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Objective To investigate the risk factors of infection after hepatectomy for liver cancer, and to establish and validate a risk prediction model. Methods The clinical data of 167 patients with primary liver cancer who underwent hepatectomy in People's Hospital of Wuhan University from January 2020 to March 2022 were retrospectively collected. All patients were divided into postoperative infection group ( n =28) and non-infection group ( n =139) according to whether postoperative infection complications occurred. The t -test or Mann-Whitney U test was used for comparison of continuous data between two groups and the chi-square test was used for comparison of categorical data between two groups. Univariate analysis and logistic regression analysis were used to screen the risk factors of infection after hepatectomy for hepatocellular carcinoma, and a nomogram risk prediction model for postoperative infection was established. All patients were randomly divided into training cohort ( n =119) and the validation cohort ( n =48) according to the ratio of 7∶ 3, the Bootstrap method was used for internal validation of the model, and the model calibration curve and ROC curve were used to evaluate the calibration and discrimination of the nomogram model. Results Postoperative infection occurred in 28 of 167 patients (16.8%). Logistic regression analysis showed that diabetes, CONUT score ≥4 points, preoperative NLR, operation time, intraoperative blood loss, and drainage tube placement time > 7 d were independent risk factors for infection after hepatectomy for liver cancer (all P 7 d has good predictive performance and has high predictive value for high-risk patients.
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Objective To analyze the serological markers and surgical indicators associated with biliary complications after orthotopic liver transplantation, explore their influencing factors and predictive indicators. Methods A retrospective analysis was performed for the clinical data of 101 patients who underwent orthotopic liver transplantation in Renmin Hospital of Wuhan University from January 2016 to June 2022, according to the presence or absence of biliary complication (BC) at 6 months after surgery, they were divided into BC group with 21 patients and non-BC group with 80 patients.The t -test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.Univariate and multivariate Logistic regression analyses were performed, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of combined indicators. Results Among the 101 patients, 21(20.8%) experienced BC.The multivariate Logistic regression analysis showed that MELD score (odds ratio[ OR ]=0.134, 95% confidence interval[ CI ]: 0.031-0.590, P =0.008), SⅡ/Alb ( OR =1.415, 95% CI : 1.181-1.696, P =0.001), and plasma transfusion volume ( OR =1.001, 95% CI : 1.000-1.002, P =0.032) were independent risk factors for the development of BC in patients after liver transplantation.MELD score, SⅡ/Alb, plasma transfusion volume, MELD+SⅡ/Alb, and MELD+SⅡ/Alb+plasma transfusion volume had an area under the ROC curve of 0.712, 0.870, 0.712, 0.900, and 0.918, respectively, in predicting BC after liver transplantation. Conclusion SⅡ/Alb, plasma transfusion volume and MELD score are independent risk fators for BC after liver transplantation.The combination of three indicators has good predictive value and clinical guiding significance for BC after liver transplantation.
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At present, hepatectomy has become the preferred treatment modality for most benign and malignant hepatobiliary diseases. Liver failure is a common complication after hepatectomy, and for malignant diseases, how to remove the lesion to the maximum extent and reduce the incidence rate of liver failure after hepatectomy is the key problem at present. Accurate and adequate preoperative evaluation of liver reserve function can provide a basis for judging the progression, therapeutic outcome, and prognosis of liver diseases. There are currently various methods for evaluating liver reserve function and surgical feasibility, each with its own advantages and disadvantages, and there is still a lack of a single comprehensive evaluation method. This article reviews the characteristics of commonly used evaluation methods and related research advances.
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Liver cancer has a high degree of malignancy and its prognosis is poor. The biological behavior of liver cancer with its high degree of malignancy and high tumor heterogeneity impact on its therapeutic effect. The rapid development of precision therapy in the field of cancer provides a platform for application of the precision therapy mode in liver cancer treatment. This article reviews the combined impact by using immune checkpoint inhibitors therapy under precision medicine with targeted therapy, radiotherapy, chemotherapy, oncolytic viruses, tumor vaccines, fecal bacteria transplantation and other therapies.
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Objective:To investigate the effect of ring finger protein 187 (RNF187) on cell pro-liferation, migration and invasion of hepatocellular carcinoma (HCC).Methods:Messenger RNA (mRNA) level of RNF187 in HCC was analyzed by bioinformatics. Huh7 cells transfected with small interfering RNA (siRNA) of negative control or target gene respectively were classified as non-transfection (NC) group and RNF187 knockdown group. After 24 hours of transfection, the above two groups dimethyl sulfoxide (DMSO) were used as NC+ DMSO group and RNF187 knockdown + DMSO group. 24 hours after transfection with siRNA of target gene, the cells dealt with bafliomycin A1 (BFA) were set as RNF187 knockdown + BFA group. The regulation of RNF187 on malignant biological behavior and autophagy level of HCC cells were explored by cell counting kit-8 (CCK8) proliferation assay, cell scratch assay, transwell assay and western blot.Results:Compared with normal liver tissue, the mRNA level of RNF187 was higher in HCC tissue ( P<0.05). Compared with NC group, the absorbance at 48 h and 72 h and the scratch healing rate at 12 h and 24 h of RNF187 knockdown group were all lower, the differences were statistically significant (all P<0.001). The number of transmembrane cells in RNF187 knockdown group (39.50±5.57) at 24 h was lower than that in NC group (128.25±17.35), the differences were statistically significant ( t=9.74, P<0.001). Compared with NC group, the relative expression of total LC3 and Beclin-1 in RNF187 knockdown group all increased, while the relative expression of phosphorylated mammalian target of rapamycin decreased, the difference were statistically significant (all P<0.05). Compared with RNF187 knockdown+ DMSO group, the autophagy flow level, the 48 h and 72 h absorbance, the scratch healing rate at 24 h in RNF187 knockdown + BFA group were higher, the differences were statistically significant (all P<0.001). The number of transmembrane cells in RNF187 knockdown + BFA group (119.00±2.65) was more than that in RNF187 knockdown + DMSO group (57.67±2.52), the differences were statistically significant ( t=29.09, P<0.001). Conclusion:RNF187 is highly expressed in HCC tissue and knockdown of RNF187 inhibits the malignant biological behavior of HCC by enhancing the level of autophagy.
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Hepatocellular carcinoma is one of the most common cancers and causes of cancer-related death in the world, the insidious onset, rapid progression and poor prognosis make the treatment more difficult. At present, the current therapeutic options, include surgical resection, ablation, postoperative recurrenceare still with disadvantages. The efficacy of targeted drug therapy is also unsatisfactory. Immunotherapy is a promising research direction. Immunosuppressants at the molecular level have shown initial success, while adoptive immunocell therapy at the cellular level has also shown promising results, the typical example is chimeric antigen receptor cell therapy. The purpose of this review is to summarize the recent research progress on chimeric antigen receptor cellular therapy in liver cancer.
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Tumor microenvironment is composed of tumor cells and their internal and external environment, and the components vary slightly between different types of tumor. Liver cancer microenvironment is a tumor-promoting microenvironment constructed by hepatoma cells and immune cells and can lead to the development, invasion, and metastasis of liver cancer by recruiting inflammatory cells, inhibiting antitumor immune response, promoting angiogenesis, and promoting drug resistance. This article discusses the characteristics of liver cancer microenvironment, the composition and role of liver cancer microenvironment, and the new advances in microenvironment-targeting therapy for liver cancer.
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Currently, multiple difficulties exist in clinical liver transplantation, such as shortage of donor liver, increasing quantity of patients waiting for liver transplantation and lack of matching donors, etc. Some children and adult patients have little chance of undergoing liver transplantation, which also limits the development of liver transplantation. In this context, split liver transplantation emerges, in which 1 donor liver can be applied to 2 or even more recipients. It may effectively increase the utilization rate of donor liver and alleviate the shortage of donor liver. With the development of split liver transplantation, the survival rate of split liver transplantation is comparable to that of total liver transplantation. Multiple transplantation centers have routinely adopted split liver transplantation. In this article, the development of split liver transplantation, the selection and matching of donors and recipients, the split and reconstruction techniques of donor liver and postoperative complications were reviewed, aiming to provide reference for subsequent development of split liver transplantation in clinical practice and increase the chance of liver transplantation for more patients diagnosed with end-stage liver diseases.
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Objective The objective of this study was to analyze the expression of ubiquitin -conjugating enzyme E2T (UBE2T)in primary liver cancer and its relationship with clinicopathological parameters and prognosis of patients with liver cancer. Methods The second generation sequencing data and clinical pathological data of UBE2T gene mRNA in normal liver tissues and liver cancer tissues were downloaded from the Cancer Genome Atlas(TCGA)database. The expression of UBE2T in cancer tissues and normal tissues was analyzed to elucidate the relationship between UBE2T at mRNA level and clinicopathological parameters of patients with liver cancer. Kaplan-Meier was used for prognostic analysis. The Cox proportional hazard regression model was performed for the multivariate analysis of the prognostic factors associated with HCC. Based on the results of gene set enrichment analysis(GSEA), UBE2T was involved in the possible regulating pathways of HCC development. Results The expression of UBE2T at mRNA level in hepatocarcinoma tissues was significantly higher than that in adjacent tissues(P<0. 01). The high expression of UBE2T was closely related to pathological grade,TNM staging,and vascular invasion(P<0. 01),suggesting a poor prognosis of patients with liver cancer. Multivariate Cox regression analysis showed that TNM staging,vascular invasion and UBE2T expression were independent risk factors affecting the prognosis of patients with liver cancer. Conclusion The high expression of UBE2T is significantly associated with the clinicopathological factors and prognosis of patients with liver cancer. It can be used as a potential marker for predicting the prognosis of liver cancer patients and a target for tumor therapy.
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Objective To explore the clinical effect and feasibility of cold cycle microwave ablation combined with laparoscopic hepatectomy for hepatic hemangioma.Methods Thirteen cases of hepatic hemangiomas were treated with cold cycle microwave ablation combined with laparoscopic hepatictomy,and their clinical data were analyzed retrospectively from March 2015 to October 2017 in the First People's Hospital of Jiangxia District of Wuhan City,including 5 males and 8 females with an average age of 52 years and age range of 45-68 years.The course of disease was 18 months to 8 years,with an average of 4.2 years.The clinical data were retrospectively analyzed and the operation time,intraoperative blood loss,postoperative hospital stay,liver function changes and complications were recorded.The data were analyzed using SPSS 17.0 statistical software,and measurement data with normal distribution were expressed as mean ± standard deviation (Mean ± SD).Results The operations of the 13 cases were successful,including 7 cases of single hepatic hemangioma (the lesions were located in segments 11,111 and Ⅳ) and 6 cases of multiple hepatic hemangioma (the lesions were located in segments Ⅱ,Ⅲ,Ⅳ,Ⅶ and Ⅷ).No hepatic portal occlusion was performed during the operation.The operation time was (135.4 ± 35.8) min,intraoperative blood loss was (95.2 ± 22.7) ml,the postoperative hospital stay was (6.4 ± 0.8) d.On the first postoperative day,alanine aminotransferase was (354.2 ± 75.4) IU/L,and aspartate aminotransferase was (382.7 ± 68.5) IU/L,during the first week after surgery,alanine aminotransferase and aspartate aminotransferase both decreased to the normal range,and no serious complications such as bile leakage or hemorrhage occurred after surgery.No recurrence was observed after 6 to 12 months of follow-up.Conclusions Under the premise of strict control of surgical indications,laparoscopic cold-circulation microwave ablation combined with hepatectomy for hepatic hemangioma is safe and feasible.It can simultaneously treat multiple lesions,and cold-cycle microwave ablation can effectively reduce intraoperative bleeding with a minimally invasive effect.
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Objective To explore the prognostic value of sarcopenia in patients undergoing pancreati-coduodenectomy.Method Clinicopathologic data and follow-up information of 116 patients undergoing pancre-aticoduodenectomy at Renmin Hospital of Wuhan University between March 2011 and August 2016 were collected for statistical analysis.Results Among the 116 patients,the prevalence of sarcopenia was 42.2％ (n =49).When compared to the rest of the patients who did not have sarcopenia,the sarcopenia group had longer recovery time [(17.33±6.54) d vs.(13.46±9.32) d,P=0.013] and increased risk of complications (complications in general,59.2％ vs.38.8％,x2 =4.714,P =0.030;Clavien-Dindo ≥ 3:26.5％ vs.10.4％,x2 =5.130,P=0.024).Both the Kaplan-Meier survival analysis (P＜0.05) and the Cox proportional hazard model (overall survival:hazard ratio =2.285,95％ CI =1.521-3.431;recurrence-free survival,hazard ratio =2.167,95％ CI=1.445-3.248) indicated sarcopenia as the risk factor for poorer overall survival and recurrence-free survival.Conclusions Sarcopenia was an independent predictor of poor prognosis for patients undergoing pancreaticoduodenectomy.Patients with sarcopenia had higher risk of developing complications after surgery and lower overall survival rate and recurrence-free survival rate.
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Mutations and polymorphisms of genes associated with pancreatic function are involved in the development and progression of pan-creatitis. In addition,systemic inflammatory response also affects the severity of pancreatitis,while mutations and polymorphisms of genes which encode inflammatory factors and cytokines can regulate the expression of such factors and thus affect the progression of systemic inflam-matory response. This article reviews the association between pancreatitis and polymorphisms of genes related to cationic trypsinogen,pancre-atic secretory trypsin inhibitor,cystic fibrosis conductance regulator,inflammatory factors,and cytokines.
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Objective To study the impact of preoperative nutritional support on the clinical outcomes in patients with malnutrition who underwent transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma.Methods 46 patients with malnutrition underwent TACE after operation for primary liver cancer were randomly divided into the experimental group (n =23) and the control group (n =23).The patients in the experimental group received preoperative nutritional support,but patients in the control group did not receive preoperative nutrition support.The preoperative and postoperative nutritional status,the incidences of postoperative complication,the liver function,the lengths of hospital stay,the costs of nutrition support and the costs of hospitalization were compared between the two groups.Results On the day before the operation,on postoperative day 1,day 7,and one month,the levels of serum albumin,and on the postoperative day 7 and one month,the levels of pre-albumin were significantly higher in the experimental group than in the control group,and the differences were significantly different [(38.4 ± 1.5) g/L vs.(32.8±0.8) g/L,(37.6±1.3) g/Lvs.(31.4±0.9) g/L,(39.0±1.6) g/L vs.(32.0±0.7) g/L,(39.8±2.2) g/L vs.(33.0±2.0) g/L,respectively,P＜0.05],[(160.0±14.6) mg/L vs.(131.0 ± 16.5) mg/L,(163.0 ± 17.7) mg/L vs.(135.0 ± 17.1) mg/L,respectively,P ＜0.05].The incidences of complication were significantly lower in the experimental group than that of the control group (52.2％ vs.91.3％,P ＜0.05).The length of hospital stay in the experimental group was shorter than that of the control group [(19.9 ± 2.0) d vs.(24.8 ± 2.7) d,P ＜ 0.05].The cost in the experimental group was significantly lower than that in the control group [(20 108.9 ± 1 142.4) yuan vs.(23 174.1 ± 1 128.5) yuan,P ＜ 0.05].The cost in nutrition support in the experimental group was similar to that of the control group (P ＞ 0.05).Conclusions Preoperative nutritional support was helpful in reducing the incidence of postoperative complications,in shortening the length of hospital stay and in reducing medical costs.Nutritional support improved the nutritional status of the patients with primary hepatocellular carcinoma after surgery and TACE.
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As an important immune organ,spleen also plays a crucial role in stabilizing hematologic system.Previous reports support that splenectomy must be performed after the ligation of spleen vessels.At recent time,with the deep knowledge of the anatomy and function of spleen,the surgeons have tried to preserve this organ after the ligation of the vessels.From March 2012 to April 2016,five patients in our hospital have undergone the distal pancreatectomy with spleen preservation after the ligation of splenic vessels,and all the patients' outcomes were satisfactory in the follow-up.This essay aims to discuss the safety and feasibility of preserving spleen after the ligation of the vessels by reporting our own experience and reviewing related literatures on this topic.
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Considerable clinical and experimental evidence supports that liver injury in acute pancreatitis (AP) is a sign for the potential progression to systemic inflammatory reaction.The Kupffer cells,various cytokines and macrophage migration inhibitory factor (MIF) play important roles in the pathogenesis of AP associated liver injury.However,the specific molecular mechanism of the liver damage remains uncertain.Therefore,efforts should be made to clarify the regulatory mechanism and related cell signaling disorders of liver injury in AP,which could not only identify novel therapeutic targets,but also provide new insight into improving the clinical treatment.Here our review discusses the recent research progress on the etiology,pathology and diagnosis and treatments of liver injury in AP.
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Objective To investigate the effects of preoperative nutrition support on postopreative clinical outcome in patients with nutritional risk with pancreaticoduodenectomy.Methods Forty six patients with pancreaticoduodenectomy complicated with malnutrition from June 2011 to September 2013 in Department of Hepatobiliary and Lapoaroscopic Surgery of People's Hospital of Wuhan University were randomly divided into experimental group (n =23) and control group (n =23) with random number table,patients in experimental group received preoperative nutrition support,but patients in control group did not receive preoperative nutrition support.The preoperative and postoperative nutritional status,the incidence of postoperative complications,the length of hospital stay,and the cost of hospitalization in the two groups of patients was compared.Results In terms of intra-operative blood loss and the operative time,experimental group was significantly lower than those in control group [(340 ±90)min vs (420 ± 104)min,(761 ± 100)ml vs (901 ± 150)ml,P＜0.01],on the 1st day of preoperation,the 1st day,7th day and 14th day of post operation,the levels of serum albumin was significantly higher than those in control group [(30.6 ± 1.8) g/L vs (24.6±2.2) g/L on the,P＜0.05];and on the 1st day of pre-operation,the 1st day,7th day of post operation,the levels of transferrin were significantly higher in experimental group than in control group [(3.23 ± 0.65) g/L vs (2.38 ± 0.49) g/L on the,P ＜ 0.05);the rate of post operative complication were significantly lower in experimental group than that in control group (52.2％ vs 21.7％,P=0.000);the postoperative anal exhaust time was earlier in experimental group than that in control group [(6.4 ± 0.6) d vs (9.5 ± 0.6) d,P =0.000),and the length of hospital stay was shorter in experimental group [(20.1 ± 6.5) d vs (26.7 ± 9.5) d,P =0.014),and the cost in experimental group was lower [(99 ± 13) thousand yuan vs (115 ± 13) thousand yuan,P =0.000),however,the cost of nutrition support between the two groups was not significantly different (P =0.210).Conclusions Preoperative nutrition support is helpful to reduce the incidence of postoperative complications,shorten the length of hospital stay,to save medical costs for patients with pancreaticoduodenectomy.
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Objective To analyze the impact of obesity on short-term prognosis in patients who underwent surgery for cirrhotic portal hypertension with hypersplenism.Methods The clinical data of 310 patients with cirrhotic portal hypertension who underwent splenectomy and portaazygous devascularization between Apr.2002 and Jue.2012 were prospectively analyzed.According to the body mass index (BMI),these patients were divided into the non-obesity group (BMI ＜ 28 kg/m2) and the obesity group (BMI ≥28 kg/m2).There were 78 patients in the obesity group (male:female 56:22; mean age 48.7 ± 8.3years).There were 232 patients in the non-obesity group (male:female 166:66; mean age 46.3 ± 6.9years).The postoperative outcomes in the two groups were analyzed.Results When compared with the nonobesity group,there were significant differences in age (48.7 ± 8.3 in obesity group vs 46.3 ± 6.9 years in non-obesity group),perioperative blood transfusion (400 ± 100 vs 200 ± 100 ml),intraoperative blood loss (370 ± 110 vs 240 ±60 ml),operation time (180 ±40 vs 150 ±35 min),serum albumin level after surgery (28.1 ±2.6 vs 31.2 ±2.3 g/L),drainage volume (280 ±70 vs 230 ±60 ml) and hospital stays (10.5 ±3.0 vs 8.5 ± 2.5 days) in the obesity group (P ＜ 0.05).However,there were no significant differences in gender,preoperative level of liver function,platelet counts (preoperative and postoperative) and postoperative deaths (P ＞ 0.05).Conclusion BMI was a significant independent prognosis risk factor for patients with cirrhotic portal hypertension undergone splenectomy and portaazygous devascularization.
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Objective To evaluate the therapeutic effectiveness and safety of combining chemoembolization using microspheres with iodized oil in the treatment of patients with hepatocellular cancer.Methods According to the inclusion and exclusion criteria,two reviewers independently completed the whole process of data search,selection,collection and quality assessment.The Medline,Cancer Lit,PUBMED,EMBASE,Cochrane Library,CNKI,CBM,VIP,Wanfang Data and Grey literature were searched for randomized controlled trails (RCTs) on combining chemoembolization using microspheres with iodized oil in the treatment of liver cancer.The search was from January 2005 to December 2012.The software package Rev Man 5.1 (the Cochrane collaboration) was used to conduct the Meta-analysis and to analyze the data.Results Of the 159 trials selected out from January 2005 and December 2012 for review,only five RCT involving 471 patients were finally included into the analysis.When compared with chemoembolization by iodized oil alone,the combination treatment significantly improved the therapeutic effectiveness (CR + PR).However,there was no obvious difference between the two methods of treatment in the incidence of adverse reaction.Conclusions Combining chemoembolization using microspheres with iodized oil for patients with hepatocellular cancer was effective in controlling liver cancer progression.There is still a need to reduce the incidence of adverse reaction in future.
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Objective To investigate the protective effect of rosiglitazone on acute necrotizing pancreatitis (ANP) associated lung injury in rats.Methods Seventy-five male Wistar rats were randomly divided into sham operation group (SO group),acute necrotizing pancreatitis group (ANP group) and rosiglitazone pretreatment group (ROSI group).ANP model was induced by retrograde infusion of 5％ sodium taurocholate into the biliopancreatic duct.Thirty minutes after ANP induction,ANP groups were injected with 10％ DMSO (0.2 ml/100 g) through femoral vein,and ROSI group were injected with ROSI dissolved with 10％ DMSO (6 mg/kg) through femoral vein,while SO group was injected with normal saline,and 30 minutes later was injected with same amount of 10％ DMSO.Rats were sacrificed at 3 h,6 h and 12 h after the operation.Serum amylase and lung wet/dry weight ratio (W/D) were measured,lung tissues were harvested for pathologic examinations.STAT1 protein and phosphorylation-STAT1 protein (p-STAT1) expression were detected by Western blot.Results The serum levels of amylase,lung W/D,pathologic score of lung tissues in ANP group were increased with time,and reached the peak at 12 h,which were (5017 ± 203)U/L,3.12 ±1.30,(3.33 ±0.18) score,and these were significantly higher than those in SO group (P ＜ 0.05 or 0.01),the expression of STAT1 protein was not statistically significant,but the expression of p-STAT1 reached the peak at 3 h (5.23 ± 0.03),then it gradually decreased,but it was still significantly higher than that in SO group (0.16 ± 0.04,p ＜ 0.01).The serum levels of amylase,lung W/D,pathologic score of lung tissues in ROSI group at 12 h were (1912 ± 164) U/L,1.83 ± 1.26,(2.78 ± 0.16),which were significantly lower than those in ANP group (P ＜ 0.05).The expression of STAT1 protein was not statistically significant,and the expressions of p-STAT1 at 3 h,6 h,12 h was 0.41 ±0.04,0.22±0.05,0.15 ±0.03,which were significantly lower than those in ANP group (P ＜ 0.05).Conclusions Rosiglitazone has the protective effect on ANP associated lung injury by inhibition of phosphorylation-STAT1 protein expression in the early phase.
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Objectives To study the effect of preoperative platelet transfusion for splenectomy and devascularization in the prevention of intraoperative and postoperative bleeding.Methods The 230 patients with cirrhosis and portal hypertension who received splenectomy and periesophagogastric davascularization were divided into strata A,B and C according to the platelet counts.Stratum A patients had a platelet count of less than 30× 10/L,B between 30× 10/L and 50× 109/L,and C more than 50 × 109/L.The patients in each stratum were then randomly divided into a preoperative transfusion group (T group) and a non-transfusion group (NT group).The amounts of intraoperative bleeding,postoperative drainage in 48 hours after operation,rates of postoperative bleeding,and general medical conditions were compared.Results A comparison in stratum A showed lower amounts of intraoperative bleeding and 48 hour postoperative drainage,and a lower rate of bleeding in the T group (P＜0.05).There were no significant differences between the T and the NT groups in strata B and C (P＞0.05).Conclusions For patients with a platelet count lower than 30 × 109/L,preoperative platelet transfusion significantly reduced bleeding suggesting that preoperative platelet transfusion for splenectomy and periesophagogastric devascularization should be a routine.For those patients whose platelet count was above 30 × 109/L,platelet transfusion is not recommended.