BACKGROUND:Ischemia/reperfusion (IR)injury during the pancreas transplantation can cause numerous postoperative complications, among which,secondary pancreatitis can cause small intestinal mucosal injury and result in severe Consepuence.OBJECTIVE:To observe the protective effect of ischemic preconditioning (IPC) on small intestinal mucosal barrier after pancreas transplantation in rats.DESIGN:Randomized controlled animal trial.SETTING:Department of Gastrointestinal Surgery,Xijing Hospital,Fourth Military Medical University of Chinese PLA.MATERIALS:This trial was done in the Laboratory of Gastrointestinal Surgery,Xijing Hospital,Fourth Military Medical University of Chinese PLA between September 2001 and April 2004.Eighty-three male SD rats were involved in this trial.METHODS: Forty-seven rats were randomly chosen to prepare diabetic rat models by penile-intravenous injection of 65 mg/kg streptozotocin.Thirty-six successful model rats were randomized into 3 groups,with 12 in each group:IR group,donor IPC(DIPC)group and recipient with two hindlims IPC(RIPC)group.Twelve of the remaining 36 normal rats served as control group,and the other 24 rats were used as donors.Laparotomy was conducted only in control group,and pancreas transplantation was conducted in the other 3 groups In DIPC group,the splenic vessels of donors were blocked for 5 minutes and reperfused for 5 minutes twice before obtaining pancreas from donor;In the RIPC group, blood flow of two hindlimbs of recipients was blocked for 5 minutes and reperfused for 5 minutes before reperfusing the pancreas of donor,and this procedure was repeated 3 times.IR group was untouched.MAIN OUTCOME MEASURES:① On the 5th day after operation,6 rats were randomly chosen from each group to detect small intestinal permeability[expressed with plasm fluorescent-isothiocyanate-dextran(FITC-dextran)concentration]and absorption function(expressed with plasm xylose concentration).② On the 5th day after operation.blood was taken from the left 6 rats in each group to detect serum tumor necrosis factor-α(TNF-α) and nitric oxide(NO)level as well as superoxide dismutase(SOD)and amylase activity.Ileal mucosal tissue was taken to detect wet weight of small intestinal mucosa,the height and width of microvilli,malonaldehyde(MDA)level and myeloperoxidase(MPO)activity.At the same time,mesenteric lymph node,liver and splenic tissue were taken to perform bacterial culture.Bacterial translocation was observed.RESULTS:After supplement,72 rats were involved in the result analysis.①Plasm FITC-dextran concentration of IR group were higher than that in control group,DIPC group and RIPC group,respectively(P＜0.01).②Plasm xylose concentration in the IR group was lower than that in the control group,DIPC group and RIPC group,respectively(P＜0.01).③Bacterial translocation rate in the IR group was higher than that in the control group,DIPC group and RIPC group,respectively(P＜0.01).④Small intestinal mucosal injury degree in the IR group was lower than that in the other 3 groups(P＜0.01).⑤Small intestinal MPO activity and MDA level in IR group were significantly higher than those in the other 3 groups(P＜0.01). Serum SOD activity and NO level were lower but amylase activity and TNF-α 1evel were higher in the IR group as compared with the other 3 groups(P＜0.01).CONCLUSION:IPC of two hindlimbs in both donor and recipient can protect small intestinal mucosal barrier and reduce bacterial translocation rate after pancreas transplantation in rats.

BACKGROUND: Pancreas transplantation alone (PTA) is an effective therapy for diabetic patients who do not occur chronic complications. It's important to establish the stable PTA animal models to investigate immunologic tolerance or ischemic/reperfusion injury.OBJECTIVE: To establish the model of pancreas transplantation alone (PTA) with enteric drainage in rat.DESIGN: Grouping and controlled animal experiment SETTING: Department of Gastrointestinal Surgery, Xijing Hospital,Fourth Military Medical University of Chinese PLA MATERIALS: Totally 90 SD male rats, with the body mass of 250-320 g,were chosen in this study. 58 rats were induced by intravenous administration of streptozotocin (STZ) at a dose of 65 mg/kg via penile vein and the rats whose fasting plasma glucose exceeded 19.4 mmol/L for more than 2weeks were selected, 22 rats was successful. Rats were randomly assigned to 2 groups: control group (10 healthy rats) and group PTA consisted of 22diabetic rats, which received PTA from 22 normal donors.METHODS: This experiment was conducted at the laboratory of Department of Gastrointestinal Surgery, Xijing Hospital, Fourth Military Medical University of Chinese PLA from January 1999 to July 2004. The blood vessels reconstruction of PTA were performed using end-to-side anastomosis between the donors' abdominal aorta segment (abdominal artery and splenic artery) and recipients' abdominal aorta, and end-to-end anastomosis between the donors' portal vein segment (splenic vein) and recipients'left renal vein (use a cuff). Pancreas exocrine drainage was made by pancreas intestine anastomosis (Roux-Y).MAIN OUTCOME MEASURES: Body mass, food intake, water intake and fasting blood glucose were monitored 2 days before operation and 1,3,7,14 and 30 days after operation, and the failure causes were analyzed.RESULTS: 22 rats in the model group and 10 rats in the normal control the vein of the rats , very severe diabetic symptoms appeared in 22 rats:Body mass, food intake, fasting blood glucose was increased than that of cipients operation was (32.2±12.7) minutes and (63.4±15.9) minutes respectively. And the mean time of warm and cold ischemic time was 0minute and (48.6±18.3) minutes, respectively. 11 of the 22 cases (50%)died or lost their function of the endocrine within 1 month in Group PTA.The main complications were secondary pancreatitis and pancreas leakage after transplantation (7 cases, 31.8%). All successful recipients' blood glucose lowed on the 1st and recovered to be normal on the 3nd after transplantation (P ＜ 0.01), and their food intake, water intake and urine volume decreased and became stable 14 days later.CONCLUSION: This method can be used to establish relative stable animal model. Successful PTAs may improve the pancreatic endocrine function of the diabetic rats.

ObjectiveTo investigate the effect of ischemic preconditioning (IPC) in the posterior limbs of rats of donor' pancreas graft, and analyze the correlations with adenosine. Methods18 steptozozin (STZ)-induced diabetic SD rats were randomly assigned to 3 groups: group I/R (n=6) received pancreas transplantation alone (PTA), Group IPC (n=6) received pancreas transplantation alone exposed IPC with 5 minutes ischemic and 5 minutes reperfusion induced by ligating donor's posterior limb three times before ablating donors, Group IPC+DPCPX received same treatment with Group IPC, but separately injected adenosine A1 receptor antagonist 8-cyclopentyl-1, 3-dipropylxanthine (DPCPX) before IPC. The blood glucose, TNF-α in serum, MDA and MPO in pancreatic tissue were monitored before and after reperfusion, and apoptotice cells were stained by TUNEL technique 2 h after reperfusion.ResultsThe blood glucose, TNF-α, apoptotice index (AI), MDA and MPO of group I/R were higher than that of Group IPC and Group IPC+DPCPX after reperfusion(P<0.01), but those of Group IPC+DPCPX were not markedly different with Group IPC(P>0.05). ConclusionIPC in the posterior limbs of rats can protect rat pancreas graft from I/R injury during PTA. Adenosine do not participate in the signal mechanism of this protection.

ObjectiveTo observe the effect of ischemic preconditioning (IPC) on apoptosis of transplanted pancreas cells in rats.Methods6 normal SD rats were assigned as control group. 18 steptozozin-induced diabetic SD rats were randomly divided into 3 groups: the I/R group (n= 6, received pancreas transplantation alone), DIPC group (n=6, received pancreas transplantation exposed IPC with 5 min ischemic and 5 min reperfusion twice) and RIPC group (n=6, received pancreas transplantation exposed IPC with 5 minutes ischemic and 5 minutes reperfusion induced by ligating donors' posterior limbs three times before anastomosing vessel). The blood glucose in serum, superoxide dismutase (SOD), myeloperoxidase (MPO), TUNEL cells in graft were monitored.ResultsAfter reperfusion, compared with the I/R group, the mean blood glucose levels, MPO levels and apoptotice index of graft reduced, the mean SOD levels of graft heightened in DIPC and RIPC groups significantly (all P<0.01).ConclusionIschemic preconditioning induced by graft and ligating donors' posterior limbs can reduce apopotosis of transplanted pancreas cells.

Objective To investigate the effect of ischemic preconditioning (IPC) on pancreas transplantation(PT) in rats. Methods Steptozozin-induced diabetic SD rats were randomly assigned to 2 groups: group I/R (ischemia/reperfusion), consisted of 30 diabetic rats which received PT; group IPC, consisted of 30 diabetic rats which received pancreas transplantation and IPC. Six rats in each group were randomly sacrificed at 2 days before PT, and 3 days and 7days after PT, to detect the level of blood sugar and amylase,and pancreatic sections were stained with HE simultaneously; 6 rats were used to observe various metabolic indexes , and other 6 rats were used to observe the rat survival rate. Results The rats of group IPC had a higher 1 month survival rate than group I/R (5/6 vs 3/6, P

Objective To investigate the effect of pancreatic transplantion(PTA) using diverse operative (methods) in rats. Method Inbred SD rats were used as donor and recipient, and were randomly assigned (into) 4 groups:Normal control group( Group NC), consisted of 10 rats;diabetes group(Group DC) consisted of 10 rats;PTA with enteric drainage group(Group E-D), consisted of 22 diabetic rats;PTA using bladder reconstruction group(group B-D), consisted of 22 rats.Arterial supply of transplanted pancreas was (performed) by using end-to-side anastomosis of the donors' abdominal aorta(with splenic artery) and (recipients)′ abdominal aorta; and venous drainage was performed by using end-to-end anastomosis of the (donors)' portal vein segment(with splenic vein) and (recipients)′ left renal vein(cuff method). The fasting blood glucose, body weight, food intake, water intake and urine volume of the recipient were monitored before transplantation and on the 1st, 3rd, 7th, 14th, 30th day after operation, and also the reasons of failures were analyzed. Results The operative time of recipient in E-D group was significantly longer than that in B-D group(P

Objective:To analyze the sleep quality and sleep structure of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) complicated with patent foramen ovale (PFO), and to study the effect of PFO on the sleep structure of OSAHS.Methods:Fifty-six patients with OSAHS complicated with PFO, 64 patients with simple OSAHS and 62 controls were collected from December 2018 to March 2020 in Centre of Sleep Disorders, the Second Affiliated Hospital of Zhengzhou University. Pittsburgh Sleep Quality Index and polysomnography were used to compare the sleep quality and sleep structure of the three groups.Results:Compared with the control group [6/62(9.68%)], OSAHS complicated with PFO group [54/56(96.43%)] and simple OSAHS group [53/64(82.81%)] had higher incidence of poor sleep quality (χ2=112.08, P<0.0l). Furthermore, compared with the control group, the OSAHS complicated with PFO group and simple OSAHS group showed reduced sleep efficiency [PSQI total score was 0.5 (0, 1), 2 (1, 3) and 2 (1, 2) respectively, H=74.549, P<0.01] and reduced proportions of rapid eye movement (REM; 20.45%±3.49%, 12.19%±5.95% and 15.11%±7.21%,respectively, F=21.17, P<0.01) and slow wave sleep (N3; 21.24%±4.12%, 14.15%±6.08%, 17.68%±6.35%, respectively, F=29.51, P<0.01); the N1 (4.47%±2.40%, 9.50%±5.34%, 9.55%±4.61%, respectively, F=30.07, P<0.05) and N2 sleep (53.88%±4.35%, 64.09%±7.49%, 58.14%±6.67% , respectively, F=46.21, P<0.05) were prolonged; the inocturnal lowest oxyhemoglobin saturation (SpO 2) level was lower, mean SpO 2 reduction at night was higher [3.00% (0, 4.00%),6.00% (5.00%, 8.75%) and 4.00% (4.00%, 5.00%), respectively, H=72.24, P<0.05], and periodic leg movement index [16.30(4.80, 32.82), 33.30(9.26, 54.80) and 23.10(8.38, 31.83),respectively, H=17.86, P<0.05], arousal index [11.60(7.73, 17.55), 23.90(14.03, 30.45) and 15.6(11.23, 20.78), respectively, H=22.80, P<0.05] and sleep apnea and hypopnea index (AHI; 1.60±1.38, 23.90±7.27 and 16.24±4.22,respectively, F=136.97, P<0.05) increased. Compared with the simple OSAHS group, the incidence of poor sleep quality was higher, the proportions of slow wave sleep (N3, F=29.51, P=0.047) and REM ( F=21.17, P=0.012) were decreased, N2 sleep ( F=46.21, P=0.000) was prolonged, mean SpO 2 reduction at night ( Z=54.28, P=0.000), wake after sleep onset [116.00(89.88, 143.00) min vs 135.00(118.50, 168.38) min, Z=25.71, P=0.023], arousal times [14.00(8.25, 8.00) vs 17.50(9.00,23.00),respectively, Z=19.68, P=0.041], microarousal ( Z=23.57, P=0.044), and AHI ( F=136.97, P=0.000) were increased in the OSAHS complicated with PFO group. Conclusions:OSAHS complicated with PFO patients had poor sleep quality and high incidence of sleep disorders. They had sleep disorder at night, which was characterized by the decrease of REM sleep and slow wave sleep, the prolongation of N2, the decrease of nocturnal SpO 2 and the increase of awakening times, and the increase of arousal times and AHI. PFO can aggravate the sleep disorder of OSAHS.

Objective To investigate the long-term effect of frailty on heart failure with reduced ejection fraction(HFrEF)in elderly patients.Methods A retrospective analysis was conducted on 245 HFrEF patients aged ≥75 years admitted to our hospital from October 2017 to October 2020 due to acute exacerbation of chronic heart failure(HF).Based on their clinical frailty scale(CFS)score,they were divided into frailty group(1-4,135 cases)and non-frailty group(5-9,110 cases).Their general clinical data,clinical medication,and prognosis were compared between the two groups,and the influencing factors for frailty and death were analyzed.Results Faster heart rate,higher NT-proBNP level,and larger proportions of male,diabetes,coronary heart disease,≥5 chronic diseases,LVEF ≤35％,anemia and increased troponin I level,while lower BMI,eGFR and score of activity of daily living scale were observed in the frailty group than the non-frailty group(P＜0.05,P＜0.01).The frail group had significantly lower utilization rates of angiotensin converting enzyme inhibitors(ACEI),angiotensin receptor blockers(ARB),angiotensin receptor enkephalin inhibitors(ARNI)β receptor blockers,and sodium-glucose cotransporter 2 inhibitors than the non-frailty group(P＜0.01).Additionally,the frailty group exhibited a higher incidence of emergency room visits/readmissions within 3 months and 2-year mortality than the non-frailty group(P＜0.05,P＜0.01).Binary logistic regression analysis revealed that ≥5 chronic diseases,LVEF ≤ 35％,BMI,and GFR were independent risk factors for frailty(OR=0.167,95％CI:0.064-0.453,P=0.000;OR=0.306,95％CI:0.160-0.586,P=0.000;OR=0.868,95％CI:0.786-0.958,P=0.005;OR=0.966,95％CI:0.943-0.991,P=0.007),while ≥5 chronic disea-ses and frailty were independent risk factors for death in HF patients(P＜0.05).Conclusion The incidence of frailty is high in elderly HF patients with HFrEF.They have poor compliance to guideline directed drug therapy(GDMT).Frailty is an independent risk factor for long-term mor-tality in the patients.

Objective To explore the difference in efficacy of metoprolol versus ivabradine in the treatment of postural orthostatic tachycardia syndrome(POTS)in the elderly after COVID-19 infection.Methods A total of 110 patients diagnosed with POTS at our department from Decem-ber 1,2022 to January 31,2023 were included.According to their drug regimen,they were divided into metoprolol group(62 patients)and ivabradine group(48 patients).On the 28th day of out-patient follow-up,the resting heart rate,heart rate of 10 min of standing,symptom disappearance rate,hospitalization rate,and mortality rate were compared between the two groups.Results On the 28th day of treatment,the resting heart rate and postural heart rate for 10 min were decreased in both groups when compared with the levels at initial diagnosis(P＜0.01).And there were no significant differences in the two types of heart rate between the two groups on the 28th day(71.0±7.0 vs 72.1±7.0,P=0.401;76.5±7.2 vs 77.4±7.6,P=0.573).No obvious differences were observed between the two groups in symptom disappearance rate,hospitalization rate,or mortality rate(88.7％vs 89.6％,3.2％vs2.1％,0％vs 0％,P＞0.05).Conclusion Metoprolol and ivabradine can effectively treat POTS in the elderly patients after COVID-19 infection.

Objective To assess the safety of femoral artery puncture procedures guided by X-ray and ultrasound among elderly patients.Methods A total of 480 patients undergoing transcatheter interventional treatment for cardiovascular and cerebrovascular diseases through the femoral ar-tery in our hospital between January 2016 and December 2022 were enrolled in the study.Of them,326 patients receiving femoral artery puncture guided by X-ray fluoroscopy were assigned into X-ray group,while the other 154 patients guided by vascular Doppler ultrasound were into ultrasound group.With propensity score matching(PSM)in a ratio of 1∶1,finally 270 patients were included.Their general clinical data,success rate of puncture,puncture site,and incidence of vascular complications were compared between the two groups.Multivariate logistic regression analysis was used to identify the risk factors for vascular complications.Results Before PSM,there were no statistical differences in the mean distance from the skin fold to the bifurcation of the common femoral artery(2.5±1.0 cm vs 2.4±0.8 cm)or the distance from the fold to the in-guinal ligament(6.4±1.4 cm vs 6.3±1.7 cm)between the X-ray group and the ultrasound group(P＞0.05).After PSM,the X-ray group exhibited an obviously higher incidence of puncture points below the common femoral artery than the ultrasound group(14.8％vs 6.7％,P＜0.05),but no significant differences were observed in the one-time success rate of puncture or the occur-rence of vascular complications between the two groups(P＞0.05).Multivariate logistic regres-sion analysis indicated that the presences of non-common femoral artery and femoral artery calci-fication at the puncture site was independent risk factors for vascular complications(OR=8.379,95％CI:3.561-19.717;OR=3.922,95％CI:1.664-9.242).Conclusion There is no statistical disparity in safety between X-ray-versus ultrasound-guided femoral artery puncture procedures.Cli-nicians should choose appropriate puncture procedure or combine them together based on individual con-dition of patients.