Discriminant analysis of the risk of nosocomial mortality in patients with traumatic hemorrhagic shock / 中华普通外科杂志

Objective:To investigate the use of discriminant analysis to predict the risk of nosocomial mortality in patients with traumatic hemorrhagic shock.Methods:The clinical data of 238 patients with traumatic hemorrhagic shock admitted to Peking University People's Hospital from Sep 2013 to Aug 2020 were retrospectively analyzed. Patients were divided into survival group (214 cases) and death group (24 cases). Stepwise discriminant analysis was used to establish a discriminant model.Results:The difference of history of stroke (9.8% vs. 25.0%), main site of bleeding (extremities)(58.9% vs. 29.2%), APACHEⅡ score (16.4±5.1 vs. 23.2±6.1), blood lactic acid [2.1(1.1-3.5) mmol/L vs. 4.9(2.0-13.4) mmol/L] and surgery (92.5% vs. 58.3%) between the two groups was all statistically significant (all P<0.05). Finally, There are five indicators that entered the discriminant model: history of stroke, main site of bleeding (extremities), blood lactic acid, APACHE Ⅱ score and surgery. The area under the ROC curve for predicting the risk of mortality in patients with traumatic hemorrhagic shock was 0.857, 95% CI 0.754-0.959. Conclusions:The established discriminant model has a high accuracy in predicting the risk of in-hospital mortality in patients with traumatic hemorrhagic shock.

Stability and pathophysiology of volume-controlled hemorrhagic shock model in rat / 中华普通外科杂志

Objective:To establish a rat model of volume-controlled hemorrhage and observe the pathophysiological changes that ensued.Methods:Sprague Dawley (SD) rats were subjected to femoral arterial cannulation and hemorrhage for 40% or 50% of total volume. The hemodynamics data and arterial blood gas were collected, and survival after hemorrhage was monitored for 24 hours ( n=8/group). Then lung, liver, intestine and kidney were collected for HE staining after 40% hemorrhage at 4, 8 and 12 hours ( n=6/group). Results:Mean arterial pressure of 40% and 50% blood loss group decreased significantly from (90±5)mmHg and (93±4)mmHg to (40±4)mmHg and (34±4)mmHg ( P<0.05). Heart rate of 40% and 50% blood loss group increased significantly from (330±35) bpm and (336±32) bpm to (478±36) bpm and (490±21) bpm ( P<0.05). Hemoglobin and pH decreased significantly following hemorrhage, while lactate increased. The survival rate of 50% blood loss group was just 12.5% and 40% blood loss group was 100% ( P<0.05). Compared with sham group, the most significant injury was observed in lung and small intestine after 4 hours, in liver after 8 hours and in kidney after 12 hours following hemorrhage. Conclusion:This study established a stable and repeatable volume-controlled hemorrhagic shock model in rat.

Cytokine-like protein 1 enhances the pro-inflammatory functions of neutrophils in septic mice / 中华急诊医学杂志

Objectives:To analyze the effect of cytokine-like protein 1 (CYTL1) on the pro-inflammatory functions of neutrophils in septic mice.Methods:C57BL/6 mice were randomly (random number)divided into the sepsis group and control group, with 6-12 mice in each group. A septic mouse model was established by the procedure of cecal ligation and puncture (CLP). Neutrophils were isolated from peripheral venous blood 8 h after the procedures according to the density gradient centrifugation method, and the neutrophils were treated with CYTL1 recombinant protein. The Boyden chemotaxis assays were used to detect the activity of CYTL1. fMLF and interleukin-8 were used as positive controls. Phagocytosis was determined by confocal microscopy or on a FACSVerse. Reactive oxygen species generation in neutrophils were monitored with the commercial CellROX Green fluorescent probe.Results:Compared with the control group, CYTL1 showed strong chemotactic activity on neutrophils of septic mice [(10.0 ± 2) vs (66.3 ± 4), t=-21.6, P <0.0001]. CYTL1 has stronger chemotactic activity than IL-8 [(66.3 ± 4.0) vs (21.7 ± 6.5), t = 10.1, P = 0.001]. But the chemotactic activity of fMLF and CYTL1 changed little on neutrophils of septic mice [(66.3 ± 4.0) vs (86.0 ± 13.5), t=-2.4, P = 0.073]. CYTL1 could augment the uptake of E.coli by neutrophils compared with the sepsis group [(7.35 ± 1.66) vs (2.84 ± 0.62), t = 4.4, P = 0.012]. The number of E.coli particles swallowed intracellular by a single cell significantly increased upon the stimulation of CYTL1. CYTL1 could also enhance the intracellular reactive oxygen species production of neutrophils of septic mice [(84340.1 ± 5353.5) vs (351018.7 ± 72291.7), t = 6.4, P = 0.003]. Conclusions:CYTL1 can prompt the pro-inflammatory functions of neutrophils in septic mice. In the early phase of bacterial infection, this protein may play an important role in regulating the inflammation.

Medical quality control in construction of trauma center / 中华创伤杂志

The National Health Commission recently has released a notice about further promoting the trauma rescue and treatment in China, which includes four main contents as follows: ( 1 ) to strengthen the establishment of regional trauma rescue and treatment system based on trauma center;(2) to lift the specialized medical service ability related to trauma rescue and treatment; ( 3 ) to further develop the radiant and stimulating role of National Trauma Medical Centre and National Regional Trauma Medical Center;(4) to enhance the trauma-related professional training and public health education. In this article, we interpret the third aspect regarding medical quality control and maintenance of trauma treatment, providing reference for better understanding the specific requirements of the document.

Risk factors associated with myocardial injury after non-cardiac major surgery in ICU admitted patients / 中华普通外科杂志

Objective@#To analyze the risk factors related to the myocardial injury after non-cardiac surgery (MINS) in patients who underwent major abdominal surgery.@*Methods@#The clinical data of all patients admitted in the surgical ICU of Peking University People′s Hospital from Jan 2016 to Dec 2018 were analyzed. Logistic multivariate analysis was performed to analyze the association of clinical characteristics with the incidence of MINS.@*Results@#A total of 322 patients were included, 48.4% (156/322) were diagnosed as with MINS. 97.4% (152/156) of MINS occurred during the first 72 h of admission. Multivariate analysis showed that independent predictive factors of MINS were age >65y (OR=1.747, P=0.021), body mass index (OR=1.085, P=0.008), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ, OR=1.066; P=0.047), hypertension (OR=1.747, P=0.027), blood lactate (OR=1.393, P=0.001) and acute kidney injury (OR=2.065, P=0.047).@*Conclusions@#The incidence of MINS in patients who underwent major abdominal surgery was high. Age, body mass index, APACHE Ⅱ score, hypertension, blood lactate level and acute kidney injury after surgery were independent risk factors of MINS.

Risk factors associated with myocardial injury after non-cardiac major surgery in ICU admitted patients / 中华普通外科杂志

Objective To analyze the risk factors related to the myocardial injury after non-cardiac surgery (MINS) in patients who underwent major abdominal surgery.Methods The clinical data of all patients admitted in the surgical ICU of Peking University People's Hospital from Jan 2016 to Dec 2018 were analyzed.Logistic multivariate analysis was performed to analyze the association of clinical characteristics with the incidence of MINS.Results A total of 322 patients were included,48.4％ (156/322) were diagnosed as with MINS.97.4％ (152/156) of MINS occurred during the first 72 h of admission.Multivariate analysis showed that independent predictive factors of MINS were age ＞ 65y (OR =1.747,P =0.021),body mass index (OR =1.085,P =0.008),acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ,OR =1.066;P =0.047),hypertension (OR =1.747,P =0.027),blood lactate (OR =1.393,P=0.001) and acute kidney injury (OR=2.065,P=0.047).Conclusions The incidence ofMINS in patients who underwent major abdominal surgery was high.Age,body mass index,APACHE Ⅱ score,hypertension,blood lactate level and acute kidney injury after surgery were independent risk factors of MINS.

Clinical characteristics and predictors of mortality in patients with candidemia in intensive care unit / 中华危重病急救医学

Objective To investigate the clinical characteristics and predictors of mortality in patients with candidemia in intensive care unit (ICU). Methods The patients with candidemia admitted to ICU of Peking University People's Hospital from January 2010 to December 2017 were enrolled. The general clinical data, indicators related to Candidia infection and prognosis were collected, and the clinical characteristics, infection characteristics and prognosis of patients with candidiasis were analyzed. Patients were divided into death group and survival group according to hospital survival status. The differences of each index were compared between two groups. The independent risk factors of mortality in patients with candidemia were analyzed by multivariate Logistic regression analysis. Results A total of 95 patients (55 males) with candidemia were included, with an average age of (69.3±16.5) years, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) was 24.7±3.6, sequential organ failure assessment (SOFA) was 6.6±2.7. Candida albicans accounted for the largest proportion of Candida infections (n = 56, 58.9%). Thirty-two (33.7%) patients received inadequate antifungal therapy and 38 (40.0%) patients received inadequate source control. Fifty-five (57.9%) patients were died in hospital. Compared with the survival group, patients in the death group was older (years: 72.5±14.6 vs. 64.9±18.0, P < 0.05), had higher APACHEⅡ and SOFA scores (26.6±2.2 vs. 22.1±3.6, 7.9±2.0 vs. 4.7±2.4, both P ﹤ 0.01), higher rate of glucocorticoid treatment (18.2% vs. 10.0%, P < 0.05), and higher proportion of Candida albicans and Candida glabrata (69.1% vs. 45.0%, 10.9% vs. 7.5%, both P < 0.05), the rate of multi-site Candida infection also significantly increased (47.3% vs. 17.5%, P < 0.05). Intra-abdominal infection was the primary infection site and more common in death group (49.1% vs. 35.0%, P < 0.05). The rates of sepsis (87.3% vs. 62.5%), inadequate antifungal therapy (49.1% vs. 10.0%), inadequate source control (60.0% vs. 12.5%) in death group were all higher than those in survival group (all P < 0.01). It was shown by multivariate Logistic regression analysis that APACHE Ⅱ[odds ratio (OR) = 1.605, P = 0.002, β = 0.473], SOFA (OR = 1.501, P = 0.029, β = 0.406), inadequate antifungal therapy (OR = 12.084, P = 0.006, β = 2.492) and inadequate source control (OR = 7.332, P = 0.024, β = 1.992) were independent risk factors for mortality in ICU patients with candidemia. Conclusions Candidemia patients were severe and had poor prognosis. APACHE Ⅱ, SOFA, inadequate antifungal therapy and inadequate source control were independent risk factors of mortality.

Non-oxygenation factors relate with postoperative prolonged mechanical ventilation in aortic dissection patients / 中华普通外科杂志

Objective To identify the correlative and risk factors of non-oxygenation factors associated with postoperative prolonged mechanical ventilation (PMV) of aortic dissection(AD).Methods AD patients undergoing surgery during January 2010 and January 2015 were enrolled.Prolonged mechanical ventilation was defined that duration of ventilation more than 48 h.Results There were 240 patients,average age was (50 ± 12)years.The correlative factors with postoperative PMV were:pre-opervative white blood cell (WBC) (r =0.241,P =0.003),emergency operation (r =0.263,P =0.004),Debakey type (r =-0.379,P =0.000),duration of operation (r =0.329,P =0.000),postoperative diastolic pressure (r =-0.205,P =0.007),heart rate (r =0.246,P =0.001),postoperative hemoglobin (r =-0.213,P =0.005),calcium(r =-0.262,P =0.001),glucose (r =0.274,P =0.000),lactate(r =0.272,P =0.000) and pericardial effusion (r =0.239,P =0.032).Logistic analysis indicated that:the duration of operation,WBC and postoperative blood calcium were:2.063,1.285,0.016,respectivly(all P ＜ 0.05).Conclusions The correlative factors were:preoperative WBC,emergency operation,Debakey Type,duration of operation,heart rate,postoperative diastolic pressure,hemoglobin,calcium,glucose,lactate,and pericardial effusion.Duration of operation,WBC and postoperative blood calcium were risk factors predicting PMV.

Evaluation function of intermedin on prognosis of elderly patients with sepsis / 中华危重病急救医学

Objective To investigate the predicting value of intermedin (IMD) for the prognosis of elderly sepsis patients.Methods A retrospective analysis was conducted. Forty-one patients with sepsis, aged ≥65 years, and admitted to geriatrics intensive care unit of Aerospace Center Hospital from April 2015 to December 2016 were enrolled. Thirty healthy patients were studied as control during the same time. The expression of C-reactive protein (CRP), procalcitonin (PCT) and IMD were tested within 24 hours during hospitalization, and the acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score and prognosis was evaluated. According to APACHE Ⅱ score, patients were divided into 3 groups, 10-20 score, 21-30 score, and > 30 score group. And based on the prognosis, the patients were divided into death group and survival group. The differences of expression levels of CRP, PCT and IMD in each group were assessed. The relationship of IMD and infection index was analyzed by Pearson correlation. Receiver operating characteristic curve (ROC) was used to evaluate the prognostic value of CRP, PCT and IMD in patients with sepsis.Results Compared with the control group, the levels of CRP, PCT and IMD were significantly higher in the sepsis patients [CRP (mg/L): 114.71±40.08 vs. 4.03±2.68, PCT (μg/L): 1.338±0.812 vs. 0.007±0.001, IMD (ng/L):43.03±9.67 vs. 16.77±2.06, allP 30 score groups, PCT (μg/L) were 0.397±0.129, 1.164±0.326, and 1.999±0.888, respectively (F = 19.392,P = 0.000); IMD (ng/L) were 29.12±5.60, 40.48±4.40,52.75±4.73, respectively (F = 33.310,P = 0.000). There was no significant difference in CRP among APACHE Ⅱ score groups (F = 2.137,P = 0.132). The level of IMD was positively correlated with CRP and PCT (r1 = 0.351,P1 = 0.024;r2 = 0.617,P2 = 0.000), and there was no correlation with temperature and white blood cell count (r1 = 0.063,P1 = 0.697;r2 = 0.064,P2 = 0.692). The expression of PCT and IMD in the death groups were significantly higher than the survival group [PCT (μg/L): 1.547±0.883 vs. 1.043±0.608, IMD (ng/L): 47.44±8.23 vs. 36.80±8.13, bothP < 0.05], while CRP was not significantly different. The area under the ROC curve [AUC (95% confidence interval, 95%CI)] of IMD was larger than that of PCT and CRP [0.809 (0.675-0.943) vs. 0.680 (0.511-0.849), 0.664 (0.490-0.838)]; when cut-off value of IMD was 41.58 ng/L, the sensitivity was 75.0% and the specificity was 82.4%.Conclusions The levels of CRP, PCT and IMD were increased in elderly sepsis patients, and IMD and PCT can better reflect the severity of sepsis. IMD is more valuable in predicting the prognosis of sepsis patients.

Mutilpe goals directed periopertive fluid strategy in patients of retroperitoneal tumors / 中华普通外科杂志

Objective To evaluate perioperative fluid infusion strategies in retroperitoneal tumor patients.Method Data of 89 retroperitoneal tumor patients in Peking University People's Hospital and Peking University International Hospital were collected and devided into intraoperative minor haemorrhage group (761 ml) and massive haemorrhage group (4 813 ml),including postoperative fluid treatment,input and output volume,serum brain natriuretic peptide level and postoperation complications.Results Fluid input on the 1st day after operation,the 2nd day,the 3rd day respectively were (7 565 ±4 757),(3 869 ± 727),(3 289 ± 897),(3 096 ± 567) ml in the minor haemorrhage group,and (13 927 ± 5 612),(5 192 ± 1 274),(3 786 ± 1 137),(3 797 ± 719) ml in the massive haemorrhage group (t =-4.637,-3.117,-2.460,-2.982,P =0.04,0.048,0.36,0.038).BNP level respectively were (33 ±25),(82 ±66),(116 ± 54),(145 ± 75) ng/ml in the minor haemorrhage;respectively,(70 ± 65),(165 ± 153),(256 ± 220),(442 ± 412) ng/ml in the massive haemorrhage group (t =-4.637,-3.117,-2.460,-2.982,P =0.041,0.038,0.046,0.04).The accumulative percentage of negative fluid balance was 100％ in 3 days after operation.Acute kidney injury (AKI),cardiac,respiratory events,major intraabdominal complications deep venous thrombosis developed in minor and massive haemorrhage group were 4.7％,7.1％,4.7％,14.3％,9.5％ vs.25.1％,27.6％,46.8％,10.6％,17.0％ respectively (x2 =2.89,5.89,19.96,0.044,0.674,P=0.049,0.015,0.001,0.834,0.412).Conclusions Multiple goals directed fluid strategy leads to a better outcome by decreasing the AKI rate.BNP level could be used as a goal marker in fluid treatment.

Comparison of ultrasonic cardiac output monitor and pulse indicated continuous cardiac output monitor on determination of hemodynamic parameters in critical patients / 中华危重病急救医学

Objective To evaluate the difference and correlation between ultrasonic cardiac output monitor (USCOM) and pulse indicated continuous cardiac output (PiCCO) monitor on determination of hemodynamic parameters in critical patients.Methods A prospective observation self-control study was conducted.The critical patients who need hemodynamics monitoring,and admitted to Department of Critical Care Medicine of Peking University People's Hospital from March 2013 to December 2015 were enrolled.Cardiac output (CO),cardiac index (CI),stroke volume (SV),and stroke index (SI) were determined by PiCCO using thermodilution method at immediately (0 hour) and 24 hours after successful location of PiCCO catheter for 3 times then the above indexes were measured with USCOM,and the average values were chosen for statistical analysis.The differences in above parameters between the two methods,and the correlation of the parameters monitored by two methods were evaluated by Pearson linear correlation method,the consistency test was conducted by Bland-Altman method.Results In 31 critical patients enrolled,there were 18 males and 13 females,aging 29-89 years old with the mean of (48.1 ± 36.3) years,body mass of (68.7 ± 17.5) kg,and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score of 21.2 ± 3.1.CO,CI,SV,and SI detected by USCOM were significantly higher than those detected by PiCCO [CO (L/min):6.32 ± 1.98 vs.5.86 ± 1.72,t =4.887,P =0.000;CI (mL· s-1· m-2):61.68 ± 20.17 vs.56.84± 17.34,t =5.189,P =0.000;SV (mL):61.9 ± 19.7 vs.57.0± 16.9,t =3.977,P =0.000;SI (mL/m2):36.84 ± 12.67 vs.33.33 ± 10.79,t =4.278,P =0.000].It was shown by correlation analysis that CO,CI,SV,and SI monitored by USCOM and PiCCO was positively correlated (R2 value was 0.795,0.798,0.837,and 0.827,respectively,all P =0.000).It was shown by Bland-Altman analysis that the mean CO change (ΔCO) from 0 hour to 24 hours was 0.1 L/min,and the 95％ confidence interval was-0.62 to 0.80.Conclusion There was significant difference in the comparison of hemodynamics parameters monitored by USCOM and PiCCO respectively in critical patients,the overall values monitored by USCOM were higher than those monitored by PiCCO monitoring,but the correlations were good.

Risk factors of major adverse cardiac events of critical care patients after non cardiac surgery / 中华普通外科杂志

Objective To investigate the incidence and the risk factors of major adverse cardiac events of critical care patients after noncardiac surgery.To study the incidence of myocardial injury after noncardiac surgery (MINS).Methods A retrospective analysis of critical care patients (n =1 087) after noncardiac surgery from January 2012 to January 2013 in our hospital was carried out.The clinical data of the medical history, intraoperative conditions, postoperative conditions and cardiac troponin Ⅰ (cTNI) were collected.Major adverse cardiac events included unstable angina, non fatal myocardial infarction, severe arrhythmia, heart failure and cardiovascular death.Risk factors of major adverse cardiac events of critical care patients after noncardiac surgery were analyzed using Logistic regression.Results The 30 d non cardiac surgery incidence of major adverse cardiac events was (94/1 087) 8.6％, the incidence of MINS was (168/1 087) 15.5％, Logistic regression analysis showed that the risk factors of major adverse cardiac events after non cardiac surgery were age (OR 1.03,95％ CI 1.01-1.05, P =0.002), a history of chronic renal insufficiency(OR 3.12,95％ CI 1.44-6.74,P =0.004), rise of cTNI 24 h after operation (OR 2.04,95％ CI 1.16-3.58,P =0.014) and use of vasopressor drugs within 24 h after operation (OR 2.34,95％ CI 1.25-4.38,P =0.008).Conclusions The incidence of major adverse cardiac events and the MINS of critical care patients after noncardiac surgery is high.Old age, history of chronic renal insufficiency, rise of cTNI 24 h after operation and vasopressor drugs within 24 h after operation are the independent risk factors.

The protective effect of interleukine-33 on mouse warm hepatic ischemia-reperfusion injury by regulating Th1/Th2 cells / 中华普通外科杂志

Objective To study the protective effect of interleukin-33 (IL-33) on mouse warm hepatic ischemia-reperfusion (I/R) injury.Methods On a mouse warm hepatic I/R injury model IL-33 mRNA and protein levels during hepatic ischemia and reperfusion period were determined,and then mice were divided into control group,model group,recombinant IL-33 intervention group and anti ST2L antibody intervention group,and mice were sacrificed after 6 hours of reperfusion.Serum aspartate aminotransferase (AST),alanine aminotransferase (ALT) protein levels were determined.Liver pathology was observed by transmission electron microscopy and serum cytokine level (tumor necrosis factor-α,interferon-γ,IL-4,IL-5,IL-13) were measured by flow cytometry CBA method.Results The level of IL-33 mRNA and protein were significantly higher in the reperfusion stage (t2 h =-3.574,t6 h =-4.147 ; P ＜ 0.05).After intervention by recombinant IL-33,the level of serum ALT and AST decreased significantly (tALT =4.592,tAST =3.471 ; P ＜ 0.05),the severity of pathological damage was reduced,the levels of IL-4,IL-5,IL-13 increased and that of IFN-γ decreased,with statistically significant difference in comparison with the control groups (tIL-4 =-4.995,tIL-5 =-4.584,tIL-13 =-4.431 ; P ＜ 0.05).Anti-ST2L antibody intervention effected the opposite.Serum TNF-α level did not change in intervention groups compared with that in model group (tTNF-α =0.261,P ＞ 0.05).Conclusions IL-33 mRNA and protein level increased in mice with hepatic I/P injury.IL-33 exerts a protective effect on the I/R injured liver after binding to its receptor ST2L.

Pre-and intra-operative risk factors associated with delayed weaning from ventilator during early postoperative period in patients undergoing liver transplantation / 中华麻醉学杂志

Objective To evaluate the pre- and intra-operative risk factors associated with delayed weaning from ventilator during the early postoperative period in patients undergoing liver transplantation.Methods Two hundred and twelve patients (152 male, 60 female) aged 22-69 yr undergoing liver transplantation from Sept 2004to Aug 2006 were enrolled in this study and were divided into 2 groups according to the time when the patients were weaned from ventilator: normal weaning group (Group A, the patients weaned from ventilator within 24 h after operation) and delayed weaning group (Group B, the patients weaned from ventilator more than 24 h after operation). Routine anesthesia wes performed. Blood and blood products were transfused according to the guidelines for blood transfusion to maintain the mean arterial pressure (MAP)≥60 mm Hg during operation. Sixteen preoperative variables (age＞64 yr, gender, BMI ≥ 30kg/m2, PaO2＜75 mm Hg,pleural effusion, a history of asthma, smoking, drinking alcohol, coronary artery disease, diabetes mellitus, encephalopathy＞grade 3, spontaneous bacterial peritonitis, preoperative MELD score, serum albumin, ascites≥20 ml/kg and moderate hepatopulmonary hypertension) and 7 intraoperative variables (duration of operation, duration of anhepatic stage, transfusions of RBC,fresh frozen plasma (FFP), crystalloid and colloid, and urine output＜ 1 ml·kg-1·h-1) were recorded and compared between the two groups.Results There were significant differences in 9 preoperative variables (age ＞ 64 yr, PaO2＜75 mm Hg, pleural effusion,encephalopathy＞grade 3, spontaneous bacterial peritonitis, preoperative MELD score, serum albumin, ascites≥20 ml/kg and moderate hepato-pulmonary hypertension) and 5 intraoperative variables (transfusions of RBC, FFP, crystalloid and colloid, and urine output＜1 mi·kg-1·h-1) between the two groups (P＜0.05 or 0.01). And logistic regression analysis showed that 5preoperative variables (age＞64 yr, PaO2＜75 mm Hg, encephalopathy ＞ grade 3, preoperative MELD score, and moderate hepato-pulmonary hypertension) and 2 intraoperative variables (transfusion of RBC and urine output＜1 ml·kg-1·h-1) were confirmed to be associated with delayed weaning from ventilator.Conclusion Such variables es age ＞ 64 yr, preoperative PaO2 ＜ 75 mm Hg, encephalopathy ＞ grade 3, preoperative MELD score, moderate hepato-pulmonary hypertension, transfusion of RBC during operation and urine output ＜ 1 ml· kg-1 · h-1 are associated with delayed weaning from ventilator during early postoperative period after liver transplantation.

Characteristics of hepatic progenitor cells activation in liver tissues of patients with hepatitis B cirrhosis / 中华临床感染病杂志

Objective To observe the characteristics of hepatic progenitor cells(HPCs)activation in liver tissues of patients with hepatitis B cirrhosis,and to investigate the relationship between the number of HPCs and HBV infection.Methods Cytokeratin 7(CK7)-was stained immunohistochemically in liver tissues of 16 patients with hepatitis B cirrhosis.HPCs and duetular reactions were quantitively analyzed.The expression of HBsAg and HBcAg were also detected to evaluate its relationship with HPCs activation.Results HPCs were extensively activated and marked duetular reactions can be observed in cirrhotic liver tissues.Tlle expression of HBsAg was positively correlated with HPCs activation.Conclusions HPCs are extensively activated in cirrhotic liver tissues,and HBV infection may facilitate its activation.

Which patients are likely to have a persistent hypersplenism after liver transplantation for the treatment of dysfunctional liver cirrhosis and hypersplenism / 中华普通外科杂志

Objective To evaluate the recovery of normal splenic function of hyperplenism in patients of liver transplantation. Methods In this study,93 liver transplant patients(all with pretransplant hypersplenism)were divided into group in which the platelet count become normal and the group in which the platelet count failed to recover. Results Hypersplenism disappeared after transplantation in 60 patients(64.5%),hypersplenism after transplantation persisted in 33 patients (35.5%);the portal vein pressure in new liver period,the splenic veinous blood flow after transplantation and the size of spleen were all significantly different between the two groups.The platelet count on three months after operation significantly correlates with pretransplant platelet count,the size of the spleen,the portal vein pressure in new liver phase and the posttransplant size of spleen.Conclusions The persistence of hypersplenism after liver transplantation is common,in may correlate with an unsatisfactory fall in portal pressure after transplantation,characteristics of splenomegaly and poor splenic venous blood flow.

Effects of tacrolimus on reperfusion injury in orthotopic liver transplantation / 中华消化外科杂志

Objective To investigate the effects of tacrolimus on reperfusion injury in orthotopic liver transplantation.Methods The rat models of orthotopic liver transplantation were established.SD rats in experimental group(n=40)were injected with tacrolimus while control group(n=40)with normal saline.The serum levels of TNF-α,IL-1,ALT,AST,LDH,endothelin(ET)and malondialdehyde(MDA)were detected at 24,48,96 hours after reperfusion.Uhrastruetural changes and cellular apoptosis of liver and synthesis of mRNA of Fas and Bcl-2 were checked. According to the immunosuppression regimen,112 patients with end-stage liver cirrhosis were divided into tacrolimus group(n=63)and cyclosporin A group(n=49).The levels of hepatic enzymes and the rate of acute rejection in patients of the two groups after liver transplantation were compared.Results Levels of TNF-α,IL-1,AIJT,AST,LDH,ET and MDA in experimental group were significantly lower than those in control group(P＜0.05).Rats in experimental group had less Fas mRNA synthesis.minor liver ultrastructure lesion and cellular apoptosis than control group.Compared with cyclosporin A group,acute rejection was decreased in tacrolimus group(x2=39.0,P＜0.05).Conclusions Tacrolimus may lessen reperfusion injury and cellular apoptosis in rat orthotopic liver transplantation,and it may also alleviate reperfusion injury in human liver transplantation and reduce the rate of acute rejection.

Expression of extracellular signal-regulated kinase and its relationship with clinicopathological characteristics of breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the expression of extracellular signal-regulated kinase (ERK) and its relationship with clinicopathological characteristics of breast cancer as well as the effect of preoperative chemotherapy on ERK expression.</p><p><b>METHODS</b>Expression of ERK-1 and ERK-2 protein was examined by Western blot in the breast cancer and normal breast (control) tissue of 48 patients, of whom 8 had received preoperative chemotherapy of 5'-deoxy-5-fluorouridine (5'-DFUR), with distribution of ERKs protein detected by immunohistochemical method.</p><p><b>RESULTS</b>Expression of ERK-1 and ERK-2 protein was increased in tumor specimen as compared with control tissue (P < 0.01). A positive correlation was observed between ERK-1 and ERK-2 (r = 0.457, P < 0.01). Protein level of ERK-1 and ERK-2 was higher in stage III patients than in stage I and stage II patients (P < 0.05). Expression of both ERK-1 and ERK-2 in the carcinoma tissue was decreased in patients who had received preoperative chemotherapy of 5'-DFUR. ERK-1 and ERK-2 proteins were mainly located in the cytoplasm.</p><p><b>CONCLUSION</b>The hyperexpression of ERK may play an important role in the initiation and development of human breast cancer. Preoperative chemotherapy of 5'-DFUR is able to partially inhibit ERK expression.</p>

Hepatic artery reconstruction in 107 cases of orthotopic liver transplantation / 中国普通外科杂志

Objective To investigate the key steps of hepatic artery reconstruction and the factors influencing the outcome of hepatic artery reconstruction in orthotopic liver transplantation. Methods The clinical data of 107 consecutive orthotopic liver transplantation patients was retrospectively reviewed to assess the key steps in hepatic artery reconstruction. The risk factors and the diagnosis and treatment of vascular complications were also discussed. Results The incidence of hepatic artery related complications in orthotopic liver transplantation was associated with the quality of the donor hepatic artery,the method used for anastomosis and the use of microsurgical technique. The main hepatic artery related complications were hepatic artery thrombosis and stenosis. The incidence of the vascular complications was 6.54%,and the mortality rate was 85.7%. Conclusion The major influence factors of vascular complications were the quality of the donor artery,the reconstruction way of donor-recipient artery and the use of microsurgical technique .

Perioperative continuous renal replacement therapy(CRRT) in patients undergoing orthotopic liver transplantation / 中国普通外科杂志

Objective To analyze the role of continuous renal replacement therapy(CRRT) in the prevention of renal failure in perioperative patients undergoing orthotopic liver transplantation. Methods The clinical data of renal function were reviewed in 21 liver transplantation patients receiving CRRT during perioperative period. Results Serum Cr level decreased after CRRT in all 21 patients; The overall mortality in this group was 38.1%. The mortality rate was 8.3% in the 12 cases in whom the renal function recovered, and that was 77.8% in the 9 cases in whom the renal function did not recover (?~2=5.838,P