Objective To establish a rat model of acute antibody-mediated rejection (AMR) in kidney transplantation and investigate the preventive effect of dihydroartemisinin (DHA) on acute AMR. Methods BN rats were used as donors and Lewis rats as recipients. Kidney transplantation was performed 2 weeks after skin transplantation for sensitization. After establishing the acute AMR model in rat kidney transplantation, the recipients of experimental groups included the syngeneic kidney transplantation group (6 rats), the allogeneic kidney transplantation group (6 rats), the syngeneic skin transplantation followed by kidney transplantation group (12 rats), and the allogeneic skin transplantation followed by kidney transplantation group (24 rats). The groups for investigating the preventive effect of DHA on acute AMR included the control group (allogeneic skin transplantation followed by kidney transplantation) and the DHA group (allogeneic skin transplantation followed by kidney transplantation + DHA), with 12 rats in each group. The survival time of recipient rats, serum donor-specific antibody (DSA) levels and graft pathological changes were used to identify the acute AMR model. On this basis, DSA levels, pathological changes in the transplant kidneys and peripheral blood B-cell levels were detected to assess the preventive effect of DHA on acute AMR. Results Compared with the allogeneic kidney transplantation group, skin transplantation sensitization significantly shortened the survival time of recipient rats (P<0.01). Compared with the syngeneic skin transplantation followed by kidney transplantation group, the allogeneic skin transplantation followed by kidney transplantation group showed significantly elevated serum DSA-IgG levels from 7 days after skin transplantation to 5 days after kidney transplantation (P<0.01), and significantly elevated DSA-IgM levels at 7 and 14 days after skin transplantation(all P<0.01). The transplant kidneys in the allogeneic skin transplantation followed by kidney transplantation group showed a small number of inflammatory cell infiltrations, tubular necrosis, capillaritis, and C4d deposition starting from 1 day after kidney transplantation, with these pathological changes worsening as the post-transplantation days increased. The kidney damage became significant starting from 3 days after transplantation. The above pathology manifestations were consistent with the characteristics of acute AMR. On the basis of establishing the acute AMR model, DHA treatment significantly prolonged the survival time of recipient rats (P<0.01) , and reduced serum DSA-IgG and DSA-IgM levels. DHA treatment significantly alleviated the pathological manifestations of acute AMR, including kidney damage, inflammatory cell infiltration, capillaritis and tubular necrosis, and also reduced C4d deposition in the transplant kidneys, inflammatory cell infiltration and peripheral blood CD19⁺ B-cell levels. Conclusions An acute AMR model is established by performing kidney transplantation 2 weeks after allogeneic skin transplantation in rats. It is discovered that DHA has immunosuppressive effects and may effectively prevent acute AMR, which provides a new strategy for the management of clinical AMR.

Objective:To evaluate the effect of controlled low central venous pressure with milrinone on laparoscopic hepatectomy in the patients.Methods:Fifty American Society of Anesthesiologists physical statusⅠ-Ⅲ patients of both sexes, aged 18-64 yr, with body mass index of 18-30 kg/m 2, of Child-Pugh grade A or B, undergoing elective laparoscopic hepatectomy, were divided into 2 groups ( n=25 each) using a random number table method: milrinone group (group M) and nitroglycerin group (group NG). After the start of surgery, milrinone 0.5 μg·kg -1·min -1 was continuously infused in group M, and nitroglycerin was continuously infused with the initial dose of 0.5 μg·kg -1·min -1 to maintain central venous pressure (CVP)≤5 mmHg in group NG.Mean arterial pressure and heart rate were recorded on admission to the operation room (T 0), at skin incision (T 1), at the beginning of liver resection (T 2), at completion of liver resection (T 3), at the end of operation (T 4), and CVP, cardiac index and stroke volume variation were recorded at T 1-4.Internal jugular vein blood samples were collected to determine the concentrations of hemogloblin, blood lactate at T 1 and T 4, and serum alanine aminotransferase, aspartate aminotransferase and creatinine concentrations at 1, 3 and 7 days after surgery.The score of blood oozing in hepatic surgical field, amount of norepinephrine used, blood loss, postoperative recovery and occurrence of complications within 7 days after operation were recorded. Results:Compared with group NG, cardiac index was significantly increased at T 2, 3, the CVP was decreased at T 2, the blood oozing score, blood loss, consumption of norepinephrine, and concentrations of blood lactate were decreased, and the postoperative drainage indwelling time was shortened in group M ( P<0.05). There was no significant difference in the serum alanine aminotransferase, aspartate aminotransferase and creatinine concentrations and incidence of postoperative complications at 1, 3 and 7 days after operation between the two groups ( P>0.05). Conclusions:Milrinone is better than nitroglycerin in decreasing central venous pressure, reducing blood loss, maintaining stable circulatory function and tissue perfusion in laparoscopic hepatectomy.

Objective:To investigate the effect of dexmedetomidine (DEX) on reducing urethral stimulation in patients undergoing laparoscopic gastrointestinal surgery.Methods:From January 2019 to February 2020, 90 patients undergoing elective laparoscopic gastrointestinal surgery under general anesthesia in the Third Affiliated Hospital of Sun Yat-sen University were selected. They were randomly divided into 3 groups: catheterization before induction (group A), catheterization during induction (group B), and catheterization after induction (group C). In group A, patients received general anesthesia after awake catheterization. In group B, intravenous injection of DEX 0.5 μg/kg was pumped for 10 minutes, followed by catheterization and induction. In group C, patients received general anesthesia and then catheterization. Visual analogue scale (VAS) score of urethral stimulation, morphine dosage and the incidence of agitation during resuscitation were recorded. The heart rate and mean arterial pressure of the three groups were compared at the time of entering the room, catheterization, tracheal intubation, entering postanesthesia care unit (PACU), about extubation and 30 minutes after extubation.Results:The fluctuation of blood pressure and heart rate in group B was significantly less than that in group A and group C at the time of extubation and 30 minutes after extubation ( P<0.05). VAS of urethral stimulation in group B [(2.9±0.9)point] was significantly lower than that in group A [(4.4±1.8)point] when catheter was indwelling ( P<0.05). After extubation, VAS in group B [(2.8±1.1)point] was significantly lower than that in group A [(3.2±1.2)point] and C [(5.2±1.8)point] ( P<0.05). The utilization rate of morphine within 24 hours after surgery in group B (10%) was significantly lower than that in the other two groups (40%, 57%), and the incidence of postoperative agitation in group A and B was lower than that in group C within PACU ( P<0.05). The satisfaction of patients in group B (86.7%) was higher than that in group A (70%) and C (46.7%). The satisfaction of PACU personnel in group A (76.7%) and B (80%) was significantly higher than that in group C (43.3%). Conclusions:Sedation with dexmedetomidine during urethral catheterization can reduce urethral stimulation during resuscitation and improve patients' and PACU staffs' satisfaction.

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.

Objective To observe the effects of massage on inflammation,oxidative stress and autophagy during the repair of acute contusion of skeletal muscles so as to explore its biological mechanisms.Methods Forty-two adult Sprague-Dawley rats were randomly divided into a control group (n =6),a model group (n =18),and a treatment group (n =18).Acute contusion of the gastrocnemius muscles of the rats in the model and treatment groups was inflicted using a home-made impactor.Beginning forty-eight hours later,15 minutes of massage was administered daily for two weeks.After one,7 and 14 days of the massage treatment,the injured gastrocnemius was resected from 6 rats of both the model and treatment groups.Morphological changes were observed using haematoxylin and eosin (HE) staining.The serum content of tumor necrosis factor alpha (TNF-α),interleukin1β (IL-1 β),C reactive protein (CRP) and prostaglandin E2 (PGE2) were detected using enzyme-linked immunosorbent assay (ELISA).The serum content of superoxide (SOD) and malondialdehyde (MDA) were detected using spectrophotometry.The expression of microtubule-associated protein 1 light chain 3 (LC3),Bcl-2 homeodomain protein Beclin1 and ubiquitin binding protein P62 were detected using Western blotting.Results The HE staining showed more significant collapse and swelling of cells in the model group than in the control group at each time point.New muscle cells were observed at days 7 and 14 in the model group.At each time point,significantly better recovery was observed in the treatment group compared to the model group,with more new muscle cells and better cell morphology.According to the ELISA results,a significant increase in serum pro-inflammatory factors occurred in the model group compared to the control group and compared to the treatment group after one day and 7 days of treatment.The average serum content of SOD and MDA in the model group was significantly higher than in the control group,while the average serum content of SOD in the treatment group was significantly higher than in the model group and that of MDA was significantly lower.Western blotting showed a significant decrease in LC3 (Ⅱ/Ⅰ) and Beclin1,as well as a significant increase in P62 in the model group at each time point compared with the treatment group and the controls.Conclusion Inflammation and oxidative stress increase significantly in a skeletal muscle after injury,but autophagy decreases significantly.Massage can effectively reduce the inflammatory response and oxidative stress and promote autophagy,which leads to quicker repair of skeletal muscles.

Objective To study the mechanism of lidocaine injection in the alleviation of pains of propofol injection. Methods 430 patients, who underwent elective gastrointestinal endoscopy under general anesthesia , were randomly assigned into 3 groups: group A received 2 mL NS intravenous injection on the right dorsal hand;group B received 40 mg Lidocaine intravenous injection on the right dorsal hand and group C received 40 mg lidocaine intravenous injection on the left dorsal hand. All groups received 2 mg/kg Propofol intravenous injectionon the right dorsal hand at the rate of 20 mL/min. The injection pains were evaluated while the dosage reached 1/4 of the total (2 mg/kg). The left dosage of Propofol and 50 μg Fentanil were pumped after evaluation. Propofol dosage was added when needed. Mean arterial pressure (MAP) and heart rate (HR ) were recorded before Propofol injection and 1, 3, 5 minutes after Propofol injection. Results VRS comparisons: Tthe rate of pain incidence of group B was significantly lower than those of group A and C. MAP were declined dramatically at the time points of 1 minute, 3 minutes and 5 minutes after propofol injection, as compared to before propofol injection. The HR was declined dramatically 5 minutes after propofol injection. Conclusion Intravenous Lidocaine of 40 mgcould reduce Propofol-induced injection pain of the same vein. Local effect of Lidocaine but not its systemic function may play an important role in reducing Propofol-induced injection pain.

Objective To evaluate the effects of hypoxia/reoxygenation (H/R) on apoptosis and gap junction in isolated renal tubular epithelial cells of rats.Methods The renal tubular epithelial cells were seeded in 6-well plates at a density of 1 × 105 cells/ml and randomly divided into 2 groups (n =18 wells each) using a random number table:control group (group C) and H/R group.In group C,the cells were cultured in a regular incubator with 21％ oxygen at 37 ℃.In group H/R,the cells were incubated in an anaerobic chamber for 24 h and then returned to a regular incubator and incubated for 4 h.Hoechst33258 staining method and flow cytometry were used to detect the cell apoptosis.Gap junction function was determined by specific parachute assay.Gap function protein connexin 43(Cx43) expression was measured by Western blot.Results Compared with group C,the apoptosis rate was significantly increased and gap junction function and Cx43 expression were decreased in group H/R (P ＜ 0.05).Conclusion H/R promotes apoptosis in isolated renal tubular epithelial cells through destroying intercellular gap junction in rats.

Objective To evaluate the effects of propofol,etomidate and midazolam on gap junction function in rats in vitro and in vivo.Methods Experiment Ⅰ NRK52E cells were seeded in 6-well plates with the density of 1.0 × 105/ml and randomly divided into 4 groups (n =6 wells each):control group (group C),propofol group (group P),etomidate group (group E) and midazolam group (group M).In group C,NRK52E cells were cultured in DMEM-F12 culture medium containing 10％ fetal bovine serum.In P,E and M groups,propofol,etomidate and midazolam (with the final concentrations of 15,8 and 4μmol/L,respectively) were added to the culture medium,respectively,and the cells were then incubated for 1 h.Parachute dye-coupling assay was used to measure the gap junction function in NRK52E cells.Experiment Ⅱ Twenty-four male Sprague-Dawley rats,aged 2 months,weighing 220-280 g,were randomly divided into 4 groups (n =6 each):propofol group (group P),etomidate group (group E),midazolam group (group M),and control group (group C).In P,E and M groups,propofol 100 mg/kg,etomidate 6 mg/kg and midazolam 5 mg/kg were injected intraperitoneally once a day for 3 consecutive days,respectively.The equal volume of normal saline was given instead in group C.The animals were sacrificed at 30 min after the last administration and the renal cortex was harvested to measure the gap junction function using tissue scrape and load assay.Results Compared with group C,the gap junction function was significantly decreased in P and E groups (P ＜ 0.05),and no significant change was found in the gap junction function in group M (P ＞ 0.05).Conclusion Propofol and etomidate significantly inhibit the gap junction function in NRK52E cells and renal tissues in rats,but midazolam produces no effect.

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 evaluate the cardiac function of the patients with liver cirrhosis before orthotopic liver transplantation(OLT)using Swan-Ganz catheter.Methods Sixty ASAⅡ-Ⅳ patients aged 45-64 yr with liver cirrhosis scheduled for OLT without veno-venous bypass were allocated into 2 groups according to preoperative liver function:compensated group(group C,n=28)and decompensated group(group H,n=32).Anesthesia was induced with midazolam 3-5 mg,fentanyl 0.15-0.2 mg,propofol 1 mg/kg and vecuronium 0.1 mg/ks and maintained with 0.5%-3.0% isoflurane,fentanyl 0.05-0.10 mg and vecuronium 4 mg/h.The patients were mechanically ventilated after tracheal intubation,and P_(ET)CO_2 was maintained at 30-45 mm Hg.Radial artery was cannulated and Swan-Ganz catheter was placed via right internal jugular vein for monitoring of mean arterial pressure(MAP),cardiac output(co),cardiac index(CI),right ventricular ejection fraction(RVEF),mean pulmonary arterial pressure(MPAP),pulmonary arterial wedge pressure(PAWP),right atrial pressure(RAP),right ventricular end-diastolic volume(RVEDV),fight ventricular end-systolic volume(RVESV)and stroke volume index(SVI).Right and left ventricular stroke work index(RVSWI,LVSWI)and systolic and pulmonary vascular resistance(SVR,PVR)were calculated.Results CO,CI,SVI,MPAP,PAWP,RVEDV,RVESV,RVSWI and LVSWI were significantly elevated in group H as compared with group C indicating hyper-hemodynamic state.The SVR and PVR were significantly decreased in group H.There was no significant difference in HR,MAP,RAP and RVEF between the two groups.Conclusion The patients with decompensated liver function before OLT are in a hyper-hemodynamic state.More attention should be paid to perioperative myocardial protection.