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.

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.

Objective To investigate the changes in systemic and pulmonary hemodynamics in patients with liver cirrhosis and portopulmonary hypertension(PPH)during liver transplantation.Methods Eight patients with liver cirrhosis and PPH(5 male,3 female)aged 50-63 yr weighing 45-80 kg were included in PPH group. Another 8 liver-cirrhotic patients without PPH served as control group.The patients were premedicated with intramuscular phenobarbital 0.1 g and atropine 0.5 mg.Anesthesia was induced with midazolam 3-5 mg,fentanyl 0.15-0.2 mg,propefol 1 mg?kg~(-1) and vecuronium 0.1 mg?kg~(-1) and maintained with 0.5%-3% isoflurane inhalation and intermittent Ⅳ boluses of fentanyl and vecuronium.The patients were mechanically ventilated after tracheal intubation.P_(ET)CO_2 was maintained at 30-45 mm Hg.Right subclavian vein was cannulated for fluid and drug administration and blood transfusion.Radial artery was cannulated for BP monitoring.Swan-Ganz catheter was placed via right internal jugular vein.BP,CVP,MPAP,PAWP,CI,PVRI and SVRI were monitored and recorded before operation(baseline),during preanhepatic phase,at 3 and 30 min of anhepatic phase and 3,7, 15,60 min of neohepatic phase and at the end of operation.Results(1)The two groups were comparable with respect to fluid balance,the amount of vasoactive drugs used during anhepatic and neohepatic phase,duration of anhepatic phase and operation.(2)MPAP and PVRI were significantly higher before operation in PPH group than in control group.(3)CI,MPAP, PAWP and CVP were siguificanfly decreased during anhepatic phase as compared to the baseline values(before operation)in both groups and then gradually returned to and even exceeded the baseline values during neohepatic phase.(4)During neohepatic phase PVRI in PPH group was significantly increased as compared to the baseline value and was significantly higher than that in control group.Conclusion MPAP and PVRI are significantly increased during neohepatic phase in patients with PPH and need to be treated.

BACKGROUND:Oxidative injury is considered to be one of the important factors of cerebral ischemia-reperfusion injury.Superoxide dismutase 2(SOD2)is a key mitochondrial antioxidant molecule,and fenofibrate can regulate the expression of SOD2 by activating peroxisome proliferator-activated receptor α. OBJECTIVE:To explore whether the mechanism of fenofibrate in the treatment of cerebral ischemia-reperfusion injury depends on the expression of SOD2. METHODS:The TALENs system was used to construct SOD2 transgenic mice.The transgenic mice were genotyped by PCR and DNA sequencing techniques.The expression of SOD2 protein in transgenic mice was detected by western blot assay.Wild-type and SOD2 transgenic mice were randomly divided into four groups:wild-type control group(n=6),wild-type fenofibrate group(n=6),SOD2 transgenic control group(n=5)and SOD2 transgenic fenofibrate group(n=5).A mouse model of middle cerebral artery occlusion was prepared using the suture-occlusion method.After 90 minutes of ischemia,the thread was removed to reperfuse cerebral blood flow for 30 minutes.A cerebral blood flow monitor was used to monitor local cerebral blood flow.Brain tissue slices were taken for 2,3,5-triphenyltetrazolium chloride staining to analyze the situation of cerebral infarction in each group. RESULTS AND CONCLUSION:After PCR and DNA sequencing analysis,nine SOD2+/+ transgenic mice were successfully constructed.After cerebral ischemia-reperfusion,the wild-type fenofibrate group showed partial recovery of cerebral blood flow and significantly reduced cerebral infarction volume compared with the wild-type control group(P<0.001).There was no significant difference in cerebral blood flow and cerebral infarction volume between the SOD2 transgenic fenofibrate group and the SOD2 transgenic control group.The SOD2 transgenic control was superior to the wild-type control group in terms of improving cerebral blood flow and cerebral infarction(P<0.001).There were also no significant differences in cerebral blood flow and cerebral infarction volume between the wild-type fenofibrate group and the SOD2 transgenic control group and between the wild-type fenofibrate group and the SOD2 transgenic fenofibrate group.To conclude,the expression of SOD2 is one of the mechanisms of fenofibrate in the treatment of cerebral ischemia-reperfusion injury.

Objective: To investigate the efficacy of pharmacist intervention in perioperative prophylactic application of antibiotics. Methods: From August 2017 to August 2018, 148 cases received surgery in Zhejiang Rongjun Hospital were selected, using odd-even grouping method, the patients were divided into two groups, with 74 cases in each group.The control group used antibacterial drugs without pharmacists intervention, the observation group used antibacterial drugs through pharmacists intervention.The use of antimicrobial agents was compared between the two groups. Results: The duration of prophylactic medication, the duration of hospitalization in the observation group were (2.59±0.24)d, (8.47±0.83)d, respectively, which in the control group were (3.76±0.36)d, (10.74±1.32)d, respectively, the differences between the two groups were statistically significant(t=23.262, 12.523, all P<0.01). The total cost of antibacterial drugs and the total drug cost in the observation group were (778.62±76.35)CNY, (3 036.75±302.11)CNY, respectively, which in the control group were (1 063.26±105.32)CNY, (4 698.64±1 452.28)CNY, respectively, and the differences between the two groups were statistically significant(t=18.823, 9.638, all P<0.01). The antibacterial drug use satisfaction of the observation group was 97.30%(72/74), which of the control group was 74.32%(55/74), the difference between the two groups was statistically significant(χ²=16.038, P<0.01). Conclusion The rational use of antibiotics can be promoted by pharmacist intervention in perioperative prophylaxis patients.