Surgical Video Review of Warm Ischemia Time during Laparoscopic Partial Nephrectomy and Impact on Positive Surgical Margins and Postoperative Complications

Introduction: A surgical video review is an emerging tool for quality improvement, especially in complex surgeries such as laparoscopic partial nephrectomy (LPN). Assessing and measuring the warm ischemia time (WIT) during LPN by dividing it into the time used for resection (ResT), time used for reconstruction (RecT) and intermediate time (IntT) has not been performed before. This study aimed to analyze the factors that can influence all these surgical times and assess their impact on positive surgical margins (PSM) and complication rates. Methods: We evaluated 36 surgical video recordings from patients who underwent LPN and measured WIT, ResT, RecT and IntT with a stopwatch. Factors such as tumor characteristics and surgeon experience were also recorded. SPSS software was used to identify the predictor factors for all these surgical times and to correlate the ResT with PSM and RecT with the complication rate. Results: We recorded a mean WIT of 887 seconds. The mean ResT, RecT and IntT were 240 (27.2% of WIT), 473 (52.6% of WIT) and 173 s (20.2% of WIT), respectively. We found a moderate correlation between the WIT (p = 0.030), IntT and the R.E.N.A.L. score (p = 0.019). The surgeon with less than 100 LPN had significantly longer WIT, ResT, and RecT values, with means of 977 (p = 0.015), 268 (p = 0.019) and 530 seconds (p = 0.015), respectively. No correlation was found between ResT and PSM (p = 0.418);however, a strong correlation was found between RecT and the probability of developing complications (p = 0.012). Conclusion: The surgeon’s experience influences WIT, ResT, and RecT, but not IntT, which depends on tumor complexity. RecT affects the probability of developing complications. IntT represents a fifth of the WIT and efforts to reduce the WIT should focus on reducing the IntT for complex tumors, by improving surgical planning.

Biliary tract injury caused by different relative warm ischemia time in liver transplantation in rats

BACKGROUND: There is a controversy over the degree of liver and biliary injury caused by the period of secondary warm ischemia. A liver autotransplantation model was adopted because it excludes the effects of infection and immunological rejection on bile duct injury. This study was undertaken to assess biliary tract injury caused by relative warm ischemia (secondary warm ischemia time in the biliary tract) and reperfusion. METHODS: One hundred and two rats were randomly divided into 5 groups: group I (control); groups 11 to V, relative warm ischemia times of 0 minute, 30 minutes, I hour and 2 hours. In addition to the levels of serum alkaline phosphatase, and total bilirubin, pathomorphology assessment and TUNEL assay were performed to evaluate biliary tract damage. RESULTS: Under the conditions that there were no significant differences in warm ischemia time, cold perfusion time and anhepatic phase, group comparisons showed statistically significant differences. The least injury occurred in group H (portal vein and hepatic artery reperfused simultaneously) but the most severe injury occurred in group V (biliary tract relative warm ischemia time 2 hours). CONCLUSIONS: Relative warm ischemia is one of the factors that result in bile duct injury, and the relationship between relative warm ischemia time the bile injury degree is time-dependent. Simultaneous arterial and portal reperfusion is the best choice to avoid the bile duct injury caused by relative warm ischemia. (Hepatobiliary Pancreat Dis Int 2009; 8: 247-254)

Influence of warm ischemia injury on hepatic functional status and survival of liver graft in rats

OBJECTIVES: To investigate the changing patterns of functional and histological status, observe the posttransplantation survival of liver graft under different warm ischemia time (WIT) in rats, and determine the maximum limitation of liver graft to warm ischemia. METHODS: According to WIT, the rats were randomized into 7 groups, with WIT of 0, 10, 15, 20, 30, 45, 60 minutes respectively. Serum concentrations of alanine aminotransferase, aspartate aminotransferase, and lactate dehydrogenase were measured at 1, 2, 3 and 5 days after orthotopic liver transplantation respectively. Liver graft specimens were observed histopathologically at the same interval. The rats' survival in each subgroup was observed. RESULTS: In terms of graft survival, there was no significant difference between subgroups within 30-minute WIT. In the group with 30-minute WIT, the recipient rats' survival rate was 83.3% (10/12) at one week, 58.3% (7/12) at one month, and 50.0% (6/12) at 3 months. In the group with 45-minute WIT, the recipient rats' survival rate was 66.7% (8/12) at one week, 33.3% (4/12) at one month, and 8.3% (1/12) at 3 months, whereas only 8.3% (1/12) of the rats had one-week survival in the group with 60-minute WIT. CONCLUSIONS: These results indicate that rat liver graft could be safely subject to warm ischemia within 30 minutes. When WIT is prolonged to 45 minutes, the recipients long-term survival is severely insulted, and both function and histological structure of liver graft may develop irreversible damage when WIT is prolonged to 60 minutes.

Dynamic microcirculatory changes in liver graft from non-heart-beating donor with warm ischemia injury in rat

BACKGROUND: Since the 1990s, liver grafts from non- heart-beating donor (NHBD) have become an alternative because of the deficiency of grafts from heart-beating-do- nors (HBDs). Warm ischemia injury, however, directly influences the grafts' activity and functional recovery after operation. We investigated the microcirculatory change of liver graft at different warm ischemia time (WIT) in rats and determined the maximum limitation of liver graft to warm ischemia. METHODS: According to WIT, 120 rats were divided ran- domly into 5 groups of 0, 15 , 30 , 45 , 60 minutes respec- tively. The microcirculatory changes of their liver grafts were measured including serum level of hyaluronic acid (HA) and ultrastructural changes. After orthotopic liver transplantation (OLT), the recovery of microcirculation of the liver grafts after 24 hours, 48 hours and 3 days was ob- served. RESULTS: Microcirculatory changes and function of the liver grafts became normal after reperfusion when the WIT was less than 30 minutes. In the 45-minute WI group, part of blood sinusoids was full of cytoplasmic blebs stemming from the microvilli of hepatocytes and hemocytes. The se- rum level of HA in each group after 45 minutes of WI re- covered after reperfusion. CONCLUSIONS: The microcirculatory change of rat liver graft is reversible when the WIT is less than 30 minutes: rat liver graft could be safely subject to warm ischemia within30 minutes. The maximal 45 minutes of WI can be tolera- ted by the microcirculatory function of liver graft. After 60 minutes of WI, irreversible disturbance of microcirculation may appear.

Energy metabolism and survival of liver grafts from non-heart-beating donor rats with warm ischemia injury

BACKGROUND: The shortage of donor livers is a critical limiting factor for the use of liver transplantation in treatment of end-stage liver diseases. Organs from non- heart-beating donors seem to be an effective option to alleviate this problem. Warm ischemia injury, however, directly influences the grafts' activity and functional recovery after operation. We investigated the energy metabolism and post-transplant survival of liver grafts after different warm ischemia times (WITs) in rats and determined the maximum limit for liver grafts with warm ischemia. METHODS: Rats were randomized into 7 groups with WITs of 0 (control), 10, 15, 20, 30, 45 or 60 minutes. The indices of energy metabolism were measured by reversed- phase high performance liquid chromatograpy and all liver graft specimens were subjected to ultrastructural observation. After orthotopic liver transplantation (OLT), the recovery of energy metabolism in liver grafts after 24 and 48 hours and the survival of the rats were assessed. RESULTS: The levels of adenosine triphosphate (ATP) and energy charge (EC) decreased gradually after different WITs in a time-dependent manner, and this was especially significant within 30 minutes. The levels of ATP and EC in liver grafts with 30 minutes of warm ischemia largely recovered 24 hours after OLT, with 45 minutes of warm ischemia partially recovered 48 hours after OLT, and with 60 minutes of warm ischemia, hardly recovered even 48 hours after OLT. The survival time after OLT did not significantly change with up to 30 minutes of WIT, while long-term survival was reduced with 45 and 60 minutes of WIT.CONCLUSIONS: The levels of ATP and EC after OLT may be important criteria for evaluating the quality of a liver graft. The WIT of a liver graft is closely related to the recovery of hepatic energy metabolism and the graft survival.

Dynamical changing patterns of histological structure and ultrastructure of liver graft undergoing warm ischemia injury from non-heart-beating donor in rats

瞄准：调查肝接枝的组织学、极端结构的特征在期间在老鼠并且到的温暖的局部缺血时间(机智) 不同预言肝接枝的最大的限制温暖局部缺血。方法：老鼠被使随机化进分别地为 0， 10， 15， 20， 30， 45 和 60 min 经历温暖的局部缺血损害的 7 个组。所有标本经历了温暖的局部缺血损害被光和电子动态地调查显微镜学，并且组织化学染色。在常位的肝移植(OLT ) 以后，在 6， 24 和 48 h 以后的肝接枝的形态学的恢复被观察。结果：从 non-heart-beating 施主(NHBD ) 的施主肝在温暖的局部缺血时期并且在灌注时期经历了局部缺血损害。词法变化是断然与以一种时间依赖者方式的温暖的局部缺血损害有关在灌注经期期间。当机智在 30 min 以内时，结果证明 histiocyte 退化的不同的度被遵守，并且与机智的延伸变得更严重，没有明显的 hepatocyte 坏死在任何标本被注意。在为 45 min 经历温暖的局部缺血损害的组，小局灶性坏死首先发生在肝的腹片的中央区域。在为 60 min 经历温暖的局部缺血损害的组，补缀或传播的坏死被观察，区域逐渐地被扩大，当肝窦状隙 endothelial 显然是肿的时。肝窦状隙被妨碍，微循环在混乱。结论：当 WIT 在 30 min 以内时，经历温暖的局部缺血损害的老鼠肝接枝在可逆阶段。45 min 机智可以是老鼠肝接枝的一个临界点忍受温暖的局部缺血损害。当 WIT 是超过 60 min 时，损坏是不可逆的。

Dynamical changing patterns of glycogen and enzyme histochemical activities in rat liver graft undergoing warm ischemia injury

AIM: To investigate the changing patterns of glycogen and enzyme histochemical activities in rat liver graft under a dif ferent warm ischemia time (WIT) and to predict the tolerant time limitation of the liver graft to warm ischemia injury.METHODS: The rats were randomized into five groups, WTT was 0, 15, 30, 45, 60 min, respectively, and histochemical staining of liver graft specimens was observed. The recovery changes of glycogen and enzyme histochemistry activities were measured respectively 6 and 24 h following liver graft implantation.RESULTS: The activities of succinic dehydrogenase, cytochrome oxidase, apyrase (Mg++-ATPase) and content of glycogen were decreased gradually after different WIT in a time-dependent manner. The changes were significant when WIT was over 30 min.CONCLUSION: Hepatic injury is reversible within 30 min of warm ischemia injury. Glycogen and enzyme histochemistry activities of liver grafts and their recovery potency after reperfusion may serve as criteria to evaluate the quality of liver grafts.

Establishment of a rat liver transplantation model with prolonged biliary warm ischemia time

AIM:To investigate the impact of different time points of secondary warm ischemia on bile duct in a rat autologous liver transplantation model with external bile drainage.METHODS:One hundred and thirty-six male inbred SD rats were randomly assigned to one of four groups(Ⅰ-Ⅳ) according to the secondary warm ischemia time of 0,10,20 and 40 min.A rat model of autologous liver transplantation with continuous external biliary drainage under ether anesthesia was established.Ten rats in each group were used to evaluate the one-week survival rate.At 6 h,24 h,3 d and 7 d after reperfusion of the hepatic artery,6 rats were killed in each group to collect the blood sample via the infrahepatic vena cava and the median lobe of liver for assay.Warm ischemia time of liver,cold perfusion time,anhepaticphase,operative duration for biliary external drainage and survival rates in the four groups were analyzed for the establishment of models.RESULTS:No significant difference was shown in warm ischemia time,anhepatic phase and operative duration for biliary external drainage among the four groups.Five of the 40 rats in this study evaluated for the one-week survival rate died,including three deaths of severe pulmonary infection in group Ⅳ.A significant decrease of one-week survival rate in group Ⅳ was noted compared with the other three groups.With the prolongation of the biliary warm ischemia time,the indexes of the liver function assessment were significantly elevated,and biliary epithelial cell apoptosis index also increased.Pathological examinations showed significantly aggravated inflammation in the portal area and bile duct epithelial cell injury with the prolonged secondary warm ischemia time.Microthrombi were found in the micrangium around the biliary tract in some sections from groups Ⅲ and Ⅳ.CONCLUSION:The relationship between secondary warm ischemia time and the bile duct injury degree is time-dependent,and 20 min of secondary warm ischemia time is feasible for the study of bile duct injury.

Effects of warm ischemia time on biliary injury in rat liver transplantation

AIM:To investigate the effect of different secondary warm ischemia time (SWIT) on bile duct injury in livertransplanted rats. METHODS:Forty-eight male inbred Sprague-Dawley rats were randomly assigned into four groups:a shamoperation group and three groups with secondary biliary warm ischemia time of 0 min, 10 min and 20 min. A rat model of autologous liver transplantation under ether anesthesia was established, and six rats were killed in each group and blood samples and the median lobe of the liver were collected for assay at 6 h and 24 h after hepatic arterial reperfusion. RESULTS:With prolongation of biliary warm ischemia time, the level of vascular endothelial growth factor-A was significantly decreased, and the value at 24 h was higher than that at 6 h after hepatic arterial reperfusion, but with no significant difference. The extended biliary SWIT led to a significant increase in bile duct epithelial cell apoptosis, and a decrease in the number of blood vessels, the bile duct surrounding the blood vessels and bile duct epithelial cell proliferation in the early postoperative portal area. Pathologic examinations showed that inflammation of the rat portal area was aggravated, and biliary epithelial cell injury was significantly worsened. CONCLUSION:A prolonged biliary warm ischemia time results in aggravated injury of the bile duct and the surrounding vascular plexus in rat autologous orthotopic liver transplantation.

Can the rat donor liver tolerate prolonged warm ischemia?

INTRODUCTIONThe last two decades of the twentieth century havewitnessed increasingly successful rates of livertransplantation.The number of liver transplantations hasincreased steadily while the number of organ donors

Warm ischemia time and elevated serum uric acid are associated with metabolic syndrome after liver transplantation with donation after cardiac death

AIM To describe the prevalence of posttransplant metabolic syndrome(PTMS) after donation after cardiac death(DCD) liver transplantation(LT) and the pre-and postoperative risk factors.METHODS One hundred and forty-seven subjects who underwent DCD LT from January 2012 to February 2016 were enrolled in this study. The demographics and the clinical characteristics of pre-and post-transplantation were collected for both recipients and donors. PTMS was defined according to the 2004 Adult Treatment Panel-Ⅲ criteria. All subjects were followed monthly for the initial 6 mo after discharge, and then, every 3 mo for 2 years. The subjects were followed every 6 mo or as required after 2 years post-LT.RESULTS The prevalence of PTMS after DCD donor orthotopic LT was 20/147(13.6%). Recipient's body mass index(P = 0.024), warm ischemia time(WIT)(P = 0.045), and posttransplant hyperuricemia(P = 0.001) were significantly associated with PTMS. The change in serum uric acid levels in PTMS patients was significantly higher than that in non-PTMS patients(P < 0.001). After the 1 s t mo, the level of serum uric acid of PTMS patients rose continually over a period, while it was unaltered in non-PTMS patients. After transplantation, the level of serum uric acid in PTMS patients was not associated with renal function.CONCLUSION PTMS could occur at early stage after DCD LT with growing morbidity with the passage of time. WIT and post-LT hyperuricemia are associated with the prevalence of PTMS. An increased serum uric acid level is highly associated with PTMS and could act as a serum marker in this disease.

Morphological alterations and redox changes associated with hepatic warm ischemia-reperfusion injury

AIM To study the effects of warm ischemia-reperfusion(I/R) injury on hepatic morphology at the ultrastructural level and to analyze the expression of the thioredoxin(TRX)and glutaredoxin(GRX) systems.METHODS Eleven patients undergoing liver resection were subjected to portal triad clamping(PTC). Liver biopsies were collected at three time points; first prior to PTC(baseline), 20 min after PTC(post-ischemia) and 20 min after reperfusion(post-reperfusion). Electron microscopy and morphometry were used to study and quantify ultrastructural changes, respectively. Additionally, gene expression analysis of TRX and GRX isoforms was performed by quantitative PCR. For further validation of redox protein status, immunogold staining was performed for the isoforms GRX1 and TRX1.RESULTS Post-ischemia, a significant loss of the liver sinusoidal endothelial cell(LSEC) lining was observed(P = 0.0003) accompanied by a decrease of hepatocyte microvilli in the space of Disse. Hepatocellular morphology was well preserved apart from the appearance of crystalline mitochondrial inclusions in 7 out of 11 patients. Postreperfusion biopsies had similar features as post-ischemia with the exception of signs of a reactivation of the LSECs. No changes in the expression of redox-regulatory genes could be observed at mR NA level of the isoforms of the TRX family but immunoelectron microscopy indicated a redistribution of TRX1 within the cell.CONCLUSION At the ultrastructural level, the major impact of hepatic warm I/R injury after PTC was borne by the LSECs with detachment and reactivation at ischemia and reperfusion, respectively. Hepatocytes morphology were well preserved. Crystalline inclusions in mitochondria were observed in the hepatocyte after ischemia.

Cold ischemia time in liver transplantation:An overview

The standard approach to organ preservation in liver transplantation is by static cold storage and the time between the cross-clamping of a graft in a donor and its reperfusion in the recipient is defined as cold ischemia time(CIT).This simple definition reveals a multifactorial time frame that depends on donor hepatectomy time,transit time,and recipient surgery time,and is one of the most important donor-related risk factors which may influence the graft and recipient’s survival.Recently,the growing demand for the use of marginal liver grafts has prompted scientific exploration to analyze ischemia time factors and develop different organ preservation strategies.This review details the CIT definition and analyzes its different factors.It also explores the most recent strategies developed to implement each timestamp of CIT and to protect the graft from ischemic injury.

Assessment of Warm and Cold Ischemia on Functions of the Operated Kidney with ^99mTc-DMSA in Renal Masses: A Prospective and Randomized Study

Objective: To examine the effect of warm and cold ischemia on functions of the operated kidney in cases with a normal contralateral kidney undergoing nephron sparing surgery. Methods: This study enrolled 40 patients with a normal contralateral kidney and without a renal function threatening risk factor, who were operated with NSS. The patients were randomized at admission. They were divided into 2 equal groups as warm and cold ischemia. An ice application for 10 minutes was done to cold ischemia group after clamping renal artery. Renal functions were evaluated with Technesium-99m-Dimercaptosuccinic Acid (DMSA) and serum creatinine at the preoperative and postoperative (day 1, day 15, month 6, and month 12) period. Statistical analysis was done with Mann Whitney U test, Wilcoxon Signed Rank test, and Fredman test. A p value below 0.05 was considered statistically significant. Results: There were no significant differences between the groups in terms of age, body mass index, ischemia time, tumor size, amount of hemorrhage, and procedure time. Both groups had a significantly higher DMSA uptake at the preoperative period compared with the postoperative period (postoperative day 1, day 15, month 6, and month 12) (p 0.001). However, both groups had similar DMSA uptake results at the postoperative period. Preoperative and postoperative creatinine levels were not significantly different from each other in both groups. Conclusion: Based on tumor localization, nephron sparing surgery without use of superficial cooling appears as a viable option for small renal masses.

基于3D Slicer软件的局限性肾癌供血动脉解剖分布研究

目的利用3D Slicer软件分析局限性肾癌供血动脉进入肿瘤的位置、数目与分布规律,为肾部分切除术中精准缝合提供解剖依据。方法收集2021年1月—2022年6月西安交通大学第二附属医院泌尿外科因肾癌行肾部分切除术的患者资料,将患者术前肾动脉计算机断层扫描(CT)血管成像资料以DICOM格式导入3D Slicer软件,从水平面、矢状面和冠状面对肿瘤-血管的相对位置进行重建,分析各平面中肿瘤供血动脉的数目及分布特点。结果共收集112例(男59例、女53例)肾癌患者相关资料,肿瘤均为单发,RENAL评分为4~10分,肿瘤分期T1a 58例、T1b 48例、T2a 6例。其中38例(33.93%)有1条肿瘤供血动脉、53例(47.32%)有2条肿瘤供血动脉、21例(18.75%)有3条肿瘤供血动脉。这207条肿瘤供血动脉中有22条(10.63%)经肿瘤-肾脏接触面(肿瘤床)浅部进入肿瘤,有185条(89.37%)经肿瘤床深部进入肿瘤。结论在局限性肾癌中,近90%的供血动脉由肿瘤床深部进入肿瘤,为肾部分切除术中精准肿瘤切除及创面缝合提供了解剖依据。

温针灸对后循环缺血眩晕大鼠神经递质和IKB/NF-κB信号通路的影响

目的:研究温针灸对后循环缺血眩晕大鼠神经递质和人核因子κB抑制蛋白(inhibitor of NF-κB,IKB)/核转录因子κB(nuclear factor-κB,NF-κB)信号通路的影响。方法:应用随机数字表法将70只SD大鼠随机分为温针灸组、假手术组、模型组、普通针刺组和药物组各14只。假手术组仅分离大鼠右侧颈总动脉(common carotid artery,CCA)及右侧锁骨下动脉(subclavian artery,SCA),不进行CCA及SCA结扎术,直接缝合,其余各组进行CCA及SCA结扎建立后循环缺血眩晕大鼠模型。假手术组及模型组不进行干预;药物组给予盐酸氯桂利嗪治疗;普通针刺组在药物组基础上于“风池“”率谷“”百会”穴进行普通针刺;温针灸组在药物组基础上于“风池“”率谷“”百会”穴进行温针灸。干预结束后,采用激光多普勒血流仪检测各组大鼠前庭神经核血流量下降率;应用TUNEL法检测各组大鼠前庭神经核细胞凋亡指数(apoptotic index,AI);蛋白免疫印迹(western blot,WB)法检测各组大鼠前庭神经核B淋巴细胞因子相关X蛋白(Bcl-2-associated X protein,Bax)、B淋巴细胞瘤2(B cell lymphama,Bcl-2)和含半胱氨酸的天冬氨酸蛋白水解酶3(cysteinyl aspartate specific proteinase 3,caspase-3)蛋白表达;检测各组大鼠脑组织IKB mRNA、NF-κB mRNA及IKB、NF-κB p65蛋白表达;酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)检测大鼠神经递质变化情况。结果:与模型组比较,药物组、温针灸组和普通针刺组大鼠治疗后右侧前庭神经血流下降率、前庭神经核AI均降低(P<0.05),温针灸组低于普通针刺组和药物组(P<0.05);与模型组比较,药物组、温针灸组和普通针刺组大鼠前庭神经核Bax和Caspase-3蛋白表达降低,Bcl-2蛋白表达升高(P<0.05),温针灸组Bax和Caspase-3蛋白表达低于药物组和普通针刺组(P<0.05),Bcl-2蛋白表达高于药物组和普通针刺组(P<0.05);与模型组比较,药物组、温针灸组和普通针刺组大鼠海马区与大脑皮质中乙酰胆碱酶、谷氨酸浓度降低,去甲肾上腺素、5-羟色胺、γ-氨基丁酸浓度升高(P<0.05),温针灸组乙酰胆碱酶、谷氨酸浓度低于普通针刺组和药物组(P<0.05),5-羟色胺、γ-氨基丁酸高于药物组和普通针刺组(P<0.05);与模型组比较,药物组、温针灸组和普通针刺组大鼠脑组织中IKB、NF-κBp65蛋白及mRNA表达降低(P<0.05),温针灸组低于普通针刺组和药物组(P<0.05)。结论:温针灸能够改善后循环缺血眩晕大鼠眩晕症状,降低神经细胞凋亡,调节神经递质紊乱,其作用机制可能与调控IKB/NF-κB信号通路有关。

Protective effects of ischemic preconditioning and application of lipoic acid prior to 90 min of hepatic ischemia in a rat model

AIM: To compare different preconditioning strategies to protect the liver from ischemia/reperfusion injury focusing on the expression of pro- and anti-apoptotic proteins. Interventions comprised different modes of ischemic preconditioning (IP) as well as pharmacologic pretreatment by α-lipoic acid (LA). METHODS: Several groups of rats were compared: sham operated animals, non-pretreated animals (nt), animals receiving IP (10 min of ischemia by clamping of the portal triad and 10 min of reperfusion) prior to sustained ischemia, animals receiving selective ischemic preconditioning (IPsel, 10 min of ischemia by selective clamping of the ischemic lobe and 10 min of reperfusion) prior to sustained ichemia, and animals receiving 500 μmol α-LA injected i.v. 15 min prior to the induction of 90 min of selective ischemia. RESULTS: Cellular damage was decreased only in the LA group. TUNEL-positive hepatocytes as well as necrotic hepatocyte injury were also decreased only by LA (19 ± 2 vs 10 ± 1, P < 0.05 and 29 ± 5 vs 12 ± 1, P < 0.05). Whereas caspase 3- activities in liver tissue were unchanged, caspase 9- activity in liver tissue was decreased only by LA pretreatment (3.1 ± 0.3 vs 1.8 ± 0.2, P < 0.05). Survival rate as the endpoint of liver function was increased after IP and LA pretreatment but not after IPsel. Levels of lipid peroxidation (LPO) in liver tissue were decreased in the IP as well as in the LA group compared to the nt group. Determination of pro- and anti-apoptotic proteins showed a shift towardsanti-apoptotic proteins by LA. In contrast, both our IP strategies failed to influence apototic cell death. CONCLUSION: IP, consisting of 10 min of ischemia and 10 min of reperfusion, protects only partly against ischemia/reperfusion injury of the liver prior to 90 min of selective ischemia. IPsel did not influence ischemic tolerance of the liver. LA improved tolerance to ischemia, possibly by downregulation of pro-apoptotic Bax.

腹腔镜下肾部分切除术后出现急性肾损伤的影响因素分析

目的探讨腹腔镜下肾部分切术后出现急性肾损伤的影响因素。方法回顾性分析2019年1月至2022年4月郑州大学第一附属医院泌尿外科收治的79例接受腹腔镜下肾部分切除术(LPN)的肾细胞癌(RCC)患者的临床资料,按照术后是否发生急性肾损伤(AKI)分为AKI组(n=20),和非AKI组(n=59)。通过病历系统收集患者年龄,性别,体质量指数(BMI),合并疾病(高血压、糖尿病),术前尿酸、尿素氮、热缺血时间(WIT)、肿瘤最大径以及术前、术后48 h内血清肌酐(Scr)等临床资料。采用单因素、多因素Logistic回归分析LPN术后AKI的发生因素,并采用受试者工作特征(ROC)曲线分析危险因素对LPN术后AKI发生的预测价值。结果79例接受LPN的RCC患者中,术后诊断为AKI的有20例(25.3%)。AKI组和非AKI组年龄(t=2.149,P=0.036)、BMI(t=2.221,P=0.029)、术前尿素氮(Z=3.734,P<0.001)、WIT(Z=4.300,P<0.001)、肿瘤最大径(Z=3.191,P<0.001)、术前Scr(t=3.628,P=0.001)、术后48 h内的Scr(t=8.474,P<0.001)比较差异均有统计学意义。而多因素logistic回归分析结果显示,WIT(P<0.001)、BMI(P=0.021)是LPN术后发生AKI的独立危险因素。ROC曲线分析结果示,BMI、WIT的截断值依次为25.15 kg/m 2、25.50 min,曲线下面积分别为0.651、0.822。结论BMI和WIT是LPN术后发生AKI的危险因素,并且具有一定的预测价值。

温针灸联合药物治疗稳定型心绞痛合并抑郁的疗效观察及对血清resistin和adropin水平的影响

目的观察温针灸联合药物治疗稳定型心绞痛合并抑郁的临床疗效及对患者血清抵抗素(resistin)和能量平衡相关蛋白(adropin)水平的影响。方法将90例稳定型心绞痛合并抑郁患者随机分为对照组和观察组,每组45例。对照组在常规治疗基础上予盐酸舍曲林片口服,观察组在对照组基础上予温针灸治疗。比较两组治疗前后汉密尔顿抑郁量表-17(Hamilton depression scale-17,HAMD-17)评分、患者健康问卷-9(patient health questionnaire-9,PHQ-9)评分、心绞痛的发作频率、发作持续时间、疼痛程度、心肌缺血总负荷(total ischemia burden,TIB)及血清resistin和adropin水平。比较两组临床疗效。结果观察组总有效率高于对照组(P<0.05)。治疗后,两组HAMD-17和PHQ-9评分均降低(P<0.05),且观察组低于对照组(P<0.05);两组心绞痛发作频率、发作持续时间、疼痛程度均改善(P<0.05),且观察组优于对照组(P<0.05);两组TIB均降低(P<0.05),且观察组低于对照组(P<0.05)。治疗后,对照组血清resistin水平无明显变化(P>0.05),血清adropin水平升高(P<0.05);观察组血清resistin水平降低(P<0.05),血清adropin水平升高(P<0.05),且均优于对照组(P<0.05)。结论在常规治疗基础上,温针灸联合口服盐酸舍曲林片治疗稳定型心绞痛合并抑郁的疗效优于单一口服盐酸舍曲林片治疗,可改善患者抑郁状态,缓解心绞痛症状,改善心肌缺血情况,可能与其调节血清resistin和adropin水平有关。

氢分子及其制品对肺移植保护作用的研究进展

肺移植术后缺血-再灌注损伤是导致原发性移植物功能障碍的主要原因,进而会降低肺移植受者的移植肺功能和总体生存率。氢分子作为一种生理调节性分子,具有抗炎、改善氧化应激、减轻直接细胞损伤和缓解上皮细胞水肿等作用。近年来,越来越多的研究证明氢分子及其制品(主要是氢气和富氢溶液)可以显著改善肺移植术后缺血-再灌注损伤等并发症。本文就氢分子及其制品在肺移植中的保护作用及具体机制进行回顾总结,旨在为氢分子及其制品作为一种新的肺移植相关并发症治疗手段提供理论依据,进而改善肺移植受者的总体预后及生活质量。