Objective To assess the effect of continuous low-dose infusion of adenosine on hepatic arterial flow (HAF) of patients with liver graft during surgery.Methods From Jan 2009 to Aug 2009,44 patients underwent orthotopic liver transplantation (OLT).10 patients were enrolled to receive adenosine treatment and 34 patients served as controls.Following arterial reperfusion,a 16G central venous catheter was placed into the gastroduodenal artery and adenosine was continuously infused at doses ranging from 0.7 to 4.2 μg · kg-1 · min-1 for 30 min.HAF and portal vein flow (PVF) were measured using a real-time time flow meter prior to,during and 10 min after adenosine infusion.Data on gender,age,postoperative hospital stay,ICU stay,hepatic biochemical indicators and 1-year survival rate were compared between the two groups.Results Adenosine significantly increased HAF at doses from 1.4 to 2.8 μg · kg-1 · min-1 Doses ＞2.8 μg · kg-1 · min-1 did not further increase HAF.HAF increased by 150.3％ ± 161.2％ (P ＜0.05) while PVF showed no significant changes (P ＞ 0.05) during adenosine infusion.No significant differences were found on MAP [(85.6 ± 13.0) vs 84.0 ± 13.6,P ＞0.05] and HR [(74.5 ± 10.0) vs (74.1 ± 9.6),P ＞ 0.05] before and after adenosine infusion.In addition,there were no significant differences between the adenosine group and the control group on patients' gender,age,postoperative hospital stay,ICU stay,hepatic biochemical indicators and 1-year survival rate.Conclusion This pilot study concluded that adenosine administration directly into the HA significantly increased HAF of liver grafts without systemic side effects.

The changes of serum malondialdehyde, myeloperoxidase, total antioxidant capacity, superoxide dismutase activity, and glutathione peroxidase were observed in patients with Graves′ disease. The myeloperoxidase level increased in patients with Graves′ disease. The balance between oxidation and antioxidative defense was disrupted in patients with newly-onset Graves′ disease. Oxidative stress seems to be related to hyperthyroidism.

Objective To evaluate the value of intermittent splenic artery occlusion in the treatment of iatrogenic splenic injury and the cause of ischemia reperfusion injury.Methods Experimental animals using dogs were divided into experimental group and control group according to whether the splenic artery was blocked.The animal model of iatrogenic splenic injury was established by general anesthesia.Experimental group was treated with intermittent splenic artery blockage combined with gelatin sponge oppression of the wound to stop bleeding.The first time of splenic artery occlusion was 15 min and continued for 10 min and for another 5 rmin if still bleeding.Then hemostatic effect after removing blocking and oppression was observed.Control group was only treated with gelatin sponge compression to stop bleeding.Blood samples and tissue samples were collected before blocking and after reperfusion for 2 hours in experimental group,and before compression and relieving the compression for 2 hours in control group.IL-1 (interleukin),SOD (superoxide disproportionation enzyme),MPO (myeloperoxidase),MDA (malondialdehyde) and caspase-3 (aspartame acid cysteine protease) were detected.Results The control group still had bleeding,while the experimental group had successfully stopped bleeding.Serum markers before and after occlusion in the experinental group were IL-1 (124.4 ± 106.8 vs.121.2 ± 105.1),SOD (4.7 ± 2.7 vs.5.2 ± 1.8) and MDA (8.8 ±6.5 vs10.8 ±7.5).There were no significant differences on serum markers in two groups after occlusion/oppression including IL-1 (121.2 ± 105.1 vs.162.8 ± 73.8),SOD (5.2 ± 1.8 vs.4.7 ± 2.8) and MDA (10.8 ±7.5 vs.9.6 ±6.6) (P＞0.05).Histological indicators before and after occlusion in the experimental group included MPO (0.62 ±0.23 vs.0.68 ±0.21) and Caspase-3 (0.90 ±0.29 vs.0.86 ± 0.26),and there was no statistical difference on MPO (0.68 ±0.21 vs.0.86 ±0.23 after two sets of experiments) and Caspase-3 level (0.86 ± 0.26 vs.1.21 ± 0.18) (P ＞ 0.05) in two groups after occlusion/ oppression.Conclusion The therapeutic effect of intermittent splenic artery occlusion combined with gelatin sponge compression hemostasis is safe and effective and without obvious ischemia reperfusion injury.

Objective:To investigate the effect of early enteral nutrition combined with Bacillus in the treatment of patients with digestive tract perforation.Methods:59 patients with emergency digestive tract perforation were randomly divided into experimental group (EN plus Bacillus,n =31) and control group (TPN,n =28).The patients in the experimental group were given enteral nutrition plus Bacillus after first days (＜ 24 h),and the control group was treated with parenteral nutrition support on the first day after surgery.The average hospitalization time,length of ICU stay,incidence of complications,and serum C-reactive protein in the two groups were analyzed.Results:The average length of hospitalization time,ICU stay,recovery of bowel function and eating time were significantly shorter in the experimental group than in the control group(P ＜ 0.05).There was no significant difference in nutrition index between the two groups during the perioperative period (P ＞ 0.05).The C-reactive protein in the experimental group was significantly lower than that in the control group fourth days after operation (P ＜ 0.05).The incidence of postoperative wound infection in the experimental group was significantly lower than that of the control group (P ＜ 0.05).There was no significant difference in the incidence of other complications.Conclusion:Early administration of enteral nutrition combined with Bacillus can significantly shorten the intestinal function recovery time,decreasethe average hospitalization days,reduce the postoperative wound infection rate and thus improve the outcome of patients with digestive tract perforation.

Objective:To evaluate the effect of portal vein restriction combined with hepatic artery ligation on Sprague Dawley(SD) rats liver regeneration and injury.Methods:Twenty-four healthy and clean SD male rats, 250-280 g, 7-8 weeks old, were randomly divided into portal vein ligation (PVL) group, mild restriction group and moderate restriction group with 8 rats in each group. In PVL group, the right, caudal and left branches of portal vein were ligated, and only the right branches of portal vein were preserved. The operation of mild and moderate restriction group was the same as PVL, however, the left branch of the portal vein was slightly and moderately restricted, and the left branch of the hepatic artery was ligated at the same time. At 72 hours after the operation, the left middle lobe was stained with hematoxylin-eosin and the total necrosis score was calculated. The right middle lobe was immunostained for Ki-67 and the number of positive cells was counted. The liver regeneration rate of the right middle lobe was calculated and the serum liver function indexes were measured.Results:The hepatic regeneration rate of right middle lobe in PVL group was (109.1±10.9)%, while that in moderate restriction group was (105.0±12.3)%, which was significantly higher than that in the mild restriction group (67.1±6.4)%, the differences were statistically significant ( P<0.05). The Ki-67 result was also higher in the PVL group than the mild restriction group. The total necrosis score was 4.50(3.25, 6.00) in moderate restriction group, 2.00(1.25, 3.00) in PVL group and 0(0, 0.75) in mild restriction group. The three groups showed a decreasing trend and the differences were statistically significant ( P<0.05). Alanine aminotransferase in mild restriction group was (48.4±11.4) U/L, was significantly lower than that in PVL group (67.2±12.2) U/L and moderate restriction group (74.3±14.2) U/L, the difference was statistically significant ( P<0.05). There were no significant differences in serum levels of aspartate aminotransferase, albumin and total bilirubin among the three groups ( P>0.05). Conclusion:Appropriate portal vein restriction combined with hepatic artery ligation can effectively induce the regeneration of liver tissue on the reserved lobe and control the damage of liver tissue on the occluded lobe.

Objective: To evaluate the effect of dexmedetomidine on pyroptosis during lung ischemia-reperfusion (I/R) in rats. Methods: Adult male Sprague-Dawley rats, weighing 250-320 g, were used in this study.The model of isolated lung perfusion was established using an IL-2 Isolated Perfused Rat or Guinea Pig Lung System after the rats were anesthetized.Thirty lungs in which an ex vivo lung perfusion model was successfully established were divided into 3 groups (n=10 each) by a random number table method: control group (C group), I/R group and dexmedetomidine group (DEX group). The lungs were continuously perfused with K-H solution for 150 min in C group.After 15 min of perfusion, lungs were subjected to 60-min suspension of ventilation and perfusion, followed by 75 min of reperfusion and ventilation to establish the model of lung I/R injury in I/R and DEX groups.In DEX group, dexmedetomidine 10 nmol/L was added to K-H solution at the beginning of reperfusion.Lung tissues were obtained for determination of wet/dry weight ratio (W/D ratio) and for examination of pathological changes (with a light microscope) and ultrastructure (using an electron microscope), and the alveolar damage rate (IAR) was calculated.The expression of pyroptosis-related factors including NOD-like receptor family protein 3 (NLRP3), caspase-1, interleukin-1β (IL-1β), IL-18 and gasdermin D (GSDMD) protein and mRNA was detected by Western blot or by real-time polymerase chain reaction. Results: Compared with C group, the W/D ratio and IAR in lung tissues were significantly increased, and the expression of NLRP3, caspase-1, IL-1β, IL-18 and GSDMD protein and mRNA was up-regulated in I/R and DEX groups (P<0.05). Compared with I/R group, the W/D ratio and IAR in lung tissues were significantly decreased, the expression of NLRP3, caspase-1, IL-1β, IL-18 and GSDMD protein and mRNA was down-regulated (P<0.05), and the pathological changes were significantly attenuated in DEX group. Conclusion The mechanism by which dexmedetomidine reduces isolated rat lung I/R injury may be related to inhibiting pyroptosis.

AIM:To investigate the serum miRNA-101 expression level in patients with newly diagnosed type 2 diabetes mellitus (T2DM),and to evaluate the clinical implications of miRNA-101 expression level variation.METHODS:qRT-PCR was used to determine the serum miRNA-101 expression level.Pearson correlation analysis was performed to observe the relationship between two variables.Multiple stepwise linear regression analysis was used to assess the association of serum miRNA-101 level and other parameters.RESULTS:Serum miRNA-101 level in patients with newly diagnosed T2DM was significantly higher than that in control subjects (P ＜ 0.05).The serum level of miRNA-101 was positively correlated with the glycosylated hemoglobin A1c (HbA1c,P ＜0.05).Multiple linear regression analysis revealed that the circulating miRNA-101 was in significant positive correlation with HbA1c (P ＜ 0.05) after adjustment for age,sex and body weight.CONCLUSION:Enhanced circulating miRNA-101 level in newly diagnosed T2DM patients may be associated with elevation of HbA1 c.

Objective:To investigate the perioperative alterations and management of coagulation function in patients of massive blood transfusion during retroperitoneal tumor (RT)resection.Methods:Fourty-seven RT patients at Peking University International Hospital from Jan 2016 to Dec 2021 undergoing resection with massive blood transfusion more than 20 U within 24 h were reviewed for coagulation function before and after surgery.Results:Intraoperative bleeding was 3 000-25 800 ml, 10 patients had blood loss ≥10 000 ml. During the operation, (25.3±9.9) U of red blood cells were transfused, (2 720±1 369) ml plasma transfused, and (2.4±3.3) U platelets were transfused in 6 patients. Fourty-five patients received intraoperative albumin of (79.5±46.5) g; All 47 patients received fibrinogen of (2.3±1.3) g; Prothrombin complex was given in 45 patients (1 205±807) U. Preoperative hemoglobin was statistically different compared to postoperatively and days 1, 3 and 5 ( W=1 790, P<0.001; W=1 672, P<0.001; W=1 704, P<0.001; W=1 486, P=0.004);As with platelets, the difference was also statistically significant compared to postoperative days 1, 3, and 5 ( W=2 153, P<0.001; W=2 092, P<0.001; W=1 732, P<0.001); Preoperative albumin was different compared to postoperative days 1 and 3 ( W=1 568, P<0.001; W=1 578, P<0.001,); Preoperative fibrinogen was different compared to postoperative day 1 ( W=1 964, P<0.001). PT and APTT were prolonged on postoperative days 1 and 3 ( W=628, P<0.001, W=804, P=0.023) ( W=661, P<0.001, W=796, P=0.02). Patient's preoperative fibrin degradation products and D-dimer were above the normal value and were higher on postoperative days 3 and 5 ( W=498, P<0.001, W=345, P<0.001). Conclusions:Coagulation disorders occur perioperatively in patients with massive transfusion while undergoing surgery for RT.The implementation of ratiional transfusion strategy and close postoperative survey and management of coagulation dysfunction help avoid the coagulation related morbidities.

Objective To explore the impact of work-family conflict on job satisfaction and turnover intention of anesthesiologists in Heilongjiang Province.Methods Questionnaire survey was used for data collection.Descriptive statistics,Pearson correlation analysis and multivariate linear hierarchy regression analysis were performed to analyze the impact of work-family conflict on job satisfaction and turnover intention of anesthesiologists.Results The average value of work-family conflict among anesthesiologists was (2.99 ± 0.57).The finding indicated that work-family conflict of anesthesiologists had a significant negative effect on job satisfaction (β=-0.248,P＜0.01) and a positive effect on turnover intention (β=0.329,P＜0.01).Conclusion Anesthesiologists' work-family conflict is above the middle level in Heilongjiang Province.The work-family conflict of anesthesiologists can reduce job satisfaction and increase turnover intention.

Objective To examine the current situation of the career plateau among anesthesiologists and analyze the impact of occupational stressors on it. Methods A questionnaire survey was conducted on the anesthesiologists. A total of 300 questionnaires were distributed and 278 questionnaires were effectively collected. Statistical analysis using SPSS 19.0 was performed to assess the status quo of career plateau among anesthesiologists. Pearson correlation analysis and stepwise regression analysis were used to analyze the influence of occupational stressors on career plateau . Results The average value of occupational stressors among anesthesiologists was (3.22±0.55), and the average value of career plateau was (3.90±0.70). Occupational interest in the occupational stressors of anesthesiologists is negatively correlated with the occupational plateau (r=-0.552, P<0.01), and career development is negatively correlated with occupational plateau (r=-0.541, P<0.01) as well. Both occupational interest and career development show a negative predictive effect on the career plateau (β=-0.359, P<0.01 andβ=-0.334, P<0.01, respectively). Conclusion Career plateau among anesthesiologists is at a medium-to-high level. Occupational interest and occupational development in occupational stressors have a negative predictive effect on occupational plateaus, so hospital managers should pay attention to them.