Objective To evaluate the effect of lipo-alprostadil on lung injury in patients undergoing orthotopic liver transplantation.Methods Forty-eight ASA Ⅱ-Ⅳ patients of both sexes,aged 45-64 yr,weighing 45-70 kg,scheduled for elective orthotopic liver transplantation,were randomly assigned to one of 2 groups (n =24 each):control group (group C) and lipo-alprostadil group (group A).Anesthesia was induced with midazolam,propofol,fentanyl and vecuronium and maintained with sevoflurane,sufentanil and vecuronium.The patients were tracheal intubated and mechanically ventilated.Lipo-alprostadil 5 μg in 10 ml of normal saline was infused intravenously and slowly over 30 min before induction of anesthesia and at 1 h of neohepatic phase in group A.Lipoalprostadil was not administrated in group C.Peak inspiratory pressure (PIP),mean inspiratory pressure (Pmean),dynamic lung compliance (Cd),oxygenation index (OI),respiratory index (RI) and the concentrations of inflammatory cytokines in exhaled breath condensate (EBC) were recorded immediately before operation,at the end of operation,and at 24 h after operation.The occurrence of pulmonary complications was recorded within 7days after operation.Results Compared with group C,PIP,Pmean,RI,and TNF-α and IL-8 concentrations in EBC were significantly decreased,while Cd and OI were increased at the end of operation and 24 h after operation,and the incidence of acute lung injury and pulmonary infection were decreased within 7 days after operation (P ＜0.05),and no significant change in the other indexes was found in group A (P ＞ 0.05).Conclusion Lipo-alprostadil has protective effect on lung in patients undergoing orthotopic liver transplantation.

Objective To investigate the efficacies of preoperative location with titanium clip and methylene blue staining in laparoscopic colectomy.Methods The clinical data of 31 patients with colorectal polyps which could not be resected under endoscope were admitted to the Third Affiliated Hospital of Sun Yat-Sen University from August 2006 to September 2012 were retrospectively analyzed.According to the methods of preoperative location of colorectal polyps,all patients were divided into the titanium clip group (18 patients) and the methylene blue group (13 patients).Titanium clip group:enteroscopic and pathological examination were firstly performed,and then 1 or 2 titanium clips were placed at the superior and inferior part of the polyps.After enteroscopic examination,abdominal X ray examination was performed to detect the position of polyps according to the positions of the titanium clips.Methylene blue group:after colonoscopy,methylene blue of 1 mL was injected into the adjacent mucosa of the polyps,and 4 positions around the polyps were selected for the injection of methylene blue.If the 2 locating methods were failed,intraoperative enteroscopy was performed.Laparoscopic resection for intestine or mesenterium was performed according to the treatment principle of colorectal neoplasms,and the location efficacy of the 2 methods and the treatment of the 2 groups were analyzed.The measurement data and the count data were analyzed using the t test and chi-square test,respectively.Results The success rates of the titanium clip group and the methylene blue group were 15/18 and 8/13,with no significant difference between the 2 groups (x2=0.284,P ＞0.05).The polyps in 8 patients which were failed to be localized by titanium clip or methylene blue were localized by intraoperative enteroscopy,while the operation time was prolonged to (44 ± 13)minutes.No positioning errors were detected in all the 31 patients.Laparoscopic right colectomy was performed on 4 patients,laparoscopic left colectomy on 11 patients,laparoscopic sigmoid colectomy on 9 patients,laparoscopic anterior resection of rectum on 7 patients.No morbidity or mortality was detected in the 2 groups.The length of specimen,distance between the proximal margin and the superior margin of the tumor,distance between the distal margin and the inferior margin of the tumor (patients with colonic polyps),distance between the distal margin and the inferior margin of the tumor (patients with high rectal polyps),and the number of lymph node resected were (20 ± 7) cm,(11 ± 4) cm,(8.6 ± 3.1) cm,4.2 ± 1.1,8 ± 5 in the titanium clip group,and (20 ± 5) cm,(9 ± 3) cm,(9.1 ± 2.8) cm,4.6 ± 0.5,7 ± 6 in the methylene blue group,with no significant difference between the 2 groups (t =0.053,0.918,0.213,1.486,0.267,P ＞0.05).Fifteen patients had cancerization of the polyps,including 8 patients with TNM Ⅰ stage,6 with TNM Ⅱ] stage and 1 with TNM Ⅲ stage.Conclusions For patients with colorectal polyps located at the intestine above the descending colon,titanium clip locating is easy,safe and effective,and it could be the first choice for locating the colorectal polyps.Endoscopic methvlene blue staining is simple but high technique demanding.Intraoperative enteroscopy is precise for locating the polyps at the intestine below the descending colon.

Objective To observe the effect of electroacupuncture in preventing delayed cerebral vasospasm (DCVS).Method Sixteen healthy Japanese big ear rabbits were randomized into a treatment group and a control group, 8 in each group. The treatment group was developed into models by intramuscular anesthesia on the 6th day after 5 days’ 20-min daily intervention of transcutaneous acupoint electrical stimulation during a specific time period; the control group was developed into models by the same way on the 6th day but without electrical stimulation. The diameter of basilar artery was measured by using CTA prior to the electrical stimulation and after modeling in both groups, the plasma levels of ET-1, CGRP, and IL-6 were detected, and behavioral changes 1 d, 3 d, and 5 d after modeling were observed.Result After modeling, there was a significant difference in comparing the basilar artery diameter between the two groups (P<0.05). The plasma levels of ET-1, CGRP, and IL-6 in the treatment group were significantly different from that in the control group (P<0.05). In the treatment group, the neural function scores 3 d and 5 d after modeling were markedly different from that 1 d after modeling (P<0.05). There were significant differences in comparing the neural function scores 3 d and 5 d after modeling between the two groups (P<0.05).Conclusion Pre-intervention with electroacupuncture prevents and improves DCVS possibly via modulating the levels of ET-1, CGRP, and IL-6, and subsequently involving in anti-inflammation, immune inhibition, and vasodilation.

Objective:To explore the value of ultrasonic measurement of optic nerve sheath diameter (ONSD) in predicting the risk of death in patients with severe brain injury.Methods:This was a prospective observational study based on 84 postoperative patients with severe brain injury from January 2020 to September 2020 in our department. The patients were divided into two groups: the survival group and the deceased group. The clinical features between the two groups were compared. Receiver operating characteristic (ROC) curves were used to evaluate the sensitivity and specificity of ONSD, neuron-specific enolase (NSE) and the combination of the two in predicting death in patients with severe brain injury. Binary logistic regression was used to analyze the independent risk factors for death. A prediction model for the risk of death was constructed.Results:There were 61 cases (72.6%) in the survival group and 23 cases (27.4%) in the deceased group. There were significant differences in age, Glasgow coma score (GCS), ONSD and NSE at 12 h after surgery between the two groups. According to the ROC curve, the optimal cutoff levels of ONSD and NSE for predicting death were 5.5 mm and 21.75 ng/mL, respectively. When the two indicators were combined, the area under the curve was 0.897 ( P<0.01). At this threshold, the sensitivity and specificity were 100% and 70.5%, respectively. ONSD ( OR=9.713; 95% CI: 1.192-79.147) and GCS scores ( OR=0.492; 95% CI: 0.318-0.763) at 12 h after surgery were independent risk factors for death in patients with severe brain injury (both P<0.05). Conclusions:Early postoperative ONSD is an independent risk factor for death in patients with severe brain injury. The combination of ONSD and NSE has the best predictive effect.

Objective:To explore the relevance between secondary retroperitoneal infection, as well as the outcomes, and the approach of intensive care unit (ICU) admission for the patients suffered from acute pancreatitis.Methods:Patients with acute pancreatitis admitted to the ICU of the Second Affiliated Hospital of Anhui Medical University from January 2013 to July 2022 were retrospectively analyzed. According to ICU admission approaches, the patients were divided into the emergency group (first admission or transferred from the emergency department) and the delayed group (transferred from the general wards due to disease evolution). Patients were also divided into retroperitoneal infection group and non-retroperitoneal infection group according to whether retroperitoneal infection was accompanied. Patients' baseline data including gender, age, underlying diseases, laboratory test indicators, acute physiology and chronic health evaluationⅡ score (APACHEⅡ), sequential organ failure assessment (SOFA), computed tomography severity index (CTSI), bedside index of severity in acute pancreatitis (BISAP), and acute complications were collected. Univariate and multivariate logistic regression was used to analyze the risk factors of retroperitoneal infection in patients with acute pancreatitis.Results:A total of 271 patients with acute pancreatitis were enrolled, including 95 cases in the emergency group and 176 cases in the delayed group. The cohort included 71 cases with and 200 cases without retroperitoneal infection development. The incidence of retroperitoneal infection and the 30-day mortality of patients in the delayed group, which was observed with a significantly longer ICU stay (days), [(15.4±21.3) vs. (8.6±10.8), P<0.05], were significantly higher than those in the emergency group [retroperitoneal infection incidence rate: 31.82% (56/176) vs.15.79%(15/95), 30-day mortality: 13.64%(24/176) vs. 4.21%(4/95), both P<0.05]. Univariate Logistic analysis showed significant differences in diabetes, APACHEⅡ, SOFA, CTSI and BISAP score, urea nitrogen, creatinine, blood calcium, D-D dimer, peritoneal puncture catheter drainage and ICU transferred from general wards due to disease evolution between the retroperitoneal infection group and the non-retroperitoneal infection group. Multivariate Logistic regression analysis showed that diabetes, SOFA score, CTSI score, peritoneal puncture catheter drainage and transfered from general wards to ICU due to disease evolution were independent risk factor for retroperitoneal infection in acute pancreatitis patients[odds ratio were 3.379, 1.150, 1.358, 3.855, 2.285, respectively]. Conclusions:Acute pancreatitis patients in ICU transferred from general wards are more likely to develop retroperitoneal infection, and have a higher risk of mortality and a longer ICU stay. Delayed admission to ICU, diabetes, SOFA score, CTSI score and peritoneal puncture catheter drainage are independent risk factors for retroperitoneal infection in patients with acute pancreatitis.