Objective To evaluate the difference and correlation between ultrasonic cardiac output monitor (USCOM) and pulse indicated continuous cardiac output (PiCCO) monitor on determination of hemodynamic parameters in critical patients.Methods A prospective observation self-control study was conducted.The critical patients who need hemodynamics monitoring,and admitted to Department of Critical Care Medicine of Peking University People's Hospital from March 2013 to December 2015 were enrolled.Cardiac output (CO),cardiac index (CI),stroke volume (SV),and stroke index (SI) were determined by PiCCO using thermodilution method at immediately (0 hour) and 24 hours after successful location of PiCCO catheter for 3 times then the above indexes were measured with USCOM,and the average values were chosen for statistical analysis.The differences in above parameters between the two methods,and the correlation of the parameters monitored by two methods were evaluated by Pearson linear correlation method,the consistency test was conducted by Bland-Altman method.Results In 31 critical patients enrolled,there were 18 males and 13 females,aging 29-89 years old with the mean of (48.1 ± 36.3) years,body mass of (68.7 ± 17.5) kg,and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score of 21.2 ± 3.1.CO,CI,SV,and SI detected by USCOM were significantly higher than those detected by PiCCO [CO (L/min):6.32 ± 1.98 vs.5.86 ± 1.72,t =4.887,P =0.000;CI (mL· s-1· m-2):61.68 ± 20.17 vs.56.84± 17.34,t =5.189,P =0.000;SV (mL):61.9 ± 19.7 vs.57.0± 16.9,t =3.977,P =0.000;SI (mL/m2):36.84 ± 12.67 vs.33.33 ± 10.79,t =4.278,P =0.000].It was shown by correlation analysis that CO,CI,SV,and SI monitored by USCOM and PiCCO was positively correlated (R2 value was 0.795,0.798,0.837,and 0.827,respectively,all P =0.000).It was shown by Bland-Altman analysis that the mean CO change (ΔCO) from 0 hour to 24 hours was 0.1 L/min,and the 95％ confidence interval was-0.62 to 0.80.Conclusion There was significant difference in the comparison of hemodynamics parameters monitored by USCOM and PiCCO respectively in critical patients,the overall values monitored by USCOM were higher than those monitored by PiCCO monitoring,but the correlations were good.

Objective To identify the correlative and risk factors of non-oxygenation factors associated with postoperative prolonged mechanical ventilation (PMV) of aortic dissection(AD).Methods AD patients undergoing surgery during January 2010 and January 2015 were enrolled.Prolonged mechanical ventilation was defined that duration of ventilation more than 48 h.Results There were 240 patients,average age was (50 ± 12)years.The correlative factors with postoperative PMV were:pre-opervative white blood cell (WBC) (r =0.241,P =0.003),emergency operation (r =0.263,P =0.004),Debakey type (r =-0.379,P =0.000),duration of operation (r =0.329,P =0.000),postoperative diastolic pressure (r =-0.205,P =0.007),heart rate (r =0.246,P =0.001),postoperative hemoglobin (r =-0.213,P =0.005),calcium(r =-0.262,P =0.001),glucose (r =0.274,P =0.000),lactate(r =0.272,P =0.000) and pericardial effusion (r =0.239,P =0.032).Logistic analysis indicated that:the duration of operation,WBC and postoperative blood calcium were:2.063,1.285,0.016,respectivly(all P ＜ 0.05).Conclusions The correlative factors were:preoperative WBC,emergency operation,Debakey Type,duration of operation,heart rate,postoperative diastolic pressure,hemoglobin,calcium,glucose,lactate,and pericardial effusion.Duration of operation,WBC and postoperative blood calcium were risk factors predicting PMV.

ObjectiveTo manage the early immunosuppressant-associated hypertention in liver transplantation patients. MethodsFifty-six liver transplantations were performed from May 2000 to May 2002, their clinical feature (data of blood pressure and treatment) were analysed. ResultThe incidence of hypertension after liver transplantation was 70% in 2 weeks, 66% in one month. The incidence in cyclosporine group and FK506 group was 73% (31/40) and 33%(3/9) respectively(P

Objective To study the protective effect of interleukin-33 (IL-33) on mouse warm hepatic ischemia-reperfusion (I/R) injury.Methods On a mouse warm hepatic I/R injury model IL-33 mRNA and protein levels during hepatic ischemia and reperfusion period were determined,and then mice were divided into control group,model group,recombinant IL-33 intervention group and anti ST2L antibody intervention group,and mice were sacrificed after 6 hours of reperfusion.Serum aspartate aminotransferase (AST),alanine aminotransferase (ALT) protein levels were determined.Liver pathology was observed by transmission electron microscopy and serum cytokine level (tumor necrosis factor-α,interferon-γ,IL-4,IL-5,IL-13) were measured by flow cytometry CBA method.Results The level of IL-33 mRNA and protein were significantly higher in the reperfusion stage (t2 h =-3.574,t6 h =-4.147 ; P ＜ 0.05).After intervention by recombinant IL-33,the level of serum ALT and AST decreased significantly (tALT =4.592,tAST =3.471 ; P ＜ 0.05),the severity of pathological damage was reduced,the levels of IL-4,IL-5,IL-13 increased and that of IFN-γ decreased,with statistically significant difference in comparison with the control groups (tIL-4 =-4.995,tIL-5 =-4.584,tIL-13 =-4.431 ; P ＜ 0.05).Anti-ST2L antibody intervention effected the opposite.Serum TNF-α level did not change in intervention groups compared with that in model group (tTNF-α =0.261,P ＞ 0.05).Conclusions IL-33 mRNA and protein level increased in mice with hepatic I/P injury.IL-33 exerts a protective effect on the I/R injured liver after binding to its receptor ST2L.

[ Objective ] To screen the duck model with congenital infection of duck hepatitis B virus (DHBV) by polymerase chain reaction (PCR) method. [Methods] Serum DHBV-DNA level in one-day-old ducklings was detected by PCR method and was compared with that by Dot-blot method. Ducklings with serum DHBV-DNA being negative confirmed by PCR method were inoculated DHBV-DNA positive serum to establish acquired infection models. Pathological features of liver tissues in the congenital infec tion model and the acquired infection model were also observed. [Results] Sensitivity and specificity of PCR detecting serum DHBV-DNA were superior to those of Dot-blot method. In the congenital infection model, viremia maintained long time, the titer of serum DHBV-DNA was high and the inflammatory af fection in liver tissues was slight as compared with those in the acquired infection model. [Conclusion] The duck model with congenital infection of DHBV screened by PCR method is more suitable for the phar macological and pharmacodynamic research of drugs for chronic hepatitis B.

Objective To investigate the effects of tacrolimus on reperfusion injury in orthotopic liver transplantation.Methods The rat models of orthotopic liver transplantation were established.SD rats in experimental group(n=40)were injected with tacrolimus while control group(n=40)with normal saline.The serum levels of TNF-α,IL-1,ALT,AST,LDH,endothelin(ET)and malondialdehyde(MDA)were detected at 24,48,96 hours after reperfusion.Uhrastruetural changes and cellular apoptosis of liver and synthesis of mRNA of Fas and Bcl-2 were checked. According to the immunosuppression regimen,112 patients with end-stage liver cirrhosis were divided into tacrolimus group(n=63)and cyclosporin A group(n=49).The levels of hepatic enzymes and the rate of acute rejection in patients of the two groups after liver transplantation were compared.Results Levels of TNF-α,IL-1,AIJT,AST,LDH,ET and MDA in experimental group were significantly lower than those in control group(P＜0.05).Rats in experimental group had less Fas mRNA synthesis.minor liver ultrastructure lesion and cellular apoptosis than control group.Compared with cyclosporin A group,acute rejection was decreased in tacrolimus group(x2=39.0,P＜0.05).Conclusions Tacrolimus may lessen reperfusion injury and cellular apoptosis in rat orthotopic liver transplantation,and it may also alleviate reperfusion injury in human liver transplantation and reduce the rate of acute rejection.

Objective To evaluate the recovery of normal splenic function of hyperplenism in patients of liver transplantation. Methods In this study,93 liver transplant patients(all with pretransplant hypersplenism)were divided into group in which the platelet count become normal and the group in which the platelet count failed to recover. Results Hypersplenism disappeared after transplantation in 60 patients(64.5%),hypersplenism after transplantation persisted in 33 patients (35.5%);the portal vein pressure in new liver period,the splenic veinous blood flow after transplantation and the size of spleen were all significantly different between the two groups.The platelet count on three months after operation significantly correlates with pretransplant platelet count,the size of the spleen,the portal vein pressure in new liver phase and the posttransplant size of spleen.Conclusions The persistence of hypersplenism after liver transplantation is common,in may correlate with an unsatisfactory fall in portal pressure after transplantation,characteristics of splenomegaly and poor splenic venous blood flow.

Objective To evaluate the pre- and intra-operative risk factors associated with delayed weaning from ventilator during the early postoperative period in patients undergoing liver transplantation.Methods Two hundred and twelve patients (152 male, 60 female) aged 22-69 yr undergoing liver transplantation from Sept 2004to Aug 2006 were enrolled in this study and were divided into 2 groups according to the time when the patients were weaned from ventilator: normal weaning group (Group A, the patients weaned from ventilator within 24 h after operation) and delayed weaning group (Group B, the patients weaned from ventilator more than 24 h after operation). Routine anesthesia wes performed. Blood and blood products were transfused according to the guidelines for blood transfusion to maintain the mean arterial pressure (MAP)≥60 mm Hg during operation. Sixteen preoperative variables (age＞64 yr, gender, BMI ≥ 30kg/m2, PaO2＜75 mm Hg,pleural effusion, a history of asthma, smoking, drinking alcohol, coronary artery disease, diabetes mellitus, encephalopathy＞grade 3, spontaneous bacterial peritonitis, preoperative MELD score, serum albumin, ascites≥20 ml/kg and moderate hepatopulmonary hypertension) and 7 intraoperative variables (duration of operation, duration of anhepatic stage, transfusions of RBC,fresh frozen plasma (FFP), crystalloid and colloid, and urine output＜ 1 ml·kg-1·h-1) were recorded and compared between the two groups.Results There were significant differences in 9 preoperative variables (age ＞ 64 yr, PaO2＜75 mm Hg, pleural effusion,encephalopathy＞grade 3, spontaneous bacterial peritonitis, preoperative MELD score, serum albumin, ascites≥20 ml/kg and moderate hepato-pulmonary hypertension) and 5 intraoperative variables (transfusions of RBC, FFP, crystalloid and colloid, and urine output＜1 mi·kg-1·h-1) between the two groups (P＜0.05 or 0.01). And logistic regression analysis showed that 5preoperative variables (age＞64 yr, PaO2＜75 mm Hg, encephalopathy ＞ grade 3, preoperative MELD score, and moderate hepato-pulmonary hypertension) and 2 intraoperative variables (transfusion of RBC and urine output＜1 ml·kg-1·h-1) were confirmed to be associated with delayed weaning from ventilator.Conclusion Such variables es age ＞ 64 yr, preoperative PaO2 ＜ 75 mm Hg, encephalopathy ＞ grade 3, preoperative MELD score, moderate hepato-pulmonary hypertension, transfusion of RBC during operation and urine output ＜ 1 ml· kg-1 · h-1 are associated with delayed weaning from ventilator during early postoperative period after liver transplantation.

Objective To analyze the role of continuous renal replacement therapy(CRRT) in the prevention of renal failure in perioperative patients undergoing orthotopic liver transplantation. Methods The clinical data of renal function were reviewed in 21 liver transplantation patients receiving CRRT during perioperative period. Results Serum Cr level decreased after CRRT in all 21 patients; The overall mortality in this group was 38.1%. The mortality rate was 8.3% in the 12 cases in whom the renal function recovered, and that was 77.8% in the 9 cases in whom the renal function did not recover (?~2=5.838,P

Objective To investigate the timing, target and method for the treatment of preoperative coagulopathy in patients undergoing orthotopic liver transplantation. Methods We retrospectively assessed 168 adult patients undergoing orthotopic liver transplantation from 2002 to 2004. Preoperative prothrombin time(PT) , prothrombin activity (PTA) , international normalizing ratio(INR) , activated partial thromboplastin time(APTT) , fibrinogen (FIB) , and platelet count (PLT) were assessed. The relationship between PTA and intraoperative blood loss or use of blood product, preoperative plasma exchange and intraoperative blood loss or use of blood product were analysed. Results Preoperative normocoagulation significantly decreased intraoperative blood loss and blood product' s requirement. PTA level was in negative correlation with intraoperative blood loss and blood transfusion. Preoperative plasma exchange effectively reduced intraoperative bleeding and blood product's requirement. Conclusion Aggressive coagulatory therapy should be adopted to improve coagulation condition in order to reduce intraoperative blood loss and blood product's requirement.