RESUMEN
Objective To analyze the relative indicators associated with warm ischemia time (WIT).Methods We established the porcine donor after cardiac death (DCD) model and monitored biochemical parameters (glucose,lactate,pyruvate,glycerol,and glutamate) changes of porcine livers at different WIT by microdialysis technique.The pathological changes were also observed during different WIT by HE staining.Results As the extension of WIT,the morphology injury of the graft aggravated:glucose and pyruvate levels slightly declined in the early stage,and then increased with WIT entension;glycerol levels increased with WIT entension;lactate levels and lactate/pyruvate ratio increased significantly after 20 min of WIT.The expression of lactate and lactate/pyruvate ratio were increased with the prolonged WIT.Pearson correlation analysis of all factors with liver ischemia time and liver pathological injury degree (P＜0.05) showed the obvious correlation between lactate,lactate/pyruvic acid ratio with liver ischemia time and liver pathological injury degree,and of positive correlation (P＜0.001,and correlation coefficients were 0.682 and 0.453 respectively).The ROC curve analysis revealed that the area under the curve was 0.950 for lactate,and 0.885 for pyruvate,respectively.When the critical value of lactic acid was 2.3736,the sensitivity was 90％ and specificity was 95％.When the critical value of lactate/pyruvate ratio was 0.0257,the sensitivity was 80％ and specificity was 83％.Conclusion The level of lactic acid and lactate/pyruvate ratio are significantly related to the WIT.These factors may be used as a predictor of donor liver warm ischemia injury.Reference range of these indicators needs further discussion based on larger sample research.
RESUMEN
Objective To evaluate intraoporative ultrasonography (IOUS) of liver tumors. Methods In this study, 45 patients with liver tumors were examined by the IOUS(Logiq 500 scanner with a dedicated 5 ～ 7.5 MHz linear-array intraoperative transducer), and the results of IOUS were compared with those of preoperative ultrasonography (PHILIPS HDI 5000 scanner with a 3.5 ～ 5 MHz convex-array transducer) and computed tomography (CT). Results For tumors with a diameter ≥ 1 cm, the detection rate of IOUS was 100%, which was higher than that of preoperative ultrasonography and CT (100% vs 89.80% and 97.96%), though there was no statistical significance(xc2 = 3.372 ,P >0.05 and Fisher exact probability was 1.00) ; For tumors with a diameter < 1 cm, IOUS had a significantly higher detection rate than preoperative uhrasonography and CT(90.70% vs 62.79% and 74.42%, respectively,the former x2= 9.382, the latter x2 = 3.957, both P < 0.05) ;The total detection rate of IOUS was significantly higher than that of preoperative ultrasonography and CT (95.65% vs 77.17% and 86. 96%, respectively, the former x2 = 13.378, the latter x2 = 4.381, both P < 0.05). All the detected lesions underwent surgical resection or intratumoral injection of ethanol with the guidance of IOUS. Conclusions Compared with preoperative imaging examination, IOUS not only can enhance the detection rates of preoperatively overlooked lesions, but also can provide more valuable information to guide the surgical procedures.