Metabolism of prostaglandins in porcine liver transplantation with a graft harvested after 30- and 60-minute warm ischemia

The influence of warm ischemia on the metabolism of prostaglandins was investigated using a pig liver transplantation model employing the temporary portal arterialization technique. Eighteen pigs were divided into three groups according to warm ischemia time: 0 min (group I,n=6), 30 min (group II,n=6), and 60 min (group III,n=6). During portal arterialization, the hepatic venous prostaglandin E₂ (PGE₂) level in group III (3356.0±1011.8pg/ml) was significantly higher than that in group I (831.7±182.1pg/ml;P=0.0285). The hepatic venous PGE₂ levels were significantly higher than the arterial counterparts in all groups both at the beginning and during portal arterialization. At 60 min after portal revascularization, the arterial PGE₂ level in group III (886.7±268.0pg/ml) was significantly higher than that in groups I (99.0±18.6 pg/ml;P=0.0116) and II (204.2±65.4pg/ml;P=0.0282). Neither thromboxane B₂ (TXB₂) nor 6-keto PGF_1α showed any significant differences. In conclusion, the intra-operative changes of PGE₂ thus reflected the degree of warm ischemic damage, and PGE₂ could also be released from the graft. On the other hand, the increased levels of TXB₂ and 6-keto PGF_1α were throught to have an extrahepatic origin.     

Beneficial effects of administering intraportal prostaglandin E1 postoperatively to hepatectomy patients with massive intraoperative blood loss

Massive intraoperative blood loss is a major cause of complications following hepatectomy. To evaluate the efficacy of intraportal prostaglandin E₁ (PGE₁) for preventing liver deterioration in hepatectomy patients with an intraoperative blood loss of over 2000 ml, a retrospective analysis was conducted on 10 patients given intraportal PGE₁ (portal group), 6 given intravenous PGE₁ (venous group), and 10 given no treatment (control group). PGE₁ was infused at 250 or 500 g/day in the portal group and at 720 g/day in the venous group, and continued for 3 days postoperatively. Alanine aminotransferase (ALT) and total bilirubin (T.Bil) were measured on postoperative days (PODs) 1, 3, 5, and 7. ALT was lower in the portal group than in the other two groups on each POD, and significantly lower than in the control group on POD 3 (P<0.05). T.Bil was significantly lower in the portal group than in the control group on PODs 5 and 7 (P<0.05). T.Bil on POD 7 was under 1.5 mg/dl in 1 (10.0%), 6 (60.0%), and 2 (33.3%) of the control, portal, and venous group patients, respectively, with a significant difference between the control and portal groups (P<0.05). These results confirmed that intraportal PGE₁ was beneficial for improving hepatic function and preventing cholestasis in patients with a blood loss of over 2000 ml at risk of developing postoperative liver deterioration.     

Negative pressure wound therapy for seroma prevention and surgical incision treatment in spinal fracture care

To evaluate the clinical use and economic aspects of negative pressure wound therapy (NPWT) after dorsal stabilisation of spinal fractures. This study is a prospective randomised evaluation of NPWT in patients with large surgical wounds after surgical stabilisation of spinal fractures by internal fixation. Patients were randomised to either standard wound dressing treatment (group A) or NPWT (group B). The wound area was examined by ultrasound to measure seroma volumes in both groups on the 5th and 10th day after surgery. Furthermore, data on economic aspects such as nursing time for wound care and material used for wound dressing were evaluated. A total of 20 patients (10 in each group) were enrolled. Throughout the whole study, mean seroma volume was significantly higher in group A than that in group B (day 5: 1·9 ml versus 0 ml; P = 0·0007; day 10: 1·6 ml versus 0·5 ml; P <0·024). Furthermore, patients of group A required more wound care time (group A: 31 ± 10 minutes; group B 13·8 ± 6 minutes; P = 0·0005) and more number of compresses (total number; group A 35 ± 15; group B 11 ± 3; P = 0·0376). NPWT reduced the development of postoperative seroma, reduced nursing time and reduced material required for wound care.     

Anabolic Effect of Prostaglandin E2 in Bone Is not Dependent on Pituitary Hormones in Rats

Prostaglandin E₂ (PGE₂) is an anabolic agent of bone in vivo but the mechanism of its action still remains unclear. The aim of this study was to determine whether the effect of PGE₂ on skeleton is mediated by pituitary hormones. Forty female, Sprague-Dawley rats were divided into four groups: baseline control (basal), age-matched intact control (CON), hypophysectomy (HX), and HX + PGE₂ (2 mg/kg/day) with 10 animals in each group. The basal group was sacrified at 2 months of age, and the remaining groups after 6 weeks of treatment. Cancellous and cortical bone histomorphometry was performed on double fluorescent-labeled 40 μm-thick sections of the proximal tibia and tibial shaft. Our results show that HX resulted in a cessation of bone growth, a decrease in cancellous bone volume, and cortical bone gain compared with the age-matched, intact CON rats. Compared with the HX group, the HX + PGE₂ group had a significantly greater tibial bone density (mean ± SE, HX + PGE₂:1.595 ± 0.007 versus HX:1.545 ± 0.013), percent cancellous bone volume (21.4 ± 2.0 versus 8.41 ± 1.70), percent cortical bone area (87.2 ± 0.85 versus 81.7 ± 0.7), and ratio of cortical area to marrow area (7.14 ± 0.56 versus 4.52 ± 0.21). Increased bone masses by PGE₂ in the HX animals were accompanied by an increase in the trabecular and endosteal-labeled surface and bone formation rate. The trabecular number and width were increased whereas trabecular separation was decreased in the HX + PGE₂ group compared with the HX group (P < 0.05). PGE₂ treatment also caused a decrease in the tibial endosteal eroded surface and medullar cavity of the HX animals. In conclusion, this study clearly demonstrates that PGE₂ (2 mg/kg/day) in the HX rats increases both cortical and cancellous bones and improves trabecular architecture in the tibia after 6 weeks of treatment. These skeletal alterations are due to a stimulation of bone formation and a suppression of bone resorption activity. These findings suggest that the anabolic effect of PGE₂ in bone is independent of pituitary hormones.     

Effect of low-dose infusion of prostaglandin E1 on vecuronium-induced neuromuscular blockade

The effect of low-dose (20 ng·kg⁻¹·min⁻¹) infusion of prostaglandin E₁ (PGE₁) on vecuronium-induced neuromuscular blockade was studied. The study population consisted of 24 elderly patients (65–75 years old) and 24 younger adult patients (25–56 years old). They were randomly assigned to the control and PGE₁ groups. The steady-state dose requirement (SSDR) of vecuronium was derived from ondemand infusion of the drug which produced a stable twitch height of 20% of its baseline reading, and recovery time after steady-state infusion was defined as the time for recovery from twitch height from 25% to 75%. The patients in the PGE₁ group received an infusion of PGE₁ 20 ng·kg⁻¹·min⁻¹, while those in the control group received an infusion of normal saline. The SSDR (23.2±9.1 and 34.2±5.9 μg·kg⁻¹. hr⁻¹, respectively;P=0.02) was significantly less and the recovery time (35.0±9.5 and 19.9±4.2 min, respectively;P=0.01) was significantly longer in the elderly than in the younger patients. However, low-dose infusion of PGE₁ significantly increased the SSDR (23.2±9.1 to 37.4±3.7 μg· kg⁻¹·hr⁻¹;P=0.01) and shortened the recovery time (35.0±9.5 to 23.5±4.0 min;P=0.02) in elderly patients. We concluded that low-dose infusion of PGE₁ is effective in preventing the prolonged action of vecuronium in elderly patients.     

The effects of prolonged peritendinous administration of PGE1 to the rat Achilles tendon: a possible animal model of chronic Achilles tendinopathy

We studied the effects of peritendinous Achilles tendon injections of prostaglandin E₁ (PGE₁) on the Achilles tendon of rats. Five groups of Sprague-Dawley rats (n = 24 each) were studied. Groups 1 to 4 received weekly peritendinous injections. In group 1, one side was injected with 800 ng of PGE₁ in 0.5 ml of 0.9% NaCl and the contralateral side was injected with 0.5 ml of 0.9% NaCl. In group 2, one side was injected with 800 ng of PGE₁. In group 3, one side was injected with 0.5 ml of 0.9% NaCl. In group 4, a syringe needle was inserted in the peritenon unilaterally, but no substances were administered. In groups 2, 3, and 4, the contralateral tendon was used as the control. In group 5, treatment was not administered. Eight rats in each group were killed at each time point, after 7, 21, and 35 days of treatment. On day 7, values for average water content and average wet weight of the tendons treated with PGE₁ were significantly higher than those in the control tendons (analysis of variance [ANOVA]; P = 0.02), with a histological picture of acute inflammation. On day 21, approximately half of the PGE₁-treated tendons showed fibrosis of the paratenon, with adhesions and intra-tendinous degeneration, with the other half still showing a picture of acute inflammation. On day 35, all of the PGE₁-treated tendons showed fibrosis of the paratenon, with adhesions and intra-tendinous degeneration. At all time points, there was no evidence of pathology in the tendons that had not received PGE₁. Sham peritendinous injections and injections of normal saline did not produce inflammation in the Achilles tendons. Initially, local administration of PGE₁ produced acute inflammation of the tendon and its surrounding tissues. Prolonged PGE₁ administration produced peri- and intra-tendinous degeneration, providing a cheap, reproducible model of Achilles tendinopathy, which would allow studies of the effects of conservative and surgical management of the condition. Received: September 11, 2000 / Accepted: March 24, 2001     

Evaluation of the acetaminophen absorption test for early detection of orthotopic small bowel transplant rejection

We evaluated the efficiency of the acetaminophen (AC) absorption test as a marker of graft rejection in orthotopic small bowel transplantation (SBTX) in rats. Brown Norway (BN) rats were used as donors and Lewis (LEW) rats as recipients. Orthotopic allogenic SBTX was accomplished using a cuff technique for vessel anastomosis. Animals were divided into: group A (n = 9), untreated; group B (n = 15), extended small bowel resection; group C (n = 12), syngeneic SBTX without immunosuppressants; group D (n = 15), allogenic SBTX with tacrolimus (0.1 mg/kg per day); group E (n = 15), allogenic SBTX with tacrolimus (0.5 mg/kg per day). Serum AC was measured 15 min following the instillation of 0.15 g/kg AC into the stomach on postoperative days (POD) 1, 3, and 7. Grafts were examined histologically. The group D grafts showed progressive acute rejection histologically, from normal on POD 1, to moderate on POD 3, and severe on POD 7. Serum AC in group D decreased significantly from 53.1 ± 3.9 μg/ml on POD 1, to 35.0 ± 12.0 μg/ml on POD 3, and 10.9 ± 5.6 μg/ml on POD 7. No remarkable change was observed in the other groups. Serum AC correlated well with histological changes in rats subjected to SBTX, resulting in acute rejection. The AC absorption test could be useful for detection of progressive graft rejection in clinical SBTX. Received: August 17, 2000 / Accepted: March 6, 2001     

Evidence for abnormal regulation of circulating 1α,25-dihydroxyvitamin D in patients with pulmonary tuberculosis and normal calcium metabolism

Summary Available evidence indicates that hypercalcemia in pulmonary tuberculosis results from increases in circulating 1α,25-dihydroxyvitamin D [1α,25(OH)₂D]. To further characterize vitamin D metabolism in this disorder, the effects of vitamin D, 100,000 units a day for 4 days, were compared in 25 normal subjects and 11 patients with active pulmonary tuberculosis who were normocalcemic and had not had hypercalcemia. Serum calcium, phosphorus, 25-hydroxyvitamin D (25-OHD) and 1α,25(OH)₂D were measured. Whereas vitamin D increased mean serum 25-OHD from 20±2 (±SE) to 40±5 ng/ml (P<0.001) and did not change mean serum 1α,25(OH)₂D in the normals (33±2 vs. 31±2 pg/ml), it increased mean serum 25-OHD from 21±4 to 55±13 ng/ml (P<0.05) and mean serum 1α,25(OH)₂D from 28±2 to 35±3 pg/ml (P<0.05) in the patients. Serum calcium was normal and remained within the normal range in all subjects and patients. The findings indicate that there is a modest but significant abnormality in the regulation of circulating 1α,25(OH)₂D in normocalcemic patients with pulmonary tuberculosis. The results are similar to those previously reported by us in normocalcemic patients with sarcoidosis.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Hyperthermia-induced HSP expression correlates with improved rat renal isograft viability and survival in kidneys harvested from non-heart-beating donors

Transient sublethal hyperthermia followed by recovery from heat stress, referred to as heat shock preconditioning, exerts a protective effect on ischemia/reperfusion-induced injury in many systems. This effect is considered to be correlated to heat shock proteins (HSPs) and might be a critical factor in kidney graft function and survival. This study was designed to examine the impact of heat shock preconditioning on kidney isograft function and survival in a model utilizing non-heart-beating (NHB) donors. Four groups of male Lewis rats (n = 10/group) subjected either to whole body hyperthermia (groups A and C) or to sham anesthesia (groups B and D) were allowed 24 h recovery. Thereafter, 20 min of warm ischemia (A/B), and in a separate set of experiments 40 min of warm ischemia (C/D), were induced by suprarenal aortic cross clamping before renal procurement. After 24-h preservation with University of Wisconsin solution at 4 °C, orthotopic kidney transplantations were performed to syngeneic bilaterally nephrectomized recipients. Tissue specimens were taken to determine HO-1/HSP32, 72, and 90 induction by Western blot analysis. Renal function was measured by means of serum creatinine and creatinine clearance on days 0, 3, and 7 as well as urine volume, protein content, and creatinine levels daily. HO-1/HSP32 and HSP72 were found to be expressed constitutively. Moreover, heat shock strongly induced renal HSP72 and HSP32/HO-1, and to a lesser extent HSP90, expression. For recipients of group A grafts, the graft survival rate was 10/10, whereas it was 7/10 (70 %) in recipients of group B grafts (log rank p < 0.05). Following 40 min of warm ischemia, 6/10 (60 %) recipients survived, whereas all sham treated animals died with anuria within 6 days (log rank p = 0.01). Heat shock preconditioning strongly improved graft viability and reduced functional impairment. Creatinine clearance (CRC) on day 3 post Tx was 0.43 ± 0.24 ml/min in preconditioned animals (group A) and 0.07 ± 0.09 ml/min (p < 0.001) in sham preconditioned (group B), whereas it was 0.91 ± 0.33 ml/min and 0.03 ± 0.02 ml/min (p < 0.00 001) on day 7 post Tx. Following 40 min NHB time, CRC in survivors of preconditioned graft recipients (group C) was 0.32 ± 0.2 ml/min (day 3 post Tx) and 0.23 ± 0.08 ml/min (day 7 post Tx) and was significantly better than CRC of group B (p < 0.01 and p < 0.00001, respectively). CRCs prior to NHB procedures were comparable in all animals ranging between 1.31 and 1.72 ml/min. Serum creatinine as well as proteinuria were significantly increased after transplantation in both groups but recovered within 5 days in recipients of preconditioned grafts, whereas kidneys from donors without HP did not recover function. Histological alterations were also diminished following HP. Hyperthermic preconditioning induces strong and long lasting HO-1/HSP32, HSP72, and HSP90 expression in rat kidneys. HP increases survival following transplantation and improves renal graft function including proteinuria, volume output, and creatinine clearance. HSP induction might be used to develop novel approaches in clinical transplantation. Received: 3 November 2000 Revised: 27 February 2001 Accepted: 29 May 2001     

Prevention of contrast-induced nephropathy with prostaglandin E1 in high-risk patients undergoing percutaneous coronary intervention

Purpose

Contrast-induced nephropathy (CIN) is an important complication in the use of iodinated contrast media. The present study aimed to assess the safety and efficacy of prostaglandin E₁ (PGE₁) in prevention of CIN in patients with high-risk factors undergoing percutaneous coronary intervention (PCI).

Methods

The study group consisted of 163 patients who had undergone a coronary intervention procedure between January 1, 2012 and October 31, 2012. Study participants were randomly assigned to either the PGE₁ group (82 patients) or the control group (81 patients). Patients in the PGE₁ group received PGE₁ intravenous infusion of 20 ng/kg/min for 6 h before and after the administration of contrast media. The control group received 0.9 % sodium chloride solution for routine hydration only. A nonionic, low-osmolality contrast agent was used in our laboratory at this time. Serum creatinine (Scr) values and estimated glomerular filtration rate were measured before and within 48 h of the administration of contrast agents. CIN was defined as an increase of ≥0.5 mg/dL or ≥ a 25 % increase in Scr concentrations over baseline within 48 h of angiography.

Results

The amount of contrast agent administered was similar for the PGE₁ and control groups (156 ± 63 vs. 161 ± 68 mL, P > 0.05). The incidence of CIN was lower in the PGE₁ group than in the control group (3.7 vs. 11.1 %, P < 0.05). No serious adverse effects were observed.

Conclusions

In patients with high-risk factors undergoing PCI, the use of PGE₁ for prevention of CIN is safe and efficacious.     

RANTES in the postoperative course after liver transplantation

Abstract RANTES (regulated upon activation, normal T‐cell expressed and secreted), an inflammatory cytokine, promotes accumulation and activation of leukocytes. In 67 liver transplantations, systemic concentrations of RANTES were correlated to graft survival and incidence of rejection. RANTES levels either increased to highly elevated levels at day 14 (84 ± 64 ng/ml; group 1; n = 43) or remained within the limit of healthy controls (19 ± 11 ng/ml at day 14; group 2; n = 24). The 100‐day graft function rate was 0.91 in group 1 and 0.63 in group 2 (P = 0.002). The risk ratio for rejection during the first 100 days was increased 2.2‐fold in group 2 compared to group 1 (P = 0.02). High postoperative release of RANTES after liver transplantation, a beneficial factor, may reflect a general systemic immunological activation. It can be concluded that high early systemic RANTES levels may play a role in immunological recognition leading to a tolerance of the liver graft.     

Kidney transplantation from living related donors aged more than 60 years: a single center experience

Abstract

Objectives: To evaluate whether the outcomes of renal grafts from living related donors more than 60 years old are acceptable, in terms of renal function and patient/graft survival. Material and Methods: Twenty-one patients who received kidneys from donors older than 60 years constituted the study group (Group 1). The control group (Group 2) consisted of 110 patients who received renal transplants from ideal donors, aged 18 to 45 years. The recipients were analyzed for posttransplantation serum creatinine, the number of acute rejection episodes and delayed graft function, and patient/graft survival. Results: The mean age of donors was 62.6?±?2.2 years in Group 1 and 32.8?±?7.0 years in Group 2. Recipient serum creatinine was higher on postoperative day 1, year 1, year 5 in Group 1 than that in Group 2 (536.8?±?203.3 vs. 409.8?±?213.8, 142.4?±?38.2 vs. 100.3?±?22.9, 152.6?±?42.7 vs. 107.1?±?22.1, respectively; all p?<?0.05). Acute rejection was seen in 4 cases in Group 1 (19.0%) and in 15 cases in Group 2 (13.6%; p?=?0.759). Delayed graft function was seen in two cases in Group 1 (9.5%) and in four cases in Group 2 (3.6%; p?=?0.540). One-, 3- and 5-year patient survival was 100%, 100% and 100% for Group 1, and 97%, 97% and 97% for Group 2. Corresponding death-censored graft survival was 100%, 100% and 100% for Group 1, and 98%, 98% and 96% for Group 2. No significant difference was observed in terms of patient/graft survival. Conclusions: Although compromising renal function, donor age did not affect patient and graft survival in the 5-year follow-up in our study. Age alone seems not to be an exclusion criterion to living kidney donation.     

Plasma Profiles of Ivermectin in Horses following Oral or Intramuscular Administration

A study was undertaken in order to evaluate and compare ivermectin's (IVM) plasma disposition kinetic parameters after oral or intramuscular (IM) administration in horses. Ten clinically healthy adult horses, weighing 380–496 kg body weight (BW), were allocated to two experimental groups of five horses. Group I, was treated with an oral paste formulation of IVM at the manufacturer's recommended dose of 0.2 mg/kg BW. Group II, was treated IM with an injectable 1% formulation of IVM at a dose of 0.2 mg/kg BW. Blood samples were collected by jugular puncture at different times between 0.5 h and 75 days post‐treatment. After plasma extraction and derivatization, samples were analysed by high‐performance liquid chromatography with fluorescence detection. A computerized kinetic analysis was performed, and data were compared using the Wilcoxon signed rank test. The parent molecule was detected in plasma between 30 min and either 20 (oral) or 40 (IM) days post‐treatment. Significant differences were found for the time corresponding to peak plasma concentrations (t_max) and for absorption half‐life. Peak plasma concentrations (C_max) of 51.3 ± 16.1 ng/ml (mean ± SD) were obtained after oral administration and of 31.4 ± 6.0 ng/ml for the IM route. The values for area under concentration–time curve were 137.1 ± 35.9 ng day/ml for the group treated orally, and 303.2 ± 4.3 ng day/ml for the IM treated group. The mean plasma residence times were 4.2 ± 0.4 and 8.9 ± 0.7 days for oral and IM‐treated groups, respectively. The results of this study show that the route of administration considerably affects the disposition of IVM. A significant difference in bioavailabilty and half‐life of elimination of IVM was observed after IM administration compared with oral administration. A close relationship between pharmacokinetic profiles and the clinical efficacy of IVM was established.     

Influence of postoperative acute-phase response on angiogenesis and tumor growth: Open vs. laparoscopic-assisted surgery in mice

Inflammatory responses and tumor growth are increased after laparotomy compared with laparoscopy in some animal models. Proinflammatory cytokines interleukin-6 (IL-6) and interleukin-1 beta (IL-1β) upregulate the expression of vascular endothelial growth factor (VEGF). Our aim was to investigate the influence of postoperative inflammatory responses on angiogenesis and tumor growth. 5 Χ 10⁶ B51LiM cells were injected into the cecal wall of Balb/c mice. After 2 weeks, the animals were randomized into the following three groups: open cecectomy (OC), CO₂-laparoscopic-assisted cecectomy (LC), and helium-laparoscopic-assisted cecectomy (LH). On postoperative day 12, the mice were killed. Tumor load scores and weight were significantly greater after laparotomy than after laparoscopy. Serum IL-6 levels 6 hours after surgery (OC: 4157 ± 1297 pg/ml vs. LC: 2514 ± 1417 pg/ml vs. LH: 2255 ± 1714 pg/ml) and VEGF levels on postoperative day 12 (OC: 231 ± 125 pg/ml vs. LC: 45 ± 9 pg/ml vs. LH: 49 ± 8 pg/ml), measured by enzyme-linked immunosorbent assay, were significantly higher in the laparotomy group. Microvessel density was also significantly higher in the OC group (OC: 34.3 ± 11.5 vs. LC: 15.5 ± 12.5 vs. LH: 18.5 ± 11.9). There was a positive correlation between IL-6 and VEGF postoperative serum levels (rho = 0.67; P < 0.001). We concluded that increased systemic levels of proinflammatory cytokines and VEGF are associated with increased angiogenesis and tumor growth after laparotomy compared to laparoscopy in mice. Presented at the Fifty-Seventh Annual Sessions of the Owen H. Wangensteen Surgical Forum, The American College of Surgeons Clinical Congress, San Francisco, California, October 6–10, 2002; and published as an abstract in Journal ofthe American College of Surgeons 2002; 195:S69. Supported by an International Fellowship Grant from the American Society of Colon and Rectal Surgeons (M.P.) and by a Postdoctoral Grant (EX2001-35105008) from the Ministry of Education and Culture of Spain.     

锚定法单开门椎管成形术对术后轴性症状和颈椎曲度影响的病例对照研究

目的：观察评价锚定法单开门椎管成形术在降低术后轴性症状发生和减少颈椎曲度丢失中的作用。方法：选择2004年10月至2007年5月行锚定法单开门椎管成形术并获得完整随访的患者56例（锚定单开门，A组），与50例同期行传统单开门手术的患者（传统单开门，B组）进行对比分析，记录手术时间、术中出血量、轴性症状及JOA（17分法）评分，根据X线片测量C2与C7椎体后壁切线夹角d。结果：手术时间：A组（116．0±27．9）min，B组（120．0±18．9）min，差异无统计学意义（P〉0．05）；术中出血量：A组（148．0±68．3）ml，B组（152．0±63．4）ml，差异无统计学意义（P〉0．05）；A组23例（41．1％）发生轴性症状或加重，B组38例（76．0％）发生轴性症状或加重，差异有统计学意义（P〈0．05）；JOA评分：A组改善率（61．1±24．5）％，B组改善率（53．3±23．3）％，差异有统计学意义（P〈O．05）；A组术前颈曲夹角（6．3°±5．1°）与术后颈曲夹角（6．6°±4．5°）比较无统计学意义（P〉0．05），B组术前颈曲夹角（5．9°±5．1°）与术后颈曲夹角（4．8°±3．5°）比较有统计学意义（P〈0．05）。结论：锚定法单开门椎管成形术能减少术后轴性症状的发生和颈椎曲度的丢失，有利于早期功能锻炼，能提高脊髓型颈椎病的治疗效果。     

高血压病人在全膝关节置换术中不同时期应用止血带的临床效果比较

目的 探讨止血带在高血压病人全膝关节置换术（total knee arthroplasty, TKA）中的使用效果,分析合并高血压的TKA病人在不同时期使用止血带对术中失血、术后失血、术后康复锻炼以及术后并发症等方面的影响。方法 2015年3月至2018年3月因膝骨关节炎于我院接受初次TKA的60例高血压病人,根据止血带使用时间的不同分为三组,其中A组20例病人在切皮前开始使用气囊止血带,缝合完毕加压包扎后松开;B组20例病人在安放水泥型膝关节假体前开始使用气囊止血带,缝合完毕加压包扎后松开;C组20例病人在安放水泥型膝关节假体前开始使用气囊止血带,骨水泥凝固后松开。分别记录3组病人术中、术后失血量,围手术期输血量。采用疼痛视觉模拟量表（visual analogue scale, VAS）评价病人疼痛情况、美国膝关节协会评分（knee society score, KSS）评价病人术后3 d、3周、1年的膝关节功能。结果 A组的术中失血量为（170.81±34.83） ml,B组为（194.95±24.96） ml,C组为（248.88±25.86） ml,差异有统计学意义（F=5.834,P=0.022）;A组总失血量为（923.56±197.79） ml,B组为（773.67±183.76） ml,C组为（827.50±182.79） ml,差异有统计学意义（F=4.733,P=0.031）。A组术后3 d肿胀率及VAS评分［9.93%±0.97%、（7.32±1.26）分］明显高于B组［6.03%±0.85%、（4.72±0.82）分］及C组［5.91%±0.73%、（4.94±0.63）分］;术后3周时,A组的KSS评分为（46.74±6.72）分,明显低于B组的［（69.72±7.93）分］、C组的［（68.83±7.86）分］;上述差异均有统计学意义（P均＜0.05）。术后1年,3组之间的KSS评分差异无统计学意义（F=2.314,P=0.834）。A组有1例发生深静脉血栓,有1例发生术后贫血,2例发生肌间静脉血栓,B组无并发症出现,C组有1例发生肌间静脉血栓。结论 安放水泥型膝关节假体前开始使用止血带,缝合完毕加压包扎后松开,可明显改善病人的术中出血量及术后近期功能效果,术后并发症少,但远期临床疗效有待进一步观察。     

Biochemical Evidence of Metabolic Bone Disease in Women Following Roux-Y Gastric Bypass for Morbid Obesity

Twenty-six female patients were recalled for examination 10 years after a Roux-Y gastric bypass (RGB) procedure for morbid obesity, to determine whether there was biochemical and/or bone densitometry evidence of metabolic bone disease. These patients were compared with seven control patients who had achieved weight loss by dietary restriction. The serum calcium (4.3 ± 0.03 vs 4.6 ± 0.06 mEq/l; p = 0.002) was decreased in the RGB group. Both the serum alkaline phosphatase level (121.0 ± 7.6 vs 87.3 ± 8.3 U/l; p = 0.018) and the serum osteocalcin (12.6 ± 1.2 vs 9.5 ± 1.9 mug/ml; p = 0.078) level increased in the RGB group. The 1,25(OH) vitamin D level (50.5 ± 2.5 vs 40.5 ± 4.9 pg/ml; p = 0.152) was similar for both groups; the 25(OH) vitamin D level (24.3 ± 1.6 vs 35.9 ± 3.4 ng/ml; p = 0.008) was decreased in the RGB group as compared with the control group. Bone mineral density was elevated in three of the lumbar measurement sites, and marginally decreased (0.90 ± 0.02 g/cm₂ vs 1.03 ± 0.06 g/cm₂; p = 0.067) in the femoral neck of the RGB group compared with the controls. This biochemical pattern suggests the development of metabolic bone disease following the RGB.     

Attenuation of Kupffer Cell Function in Acute on Chronic Liver Injury Enhanced Engraftment of Transplanted Hepatocytes

Background The present study was designed to elucidate the relationship of engraftment efficiency of transplanted cells and Kupffer cell function in mice with acute on chronic liver injury and acute liver injury. Methods The recipient dipeptidyl peptidase IV knockout (DPPIV^–/–) mice were divided into two groups: (1) the acute on chronic liver injury group (CCl₄/APAP group) that received CCl₄ (1 ml/kg) twice a week for 4 weeks following one dose of acetaminophen (APAP), 600 mg/kg; (2) the acute liver injury group (APAP-only group) that received a single dose of APAP at 600 mg/kg. DPPIV^+/+ hepatocytes were transplanted 24 h after APAP intoxication. Engraftment efficiency was evaluated at day 7 and day 14 after transplantation. The tumor necrosis factor-α (TNF-α) mRNA expression level of Kupffer cells immediately before cell transplantation was compared between the two groups before and after lipopolysaccharide (LPS, 100 ng/ml) stimulation. Results The number of transplanted cells and clusters in each 100× microscopic field were higher in the CCl₄/APAP group at both day 7 (21.5 ± 6.3 versus 8.3 ± 4.0, p < 0.001; 14.9 ± 4.6 versus 6.6 ± 3.4, p < 0.001, respectively) and day 14 (17.3 ± 4.4 versus 10.2 ± 3.3, p = 0.001; 12.6 ± 3.2 versus 7.9 ± 1.6, p = 0.004, respectively). After LPS stimulation, the expression level of TNF-α was lower (175.7 ± 54.6 versus 465.6 ± 64.2, p = 0.002), and the increment of TNF-α expression was also less significant in the CCl₄/APAP group (1.5-fold versus 6.5-fold, p = 0.014). Conclusions Chronic liver injury desensitized Kupffer cells and reduced TNF-α expression, two results that correlated with the increased engraftment of transplanted cells.     

经皮椎弓根螺钉结合椎体成形术治疗骨质疏松性胸腰段骨折

目的 :探讨经皮椎弓根螺钉固定(PPSF)结合伤椎骨水泥强化治疗胸腰段骨质疏松性椎体压缩性骨折(OVCF)的临床疗效。方法 :对2014年1月至2015年12月收治的94例胸腰段OVCF患者进行回顾性分析,其中男31例,女63例;年龄65~70岁,平均67.2岁;T_(11)15例,T_(12)32例,L_129例,L_218例。根据治疗方法分为PPSF结合PVP治疗组(A组,43例),PVP治疗组(B组,51例)。记录两组手术时间、术中出血量、伤椎骨水泥用量、术后卧床时间,比较两组术前,术后3 d、1年伤椎前缘高度百分比、矢状面Cobb角及视觉模拟评分(VAS),并观察两组术后并发症情况。结果:94例患者均获随访,时间12~24个月,平均18.5个月。手术时间A组为(96.2±28.7)min,B组为(31.8±10.6)min;术中出血量A组为(62.2±25.5)ml,B组为(25.4±10.9)ml;伤椎骨水泥用量A组为(5.5±0.5)ml,B组为(4.9±1.1)ml;术后卧床时间A组为(5.1±1.8)d,B组为(1.8±0.7)d。A组较B组手术时间更长,术中出血量更多,伤椎骨水泥用量更大,术后卧床时间更长(P0.05)。两组患者术后3 d及1年伤椎高度百分比、Cobb角均较术前明显恢复。末次随访时,伤椎前缘高度百分比、Cobb角A组[(85.6±3.5)%和(11.9±5.3)°]均优于B组[(84.2±4.5)%和(15.3±3.4)°](P0.05)。B组出现3例伤椎再次骨折塌陷的情况。两组患者术后3 d、1年VAS均较术前明显降低,两组差异无统计学意义(P0.05)。结论:采用PPSF结合PVP较单纯采用PVP治疗胸腰段OVCF,能获得较强的椎体强度和刚度,更有利于改善伤椎的复位效果,维持伤椎高度,防止椎体塌陷。