Objective To investigate the safety and effectiveness during perioperative period in patients undergoing laparoscopic hepatectomy under ERAS program.Methods A retrospective study was carried out,in 40 patients under ERAS programs from Sep 2016 to Aug 2017 compared with 40 patients in control group from Sep 2015 to Aug 2016 in intraoperative central vein pressure,blood loss,postoperative stress indicators,the incidence of moderate to severe pain,exhaust time,oral feeding time,ambulation time,complications,hospital stays and costs and patient satisfaction.Results Compared with control group,the intraoperative blood loss was decreased by controlling central venous pressure (t =2.556,P =0.013),earlier exhaust,oral intake of food and ambulation (P ＜0.001),lower incidence rate of moderate to severe pain (x2 =11.314,P ＜ 0.001),and higher patient satisfaction (t =6.816,P ＜ 0.001) in ERAS group,though there were no significant differences in extubation time (t =0.336,P =0.738).The average hospital stays were 2.8 days shorter (16.6 ± 3.0 vs.19.4 ± 6.4,t =2.514,P =0.015),and hospital expenses were (￥)6 000 less than control group (5.4 ±0.7 vs.6.0± 1.5,t =2.338,P =0.023).Conclusion ERAS programs applied to patients undergoing laparoscopic hepatectomy can safely and effectively accelerate patient recovery.

Objective To study the radiation-induced mitochondrial damage and energy metabolic alteration in pancreatic exocrine cells,and to explore underlying mechanism.Methods Rat pancreatic exocrine cells (AR42 J) were divided into control group and experimental group irradiated with 6 Gy of X-rays.Mitochondrial membrane potential was detected at 24,48,72 and 96 h,the lactic acid and ATP production were detected at 24 h and 48 h,and reactive oxygen species (ROS) were detected at 24 h after irradiation.The expressions of energy metabolism related factors of HIF-1α,LDHA and PDH were detected by Western blot.The animal experiments were conducted to confirm the changes.According to random number table,eight rats were randomly divided into two groups with 4 rats in each.The irradiated group was exposed to 12 Gy of X-rays,while the control group sham-irradiated.Results Compared with the nonirradiated control group,the mitochondrial membrane potential (△Ψm) of the experimental group was progressively decreased at 24-96 h after irradiation (t =5.438-17.687,P＜0.05).The ATP content in the experimental group decreased at 24 h and 48 h (q=17.300,8.328,P＜0.05),the lactic acid increased (q =21.790,16.250,P＜0.05),and the ROS level increased (t =7.935,P＜0.05).The expressions of HIF-1α and LDHA were significantly increased,but PDH was reduced after radiation.Silencing HIF-1α by siRNA eliminated radiation-induced energy metabolic alteration.These changes were confirmed with animal experiments by locally irradiating rats.Conclusions The expression of HIF-1α is upregulated by irradiation,which leads to the change of energy metabolism as the enhancement of glycolysis pathway and the inhibition of aerobic oxidation of mitochondria in pancreatic exocrine cells.