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

INTRODUCTION Rocuronium bromide is a new steroidal nonde- polarizing neuromuscular blocking drug that has a faster onset of action than other nondepolarizing neuromuscular blocking drugs. The liver is the major route for its elimination. On the other hand, impaired liver function does not alter either atracurium’s elimination or plasma clearance (Ward and Neill, 1983; Pitter et al., 1990). The exclusion of the hepatic circulation and function during the anhepatic phase of orthotopic liv…     

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.     

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。     

Intrathymic inoculation of donor liver specific antigen alleviates rejection of liver allotransplantation

Use and effects of liver specific antigen in orthotopic liver transplantations were researched in this study. Group I: syngeneic control (Wistar-to-Wistar); Group II: acute rejection (SD-to-Wistar); Group III: Thymic inoculation of SD rat LSA day 7 before transplantation. The observation of common situation and survival time, rejection grades, NF-κB activity of splenocytes and IL-2mRNA expression of grafted liver were used to analyze acute rejection severity and immune state of animals in different groups. The common situation of group I was very well after transplantation and no signs of rejection were found. Recipients of group II lost body weight progressively All dead within day 9 to day 13 posttransplantation; median survival time was 10.7 ±0.51 days. It was an optimal acute rejection control. As for group III, 5 out of 6 recipients survived for a long time and common situation was remarkably better than that of group II. Its rejection grades were significantly lower than that of group II(P<0.05). NF-κB activity was only detected in group I at day 5 and day 7 after transplantation, whereas high activity of NF-κB was detected at all time points in groupII and the low NF-κB activity detected in group III was significantly lower than that of group II (P<0.05). No IL-2mRNA expression was detected at any time point in group I, whereas high level expression was detected at all time points in group II and the low level expression only detected at day 3 in group III was significantly lower than that of group II (P<0.05). Conclusion: LSA is an important transplantation antigen which is involved directly in the immunorejection of liver transplantation. We report here for the first time that intrathymic inoculation of LSA can alleviate the rejection of liver allotransplantation; and that grafts can survive for a long time thereby, thus leading to a novel way to achieve liver transplantation immunotolerance. Project (NO. 011106206) supported by the Science and Technology Bureau of Zhejiang Province Foundation     

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.     

Value of T-tube in biliary tract reconstruction during orthotopic liver transplantation: a meta-analysis

Objective  

To compare biliary complications after biliary tract reconstruction with or without T-tube in orthotopic liver transplantation     

Infusion of nonmyeloablative bone marrow alleviates acute rejection reaction in liver allotransplantation

Objective: To study the effect and implication of nonmyeloablative donor specific bone marrow (DSBM) infusion on the immunoreaction of liver allotransplantation. Methods: Orthotopic liver transplantation model was used in this study. Groups were set as follows: Group Ⅰ, syngeneic control (Wistar-to-Wistar); Group Ⅱ, acute rejection (SD-to-Wistar); Group Ⅲ, acute rejection treated with cyclosporine A (CsA) by intramuscular injection (SD-to-Wistar CsA); Group Ⅳ, bone marrow infusion at 7 d pretransplantation followed by short-term CsA treatment (SD-to-Wistar DSBM); Another group of short-term CsA treatment preoperatively without bone marrow infusion was also set as control. General characteristics and survival time were observed.Histological grades of rejection were determined by pathological examination. IL-2 and IFN-γ level in peripheral blood and donor liver were detected respectively by Enzyme-Linked Immuno-Sorbent Assay (ELISA) and Western blot. Chimerism of donor cells was measured by PCR for a male-specific marker (Y-chromosome-specific sequence, Sry). Results: No signs of rejection were found in Group Ⅰ. Acute rejection occurred in both Group Ⅱ and the short-term CsA treated group. All the recipients died at (9～15)d posttransplantation with a median survival time of (10.7±0.5) d and (11.2±2.4) d, respectively. Only mild rejection could be seen in Group Ⅲ. In Group Ⅳ, 4 out of 6 recipients had long-term survival (＞100 d), the histological grade of rejection was significantly lower than that of Group Ⅱ, so did the expression level of IL-2 and IFN-γ in both peripheral blood and grafted liver.Y-chromosome-specific sequence (Sry) of male SD rats could be detected in the bone marrow, spleen and thymus of female recipients at 15 d after bone marrow infusion. Conclusion: Mild preconditioning nonmyeloablative donor specific bone marrow infusion can enhance chimerism formation in recipients, alleviate the rejection of liver allotransplantation and prolong survival of liver allotransplantation.     

Off-pump coronary artery bypass grafting versus on-pumpcoronary artery bypass grafting: which is better in patients with chronic obstructive pulmonary disease?

INTRODUCTION Conventional coronary artery bypass graftin(CCABG) with cardiopulmonary bypass (CPB) habeen accepted as an effective and safe treatment fomulti-vessel coronary heat disease. CPB may stilcontribute to the operation field because of threlatively easier technical requirement; but it alscauses a serious systematic inflammatory reactiowhich will lead to dysfunction of important organand higher cost for the patients. Off-pump coronarartery bypass grafting (OPCABG) has r…     

肝癌患者血清SOD及MDA的变化研究

目的:探索肝癌患者血清SOD、MDA的变化。对肝癌患者26例和健康对照组30例。方法:对肝癌患者均应用改良TBA微量法测定血清丙二醛(MDA)、以黄嘌呤氧化酶法测定超氧化物歧化酶(SOD)水平的变化。结果:肝癌组患者血清MDA水平显著高于对照组(P<0.01),而血清SOD水平显著低于对照组(P<0.01)。结论:提示肝癌患者存在明显的抗氧化能力障碍,通过血清MDA、SOD水平的检测,可为肝癌的临床治疗及疗效观察提供一定的依据。     

Effects of pH management during deep hypothermic bypass on cerebral oxygenation: alpha-stat versus pH-stat

Objective: There is a remarkable lack of scientific evidence to support the option to use alpha-stat or pH-stat management, as to which is more beneficial to brain protection during deep hypothermic CPB. This study examined cortical blood flow (CBF), cerebral oxygenation, and brain oxygen consumption in relation to deep hypothermic CPB with alpha-stat or pH-stat management. Methods: Twenty-two pigs were cooled with alpha-stat or pH-stat during CPB to 15℃ esophageal temperature. CBF and cerebral oxygenation were measured continuously with a laser flowmeter and near-infrared spectroscopy, respectively. Brain oxygen consumption was measured with standard laboratory techniques. Results: During CPB cooling, CBF was significantly decreased, about 52.2%±6.3% (P＜0.01 vs 92.6%±6.5% of pH-stat) at 15℃ in alpha-stat,whereas there were no significant changes in CBF in pH-stat. While cooling down, brain oxygen extraction (OER) progressively decreased, about 9.5%±0.9% and 10.9%±1.5% at 15 ℃ in alpha-stat and pH-stat, respectively. At 31℃ the decreased value in pH-stat was lower than in alpha-stat (29.9%±2.7% vs 22.5%±1.9%; P＜0.05). The ratio of CBF/OER were 2.0±0.3 in alpha-stat and pH-stat, respectively; it was kept in constant level in alpha-stat, and significantly increased by 19℃ to 15℃ in pH-stat (4.9±0.9 vs 2.3±0.4; P＜0.01). In mild hypothermia, cerebral oxyhemoglobin and oxygen saturation in alpha-stat were greater than that in pH-stat (102.5%±1.4% vs 99.1%±0.7%; P＜0.05). In deep hypothermia, brain oxygen saturation in pH-stat was greater than that in alpha-stat (99.2%±1.0% vs 93.8%±1.0%; P＜0.01), and deoxyhemoglobin in pH-stat decreased more greatly than that in alpha-stat (28.7%±6.8% vs 54.1%±4.7%; P＜0.05). Conclusions: In mild hypothermic CPB, brain tissue oxygen saturation was greater in alpha-stat than in pH-stat. However, cerebral oxygenation and brain tissue oxygen saturation were better in pH-stat than in alpha-stat during profound hypothermia. PH-stat strategyprovided much more oxygen to brain tissue before deep hypothermic circulatory arrest.     

Effects of pH management during deep hypothermic bypass on cerebral oxygenation: alpha-stat versus pH-stat

Objective: There is a remarkable lack of scientific evidence to support the option to use alpha-stat or pH-stat management, as to which is more beneficial to brain protection during deep hypothermic CPB. This study examined cortical blood flow (CBF), cerebral oxygenation, and brain oxygen consumption in relation to deep hypothermic CPB with alpha-stat or pH-stat management. Methods: Twenty-two pigs were cooled with alpha-stat or pH-stat during CPB to 15℃ esophageal temperature. CBF and cerebral oxygenation were measured continuously with a laser flowmeter and near-infrared spec-troscopy, respectively. Brain oxygen consumption was measured with standard laboratory techniques. Results: During CPB cooling, CBF was significantly decreased, about 52,2%±6.3% (P<0.01 vs 92.6%±6.5% of pH-stat) at 15℃ in alpha-stat, whereas there were no significant changes in CBF in pH-stat. While cooling down, brain oxygen extraction (OER) progressively decreased, about 9.5%±0.9% and 10.9%±1.5% at 15℃ in alpha-stat and     

旁路节流调速实验曲线下凹的原因分析

本从理论上分析了在QCS003B液压实验台上所进行的旁路节流调速实验曲线下凹的原因,实践证明分析是正确的,其结论具有实际意义。     

浅议德国项目教学法在职业教育中的移植

本文笔者通过考察德国职业教育的"项目教学法",详细介绍了德国项目教学法的做法;结合机电教育中的实效性形势,根据切身教学经验,以智能程控电动机器人的教学为例,阐述了德国"项目教学法"移植做法,以及我国职业教育中引进它的可行性和必要性。     

Intestinal microflora in rats with ischemia／reperfusion liver injury

Objectives:To investigate the intestinal microflora status related to ischemia/reperfusion(I/R)liver injury and explorethe possible mechanism.Methods:Specific pathogen free grade Sprague-Dawley rats were randomized into three groups:Controlgroup(n=8),sham group(n=6)and I/R group(n=10).Rats in the control group did not receive any treatment,rats in the I/R groupwere subjected to 20 min of liver ischemia,and rats in the sham group were only subjected to sham operation.Twenty-two hourslater,the rats were sacrificed and liver enzymes and malondialdehyde(MDA),superoxide dismutase(SOD),serum endotoxin,intestinal bacterial counts,intestinal mucosal histology,bacterial translocation to mesenteric lymph nodes,liver,spleen,andkidney were studied.Results:Ischemia/reperfusion increased liver enzymes,MDA,decreased SOD,and was associated withplasma endotoxin elevation in the I/R group campared to those in the sham group.Intestinal Bifidobacteria and Lactobacillidecreased and intestinal Enterobacterium and Enterococcus     

Wernicke encephalopathy following splenectomy in a patient with liver cirrhosis: a case report and review of the literature

Objective  

To report a case of Wernicke encephalopathy in the early stage after surgery.     

温血诱停及终末再灌注在冠状动脉搭桥术中的应用

目的：总结温氧合血诱导傅及终末再灌注心肌保护在冠状动脉搭桥术中应用的经验，方法：21例冠心病患者中85．75％为多支冠状动脉病变，8例左室射血分数≤45％，其中3例＜30％，均在中等低温外外循环下CABG。急症CABG1例。常规采用左乳内动脉（LIMA）与左前降支（LAD）搭桥，余均选用大隐静脉桥。人均搭桥2．8支。心肌保护方法为主动脉根部温氧合血顺灌诱导停搏及终末再灌注。4℃冷晶体停搏液间断灌注维持停搏。观察心脏自动复跳率及复苏后心律紊乱情况，术后恢复情况，结果：心脏自动复跳率90．5％，复跳后心律规则、平稳、术后左室顺应性，心功能恢复良好，术后病人心绞痛完全消失，结论：温氧合血诱导停搏及终末再灌注心肌保护效果好，对心功能不全，心肌能贮低下的高危病例应采用温氧合血诱导停搏及终末再灌注并适用于冠状动脉搭桥术。     

A novel way of liver preservation improves rat liver viability upon reperfusion

Background/aim： Currently, the liver is cold-preserved at 0-4 ℃ for experimental and clinical purposes. Here, we investigated whether milder hypothermia during the initial phase of the preservation period was beneficial for liver viability upon reperfusion. Methods： In the first set of experiments, rat livers were preserved either conventionally in clinically used histidine-trypthopan-ketoglutarate （HTK） solution （Group A： 45 min and Group B： 24 h） or by slow cooling HTK solution （from 13 ℃ to 3 ℃） during the initial 45 min of preservation （Group C： 24 h）. In the second set of experiments, additional groups of livers were evaluated： Group BB-preservation according to Group B and Group CC-preservation according to Group C. Further, some livers were preserved at 13 ℃ for 24 h. Livers were then reperfused using a blood-free perfusion model. Results： Bile production was approximately 2-fold greater in Group C compared to Group B. Alanine transaminase （ALT） and aspartate transaminase （AST） release into perfusate were 2-3-fold higher in Group B compared to Group C. No significant differences were found in ALT and AST release between Group C and Group A. Livers in Group CC compared to Group BB exhibited significantly lower portal resistance, greater oxygen consumption and bromosulfophthalein excretion into bile and lower lactate dehydrogenase （LDH） release into perfusate. Histological evaluation of tissue sections in Group BB showed parenchymal dystrophy of hepatocytes, while dystrophy ofhepatocytes was absent in Group CC. Livers preserved at 13 ℃ for 24 h exhibited severe ischemic injury Conclusion： These results suggest that the conventional way of liver preservation is not suitable at least for rat livers and that slow cooling of HTK solution during the initial phase of cold storage can improve liver viability during reperfusion.     

丹参注射液治疗肝纤维化的实验研究

目的探讨丹参注射液抗肝纤维化作用机理.方法取40只成年wistar大鼠,利用猪血清腹腔注射法,连续6周,复制免疫性肝纤维化模型.治疗组采用大、小剂量丹参液肌肉注射,其剂量分别为0.3ml/kg和0.15ml/kg,每日一次,连续4周.取肝脏切片,HE和Mollory染色,光镜下观察.检测血清SOD活性、MDA含量和肝功能.结果大剂量治疗组肝细胞空泡减少,胶原纤维大部分消失,SOD活性增高,MDA含量降低,与模型组比较有显著性差异(P＜0.05).结论大剂量肌注丹参液,具有治疗肝纤维化的功能.