol consisted of three stages: a single extrastimulus introduced at progressively shorter coupling intervals during sinus rhythm, pacing at incremental rates to the point of second-degree AV block, and bursts of rapid pacing. On repeat stimulation while on oral antiarrhythmic therapy (37 pacing studies) NQT was still inducible in 12 cases. During the follow-up period ten patients developed a recurrence of NQT:nine cases out of 12 (75%), in whom NQT was inducible while on antiarrhythmic therapy, and one case out of 25 (4%), in whom NQT was not inducible (P less than 0.001). The sensitivity of TAP in predicting the outcome of the patients with NQT was 90%, and the specificity 89%. The negative predictive value of TAP (prediction of no recurrence of NQT) was 96%, and the positive predictive value (prediction of recurrence of NQT) was 75%. We conclude that TAP is a simple and accurate method for predicting the efficacy of antiarrhythmic treatment in patients with NQT.     

TAP1基因多态性与新疆地区维吾尔族变应性鼻炎相关性

目的初步探讨抗原提呈相关转运蛋白1（transporter associated with antigen processing 1,TAP1）＊rs1135216及rs2071480位点基因多态性与新疆维吾尔族变应性鼻炎易感性的关系。方法应用SNaPshot SNP分型技术检测150例变应性鼻炎患者（病例组）、150名体检健康者（对照组）血清样本TAP1＊rs1135216及rs2071480基因位点多态性,并与NCBI基因库中世界其他种族人群进行比较。结果新疆维吾尔族人群中TAP1两位点基因型频率及其等位基因频率在病例组与对照组间差异均无统计学意义（P〉0.05）;维吾尔族TAP1两位点基因型及等位基因与世界其他种族人群相比较,差异均有统计学意义（P〈0.05）;各位点基因型及等位基因频率分布符合Hardy-Weinberg平衡定律。结论 TAP1＊rs1135216及rs2071480多态性与新疆维吾尔族变应性鼻炎易感性无关,可能不是易感基因。     

TAP1基因多态性与新疆地区维吾尔族变应性鼻炎相关性

目的初步探讨抗原提呈相关转运蛋白1(transporter associated with antigen processing 1,TAP1)*rs1135216及rs2071480位点基因多态性与新疆维吾尔族变应性鼻炎易感性的关系。方法应用SNaPshot SNP分型技术检测150例变应性鼻炎患者(病例组)、150名体检健康者(对照组)血清样本TAP1*rs1135216及rs2071480基因位点多态性,并与NCBI基因库中世界其他种族人群进行比较。结果新疆维吾尔族人群中TAP1两位点基因型频率及其等位基因频率在病例组与对照组间差异均无统计学意义(P>0.05);维吾尔族TAP1两位点基因型及等位基因与世界其他种族人群相比较,差异均有统计学意义(P<0.05);各位点基因型及等位基因频率分布符合Hardy-Weinberg平衡定律。结论 TAP1*rs1135216及rs2071480多态性与新疆维吾尔族变应性鼻炎易感性无关,可能不是易感基因。     

Influences of Transporter Associated with Antigen Processing (TAP) on the Repertoire of Peptides Associated with the Endoplasmic Reticulum–resident Stress Protein gp96

The endoplasmic reticulum (ER)-resident stress protein gp96 induces protective immunity and specific cytotoxic T lymphocyte (CTL) responses against antigens expressed in those cells it has been isolated from. This ability is based on peptides associated with gp96. Because gp96 is located inside the ER, our experiments address the question whether or not the repertoire of peptides associated with gp96 is influenced by the transporter associated with antigen processing (TAP). For this purpose, gp96 was isolated from cells with and without a TAP defect and used for immunization of mice. We found that for some antigens the association of peptides with gp96 required functional TAP molecules, whereas the association of peptides from other antigens was TAP independent. In the case of a TAP-dependent association of peptides with gp96, our results prove that peptide binding by gp96 in vivo occurs inside the ER and is not an artifact induced by cell lysis during the gp96 purification. The finding that some antigens can also associate with gp96 in the absence of functional TAP molecules indicates that the repertoire of peptides bound by gp96 truly reflects the entire repertoire of peptides present inside the ER and not only those peptides transported by TAP. These results, together with the earlier finding that the gp96 peptide repertoire is independent of the major histocompatibility complex molecules expressed by the cell gp96 is isolated from, give the theoretical foundation for the ability of gp96 to induce CTL responses against all kinds of intracellular antigens.     

Transversus Abdominis Block: Clinical Uses,Side Effects,and Future Perspectives

Poorly controlled acute pain during the postoperative setting after abdominal surgery can be detrimental to the patient. Current pain management practices for the postoperative abdominal surgery patient rely heavily on opioids, which are associated with many unwanted side effects. Recently, interest surrounding regional anesthesia has been growing owing to its demonstrated efficacy and safety outcomes. More specifically, the transversus abdominis plane (TAP) block procedure has attracted attention owing to its ability to successfully block peripheral pain signaling in the abdomen, its ease of use, few complications, and its greater acceptability. A majority of the studies published has demonstrated the successful reduction in pain in many abdominal surgical procedures using local anesthetics during the TAP block. However, the short duration of the pain block causes the patient to still rely on other analgesics throughout the additional postoperative days. Preliminary studies using continuous infusion catheters placed in the TAP has been one of the ways to prolong the nerve block in the abdomen; however, technical and operational issues currently limit the widespread adoption of this method. In this review, current studies will be presented and summarized to update the field on the potential benefits of the TAP block procedure, in addition to providing insight into the future direction of the drugs that could be used for TAP block.     

△NP63／TAP63在卵巢上皮性肿瘤组织中的表达及其与临床病理关系

目的研究ANP63／TAP63在上皮性卵巢肿瘤组织中的表达及其与临床病理特征的关系。方法运用荧光定量聚合酶链反应方法检测2002年-2004年54例卵巢上皮性肿瘤中ANP63／TAP63的基因水平。结果33例卵巢上皮细胞癌组织中ANP63的表达高于2l例良性上皮性肿瘤中组织。卵巢上皮细胞癌中的表达强度与肿瘤组织病理学分期相关（P〈O．05）,良性肿瘤的表达低于恶性肿瘤（P〈O．05）。ANP63的表达高于TAP63（P〈0．05）;各组间TAP63的表达差异无统计学意义（P〉0．05）。结论ANP63在上皮性卵巢癌中高表达,可能成为上皮性卵巢癌诊断及预后的分子标志物。     

Peritoneal Transfer of Thiamphenicol During Peritoneal Dialysis

The pharmacokinetics of thiamphenicol (TAP) was studied in 17 functionally anephric patients during peritoneal dialysis. Eleven patients were given single intramuscular injections of TAP in doses of 10 to 20 mg/kg of body weight. After this, serial blood samples and outflow dialysate collections were assayed for TAP by gas chromatography. The mean overall elimination rate constant was 0.036 +/- 0.007/h, the serum half time was 8.4 h, and the apparent volume of distribution was 71.0% (+/-14.39%) of the body weight. These parameters were not significantly different from those determined in anephric patients not on dialysis. The mean recovery of the administered TAP doses in the pooled outflow dialysate was 7.7% (+/-2.76%) over 22 h. In six other patients TAP was added to the inflow dialysate in concentrations of 10 to 20 mg/liter for 22 h. Throughout the dialysis periods, serum TAP levels did not rise above 4 mug/ml in transfer of TAP.