Objective To evaluate the effects of therapy with small volume of different fluids on renal blood flow in endotoxemia rats.Methods Thirty parthogen-free SD rats weighing 180-250 g were randomly divided into 5 groups (n = 6 each):group Ⅰ control; group Ⅱ LPS; group Ⅲ LPS + 7.5 % hypertonic saline (HS);group Ⅳ LPS + hydrozyethly starch (HES) 130/0.4 and groupⅤ LPS + hypertonic saline plus hydroxyethly starch (HS-HES) 40. The animals were anesthetized with intraperitoneal 3% pentobarbital 40 mg/kg. Left carotid artery was cannulated for BP and HR monitoring and fluid administration. In groupⅡ-Ⅴ LPS 1 mg/kg was administered via arterial cannula. In group Ⅲ, Ⅳ and V 4 ml/kg of 7.5% HS, HES 130/0.4 AND HS-HES 40 were administered via arterial cannula respectively at 30 min after LPS administration.In groupⅠ and Ⅱ normal saline 4 ml/kg was given insteadt. Renal blood flow was measured with Doppler ultrasound before LPS (T1 ,baseline), at 30 min after LPS (T2), 10, 30 and 60 min after fluid therapy (T3, T4, T5). The animals were then sacrificed and both kidneys were removed for microscopic examination with light microscope. Results Renal blood flow was significantly decreased and was significantly recovered to some extent by therapy with different fluids especially with HS-HES 40 in group Ⅴ. Conclusion Therapy with small volume of HS,HES or HS-HES could increase renal blood flow and inprove renal microcirculation especially HS-HES.

Objective To investigate the protective effects of astragalus preconditioning on the tolerance of ischemia time of mouse small intestine . Methods C57BL/6 mice were randomly divided into 5 groups (n = 7): sham operation group (Sham group),intestinal ischemia reperfusion group (IR group) and astragalus preconditioning group (ASIR group). IR group and ASIR group include 2 sub-groups respectively, specifically, 2 h reperfusion was performed 45 min (ASIR1) and 60 min (ASIR1) after blocking superior mesenteric artery. Intestinal terminal morphology was observed by light microscope after HE coloration . Serum levels of LPS , DAO and intestinal mucosa TNF-α were measured by ELISA. Intestinal Cyto C expression were detected by immunofluorescence. Results Astragalus preconditioning reduces Chiu′s score significantly. Expression of Cyto C was significantly down-regulated in astragalus preconditioning groups, and levels of LPS, DAO and TNF-αsignificantly decreased. The damages in IR2 group is obviously severe than in IR1, but there were no significant differences between this two groups after pretreatment with astragalus. Conclusion Astragalus preconditioning has obvious protective effects to intestinal ischemia reperfusion, and enhances the tolerance to longer time of ischemia.

Objective To observe the ultrasonic features of cystic renal cell carcinoma. Methods Ultrasonic features of 18 patients of cystic renal cell carcinoma confirmed with operation and pathology were analyzed retrospectively.Results Among 18 patients, 7 were clear-cell carcinoma of cystis degeneration, 5 were cystic renal cell carcinoma (clear cell type), 3 were multilocular renal cell carcinoma, 1 was corpora mammillaria renal cell carcinoma, and one clear-cell carcinoma was on capsule wall of cyst and 1 was nephroblastoma. Ultrasound diagnosed 15 patients and misdiagnosed 3 with a diagnostic rate of 83.33%.Conclusion Cystic renal cell carcinoma has specific ultrasonic characteristics, and having an intimate knowledge of these characteristics may be helpful to diagnosis.

AIM: To study the changes of serum levels of thromboxane A_2(TXA_2) and prostacyclin(PGI_2) in cirrhosis patients during liver transplantation.METHODS: Samples were obtained from 24 cirrhosis patients in end at five time points during liver transplantation.TXA_2 and PGI_2 level were measured by radioimmunoassay.Arterial and mixed venous blood samples used for blood gas analysis were taken at the same time.Intrapulmonary shunt(Qs/Qt) was calculated according to the standard formula.The hemodynamics parameters including continuous cardiac output index(CI),HR,mean artery blood pressure(MABP),MPAP,CVP,PAWP,SVRI,PVRI were measured during liver transplantation.RESULTS:(1) MABP decreased significantly in the early stage of anhepatic period and neohepatic period.(2) CVP,MPAP and PAWP decreased significantly during anhepatic period.They increased significantly after graft reperfusion and remain the high level.(3) CI declined significantly during anhepatic period and increased at 10 min postreperfusion of new liver.(4) SVRI and PVRI increased during anhepatic period and were higher than baseline level at 15 min after reperfusion.SVRI was lower than baseline level at 30 min after reperfusion.(5) Compared with the baseline level,6-keto-PGF1? and TXB_2 increased significantly.Compared with the level before vascular cross-clamping,6-keto-PGF1? decreased during neohepatic period and it had significant difference in statistics at the end of operation.CONCLUSION: Serum levels of TXA_2 and PGI_2 significantly change during liver transplantation and may affect the system and pulmonary circulation to some extent.

AIM: To study the changes of serum levels of nitric oxide (NO) and nitric oxide synthase (NOS) in patients during liver transplantation. METHODS: Samples were obtained from 30 patients in end liver disease at five time points during liver transplantation. NO level and NOS activity were measured by radioimmunoassay and colorimetry, respectively. Arterial and mixed venous blood samples used for blood gas analysis were taken at the same time. Intrapulmonary shunt (Qs/Qt) was calculated according to the standard formula. The hemodynamics parameters including continuous cardic output (CO), HR, MABP, CVP, SVR were measured during liver transplantation. RESULTS: (1) NO_2-/NO_3-level at 10 min before anhepatic period was significantly higher than the baseline level. Compared with NO_2-/NO_3-level at 10 min before anhepatic period, NO_2-/NO_3-level at 30 min after anhepatic period was significantly decreased. NO_2-/NO_3-level at 30 min after neohepatic period was significantly higher than the baseline level and at 30 min after anhepatic period. (2) No significant change of tNOS activity was observed. Compared with the baseline activity of inducible nitric oxide synthase (iNOS), the activity at 10 min before anhepatic period and at 30 min after neohepatic period was significantly increased. The activity at 30 min after neohepatic period was significantly higher than that at 30 min after anhepatic period. (3) MABP decreased significantly when opening the inferior vena cava. CO and CVP decreased in the anhepatic stage and increased in the reperfusion stage. SVR increased during anhepatic stage and decreased significantly during neohepatic period. (4) Qs/Qt decreased significantly during anhepatic stage and increased significantly at 30 min after neohepatic period. CONCLUSIONS: Serum level of NO and NOS activity are significantly changed during liver transplantation. High level of NO may result in low systemic vascular resistance and increasing in intrapulmonary shunt.

Objectlve investigate the role of Toll-like receptor 2 (TLR2) on polymorphonuclear neutrophil (PMN) during perioperative period in the development of postoperative systemic inflammatory response syndrome (SIRS) in patients undergoing orthotopic liver transplantation (OLT).Methods Twenty patients (18 male and 2 female, aged 33-58 yr and weighing 52-73 kg) with ASA Ⅲ or Ⅳ (NYHA Ⅱ or Ⅲ )undergoing OLT were studied. Blood samples were collected from the central vein for determination of TLR2 expression on PMN and plasma TNF-α, IL-1β and IL-8 concentrations before induction of anesthesia (T1, baseline), at 25 min of anhepatic phase (T2), 3 h (T3) and 24 h after beginning of reperfusion of the allograft (T4). The expression of TLR2 was measured by flow cytometry and the serum concentrations of TNF-α, IL-1β and IL-8 were measured by enzyme linked immunosorbant assay (ELISA). The patients were divided into SIRS and non-SIRS group depending on whether the patients developed SIRS or not within 7 days after operation. The diagnosis of SIRS was based on the criteria laid down by ACCP and SCCM in 1992.Results Ten patients developed SIRS within 7 days after operation. There was no significant difference in Child-Turcotte-Pugh (CTP) scores between the two groups. Compared with non-SIRS group, the TLR2 expression on PMN and the serum IL-1β concentration were significantly increased at T4 and the serum IL-8 concentration was significantly increased at T3 in SIRS group.There was positive correlation between serum TNF-α concentration and TLR2 expression on PMN in SIRS group ( r= 0.607, P ＜0.05).Conclusion The expression of TLR2 on PMN increases significantly at 24 h after beginning of reperfusion of allograft and may play an important role in the development of postoperative SIRS.

Objective To evaluate the changes in the expression of small intestinal thioredoxin 2 (Trx2) during different periods after orthotopic liver autotransplantation (OLAT) in rats.Methods Forty Sprague-Dawley rats,aged 8-10 weeks,weighing 210-260 g,were randomly divided into 2 groups using a random number table:sham operation group (group S,n =8) and OLAT group (n =32).Intestinal tissues were removed at 4,8,16 and 24 h after OLAT for microscopic examination and for determination of the levels of superoxide anion (O2--),hydrogen peroxide (H2 O2),glutathione peroxidase (GSH-Px),reduced glutathione (GSH) and Trx2.Intestinal damage was assessed and scored according to Chiu.Results Compared with S group,the Chiu's score and O2--activity at 4,8 and 16 h after OLAT and H2O2 content at 4 and 8 h after OLAT were significantly increased,and the levels of GSH-Px and GSH and expression of Trx2 at 4 and 8 h after OLAT were decreased in OLAT group (P ＜ 0.05).Chiu' s score at 4,16 and 24 h after OLAT and H2O2 content at 16 and 24 h after OLAT were significantly lower than those at 8 h in OLAT group (P ＜ 0.05).Conclusion The rats undergo decreased antioxidant capacity in the early phase and recovery in the late phase mediated by small intestinal Trx2 after OLAT.

AIM: To investigate the effects of non-ventilated lung with N_2O on systemic oxygenation and lactic acid level in arterial blood during one lung anesthesia. METHODS: Twenty-two patients, ASA Ⅰ-Ⅲ, scheduled for selective pulmonary surgery, were randomly divided into two groups: control group (group A, n=11) and observation group (group B, n=11). Group A: the non-ventilated lung was kept open to the air; group B: N_2O 2 cmH_2O through CPAP system was insufflated into the non-ventilated lung during one lung ventilation. The anesthesia was induced with intravenous midazolam (0.05 mg?kg~(-1)), propofol (0.5-1.0 mg?kg~(-1)), fentanyl (4 ?g?kg~(-1)), and vecuronium (0.1 mg?kg~(-1)) and was maintained with inhaling isoflurane. Blood gas analysis and lactic acid was recorded 20 min after two-lung ventilation (TLV) in the supine position, 20 min after one-lung ventilation (OLV) in the supine position, 20 min and 40 min after OLV in the lateral position and at the end of operation and the shunt fraction was calculated. RESULTS: PaO_2 in group B was significantly higher than that in group A (P

OBJECTIVETo compare the safety of anastomosis and ostomy following 2-stage definitive colonic resection when severe colonic injuries treated in the setting of damage control surgery(DCS).

METHODSClinical data of 67 patients with severely traumatic colonic injuries undergoing DCS at the Third Affiliated Hospital of Sun Yat-sen University between 2005 and 2013 were analyzed retrospectively. Patients were divided into the anastomosis group undergoing colonic resection and anastomosis (n=40), and the ostomy group undergoing anastomosis with a protecting proximal ostomy (n=27). Postoperative complications were compared between these two groups. The risk factors of colonic anastomosis leakage were analyzed.

RESULTSDemographics, injury severity, physiological imbalance on admission, transfusion during the first operative procedure were similar in the two groups (all P>0.05). Rates of anastomotic leakage, intra-abdominal abscess, enterocutaneous fistula, and would infection after definitive resection were not statistically different between the two groups (all P>0.05). Colonic anasomotic leakage rates were 15.0% (6/40) in anastomosis group and 11.1% (3/27) in ostomy group without significant difference (P>0.05). Left-sided colon injuries occurred in 7 out of 9 patients with anatomotic leakage, whose proportion was significantly higher than that in those without anastomotic leakage (7/9 vs. 24/58, 77.8% vs. 41.4%, P<0.05). A prolonged peritoneal closure was also observed in patients with anastomotic leakage (median, 10 days vs. 2 days, P<0.05).

CONCLUSIONSA strategy of diverting ostomy is not the first choice for patients suffering from severe colonic injuries in the setting of DCS. Peritoneal closure at early stage may decrease the risk of colonic anastomotic leakage.

Abdominal Abscess ; Abdominal Injuries ; Anastomosis, Surgical ; Anastomotic Leak ; Colonic Diseases ; surgery ; Humans ; Postoperative Complications ; Retrospective Studies ; Risk Factors