Incidence and predictors of post-reperfusion syndrome in living donor liver transplantation

A characteristic pattern of hemodynamic changes that may occur in reperfusion phase of liver transplantation (LT) is known as post-reperfusion syndrome (PRS). In this study, we determined the frequency of PRS and evaluated possible predictors of PRS. The medical records of 152 patients who underwent living donor LT were reviewed. PRS was defined as a decrease in mean arterial pressure of more than 30% from the baseline value for more than one min during the first five min after reperfusion. The frequency of PRS was determined, and patients were divided into two groups: PRS group and non-PRS group. Donor factors, preoperative and intraoperative recipient factors, and postoperative outcomes were compared between the two groups. PRS occurred in 58 recipients (34.2%). Preoperative model for end-stage liver disease scores of recipients and percentage of graft steatotic changes were higher in PRS group. PRS group showed higher heart rates and lower hemoglobin values preoperatively. Before reperfusion, PRS group received more transfusion and their urine output was less than that of non-PRS group. Postoperatively, peak bilirubin during the first five d after LT was higher in PRS group. In conclusion, both severity of liver disease and graft steatosis may increase risk for PRS in LT. Further prospective studies of PRS in its relationship to outcome are indicated.     

Quantitatively assessed dynamic contrast-enhanced magnetic resonance imaging in patients with chronic obstructive pulmonary disease: correlation of perfusion parameters with pulmonary function test and quantitative computed tomography

OBJECTIVES: The purpose of this study is to evaluate the correlation of the perfusion parameters of 3-dimensional, contrast-enhanced magnetic resonance (MR) imaging (3D CEMRI) with pulmonary function test (PFT) and quantitative computed tomography (CT) parameters in patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: In 14 patients with COPD, 3D CEMRI was performed. From the signal intensity-time curves, pulmonary blood flow (PBF), pulmonary blood volume (PBV), and mean transit time of each pixel was calculated. From the volumetric CT data, the quantitative parameters including the volume fraction of the lung below -950 Housefield Units (V(-950)) and mean lung density were assessed. The correlation between the MR perfusion parameters and the parameters from quantitative CT and PFT was assessed using Spearman correlation analysis. The correspondence of the regional impairment of perfusion on MR perfusion maps to the areas of emphysema on quantitative CT maps in each patient was assessed qualitatively using a 4-class visual scoring method by 2 readers. RESULTS: All 3D CEMRI examinations were successfully completed and MR perfusion parameters were obtained in all patients. The Spearman correlation test showed that PBF positively correlated with forced expiratory volume in 1 second (FEV(1))/forced vital capacity (FVC) (R = 0.49, P = 0.044), PBV positively correlated with FEV(1)/FVC (R = 0.69, P = 0.006) and negatively correlated with V-950 (R = -0.61, P = 0.020), and mean transit time positively correlated with FEV(1) (R = 0.63, P = 0.017) and FEV(1)/FVC (R = 0.76, P = 0.002). The areas of perfusion impairment on PBF and PBV maps were relatively well correlated with the areas of emphysema on CT maps [very good or good: PBF 71.5% (reader 1) and 64.3% (reader 2) of the patients, kappa = 0.47 (P < 0.001); PBV 78.6% (reader 1) and 78.6% (reader 2) of the patients, kappa = 0.89 (P < 0.001)]. CONCLUSIONS: This study shows that the deterioration of perfusion parameters measured on MR in patients with COPD, correlates with worsening of airflow limitation on PFT and emphysema index on CT. Regional heterogeneity of emphysema on CT matches with the decreased perfusion on MR.     

咪唑安定对脑缺血再灌注沙土鼠血管内皮生长因子表达的调节作用

目的 观察咪唑安定对沙土鼠全脑缺血再灌注损伤过程中血管内皮生长因子(CEGF)表达的影响,为咪唑安定临床合理应用提供实验依据.方法 健康雄性沙土鼠共72只,随机分为对照组、损伤组和治疗组(n=24).采用双血管法建立沙土鼠全脑缺血再灌注模型,对照组仅游离双侧颈总动脉但不夹闭;损伤组夹闭双侧颈总动脉10min,放开动脉夹后即刻腹腔注射生理盐水50ml/kg 1次,随后每天同一时间点在动物清醒状态下腹腔注射生理盐水50ml/kg,共6d;治疗组夹闭双侧颈总动脉10min,放开动脉夹后即刻腹腔注射0.01%咪唑安定注射液5mag/kg随后每天同一时间点在动物清醒状态下腹腔注射0.01%咪唑安定5mg/kg,共6d.以双侧动脉夹放开时间为基准点,分别在放开后6h、1d、3d、7d运用正电子发射断层显像(PET)观察脑梗死体积变化,用免疫组织化学方法观察脑组织VEGF的表达,每次的观察时间点均设在腹腔注射前.结果 对照组脑内再灌注面积无明显异常;与对照组比较,损伤组与治疗组沙土鼠在再灌注后各时间点的脑内灌注面积明显缩小(P<0.01);与损伤组比较,治疗组在再灌注后6h脑内灌注面积无差异,但在1d、3d、7d时明显增加(P<0.01).对照组脑内可见少量的VEGF阳性细胞表达.损伤组沙土鼠在再灌注6h即有VEGF阳性表达,随再灌注时间延长,表达逐渐增强,于再灌注3d时表达最强,以后缓慢下降,至7d时仍有部分表达,与再灌注6h时比较,有显著差异(P<0.01).表达细胞主要为神经胶质细胞和巨噬细胞,其次为神经细胞及血管内皮细胞.治疗组VEGF的表达趋势与损伤组相似,但在再灌注后各时间点的VEGF表达均较损伤组强(P<0.01).结论 咪唑安定5mg/(kg·d)可减少沙土鼠脑缺血再灌注损伤后脑梗死的体积,促进脑缺血再灌注损伤中内源性VEGF的表达,并由此可能对损伤后神经功能中远期的恢复产生影响.     

Osteopontin inhibits macrophage nitric oxide synthesis to enhance tumor proliferation

BACKGROUND: Interactions between tumor cells and their host environment can play a major role in regulating survival programs required for tumor progression. Osteopontin (OPN) is a glycophosphoprotein overexpressed by tumors, and is a key molecule for tumor progression and metastasis. OPN also inhibits expression of autocrine and paracrine inducible nitric oxide synthase (iNOS). Given the cytotoxic effects of macrophage NO expression, we hypothesized that tumor-derived OPN inhibits expression of local macrophage iNOS to potentiate tumor survival. METHODS: We used a coculture system of murine CT26 colorectal cancer cells with RAW264.7 murine macrophage cells. CT26 expresses OPN at high levels. RNA interference was utilized to produce long-term specific silencing of OPN in CT26. RESULTS: Inhibition of constitutive OPN synthesis in CT26 upregulates local NO production with inhibition of CT26 proliferation and promotion of CT26 apoptosis. Macrophage iNOS expression is accompanied by increased binding activity of nuclear factor-kappaB DNA. When the CT26 culture media were examined for a panel of proinflammatory cytokines, elevated concentrations of granulocyte colony-stimulating factor (G-CSF) were found. Subsequently, in CT26 cells treated with antisense-G-CSF, NO levels in CT26-RAW cocultures were significantly decreased. CONCLUSION: In our system of CT26-RAW264.7 coculture, we conclude that inhibition of OPN synthesis in CT26 results in G-CSF-mediated induction of macrophage iNOS expression with resultant inhibition of CT26 proliferation via increased apoptosis. Our results suggest that tumor-derived OPN may enhance tumor survival by down regulating expression of NO in the local microenvironment. This is one mechanism by which OPN may potentiate cancer survival and progression.     

不同黏度骨水泥椎体成形术治疗骨质疏松性椎体压缩性骨折

目的 比较采用高黏度骨水泥和低黏度骨水泥椎体成形术治疗骨质疏松性椎体压缩性骨折的临床疗效差异.方法 回顾性分析2013年9月至2014年11月我科治疗的83例骨质疏松性椎体压缩性骨折病人的病例资料.根据手术所用不同黏度骨水泥分组:采用低黏度骨水泥椎体成形术治疗的病人43例(低黏度组);采用高黏度骨水泥椎体成形术治疗的病人40例(高黏度组).记录单个椎体手术时间、骨水泥渗漏发生率,术后并发症发生率.采用疼痛视觉模拟量表(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI)对两组进行术前及术后1 d、术后3个月疼痛及功能进行评价.通过X线检查对术前、术后椎体各部进行测量,统计椎体高度变化.结果 83例病人术后均得到3个月随访.两组术前VAS评分和骨折压缩率上无差异.高黏度组的手术时间较低黏度组明显缩短(t=22.32,P=0.000).术后1 d、术后3个月,两组组内VAS评分、ODI较术前明显降低(均P=0.000),但术后组间比较无明显差异(均P>0.05).高黏度组骨水泥渗漏率较低黏度组低,差异有统计学意义(P=0.0494).椎体成形术后高黏度组椎体高度恢复优于低黏度组,差异有统计学意义(P=0.000).结论 椎体成形术中使用不同类型的骨水泥均能有效地缓解病人疼痛,改善生活质量.与低黏度骨水泥相比,高黏度骨水泥有着较低的骨水泥渗漏率,同时缩短了手术时间和降低了术中放射性的暴露.     

Randomized comparison of the effectiveness of nasal intubation using a GlideScope video laryngoscope with Magill forceps <Emphasis Type="Italic">versus</Emphasis> vascular forceps in patients with a normal airway

Purpose

The GlideScope^® video laryngoscope (GVL) is widely used for nasotracheal intubation in dental and facial plastic surgery. The angle of the Magill forceps is different from that of the GVL blade, which suggests that the Magill forceps are not the ideal forceps for use with the GVL. The purpose of this study was to compare the effectiveness of the Magill forceps vs vascular forceps for nasotracheal intubation using the GVL.

Methods

This study included 60 patients scheduled to undergo elective surgery requiring nasotracheal intubation. Patients were assigned to one of two groups—i.e., Magill forceps (group M) or vascular forceps along with a tube exchanger (group V), by computer randomization. The primary outcome was total intubation time, defined as the time from when the anesthesiologist picked up the device to the time when three successive end-tidal CO₂ waves were obtained following intubation. Secondary outcomes were blood in the endotracheal tube and trauma to the oral tissues or teeth. A blind observer assessed the presence of sore throat one hour and 24 hr after surgery.

Results

The total intubation time was significantly different between group M and group V (96.1 sec and 78.1 sec, respectively; mean difference, 18 sec; 95% confidence interval (CI), 13.7 to 49.7). The incidence of epistaxis in group M was significantly greater than that in group V (46.7% vs 16.7%, respectively; relative risk, 2.8; 95% CI, 1.2 to 6.8).

Conclusion

The total intubation time was significantly less with the vascular forceps (and tube exchanger) than with the Magill forceps. Using vascular forceps also reduced the incidence of epistaxis compared with that using the Magill forceps. Using a tube exchanger and vascular forceps offers advantages over use of Magill forceps when a GlideScope video laryngoscope is used for nasotracheal intubation.Trial registration: http://www.who.int/ictrp/network/cris2/en/, CRIS, KCT0001310. Registered 29 July 2014.

     

四肢高压电烧伤创面的早期处理

目的 总结四肢高压电烧伤创面早期治疗的临床经验.方法 选择2003年1月-2010年12月笔者单位收治的四肢高压电烧伤患者54例,其中男50例、女4例,年龄10～56岁;共有97个患肢,其中上肢67个、下肢30个,致伤部位包括腕及前臂、前臂和肘部及上臂、肩腋部、踝足部、小腿、膝周、大腿及腹股沟,共119处.伤后1～10 d手术,创面切开减张,待患者全身情况相对稳定行下述处理.(1)16个肢体(16处受伤部位)行截肢术,其中5个前臂坏死且肘及上臂受损的上肢行前臂截肢(保留肘关节),并用带蒂背阔肌肌皮瓣修复前臂残端、肘部及上臂创面;1个上臂截肢(保留肩关节)后用带蒂背阔肌肌皮瓣修复残端.(2)95处受伤部位及早清创后用各种血运丰富的组织瓣覆盖.其中5个腕部电烧伤创面行桡动脉重建3个、静脉重建1个、桡动脉及静脉重建1个,1处肘部肱动脉损伤病例行血管重建.(3)8处受伤部位行植皮手术进行修复.统计本组患者术后创面愈合情况,并随访.结果 本组16个肢体截肢术后切口均愈合.5个行血管重建的腕部电烧伤创面,手部供血和(或)静脉回流得以恢复;1例肱动脉损伤病例行动脉重建后血运良好,避免了截肢.5处受损部位组织瓣移植术后远端坏死,其中2处去除坏死组织后予以缝合,3处清创后植皮,创面均愈合.组织瓣下感染8处,其中腕部5处、肘部1处、踝足部2处,经掀起皮瓣或断蒂时再扩创缝合,创面愈合.其余组织瓣均愈合良好.8处受损部位行植皮术后,部分坏死2处,经补植皮片后愈合;其余6处直接愈合.37例患者随访6~12个月,皮瓣外形及质地良好.结论 早期行肢体切开减张、清创、血管重建以及采用修复重建外科技术,是治疗四肢高压电烧伤创面并重建肢体功能、减少截肢率的合理选择.

Abstract：

Objective To summarize the experience of early treatment of high-voltage electric burn wounds in the limbs. Methods Fifty-four patients (50 males and 4 females,aged from 10 to 56 years) with high-voltage electric burn wounds in 97 limbs (67 upper limbs and 30 lower limbs) were hospitalized in our burn wards from January 2003 to December 2010. A total of 119 burn wounds in wrist-forearm,forearm-elbow-upper arm,shoulder-axillary region,ankle-foot,lower leg,around the knee,thigh-inguinal region were treated with incision for decompression within 10 days after burn. Under the premise of relatively stable systemic condition of the patients,certain surgical operations were performed as follows. (1) Sixteen limbs with 16 wounds were amputated,among them forearm amputation was performed for 5 upper limbs with necrosis,with preservation of elbow joints,and the residual wounds of the elbow and upper arm were repaired with pedicled latissimus dorsi musculo-cutaneous flaps;1 upper limb with upper arm amputated,with preservation of shoulder joint,was repaired with pedicled latissimus dorsi musculo-cutaneous flap. (2) Ninety-five wounds were covered with various tissue flaps with abundant blood supply after early debridement,in which 3 brachial arteries,1 vein,1 brachial artery and vein were reconstructed in 5 wrist wounds,artery reconstruction was performed in elbow wound of 1 case with injured brachial artery. (3) Eight wounds were treated with free skin grafting. Wound healing conditions were observed and followed up. Results Wounds in 16 limbs healed after amputation and repair. Blood supply and (or) venous return of hands were restored in 5 wrist wounds after vessel reconstruction. After artery reconstruction,abundant blood supply was observed in 1 case with injured brachial artery and amputation was avoided. Necrosis occurred in distal parts of tissue flaps in 5 wounds after grafting,in which 2 wounds healed after removal of necrotic tissue followed by closure with suture,and 3 wounds healed after debridement and free skin grafting. Tissue flap infection occurred in wrist (5 wounds),elbow (1 wound),ankle-foot (2 wounds),and healed after debridement and suture. The other tissue flaps survived after grafting. Six wounds healed after skin grafting. Partial necrosis occurred in 2 wounds after skin grafting,and they were healed after second skin grafting. Thirty-seven patients were followed up for 6 to 12 months,the skin flaps survived with satisfactory appearance and texture. Conclusions Early extensive compartment release through fasciectomies and escharectomies,early debridement,early vascular grafting,early wound coverage with contemporary reparative and reconstructive surgical techniques are rational options for the treatment of high-voltage electric burns in the limbs.     

妊娠期妇女体质量自我管理的定性用户画像研究

目的 探究妊娠期妇女体质量自我管理特征及人群差异,为制定针对性干预措施提供参考。方法 采用目的抽样法选取15名孕产妇进行半结构式访谈,通过Colaizzi 7步法分析资料;基于自我管理理论,人工抽取妊娠期妇女体质量自我管理特征构建画像,采用词云与表格形式完成画像的可视化。结果 提取5个特征：基本特征、认知特征、行为特征、社会支持特征、心理调适特征;构建4类妊娠期妇女体质量自我管理的典型画像：自主自律型、无能为力型、放任无为型、盲目实践型。结论 妊娠期妇女体质量自我管理存在较大的群体差异性,可根据不同的用户画像群体特征,给予个性化、精准化的管理方案。