Objective To observe the changes in acid-base balance and the contents of electrolytes in patients during liver transplantation to explore the relationship between such changes and ASA grading, and to look for an optimal anesthetic intervention. Methods Arterial pH, PaO_2, PaCO_2, HCO~-_3, BE, K~+, Ca~ 2+ , Na~+, and glucose were monitored in 89 patients undergoing liver transplantation at four specific periods: before anesthesia (T_0), after skin incision (T1), 10 minutes before reperfusion (T_2), and 10 minutes after reperfusion (T_3). Changes in blood acid-base and electrolyte parameters of the patients with different ASA status were compared. Result The pH and BE in ASA V patients was significantly lower at T_0, T_1, T_2 and T_3, and HCO~-_3 was lower in ASA V at T_3. The PaCO_2 in ASA V patients was significantly higher at T_0, T_1 and T_2. The Na~+ content in ASA V patients was significant higher at T_2 and T_3. At T_0 and T_1, the glucose level in ASA Ⅳ and Ⅴ were significant higher than in ASAⅢ. Significant differences in pH, PaCO_2, HCO~-_3, BE and glucose level were observed at different stages of the surgical procedure. The pH, BE and HCO~-_3 were significantly lowered at T_2 and T_3. Mean glucose and HR levels were gradually increased from T_1 to T_3. Conclusion Patients with advanced ASA grades are more prone to acid-base and electrolyte disturbances during reperfusion of the liver transplant. High ASA grades contitute an increased risk for cardiovascular collapse after reperfusion, calling for proper treatment.

ObjectiveTo observe the effect of patient controlled analgesia (PCA) of with tramadol intravenous and epidural injection after prostate operation.Methods90 patients undergoing prostatectomy were randomly divided into intravenous PCA group (PCIA), epidural PCA group (PCEA) and control group (not using easy pain drug), with 30 cases in each group. The loading dose of tramadol was 1 mg/kg. The severity of pain, incidence of nausea and vomiting, total dosage of tramadol used in 24 h ,and patient's satisfaction were assessed.ResultsThe postoperative pain scores of PCIA group were significantly lower than that of PCEA group. Between two groups, there were no significant differences in the overall satisfaction of pain relief, sedation and vomiting.ConclusionPCA with tromadol is safe and effect after prostate operation, and the effect of intravenous PCA is better than that of epidural PCA.

ObjectiveTo investigate the remote renal injury after liver ischemia-reperfusion(I/R) and the renal protection afforded by propofol.Methods 72 male SD rats were randomly divided into three groups:normol control group, I/R group and propofol group .The animals were killed after 60 minutes ischemia of liver followed by reperfusion for 4 h,2 h. Blood urea nitrogen (BUN) and creatinine (Cr) were detected,and renal histopathologic lesion were observed.ResultsIn I/R group,the serum level of BUN and Cr increased significantly compared with the baseline before liver I/R,while propofol could decrease the serum level of BUN and Cr significantly.ConclusionPropofol can reduce the renal injury during liver I/R.

The construction and management working of clinical practice teaching base is an important component of the western medical colleges and universities.The colleges and universities highlights the status of clinical practice teaching base construction,such as improving construction management system of clinical practice teaching base,strengthening the basic teaching facilities construction,the teachers troop construction and the system construction of clinical practice teaching base,strengthening the organization,teaching and funds management of the clinical practice teaching base and improving the quality and level of graduation practice.

Objective To discuss the imaging appearances and causes of hepatic pseudolesions around the falciform ligament.Methods 40 patients (23 cases of A-type,17 cases of B-type) of hepatic pseudolesion around the falciform ligament examined by CT were collected.Combined with pathology of 2 cases,follow-up of 6 cases,MRI findings in 5 cases,and with the relevant literature reviewes,the density change of CT plain and enhanced scan and the causes of hepatic pseudolesion around the falciform ligament were analyzed retrospectively.Results There were low density in 25 cases,isodensity in 13 cases,high density in 2 cases in arterial phase,density lower than that of liver in 40 cases in portal phase,low or slightly low density in 27 cases and isodensity in 13 case of A-type in delayed phase.Of 40 cases,there were isointense in 2 cases of A-type in any sequence,and no sigal changes on out-phase images;there were intensity decline on out-phase images comparing to in-phase images in 3 cases of B type.Of 6 CT follow-up cases,there were no changes in 2 cases of A-type and shrinked or disappear in 4 cases of B-type;and there were more shrinked in 1 B-type case of MRI follow-up again after one month.Conclusion Hepatic pseudolesion of A-type can be resulted from focal fatty infiltration,and that of B-type can be caused by special blood-supply.They have characteristics in locations,and characteristic imaging appearances on CT and MRI images,and they can be clearly diagnosed generally.

Objective To study the role of lipase in inflammation in patients with acute pancreatitis.Methods Acute pancreatitis patients (n =200) were enrolled in the study.The patients were examined by computerized tomography and the severity of AP is determined by Blathazat Score.We assess the muhivariate-adjusted association of amylase and lipase with inflammatory markers of AP.We identified that lipase was more specifically correlated with AP progression than amylase,lactate dehydrogenase and creatitine kinase.Results We demonstrated that in AP patients,a doubling of lipase excretion was associated with 6.8％ increase of white blood cells (95％ CI,3.06％-10.5％,P ＜ 0.01),10.3％ (95％ CI,5.7％-14.9％,P ＜ 0.01) increase of neutrophil number but 14.8％ (95％ CI,2.3％-27.3％,P ＜0.05) decrease of lymphocytes in the blood,respectively.By contrast,amylase has no association with these cells.Both amylase and lipase had no relationship with triglyceride level in AP patients.Conclusions Lipase serves as an indicator for the severity and treatment of AP.

Objective To compare the value of contrast-enhanced ultrasonography (CEUS) with that of laparoscopic ultrasonography (LUS) in localization diagnosis of insulinoma. Methods Thirty-three patients with insulinoma,who received operation, were retrospectively reviewed. All cases were examined by both CEUS and LUS before the tumor removed. Both imaging modalities in diagnosis of insulinoma were analyzed. Results By this study the sensitivity and accuracy of CEUS were 92.31% and 90.0% respectively. Those of LUS were consistent with pathologic findings completely. The accuracy of CEUS was not different with that of LUS (χ2 = 4.21, P = 0. 04). Conclusions CEUS can be used for location diagnosis of insulinoma. For the patients expecting laparoscopic treatment, combination of CEUS with LUS will be suggested before insulinoma is removed.

Objective To evaluate the effect of exosomes from different sources on the growth, metastasis and immune microenvironment of hepatocellular carcinoma ( HCC ) in a mouse model of orthotopic transplanted hepatoma so as to provide new insight into the clinical immunotherapy of hepatocellular carcinoma. Methods The serum-derived exosomes were obtained by ultracentrifugation from Hepa1-6 cells and 3-week orthotopically tumor-bearing HCC mice. The morphology and size of exosomes were identified by transmission electron microscopy. One-week tumor-bearing HCC C57BL/6 mice were randomly divided into 3 groups ( 3 mice for each group ) , and respectively treated with tail vein injection of 120 μl PBS(control group), 120 μl Hepa1-6 cell-derived exosomes (1μg/μl, TEXcel group), and serum-derived exosomes (1μg/μl) (TEXserum group). The treatments were conduced once a week for 3 consecutive weeks. The mice were sacrificed on the 4th day after the treatments, and the liver tissue and lung tissues were dissected. The volumes of the liver cancer tissues were measured. The expression of PD-L1 protein and CD3+and FoxP3+T lymphocytes infiltration in the liver cancer tissues were respectively detected by Western Blot and immunohistochemical staining. The lung metastasis of the liver cancer was detected by hematoxylin-eosin staining. Results The diameters of the Hepa1-6 cell- and serum-derived exosomes both were about 100 nm, and were uniform vesicles with complete membrane structure. Compared with the control group, Hepa1-6 cell-derived exosomes had a certain inhibitory effect on the growth and lung metastasis of HCC, while there was no significant difference for the TEXserum group. Western Blot results showed that compared with the control group, PD-L1 protein expression was significantly up-regulated in both TEXcel group and TEXserum group. Immunohistochemical staining showed that compared with the control group, the infiltration number of Foxp3+-labeled regulatory T cells (Treg) had no significant changes in TEXcel group and the TEXserum group, and the differences were no statistically significant (all P>0.05). However, the infiltration number of CD3+-labeled T lymphocytes was significantly reduced in the two groups, and the differences were statistically significant (all P<0.05). Conclusion The Hepa1-6 cell-derived exosomes have a certain inhibitory effect on the growth and lung metastasis of HCC, and have no obvious regulation effects on the immune microenvironment of HCC. The serum-derived exosomes from orthotopically tumor-bearing HCC mice can promote the growth and lung metastasis of HCC and immunosuppress the microenvironment. The Hepa1-6 cell-derived exosomes are expected to be used for immunotherapy studies of liver cancer.

Chronic obstructive pulmonary disease (COPD) is an important healthcare problem worldwide. Often, glucocorticoid (GC) resistance develops during COPD treatment. As a classic hypoglycemic drug, metformin (MET) can be used as a treatment strategy for COPD due to its anti-inflammatory and antioxidant effects, but its specific mechanism of action is not known. We aimed to clarify the role of MET on COPD and cigarette smoke extract (CSE)-induced GC resistance. Through establishment of a COPD model in rats, we found that MET could improve lung function, reduce pathological injury, as well as reduce the level of inflammation and oxidative stress in COPD, and upregulate expression of nuclear factor E2-related factor 2 (Nrf2), heme oxygenase-1 (HO-1), multidrug resistance protein 1 (MRP1), and histone deacetylase 2 (HDAC2). By establishing a model of GC resistance in human bronchial epithelial cells stimulated by CSE, we found that MET reduced secretion of interleukin-8, and could upregulate expression of Nrf2, HO-1, MRP1, and HDAC2. MET could also increase the inhibition of MRP1 efflux by MK571 significantly, and increase expression of HDAC2 mRNA and protein. In conclusion, MET may upregulate MRP1 expression by activating the Nrf2/HO-1 signaling pathway, and then regulate expression of HDAC2 protein to reduce GC resistance.

AIM: To explore the effect of Huatanjiangqi capsule medicated serum (HTJQ) on the resistance of human bronchial epithelial cells (16HBE) to glucocorticoid (GC) stimulated by cigarette smoke extract (CSE). METHODS: After 16HBE cells were treated with HTJQ, the effects of different concentrations of HTJQ on the viability of 16HBE cells were determined by CCK-8 method. 16HBE cells were pretreated with HTJQ, and then cultured with dexamethasone (DEX) and lipopolysaccharide (LPS) for 24 hours, the effect of HTJQ on glucocorticoid (GC) resistance of 16HBE cells was determined by Enzyme-linked immunosorbent assay (ELISA). The effects of HTJQ, sulforaphane (SFN) and glutathione (GSH) on the expression of NF-E2-related factors 2 (Nrf2), Heme oxygenase-1 (HO-1) and histone deacetylase 2 (HDAC2) in 16HBE cells stimulated by CSE were measured by Western blot, and the effects of HTJQ, SFN and GSH on interleukin-8 (IL-8) in 16HBE cells were measured by ELISA. RESULTS: HTJQ promoted the proliferation of 16HBE cells at 1 h, 2 h and 4 h, the results of ELISA and Western blot showed that CSE induced GC resistance and decreased the expression of Nrf2, HO-1 and HDAC2 in 16HBE cells, HTJQ significantly decreased IL-8 and improved GC sensitivity of 16HBE cells (P<0.01), and up-regulated the expression of Nrf2, HO-1 and HDAC2 (P<0.01). In addition, HTJQ significantly up-regulated the level of GSH in 16HBE cells (P<0.01). Nrf2 agonists SFN and GSH significantly improved the glucocorticoid sensitivity of 16HBE cells (P<0.01), and up-regulated the expression of Nrf2, HO-1 and HDAC2 (P<0.01). CONCLUSION: HTJQ improves the GC resistance of 16HBE cells by up-regulating the expression of Nrf2/HDAC2 protein and the level of intracellular GSH.