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Objective:To evaluate perioperative coagulatory parameters and transfusion rates of lung transplantation recipients.Methods:Clinical data were retrospectively reviewed for 178 lung transplant recipients at China-Japan Friendship Hospital from March 2017 to July 2019. According to whether extracorporeal membrane oxygenation(ECMO)was used during perioperative period, they were divided into two groups of ECMO(131 cases)and without ECMO(47 cases). Clinical data, laboratory examinations and blood transfusion status of two groups were compared. In ECMO group, excluding secondary thoracotomy for hemostasis(7 cases)and incomplete data(2 cases), the remainders were divided into the groups of no red blood cell transfusion(63 cases), red blood cell transfusion(59 cases), plasma transfusion <1 000 ml(99 cases)and plasma transfusion≥1 000 ml (23 cases), no platelet transfusion(93 cases)and platelet transfusion(29 cases). Clinical data, laboratory examinations and ECMO-related parameters of recipients were analyzed by Bary Logistic regression.Results:Statistically significant inter-group differences existed in body mass index(BMI), disease course, primary disease, bilateral lung transplantation, laboratory examinations, postoperative blood transfusion volume, postoperative red blood cell and plasma transfusion ratio between groups with and without ECMO( P<0.05). Bilateral lung transplantation, ASA grade, differences in BMI, disease course, postoperative hemoglobin<100 g/L, postoperative PT/APTT/INR abnormalities and postoperative PLT count <100×10 9/L were independent risk factors for postoperative transfusion during ECMO. Conclusions:The application of ECMO during lung transplantation may affect the perioperative transfusion volume and demand.Fully assessing blood transfusion requirements, optimizing coagulation monitoring and identifying the independent influencing factors of postoperative blood transfusion facilitate clinical scientific and rational blood transfusions.
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【Objective】 To explore the influencing factors of perioperative red blood cell transfusion in patients underwent lung transplantation, so as to provide reference for perioperative blood management (PBM) of lung transplantation patients. 【Methods】 The clinical data of 173 lung transplant patients completed in China-Japan Friendship Hospital from March 2017 to June 2019 were retrospectively analyzed. The patients were divided into two groups according to perioperative red blood cell transfusion volume: large blood transfusion group (transfusion red blood cell volume ≥6 U, n=66) and non-large blood transfusion group (red blood cell transfusion volume <6 U, n=107). The basic information, preoperative laboratory test results, and surgical status of the two groups were statistically analyzed.The clinical data of the two groups were analyzed by univariate analysis. The factors of P<0.15 were included in the binary logistic regression analysis, and the independent influencing factors of perioperative massive blood transfusion in patients with lung transplantation were found. 【Results】 Univariate analysis of clinical data of the two groups of patients (large blood transfusion group vs. non-large blood transfusion group) showed that the differences of smoking history ratio [44(66.7%) vs 87(81.3%)], BMI(20.8±4.5 vs 22.5±4.0)(P<0.05), preoperative Hb [124(111, 138.8) vs 138(126, 149)], preoperative Hct [37.9(34.8, 42.5) vs 41.3(37.9, 44.6)], surgery duration(327.9±107.7 vs 238.4±77.0), intraoperative blood loss(1 108.6±1342.0 vs 341.8±270.8) and single lung transplantation [28(42.4%) vs 84(78.5%)] (P<0.01) were statistically significant. Logistic regression analysis showed that intraoperative blood loss (OR=1.001, P<0.05), surgery duration (OR=1.006, P<0.05), preoperative Hb (OR=0.973, P<0.01), lung transplantation type(single or double lung transplantation)( OR=0.247, P<0.05) and extracorporeal membrane oxygenation (ECMO) (OR=0.187, P<0.01) were independent factors influencing red blood cell transfusion during lung transplantation. 【Conclusion】 Intraoperative blood loss and surgery duration are risk factors for massive blood transfusion during the perioperative period. And the use of ECMO, preoperative Hb, single lung transplantation (compared to double lung transplantation) are protective factors for perioperative massive blood transfusion.
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【Objective】 To study the effect of intravenous immunoglobulin(IVIG) on the detection of blood transfusion compatibility in patients. 【Methods】 56 patients, submitted to our Hospital from March 1, 2017 to December 31, 2020, were enrolled as the research objects. They had negative unexpected antibody screening, major crossmatch incompatibility with the same blood type donors, and had a history of IVIG infusion. ABO and RhD blood groups typing, unexpected antibodies screening, crossmatch, direct antiglobulin test, indirect antiglobulin test, and acid elution test were all conducted by microcolumn gel method. 【Results】 After IVIG infusion, the initially major crossmatch incompatibility with the same blood type donors turned into compatiblity with O-type donors. Among them, 2 patients had transient discrepancy in ABO forward and reverse blood typing due to the IVIG infusion. IgG anti-A were detected in the red blood cell elution of 37 A-type patients; IgG anti-B in 2 B-type patients; 3 cases of IgG anti-A+ anti-B and 14 cases of solo IgG anti-A in 17 AB-type patients. 3 batches of IVIG preparations were detected randomly, IgG anti-A titer was 32-64, and IgG anti-B titer was 8-16. 【Conclusion】 The discrepancy in ABO forward and reverse blood typing and major crossmatch incompatibility with the same blood type donors may occur after non-O type patients received IVIG, which contains IgG types of anti-A and anti-B. In this situation, it is recommended to prepare major crossmatched O-type washed red blood cells to ensure the safety and effectiveness of clinical blood transfusion.
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Objective To investigate the protective effects of a Yiqi Huatan Quyu formulation on liver injury in chronic intermittent hypoxia rats.Methods Thirty healthy male Sprague-Dawley rats of SPF grade were randomly divided into 3 groups:Group A(normoxia and normal saline gavage),Group B(chronic intermittent hypoxia and normal saline gavage)and Group C(chronic intermittent hypoxia and Yiqi Huatan Quyu formulation gavage)(n =10 in each group).After 8 weeks of treatment,the liver tissue was extracted for protein and RNA.Western blot was used to test the protein levels of B-cellymphoma-2 associated X protein (BAX) and B-cellymphoma-2 (BCL-2),and Realtime PCR was used to test gene expression of BAX and BCL-2.Transferase-mediated dUTP nick end-labeling(TUNEL)was used to assay the apoptotic rate of liver cells.Results The expression of the BAX protein and BAX gene was higher and the expression of the BCL-2 protein and BCL-2 gene was lower in Group B than in Group A(t =13.490 and 16.480,P =0.005 and 0.002;t =5.142 and 9.776,P =0.036 and 0.001,respectively).The levels of the BAX protein and BAX gene were lower and the levels of the BCL-2 protein and BCL-2 gene were higher in Group C than in Group B(t =6.088 and 15.240,P =0.026 and 0.005;t =5.296 and 16.380,P =0.034 and 0.004,respectively).The apoptosis rate of hepatocytes was higher in Group B than in Group A(t =7.698,P =0.002),and was lower in Group C than in Group B(t=4.345,P =0.012).Conclusions The Yiqi Huatan Quyu formulation may alleviate the apoptosis of liver cells in chronic intermittent hypoxia rats by upregulating BCL-2 and down-regulating BAX levels,thus exerting protective effects on the liver.
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Objective To investigate the effect of β-lactam antibiotics on the false positive rate of the serum Aspergillus galactomannan (GM) assay in patients with lung diseases.Methods We selectively recruited 77 lung disease patients who did not meet the diagnostic criteria of invasive pulmonary Aspergillosis (IPA) and received different β-lactam antibiotics,while 41 patients without IPA who did not receive any antibiotic treatment were recruited as the control group.Serum samples for GM detection were collected from all participants.The rate of false-positive Aspergillus galactomannan was compared between the two groups.Results False-positive serum results were found in patients who received piperacillin-tazobactam (30.8％ or 8/26) and cefoperazone sulbactamand (27.8％ or 5/18).The rate of false-positive Aspergillus galactomannan in patients who receive β-lactam antibiotics were significantly higher than that in the control group (24.7％ or 19/77vs.7.3％ or 3/41,x2 =5.315,P=0.025).Taking false-positive serum Aspergillus galactomannan as the dependent variable and β-lactam antibiotic treatment as the independent variable,univariate logistic regression analysis showed that the rate of false-positive Aspergillus galactomannan in patients who received β-lactam antibiotics were 4.149 times more than that in the control group (OR=4.149,P=0.030).Conclusions The administration of β-lactam antibiotics may increase the occurrence of false-positive serum Aspergillus galactomannan,and physicians should be aware of this possible interference.
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Objective To identify microbubbles targeted (MBt) to alpha(v)beta(3) (αvβ3) via biotin-avidin bridge and evaluate the adhesion to human umbilical vein endothelial cells (HUVECs) in vitro.Methods MBt produced via biotin-avidin bridge were validated using fluorescence in vitro.Adhesion of αvβ3-integrin targeted MBt (MBαvβ3) to HUVECs was tested using the parallel plate flow chamber (PPFC) test.Results Bright green fluorescence was observed on the biotinylated microbubbles(MBB) incubated with fluorescein isothiocyanate labeled streptavidin (FITC-SA) and on MBB-SA incubated with FITC labeled biotin.There was no fluorescence seen on non-targeted control microbubbles,MBB incubated with FITC labeled protein A and MBB-SA incubated with FITC labeled protein A. The adherent rate of MBαvβ3 was significantly higher than MBt with non-specific antibody (MBN) in PPFC test,with 9.9±3.1 of MBαvβ3 and 0.8±0.3 of MBN adhered to HUVECs,respectively(P<0.05).Conclusions Avβ3 targeted microbubbles using biotin-avidin bridging method is highly efficient and reliable for HUVECs.
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Objective To investigate the usefulness of parametric imaging of contrast-enhanced ultrasound(CEUS) in imaging hepatocellular carcinoma (HCC) using dynamic vascular patterns (DVP). Methods Thirty clinically or pathologically proven HCCs that had undergone CEUS were randomly included. SonoLiver CAP sofeware was used to analyze the CEUS images and reconstruct DVP parametric images. Results The rise time, time to peak and mean transit time were (16. 72±11. 07) s, (29. 92±14. 13) s,(115. 03±90. 91)s in HCC versus (26. 59±9. 60) s, (41.67±12. 59) s, (159.26±123. 74) s in the surrounding liver parenchyma (all P <0. 05). The perfusion index was (90. 41±102. 49) % in HCC versus (54. 10±24. 99)% in surrounding liver parenchyma( P = 0.044). DVP curve and DVP parametric image could both be divided into three types:washout,non-washout and cystic type. The percentages of which were 76.7% (23/30), 20.0% (6/30) and 3.3% (1/30) in DVP curves, respectively, and 66.7% (20/30), 30.0% (9/30) and 3.3% (1/30) in DVP parametric images,respectively. Conclusions Parametric image of CEUS could demonstrates the difference of flow perfusion static between HCC and surrounding liver parenchyma dynamically and directly.
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Objective To evaluate the diagnostic performance of real-time contrast-enhanced ultrasound (CEUS)in characterizing complex cystic focal liver lesions(FLLs).Methods Sixty seven complex cystic FLLs in 65 patients were examined with baseline ultrasound(BUS)and CEUS.BUS and CEUS images were reviewed by a resident radiologist and a staff radiologist independently.Diagnostic performance was evaluated using receiver operating characteristic(ROC)analysis and the interobserver agreement was analyzed by weighted k statistics.Results After ROC analysis,the areas under the ROC curve(Az)were 0.917 for the staff radiologist and 0.774(P=0.044)for the resident radiologist on BUS,and were 0.935 and 0.922(P=0.42)on CEUS.A significant difference in Az between BUS and CEUS was found for the resident radiologist(0.774 versus 0.922,P=0.047),whereas not found for the staff radiologist(0.917 versus 0.935,P=0.38).Better results of specific diagnosis were obtained on CEUS[28.4%(19/67)before versus 58.2%(39/67)after review of CEUS images for resident radiologist,and 26.9%(18/67)versus 76.1%(51/67)for staff radiologist,both P＜0.001].Interobserver agreement was improved after review of CEUS images[K=0.325(95%confidence interval:0.214-0.436)on BUS versus k=0.774(95%confidence interval:0.688-0.860)on CEUS].Conclusions Real-time CEUS improves the capability of discrimination between malignant and benign lesions and specific characterization for complex cystic FLLs,as well as the interobserver agreement.
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Objective To investigate the features of low grade dysplastic nodule(LGDN)and high grade dysplastic nodule(HGDN)in cirrhotic liver on the baseline ultrasound(BUS)and contrast-enhanced ultrasound (CEUS).Methods Seventeen LGDNs and 16 HGDNs which were pathologically proved underwent baseline and CEUS examination.CEUS was performed with contrast pulse sequence(CPS)and contrast harmonic imaging (CHI)and used SonoVue as contrast agent.Results Significant differences(all P>0.05)were not shown between LGDN and HGDN for manifestations on both the BUS and CEUS.After contrast agent injected, hyperenhancement in arterial phase and hyper-or iso-enhancement in late phase,hypo-enhancement in early arterial phase and iso-enhancement through late arterial,portal and late phase,hyper-enhancement in arterial phase and hypo-enhancement in late phase,iso-enhancement in arterial,portal and late phase,iso-enhancement in arterial phase and hypo-enhancement in late phase were showed in 10(30.3%),10(30.3%),8(24.3%),4(12.1%),1(3.0%)cases of DN, respectively.Conclusions LGDN and HGDN displayed similar feature on both the BUS and CEUS.There were complicated manifestations of DN on the CEUS and the main contrast-enhanced sonographic feature of DN was,different from regenerative nodule and hepatocellular carcinoma.CEUS was helpful in diagnosing DN in cirrhotic liver.
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Objective To prepare phospholipid-based sulfur hexafluoride gas-filled microbubbles, which were designed for targeting microbubbles. Methods The microbubbles composed of DSPC and mPEG2000-PE were produced by film-sonication method,and were compared with SonoVue. In the physical chemistry characteristics studies, the morphology, particle diameter, concentration, pH value and osmotic pressure were investigated. In the echogenicity studies, contrast harmonic imaging technique was used to investigate the enhancement of vitro water sac and normal rabbit kidney parenchyma. Results The lipid microbubbles were well-distributed, round with air holes. The average diameter of self-made microbubbles and SonoVue were 2.25 μm and 2.50μm respectively. The average diameter of self-made microbubbles and SonoVue distributed from 0.4 μm to 10 μm and 0.2 μm to 10 μm,and 90% were under 6 μm and 8 μm respectively,the concentration were 5 x 108～10 x 108/ml and 1 x I08～5 x 108/ml respectively with a stability of 6 hours. In vitro water sac, the gray scale of self-made lipid microbubbles and SonoVue were 121.67±6.76 and 122.33 ± 4.53 respectively( P>0.05). In normal rabbit kidney parenchyma, the peak video intensity of normal rabbit kidney parenchyma of self-made lipid microbubbles and SonoVue were 72.00 ± 7.21 and 74. 65± 10.93 respectively(P>0.05). Conclusions The lipid microbubbles have satisfactory physical chemistry characteristics and echogenicity.
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Objective To compare the enhancement pattern of hilar cholangiocarcinoma on contrast-enhanced sonography(CEUS) and contrast-enhanced computed tomography(CECT). Methods Thirty-two hilar cholangiocarcinoma lesions in 32 patients were evaluated by CEUS and CECT. CEUS was performed with contrast agent of SonoVue and low mechanical index contrast specific mode. CECT was performed with contrast media of Ultravist and a standard biphasic helical CT scanning protocol. Results In arterial phase of CEUS and CECT,the numbers of the lesions showing hyper-enhancement were 14 (43.8 % ) and 12 (37.5 % ), iso-enhancement were 14 (43.8%) and 9(28. 1%),hypo-enhancement were 4(12.5%) and 11(34.4%),respectively (P = 0. 162).Three lesions (9.4%) showed periphery rim-like hyper-enhancement and 29 (90.6%) showed diffuse homogeneous or heterogeneous enhanced of the whole tumor on CEUS, whereas for CECT the number were 2 (6. 3%) and 30 (93. 8%) respectively ( P = 1. 000). In portal phase, the numbers of the lesions showing hypo-enhancement on CEUS and CECT were 30 (93.8 % ) and 23 ( 71.90% ), iso-enhancement were 1 ( 3.1 % ) and 8 ( 25.0 % ), hyper-enhancement were 1(3. 1%) and 1 (3. 1%), respectively ( P = 0. 046). The portal vein invasion was correctly detected in 16 ( 84. 2 % ), 17 (89. 5 % ), 15 (78.9 % ) lesions with baseline ultrasound, CEUS and CECT, respectively. CEUS and CECT correctly diagnosed 30(93.8% ) and 25 (78. 1% ) lesions prior to operation (P = 0. 125). Conclusions The enhancement pattern of hilar cholangiocarcinoma on CEUS was similar with that on CECT in arterial phase, whereas in portal phase hilar cholangiocarcinoma was prone to show hypo-enhancement on CEUS. CEUS and CECT has similar diagnostie efficacy prior to operation.
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<p><b>OBJECTIVE</b>To explore low density lipoprotein (LDL) oxidation by macrophage myeloperoxidase (MPO) at molecular level.</p><p><b>METHODS</b>Using a mouse macrophage model, we examined the relationship between LDL oxidation and macrophage MPO by measuring macrophage MPO activity, LDL oxidation products, MPO gene expression and cellular orientation of LDL oxidation.</p><p><b>RESULTS</b>MPO gene expression increased to its maximum gradually when the concentration of LDL was increased, and then maintained at that level. NaN(3) inhibied the elevation of MPO activity and LDL oxidation, which was LDL concentration-dependent. After the composition of macrophage membrane was roughly analyzed, it was determined that the contents of MPO and LDL in 5% sucrose were 7.667 and 21 times higher than those in 10% sucrose, respectively.</p><p><b>CONCLUSION</b>LDL is attached to the "microdomain" of the macrophage membrane in which LDL is oxidized by MPO.</p>
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Animals , Mice , Lipoproteins, LDL , Metabolism , Macrophages , Metabolism , Oxidation-Reduction , Peroxidase , Genetics , MetabolismABSTRACT
OBJECTIVE: To investigate the effects of episodic hypoxia(EHYP) on liver CYP3A2 and CYP2E1. METHODS: Healthy masculinity rats were divided randomly into five groups: control group, 3 -day EHYP group, 7 -day EHYP group, 14 -day EHYP group, and 28 -day EHYP group. 24 h after the management of EHYP, the rats were anesthetized by intraperitoneal injection, and the eyeball blood 2ml was drawn to prepare serum. The activities of ALT and AST in the serum were determined by enzymatic methods. The activities of liver microsomal erythromycin demethylase(ERD) and aniline hydroxylase(ANH) were detected by spectrophotography. The levels of mRNA expression of CYP3A2,CYP2E1 were assayed with RT-PCR. RESULTS: The serum activities of ALT,AST showed no remarkable change. However, after 7 days of hypoxia, ERD and ANH activities were remarkably elevated, and at 28 days induction rates reached up to155.5% and 42.2%, respectively. Meanwhile, the levels of mRNA expression of CYP3A2,CYP2E1 also increased by 220.5% and 102.8%, respectively. CONCLUSION: Chronic EHYP can remarkably increase the activities of ERD and ANH, whose mechanism is probably related to up-regulating of CYP3A2 and CYP2E1 expression at the transcriptive level.
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AIM: To observe whether arachidonic acid (AA) could induce apoptosis in mouse fibroblast cell line L929 and the potential mechanism involved. METHODS: The viability and damaged degree of L929 was monitored by MTT and the release of lactate dehydrogenase (LDH). Lipid peroxidation in L929 was measured as malondialdehyde (MDA) content by colorimetric assay. Hoechst 33258 staining was used to observe AA-induced morphological changes. Agarose gel electrophoresis was used to detect DNA fragmentation. RESULTS: Treatment of L929 cell with AA for 24 h, in the range of 40-160 ?mol/L, caused a great decrease in cell survival and increased MDA contents and the release of LDH simultaneously( P
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AIM: To explore the effects of homocysteine on the apoptosis in PC12 cells and the relationship between the apoptosis and the expression of the bcl-2 as well as bax gene. METHODS: Cell viability was determined by MTT assay. Cell apoptosis was assessed by phase-contrast microscope, fluorescence microscopy and flow cytometry (FCM). The expression of bcl-2 and bax mRNA was measured by semiquantitative reverse transcription polymerse chain reaction (RT-PCR). RESULTS: Treatment of PC12 cells with Hcy plus 10 ?mol/L copper for 12 h, in the range of 0.125, 0.25, 0.5, 1.0 mmol/L, caused a great decrease in cell viability: 81%, 79%, 69%, 57%, and induced typical morphological changes of apoptosis in a dose-dependent manner. The apoptosis ratios were respectively 8.00%, 10.37%, 17.26% and 20.19%, respectively. The expression of bcl-2 was significantly decreased (from 0.517 to 0.198) whereas bax was significantly increased (from 0.302 to 0.619). CONCLUSION: Homocysteine plus copper may induce apoptosis in PC12 cells through the down-regulation of bcl-2 and the up-regulation of bax gene expression.