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Ischemia-reperfusion (I / R) is a complex hemodynamic process that can cause tissue damage through oxidative stress, mitochondrial dysfunction, and inflammatory reactions. It is an important factor leading to poor prognosis in patients, and the exploration of effective prevention and treatment measures is of significant clinical significance. As an endogenous hormone with strong antioxidant and anti-inflammatory properties, Melatonin plays an important role in reducing cell death and improving tissue I / R injury. Therefore, this article reviews the relationship between Melatonin and organ I/R injury in order to provide a theoretical basis for the clinical application of melatonin to alleviate organ I/R injury.
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Acute-on-chronic liver failure (ACLF) is a potentially reversible entity that occurs in patients with chronic liver disease accompanied with or without cirrhosis and is characterized by extrahepatic organ failure and high short-term mortality. Currently, the most effective treatment method for patients with ACLF is liver transplantation; therefore, admission timing and contraindications must be emphasized. The function of vital organs such as the heart, brain, lungs, and kidneys should be actively supported and protected during the liver transplantation perioperative period in patients with ACLF. Focusing on the anesthesia management level during anesthesia selection, intraoperative monitoring, three-stage management, prevention and treatment of post-perfusion syndrome, monitoring and management of coagulation function, volume monitoring and management, and body temperature monitoring management for liver transplantation should strengthen anesthesia management. Additionally, standard postoperative intensive care treatment should be recommended, and grafts and other vital organ functions should be monitored throughout the perioperative period to promote early postoperative recovery in patients with ACLF.
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Humans , Liver Transplantation , Acute-On-Chronic Liver Failure/surgery , Liver Cirrhosis/complications , Perioperative Period , PrognosisABSTRACT
Ferroptosis is a newly-emerged pattern of programmed cell death discovered in recent years, which is defined as iron-dependent programmed necrosis mediated by lipid peroxidation damage. As a conservative procedure, ferroptosis plays a vital role in the development and diseases of multiple organisms including plants and animals. Since ferroptosis was first reported in 2012, growing interests have been diverted to the process of ferroptosis and its role in disease treatment. Ischemia-reperfusion injury is a common pathological process during organ transplantation, and ferroptosis is considered as one of the main patterns inducing ischemia-reperfusion injury. Consequently, the definition, regulatory mechanism and the mechanisms of ferroptosis in ischemia-reperfusion injury after kidney, liver, heart and lung transplantations were reviewed, aiming to provide theoretical basis for the prevention and treatment of ischemia-reperfusion injury in organ transplantation.
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Organ transplantation is an effective treatment for multiple end-stage diseases. In recent years, rapid progress has been made in the field of organ transplantation, which has been widely accepted and applied in clinical practice. However, low utilization rate of donors and high postoperative complications remain to be urgently resolved. Heat shock protein (HSP) is a category of protein family induced by heat shock or other stressors. Upon stress stimulation, HSP plays an anti-inflammation, anti-oxidation and anti-apoptosis role in mitigating the stress-induced damage. HSP is also involved in the processes of promoting immune response and anti-rejection, etc. Organ transplantation, as a stress stimulus, could induce HSP to function in the process of organ transplantation through many patterns, thereby alleviating the allograft damage, improving the utilization rate of donors and prolonging the postoperative survival of recipients. In this article, research status on the role of HSP in lung transplantation, heart transplantation, liver transplantation and kidney transplantation were reviewed, aiming to provide reference for donor protection of organ transplantation and treatment of postoperative complications.
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Short-chain fatty acids (SCFAs) are organic acids with no more than 6 carbon atoms produced during the anaerobic fermentation of dietary fiber in the intestinal tract, which can regulate intestinal flora, repair intestinal mucosal barrier, and reduce intestinal injury.Ischemia-reperfusion injury (IRI) is the main cause of various diseases, and the pathological mechanisms involved are intricate, among which inflammation, oxidative stress, apoptosis and autophagy are the most common. According to current studies, SCFAs can affect the occurrence and development of IRI in various organs by regulating different cell signal transduction. In this paper, the role and mechanism of SCFAs in alleviating tissue and organ ischemia-reperfusion injury were preliminarily summarized, providing theoretical reference for clinical prevention and treatment of IRI.
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Objective:Analysis the protective effect of the partial femoral to femoral cardiopulmonary bypass(CPB) on thoracoabdominal aortic aneurysm repair(TAAAR).Methods:From September 2016 to August 2020, 50 cases of TAAAR under partial CPB were performed at our hospital. Thirty males and 20 females with an average age of(40.5±12.4) years old(ranging 21 to 69 years old) were involved. Partial CPB without selective organ perfusion were applied at the early stage. Since November 2019, the adjunct of perfuse the celiac and superior mesenteric artery with warm blood and irrigate the renal artery with 4℃ HTK solution was used in TAAAR, and 25 patients were operated under this adjunct.Results:The average CPB time was(116.9±35.4) min, the lowest central body temperature during the partial CPB was(34.7±0.7)℃. Total early postoperative mortality was 6%(3/50, 3 deaths in partial CPB alone group). Paraplegia occurred in 4 cases(8%), new happened postoperative hemodialysis was in 6 cases(16%). Among the hemodialysis event, 2 cases(8%, 2/25) were in the group with selective organ perfusion, and 4 cases(16%, 4/25) in the group without using the adjunct.Conclusion:Mild hypothermic partial cardiopulmonary bypass combined with selective organ perfusion have protective effects on spinal cord and abdominal organ in patients underwent TAAAR.
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As a dangerous disease with rapid progression, endotoxemia is easy to induce the damage to multiple organs. However, its specific and efficient treatment methods are still lacking at present. Both Qingkailing Injection(QKLI) and Shengmai Injection(SMI) have been proved effective in anti-inflammation, anti-endotoxin and organ protection. In this study, carrageenan and endotoxin were injected successively into rats to establish an endotoxemia model. Different doses of QKLI and SMI were administered to the endotoxemia rats by intraperitoneal injection separately or in combination. Then the count of white blood cells, the number of platelets, the content of cytokines, biochemical indexes, organ coefficient and pathological changes of main organs in the rats were detected. The results showed that the rats in the model group had obvious symptoms of endotoxemia, i.e., leucopenia, thrombocytopenia, increase in cytokines(IL-6 and TNF-α) and biochemical indexes of liver and kidney function as well as pathological damage to liver, kidney and lung. QKLI alone can alleviate the above symptoms of endotoxemia and the organ injury. SMI alone is less effective in improving disseminated intravascular coagulation(DIC) and cytokine secretion complicated with endotoxemia, but capable of reducing the inflammation degree of the lung, liver and kidney. The combination of QKLI and SMI remarkably increased the number of platelets in the peripheral blood, improved the liver and kidney function and reduced inflammatory factors, with lung, liver, kidney and other organ structures protected well. Moreover, the improvement effect of the combination of QKLI and SMI was stronger than those of the two injections alone at fixed doses, indicative of a synergistic effect.
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Animals , Rats , Drug Combinations , Drugs, Chinese Herbal , Endotoxemia/drug therapyABSTRACT
With the increasing quantity of organ donors and the continual expansion of the definition of extended criteria donor (ECD) livers, the quality of donor liver has become a prominent issue affecting the high-quality development of liver transplantation, which is also the study focus in related fields. Resolving the shortage of organs to the maximal extent and promoting the high-quality development of organ transplantation lead the development direction of organ donation and transplantation in China. In recent years, the application of mechanical perfusion (MP) for the perfusion, preservation, evaluation and repair of donor liver has become a hot topic to improve the quality of liver transplantation within the international community. In this article, according to different conditions of the application of ECD livers in liver transplantation at home and abroad in combination with the research progress on MP in the international community and relevant research experience of our center, the feasibility of establishing an organ intensive care unit (ICU) with integrated organ protection techniques was discussed, aiming to promote the high-quality development of organ transplantation in China and further expand the technical connotation of the "Chinese model" of organ donation and transplantation.
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Acute-on-chronic liver failure (ACLF) is a syndrome of acute liver failure complicated by other organ failure on the basis of chronic liver disease. Liver transplantation is the only effective treatment for ACLF. There is still discussion space on the optimal operation timing of ACLF, how to reduce postoperative infection rate, improvement of nutrition and body function. Transplantation Immunology Committee of Branch of Organ Transplantation Physician of Chinese Medical Doctor Association and Enhanced Recovery of Liver Transplantation Group of Enhanced Recovery after Surgery Committee of Chinese Research Hospital Society organized relevant experts to discuss the perioperative management of ACLF liver transplantation from the operation timing, organ protection, nutritional support, infection prevention and control, rehabilitation exercise and regulation of the internal environment, etc. And the expert consensus was developed for the reference of clinicians.
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@#Anesthesiology in China is transforming from traditional anesthesia only to perioperative medicine. Perioperative medicine has a more comprehensive idea from the perspective of being patient- oriented ，regarding comfort and aponia，rapid recovery and good prognosis of patients as the goal. It also requires individualized perioperative treatment scheme. Since organ protection is a critical issue in perioperative medicine ，patients benefit from maintaining favorable organ function and preventing failure induced by injury. Organ transplantation will become one of the hotspots in future medicine with the development of surgery. Liver transplantation ，as the main type of transplantation ，causes multiple organ dysfunctions during the perioperative period. It is an urgent and key point of perioperative medicine to illustrate its mechanisms and establish relevant protections.
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Ischemia and reperfusion injury has a serious effect on the organs’function. How to protect organs from injury and reduce organ damage during ischemia-reperfusion period is the main concerns of many researches. It is reported that electrical stimulation can alleviate ischemia and reperfusion injury of some organs. In this paper, we will review the effect of electric stimulation on organ ischemia-reperfusion injury and analyze the mechanism of electric stimulation and provide new ideas for the prevention and treatment of clinical organ ischemia-reperfusion injury.
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Objective To study the effects of different preservation methods on the isolated liver injury and regeneration.Methods Twelve Sprague-Dawley rats were randomly assigned to two groups:static cold storage (SCS) and hypothermic machine perfusion (HMP) (n =6 each).Histidinetryptophan-ketoglutarate solution (HTK) was used as preservation solution.The graft was preserved in HTK (4 C) for 6 h in SCS group,and that was perfused using HTK in HMP group.Liver tissue was obtained and fixed in 10％ neutral formalin for immunohistochemistry.The fresh liver tissue was collected and stored in-80℃ for RT-PCR and Western blotting analyses.Results Compared to SCS,HMP improved liver regeneration ability in terms of PCNA and ki67 detection and promoted cell proliferation in PCR levels (Cdc25A,cdk1,cdk6) and Western blotting levels (Cyelin D1,Cyclin E1).Conclusion HMP is superior to SCS in liver regeneration,and expected to be the ideal method for preservation of donor liver.
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Objective To study the effects of different preservation methods on the isolated liver injury and regeneration.Methods Twelve Sprague-Dawley rats were randomly assigned to two groups:static cold storage (SCS) and hypothermic machine perfusion (HMP) (n =6 each).Histidinetryptophan-ketoglutarate solution (HTK) was used as preservation solution.The graft was preserved in HTK (4 C) for 6 h in SCS group,and that was perfused using HTK in HMP group.Liver tissue was obtained and fixed in 10％ neutral formalin for immunohistochemistry.The fresh liver tissue was collected and stored in-80℃ for RT-PCR and Western blotting analyses.Results Compared to SCS,HMP improved liver regeneration ability in terms of PCNA and ki67 detection and promoted cell proliferation in PCR levels (Cdc25A,cdk1,cdk6) and Western blotting levels (Cyelin D1,Cyclin E1).Conclusion HMP is superior to SCS in liver regeneration,and expected to be the ideal method for preservation of donor liver.
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Objective To investigate the factors influencing delayed graft function (DGF)following kidney transplants from donation after citizens death (DCD) in single transplant center.Methods The clinical data of 504 kidney transplants from DCD in the First Hospital of Jilin University between August,2011 and May,2017 were collected and analyzed retrospectively.The functional recovery of kidney graft and the related factors were analyzed,respectively.Results The DGF occurred in 32 cases among 504 kidney transplant recipients during perioperative period,who received dialysis treatment (6.3％).The average recovery time of DGF was 21.0 ± 17.1 days.The average dialysis duration (41.3 ± 38.2 months) pre-transplant in DGF group was significantly longer than that in non-DGF group (28.9 ± 26.2 months) (P =0.024).The average age of donors (42.7 ±9.4 years) in DGF group was significantly older than that in non-DGF group (39.0 ± 15.9 years) (P=0.009).The ratio of donors who received CPR treatment in DGF group (21.9％) was significantly higher than that in non-DGF group (6.4％) (P =0.001).The average last serum creatinine level of donors in DGF group (149.3 ± 98.3 mol/L) was significantly higher than that in non-DGF group (92.8 ± 41.6 mol/L) (P＜0.001).The multivariate analysis revealed that CPR treatment for donors before organ donation,the last serum creatinine level of donors as well as BMI of kidney transplant recipients were all independent risk factor influencing DGF (P =0.001,P＜0.001 and P =0.008,respectively).Conclusion Our study focused on analysis of factors influencing DGF following kidney transplants from DCD in single transplant center.The results of this study are helpful to find and avoid the high risk factors that could influence DGF,reduce the incidence of DGF,improve the quality of patients' life as well as reduce the cost of medical treatment.
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Combined acupuncture-medication anesthesia refers to an anesthesia method by combining acupuncture and small dose of anesthetics, i.e. acupuncture plus local anesthesia, acupuncture plus epidural anesthesia, acupuncture plus general anesthesia, and so on, used in cardiac, chest, skull, throat, abdominal, and urinary operations. Clinical studies show that the combined acupuncture-medication anesthesia has integrated the advantage of acupuncture in regulating the function of internal organs and the advantage of drugs insedation, thus producing a better protective effect on important organs than dry drug anesthesia during and after operation. This article summarized the latest research progress of the combined acupuncture-medication anesthesia in protecting organs duringthe perioperative period of pneumonectomy, pointed out the research frontiers of the application of this anesthesia method in pneumonectomy, and was of valuable reference for the clinical study in the future.
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Objective To observe the effects of transdermal acupoint electric stimulation(TEAS)assisting sodium nitroprus-side induced controlled hypotension on serum glucose (Glu),angiotensin Ⅱ (ATⅡ)and superoxide dismutase (SOD),and to inves-tigate the protective effect of TEAS under controlled hypotension anesthesia.Methods 60 cases undergoing elective endoscopy si-nus surgery by adopting sodium nitroprusside induced controlled hypotension under general anaesthesia maintained the mean arterial pressure(MAP)in 50-60 mm Hg and were randomly and equally divided into two groups.The group Ⅰ conducted TEAS,while the group Ⅱ did not conduct TEAS.The controlled hypotension time and surgery time were recorded in the two groups;Glu and ATⅡ values were detected before anesthesia (T0 ),30 min after hypotension (T1 ),hypotension stopping(T2 );SOD was detected at T0 ,T2 ,30 min after hypotension(T3 ).Results The operation time and controlled hypotension continuous time had no statistically significant difference between the two groups(P >0.05).The Glu value in the group Ⅰ had no statistically significant difference a-mong the 3 time points,while which at T1 ,T2 was higher than that at T0 in the group Ⅱ(P 0.05),which at T1 ,T2 in the group Ⅱwas higher than that in the group Ⅰ (P <0.05);the SOD value at T2 was lower than that at T0 in the group Ⅰ,which at T2 ,T3 in the group Ⅱwas lower than that in the group Ⅰ(P <0.05).Conclusion TEAS assisting sodium nitroprusside controlled hypotension can better in-hibit the stress response.
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Objective To explore the effect of candesartan combined with levamlodipine besylate on hypertension and target organ protection.Methods One hundred and twenty-two patients with hypertension and proteinuria from February 2011 to July 2013 were divided into observation group (61 cases) and control group (61 cases) by random number table method.Patients in both groups were given oral candesartan 8 mg/d,and the observation group was treated with levamlodipine besylate 2.5 mg/d on this basis.Six months after treatment,the blood pressure levels,carotid intima-media thickness (IMT),interventricular septum thickness (IVST),left ventricular posterior wall thickness (LVPWT),left ventricular end diastolic diameter (LVEDD),left ventricular mass index (LVMI) and renal function between 2 groups were observed.Results After 6 months of treatment,the total effective rate in observation group was 86.9％ (53/61),and in control group was 72.1％ (44/61),there was significant difference (P ＜ 0.05).Systolic blood pressure and diastolic blood pressure levels in two groups after treatment were decreased,in observation group which were lower than those in control group,and there was significant difference (P ＜ 0.05).IVST,LVEDD,LVPWT,LVMI and carotid IMT in 2 groups after treatment was lower than that before treatment,in observation group which was obviously lower than that in control group [(8.5 ± 1.3) mm vs.(9.2 ± 1.2) mm,(39.6 ± 4.8)mm vs.(44.3 ± 3.9) mm,(8.4 ± 1.4) mm vs.(9.1 ± 1.3) mm,(89.4 ± 9.3) g/m2 vs.(97.3 ± 8.9) g/m2,(8.3 ± 0.3) mm vs.(8.7 ± 0.5) mm],and there were significant differences (P ＜ 0.05).Urea nitrogen between 2 groups before and after treatment had no significant difference(P ＞ 0.05).The serum creatinine,creatinine clearance rate,total 24 h urinary albumin and microalbuminuria in 2 groups was significandy improved compared with that before treatment,and in observation group after treatment was obviously improved compared with that in control group [(94.6 ±25.5) μmol/L vs.(118.5 ±38.4) μmol/L,(102 ±24) ml/min vs.(96 ± 18) ml/min,(1.05 ± 0.51) mg/24 h vs.(1.27 ± 0.22) mg/24 h,(155 ± 36) mg/L vs.(185 ± 41) mg/L],there were significant differences (P ＜ 0.05).Conclusions The effect of candesartan combined with levamlodipine besylate in treatment of hypertension and proteinuria is better than monotherapy.Combination therapy in reversing left ventricular,improving carotid IMT,protecting kidney function and reducing proteinuria has significant effect,and has no obvious adverse reactions.It is worthy of clinical application.
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This study was aimed to observe the effect of Tao-He Cheng-Qi Decoction (THCQD) on tissue injury of different organs among rats with sepsis. A total of 100 Kunming male SD rats of clean grade were randomly divided into five groups, which were the normal control group, model 6 h control group, model 12 h control group, THCQD 6 h group and THCQD 12 h group. The normal control group received no treatment. The classic CLP method was ap-plied in the establishment of sepsis rat model in other groups. Intragastric administration of saline 1 ml/100 g (weight) was given to each rat in the model group every day. Intragastric administration of THCQD 1 ml/100 g (weight) was given to each rat in the THCQD group every day. The model was established after 7 days. Tissue speci-mens of lung, heart, kidney, liver, and small intestine were collected at 6 h and 12 h after modeling, respectively. Pathomorphological changes of each group were observed by light microscopy and electron microscope. The results showed that compared with the model group at the same time point, pathomorphological changes of tissues of the lung, heart, kidney in THCQD group were not significant. However, pathomorphology of tissues of the liver and small intestine changed significantly in the THCQD 12h group. And there were statistical differences (P < 0.05) between two groups in the score of pathomorphology. It was concluded that THCQD had protective effect on tissues of the liv-er and small intestine among rats with sepsis. However, the mechanism is not clear and requires further research.
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Liver transplantation is the most effective treatment for patients with advanced liver diseases. Patients undergoing liver transplantation are likely to have severely impaired liver function and poor general condition. Meanwhile, the operation is complicated and needs long time; the hemodynamics fluctuates greatly during operation and many drugs are needed after operation. All the above factors are likely to induce injuries to the heart, brain, lung, etc, and resulting in severe complications and finally leading to the death of patients. Therefore the protection of organs during perioperative period is an important step for liver transplantaion of advanced liver diseases, and it is also a focus of study in the area. This article summarizes the injury mechanism and protection strategy of organs in patients during perioperative period of liver transplantation.
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Malperfusion of major organs which frequently accompanies acute aortic dissection is one of the major causes of death. Malperfusion does not only develop before surgery, but also during or after surgery in various manifestations according to the aortic branches involved. Expeditious diagnostic and therapeutic measures based on high degree of clinical suspicion are mandatory for successful treatment. The authors report four cases of acute aortic dissection accompanied by malperfusion of various organs that were successfully treated.