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Objective:To compare the histological differences between magnetic anastomosis and traditional suture in canine portal vein (PV) .Methods:Eighteen healthy Chinese garden dogs, either gender, 8-12 months and weighing 13.5-18.9 kg, were randomly divided into magnetic compressive anastomats (MCA) group ( n=9) and hand-sewing (HS) group ( n=9) for PV reconstruction. The time of PV anastomosis was compared between the two groups. HE and Masson staining were performed immediately and at 4, 8, 12 and 24 weeks after operation. The ultrastructure of the anastomosis was observed using scanning and transmission electron microscopy. Results:All dogs survived. The PV anastomosis time was significantly shorter in MCA group (3.58±2.75) min than that HS group (12.89±3.12) min, P<0.01. In MCA group, the vascular wall of anastomotic stoma was well aligned immediately after operation, and the shrinkage was obvious in HS group by gross eyes. At 24 weeks, electron microscope scanning showed the re-endothelialization was smooth and endothelial cells arranged regularly at the anastomotic site of the MCA group, whereas different-sized and irregularly aligned endothelial cells and large collagenous fibers arranged in disorder were present at the HS anastomotic stoma. Representative HE and Masson staining confirmed that the magnetic device was associated with decreased infiltration of inflammatory cells and deposition of fibrotic collagen at 24 weeks explanted anastomotic stomas compared with the HS group. Conclusions:Compared with the HS, MCA produced shorter anastomosis time, smooth anastomotic intima, light fibrous tissue hyperplasia, no foreign body residue, mild inflammatory reaction and reliable technique for canines PV anastomosis.
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Objective:To invent a set of novel magnetic anastomotic device based upon the technique of magnetic compression anastomosis(MCA)for rapid venous reconstruction during ex situ liver resection, and verify its clinical value and performance in animal models. Methods:Fiften adult mongrel dogs of either gender underwent the ex situ liver resection. The novel magnetic vessel anastomosis device for the venous reconstruction of liver autotransplantation procedure was performed on 8 mongrel dogs(MCA group), and the traditional handsewing technique was used on 5 additional dogs(THS group). Time for completing venous reconstruction and time of venous anastomosis, venous velocity, intraoperative and postoperative survival and complications were recorded. Patency was detected via color Doppler ultrasound scans and X-ray cholangiography after surgery. The changes of intestinal lumen and kidney were also observed. Results:The time required to perform IVC and PV reconstruction for liver autotransplantation was significantly shorter for the magnetic vessel anastomosis device(9.5±2.5) min than for THS(30.7±3.4) min. There was significant difference in anhepatic period( P=0.0000). After operation, except one died, other nine animals in group A survived after operation but all five cases died in the THS group during liver autotransplantation. Vascular X-ray angiography and color Doppler ultrasound found blood flow MCA group normal, and there wasn't stoma stenosis. Conclusions:MCA technique could be fast and efficacious to complete venous reconstruction for liver autotransplantation in ex situ liver resection operation, and helpful to reduce organ ischemia-reperfusion injury.
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Ischemia-reperfusion (IR) injury is a major cause of clinical emergencies during and after surgical procedures.Propofol protects the heart from cardiovascular IR injury by inhibiting autophagy. MicroRNAs (miRNAs)participate in anesthetic-regulated cardiovascular injury. MiR-20b-5p targets unc-51-like autophagy activatingkinase 1 (ULK1). Its role in propofol-modulated cardiovascular IR injury remains unclear, however. In thisstudy, we used an in vitro model of hypoxia-reoxygenation (HR)-induced injury to human umbilical veinendothelial cells (HUVECs) to determine the protective effect of miR-20b-5p in cells preconditioned withpropofol. We found that miR-20b-5p was significantly higher and ULK1 was lower in propofol-preconditionedHUVECs with HR injury than in HUVECs with HR injury only. Additionally, miR-20b-5p overexpressionincreased cell viability and repressed autophagy and apoptosis more in propofol-preconditioned HUVECs withHR injury than in HUVECs with HR injury only. A luciferase reporter assay confirmed the target reactionbetween miR-20b-5p and ULK1. Overexpression of ULK1 restrained the protective effect of miR-20b-5p inpropofol-preconditioned HUVECs with HR injury. In conclusion, our results indicate that propofol inhibitsautophagic cell death via the miR-20b-5p-ULKI axis and that ULK1 may be a therapeutic target for cardiovascular IR injury
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Objective To investigate the effect of peginterferon alfa-2a injection (PEG-IFNα-2a) combined with ribavirin (RBV) in the treatment of chronic hepatitis C virus (1b) in patients with chronic hepatitis C. Methods The clinical data of patients with type 1b chronic hepatitis C in our hospital from May 2010 to October 2015 were retrospectively analyzed. According to the method of treatment, the patients were divided into IFNα-2a combined with RBV group and PEG-IFNα-2a combined with RBV group. The rapid virologic response (RVR), early virologic response (EVR), and sustained virologic response (SVR) rate were observed in the two groups. The liver function, expressions of CD4+T and CD8+T cell of peripheral blood and the incidence of adverse reaction were compared between the two groups before and after treatment. Results The RVR, EVR, SVR of two groups was no significant difference (χ2=0.641, 0.946, 0.154, P=0.423, 0.331, 0.694). After treatment, the levels of ALT , AST, DBIL and TBIL in PEG-IFNα-2a combined with RBV group were lower than those in IFNα-2a combined with RBV group (P<0.05). Of the PEG-IFNα-2a combined with RBV group, the CD4+T level was lower and the CD8+T level was higher than that in PEG-IFNα-2a in the combined Leigh Bhave Lin group were lower than that in the IFNα-2a level was lower IFNα-2a combined with RBV group(P<0.05). There was no significant difference in the incidence of influenza-like symptoms, marrow suppression, somnolence and abnormal laboratory indexes between two groups. Conclusion PEG-IFN alpha -2a combined with RBV has a good therapeutic effect on type 1b chronic hepatitis C virus, and has good safety and clinical application value.
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Objective To compare the effects of intraoperative anesthetic management on im-mune function between enhanced recovery after surgery (ERAS)and traditional approach in laparo-scopic rectal surgery.Methods Clinical data of 90 laparoscopic rectal surgery in Shanxi Provincial People’s Hospital from January 2013 to January 201 5 were prospectively analyzed.90 cases (male 5 1 cases,female 39 cases,aged 48-70 years,ASA grade Ⅰ-Ⅲ)were randomly divided into two groups (n = 45 each)using a random number table:ERAS group (group A,n = 45 )and control group (group B,n = 45 ).In group A patients were treated with epidural general anesthesia,maintaining perioperative normothermia,perioperative goal-directed fluid therapy and patient controlled epidural analgesia,while in group B routine anesthetic management and patient controlled intravenous analgesia were used.The levels of blood CRP and IL-6,CD3 + ,CD4 + ,CD8 + ,CD4 +/CD8 + on the first day before operation,the first day and the third day after operation were recorded.Results The blood CRP and IL-6 levels in two groups were increased on the third day after operation(P <0.05), however the increase was more significantly in group A than in group B (P <0.05).Compared with the first day before operation,CD3 + ,CD4 + ,CD8 + and CD4 +/CD8 + levels in two groups were de-creased on the third day after operation(P <0.05),on the third day group A decreased significantly, which was more than that in group B(P <0.05).Conclusion In the relief of operative stress and the protection of immune function through enhanced recovery after surgery in anesthetic management.
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BACKGROUND:Chitosan and sodium hyaluronate are two kinds of anti-adhesion materials commonly used, but there are relatively few reports on their anti-adhesion effects in obstetrics patients. OBJECTIVE:To explore the anti-adhesion effects of chitosan and sodium hyaluronate in obstetric patients. METHODS:Totaly 180 cesarean section patients, aged 23-39 years, were equaly divided into control group, chitosan group and sodium hyaluronate group according to treatment methods. Patients in the control group were given the routine cesarean section; patients in the chitosan and sodium hyaluronate group were respectively given local smearing of chitosan and hyaluronate sodium. At 1 day after operation, the levels of serum interleukin-6, interleukin-10, tumor necrosis factor-α and C-reactive protein were determined in the three groups. Then, the patients were folowed up for 1 month to observe the occurrence of postoperative adhesion and complications. RESULTS AND CONCLUSION:The incidence rate of postoperative adhesions was lower in the chitosan and sodium hyaluronate groups than the control group (P < 0.05). The levels of serum interleukin-6, interleukin-10, tumor necrosis factor-α and C-reactive protein were also lower in the chitosan and sodium hyaluronate groups than the control group (P < 0.05). In addition, the incidence rates of postoperative infection, bleeding and pain were lower in the chitosan and sodium hyaluronate groups than the control group (P < 0.05). However, there was no difference between the chitosan and sodium hyaluronate groups. These findings indicate that the chitosan and sodium hyaluronate are both effective against postoperative adhesions in cesarean section patients, and reduce the incidence of complications.
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Objective To investigate the genotypes of host killing genes and their single nucleotide polymorphisms (SNPs). Methods Three hundred and twenty strains of Escherichia coli that collected from the First Affiliated Hospital of Wenzhou Medical College were analyzed. The first sample ( E1 ) contains 160 strains isolated during the years from 2002 to 2003. The second sample (E2) contains 160 strains covering the years from 2008 to 2009. The plasmids of Escherichia coli were extracted by alkaline lysis method. Solexa/Illumina sequencing technology was used to sequence plasmids metagenome. Solexa Genome Analysis System and Soap programs were used to analyze gene distribution, SNPs and lineage-specific mutations. Results 11 077 768 reads were generated and 0. 045% of them can map to the reference sequences from El sample. Whereas 9 377 792 reads were generated and 0. 053% of which mapped to the reference from E2 sample. There are nine host killing genes identified in the two samples, of which hok gene is the most prevalent. A total of 29 SNP sites dispersed in five genes of the two samples. Approximately 33% of them were non-synonymous mutations. One position of A and G is the most prevalent polymorphism. Conclusion The known nine genotypes of host killing genes were all identified in plasmids of Escherichia coli in Wenzhou. hok gene showed the highest frequency. There were SNPs in five genotypes.
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Objective To establish a model of rat orthotopic liver transplantation and investigate the relationship among cold preservation time, activation of nuclear transcription factor-κB (NF-κB) and donor preservation injury after liver transplantation. Methods Orthotopic liver transplantation was performed in Wistar rats which were randomly divided into the following groups according to the different duration of liver cold storage in UW solution: group A (sham operation, n=10), group B NF-κB in liver before and after transplantation was measured by electrophoretic mobility shift assays; protein expression of tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β) in the liver was measured by immunohistochemistry; the serum TNFα and IL-1β, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and hepatic cell apoptosis were examined. Results With extended cold storage duration, the activity of NF-κB in the donor liver increased (P<0.05, group D vs. groups A, B and C). TNF-α and IL-1β levels also increased (P<0.05, group D vs. groups A, B and C). Donor liver reperfusion injury was gradually aggravated with the prolonging of graft cold preservation. Both the serum TNF-α and IL-1β levels increased highly (P<0.05 group A vs. groups B, C and D),NF-κB in the liver significantly increased (P<0.05, group A vs. groups D, B and C) with gradual prolonging of graft cold preservation time. The serum ALT and AST level and apoptosis index level elevated greatly (P<0.05, group A vs. groups D, B and C). Conclusion NF-κB of donor liver was activated inductively in cold preservation phase and activated explosively in reperfusion phase. The longer cold preservation time was, the higher NF-κB level in donor liver became. NF-κB led to the expression of TNF-α and IL-1β in donor liver. Inflammatory factors are one of the most important mechanisms for the donor liver injury after liver transplantation.
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Objective To summarize our experiences in the diagnosis and treatment of traumatic splenic rupture (TSR), in order to improve the diagnosis and treatment effect of TSR. Methods Retrospective (analysis) of the diagnosis and treatment of 184 patients with traumatic splenic rupture in recent 9 years was made. Results The preoperative correct diagnosis rate was 96.7% and was established on the history of (injury), clinical presentation, abdominal paracentesis, abdominal ultrasonography and CT. All the 34 of (patients) treated nonoperatively were cured. Of the 150 patients treated by operation, two died during operation and 148 patients were cured. Conclusions Combination of obtaining a detailed history of injury, physical examination, abdominal paracentesis, abdominal ultrasonography and CT can improve the accuracy rate of (preoperative) diagnosis.Under the ensurrance of the safety of the patients' life, preservation of the spleen should be performed if possible, especially for children. Both splenorrhaphy with or without ligation of splenic artery are simple, safe and effective methods to salvage the spleen.