Objective This study was to investigate the management of hemodynamics during operation in patients undergoing orthotopic liver transplantation. Method Hemodynamic parameters were monitored during operation. Norepinephrine, epinephrine or dopamine, as well as nitroglycerin or PGE 1 were used in 21 cases to maintain a stable hemodynamics. Results Our data demonstrated that rational use of norepinephrine and epinephrine was beneficial in maintaining vital organ perfusion and improving tissue oxygenation. Compared with PGE 1, nitroglycerin was shown to be more controllable in lowering pulmonary artery hypertension, and notably, it significantly increased renal blood flow. Conclusion The results of this sudy indicated that in addition to fluid resuscitation, different combinations of vasoactive agents were beneficial in maintaining hemodynamic stability

Objective To explore the correlation between platelet function and immunity index in patients with sepsis. Methods The platelet function and immune indexes of one hundred and one patients with sepsis treated in Shanxi Dayi Hospital from July 1st, 2016 to October 31st, 2017 were analyzed retrospectively. According to their shock,they were divided into shock group (34 cases) and non shock group (67 cases). Another 50 healthy people in the same period in our hospital were selected as control group. The relationship between platelet function and immune indexes was compared. Results ( 1) the incidence of maximum blood block intensity decreased in the thrombus map of the septic shock group was higher than that in the non shock group, and the difference was statistically significant ( 65. 67%( 44/67 ) vs. 23. 53%(8/34),χ2＝41. 28,P＜0. 05); (2) the CD4+T lymphocyte and C3 in the septic shock group were all lower than those in the non shock group ((47. 28%±7. 78) vs. (54. 93%±11. 26),t＝3. 554,P＜0. 05; (0. 42 ±0. 23) g/L vs. (0. 75±0. 19) g/L,t＝－3. 057,P＜0. 05),the ratio of CD4+/CD8+T lymphocyte was higher than that in non shock group ((2. 68±0. 18) vs. (2. 45±0. 07),t＝7. 18,P＜0. 001)). (3) the maximum intensity of blood clots was correlated with the percentage of CD4+T lymphocyte,CD4+/CD8+T lymphocyte ratio,complement C3,acute physiology and chronic health status score system II score,and sequential organ failure score ( r ＝ 0. 617, 0. 411, 0. 563,－ 0. 631,－ 0. 547, P＜ 0. 01, or P＜ 0. 05 ) . Conclusion Thrombocytopenia is present in septic patients,which is correlated with changes in immune indices.

Objective:To evaluate the prognostic value of thromboelastography maximum amplitude(MA)and arterial blood lactate levels for sepsis in elderly patients.Methods:A retrospective analysis was performed on clinical data of 63 sepsis patients(≥60 years old)admitted to the Intensive Care Unit(ICU)of Bethune Hospital of Shanxi Province from December 2018 to February 2020.MA values, white blood cell counts, lymphocyte counts, platelets, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)scores, sequential organ failure assessment(SOFA)scores, underlying diseases, body mass index, laboratory test results and other related treatments were analyzed.The subjects were divided into the survival group and the death group according to the 28-day survival outcome.Differences in MA, APACHE Ⅱ scores, SOFA scores and laboratory test results between the two groups were analyzed, and the correlations of MA with infection parameters and age were examined.Influencing factors of survival outcomes were analyzed using multivariate Logistic regression.The receiver operating characteristic curve(ROC)was used to calculate the prognostic value of MA and arterial lactate for sepsis in elderly patients.Results:The main sources of infections were pulmonary and abdominal(79.4%, 50/63)in 63 elderly patients with sepsis.The incidences of positive blood cultures and deaths were 15.9%(10/63)and 66.7%(42/63), respectively.There existed significant differences in lymphocyte counts, arterial lactate levels, MA and lengths of stay in the ICU between the survival group and the death group( t=3.847, 2.153, 2.745, -3.574, respectively, all P<0.05).MA was correlated with arterial lactate, SOFA score and survival outcome( r=-0.498, -0.506, and -0.358, respectively, all P<0.05).Multivariate Logistic regression analysis showed that MA and arterial lactate were independent factors for the survival outcome( OR=1.626, 0.766, all P<0.05).The area under the ROC curve(AUC, 95% CI)for the combination of MA and arterial lactate was larger than that of either MA or arterial lactate alone(0.89, range: 0.763-0.846; 0.58, range: 0.574-0.730; 0.77, range: 0.521-0.832; all P<0.05). Conclusions:The combination of thromboelastography maximum amplitude and lactate in arterial blood has important clinical value in assessing the prognosis of elderly patients with sepsis.

Objective:To screen lipid biomarker in sepsis patients with different survival outcome based on ultra high performance liquid chromatography-mass spectrometry(UHPLC-MS/MS) technique.Methods:From September 2019 to April 2020, 30 septic patients admitted in Department of Intensive Care Unit and 30 cases of physical examination at the same time in Shanxi Bethune Hospital were studied. Lipid metabolite in serum were detected by UHPLC-MS/MS technique. According to the 28 day survival outcome of sepsis patients, they were divided into survival group (21 cases) and death group (9 cases). The baseline data of case group and control group, survival group and death group were compared respectively. Independent sample t-test and orthogonal partial least squares discriminant analysis (OPLS-DA) were further performed to identify lipid biomarkers related to sepsis survival outcome. Receiver operating characteristic (ROC) curve to evaluate the predictive efficacy of differential lipids on the survival outcome of biomarker sepsis patients. Results:There were 32 lipid subclasses and 1 437 differential lipid molecules in the sepsis group compared with the control group. 196 differential lipid molecules in the sepsis survival group and the death group were screened according to the OPLS-DA model (variable weight of projection (VIP)>1), which were glycerophosphingolipids (129), sphingolipids (52), glycerides (14), and sterols (1).All the original data were statistically analyzed by univariate independent sample t-test. There were statistically significant differences in 15 lipid molecules between the two groups. Combined with VIP > 1 and P < 0.01, three lipid molecules were finally screened, which were sphingomyelin (SM) lipid molecules, SM (d30∶1), SM (d32∶2), SM (d32∶1). ROC curve analysis showed that the areas under curves of the above three lipid molecular were 0.915, 0.892, 0.898, respectively. The sensitivity was 77.27%, 95.45%,72.73%. The specificity was 100.0%, 87.5%,100.0%. Further Z-test showed that there was no significant difference in the area under the ROC curve ( Z(SM (d30∶1) and SM (d32∶1)) =0.36, P=0.722; Z(SM (d30∶1) and SM (d32∶2))=0.34, P=0.732; Z(SM (d32∶1) and SM (d32∶1))=0.07, P=0.942). Conclusions:Sphingomyelin may be involved in the formation of different clinical outcomes of sepsis, and has a good predictive effect on the survival outcome of sepsis.

Objective　To explore the effects of ox-LDL on the biosynthesis of resolving D2 (RvD2) by human periphery blood mononuclear cells (PBMCs)-derived macrophages in ischemic stroke (IS).Methods　Matured macrophages were derived from PBMCs of ischemic stroke patients and healthy controls,and were grouped to vehicle group and oxidized low-density lipoprotein (ox-LDL) group.We compared the level of RvD2,15-lipoxygenase (15-LOX) and 5-lipoxygenase (5-LOX),as well as G-protein coupled receptor 18 (GPR18).between groups,and determined the formation of foam cells.Results　Compared with vehicle group,the level of RvD2(P<0.001),15-LOX and GPR18(P<0.05) in ox-LDL stimulated group was significantly increased,however,no significant difference in the expression of 5-LOX between ox-LDL and vehicle group was observed.After ox-LDL stimulation,compared with healthy control,elevation of RvD2 synthesis in ischemic stroke group was significantly lower（P<0.05）,and foam cell formation was also more severe in macrophages of stroke patients.Conclusion　Ox-LDL stimulates biosynthesis of RvD2 by human macrophage,perhaps through enhancing 15-LOX expression.Moreover,function of increasing RvD2 synthesis upon ox-LDL stimulation is impaired in stroke patients.