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Objective:To evaluate the effect of autologous platelet plasmapheresis (APP) and reinfusion on acute kidney injury (AKI) after total aortic arch replacement.Methods:Sixty American Society of Anesthesiologists physical status Ⅲ or Ⅳ patients of both sexes, aged 18-64 yr, with body mass index of 19-34 kg/m 2, scheduled for total aortic arch replacement under general anesthesia, were divided into 3 groups( n=20 each)using a random number table method: APP-reinfusion group (group A), acute normovolemic hemodilution (ANH) group (group N) and autologous blood withdrawal-reinfusion group (group C). In group A, APP was completed before the operation, concentrated red blood cells were transfused timely according to the intraoperative conditions, and platelet-poor and platelet-rich plasma were transfused after protamine neutralization.In group N, ANH was completed before the operation, and the whole blood released was transfused after protamine neutralization.Autologous blood withdrawal and washed red blood cell (RBC) transfusion were only performed in group C, and autologous blood withdrawal was performed in group A and group N. Cervical venous blood and urine samples were collected at 10 min after anesthesia induction (T 1), at 5min after cardiopulmonary bypass (T 2), immediately after the end of surgery (T 3), at 24h and 48h after surgery (T 4、5) for determination of the concentrations of hematocrit (Hct), plasma free hemoglobin (fHb), urinary neutrophil gelatinase-associated lipocalin (NGAL), tissue metalloproteinase-inhibitor -2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP-7) and for calculation of [TIMP-2]×[IGFBP-7]. Glomerular filtration rate (GFR) and concentrations of reatinine (Scr), urea, uric acid and cystatin C were measured before surgery, on the right postoperative day, and at 1, 2 and 3 days after surgery.The intraoperative requirements for allogeneic blood product transfusion, postoperative mechanical ventilation time, duration of intensive care unit (ICU) stay and hemodialysis were recorded. Results:Compared with group C, the postoperative requirement for allogeneic RBC transfusion in group A and group N and the allogeneic platelet transfusion in group A were significantly reduced, Hct at T 2 in group N was decreased, fHb at T 3 and T 4 in groups N and group A was decreased, Scr concentration on the right postoperative day and at 1 day after operation in group A was decreased, and cystatin C concentration on the right postoperative day and at 2 and 3 days after operation in group A was decreased ( P<0.05). Compared with group N, the postoperative requirement for the allogeneic platelet transfusion, concentrations of NGAL and TIMP-2 at T 3-5, IGFBP-7 concentration and [TIMP-2]×[IGFBP-7] at T 3 and T 4, Scr concentration on the right postoperative day and at 1 day after operation and cystatin C concentration on the right postoperative day and at 2 and 3 days after operation were significantly decreased in group A ( P<0.05). Conclusion:APP-reinfusion provides better efficacy in alleviating postoperative AKI than ANH in the patients undergoing total aortic arch replacement.
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@#Objective To investigate the effect of early postoperative systemic inflammatory response syndrome (SIRS) on the short-term outcome of patients with acute Stanford type A aortic dissection (ATAAD). Methods The clinical data of 88 patients with ATAAD who were treated in our hospital from January 2018 to January 2020 were retrospectively analyzed. Patients were divided into a SIRS group (n=37) and a non-SIRS group (n=51) according to whether SIRS occurred within 24 hours after surgery. The perioperative data of the two groups were compared. Results There was no significant difference between the two groups in general clinical data, preoperative left ventricular ejection fraction, white blood cell (WBC) and body temperature (P>0.05). Compared with the non-SIRS group, the cardiopulmonary bypass time in the SIRS group was significantly longer (P<0.05), and the WBC and body temperature within 1 day after surgery in the SIRS group were higher (P<0.01). A significant difference was revealed in the mechanical ventilation time, ICU stay, total hospitalization time and hospitalization costs between two groups (P<0.01). Patients in the SIRS group had higher postoperative acute physiology and chronic health evaluationⅡscores, sequential organ failure assessment score as well as a greater risk of developing postoperative acute lung injury, acute kidney injury, continuous renal replacement therapy, delirium, liver dysfunction and morbidity (P<0.05). Conclusion Early postoperative SIRS significantly increases the incidence of major adverse complications and the mortality rate of patients with ATAAD.
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Myxomas are the most frequent, cardiac benign cardiac tumors which often present with stroke caused by tumorous orthrombotic emboli. The treatment of embolic stroke due to cardiac myxoma is still a clinical and technical challenge. A 61-year-old man who had an embolic stroke in the left middle cerebral artery was admitted to the Third Poeple′s Hospital of Huizhou. The initial National Institutes of Health Stroke Scale (NIHSS) score was 16. He received endovascular thrombectomy after intravenous recombinant tissue plasminogen activator (rt-PA) one hour after stroke onset. No intracranial hemorrhage developed. Pathological study of embolus showed a myxoma. A cardiac mass was found in the left atrium and removed surgically three weeks after stroke. Pathological study of the tumor showed a myxoma. At the one-month follow-up after excision of myxoma, the NIHSS score was 1 and the modified Rankin scale score was 0. No recurrence of embolism occurred after surgical resection. Endovascular thrombectomy after intravenous rt-PA (bridging therapy) for embolic stroke due to cardiac myxoma is safe and effective, and early resection of atrial myxoma can effectively avoid recurrence of cerebral infarction.
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Myxomas are the most frequent, cardiac benign cardiac tumors which often present with stroke caused by tumorous orthrombotic emboli. The treatment of embolic stroke due to cardiac myxoma is still a clinical and technical challenge. A 61-year-old man who had an embolic stroke in the left middle cerebral artery was admitted to the Third Poeple′s Hospital of Huizhou. The initial National Institutes of Health Stroke Scale (NIHSS) score was 16. He received endovascular thrombectomy after intravenous recombinant tissue plasminogen activator (rt-PA) one hour after stroke onset. No intracranial hemorrhage developed. Pathological study of embolus showed a myxoma. A cardiac mass was found in the left atrium and removed surgically three weeks after stroke. Pathological study of the tumor showed a myxoma. At the one-month follow-up after excision of myxoma, the NIHSS score was 1 and the modified Rankin scale score was 0. No recurrence of embolism occurred after surgical resection. Endovascular thrombectomy after intravenous rt-PA (bridging therapy) for embolic stroke due to cardiac myxoma is safe and effective, and early resection of atrial myxoma can effectively avoid recurrence of cerebral infarction.
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@#The incidence of cardiovascular disease remains high, and surgery is an important measure for the treatment of cardiovascular disease. However, cardiovascular surgery is complicated and difficult, and it is one of the departments with the highest rate of allogeneic blood transfusion. Allogeneic blood transfusion significantly increases the complications and mortality of patients, while autologous blood transfusion can effectively reduce allogeneic blood transfusion and adverse reactions. Autologous plateletpheresis technology is a popular autotransfusion method in recent years. This article reviews the autologous plateletpheresis technology and its clinical application in cardiovascular surgery.
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Myxomas are the most frequent,cardiac benign cardiac tumors which often present with stroke caused by tumorous orthrombotic emboli.The treatment of embolic stroke due to cardiac myxoma is still a clinical and technical challenge.A 61-year-old man who had an embolic stroke in the left middle cerebral artery was admitted to the Third Poeple's Hospital of Huizhou.The initial National Institutes of Health Stroke Scale (NIHSS) score was 16.He received endovascular thrombectomy after intravenous recombinant tissue plasminogen activator (rt-PA) one hour after stroke onset.No intracranial hemorrhage developed.Pathological study of embolus showed a myxoma.A cardiac mass was found in the left atrium and removed surgically three weeks after stroke.Pathological study of the tumor showed a myxoma.At the one-month follow-up after excision of myxoma,the NIHSS score was 1 and the modified Rankin scale score was 0.No recurrence of embolism occurred after surgical resection.Endovascular thrombectomy after intravenous rt-PA (bridging therapy) for embolic stroke due to cardiac myxoma is safe and effective,and early resection of atrial myxoma can effectively avoid recurrence of cerebral infarction.
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Liver resection is the mainstay of treatment for patients with hepatocellular carcinoma (HCC). Most of HCC patients are associated with varied degrees of liver cirrhosis.Severity of liver cirrhosis adversely affects the outcomes of liver resection, and also plays a vital role in making an appropriate surgical strategy for HCC.In current surgical practice for HCC, liver function and functional reserve are the focus of preoperative evaluation. Liver cirrhosis is still widely regarded as an one-stage entity. The pathological severity of liver cirrhosis is largely ignored. As neither liver function nor functional reserve can reflect the pathological severity of liver cirrhosis when liver function is at the stage of compensation. Preoperative evaluation on the severity of cirrhosis has not been established in a surgical setting.Thus, there is an urgent need to stage the severity of cirrhosis in surgical practice in order to make more precise surgical modalities for individual patients.This article mainly introduces the ongoing research progress in staging the severity of liver cirrhosis while treating HCC at Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, and emphasizes the importance of staging the severity of cirrhosis in surgical treatment of HCC.
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Liver resection is widely accepted as firstline treatment for patient with liver cancer.Most patients with liver cancer have varied degrees of liver cirrhosis,which is an important risk factor adversely affect the outcomes of liver resection.The adverse effects are more significant as the increase of degree of liver cirrhosis.At present,it is generally believed that liver resection of 60％ volume is appropriate for patients with liver cirrhosis when liver function is within Child A.However,surgeons usually assess whether a patient has liver cirrhosis using "Yes" or "No",ignoring the pathological severity of liver cirrhosis.How to determine the extent of liver resection for patients combined with liver cirrhosis is still controversial.The authors have proposed a method for evaluating the degree of cirrhosis before and during surgery.It is believed that the extent of liver resection should be appropriately reduced with the increase of degree of liver cirrhosis.Further studies are needed to investigate how to accurately assess the severity of liver cirrhosis and how to scientifically determine the extent of liver resection before operation.
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Objective To evaluate the effectiveness and safety of transarterial ehemoembolization(TACE) combined with radiofrequency ablation(RFA) and surgical resection(SR) in the treatment of early stage hepatocellular carcinoma(HCC).Methods PubMed,Medline,Embase,China biomedical database,Wanfang database,CQVIP database and Chinese Journal Full-text database were retrieved by computer.Prospective or retrospective studies of TACE combined with RFA and SR for treating early HCC published from January 2000 to March 2016 were collected.Results Four randomized or non-randomized concurrent controlled trials were included,involving 697 patients.The 1-year and 3-year overall survival(OS) rates in the TACE-RFA group were[94.40％(337/357) and 59.94％(214/357),which in the SR group were 92.35％(314/340) and 68.24％ (232/340),the difference between the two groups was not statistically significant(OR=1.43,95％CI:0.79-2.60,P=0.24,I2 =0％;OR=0.77,95％CI:0.56-1.07,P=0.12,I2 =45％).The 1-year relapse-free survival(RFS) rate of the TACE-RFA group and the SR group was similar [81.5％(291/357) vs.80.3％(273/340),OR=1.07,95％CI:0.73-1.57,P=0.74,I2=0％],while the 3-year RFSrate of the TACE-RFA group was obviously lower than that of the SR group(29.97％ vs.44.41％,OR=0.56,95％CI:0.40-0.77,P=0.000 5,I2 =0％).The incidence rate of severe complications in the TACE-RFA group was evidently lower than that in the SR group(1.43％ vs.5.07％,OR=0.23,95％CI:0.10-0.54,P=0.000 7,I2 =10％).Conclusion Compared with TACE-RFA,SR can significantly reduce the long term recurrence rate of early stage HCC,but the occurrence rate of severe complications in SR is higher than that in TACE-RFA.
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Liver functional reserve which functioned as the major evaluation factor for the tolerance of the liver surgery or the liver trauma had already been used wildly in preoperative evaluation for liver surgery.So far there were plenty of techniques for liver functional reserve.But each technique had its own advantages and disadvantages.This article briefly discussed the most wildly used techniques for liver functional reserve in preoperative evaluation.
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Object To study the effect of puerarin on the expression of inflammatory factors and miR-155-3p in human umbilical vein endothelial cells ( HUVEC) induced by visfatin.Methods The HUVEC cell injury model was es-tablished with visfatin.Cell proliferation was measured by MTT assay.Cell apoptosis was detected by flow cytometry.The level of CRP and NF-κB was detected by ELISA, and the expression of miR-155-3p was detected by RT-PCR.The expres-sion of myeloid differentiation factor 88 ( MyD88) was identified by western blotting.Results Visfatin induced cell prolif-eration and inhibited apoptosis in HUVEC, meanwhile the expressions of both CRP and NF-κB were significantly increased, compared with that of the control group (P<0.01).Puerarin at moderate and high concentrations obviously reduced the HUVEC injury induced by visfatin, mainly through down-regulating the expression of CRP and NF-κB, as well as up-regu-lating the level of miR-155-3p in the HUVEC.MiR-155-3p mimic markedly decreased the level of MyD88, CRP and NF-κB in the HUVEC induced by visfatin (P<0.05).Conclusions Pueprarin obviously alleviates HUVEC injury induced by visfatin, probably related to down-regulating the level of MyD88, CRP, NF-κB, and up-regulating the expression of miR-155-3p in HUVEC.
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Objective To study the closure time of neonatal ductus venosus and the Z score regression equation, and to explore the variation of closure time of neonatal ductus venosus with gestationalage.Methods Color doppler ultrasound was applied to detect the closure time of neonatal ductus venosus in normal newborns, Z score regression equation ( lnY =a +bX +cX2 ) for the closure time of neonatal ductus venosus ( Y ) was developed by regression analysis which used gestational age ( X) as an independent variable. The Z scores of the closure time of neonatal ductus venosus in different gestational age were calculated by the formula [ Z = ( M - Y )/S x , M for observation value, Y for predictivevalue].Results There were 432 cases in our study.The closure time of neonatal ductus venosus was negatively related to gestational age ( r = -0. 938 , P <0. 001 ) . The nonlinear regression equation was lnY= -5. 228+0. 089X-0. 000228X2, R2 =0. 854, Sx =0. 214(P<0. 001). Based on the predicted mean of the closure time and Sx related to different gestational age, Z scores for specific closure time of neonatal ductus venosus could be calculated by the formula [ Z =( M -Y)/Sx ] . The Z scores were normally distributed,and did not change with gestational age.Conclusions Theclosure & nbsp;time of neonatal ductus venosus is negatively related to gestational age. The Z scores obtained by the predicted nonlinear regression equation are normally distributed.
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Objective To evaluate the effect of ischemic postconditioning on myocardial injury in the patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).Methods Thirty patients of both sexes,aged 21-59 yr,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ (New York Heart Association Ⅱ or Ⅲ),with left ventricular ejection fraction ≥ 40％,scheduled for elective cardiac valve replacement under CPB,were divided into 2 groups (n=15 each) using a random number table:control group (C group) and ischemic postconditioning group (P group).In group P,ischemic postconditioning was induced by 3 cycles of 30 s aortic unclamping followed by 30 s cross-clamping starting from 5 min before complete opening of the ascending aorta.After induction of anesthesia and before operation (T1),at 1 h after opening of the ascending aorta (T2),at the end of operation (T3),and at 12,24 and 48 h after opening of the ascending aorta (T4-6),blood samples were taken from the radial artery for determination of plasma concentrations of heart-type fatty acid-binding protein (H-FABP),ischemia-modified albumin (IMA),and cardiac troponin Ⅰ (cTnI).Myocardial specimens in the right auricle were obtained at T2,and the pathological changes were examined using an optical microscope.Results The concentrations of plasma cTnI at T2-6 and H-FABP and IMA at T2-5 were significantly higher than those at T1 in the two groups (P＜0.05).Compared with group C,the concentrations of plasma cTnI at T2-6,H-FABP at T2-4,and IMA at T2,3 were significantly decreased (P＜0.05),and the pathological changes of myocardial tissues were significantly reduced in group P.Conclusion Ischemic postconditioning can reduce myocardial injury in the patients undergoing cardiac valve replacement under CPB.
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Objective To upgrade No.1 Military Medical Project from single operation to Oracle RAC to eliminate single failure of the operation system, protect medical data and lay a foundation for the following upgrade and deployment.Methods RAC software and hardware environment was constructed for database upgrade and deployment of Data Guard.Results The database was gifted with high availability and high performances, and database maintenance and upgrade could be carried out with the operation system less ceased than before.Conclusion The database is upgraded from a single-mode rigid architecture to a multi-mode elastic one, with the performances, safety and extendibility enhanced greatly.
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Objective To evaluate the effects of ulinastatin postconditioning and combination of ulinastatin preconditioning and postconditioning on myocardial apoptosis in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Eighty New York Heart Association (NYHA) class Ⅱ or Ⅲ patients of both sexes,aged 21-59 years,scheduled for cardiac valve replacement with CPB,were randomly divided into four groups (n =20 each):normal saline control group (group C),ulinastatin preconditioning group (group U1),ulinastatin postconditioning group (group U2) and ulinastatin preconditioning plus postconditioning group (group U3).In group U1,uinastatin 20000 U/kg was infused via the central vein at 500-1000 U·kg-1 · min-1 after endotracheal intubation until 10 minutes before blocking the ascending aorta.In group U2,ulinastatin 10000 U/kg was infused via the aortic root at 4000-5000 U· kg-1 · min-1 at 5-7 minutes before opening the aorta.In group U3,ulinastatin preconditioning and postconditioning were performed as described in groups U1 and U2.In group C,the same volume of normal saline was infused instead of ulinastatin.Blood samples were taken from the radial artery at 10 minutes before blocking the ascending aorta,40 minutes after blocking the ascending aorta,45 minutes after opening the aorta and at the end of operation for determination of plasma concentrations of tumor necrosis factor-alpha (TNF-α) and soluble tumor necrosis factor receptor 1 (sTNF-R1).Myocardial tissues were obtained from the right atrial appendage at 45 minutes after opening the aorta for determination of the expression of TNF-α,bcl-2,bax,caspase-3,and apoptosis.The bcl-2/bax ratio and apoptotic index were calculated.Results Plasma concentrations of TNF-α and sTNF-R1 and the expression of TNF-α,bax,caspase-3 and apoptotic index were lower and the expression of bcl-2 and bcl-2/bax ratio were higher in groups U1,U2 and U3 than in group C and they were lower in group U3 than in groups U1 and U2 (P ＜ 0.05).Conclusion Ulinastatin postconditioning can inhibit myocardial apoptosis in patients undergoing cardiac valve replacement with CPB,and the efficacy of combination of ulinastatin preconditioning and postconditioning is stronger than that of ulinastatin postconditioning.The mechanism is involved in balancing the expression of bax and bcl-2 and down-regulating the expression of TNF-α and its receptor.
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<p><b>OBJECTIVE</b>To assess the feasibility and safety of thoracoscopic bulla resection under laryngeal mask anesthesia with low tidal volume high-frequency lung ventilation.</p><p><b>METHODS</b>Sixty patients with pulmonary bulla were randomized into two groups (n=30) to undergo video-assisted thoracoscopic surgery (VATS) for bulla resection with laryngeal mask anesthesia and high-frequency low tidal volume lung ventilation general anesthesia and or with intubation anesthesia and one-lung ventilation through double-lumen endotracheal intubation.</p><p><b>RESULTS</b>No significant differences were found in anesthesia time, surgery time, intraoperative lowest SpO2, intraoperative highest PetCO2, operative field, anesthetic effects, or blood loss between the two groups. The post-operative WBC and NEU% showed significantly smaller increments in the mask anesthesia group than in the intubation group, and the postoperative awake time, initial eating time, ambulation time, in-hospital stay, and drainage time were significantly shortened in the former group with also lower incidences of gastrointestinal reactions, throat discomfort and hoarseness.</p><p><b>CONCLUSION</b>Thoracoscopic bulla resection under laryngeal mask anesthesia with low tidal volume high-frequency lung ventilation is safe and feasible and results in better patient satisfaction and shorter in-hospital stay than procedures performed under intubation anesthesia with one-lung ventilation.</p>
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Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Anesthesia, General , Methods , Blister , High-Frequency Ventilation , Intubation, Intratracheal , Laryngeal Masks , Lung Diseases , General Surgery , One-Lung Ventilation , Thoracic Surgery, Video-AssistedABSTRACT
Objective To observe the efficacy and safety of sorafenib in the treatment of the unresectable hepatocellular carcinoma.Methods According to the inclusion criteria,33 patients with the unresectable hepatocellular carcinoma were given sorafenib (400 mg for twice per day).During the course of treatment,dose was adjusted based on the degree of the adverse effects.Tumor response to sorafenib and safety was assessed every 6-8 weeks using the modified RECIST criteria.The survial curve for the time to progression (TTP) and overall survival (OS) were estimated.Results In this series,there was no patients achieved complete response (CR) and partial response (PR),1 1 patients were evaluated as with stable disease(SD),22 patients were with progressive disease (PD).The median TTP was 5.6 months (2.3-8.9 months).The median TTP was longer in patients with BCLC B than BCLC C stage.TTP was longer in good than in poor performance status patients,and shorter in extrahepatic metastasis than in no extrahepatic metastasis patients.The overall incidence of adverse events was 75.8％.The most common adverse events were hand foot skin reaction,diarrhea,hypertension and rash.Three patients had grade 3 adverse events.Conclusions Sorafenib can extend the median time to progression in patients with unresectable hepatocellular carcinoma.Patients with earlier stage of HCC and better performance status are hopeful for more positive response to the treatment of sorafenib.
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<p><b>OBJECTIVE</b>To investigate the expression of casein kinase 2β in esophageal carcinoma tissues and analyze its clinical significance.</p><p><b>METHODS</b>The expression of CK2β in a tissue chip containing 60 normal esophageal mucosa and 60 colorectal cancer specimens were detected immunohistochemically. Ten human esophageal carcinoma and adjacent normal tissues were examined for the expression of CK2β protein and mRNA using Western blotting and real-time quantitative PCR, respectively.</p><p><b>RESULTS</b>A strong expression of CK2β was found in 85.71% of the esophageal cancer tissues; 1.79% of the cancer tissues were negative for CK2β expression, and 1.79% and 10.71% of the cancer tissues were weakly and moderately positive, respectively. In the normal mucosal tissues, 96.67% of the tissues were negative for CK2β and 3.33% showed weak CK2β expression, showing a significant difference in the distribution of CK2β between normal and esophageal carcinoma tissues (P<0.001). The expression level of CK2β in esophageal cancers was associated with the pathological stage (TNM) (P=0.010). Western blotting and real-time quantitative PCR also confirmed an increased CK2β expression in the esophageal cancer tissues.</p><p><b>CONCLUSION</b>The high expression of protein kinase CK2β is closely related to the carcinogenesis and malignancy of esophageal cancer.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Carcinoma, Squamous Cell , Metabolism , Pathology , Casein Kinase II , Metabolism , Esophageal Neoplasms , Metabolism , Pathology , Gene Expression Regulation, Neoplastic , Neoplasm StagingABSTRACT
<p><b>OBJECTIVE</b>To summarize our experience with video-assisted thoracoscopic (VATS) removal of esophageal leiomyoma located with endoscopy during operation.</p><p><b>METHODS</b>Between January 2006 and December 2010, 55 patients with esophageal leiomyoma underwent VATS enucleation. The surgical procedure was similar to that of open thoracotomy with intraoperative endoscopic location of the tumor and examination of the mucosal integrity especially for tumors less than 1 cm in diameter.</p><p><b>RESULTS</b>Of the 55 patients undergoing VATS tumor removal, 54 patients completed the procedures smoothly, and 1 patient experienced ventricular fibrillation during the operation to require an open thoracotomy. Endoscopy was used in 38 patients during the operation. VATS enucleation differed significantly from open thoracotomy in the volume of bleeding, postoperative fasting days and postoperative hospital stay (P<0.05). The symptoms were completely relieved after the operation without postoperative complications. The patients were followed up for 8 to 59 months (mean 23.0 months) and no recurrence was found.</p><p><b>CONCLUSION</b>VATS removal of esophageal leiomyomas is minimally invasive, safe and effective and can serve as the primary option for surgical removal of esophageal leiomyomas.</p>
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Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Esophageal Neoplasms , General Surgery , Gastroscopy , Methods , Leiomyoma , General Surgery , Thoracic Surgery, Video-Assisted , Methods , Thoracoscopy , Thoracotomy , Treatment OutcomeABSTRACT
ObjectiveTo investigate the effects of ulinastatin postconditioning and combining ulinastatin postconditioning with pretreatment on myocardial inflammatory response in patients undergoing cardiac valve replacement under CPB.MethodsEighty NYHA class Ⅱ or Ⅲ patients of both sexes aged 21-59 yr undergoing cardiac valve replacement under CPB were randomly divided into 4 groups ( n =20 each): group control (group C) ; group ulinastatin pretreatment ( group U1 ) ; group ulinastatin postconditioning (group U2 ) and group ulinastatin pretreatment and postconditioning combined (group U3 ).Ulinastatin 20 000 U/kg was infused via central vein at 500-1000 U·kg-1 ·min-1 after tracheal intubation until 10 min before cross-clamping of ascending aorta in groups U1 and U3.Ulinastatin 10 000 U/kg was infused into root of aorta at 4000-5000 U· kg- 1 · min- 1 at 5-7 min before declamping of aorta in groups U2 and U3.Blood samples were obtained from radial artery before cross clamping of ascending aorta,at 40 min after aortic cross-clamping,at 45 min after declamping of aorta (T3) and at the end of operation for polymorphonuclear leukocyte (PMN) count,routine analysis of blood and determination of plasma concentrations of IL-10,TNF-α,IL-1 and IL-6 (by ELISA).Myocardial specimens were obtained at 45 min after declamping of aorta for determination of IL-1β and IL-6 expression by immune-histochemistry.Results Ulinastatin pretreatment and/or postconditioning significantly increased plasma IL-10 concentration and decreased plasma IL-1,IL-6,TNF-α concentrations and PMN count and myocardial IL-1β and IL-6 expression in groups U1,U2 and U3 as compared with group C.Plasma IL-10 concentration was significantly higher and plasma IL-1,IL-6 and TNF-α concentrations,PMN count and myocardial IL-1β and IL-6 expression were lower in group U3 than in groups U1 and U2.ConclusionUlinastatin postconditioning can inhibit myocardial imflammatory response in patients undergoing valve replacement under CPB.The protective effect can be augmented by combining ulinastatin postconditioning with pretreatment.