Impact of bariatric surgery on glucose and lipid metabolism and liver and kidney function in food-induced obese diabetic rats

BACKGROUND Obesity usually causes diabetes mellitus(DM)and is a serious danger to human health.Type 2 DM(T2DM)mostly occurs along with obesity.Foodborne obesityinduced DM is caused by an excessive long-term diet and surplus energy.Bariatric surgery can improve the symptoms of T2DM in some obese patients.But different types of bariatric surgery may have different effects.AIM To investigate the effect of bariatric surgery on glucose and lipid metabolism and liver and kidney function in rats.METHODS Male Sprague-Dawley rats aged 6-8 wk underwent Roux-en-Y gastric bypass surgery(RYGB),sleeve gastrectomy(SG),or gastric banding(GB).Glucose and insulin tolerance tests,analyses of biochemical parameters,histological examination,western blot,and quantitative real-time polymerase chain reaction were conducted.RESULTS In comparison to the sham operation group,the RYGB,SG,and GB groups had decreased body weight and food intake,reduced glucose intolerance and insulin insensitivity,downregulated biochemical parameters,alleviated morphological changes in the liver and kidneys,and decreased levels of protein kinase Cβ/P66shc.The effect in the RYGB group was better than that in the SG and GB groups.CONCLUSION These results suggest that RYGB,SG and GB may be helpful for the treatment of foodborne obesity-induced DM.

Comparative Assessment of Melatonin-Afforded Protection in Liver, Kidney and Heart of Male Mice against Doxorubicin Induced Toxicity

Melatonin (MEL) was investigated for protection against the anthracycline antibiotic doxorubicin (Dox) that is well known for its oxidative damage to various body organs. It was aimed to have a comparison of this protection to heart, liver and kidney in the treated subjects. In this study, groups of mice were treated with Dox and melatonin and their individual or combined effects were evaluated by assessing lipidperoxidation, non-protein sulfhydryls (NP-SH) and nitrate/nitrite (NO) contents in these tissues. Plasma aminotransferases, LDH and CK-MB enzyme activities were measured. Moreover, these tissues were subject to histopathological assessment. MEL co-treatment significantly prevented any rise in lipidperoxides more significantly in heart and liver as compared to kidney. In tandem, MEL prevented a decline in GSH that was observed by Dox alone in liver and kidney. Dox significantly increased total NO levels in all the tissues. Melatonin at both dose levels could not afford protection against nitrosative stress. MEL in combination treatment provided significant

Metabolic Acidosis in the Surgical Intensive Care Unit: Risk Factors, Clinical Correlates and Outcome. Findings from a High Dependency Heart and Vascular Surgical Center in Nigeria

Background: Metabolic acidosis (MA) is a common finding on the surgical ward, more so in the intensive care unit. Diseases affecting the major organ systems of the body and higher grades of surgery are common risk factors for MA. It is associated with poor treatment outcome. Aim: To determine the risk factors and clinical correlates of metabolic acidosis and assess its relationship with treatment outcome. Methodology: A retrospective study at the “Tristate Heart and vascular Center” in Ilishan-Remo South west Nigeria, on patients that had cardiac and vascular surgeries from January 2015 to December 2019. Three hundred and forty two participants took part in the study. The demographic, clinical and laboratory findings were entered. Statistical analysis was with Student’s t-test and Chi square. Results: Two hundred and six males and 136 females were studied. The incidences of metabolic acidosis prior to induction, on post-operative day one (POD1) and on POD28 were 20.7%, 39.8% and 14.1% respectively. Nine (2.6%) participants died during admission, of this, 6 (66.7%) had MA at presentation but all (100%) had MA on POD1. The Risk factors for MA were advanced age, comorbidities, open heart surgery, elevated systolic blood pressure and low eGFR. Metabolic acidosis was a risk factor for prolonged hospital stay, perioperative death and declining kidney function which was commoner among participants with preexisting kidney dysfunction. Conclusion: The incidence of metabolic acidosis was 20.7% at induction of anesthesia, rose to 39.8% on POD1 and by POD28, it has significantly reduced to 14.1%. While advancing age and comorbidities were risk factors for MA, the occurrence of MA increased the risk of declining kidney function, prolonged hospital stay and death.

Effects of Noise Pollution on Functions of the Liver and Kidney of Rats

To study the effects of noise pollution on the functions of the liver and kidney of rats, a total of 40 male SPF Wistar rats were randomly divided into a control group and three experimental groups. The rats in the experimental groups were respectively stimulated with 38, 55 and 70 dB noise for 15 days, and the levels of blood components were determined by an automatic biochemical analyzer. The results showed that in compari-son with the control group, the level of the blood glucose in the experimental groups increased by 23.53%, 52.94% and 88.24%, respectively, and the differences were statistically significant （P〈0.01）. The levels of triglyceride in the blood rose by 20.83%, 38.54% and 79.68%, respectively, and the differences were also statistically significant （P〈0.01）. The level of globulin in the blood increased by 16.49%, 21.13% and 51.78%, and the level of albumin in the blood rose by 9.51 %, 12.67% and 17.89%, respectively. The level of total bilirubin in the blood increased by 27.04%, 41.63% and 73.67%, respectively, and the differences were statistically significant （P〈0.01）. The level of creatinine in the blood rose by 9.72%, 10.21% and 20.99%, respectively. The level of amylase in the blood reduced by 6.6%, 13.05% and 23.89%, respectively. The level of creatine kinase in the blood decreased by 19.81%, 27.37% and 36.81 %, respectively, and the level of urea in the blood reduced by 11.19%, 12.77% and 19.26%, respectively. The results revealed that noise pollution could significantly affect the levels of blood components and the functions of the liver and kidney of rats.

Current status and recent advances of liver transplantation from donation after cardiac death

The last decade saw increased organ donation activity from donors after cardiac death (DCD). This contributed to a signif icant proportion of transplant activity. Despite certain drawbacks, liver transplantation from DCD donors continues to supplement the donor pool on the backdrop of a severe organ shortage. Understanding the pathophysiology has provided the basis for modulation of DCD organs that has been proven to be effective outside liver transplantation but remains experimental in liver transplantation models. Research continues on how best to further increase the utility of DCD grafts. Most of the work has been carried out exploring the use of organ preservation using machine assisted perfusion. Both ex-situ and in-situ organ perfusion systems are tested in the liver transplantation setting with promising results. Additional techniques involved pharmacological manipulation of the donor, graft and the recipient. Ethical barriers and end-of-life care pathways are obstacles to widespread clinical application of some of the recent advances to practice. It is likely that some of the DCD offers are in fact probably "prematurely" of-fered without ideal donor management or even prior to brain death being established. The absolute benef its of DCD exist only if this form of donation supplements the existing deceased donor pool; hence, it is worthwhile revisiting organ donation process enabling us to identify counter remedial measures.

Diabetes mellitus is a risk factor of acute kidney injury in liver transplantation patients

Background: Diabetes mellitus has become an increasing global health burden with rapid growing prevalence. Patients with diabetes have higher susceptibility to acute kidney injury(AKI). Liver transplantation(LT) predisposes the kidney to injury. However, the association between diabetes and AKI in LT patients remains unclear. Methods: We conducted a retrospective cohort study examining risk factors for AKI in patients undergone orthotopic LT. Potential risk factors including baseline estimated glomerular filtration rate(e GFR), the model for end-stage liver disease(MELD) score, diabetes, hypertension and intraoperative blood loss were screened. The primary endpoint was AKI occurrence. Multivariate logistic regression was used to analyze the association between potential risk factors and AKI. Results: A total of 291 patients undergone orthotopic LT were included in the present study. Among them, 102 patients(35.05%) developed AKI within 5 days after LT. Diabetes was identified as an independent risk factor for AKI. Patients who developed AKI had worse graft function recovery and higher mortality within 14 days after LT compared to those who did not develop AKI. AKI patients with diabetes had a significant decline of e GFR within the first postoperative year, compared with patients who did not develop AKI and who developed AKI but without diabetes. Conclusions: Diabetes is an independent risk factor for AKI after orthotopic LT. AKI is associated with delayed graft function recovery and higher mortality in short-term postoperative period. Diabetic patients who developed AKI after LT experience a faster decline of e GFR within the first year after surgery.

Dynamic monitoring of serum liver function indexes in patients with COVID-19

BACKGROUND Some patients with the novel 2019 coronavirus disease(COVID-19)display elevated liver enzymes.Some antiviral drugs that can be used against COVID-19 are associated with a risk of hepatotoxicity.AIM To analyze the clinical significance of the dynamic monitoring of the liver function of patients with COVID-19.METHODS This was a retrospective study of patients diagnosed with COVID-19 in January and February 2020 at the Department of Infection,Shantou Central Hospital.The exclusion criteria for all patients were:(1)History of chronic liver disease;(2)History of kidney disease;(3)History of coronary heart disease;(4)History of malignancy;or(5)History of diabetes.The serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),γ-glutamyltransferase,and total bilirubin of patients with COVID-19 were measured on days 1,3,7 and 14 after admission,and compared to non-COVID-19 patents.RESULTS Twelve patients with COVID-19(seven men and five women)and twelve controls(eight men and four women)were included.There were one,two,and nine patients with severe,mild,and moderate COVID-19,respectively.There were no differences in age and sex between the two groups(both P>0.05).No significant differences were found in albumin,ALT,AST,γ-glutamyltransferase,or total bilirubin between the controls and the patients with COVID-19 on day 1 of hospitalization(all P>0.05).Serum albumin showed a decreasing trend from days 0 to 7 of hospitalization,reaching the lowest level on day 7.Total bilirubin was higher on day 3 than on day 7.ALT,AST,andγ-glutamyltransferase did not change significantly over time.The severe patient was observed to have ALT levels of 67 U/L and AST levels of 75 U/L on day 7,ALT of 71 U/L and AST of 35 U/L on day 14,and ALT of 210 U/L and AST of 123 U/L on day 21.CONCLUSION Changes in serum liver function indicators are not obvious in the early stage of COVID-19,but clinically significant changes might be observed in severe COVID-19.

Value of serum PCT content for evaluating inflammatory factor release and organ function injury in neonatal septicemia

Objective: To explore the value of serum PCT content for evaluating inflammatory factor release and organ function injury in neonatal septicemia. Methods: 48 children who were diagnosed with neonatal septicemia in our hospital between March 2015 and May 2018 were selected as the septicemia group, and 50 healthy neonates delivered in our hospital during the same period were selected as the normal control group. The differences in PCT and inflammatory factor contents in serum as well as liver and kidney function index levels in peripheral blood were compared between the two groups. Pearson test was used to evaluate the correlation of serum PCT content with inflammatory factor release as well as liver and kidney function injury in children with neonatal septicemia. Results: The serum PCT content of septicemia group was significantly higher than that of normal control group;serum hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), interleukin-8 (IL-8) and soluble intercellular adhesion molecule-1 (sICAM-1) contents were higher than those of normal control group;peripheral blood aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyl transpeptidase (γ-GGT) and alkaline phosphatase (ALP) levels were higher than those of normal control group;peripheral blood blood urea nitrogen (BUN), serum creatinine (Scr) and serum β2-microglobulin (β2-M) levels were higher than those of normal control group (P<0.05). Correlation analysis showed that serum PCT content in children with neonatal septicemia was directly correlated with the degree of inflammatory response as well as the degree of liver and kidney function injury (P<0.05). Conclusion: The serum PCT content abnormally increases in children with neonatal septicemia, and the specific content is consistent with the disease severity and has certain clinical value for the judgment of children's condition.

Serum RAAS molecules and their relationship with the systemic inflammatory response and target organ function in patients with severe acute pancreatitis

Objective:To explore the relationship of renin-angiotensin-aldosterone system (RAAS) activity with the systemic inflammatory response and target organ function in patients with severe acute pancreatitis.Methods: A total of 78 patients with severe acute pancreatitis who were treated in our hospital between August 2012 and March 2016 were selected as the observation group, and 50 healthy people who underwent physical examination in our hospital during the same period were selected as the normal control group. The differences in the contents of RAAS indexes, inflammation indexes as well as liver and kidney function indexes were compared between the two groups, and Pearson test was used to evaluate the correlation between RAAS activity and illness in patients with severe acute pancreatitis. Results: Serum RAAS indexes E, Ang-Ⅱ and ALD levels of observation group were higher than those of normal control group;serum inflammation indexes IL-6, IL-8, IL-10 and CRP levels were higher than those of normal control group;serum liver function indexes ALP,γ-GT and AST levels were higher than those of normal control group;serum kidney function indexes Scr, BUN and UA levels were higher than those of normal control group. The RAAS activity of patients with severe acute pancreatitis was directly correlated with serum levels of inflammation indexes as well as liver and kidney function indexes.Conclusion: The RAAS activity increases in patients with severe acute pancreatitis, and the specific increase extent is consistent with systemic inflammatory response as well as liver and kidney function damage.

Prognostic and diagnostic scoring models in acute alcoholassociated hepatitis:A review comparing the performance of different scoring systems

Alcohol-associated hepatitis(AAH)is a severe form of liver disease caused by alcohol consumption.In the absence of confounding factors,clinical features and laboratory markers are sufficient to diagnose AAH,rule out alternative causes of liver injury and assess disease severity.Due to the elevated mortality of AAH,assessing the prognosis is a radical step in management.The Maddrey discriminant function(MDF)is the first established clinical prognostic score for AAH and was commonly used in the earliest AAH clinical trials.A MDF>32 indicates a poor prognosis and a potential benefit of initiating corticosteroids.The model for end stage liver disease(MELD)score has been studied for AAH prognostication and new evidence suggests MELD may predict mortality more accurately than MDF.The Lille score is usually combined to MDF or MELD score after corticosteroid initiation and offers the advantage of assessing response to treatment a 4-7 d into the course.Other commonly used scores include the Glasgow Alcoholic Hepatitis Score and the Age Bilirubin international normalized ratio Creatinine model.Clinical AAH correlate adequately with histologic severity scores and leave little indication for liver biopsy in assessing AAH prognosis.AAH presenting as acute on chronic liver failure(ACLF)is so far prognosticated with ACLF-specific scoring systems.New artificial intelligence-generated prognostic models have emerged and are being studied for use in AAH.Acute kidney injury(AKI)is one possible complication of AAH and is significantly associated with increased AAH mortality.Predicting AKI and alcohol relapse are important steps in the management of AAH.The aim of this review is to discuss the performance and limitations of different scoring models for AAH mortality,emphasize the most useful tools in prognostication and review predictors of recurrence.

基于Thinc-it工具分析抑郁症不同证型患者认知功能

目的:通过Thinc-it工具探讨抑郁症不同证型患者认知功能特点。方法:从2020年6月至2022年7月宁波市第一医院心身医学科确诊为抑郁症的患者中选取肝气郁结、气郁化火、痰气郁结、心脾两虚证型患者各50例为受试者,并选取同期在医院健康体检志愿者50例为健康对照组。应用汉密尔顿抑郁量表(hamilton depression scale,HAMD)、汉密尔顿焦虑量表(hamilton anxiety scale,HAMA)对各组受试者临床症状进行评估,并分别通过Thinc-it工具进行认知功能评估,具体包括认知损害5项问卷(5-item questionnaire for cognitive impairment,PDQ-5-D)、选择反应时间任务(selection response time,CRT)、1-Back记忆任务(selection response time,1-Back)、数字符号替代测试(digit symbol substitution test,DSST)和连线测试B(line test B,TMT-B)测试。结果:抑郁症各证型组病程、HAMD评分、HAMA评分比较,痰气郁结证组和心脾两虚证组病程时间相对更长,但组间比较,差异无统计学意义(P>0.05)。郁证各证型组HAMD评分、HAMA评分高于健康对照组,差异具有统计学意义(P<0.05)。郁证各证型组PDQ-5-D评分高于健康对照组(P<0.05),郁证各证型组间比较,差异无统计学意义(P>0.05)。与健康对照组比较,郁证各证型组CRT计数减少,CRT反应时间延长,差异具有统计学意义(P<0.05)。组间比较,心脾两虚证组CRT计数高于肝气郁结证组,痰气郁结证组CRT反应时间长于肝气郁结证组,差异具有统计学意义(P<0.05)。与健康对照组比较,郁证各证型组1-Back计数减少,痰气郁结证组、心脾两虚证组1-Back反应时间延长,差异具有统计学意义(P<0.05),郁证各证型组间比较,差异无统计学意义(P>0.05)。与健康对照组比较,郁证各证型组DSST计数减少,DSST反应时间、TMT-B耗时延长,差异具有统计学意义(P<0.05)。心脾两虚证组、痰气郁结证组DSST反应时间长于肝气郁结证组、气郁化火证组,差异具有统计学意义(P<0.05)。结论:抑郁症各证型患者均存在主观认知功能、注意力、记忆力、执行功能、信息加工处理速度等方面的损害,且各证型受损程度不一,且痰气郁结证组、心脾两虚证组在注意力、执行功能、处理速度方面较肝气郁结证组和气郁化火证组受损更严重。

Hepatitis C in non-hepatic solid organ transplant candidatesand recipients:A new horizon

Hepatitis C virus(HCV) infection is estimated to affect 130-150 million people globally which corresponds to2%-3% of the total world population. It remains the leading indication for liver transplant worldwide and has been demonstrated to negatively impact both patient and graft survival following non-hepatic organ transplantation. In the era of interferon-based therapy, although treatment and cure of HCV prior to nonhepatic transplant improved survival, tolerability and low cure rates substantially limited therapy. Interferon(IFN)-based therapy following non-hepatic solid organ transplant, due to the risk of allograft rejection, is generally contraindicated. Rapid advances in IFN-free therapy with direct acting antivirals(DAAs) in the last few years have completely changed the paradigm of hepatitis C therapy. Compared to IFN-based regimens, DAAs have less frequent and less severe adverse effects, shorter durations of therapy, and higher cure rates that are minimally impacted by historically negative predictors of response such as cirrhosis, ethnicity, and post-transplant state. Recent studies have shown that liver transplant(LT) recipients can be safely and effectively treated with DAA combination therapies; although data are limited, many of the principles of therapy in LT may be extrapolated to non-hepatic solid organ transplant recipients. Here we review the data on DAA combination therapies in transplantation, discuss the advantages and disadvantages of pre- vs post-transplant HCV therapy and future directions.

非酒精性脂肪性肝病肝纤维化程度与心脏左心室改变的关系

目的为探讨非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)肝纤维化程度与心脏左心室结构和功能的关系。方法收集2022年6月~2023年4月新疆医科大学第二附属医院收治的NAFLD患者411例,将NAFLD患者通过FIB-4无创肝纤维化评分系统进行分层,分为进展期纤维化组(n=138)和非进展期纤维化组(n=273),选择同期就诊的腹部超声检查正常的151例患者为对照组,分析NAFLD患者肝纤维化严重程度与心脏左心室结构和功能的关系。结果NAFLD患者肝纤维化是心脏舒张功能受限的危险因素(P<0.05),且肝纤维化程度越重,心脏舒张功能受限越重。结论NAFLD肝纤维化程度与心脏左心室舒张功能受限显著相关,与心脏左心室结构改变可能相关。

The Relationship of Cystatin C,Creatinine,Estimated GFR,and Cardiovascular Events

This study examined the predictive value of plasma cystatin C,creatinine and estimated glomerular filtration rate (eGFR) as risk factors for cardiovascular disease in Chinese.Plasma cystatin C and creatinine were measured in 466 coronary heart disease (CHD) patients recruited from 4 hospitals and 349 healthy controls from local communities in Wuhan,China.Cockroft-Gault formula was used to estimate the glomerular filtration rate (GFR) after adjusting for body surface area.With each measure,the study population was divided into quintiles.The results showed that the patients had significantly higher levels of plasma cystatin C,creatinine,and lower level of eGFR than controls.Lower eGFR was associated with a higher risk of cardiovascular events.As compared with the first (highest) quintile,the hazard ratios (and 95% CIs) after multivariate adjustment for CHD were as follows:third quintile,2.98 (1.54-5.78);fourth quintile,3.34 (1.58-7.09);fifth quintile,4.37(1.84-10.35).With higher cystatin C quintiles (≥1.00 mg/L and ≥1.17 mg/L),the hazard ratios for CHD were 2.16 (1.23-3.81) and 2.34 (1.25-4.38),similar to those of creatinine 2.21 (1.21-4.03) and 2.03 (1.07-3.84).However,it was plasma cystatin C not eGFR or creatinine had stronger association with ischemic stroke.The highest quintile had the hazard ratio of 4.51 (1.45-14.08) after multivariate adjustment.It was concluded that plasma cystatin C,associated with renal function,is not an independent risk factor for cardiovascular disease.eGFR is a better risk predictor for CHD than plasma cystatin C and creatinine.But for ischemic stroke,plasma cystatin C is a better risk factor than creatinine and estimated GFR.

GDF11生物学功能的研究进展

生长分化因子11(GDF11)是转化生长因子-β超家族的成员之一,近年因其在调节各种组织器官的发育和分化中的多种功能而备受关注。GDF11具有广泛的生物学效应,包括在临床应用中逆转衰老、逆转与年龄相关的病理变化和调节损伤后器官再生的能力等,如逆转年龄相关的心肌肥厚、改善衰老骨骼肌代谢、促进神经血管再生、减少肝脏脂肪变性。但是也有研究报道GDF11对心脏、骨骼肌、肝脏等并不存在有益作用。目前的研究显示GDF11在各个器官系统中的生物学功能存在争议。本文回顾近年来GDF11在各个系统及疾病中的作用,旨在对当前相关研究进行总结归纳,为以GDF11为靶点相关疾病的防治及预后提供理论依据。

Organ assessment and repair centers: The future of transplantation is near

Solid organ transplantation is limited by suitable donor organ availability and the geographic limitations that lead to prolonged ischemic times. Ex vivo organ perfusion is an evolving technology that enables assessment of organ function prior to transplantation. As a byproduct, overall out of body organ times are able to be extended. The future implications organ assessment and repair centers utilizing this technology are discussed.

麝香通心滴丸联合瑞舒伐他汀治疗冠心病合并高胆固醇血症的效果和对肝功能的影响

目的:研究麝香通心滴丸联合瑞舒伐他汀治疗冠心病(CHD)合并高胆固醇血症的效果和对肝功能的影响。方法:选取2020年6月—2022年6月在上海市嘉定区中心医院住院治疗的60例CHD合并高胆固醇血症患者,按照随机数字表法将其分为两组,每组30例,单一组给予瑞舒伐他汀治疗,联合组在单一组基础上加以麝香通心滴丸治疗,对比两组临床疗效、血脂水平、内皮功能及肝功能。结果:治疗6个月后,联合组总有效率高于单一组,差异有统计学意义(P<0.05);联合组总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)均低于单一组,高密度脂蛋白胆固醇(HDL-C)高于单一组,差异均有统计学意义(P<0.05);联合组一氧化氮(NO)高于单一组,内皮素-1(ET-1)低于单一组,差异均有统计学意义(P<0.05);两组谷丙转氨酶(ALT)、谷草转氨酶(AST)均升高,但联合组均低于单一组,差异均有统计学意义(P<0.05)。结论:使用麝香通心滴丸联合瑞舒伐他汀治疗CHD合并高胆固醇血症具有良好效果,能够有效降低患者血脂水平,改善内皮功能,且对肝功能影响较小。

超声测量肝硬化患者右心功能与Child-Pugh分级的相关性分析

目的探讨超声测量肝硬化患者右心功能与Child-Pugh分级的相关性。方法选取2021年3月至2023年3月在亳州宝璋医院就诊的78例肝硬化患者和同期78名健康体检者。根据Child-Pugh分级将78例肝硬化患者分为A级(38例)、B级(30例)、C级(10例)3组。比较肝硬化患者与健康人的右心结构及右心功能指标,比较不同分级患者右心功能差异,分析两者的相关性。结果肝硬化组RASd、RALd、RADd、RVDd、RVAW分别为(38.79±4.16)mm、(44.94±5.17)mm、(36.07±2.16)mm、(21.45±1.84)mm、(2.39±0.57)mm,均显著高于对照组(35.42±2.88)mm、(41.01±4.13)mm、(35.31±2.08)mm、(19.38±1.63)mm、(2.01±0.21)mm,差异均有统计学意义(P<0.05)。两组E/E’分别为(6.50±1.39)、(6.60±1.62),差异均有统计学意义(P>0.05);肝硬化组RVFAC、E/A分别为(43.20±6.04)%、(1.28±0.27),低于对照组(45.08±4.12)%、(1.39±0.31);而TAPSE、Tei指数分别为(23.80±3.06)mm、(0.43±0.10),高于对照组(22.61±3.11)mm、(0.37±0.12)(P<0.05)。Child-Pugh分级A级的肝硬化患者RVFAC为(41.71±5.03)%,低于B级患者(45.09±6.07)%;E/A为(1.41±0.36),高于C级患者(1.11±0.21);Tei指数为(0.38±0.09),低于C级患者(0.45±0.04),差异均有统计学意义(P<0.05)。经相关性分析,E/A与Child-Pugh分级呈现负相关,Tei指数与Child-Pugh分级呈现正相关(P<0.05)。结论超声测量肝硬化患者右心功能简便,重复性好,超声检查显示肝硬化患者存在右心功能损伤,且随肝硬化病情进展加重。

Evaluation of the contrast between tissues and thermal lesions in rabbit in vivo produced by high intensity focused ultrasound using fast spin echo MRI sequences

In this paper the goal was to measure the contrast to noise ratio (CNR) of fast spin echo (FSE) magnetic resonance imaging (MRI) sequences in detecting thermal lesions created by high intensity focused ul-trasound (HIFU) in rabbit kidney, liver, heart, and brain and lamb pancreas. A spherically focused transducer was used which is navigated inside MRI by a custom made positioning device. A simple simu-lation model was developed which predicts the CNR for the two FSE MRI sequences. The maximum con-trast measured with T1-W FSE ranges from 10 to 25. For all 5 tissues of interest if one uses TR between 400 and 500 ms the contrast is maximized. The T1 and T2 value of lesion depends strongly on the host tissue and is always lower than the host tissue. The greater the difference in T1 value, the greater the CNR. The simulated model for predicting the CNR was proven successful. The CNR measured with T2-W FSE varies between 12 and 15 for all 5 tissues. With T2-W FSE if one uses TE between 40 and 50 ms, the contrast is maximized.

HeartCon型左心室辅助装置(LVAD)的持续性循环支持对实验动物肝肾功能的影响

目的明确左心室辅助装置(LVAD)的持续循环支持是否对实验动物的肝肾功能造成不良影响。方法选取6只健康实验羊,植入HeartCon型LVAD。检测实验羊术前和术后70 d肝肾指标,包括尿素(UREA)、肌酐(CREA)、谷丙转氨酶(ALT)、谷草转氨酶(AST)和总胆红素(TBIL),评估其肝肾功能变化。结果 6只实验羊术前的UREA、CREA、ALT、AST和TBIL水平分别为(4.60±1.51) mmol/L、(94.80±23.10) μmol/L、(16.20±6.87) U/L、(82.60±17.33) U/L和(0.52±0.25) μmol/L。与植入前相比,LVAD植入后实验羊的CREA水平的变化无统计学意义(均P>0.05)。LVAD植入后,实验羊的UREA、ALT、AST和TBIL水平在术后1~14 d内出现不同程度的升高;术后14 d后,各项指标恢复至术前水平;在研究终点时,实验羊的UREA、ALT、AST和TBIL水平分已恢复到术前水平,差异均无统计学意义(均P>0.05)。结论在使用HeartCon型LVAD进行持续循环支持的70 d内,未发现持续流动式LVAD对实验动物的肝肾功能造成不良影响的证据。HeartCon型LVAD能够提供足够的循环支持,以维持适当的末端器官功能。