Dose requirements of continuous infusion of rocuronium and atracurium throughout orthotopic liver transplantation in humans

Objective: To compare the dose requirements of continuous infusion of rocuronium and atracurium throughout orthotopic liver transplantation (OLT) in humans. Methods: Twenty male patients undergoing liver transplantation were randomly assigned to two comparable groups of 10 patients each to receive a continuous infusion of rocuronium or atracurium under intravenous balanced anesthesia. The response of adductor pollicis to train-of-four (TOF) stimulation of unlar nerve was monitored. The infusion rates of rocuronium and atracurium were adjusted to maintain T1/Tc ratio of 2%–10%. The total dose of each drug given during each of the three phases of OLT was recorded. Results: Rocuronium requirement, which were (0.468±0.167) mg/(kg·h) during the paleohepatic phase, decreased significantly during the anhepatic phase to (0.303±0.134) mg/(kg·h) and returned to the initial values at the neohepatic period ((0.429±0.130) mg/(kg·h)); whereas atracuruim requirements remained unchanged during orthotopic liver transplantation. Conclusions: This study showed that the exclusion of the liver from the circulation results in the significantly reduced requirement of rocuronium while the requirement of atracurium was not changed, which suggests that the liver is of major importance in the clearance of rocuronium. A continuous infusion of atracurium with constant rate can provide stable neuromuscular blockade during the three stages of OLT.     

Evaluation of orthotopic liver transplantation with no veno-venous bypass

Objective: To assess the feasibility and outcome of orthotopic liver transplantation (OLT) with no veno-venous bypass(v-v bypass) in adult patients. Methods: Between 1999 and 2001, 43 adult patients underwent OLT with v-v bypass, 33 with no v-v bypass. The operation time, anhepatic time, amount of blood loss, amount of blood transfusion, ICU stay days of the two groups were compared; renal function and gastrointestinal function in the two groups were examined. Results: There was no significant difference in mean serum creatinine on day 3 and gas discharge time in patients with v-v bypass or not. With no v-v bypass, the average operation time was 5.7±1.3 hours, anhepatic time was 64±13 minutes, median amount of blood loss in operation was 4000±820 mL, median amount of blood transfused intraoperatively was 4650±910 mL, median ICU stay was 5.7 days; all those were lower or shorter than those with v-v bypass; and these differences between the two groups had statistical significances. Conclusion: OLT with no v-v bypass is safe and can be performed in the majority of adult patients. The practice of liver transplantation with no v-v bypass is associated with shorter total operation time, shorter anhepatic time, lower blood product usage, and shorter ICU stay compared with standard technique of OLT with routine use of v-v bypass. Project supported by Zhejiang Provincial Health Bureau (No.2000/ZD003)     

肝移植后肝功能异常的诊断及内科处理

已度过围手术期的肝移植患者,肝功能再次异常的原因主要包括原发病的复发,特别是乙型和丙型肝炎的复发、新病毒感染,特别是巨细胞病毒的感染、慢性排斥反应、排斥药物中毒所致肝损害等.临床诊断除常规检测肝功能外,主要依靠病毒学检测及病理诊断.内科治疗方法包括手术前的抗病毒治疗、预防呼吸道病毒感染、定期检测抗排斥药物的浓度、及时更换抗排斥药物等.     

外泌体来源的半乳糖凝集素-9预测肝移植术后排斥发生及预后（英文）

目的:外泌体及其内容物是各种肝脏疾病的潜在生物标志物。本研究探索外泌体及其内容物在肝移植排斥反应及预后中的作用。创新点:本研究发现外泌体及内含物半乳糖凝集素-9(galectin-9)在肝移植术后排斥及预后预测中发挥重要作用。方法:分别从急性排斥和肝功能稳定患者提取外泌体,进行分离、鉴定并检测其内含蛋白。候选蛋白通过在73个急性排斥病人和63个肝功能稳定病人切除肝的组织芯片中进行验证。最后将蛋白表达量和临床参数纳入Kaplan-Meier生存率和Cox回归分析。结论:外泌体来源的galectin-9可作为预测肝移植术后排斥发生及预后的生物学指标。     

猞猁和豹猫肝脏结构的观察比较及AQP-8在肝脏中的表达

利用生物显微技术对猞猁(Felis lynx)和豹猫(Prionailurus bengalensis)肝脏进行了比较,应用免疫组织化学方法检测了水通道蛋白-8(AQP-8)在肝脏中的表达情况.结果显示,与多数哺乳类相似,猞猁和豹猫的肝脏外被覆一层结缔组织薄膜,肝小叶的界限不清楚,中央静脉周围放射状排列着肝板、肝血窦及狄氏间隙,单层排肝细胞构成肝板,在门管区可清晰观察到小叶间静脉、小叶间动脉和小叶间胆管豹猫肝小叶的肝细胞排列较猞猁的规则,但肝细胞的直径较猞猁的小.猞猁肝细胞间比较松散,肝血窦较豹猫的发达.猞猁肝脏AQP-8的表达较豹猫的强烈.结果表明,猞猁和豹猫肝脏的组织结构及肝脏AQP-8在肝脏的表达与其生活习性相适应.     

As2O3纳米粒的制备、表征和体外治疗人肝癌细胞的研究

研究了As2O3 纳米粒的制备方法、表征及其抗肝癌细胞的作用.采用溶胶凝胶法制备As2O3 纳米粒,并用透射电镜、能谱仪和图像分析仪等方法对其进行表征及特性检测.通过MTT法和流式细胞仪法研究了不同浓度As2O3 纳米粒对人肝癌细胞株的影响,并与传统的As2O3 溶液进行了比较.实验中制备了2种粒径大小的As2O3 纳米粒子,其平均直径分别为80nm和40nm,通过能谱仪的测试证实所制备的纳米粒为As2O3,且无其他成分.体外细胞实验发现,As2O3 纳米粒处理细胞48 h后,人肝癌细胞的存活率明显低于同浓度的As2O3 溶液处理组(P<0.05).研究结果显示,通过溶胶凝胶法可将As2O3 制备成纳米粒子;体外细胞实验表明,与传统的As2O3 溶液相比,As2O3纳米粒子可对肿瘤细胞产生更强细胞毒作用.