直视下袖套法加套入式吻合大鼠全血供肝移植模型建立

目的　直视下应用套入式吻合方法重建大鼠移植肝的动脉血供。　方法　SD- SD大鼠肝移植30只,SD- Wistar大鼠肝移植5 0只。供体从腹腔干动脉开始分别结扎脾动脉、胃左动脉、胃右动脉及胃十二指肠动脉,保留肝固有动脉。以8- 0无损伤缝线作袖套法加套入式方法行供体的腹腔干动脉和受体的右肾动脉吻合,恢复移植肝动脉血供。　结果　无肝期最短13min,最长2 1min。套入式吻合肝动脉时间平均4 .0 0±1.31min;手术成功率96 .3% ;SD- SD大鼠成功2 9只,术后不使用免疫抑制剂均健康存活,最长目前已超过2个月。SD- Wistar大鼠成功4 8只,一般术后3～5 d出现急性排斥反应,不用免疫抑制剂于9d后死于排斥反应所致的肝功能衰竭。　结论　直视下袖套法加套入式吻合方法重建大鼠移植肝的动脉血供是一种稳定、可靠及易行的全血供肝移植模型     

大鼠肝移植肝动脉重建方法改进的实验研究

目的 构建重建肝动脉血供的大鼠肝移植模型.方法 在经典"二袖套"法的基础上,利用24G静脉留置针外鞘管制作动脉支架管吻合供体腹腔动脉及受体肝总动脉.结果 共进行肝移植26次.所有手术均单人操作完成.手术成功率(存活24 h以上)为92.3%(24/26).动脉吻合时间仅需(1.70±0.46)min.经解剖发现术后第1天及第30天所有动物肝动脉均通畅,搏动良好,各肝叶入口处动脉亦充盈良好.未发现胆道坏死,胰腺坏死或由于周围组织包绕形成的胆道内漏等.结论 利用支架法吻合供体腹腔动脉及受体肝总动脉的方法 是一种操作简便、耗时短、对正常生理干扰小、通畅率高的理想的大鼠肝移植肝动脉重建方法 .     

改良的套叠缝合重建肝动脉的大鼠原位肝移植模型

目的 介绍1种简便的套叠缝合重建肝动脉的大鼠原位肝移植模型。方法 采用套叠缝合重建肝动脉的大鼠原位肝移植模型20例。肝移植采用二袖套法，动脉重建利用供肝的肝总动脉与受体的肝固有动脉根部二针套叠缝合方法。结果 本方法建立大鼠原位肝移植模型的手术时间（包括供体手术）和重建动脉的时间明显缩短。大鼠30d存活率和肝动脉的通畅率均为100％。无胆道并发症发生。结论 套叠缝合重建肝动脉的大鼠原位肝移植模型简便、省时、成功率高，且对组织损伤小、更符合受体解剖生理。     

改良法重建肝动脉血供的大鼠原位肝移植模型

目的 建立一种稳定的重建肝动脉血供的大鼠原位肝移植模型，为研究肝移植术后移植免疫、胆道并发症等提供一个更加符合生理的动物模型。方法 以经典的“双袖套”大鼠原位肝移植模型为基础．将带有主动脉的供肝动脉与受体腹主动脉行端侧吻合重建肝动脉血供。结果 共施行重建肝动脉血供的大鼠原位肝移植35例。术后24h动物存活率85．7％。术后1周动物存活率82．9％。结论 用带有主动脉的供肝动脉与受体腹主动脉行端侧吻合重建肝动脉血供的方法稳定可靠，易于标准化。该模型是研究肝移植术后免疫排斥、胆道并发症的理想模型。     

大鼠原位肝移植胆道并发症的原因分析

目的研究胆道并发症的发生原因,建立稳定的大鼠原位肝移植模型。方法“二袖套法”行大鼠原位肝脏移植180例,即肝上下腔静脉（SVC）采用连续缝合法吻合,门静脉（PV）以及肝下下腔静脉（IVC）采用袖套法吻合,胆总管采用内支架胆管端端吻合法。结果模型稳定后,供肝冷缺血时间为（50．1±12．0）min,无肝期为（16．0±3．1）min,受体手术时间为（54．4±10．6）min,术后胆道并发症的发生率为40％,主要表现为肝脓肿、肝内外胆管扩张、胆泥形成等。结论胆管内支架管的选择以及手术技巧是影响大鼠肝移植术后胆道并发症发生发展的重要因素。     

改良套入缝合重建肝动脉血供的大鼠肝移植模型建立

目的构建一个稳定的重建肝动脉血液供应的大鼠原位肝移植模型。方法在经典"袖套"法的基础上,将供鼠腹腔干与受鼠的右肾动脉行"套入"法微血管吻合,重建肝动脉血液供应。结果共行重建肝动脉血液供应的大鼠原位肝移植40例次,成功37例次,手术成功率92.5%(37/40),动脉吻合时间平均为(4土1.5)min,术后受鼠4周存活率87.5%(35/40),肝动脉4周通畅率94.3%(33/35)。结论建立全血供的大鼠肝移植模型,以经典"双袖套"法为基础,用供鼠腹腔干与受鼠右肾动脉行"套入"法微血管吻合是一种稳定、可靠、可重复性强的方法。     

提高二袖套法大鼠原位肝移植成功率的手术技巧

目的　探讨二袖套法大鼠原位肝移植的手术技巧。方法　在Kamada“二袖套法”基础上进行改良。获取供肝前阻断肝门血供 10min ,再灌注 10min ;分别经腹主动脉和门静脉对肝脏进行双重灌注 ;门静脉和肝下下腔静脉用袖套法吻合 ,肝上下腔静脉用缝合法吻合 ,胆总管采用单管内支架胆管端端吻合法。结果　共施行大鼠原位肝移植 12 0次 ,手术成功率为 90 .8%。平均无肝期为 ( 2 1.0± 3.5 )min ,受体总手术时间为 ( 4 6 .0± 4 .5 )min ,1周生存率为 87.2 %。结论　良好的手术野暴露 ,娴熟的显微外科技术 ,精细的手术操作和配合有助于缩短受体无肝期及总手术时间和提高受体生存率     

改良二袖套法大鼠原位肝移植180例

目的改进二袖套法大鼠原位肝移植方法,建立稳定的大鼠肝移植模型。方法采用改良Kamada二袖套法进行大鼠原位肝移植180例,观察手术成功率、手术时间、免疫病理改变和术中、术后并发症等。结果总手术成功率85.6%,供者手术时间(40.0±3.8)min,修肝时间(14.3±2.1)min,受者手术时间(48.0±4.2)min,无肝期(22.0±2.3)min。SD-Wistar大鼠肝移植后出现免疫排斥病理改变。常见并发症有麻醉意外、气胸、失血性休克、下腔静脉空气栓塞、血栓形成或胆道梗阻等。结论改良Kamada二袖套法可提高手术成功率,减少并发症。SD-Wistar大鼠肝移植为高排斥组合,可作为肝移植免疫耐受研究的模型。     

受体肝分步切除三袖套法大鼠原位肝移植术的改进

目的探讨改进的三袖套法大鼠原位肝移植术的效果。方法56只成年健康Wistar封闭群大鼠,供受体各28只,采用受体肝分步切除的三袖套法行大鼠原位肝移植术。供肝置入时先不切除受体肝,而是在吻合血管的过程中分步切除受体肝。结果本组行大鼠原位肝移植28例,无肝期平均11.2(7~13)min,手术成功率92.9%(26/28)。死亡2例,1例死于出血,1例因肝上下腔静脉套管扭曲、脱落死亡。1周存活率82.1%(23/28)。结论采用受体肝分步切除的三袖套法行大鼠原位肝移植术,可缩短无肝期,提高术后存活率。     

豚鼠至大鼠肝移植肝下下腔静脉套管方法的改进

目的探讨豚鼠至大鼠异种原位肝移植中应用改进的肝下下腔静脉套管方法的手术效果。方法豚鼠和SD大鼠各30只分别作为供、受体,并随机配对分为实验组和对照组。实验组采用改进的肝下下腔静脉套管进行肝下下腔静脉袖套管法吻合。对照组采用常规方法进行肝下下腔静脉袖套法吻合。比较两组的供肝切取时间(切、修肝时间)、受体手术时间、无肝期时间、手术成功率、肝下下腔静脉袖套吻合口附近出血发生率以及术后生存时间。结果实验组和对照组的供肝切取时间分别为(32.2±3.5)min、(45.4±5.7)min,修肝时间分别为(14.5±2.1)min、(9.2±1.8)min,切、修肝总时间分别为(46.7±4.8)min、(54.6±6.9)min,比较差异均有统计学意义(均为P0.05)。两组受体的手术时间分别为(52.7±6.1)min、(53.2±6.5)min,无肝期分别为(16.8±2.1)min、(17.2±2.5)min,比较差异没有统计学意义(均为P0.05)。实验组与对照组的手术成功率分别为93%、53%,比较差异有统计学意义(P0.05)。两组的肝下下腔静脉袖套吻合口附近出血发生率分别为0、38%,比较差异有统计学意义(P0.05)。两组手术成功的动物的术后生存时间分别为(115±24)min、(95±29)min,比较差异无统计学意义(P0.05)。结论应用改进的肝下下腔静脉套管方法进行豚鼠至大鼠原位肝移植,手术成功率高,可用于豚鼠至大鼠原位肝移植实验研究模型的制作。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

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.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.     

Intraoperative autotransfusion is associated with modest reduction of allogeneic transfusion in prosthetic hip surgery

Background: The efficacy of intraoperative salvage and washing of wound blood and the predictors of allogeneic red cell transfusions in prosthetic hip surgery are insufficiently known.
Methods: In 96 patients, undergoing primary or revision surgery, salvaged and washed red cells and, if necessary, allogeneic blood were used to keep haematocrit not lower than 33%. The bleeding of red cells during hospital stay was calculated from the red cell balance. The preoperative red cell reserve (millilitres of red cells in excess of a haematocrit of 33%) was estimated and the difference between this volume and the total bleeding of red cells was retrospectively used to classify patients with regard to the need for red cells. Stepwise regression analysis was used to define patient-related variables associated with allogeneic blood transfusion.
Results: Preoperative knowledge of the type of operation (primary, revision), the preoperative red cell reserve, and the body mass could predict roughly half of the need for banked blood (r²=0.45). Only one-third of the total bleeding of red cells was retransfused. For complete avoidance of allogeneic blood, autotransfusion was most effective in patients with a moderate need (0–4 u). However, 32% of such patients required allogeneic blood.
Conclusions: Autotransfusion has a limited efficacy to decrease the need for allogeneic blood, and other blood-saving methods should be added for this purpose. It is difficult to predict the need for allogeneic blood preoperatively.     

缺氧对肾小管上皮细胞分泌外泌体的影响

目的    观察缺氧对肾小管上皮细胞分泌外泌体的影响,探讨外泌体在缺氧致肾脏损伤中的作用及机制。 方法    （1）常氧（21% O₂）及缺氧（1% O₂）分别处理大鼠肾小管上皮细胞（NRK-52E）48 h,收集细胞上清液并使用高速梯度离心法分离外泌体。采用透射电镜、纳米示踪分析、Western印迹、蛋白浓度定量鉴定并比较两组外泌体的基本特性。（2）在共培养实验中,以不同浓度（1、10、50、100、300 mg/L）的常氧外泌体、缺氧外泌体分别干预脂多糖（LPS）诱导的大鼠原代腹腔巨噬细胞,使用实时荧光定量PCR与酶联免疫吸附试验（ELISA）法分别检测巨噬细胞白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、诱导型氮氧化物合酶（iNOS）水平;使用Western印迹法检测巨噬细胞磷酸化（p）STAT/STAT及细胞因子信号传导抑制蛋白1（SOCS1）的蛋白表达;最后,使用实时荧光定量PCR法检测常氧外泌体与缺氧外泌体中炎性反应相关微RNA（microRNA,miR）的表达差异。 结果    （1）离心得到的囊泡具有外泌体典型的结构,粒径小于150 nm,表达外泌体标志蛋白CD63,说明分离得到外泌体。缺氧对肾小管上皮细胞分泌的外泌体形态、粒径分布比例无明显影响,但提高了外泌体的分泌量。（2）缺氧外泌体相比于常氧外泌体促进了LPS诱导的M1型巨噬细胞IL-6、TNF-α、iNOS 的表达和分泌（均P＜0.01）,同时提高STAT的磷酸化水平并减少SOCS1的蛋白表达（均P＜0.01）;对炎性反应相关microRNA检测发现缺氧外泌体中miR-155、miR-27a表达量较常氧外泌体明显升高（P＜0.05）。 结论    缺氧可改变外泌体的生物学功能,表现为协同促进LPS诱导的M1型巨噬细胞的表型转化,这可能是慢性肾脏病微炎性反应状态持续的原因之一。     

In Vitro Function and Durability Assessment of a Novel Polyurethane Heart Valve Prosthesis

Abstract While flexible-leaflet, central-flow prosthetic heart valves promise relief from anticoagulation therapy, they continue to be restricted by inadequate durability. In consequence, a novel trileaflet valve, made entirely from polyurethane, has been developed. A batch of 6 consecutively manufactured polyurethane valves was subjected to hydrodynamic function and accelerated fatigue testing. Computerized data acquisition and control systems have been introduced to improve valve testing methodologies. In terms of hydrodynamic function, the polyurethane valve demonstrates transvalvular pressure gradients similar to those for a bioprosthetic valve (Carpentier-Edwards) and levels of retrograde flow significantly less than those for either the bioprosthetic valve or a bileaflet mechanical valve (St Jude Medical). The equivalent of 10 years of cycling without failure has been exceeded by all 6 polyurethane valves in accelerated fatigue tests with 2 valves remaining intact after 674 million cycles (equivalent to approximately 17 years) in continuing tests. Highspeed photography revealed considerable differences in leaflet motion between valves cycled at accelerated and physiological rates.     

Negative pressure ventilation vs. spontaneous assisted ventilation during rigid bronchoscopy: A controlled randomised trial

Background: Ventilation during interventional rigid bronchoscopy (IRB) under general anaesthesia (jet ventilation, positive pressure ventilation and spontaneous assisted ventilation) may offer some difficulties. This study compares the effectiveness during IRB of intermittent negative pressure ventilation (INPV) and spontaneous assisted ventilation (SAV). Methods: Thirty-eight patients submitted to IRB were randomised into two groups: SAV or INPV. All patients received a total intravenous anaesthesia; INPV patients were paralysed. Pre-and intra-operative arterial blood gases and O₂ flow through a rigid bronchoscope were assessed. The endoscopist applying a subjective score evaluated the operating conditions. Results: Patients of the INPV group, as compared to the SAV group, required a lower dosage of fentanyl (2.6 ± 1.8 (μg · kg^?1· h^?1 vs. 6.6 ± 4.8 μg · kg^?1· h^?1), a lower O₂ supply (3.3 ± 2.8 1/min vs. 11.6 ± 3.4 1/min), a shorter recovery time (5.4 ± 2.9 min vs. 9.8 ± 7.1 min) and no manually assisted ventilation (0 ± 0 vs. 1 ± 1.1 nd?/procedure). Intraoperative PaCO₂ was higher in the SAV (8.1 ± 1.3 kPa) than in the INPV group (5.0 ± 1.6 kPa) and intraoperative pH differed in the two groups (7.26 ± 0.05, SAV vs. 7.47 ± 0.08, INPV). Operating conditions, as assessed by a subjective score, were considered better with INPV than with SAV (4.9 vs. 4.3). Conclusions: As compared to SAV, INPV in paralysed patients during IRB reduces administration of opioids, shortens recovery time, prevents respiratory acidosis, excludes the need for manually assisted ventilation, reduces 02 need and affords optimal surgical conditions. INPV appears a safe, non-invasive and effective ventilatory management during IRB.