Objective To explore the differential proteins between livers of control and brain dead grups,and to provide an experimental basis for the assessment of liver quality in brain dead rabbits.Methods 60 healthy male New Zealand rabbits were divided into two groups.The brain dead group (n=30) contained rabbits 2 hours (B1),6 hours (B2),and 8 hours(B3) after brain death.The sham group (n=30) contained groups of 2 hours (C1),6 hours (C2),and 8 hours (C3).At the end of the relevant experiments,blood samples and liver tissues were collected.The level of ALT and AST were determined by an automatic biochemistry analyzer and the morphologic changes of the livers were detected by HE staining.The differentially expressed proteins were screened and identified by two-dimensional gel electrophoresis,PDQuest software,matrix-assisted laser desorption ionization time of flight mass spectrometry,and the NCBI database.Results In 8 hour brain dead group,the level of ALT increased comparing with 6 h (P＜0.05),but there was no significant statistical difference in the other groups.Under real time observation with the light microscope,the livers of the brain dead groups had increased edema and infiltration of lymphocytes in the portal area,especially in the 8 hour group.However,infiltration of neutrophils also appeared in the 8 hour control group and all groups had no damage in the liver cell.There were 10 kinds of differentially expressed proteins through the two-dimensional gel electrophoresis,mass spectrometry analysis,and database query.One protein of interest was ALDH2,which showed a gradually decreasing expression in the liver when the braid dead time increased.Conclusion Brain death could lead to no damage of liver function and little damage to liver morphology.The identified protein ALDH2 may be related with liver injury after brain death and could be a new indicator in the assessment of liver quality in brain dead rabbits.

Objective To explore the way to establish the brain death model for rabbits and pathophysiological changes before and after brain death.Methods 80 healthy male New Zealand rabbits were divided into brain death group (n =60) and sham operation group (n =20),The 60 brain death rabbits were established by increasing intracranial pressure in a modified,slow,and intermittent way.The sham operation rabbits were only maintained with anesthesia.Results The 56 brain death rabbits were established successfully and maintained for 10 h with the respiration and circulation supports.2 rabbits died due to anesthetic accident,the other 2 died because of improper pressure.The surgical success rate is 93.3％ (56/60).The changes of mean artery pressure (MAP) and heart rate (HR) in brain death group were more significant than in sham operation group:MAP and HR fluctuated and showed the increased tendency.The mean MAP and HR during increasing intracranial pressure were (400.24±18.36) mm Hg (1 mm Hg=0.133 kPa) and (258.00 ± 25.70) beats/min respectively,which was significantly higher than before and after increasing intracranial pressure (P＜0.05).Conclusions The brain death model for rabbits could be established by increasing intracranial pressure in a modified,slow,and intermittent way successfully and maintained 10 h.the MAP and HR before and after brain death showed characteristic changes.The model is helpful to the further observation of organ changes in brain dead state.

Biliary complication (BC) after liver transplantation has attracted increased attention from a clinical and research perspective.BC,which affects the long-term outcome of the liver transplant,includes diseases of biliary stricture,biliary obstruction,biliary fistula,and many more that need an operation or interventional therapy.The occurrence of these diseases is related to the surgical operation,biliary tract variation,vessel injury,and quality of the donor graft.This article reviews BC and its etiology,diagnosis,and therapy in order to help future clinical and experimental studies.

Objective To compare the outcome of donation after cardiac death (DCD) versus donation after brain death (DBD) for liver transplantation.Method Such databases as PubMed,Cochrane Central Register of Controlled Trials (CENTRAL),EMbase,the ISI Web of Knowledge databases and CBMdisk were searched from Month 1990 to March 2011 for collecting the randomized controlled trials (RCTs),case control studies and cohort analysis about DCD versus DBD for liver transplantation,and the references of those trials were also searched by hand.After study selection,assessment and data extraction conducted by two reviewers independently,meta-analyses were performed by using the RevManS.1 software.The quality of evidence was assessed by using the GRADEpro software.Result DCD group had similar MELD of recipients with DBD group before operation [Z =1.37,95％ CI(-2.25,0.26),P =0.17],and DCD group got shorter cold ischemia time than DBD group [Z=2.26,95％CI(-1.76,-0.12),P =0.02].DCD group had higher hiliary complication incidence [Z =6.37,95％ CI(1.89,3.31),P＜0.000 01],higher vascular complication incidence [Z =2.14,95％ CI(1.03,2.17),P =0.03],higher liver primary non-function (PNF) incidence [Z =4.43,95％ CI (2.02,6.17),P＜0.000 01],lower 1-year graft survival rate [Z =3.78,95％ CI(0.84,0.94),P =0.0002] and lower 3 year graft survival rate[Z=2.54,95％ CI(0.73,0.96),P =0.01] than DBD group.The quality of the result was verified from low to moderate.Conclusion Liver transplantation using DCD had higher incidence of complications and lower 1-year and 3-year graft survival rate than DBD.For the poor quality of the original studies,a prudent choice is suggested.More randomized controlled trials are needed.

Objective To establish the rabbit brain death model,and observe the change of kidney function and morphology in the brain death rabbits,fully evaluate the possibility of transplantation surgery carried out with brain death donor kidney.Method 40 male healthy New Zealand rabbits were randomly divided into sham group (n =20) and brain death group (n =20),and each group further was divided into four groups according to 2,4,6 and 8 h after brain death groups.At the end of the experiment,the blood samples and kidney tissues were collected.The level of blood urea nitrogen(BUN),serum creatinine (Cr) and the apoptosis of kidney cells were determined by automatic biochemistry analyzer and TUNEL method,respectively.The morphology changes of liver were detected by HE staining.Result Although BUN values were with no obviously alteration (P＞0.05) within 8 h after brain death,the renal Cr levels in the states of 2,4 and 8 h (P＜0.05) brain death were found significantly increased compared with shamed groups.The denaturalization in the epithelial cells of renal tubule,glomerulus atrophygradually,swelling and vacuolation of epithelial cells,edema in the interstitium and inflammatory cell infiltration and partly occlusion in proximal convoluted tubule gradually emerged in the brain dead groups.The inflammatory factor intercellular adhesion molecule (ICMA) and the apoptosis index in brain dead groups increased in a time dependent manner but the expressions of protective factor HSP70 conducted a contrary tendency.Conclusin Brain death could lead to the damage of kidney function and morphology and this injury aggravated in a time dependent manner.The alterations might be relevant to the production of inflammatory factors.Within 8 h after brain death there were obvious changes in the kidney function and morphology,which provide experimental basis for the rational use of brain death donor kidney transplantation.

Objective To explore the differential proteins in livers with the help of proteomics,which provide experimental basis for the study of influence factors of liver injury in the state of brain-death.Methods Slow intracranial pressure method was used to establish the rabbit brain death model.Each liver tissue from 6 h after brain death of rabbit was collected.Total proteins were extracted and separated by two-dimensional gel electrophoresis.The image was analyzed by PDQuest software.The differentially expressed proteins between the two groups in more than two-fold were identified by matrix-assisted laser desorption ionization time of flight mass spectrometry and retrieved in the NCBI database to identify the corresponding protein.And the different proteins were re-identified by western blot.Results Two-dimensional gel electrophoresis showed that there were about 973 ± 34 and 987 ± 38 protein spots in sham and brain death groups.A total of 52 differentially expressed protein spots between the two groups,29 were up-regulated,and 23 were down-regulated.10 different proteins were:DPYL4,ALDH2,PRDX6,PDK1,THTM,RUNX1,PPA1,ADH,GCLR,CYB5.RUNX1 is a protein of interest,so the expression of RUNX1 was detected by western blot and it showed that the expression of RUNX1 in liver decreased gradually in a time-dependent manner.Conclusions Two-dimensional gel electrophoresis and mass spectrometry identification is a reliable platform and powerful tool for differential proteomics studies.Identified protein RUNX1 may be related with liver injury after brain death,which is beneficial for the understanding of the mechanism of liver damage after brain death.

Objective To establish the rabbit brain death model,observe the change of liver function and morphology in the brain death rabbits,and evaluate the possibility of transplantation surgery carried out with brain death donor liver.Methods 40 healthy New Zealand rabbits were randomly divided into sham group (n=20) and brain death group (n=20),and each group was further divided into four subgroups according to 2,4,6 and 8 h after brain death.At the end of the experiment,the blood samples and liver tissues were collected.The level of alanine transaminase (ALT),aspartate transaminase (AST) and the apoptosis of liver cells were determined by automatic biochemistry analyzer and TUNEL method respectively.The morphology changes of liver were detected by HE staining,and the levels of interleukin (IL)-1β,IL-6,IL-8,tumor necrosis factor (TNF)-α were detected by competitive inhibition ELISA.Results In 2,4,6 and 8 h group,the level of ALT and AST increased,especially in 8 h group,which were significantly different from 6 h group's.Under light microscope,there was no significant change in liver 2 and 4 h after brain death.However,in 8 h after brain death,liver cells degenerated significantly,liver cord structure disappeared,some liver cells necrosis,which was consistent with the results of apoptosis index.The levels of IL-1β,IL-6,IL-8,TNF-α were obviously increased in a time dependent manner compared with sham group.Conclusions Brain death could lead to the damage of liver function and morphology and this injury aggravated with time,which might be relevant with the production of inflammatory mediators.8 h after brain death,there were obvious change in the liver function and morphology.

Objective: To observe the clinical application effect of blood circulation enhancement technique in repairing large area of skin and soft tissue defects of extremities with super large free anterolateral thigh flap. Methods: From March 2014 to March 2017, 6 patients with large area of skin and soft tissue defects of extremities were hospitalized in our unit, including 5 males and 1 female, aged 27-65 years, 1 case of electric injury, 2 cases of coal burn, 3 cases of traffic injury, 2 cases involving upper limb, and 4 cases involving lower limb. After debridement, the wound area ranged from 26 cm×8 cm to 36 cm×15 cm, and the bone exposure area ranged from 24 cm×7 cm to 35 cm×14 cm. The blood circulation enhancement technique was used when the wound with bone exposure was repaired with super large free anterolateral thigh flap. The area of flaps ranged from 28 cm×10 cm to 38 cm×16 cm. The donor site of flap and the primary wound without bone exposure were repaired with medial thigh split-thickness skin graft of the donor leg of flap. The blood circulation enhancement technique mode during operation and the survival of flaps after operation were recorded, and the recovery of donor and recipient areas and the occurrence of complications were followed up. Results: Three patients were treated with simple vascular supercharging technique during flap transplantation, and the other 3 patients were treated with vascular supercharging and turbocharging technique during flap transplantation. All the flaps survived well in 6 patients without vascular crisis. Follow-up for 3 to 12 months after surgery showed that the blood flow of the flaps was good and the depth and superficial sensation recovered to varying degrees. Except for 1 case of upper limb flap, the other flaps had no obvious swelling and needed no second thinning. There were only depressed scars in the donor sites, and no obvious scar hyperplasia in the area without bone exposure repaired by the skin grafts. No short-term or long-term complications were found. Conclusions The application of blood circulation enhancement technique in repairing large area of skin and soft tissue defects of extremities with super large free anterolateral thigh flaps provides reliable blood supply for the flaps and results in good effect after operation, which is worth popularizing.

Objective To explore the application effect of modified installing method of high flexion rotating platform prosthesis trial model in double compartment knee arthroplasty.Methods A total of 20 patients(26 knees)with severe knee osteoarthritis admitted to Hebi People's Hospital from January 2021 to April 2022 and required double compartment knee arthroplasty were selected as the research subjects.Patients were divided into the control group(10 knees)and the observation group(16 knees)based on the installing method of high flexion rotating platform prosthesis trial model.The patients in the control group used the conventional installing method of high flexion rotating platform prosthesis test model(placing the tibial side test model,the femoral side test model and finally the pad test model),while patients in the observation group used the modified installing method of high flexion rotating platform prosthesis test model(matching the femoral test model,pad and tibial test model when the patient flexed 60° to 90°,and placing them together into the knee joint osteotomy groove).The intraoperative bleeding volume and surgical time of patients in the two groups were recorded.Before surgery,2 weeks after surgery and 18 months after surgery,the knee joint function of patients was evaluated by the American hospital for special surgery(HSS)scoring system,and the range of motion(ROM)of knee joint of patients was measured by protractor.Results The intraopera-tive bleeding volume of patients in the observation group was significantly less than that in the control group,and the surgical time was significantly shorter than that in the control group(P＜0.05).There was no statistically significant difference in preoperative HSS score and ROM of knee joint of patients between the two groups(P＞0.05).At 2 weeks and 18 months after surgery,the HSS score and ROM of knee joint of patients in the observation group were significantly higher than those in the control group(P＜0.05).Conclusion Compared with the conventional installing method of high flexion rotating platform prosthesis trial method,the modified installing method of high flexion rotating platform prosthesis trial model in double compart-ment knee arthroplasty for patients with severe knee osteoarthritis can effectively improve surgical efficiency,reduce intraopera-tive bleeding,improve knee function and increase ROM of knee joint.

Objective: To investigate the clinical effects of perforating branch flaps of medial vastus muscle in repairing secondary wounds in donor sites of free anterolateral femoral perforator flaps. Methods: From August 2014 to December 2016, 12 patients (8 males and 4 females, aged 35-72 years) with skin and soft tissue defects of extremities associated with tendon and bone exposure were treated in Hanzhong Central Hospital. The sizes of the primary wounds after debridement were 10 cm×8 cm-22 cm×14 cm, and the wounds were repaired with 12 cm×10 cm-24 cm×16 cm free anterolateral femoral perforator flaps. The anterolateral femoral donor sites, which were 8.0 cm×4.0 cm-14.0 cm×7.5 cm in the secondary wounds after skin extensional suture, were repaired with perforating branch flaps of medial vastus muscle in the size of 9.0 cm×5.0 cm-15.0 cm×8.5 cm. The medial femoral donor sites were sutured directly. Results: All the perforating branch flaps of medial vastus muscle and free anterolateral femoral perforator flaps survived in 12 patients. Following up for 6 to 12 months, the medial femoral perforator flaps had good local shape and texture. The flaps of 8 patients without cutaneous nerve transection were sensitive. The sensation of the flaps of the other 4 patients gradually recovered, and the functions of the ipsilateral knee joints were normal. Conclusions The medial femoral perforator flap has a stable anatomy and abundant blood supply, which can be used to repair the secondary wound in the donor site of the free anterolateral femoral perforator flap conveniently. It is safe and easy to be popularized. Moreover, it has a good shape and function after operation.