Objective To research anesthetic management, pathophysiologic variation of adult-to-adult living donor liver transplantation (A-ALDLT) and to probe how to improve anesthetic quality of A-ALDLT. Methods The clinical data of 47 donors from Sep. 2005 to Jan. 2007 in West China Hospital were reviewed. Intraoperative vital signs, anesthetic management, perioperative serum levels of HGB， Alb， ALT， AST, TBIL， APTT， PT were measured， and complications were assessed. Results The physical condition of all donors were good before operations and were all in grade Ⅰaccording to ASA. Under general anesthesia of intravenous and inhalation, electrocardiogram, O2 saturation, blood pressure and body temperature were continuously monitored. A radial arterial catheter and a central venous catheter were placed. Blood lavement was utilized intraoperatively in all patients. All donors maintained stable life signs intraoperatively. The average intraoperative blood losses was （603.13±317.00） ml, and donors were transfused with autologous blood 〔(381.25±171.15) ml〕, with only 4 donors required homologous blood transfusion. HR and mean arterial blood pressure (MAP) showed no significantly variations intraoperatively (Pgt;0.05). Compared with controlled central venous pressure (CVP) before and right after hepatectomy, CVP increased significantly (P＜0.05) when intubation and abdomen-closing were carried. After hepatectomy and on the first day after operation, HGB and Alb decreased significantly (P＜0.05); ALT, AST and TBIL increased significantly (P＜0.05). Right after hepatectomy, PT increased instantly and significantly (P＜0.05); On the first day after operation, APTT began to increase significantly (P＜0.05). All donors came around completely and were extubated in the liver transplantation intensive care unit on the first day after operation. There were 3 cases (6.38%) of postoperative complication, which were biliary leakage, portal vein thrombosis and serious pleural effusion. Those 3 donors were cured after treatment. Conclusion Inhalation and intravenous general anesthesia of propofol, remifen-tanil and isoflurane can maintain stable life signs and reduce liver injury. Steady anesthesia, sufficient oxygenation and effective blood protection measures, for example, by decreasing CVP to prevent bleeding and by reclaiming autologous blood to avoid transfusing homologous blood, are keys for the safety of the donor and the prevention of complications.
【摘要】 目的 探讨抗氧化应激是否参与参附注射液预处理诱导的肾脏保护作用。 方法 健康成年雄性SD大鼠21只随机分为假手术对照组（Sham组）、肾脏缺血再灌注组（I/R组）和参附注射液组（SF组）；SF组给予参附注射液10 mL/kg腹腔注射，每日1次，连续给药7d。麻醉下行右肾切除后，用无损伤动脉夹钳夹左侧肾蒂60min，再灌注24 h，制备肾缺血再灌注损伤动物模型。比较各组SD大鼠再灌注24 h肾脏组织中超氧化物歧化酶（superonidedismutase，SOD）水平、过氧化氢酶（catalese，CAT）和丙二醛（malonicalaldehyed，MDA）含量。 结果 与Sham组相比，I/R和SF组肾脏组织SOD和CAT显著降低，而MDA明显升高（Plt;0.05）；与I/R组比，参附注射液能明显增加SOD和CAT水平（Plt;0.05），降低MDA含量（Plt;0.05）。 结论 参附注射液预处理可增强缺血再灌注损伤肾脏组织抗氧化应激，其表现为增强SOD和CAT的活力，减少MDA的生成。【Abstract】 Objective To explore the protective effect of Shenfu injection combined with antioxidant system on rats’ kidney after ischemia-reperfusion injury. Methods Twenty-one male Sprague Dawley (SD) rats were randomly divided into 3 groups: sham operation group (Sham group), ischemia-reperfusion group (IR group), and shenfu injection treated group (SF group). The rats were anesthetized with valebarbitone. Bilateral kidneys were exposed through midline incision. The right kidney underwent the nephrectomy and left renal pedicels were occluded for 60 minutes with a traumatic mini-clamp and then unclamped for 24 hours. Animals in SF group received Shenfu injection (10 mL/kg) through intraperitoneal injection every day for 7 days. About 24 hours after reperfusion, superoxide dismutase (SOD), CAT and malonical aldehyde (MDA) were measured. Results The levels of MDA were lower in SF group than those in IR group (Plt;0.05). The level of SOD and CAT in SF group increased more significantly than which did in IR group (Plt;0.05). Conclusion Our finding suggests that antioxidant system in SF group works more efficiently than IR group to overcome oxidative stress in renal ischemia-reperfusion injury.
Objective To investigate the effectiveness of pretreatment with mixture of lidocaine and flurbiprofen axetil in reducing injection pain of propofol. Methods One hundred and sixty ASI I–II patients undergoing general anaesthesia were randomly allocated into four groups (40 cases in each group): the control group, the lidocaine (Lc) group, the flurbiprofen axetil (FA) group and the mixture of lidocaine and flurbiprofen axetil (hereafter termed as “mixture”) group. After the occlusion of venous drainage, patients were pretreated with 7 mL of 0.9% saline in the control group, 5 mL (50 mg) of flurbiprofen axetil and 2 mL of 0.9% saline in the FA group, 2 mL (40 mg) of 2% lidocaine and 5 mL of 0.9% saline in the Lc group, and 5 mL (50 mg) of flurbiprofen axetil and 2 mL (40 mg) of 2% lidocaine in the mixture group, respectively. The occlusion was released 2 min later and then 0.5 mg/kg propofol was injected into the vein within 5 s. During injecting propofol, the patients were asked by another anesthetist to assess and record their pain through using VSR. Results No significant differences in the demographic characteristics were found among the four groups. In comparison with the control group, the incidence rates of propofol injection pain were obviously lower in the mixture group, the FA group and the Lc group (Plt;0.05); there was a significant reduction in the incidence rate of pain in the mixture group compared with the other three groups. The median pain score was significantly lower in the mixture group and the Lc group than that in the control group. During the 24 hour follow-up after operation, neither the adverse events such as red-swelling in injection site, phlebitis or drug eruption, nor the gastrointestinal stimulating signs were found. Conclusion The mixture of flurbiprofen axetil and lidocaine is found to be more effective in reducing injection pain of propofol.
目的 观察内镜黏膜剥离术（ESD）下治疗早期食管癌的疗效及安全性。 方法 以2009年1月－2012年6月在我院消化内镜中心就诊的患者为研究对象，以内镜黏膜切除术（EMR）为对照，回顾性分析接受ESD和EMR治疗的共75例早期食管癌患者的临床资料，比较两组患者病灶整块切除率、组织学治愈切除率、手术时间及并发症等。 结果 共纳入75例患者，其中41例患者接受ESD治疗，34例接受EMR治疗。ESD和EMR组病灶整块切除率分别为90.2%（37/41）和44.1%（15/34）；治愈切除率分别为78.0%（32/41）和50.0%（17/34），整块切除率（P＜0.001）和治愈切除率（P=0.011）在两组间的分布差异均有统计学意义。ESD组患者手术平均时间（39.5 ± 11.4）min，而EMR组手术平均时间（33.5 ± 18.6）min，但二者之间的差异无统计学意义（P=0.091）。此外，术后延长出血和穿孔等并发症在两组间的分布亦无明显差异。 结论 早期食管癌患者接受ESD治疗可获得更高的整块切除率和组织学治愈切除率。
【摘要】 目的 通过建立活体大鼠心肌缺血再灌注模型，模拟人类冠心病，研究聚合血红蛋白（PolyHb）在心肌缺血再灌注中的保护作用，探究PolyHb在冠心病领域中的保护和治疗作用。 方法 将45只Sprague-Dawley（SD）大鼠随机分成3组:实验组（15只）、对照组（15只）、假手术组（15只），建立大鼠心肌缺血模型。实验组建立动物模型后，结扎冠状动脉35 min，并于结扎后5 min，通过SD大鼠尾静脉按1 mL/min的速度注射1 mL（100 g/L）的PolyHb溶液。缺血完成后开放灌注120 min。对照组建立动物模型，结扎冠状动脉35 min，并于结扎后5 min，通过SD大鼠尾静脉按1 mL/min的速度注射1 mL生理盐水。缺血完成后开放灌注120 min。假手术组仅建立动物模型，但不结扎冠状动脉，也不再灌注。比较3组SD大鼠的血流动力学参数左室内压最大上升和下降速率、心肌酶（血清肌酸激酶、乳酸脱氢酶）及病理学检查（梗死心肌占总心肌面积的百分比），来衡量PolyHb的作用。 结果 与对照组比较，用PolyHb处理的实验组可增强再灌注时左室内压最大上升和下降速率（Plt;0.05），减少血液中血清肌酸激酶和乳酸脱氢酶的含量（Plt;0.05），并明显减少心肌梗死面积百分比（Plt;0.05）。 结论 在心肌缺血的SD大鼠中，PolyHb可以有效的降低缺血再灌注损伤，从而达到心肌保护作用。【Abstract】 Objective To investigate the protective effect of polymerized hemoglobin (PolyHb) for myocardial ischemia-reperfusion and explore the field of polymerized hemoglobin in the protection and treatment of human coronary heart disease, by simulating human coronary heart disease and establishing myocardial ischemia-reperfusion model in living rats. Methods Forty-five Sprague-Dawley (SD) rats were randomly divided into 3 groups: experimental group (n=15), control group (n=15), and sham operation (SHAM) group (n=15). Rat models of myocardial ischemia-reperfusion were established. For the rats in the experimental group, we ligated their left coronary artery for 35 minutes, and injected 1 mL (100 g/L) PolyHb solution into their body at a speed of 1 mL/min 5 minutes later. After ischemia was completed, reperfusion was performed for 120 minutes. The procedures carried out for the rats in the control group were exactly the same except that the PolyHB solution was replaced by 1 mL saline solution. Ligation of the artery and reperfusion were not performed on the rats in the SHAM group. Hemodynamic parameters (maximal rising and falling rates of left ventricular pressure), enzymes (serum creatine kinase, lactate dehydrogenase) and results of histopathologic examinations (percentage of myocardial infarction area over the total myocardial area) were measured and compared among the three groups to evaluate the function of PolyHb. Results Compared with the control group, the experimental group treated with PolyHb had higher maximum rising and falling rates of left ventricular pressure (Plt;0.05), lower blood levels of creatine kinase and lactate dehydrogenase (Plt;0.05), and lower percentage of myocardial infarction area over the total myocardial area (Plt;0.05). Conclusion Polymerized hemoglobin can effectively reduce the ischemia-reperfusion injury and achieve myocardial protection in SD rats with myocardial ischemia.
ObjectiveTo explore the feasibility of targeted cryoablation for localized prostate cancer in day surgery.MethodThe clinical data of patients with localized prostate cancer who underwent cryoablation from April 2017 to May 2019 were retrospective analyzed. The patients’ satisfaction, postoperative complications, chronic pain and indwelling catheter term were recorded on the 1st (the next day after operation) and 7th day after the operation of follow-up.ResultsA total of 98 patients were included. All patients underwent the surgeries successfully. The average age of the patients was (73.43±7.86) years old. The average length of postoperative hospital stay was (1.55±0.43) days, including 34 cases (34.69%) discharged within 24 hours after the surgery. The satisfaction rate of patients was 100% on the 1st and 7th day after the operation. Twelve cases (12.24%) removed the catheter at the discharge, 83 cases (84.69%) removed the catheter on the 7th day after the operation. Because of the urinary retention, 3 cases (3.06%) removed the catheter 2 weeks after the operation. All patients were satisfied with urine control after the removal of the catheter. Ten cases (10.20%) had postoperative complications, including 3 of urinary tract infection, 3 of urinary retention, and 4 of perineal edema; the patients recovered after symptomatic treatment. On the day of surgery, 8 cases (8.16%) had slight postoperative pain in perineal (the Visual Analogue Scale scores were all 2). After oral analgesic treatment, the patients’ symptoms were alleviated.ConclusionTargeted cryoablation is a safe and effective method for the treatment of localized prostate cancer with a low incidence of postoperative complications, and it has certain feasibility in day surgery mode.
ObjectiveTo investigate the effect of dust fine particles on tumor necrosis factor-α (TNF-α), matrix metalloproteinase (MMP), transforming growth factor-β1 (TGF-β1), and collagens in the lung tissue of rats.MethodsAccording to random number table method, 96 male Wistar rats were divided into an untreated control group, a treated control group and an experimental group, with 32 rats in each group. The experimental group was exposed to the wind tunnel simulation of sandstorm (5 days per week, 5 hours per day); the untreated control group was put in the standard living environment next to the wind tunnel; the treated control group was exposed to the same wind tunnel simulation of sandstorm for 5 hours every day, the speed of wind was the same as the experimental group, but without dust; On the 30th, 60th, 90th, and 120th day, the levels of TNF-α, MMP-2, MMP-9, TGF-β1, lung collagen type Ⅰ and Ⅲ in the lung tissue of rats were determined by enzyme linked immunosorbent assay.ResultsCompared with the untreated control group and the treated control group, the content of TNF-α was higher in the experimental group on 30th, 60th, 90th and 120th day (all P<0.05). The contents of MMP-9 and MMP-2 in the experimental group on 60th and 90th day were significantly higher than those in the untreated group and the treated control group, respectively (all P<0.05). On the 30th, 60th, 90th, and 120th day, the content of TGF-β1 in the experimental group was significantly higher compared with the two control groups (all P<0.05). The contents of lung collagen type Ⅰ and type Ⅲ were higher in the experimental group on 60th, 90th and 120th day, respectively, compared with the two control groups (all P<0.05).ConclusionsThe strong sandstorm environmental exposure to a certain period of time can promote lung interstitial collagen deposition in rat. With the prolonged exposure time, the deposition of collagen increases. TNF-α, MMP-2, MMP-9 and TGF-β1 may all participate and induce the process of pulmonary fibrosis.
ObjectiveTo establish a predictive model for neck lateral lymph node metastasis (LLNM) in unilateral papillary thyroid cancer (uni-PTC) with central lymph node metastasis (CLNM). MethodsThe uni-PTC patients with CLNM were included in this study. The patients underwent thyroid surgery in the 960th Hospital of the PLA Joint Logistics Support Force from May 2018 to December 2021, who were randomly divided into the modeling group and the validation group according to the ratio of 7∶3. The risk factors of neck LLNM were analyzed by univariate and multivariate logistic regression and the nomogram of prediction model was constructed. The receiver operating characteristic (ROC) curve and calibration curve were used to validate the prediction model. ResultsA total of 237 patients were included in this study, including 158 patients in the modeling group and 79 patients in the validation group. The LLNM occurred in the 84 patients of the modeling group and 43 patients of the validation group. The multivariate logistic regression analysis was performed according to the statistical indicators in the univariate analysis results of the modeling group and the risk factors considered in the previous studies. The results showed that the patients with maximum diameter of the lesions >1 cm, multiple lesions, extraglandular invasion, the rate of CLNM ≥0.414, and lesions located at the upper portion had higher probability of LLNM (OR>1, P<0.05). The area under ROC curve of the nomogram in predicting LLNM in the modeling group was 0.834 [95%CI (0.771, 0.896)], which in the validation group was 0.761 [95%CI (0.651, 0.871)]. The calibration curve showed a good calibration degree in the prediction model. ConclusionThe clinical risk prediction model established based on the risk factors can better predict the probability of LLNM.
【Abstract】Objective To investigate the role of VEGF and its soluble VEGF receptor ( sVEGFR-1) in pathogenesis of acute lung injury ( ALI) induced by immersion in seawater after open chest trauma. Methods Sixteen hybridized adult dogs were randomly divided into control group and seawater group. The control group only suffered from open chest trauma, whereas the seawater group were exposed to seawater after open chest trauma. Blood samples were collected at the 0, 2, 4, 6, 8 h after trauma for measurement of white blood cell count, arterial blood gas, plasma osmotic pressure ( POP) , electrolyte concentration, IL-8, vWF, VEGF and sVEGFR-1 levels. The lungs tissue and BALF was collected at 8 h after trauma. Pathological changes of the lung was observed under light microscope by HE staining. Meanwhile VEGF and sVEGFR-1 levels were measured in BALF and lung tissue homogenate. Total protein concentrations in plasma and BALF were measured to calculate the pulmonary penetration index ( PPI) . Results The lung of the seawater group showed interstitial mononuclear cell and neutrophil infiltration, interstitial edema, and vascular congestion. VEGF and sVEGFR-1 were significantly increased in the plasma, while VEGF was significantly reduced in the lung tissues and BALF. The levels of IL-1β, IL-8 and vWF, just as the level of VEGF, were significantly increased in the plasma. Meanwhile, the POP and electrolyte concentration were significantly increased. In the plasma, the responses of VEGFs during the early onset of ALI induced by immersion in seawater after open chest trauma were consistent with the POP and PPI. Conclusions High plasma levels and low BALF/ lung tissue levels of VEGFs is a distinguishing characteristic during the early onset of ALI induced by immersion in seawater after open chest trauma. VEGF may be a novel biomarker which has an important role in the development of ALI.
Objective To evaluate the short-term effectiveness of talonavicular arthrodesis for Müller-Weiss disease. Methods Between May 2013 and February 2015, 13 patients with Müller-Weiss disease were treated with talonavicular arthrodesis. There were 11 females and 2 males with an average age of 59 years (range, 42-67 years). The disease duration was 8-20 years (mean, 13 years). According to Maceira stage, there were 7 cases of stage Ⅲ, 6 cases of stage Ⅳ. The foot longitudinal arch height measured on weight-bearing X-ray films was (43.1±1.8) mm; the Meary angle and talocalcaneal angle measured on lateral X-ray films were (–2.8±2.3)° and (5.8±2.4)°, respectively; the calcaneal valgus angle measured on Saltzman position X-ray films was (–2.0±0.7)°. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 43.5±12.4, and visual analogue scale (VAS) score was 7.3±1.5. Results All the patients were followed up 14-39 months (mean, 20 months). The symptoms of foot pain and intermittent claudication disappeared in all patients. All cases achieved bony union, the fusion time was 12-16 weeks (mean, 13 weeks). There was no complications such as wound infection, skin necrosis, or internal fixator broken. At last follow-up, the foot longitudinal arch height, Meary angle, talocalcaneal angle, and calcaneal valgus angle were (52.5±2.2) mm, (1.3±2.2)°, (16.5±3.7)°, and (0.4±0.7)°, respectively; the AOFAS score and VAS score were 83.8±9.1 and 1.0±0.4, respectively; all were significantly improved when compared with preoperative ones (P<0.05). Conclusion If the subtalar and calcaneocuboid joints are relatively healthy, talonavicular arthrodesis may be a reliable and effective surgical option for Müller-Weiss disease that is resistant to conservative treatment.