Objective To investigate the effects of remifentanil postconditioning and combined remifentanil-prupofol postconditioning on liver ischemia-reperfusion (I/R) injury in rats.Methods Thirty male SD rats weighing 220-280 g were randomly divided into 5 groups ( n =6 each):group sham operation (group Ⅰ ) ; group I/R (group Ⅱ ) ; group propofol postconditioning (group Ⅲ ) ; group remifentanil postconditioning (group Ⅳ ) and group combined propofol-remifentanil postconditioning (group Ⅴ ).In groups Ⅱ- Ⅴ the hepatic arteries and veins of middle and left were occluded for 30 min.In groups Ⅲ-Ⅴ propofol ( at 30 mg· kg- 1 · h - 1 ) and/or remifentanil (at 1 μg· kg- 1 · min- 1 ) were infused iv at the onset of reperfusion for 1 h.Blood samples were taken at the end of 1 h reperfusion for determination of serum AST,ALT activities and IL-8,IL-10 concentrations.The animals were sacrificed after blood sampling.Liver specimens were obtained for determination of c-fos and c-jun expression in liver cells by immuno-histochemistry and microscopic examination with scanning electron microscope.Results Liver I/R significantly increased serum AST and ALT activities and IL-8 and IL-10 concentrations and c-fos and cjun expression in liver ceils in group Ⅱ as compared with group Ⅰ.The serum AST and ALT activities,IL-8 concentration and the c-fos and c-jun expression in liver cells were significantly lower.and the serum IL-10 concentration was significantly higher in groups Ⅲ- Ⅴ than in group Ⅱ,but there were no significant differences among the groups Ⅲ - Ⅴ.The histo-pathological changes in the liver tissue were significantly attenuated in groups Ⅲ- v as compared with group Ⅱ.Conclusion Postconditioning with remifentanil and/or propofol can attenuate liver I/R injury by inhibiting inflammatory response and apoptosis in the liver cells,but there is no significant difference in the protective effects induced by postconditioning with remifentanil or propofol alone or in combination.

Objective:To investigate the effect of fat mass index (FMI) on early recovery after total knee arthroplasty (TKA).Methods:Patients who underwent primary unilateral TKA in Xi'an Honghui Hospital from July 2020 to July 2021 were retrospectively analyzed. The preoperative body composition was measured by dual energy X-ray absorptiometry and the FMI was calculated. Patients were divided into normal group (male: 3.0-6.0 kg/m 2; female: 5.0-9.0 kg/m 2), overweight group (male: 6.1-9.0 kg/m 2; female: 9.1-13.0 kg/m 2), and obese group (male: >9 kg/m 2; female: >13 kg/m 2) according to level of FMI, and the operation time, blood loss, and incidence of postoperative complications were collected. Multifactorial analysis of the effect of FMI on early recovery after TKA was performed using a generalized linear model. Draw the receiver operating characteristics (ROC) curve of BMI and FMI on the predicted effect of postoperative Western Ontario and McMaster Universities (WOMAC) osteoarthritis index scores and Knee Society Score (KSS) to compare the effect of FMI with BMI on early recovery after TKA. Results:A total of 100 patients were included in the study, 24 males and 76 females, aged 65.0±8.2 years (range, 42-81 years). There were 15 cases in normal group, 55 cases in overweight group and 30 cases in obese group. All patients successfully completed the operation and were followed up for 3.15±0.72 months (range, 2.8-3.2 months). The WOMAC scores of the obese group at 2 weeks, 1 and 2 months postoperative were 34.57±3.68, 22.03±2.79, and 15.77±2.96, which were greater than those of the normal group (28.73 ±2.58, 19.07±2.71, 12.27±3.10), as well as the overweight group (30.05±4.09, 19.33±2.42, 14.84±2.42), with statistically significant differences ( P<0.05). The KSS scores of the obese group at postoperative 1 and 2 months were 68.83±5.52 and 81.17±4.49, which were lower than those of the normal group (77.33±5.63, 87.33±4.17), as well as the overweight group (72.64±5.43, 83.73 ±5.02), with statistically significant differences ( P<0.05). The WOMAC score, KSS score, and postoperative complications at 2 months postoperatively were selected as outcome indicators to plot the ROC curve, and the ROC curve for the WOMAC score at 2 months postoperatively showed an area under the curve corresponding to FMI of 0.744 (95% CI: 0.54, 0.82), which was greater than that of BMI [0.624 (95% CI: 0.51, 0.74)], and the difference was statistically significant ( Z=2.19, P=0.021). The ROC curve for the KSS score at 2 months postoperatively showed an area under the curve corresponding to FMI of 0.718 (95% CI: 0.62, 0.82), which was greater than that of BMI [0.612 (95% CI: 0.52, 0.74)], with a statistically significant difference ( Z=2.58, P=0.016). The ROC curve for postoperative complications showed an area under the curve of 0.639 (95% CI: 0.41, 0.88) for FMI and 0.605 (95% CI: 0.37, 0.84) for BMI, with no statistically significant difference ( Z=0.48, P=0.632). Conclusion:The greater the FMI the poorer the early functional recovery after initial TKA, and FMI is more valuable than BMI in predicting the early functional recovery.