[ Objective] To find the rule of 5-hydroxytryptamine （5-HT） synthesis and metabolism in peripheral blood of suckling piglets with aging. [ Method ] All of 15 British Large White pigs at 0, 5 and 15 d of age were sel...[ Objective] To find the rule of 5-hydroxytryptamine （5-HT） synthesis and metabolism in peripheral blood of suckling piglets with aging. [ Method ] All of 15 British Large White pigs at 0, 5 and 15 d of age were selected as experimental animals, and their serumal concentrations of L- tryptophan （L-Trp）, 5-HT and 5-hydroxyindoleacetic acid （5-HIAA） in peripheral circulatory system were determined synchronously by reversed- phase high-performance liquid chromatography method with UV. [ Result] The concentration of L-Trp was （16. 92 ± 1.74） iJmol/L at birth, （59.94 ±10.88） iJmol/L at 5 d of age and （70.42± 6.48） μmol/L at 15 d of age. The concentration of 5-HT was （ 12.85 ± 1.79） iJmol/L at birth, （4.81 ±2.05） ijmol/L at 5 d of age and （5.49±1.09） μmol/L at 15 d of age. While 5-HIAA, the metabolic product of 5-HT, was not detected at all the samples selected. [ Conclusion] The L-Trp concentration of suckling piglets increase significantly with aging （ P 〈0. 05）. While the concentra- tion of 5-HT and the conversion ratio of L-Trp to 5-HT are both highest at birth （P〈0.05） and keep stable at 5 and 15 d of age.展开更多
For middle age individuals （male）, it may be difficult to find motivation for suitable exercise training, which has similarly favorable characteristics for cardiovascular adaptations as other exercises performed by ...For middle age individuals （male）, it may be difficult to find motivation for suitable exercise training, which has similarly favorable characteristics for cardiovascular adaptations as other exercises performed by younger individuals. Fifty four （n = 54）; （age = 41.57±3.25） untrained, overweight （F% = 19.52 ± 5.6）, range of （12.6-30.6）, （visceral fat area （VFA） = 111.1 cm^-2） healthy male （they are managers in four different Banks） were taking part in this research program. The participants took part on preliminary cardiac examination （echocardiography, GE Vivid 9 ultrasound machine. Body composition measured with type of ＂InBody720＂ （Biospace Co. Inc., Seoul, South Korea） Bioelectrical Impedance Analyzer （BIA）. The heart rate of the participants was measured continuously during all training sessions using heart rate belts （POLAR Team System, Finland）. Pulmonary gas exchange ＂Cardiosoft＂, （Milwaukee, USA were measured during a standardized treadmill test. Results： In many cases of the free indoor soccer play （FISP） recorded extremely high pulse rate, which is compared with the laboratory high pulse rate （LHPR）, much higher than the recommended physiological load level HR（FISP） 〉 190 beat/min; HR（LHPR） = 175 beat/min ; P 〈 0.001. Despite the many advantages of the Free Indoor Football Play （FISP） are hiding a lot of dangerous in the terms of circulatory adaptation.展开更多
This paper validates the optimal operation for a grid-connected double-fed induction generator(DFIG)in an oscillating water column power plant(OWCPP).This study presents a novel optimization technique called the circu...This paper validates the optimal operation for a grid-connected double-fed induction generator(DFIG)in an oscillating water column power plant(OWCPP).This study presents a novel optimization technique called the circulatory system-based optimization(CSBO)approach to develop six adaptive fuzzy logic controllers(AFLCs)with 30 parameters and compare them to chaotic-billiards optimization(C-BO)and genetic algorithm(GA).The proposed controller is also compared with a proportional-integral differential(PID)controller based on a self-adaptive global-best harmony search(SGHS).CSBO-based AFLCs are fully investigated under different scenarios and experimented with using a real-time interface DSP1104.The results of using CSBO-AFLCs revealed a fast time response,fast convergence,less overshoot and minimal error compared with those achieved with C-BO-AFLC,SGHS-PID and GA-AFLC during different case studies.The CSBO-based AFLCs ensure maximum power from the DFIG in an OWCPP and enhance dynamic response with very low errors.The results show that the CSBO shows better power tracking by 25%as compared with C-BO,by 45%when compared with the GA and by 56%when compared with PID.Moreover,the integral absolute errors of six controllers are investigated to demonstrate the feasibility of CSBO-AFLC.The root mean square of the errors of six controllers using CSBO is improved by 68.27%when compared with GA,by 22.57%when compared with C-BO and by 38.42%when compared with PID.These indicators demonstrate the feasibility of CSBO when compared with other algorithms with the same OWCPP.展开更多
Cyclic-system-based optimization(CSBO)is an innovative metaheuristic algorithm(MHA)that draws inspiration from the workings of the human blood circulatory system.However,CSBO still faces challenges in solving complex ...Cyclic-system-based optimization(CSBO)is an innovative metaheuristic algorithm(MHA)that draws inspiration from the workings of the human blood circulatory system.However,CSBO still faces challenges in solving complex optimization problems,including limited convergence speed and a propensity to get trapped in local optima.To improve the performance of CSBO further,this paper proposes improved cyclic-system-based optimization(ICSBO).First,in venous blood circulation,an adaptive parameter that changes with evolution is introduced to improve the balance between convergence and diversity in this stage and enhance the exploration of search space.Second,the simplex method strategy is incorporated into the systemic and pulmonary circulations,which improves the update formulas.A learning strategy aimed at the optimal individual,combined with a straightforward opposition-based learning approach,is employed to enhance population convergence while preserving diversity.Finally,a novel external archive utilizing a diversity supplementation mechanism is introduced to enhance population diversity,maximize the use of superior genes,and lower the risk of the population being trapped in local optima.Testing on the CEC2017 benchmark set shows that compared with the original CSBO and eight other outstanding MHAs,ICSBO demonstrates remarkable advantages in convergence speed,convergence precision,and stability.展开更多
BACKGROUND Glioma is the most common primary tumor in the brain originating from glial cells.In spite of extensive research,the overall survival rate is not enhanced.A number of published articles observed differentia...BACKGROUND Glioma is the most common primary tumor in the brain originating from glial cells.In spite of extensive research,the overall survival rate is not enhanced.A number of published articles observed differentially circulating levels of cytokines in glioma.Interleukin-6(IL-6)protein coded by IL-6 gene is regulated by the immune system and it has been found to have a significant role in progression and apoptosis resistance of glioma.AIM To review the role of circulatory IL-6 in the development and progression of glioma and its utility as a biomarker.METHODS Preferred Reporting Items for Systematic Reviews and Meta-analysis(PRISMA)guidelines were applied to filter the relevant studies based on inclusion and exclusion criteria.We used a combination of keywords and the Reference Citation Analysis(RCA)tool to search the potential studies and performed data extraction from selected studies.RESULTS The published results were inconsistent;however,most studies showed a significantly higher IL-6 level in glioma cases as compared to controls.Comparative IL-6 level among the different grades of glioma showed a higher level with low-grade gliomas and lower level with high-grade gliomas.CONCLUSION IL-6 level significantly differed between cases and controls,and among different cancer stages,which shows its potential as a diagnostic and prognostic marker.展开更多
BACKGROUND Liver cirrhosis is a progressive disease with high morbidity and mortality requiring effective management strategies to improve patient outcomes.Various therapies including albumin infusion,volume expanders...BACKGROUND Liver cirrhosis is a progressive disease with high morbidity and mortality requiring effective management strategies to improve patient outcomes.Various therapies including albumin infusion,volume expanders(VEs),and vasoactive agents are used to manage patients with cirrhosis.Despite numerous clinical trials,a comprehensive meta-analysis comparing the effectiveness of albumin infusion against alternative treatments is limited.This study provides the current and comprehensive synthesis of evidence,offering key insights for optimizing therapeutic strategies in patients with liver cirrhosis.AIM To systematically update available data on therapies of liver cirrhosis,we performed a meta-analysis to evaluate and compare the clinical efficacy of albumin infusion vs other VEs and vasoactive agents in patients with liver cirrhosis.METHODS A literature search from the PubMed and Embase databases(inception till June 2024)focused on hyponatremia(primary outcome)and various outcomes such as gastrointestinal bleeding,hepatic encephalopathy,severe infection,post-paracentesis-induced circulatory dysfunction(PICD),ascites reappearance,spontaneous bacterial peritonitis,hepatorenal syndrome,renal impairment,hospital stay,mortality,and safety was performed.The primary analysis pooled studies that compared albumin infusion with control.In the subgroup analysis,comparisons were made within the stratified treatment categories included in the control group.RESULTS Of the 2957 studies retrieved,31 studies(27 randomized controlled trials and 4 observational studies)comprising 6255 patients were included.Albumin use was significant in reducing odds of hyponatremia[odds ratio(OR)=0.67;95%confidence interval(95%CI)=0.53-0.85]and PICD(OR=0.38;95%CI=0.20-0.71),whereas the reduction in severe infection(OR=0.55;95%CI=0.28-1.07)did not reach statistical significance.In the subgroup analysis,albumin demonstrated a favorable improvement in lowering the incidence of hyponatremia vs inactive/standard medical therapy(OR=0.54;95%CI=0.27-1.09).For PICD,albumin use was significant compared with other VEs(OR=0.31;95%CI=0.11-0.85)but not with vasoconstrictors(OR=0.63;95%CI=0.21-1.91).In the overall subgroup analysis,a significant reduction was observed in hyponatremia(OR=0.67;95%CI=0.53-0.85)and PICD(OR=0.38;95%CI=0.20-0.71).CONCLUSION Human albumin has been shown to significantly reduce the incidence of hyponatremia and PICD in patients with liver cirrhosis,whereas its effect on severe infection remains suggestive but not statistically significant.展开更多
Temporary mechanical circulatory support (tMCS) devices such as intra-aorticballoon pumps, veno-arterial extracorporeal membrane oxygenation, and percutaneousventricular assist devices, play a major role in supporting...Temporary mechanical circulatory support (tMCS) devices such as intra-aorticballoon pumps, veno-arterial extracorporeal membrane oxygenation, and percutaneousventricular assist devices, play a major role in supporting patients withend-stage heart failure and bridging them to transplant. In 2018, the United Networkfor Organ Sharing heart allocation criteria was modified by increasing thenumber of statuses in the heart transplant waitlist to differentiate and favor thesickest patients awaiting transplantation. Within this new system, patients withtMCS devices receive the highest priority statuses. While the 2018 allocationsystem has reduced waitlist times and mortality for the highest-priority patients,some studies have shown a concomitant rise in the utilization of tMCS devices asbridge to transplant after its enaction. In this narrative review, we describe thesechanges in tMCS utilization and provide insights on how the upcoming creationof a continuous distribution allocation system may further impact these trends.展开更多
BACKGROUND Marginal donation after circulatory death(DCD)liver grafts are carefully used to combat the constant shortage of donors.Clinically,the worst outcomes are mainly related to severe ischemia-reperfusion-injury...BACKGROUND Marginal donation after circulatory death(DCD)liver grafts are carefully used to combat the constant shortage of donors.Clinically,the worst outcomes are mainly related to severe ischemia-reperfusion-injury and the dangerous effect of various inflammatory cytokines(CK).The machine perfusion(MP)is a promising device to rescue these grafts.AIM To analyze the role of MP connected to a sorbent cartridge(PerSorb®)and used for very damaged DCD pig livers.METHODS Seven grafts were procured from pigs from a slaughterhouse.Grafts were made very marginal with at least 60 minutes of donor warm ischemia time and 24 hours of static-cold ischemia time:(1)3 grafts were perfused in hypothermic MP with PerSorb(Sorb);(2)2 other grafts in hypothermic MP(HMP)without the cartridge(NoSorb);and(3)The other 2 livers stored in the ice box(NoTreat).The CK were measured at HMP start(T0)and at the end(Tend).Biopsies were taken at T0 and Tend.RESULTS All 5 grafts treated with HMP had a negative lactate trend after 3 hours of treatment(8.83 at T0 vs 6.4 at Tend of Sorb;15 at T0 vs 5.45 at Tend for NoSorb,P value>0.05).At Tend,both Sorb and NoSorb groups had better hemodynamic parameters,comparable between the two groups.Enzyme-linked immunosorbent assay analysis showed a reduction of monocyte chemotactic protein-1,tumor necrosis factor-alpha and interleukin-1βfor NoSorb group at Tend and a complete downregulation to physiological levels of the same CK in Sorb livers after 3 hours of treatment.Biopsies showed a reduction of the perisinusoidal edema for the Sorb grafts compared with the NoSorb livers.CONCLUSION These data suggest a potential protective role of treatment of grafts with MP and sorbent cartridge in reducing the inflammatory response after a severe ischemic injury.展开更多
BACKGROUND Splenic artery aneurysm(SAA)rupture is a rare,life-threatening condition characterized by acute intra-abdominal hemorrhage and hemodynamic instability.Ruptured SAAs may exhibit a biphasic and relatively slo...BACKGROUND Splenic artery aneurysm(SAA)rupture is a rare,life-threatening condition characterized by acute intra-abdominal hemorrhage and hemodynamic instability.Ruptured SAAs may exhibit a biphasic and relatively slow clinical progression,commonly referred to as the“double-rupture phenomenon”.The reported incidence of the double-rupture phenomenon ranges 12%-21%in patients with ruptured SAAs,potentially due to variations in intra-abdominal pressure.Following anesthesia induction,muscle relaxation can decrease intra-abdominal pressure,potentially triggering the double-rupture phenomenon and leading to circulatory collapse.CASE SUMMARY A 61-year-old female presented to the Department of Emergency with upper abdominal pain,abdominal distension,dizziness,and vomiting.Her vital signs were initially stable.Physical examination revealed abdominal tenderness and positive-shifting dullness.Abdominal contrast-enhanced computed tomography revealed cirrhosis,severe portal hypertension,and splenomegaly.Acute rupture was suggested by a hematoma on the upper left side outside the SAA.Surgeons deemed intravascular intervention challenging and open splenectomy inevitable.Circulatory collapse occurred after anesthesia induction,likely due to a double rupture of the SAA.This double-rupture phenomenon may have resulted from an initial rupture of the SAA into the omental bursa,forming a hematoma that exerted a tamponade effect.A second rupture into the peritoneal cavity may have been triggered by decreased intra-abdominal pressure following anesthesia induction.The patient’s life was saved through early,coordinated,multidisciplinary significant postoperative bleeding or hypoxic encephalopathy.CONCLUSION Anesthesia-induced pressure reduction may trigger a second SAA rupture,causing collapse.Early diagnosis and multidisciplinary teamwork improve outcomes.This is a rare and life-threatening case of SAA rupture,which is of great significance to the medical community for understanding and handling such emergencies.展开更多
BACKGROUND The normothermic machine perfusion pump(NMPP)could shape the future of transplantation.Providing ex-vivo optimization,NMPP attenuates ischemic insult while replenishing energy.An understanding of machine pe...BACKGROUND The normothermic machine perfusion pump(NMPP)could shape the future of transplantation.Providing ex-vivo optimization,NMPP attenuates ischemic insult while replenishing energy.An understanding of machine perfusion time(MPT)impact and potential clinical benefits is paramount and necessitates exploration.AIM To investigate the relationship between MPT and post-transplant graft function.METHODS Retrospective review of the first 50 donation after circulatory death(DCD)grafts preserved using NMPP in a tertiary institution was performed.Essential preser-vation time points,graft parameters,recipient information,and postoperative outcomes were prospectively recorded.Early allograft dysfunction(EAD),L-Graft7 score and 90-day outcomes were collected for all grafts.The first 20 re-cipients were allocated into the early group,considered the learning curve population for the center.The subsequent 30 were allocated into the late group.Recipients were also stratified into cohorts depending on MPT,i.e.,short(<8 hours),medium(8-16 hours)and long(>16 hours).RESULTS NMPP operational parameters were not predictive of EAD,L-GrAFT7 or 90-day outcomes.The early group had significantly less MPT and cold ischemia time than the late group(553 minutes vs 850 minutes,P<0.001)and(127.5 minutes vs 154 minutes,P=0.025),respectively.MPT had no impact in either group.CONCLUSION Increased MPT of DCD liver grafts had no adverse recipient results for the times utilized in this population,indicating its upper limits,likely beyond 24 hours,are not demonstrated within this study.Future studies are necessary to determine whether longer MPT is beneficial or detrimental to graft function and,if the latter,what is the maximum safe duration.Further studies of the effect of normothermic machine perfusion pump duration on long-term outcomes are also needed.展开更多
Objective To analyze the association between exposure to second-hand smoke(SHS) and 23 diseases,categorized into four classifications, among the Chinese population.Methods We searched the literature up to June 30, 202...Objective To analyze the association between exposure to second-hand smoke(SHS) and 23 diseases,categorized into four classifications, among the Chinese population.Methods We searched the literature up to June 30, 2021, and eligible studies were identified according to the PECOS format: Participants and Competitors(Chinese population), Exposure(SHS),Outcomes(Disease or Death), and Study design(Case-control or Cohort).Results In total, 53 studies were selected. The odds ratio(OR) for all types of cancer was 1.79(1.56–2.05), and for individual cancers was 1.92(1.42–2.59) for lung cancer, 1.57(1.40–1.76) for breast cancer, 1.52(1.12–2.05) for bladder cancer, and 1.37(1.08–1.73) for liver cancer. The OR for circulatory system diseases was 1.92(1.29–2.85), with a value of 2.29(1.26–4.159) for stroke. The OR of respiratory system diseases was 1.76(1.13–2.74), with a value of 1.82(1.07–3.11) for childhood asthma. The original ORs were also shown for other diseases. Subgroup analyses were performed for lung and breast cancer. The ORs varied according to time period and were significant during exposure in the household;For lung cancer, the OR was significant in women.Conclusion The effect of SHS exposure in China was similar to that in Western countries, but its definition and characterization require further clarification. Studies on the association between SHS exposure and certain diseases with high incidence rates are insufficient.展开更多
<strong>Background:</strong> Allometric scaling is a well-known research tool used for the metabolic rates of organisms. It measures the living systems with fractal physiology. The metabolic rate versus th...<strong>Background:</strong> Allometric scaling is a well-known research tool used for the metabolic rates of organisms. It measures the living systems with fractal physiology. The metabolic rate versus the mass of the living species has a definite scaling and behaves like a four-dimensional phenomenon. The extended investigations focus on the mass-dependence of the various physiological parameters.<strong> Objective: </strong>Proving the length of vascularization is the scaling parameter instead of mass in allometric relation. <strong>Method:</strong> The description of the energy balance of the ontogenic growth of the tumor is an extended cell-death parameter for studying the mass balance at the cellular level. <strong>Results:</strong> It is shown that when a malignant cellular cluster tries to maximize its metabolic rate, it changes its allometric scaling exponent. A growth description could follow the heterogenic development of the tumor. The mass in the allometric scaling could be replaced by the average length of the circulatory system in each case. <strong>Conclusion:</strong> According to this concept, the dependence of the mass in allometric scaling is replaced with a more fundamental parameter, the length character of the circulatory system. The introduced scaling parameter has primary importance in cancer development, where the elongation of the circulatory length by angiogenesis is in significant demand.展开更多
Portal hypertension is a clinical syndrome which leads to several clinical complications, such as the formation and rupture of esophageal and/or gastric varices, ascites, hepatic encephalopathy and hepato-renal syndro...Portal hypertension is a clinical syndrome which leads to several clinical complications, such as the formation and rupture of esophageal and/or gastric varices, ascites, hepatic encephalopathy and hepato-renal syndrome. In cirrhosis, the primary cause of the increase in portal pressure is the enhanced resistance to portal outflow. However, also an increase in splanchnic blood flow worsens and maintains portal hypertension. The vasodilatation of arterial splanchnic vessels and the opening of collateral circulation are the determinants of the increased splanchnic blood flow. Several vasoactive systems/substances, such as nitric oxide, cyclooxygenase-derivatives, carbon monoxide and endogenous cannabinoids are activated in portal hypertension and are responsible for the marked splanchnic vasodilatation. Moreover, an impaired reactivity to vasoconstrictor systems, such as the sympathetic nervous system, vasopressin, angiotensin II and endothelin-1, plays a role in this process. The opening of collateral circulation occurs through the reperfusion and dilatation of preexisting vessels, but also through the generation of new vessels. Splanchnic vasodilatation leads to the onset of the hyperdynamic circulatory syndrome, a syndrome which occurs in patients with portal hypertension and is characterized by increased cardiac output and heart rate, and decreased systemic vascular resistance with low arterial blood pressure. Understanding the pathophysiology of splanchnic vasodilatation and hyperdynamic circulatory syndrome is mandatory for the prevention and treatment of portal hypertension and its severe complications.展开更多
Using deep hypothermic circulatory arrest, thoracic aorta diseases and complex heart diseases can be subjected to corrective procedures. However, mechanisms underlying brain protection during deep hypothermic circulat...Using deep hypothermic circulatory arrest, thoracic aorta diseases and complex heart diseases can be subjected to corrective procedures. However, mechanisms underlying brain protection during deep hypothermic circulatory arrest are unclear. After piglet models underwent 60 minutes of deep hypothermic circulatory arrest at 14°C, expression of microRNAs(miRNAs) was analyzed in the hippocampus by microarray. Subsequently, TargetScan 6.2, RNA22 v2.0, miRWalk 2.0, and miRanda were used to predict potential targets, and gene ontology enrichment analysis was carried out to identify functional pathways involved. Quantitative reverse transcription-polymerase chain reaction was conducted to verify miRNA changes. Deep hypothermic circulatory arrest altered the expression of 35 miRNAs. Twenty-two miRNAs were significantly downregulated and thirteen miRNAs were significantly upregulated in the hippocampus after deep hypothermic circulatory arrest. Six out of eight targets among the differentially expressed miRNAs were enriched for neuronal projection(cyclin dependent kinase, CDK16 and SLC1 A2), central nervous system development(FOXO3, TYRO3, and SLC1 A2), ion transmembrane transporter activity(ATP2 B2 and SLC1 A2), and interleukin-6 receptor binding(IL6 R)– these are the key functional pathways involved in cerebral protection during deep hypothermic circulatory arrest. Quantitative reverse transcription-polymerase chain reaction confirmed the results of microarray analysis. Our experimental results illustrate a new role for transcriptional regulation in deep hypothermic circulatory arrest, and provide significant insight for the development of miRNAs to treat brain injuries. All procedures were approved by the Animal Care Committee of Xuanwu Hospital, Capital Medical University, China on March 1, 2017(approval No. XW-INI-AD2017-0112).展开更多
AIM： To investigate whether adrenomedullin, a potent vasodilator peptide, plays a role in the circulatory disturbance in cirrhosis. METHODS： Cirrhosis was induced in rats by weekly gavage of carbon tetrachloride. He...AIM： To investigate whether adrenomedullin, a potent vasodilator peptide, plays a role in the circulatory disturbance in cirrhosis. METHODS： Cirrhosis was induced in rats by weekly gavage of carbon tetrachloride. Hemodynamic studies were performed in vivo using radioactive microspheres and in vitro using isolated aortic rings. The adrenomedullin concentrations were measured by radioimmunoassay. RESULTS： Acute administration of adrenomedullin to the control rats reduced the systemic arterial pressure along with an increase of serum levels of the stable metabolite of nitric oxide （NOx）, in a dose-dependent manner. Chronic infusion of adrenomedullin reduced the vascular resistance and increased the blood flow in the systemic and splanchnic circulation. Intravenous administration of anti-adrenomedullin antibody did not affect any hemodynamic parameters in the cirrhotic rats, whereas this antibody ameliorated the blunted contractile response to phenylephrine, o-adrenergic receptor agonist, in the aortic rings of the cirrhotic rats. The adrenomedullin concentrations in the aorta were higher in the cirrhotic rats than in the controls, and correlated with the mean arterial pressure in the cirrhotic rats. Moreover, adrenomedullin blunted the contractile response to phenylephrine in both of the control aorta and cirrhotic aorta, but not in the presence of NG-nitro L-arginine methyl ester, an NO synthase inhibitor. CONCLUSION： Adrenomedullin overproduced in the vascular wall may contribute to the circulatory disturbance in cirrhosis as a local regulator of the vascular tonus rather than a circulating hormone.展开更多
AIM: To investigate the role of prostacyclin (PGI2) and nitric oxide (NO) in the development and maintenance of hyperdynamic circulatory state of chronic portal hypertensive rats. METHODS: Ninety male Sprague-Dawley r...AIM: To investigate the role of prostacyclin (PGI2) and nitric oxide (NO) in the development and maintenance of hyperdynamic circulatory state of chronic portal hypertensive rats. METHODS: Ninety male Sprague-Dawley rats were divided into three groups: intrahepatic portal hypertension (IHPH) group by injection of CCI4, prehepatic portal hypertension (PHPH) group by partial stenosis of the portal vein and sham-operation control (SO) group. One week after the models were made, animals in each group were subdivided into 4 groups: saline controlled group (n = 23), Nω-nitro-L-arginine (L-NNA)group (n = 21) group, indomethacin (INDO) group (n = 22) and high-dose heparin group (n = 24). The rats were administrated 1mL of saline, L-NNA (3.3 mg/kg-d) and INDO (5 mg/kg·d) respectively through gastric tubes for one week/then heparin (200 IU/Kg/min) was given to rats by intravenous injection for an hour. Splanchnic and systemic hemodynamics were measured using radioactive microsphere techniques. The serum nitrate/nitrite(NO2-/NO3-) levels as a marker of production of NO were assessed by a colorimetric method, and concentration of 6-keto-PGF1α, a stable hydrolytic product of PGI2, was determined by radioimmunoassay. RESULTS: The concentrations of plasma 6-keto-PGFla (pg/mL) and serum NO2-/NO3- (μmol/L) in IHPH rats (1123.85±153.64, 73.34±4.31) and PHPH rats (891.88±83.11, 75.21±6.89) were significantly higher than those in SO rats (725.53±105.54, 58.79±8.47) (P<0.05). Compared with SO rats, total peripheral vascular resistance (TPR) and spanchnic vascular resistance (SVR) decreased but cardiac index (CI) and portal venous inflow (PVI) increased obviously in IHPH and PHPH rats (P<0.05). L-NNA and indomethacin could decrease the concentrations of plasma 6-keto-PGFla and serum NO2/7NO3-in IHPH and PHPH rats (P<0.05) .Meanwhile, CI, FPP and PVI lowered but MAP, TPR and SVR increased(P<0.05). After deduction of the action of NO, there was no significant correlation between plasma PGI2 level and hemodynamic parameters such as CI, TPR, PVI and SVR. However, after deduction of the action of PGI2, NO still correlated highly with the hemodynamic parameters, indicating that there was a close correlation between NO and the hemodynamic parameters. After administration of high-dose heparin, plasma 6-keto- concentrations in IHPH, PHPH and SO rats were significantly higher than those in rats administrated vehicle (P<0.05). On the contrary, levels of serum NO2-/NO3- in IHPH, PHPH and SO rats were significantly lower than those in rats administrated Vehicle (P<0.05). Compared with those rats administrated vehicle, the hemodynamic parameters of portal hypertensive rats, such as CI and PVI, declined significantly after administration of high-dose heparin (P<0.05), while TPR and SVR increased significantly (P<0.05). CONCLUSION: It is NO rather than PGI2 that is a mediator in the formation and maintenance of hyperdynamic circulatory state of chronic portal hypertensive rats.展开更多
Background:Grafts from older donors after circulatory death were associated with inferior outcome in liver transplants in the past.But it has seemed to remain controversial in the last decade,as a result of modified c...Background:Grafts from older donors after circulatory death were associated with inferior outcome in liver transplants in the past.But it has seemed to remain controversial in the last decade,as a result of modified clinical protocols,selected recipients,and advanced technology of organ perfusion and preservation.The present study aimed to examine the impact of older donor age on complications and survival of liver transplant using grafts from donation after circulatory death(DCD).Methods:A total of 944 patients who received DCD liver transplantation from 2015 to 2020 were included and divided into two groups:using graft from older donor(aged≥65 years,n=87)and younger donor(age<65 years,n=857).Propensity score matching(PSM)was applied to eliminate selection bias.Results:A progressively increased proportion of liver transplants with grafts from older donors was observed from 1.68%to 15.44%during the study period.The well-balanced older donor(n=79)and younger donor(n=79)were 1:1 matched.There were significantly more episodes of biliary nonanastomotic stricture(NAS)in the older donor group than the younger donor group[15/79(19.0%)vs.6/79(7.6%);P=0.017].The difference did not reach statistical significance regarding early allograft dysfunction(EAD)and primary non-function(PNF).Older livers had a trend toward inferior 1-,2-,3-year graft and overall survival compared with younger livers,but these differences were not statistically significant(63.1%,57.6%,57.6%vs.76.9%,70.2%,67.7%,P=0.112;64.4%,58.6%,58.6%vs.76.9%,72.2%,72.2%,P=0.064).The only risk factor for poor survival was ABO incompatible transplant(P=0.008)in the older donor group.In the subgroup of ABO incompatible cases,it demonstrated a significant difference in the rate of NAS between the older donor group and the younger donor group[6/8(75.0%)vs.3/14(21.4%);P=0.014].Conclusions:Transplants with grafts from older donors(aged≥65 years)after circulatory death are more frequently associated with inferior outcome compared to those from younger donors.Older grafts from DCD are more likely to develop NAS,especially in ABO incompatible cases.展开更多
AIM: To investigate the effects of 1400W-a selective inducible nitric oxide synthase(iN OS) inhibitor in a model of donation after circulatory death(DCD) kidneys. METHODS: Porcine kidneys were retrieved after 25 min w...AIM: To investigate the effects of 1400W-a selective inducible nitric oxide synthase(iN OS) inhibitor in a model of donation after circulatory death(DCD) kidneys. METHODS: Porcine kidneys were retrieved after 25 min warm ischemia. They were then stored on ice for 18 h before being reperfused ex vivo with oxygenated autologous blood on an isolated organ perfusion system. The selective i NOS inhibitor 1400W(10 mg/kg) was administered before reperfusion(n = 6) vs control group(n = 7). Creatinine(1000 μmol/L) was added to the system, renal and tubular cell function and the level of ischemia reperfusion injury were assessed over 3 h of reperfusion using plasma, urine and tissue samples. RESULTS: Kidneys treated with 1400 W had a higher level of creatinine clearance(CrC l) [area under the curve(AUC) CrC l: 2.37 ± 0.97 mL /min per 100 g vs 0.96 ± 0.32 mL /min per 100 g, P = 0.004] and urine output [Total: 320 ± 96 mL vs 156 ± 82 mL, P = 0.008]. There was no significant difference in levels of fractional excretion of sodium(AUC, Fr ex Na+: Control, 186.3% ± 81.7%.h vs 1400 W, 153.4% ± 12.1%.h, P = 0.429). Levels of total protein creatinine ratio were significantly lower in the 1400 W group after 1 h of reperfusion(1h Pr/Cr: 1400 W 9068 ± 6910 mg/L/mmol/L vs Control 21586 ± 5464 mg/L/mmol/L, P = 0.026). Levels of 8-isoprostane were significantly lower in the 1400 W group [8-iso/creatinine ratio: Control 239 ± 136 pg/L/mmol/L vs 1400 W 139 ± 47 pg/L/mmol/L, P = 0.041].CONCLUSION: This study demonstrated that 1400 W reduced ischaemia reperfusion injury in this porcine kidney model of DCD donor. Kidneys had improved renal function and reduced oxidative stress.展开更多
AIM To review the clinical impact of machine perfusion(MP) of the liver on biliary complications post-transplantation, particularly ischaemic-type biliary lesions(ITBL). METHODS This systematic review was performed in...AIM To review the clinical impact of machine perfusion(MP) of the liver on biliary complications post-transplantation, particularly ischaemic-type biliary lesions(ITBL). METHODS This systematic review was performed in accordance with the Preferred Reporting Systematic Reviews and MetaAnalysis(PRISMA) protocol. The following databases were searched: PubMed, MEDLINE and Scopus. The keyword "liver transplantation" was used in combination with the free term "machine perfusion". Clinical studies reporting results of transplantation of donor human livers following ex situ or in situ MP were analysed. Details relating to donor characteristics, recipients, technique of MP performed and post-operative biliary complications(ITBL, bile leak and anastomotic strictures) were critically analysed.RESULTS Fifteen articles were considered to fit the criteria for this review. Ex situ normothermic MP was used in 6 studies, ex situ hypothermic MP in 5 studies and the other 4 studies investigated in situ normothermic regional perfusion(NRP) and controlled oxygenated rewarming. MP techniques which have per se the potential to alleviate ischaemia-reperfusion injury: Such as hypothermic MP and NRP, have also reported lower rates of ITBL. Other biliary complications, such as biliary leak and anastomotic biliary strictures, are reported with similar incidences with all MP techniques. There is currently less clinical evidence available to support normothermic MP as a mitigator of biliary complications following liver transplantation. On the other hand, restoration of organ to full metabolism during normothermic MP allows assessment of hepatobiliary function before transplantation, although universally accepted criteria have yet to be validated.CONCLUSION MP of the liver has the potential to have a positive impact on post-transplant biliary complications, specifically ITBL, and expand extended criteria donor livers utilisation.展开更多
BACKGROUND Spontaneous bacterial empyema(SBE)occurs when a hepatic hydrothorax becomes infected and runs a course similar to spontaneous bacterial peritonitis(SBP).It remains underdiagnosed as patients with cirrhosis ...BACKGROUND Spontaneous bacterial empyema(SBE)occurs when a hepatic hydrothorax becomes infected and runs a course similar to spontaneous bacterial peritonitis(SBP).It remains underdiagnosed as patients with cirrhosis do not routinely undergo diagnostic thoracentesis.Current understanding is limited by small cohorts,while studies reporting its association with ascites/SBP are conflicting.AIM To explore the incidence of SBE,to determine its association with ascites,and to summarize what is known regarding treatment and outcomes for patients with SBE.METHODS Major databases were searched until June 2021.Outcomes include the incidence of SBE in pleural effusions,SBP in peritoneal fluid,and SBE in patients without ascites within our cohort of patients with cirrhosis.We performed a meta-analysis using a randomeffects model with pooled proportions and 95%confidence intervals(CI).We assessed heterogeneity using I^(2)and classic fail-safe to determine bias.RESULTS Eight studies with 8899 cirrhosis patients were included.The median age ranged between 41.2 to 69.7 years.The majority of the patients were Child-Pugh B and C.Mean MELD score was 18.6±8.09.A total of 1334 patients had pleural effusions and the pooled incidence of SBE was 15.6%(CI 12.6-19;I^(2)50).Amongst patients diagnosed with SBE,the most common locations included right(202),left(64),and bilateral(8).Amongst our cohort,a total of 2636 patients had ascites with a pooled incidence of SBP of 22.2%(CI 9.9-42.7;I^(2)97.8).The pooled incidence of SBE in patients with cirrhosis but without concomitant ascites was 9.5%(CI 3.6-22.8;I^(2)82.5).CONCLUSION SBE frequently occurs with concurrent ascites/SBP;our results suggest high incidence rates of SBE even in the absence of ascites.The pleura can be an unrecognized nidus and our findings support the use of diagnostic thoracentesis in patients with decompensated cirrhosis after exclusion of other causes of pleural effusion.Thoracentesis should be considered particularly in patients without ascites and when there is a high suspicion of infection.The need for diagnostic thoracentesis will continue to be important as rates of multi-drug resistant bacterial infections increase and antibiotic susceptibility information is required for adequate treatment.展开更多
基金funding from " Eleventh Five-Year" National Science and Technology Support Program of China (2007BAD86B-06)
文摘[ Objective] To find the rule of 5-hydroxytryptamine （5-HT） synthesis and metabolism in peripheral blood of suckling piglets with aging. [ Method ] All of 15 British Large White pigs at 0, 5 and 15 d of age were selected as experimental animals, and their serumal concentrations of L- tryptophan （L-Trp）, 5-HT and 5-hydroxyindoleacetic acid （5-HIAA） in peripheral circulatory system were determined synchronously by reversed- phase high-performance liquid chromatography method with UV. [ Result] The concentration of L-Trp was （16. 92 ± 1.74） iJmol/L at birth, （59.94 ±10.88） iJmol/L at 5 d of age and （70.42± 6.48） μmol/L at 15 d of age. The concentration of 5-HT was （ 12.85 ± 1.79） iJmol/L at birth, （4.81 ±2.05） ijmol/L at 5 d of age and （5.49±1.09） μmol/L at 15 d of age. While 5-HIAA, the metabolic product of 5-HT, was not detected at all the samples selected. [ Conclusion] The L-Trp concentration of suckling piglets increase significantly with aging （ P 〈0. 05）. While the concentra- tion of 5-HT and the conversion ratio of L-Trp to 5-HT are both highest at birth （P〈0.05） and keep stable at 5 and 15 d of age.
文摘For middle age individuals （male）, it may be difficult to find motivation for suitable exercise training, which has similarly favorable characteristics for cardiovascular adaptations as other exercises performed by younger individuals. Fifty four （n = 54）; （age = 41.57±3.25） untrained, overweight （F% = 19.52 ± 5.6）, range of （12.6-30.6）, （visceral fat area （VFA） = 111.1 cm^-2） healthy male （they are managers in four different Banks） were taking part in this research program. The participants took part on preliminary cardiac examination （echocardiography, GE Vivid 9 ultrasound machine. Body composition measured with type of ＂InBody720＂ （Biospace Co. Inc., Seoul, South Korea） Bioelectrical Impedance Analyzer （BIA）. The heart rate of the participants was measured continuously during all training sessions using heart rate belts （POLAR Team System, Finland）. Pulmonary gas exchange ＂Cardiosoft＂, （Milwaukee, USA were measured during a standardized treadmill test. Results： In many cases of the free indoor soccer play （FISP） recorded extremely high pulse rate, which is compared with the laboratory high pulse rate （LHPR）, much higher than the recommended physiological load level HR（FISP） 〉 190 beat/min; HR（LHPR） = 175 beat/min ; P 〈 0.001. Despite the many advantages of the Free Indoor Football Play （FISP） are hiding a lot of dangerous in the terms of circulatory adaptation.
文摘This paper validates the optimal operation for a grid-connected double-fed induction generator(DFIG)in an oscillating water column power plant(OWCPP).This study presents a novel optimization technique called the circulatory system-based optimization(CSBO)approach to develop six adaptive fuzzy logic controllers(AFLCs)with 30 parameters and compare them to chaotic-billiards optimization(C-BO)and genetic algorithm(GA).The proposed controller is also compared with a proportional-integral differential(PID)controller based on a self-adaptive global-best harmony search(SGHS).CSBO-based AFLCs are fully investigated under different scenarios and experimented with using a real-time interface DSP1104.The results of using CSBO-AFLCs revealed a fast time response,fast convergence,less overshoot and minimal error compared with those achieved with C-BO-AFLC,SGHS-PID and GA-AFLC during different case studies.The CSBO-based AFLCs ensure maximum power from the DFIG in an OWCPP and enhance dynamic response with very low errors.The results show that the CSBO shows better power tracking by 25%as compared with C-BO,by 45%when compared with the GA and by 56%when compared with PID.Moreover,the integral absolute errors of six controllers are investigated to demonstrate the feasibility of CSBO-AFLC.The root mean square of the errors of six controllers using CSBO is improved by 68.27%when compared with GA,by 22.57%when compared with C-BO and by 38.42%when compared with PID.These indicators demonstrate the feasibility of CSBO when compared with other algorithms with the same OWCPP.
基金supported by the Project of Scientific and Technological Innovation Development of Jilin in China under Grant 20210103090.
文摘Cyclic-system-based optimization(CSBO)is an innovative metaheuristic algorithm(MHA)that draws inspiration from the workings of the human blood circulatory system.However,CSBO still faces challenges in solving complex optimization problems,including limited convergence speed and a propensity to get trapped in local optima.To improve the performance of CSBO further,this paper proposes improved cyclic-system-based optimization(ICSBO).First,in venous blood circulation,an adaptive parameter that changes with evolution is introduced to improve the balance between convergence and diversity in this stage and enhance the exploration of search space.Second,the simplex method strategy is incorporated into the systemic and pulmonary circulations,which improves the update formulas.A learning strategy aimed at the optimal individual,combined with a straightforward opposition-based learning approach,is employed to enhance population convergence while preserving diversity.Finally,a novel external archive utilizing a diversity supplementation mechanism is introduced to enhance population diversity,maximize the use of superior genes,and lower the risk of the population being trapped in local optima.Testing on the CEC2017 benchmark set shows that compared with the original CSBO and eight other outstanding MHAs,ICSBO demonstrates remarkable advantages in convergence speed,convergence precision,and stability.
文摘BACKGROUND Glioma is the most common primary tumor in the brain originating from glial cells.In spite of extensive research,the overall survival rate is not enhanced.A number of published articles observed differentially circulating levels of cytokines in glioma.Interleukin-6(IL-6)protein coded by IL-6 gene is regulated by the immune system and it has been found to have a significant role in progression and apoptosis resistance of glioma.AIM To review the role of circulatory IL-6 in the development and progression of glioma and its utility as a biomarker.METHODS Preferred Reporting Items for Systematic Reviews and Meta-analysis(PRISMA)guidelines were applied to filter the relevant studies based on inclusion and exclusion criteria.We used a combination of keywords and the Reference Citation Analysis(RCA)tool to search the potential studies and performed data extraction from selected studies.RESULTS The published results were inconsistent;however,most studies showed a significantly higher IL-6 level in glioma cases as compared to controls.Comparative IL-6 level among the different grades of glioma showed a higher level with low-grade gliomas and lower level with high-grade gliomas.CONCLUSION IL-6 level significantly differed between cases and controls,and among different cancer stages,which shows its potential as a diagnostic and prognostic marker.
基金Supported by National Natural Science Foundation of China,No.82070604 and No.82270618the Shanghai Municipal Key Clinical Specialty,China,No.shslczdzk01103。
文摘BACKGROUND Liver cirrhosis is a progressive disease with high morbidity and mortality requiring effective management strategies to improve patient outcomes.Various therapies including albumin infusion,volume expanders(VEs),and vasoactive agents are used to manage patients with cirrhosis.Despite numerous clinical trials,a comprehensive meta-analysis comparing the effectiveness of albumin infusion against alternative treatments is limited.This study provides the current and comprehensive synthesis of evidence,offering key insights for optimizing therapeutic strategies in patients with liver cirrhosis.AIM To systematically update available data on therapies of liver cirrhosis,we performed a meta-analysis to evaluate and compare the clinical efficacy of albumin infusion vs other VEs and vasoactive agents in patients with liver cirrhosis.METHODS A literature search from the PubMed and Embase databases(inception till June 2024)focused on hyponatremia(primary outcome)and various outcomes such as gastrointestinal bleeding,hepatic encephalopathy,severe infection,post-paracentesis-induced circulatory dysfunction(PICD),ascites reappearance,spontaneous bacterial peritonitis,hepatorenal syndrome,renal impairment,hospital stay,mortality,and safety was performed.The primary analysis pooled studies that compared albumin infusion with control.In the subgroup analysis,comparisons were made within the stratified treatment categories included in the control group.RESULTS Of the 2957 studies retrieved,31 studies(27 randomized controlled trials and 4 observational studies)comprising 6255 patients were included.Albumin use was significant in reducing odds of hyponatremia[odds ratio(OR)=0.67;95%confidence interval(95%CI)=0.53-0.85]and PICD(OR=0.38;95%CI=0.20-0.71),whereas the reduction in severe infection(OR=0.55;95%CI=0.28-1.07)did not reach statistical significance.In the subgroup analysis,albumin demonstrated a favorable improvement in lowering the incidence of hyponatremia vs inactive/standard medical therapy(OR=0.54;95%CI=0.27-1.09).For PICD,albumin use was significant compared with other VEs(OR=0.31;95%CI=0.11-0.85)but not with vasoconstrictors(OR=0.63;95%CI=0.21-1.91).In the overall subgroup analysis,a significant reduction was observed in hyponatremia(OR=0.67;95%CI=0.53-0.85)and PICD(OR=0.38;95%CI=0.20-0.71).CONCLUSION Human albumin has been shown to significantly reduce the incidence of hyponatremia and PICD in patients with liver cirrhosis,whereas its effect on severe infection remains suggestive but not statistically significant.
文摘Temporary mechanical circulatory support (tMCS) devices such as intra-aorticballoon pumps, veno-arterial extracorporeal membrane oxygenation, and percutaneousventricular assist devices, play a major role in supporting patients withend-stage heart failure and bridging them to transplant. In 2018, the United Networkfor Organ Sharing heart allocation criteria was modified by increasing thenumber of statuses in the heart transplant waitlist to differentiate and favor thesickest patients awaiting transplantation. Within this new system, patients withtMCS devices receive the highest priority statuses. While the 2018 allocationsystem has reduced waitlist times and mortality for the highest-priority patients,some studies have shown a concomitant rise in the utilization of tMCS devices asbridge to transplant after its enaction. In this narrative review, we describe thesechanges in tMCS utilization and provide insights on how the upcoming creationof a continuous distribution allocation system may further impact these trends.
文摘BACKGROUND Marginal donation after circulatory death(DCD)liver grafts are carefully used to combat the constant shortage of donors.Clinically,the worst outcomes are mainly related to severe ischemia-reperfusion-injury and the dangerous effect of various inflammatory cytokines(CK).The machine perfusion(MP)is a promising device to rescue these grafts.AIM To analyze the role of MP connected to a sorbent cartridge(PerSorb®)and used for very damaged DCD pig livers.METHODS Seven grafts were procured from pigs from a slaughterhouse.Grafts were made very marginal with at least 60 minutes of donor warm ischemia time and 24 hours of static-cold ischemia time:(1)3 grafts were perfused in hypothermic MP with PerSorb(Sorb);(2)2 other grafts in hypothermic MP(HMP)without the cartridge(NoSorb);and(3)The other 2 livers stored in the ice box(NoTreat).The CK were measured at HMP start(T0)and at the end(Tend).Biopsies were taken at T0 and Tend.RESULTS All 5 grafts treated with HMP had a negative lactate trend after 3 hours of treatment(8.83 at T0 vs 6.4 at Tend of Sorb;15 at T0 vs 5.45 at Tend for NoSorb,P value>0.05).At Tend,both Sorb and NoSorb groups had better hemodynamic parameters,comparable between the two groups.Enzyme-linked immunosorbent assay analysis showed a reduction of monocyte chemotactic protein-1,tumor necrosis factor-alpha and interleukin-1βfor NoSorb group at Tend and a complete downregulation to physiological levels of the same CK in Sorb livers after 3 hours of treatment.Biopsies showed a reduction of the perisinusoidal edema for the Sorb grafts compared with the NoSorb livers.CONCLUSION These data suggest a potential protective role of treatment of grafts with MP and sorbent cartridge in reducing the inflammatory response after a severe ischemic injury.
基金Supported by National High Level Hospital Clinical Research Funding,No.2022-PUMCH-B-119.
文摘BACKGROUND Splenic artery aneurysm(SAA)rupture is a rare,life-threatening condition characterized by acute intra-abdominal hemorrhage and hemodynamic instability.Ruptured SAAs may exhibit a biphasic and relatively slow clinical progression,commonly referred to as the“double-rupture phenomenon”.The reported incidence of the double-rupture phenomenon ranges 12%-21%in patients with ruptured SAAs,potentially due to variations in intra-abdominal pressure.Following anesthesia induction,muscle relaxation can decrease intra-abdominal pressure,potentially triggering the double-rupture phenomenon and leading to circulatory collapse.CASE SUMMARY A 61-year-old female presented to the Department of Emergency with upper abdominal pain,abdominal distension,dizziness,and vomiting.Her vital signs were initially stable.Physical examination revealed abdominal tenderness and positive-shifting dullness.Abdominal contrast-enhanced computed tomography revealed cirrhosis,severe portal hypertension,and splenomegaly.Acute rupture was suggested by a hematoma on the upper left side outside the SAA.Surgeons deemed intravascular intervention challenging and open splenectomy inevitable.Circulatory collapse occurred after anesthesia induction,likely due to a double rupture of the SAA.This double-rupture phenomenon may have resulted from an initial rupture of the SAA into the omental bursa,forming a hematoma that exerted a tamponade effect.A second rupture into the peritoneal cavity may have been triggered by decreased intra-abdominal pressure following anesthesia induction.The patient’s life was saved through early,coordinated,multidisciplinary significant postoperative bleeding or hypoxic encephalopathy.CONCLUSION Anesthesia-induced pressure reduction may trigger a second SAA rupture,causing collapse.Early diagnosis and multidisciplinary teamwork improve outcomes.This is a rare and life-threatening case of SAA rupture,which is of great significance to the medical community for understanding and handling such emergencies.
文摘BACKGROUND The normothermic machine perfusion pump(NMPP)could shape the future of transplantation.Providing ex-vivo optimization,NMPP attenuates ischemic insult while replenishing energy.An understanding of machine perfusion time(MPT)impact and potential clinical benefits is paramount and necessitates exploration.AIM To investigate the relationship between MPT and post-transplant graft function.METHODS Retrospective review of the first 50 donation after circulatory death(DCD)grafts preserved using NMPP in a tertiary institution was performed.Essential preser-vation time points,graft parameters,recipient information,and postoperative outcomes were prospectively recorded.Early allograft dysfunction(EAD),L-Graft7 score and 90-day outcomes were collected for all grafts.The first 20 re-cipients were allocated into the early group,considered the learning curve population for the center.The subsequent 30 were allocated into the late group.Recipients were also stratified into cohorts depending on MPT,i.e.,short(<8 hours),medium(8-16 hours)and long(>16 hours).RESULTS NMPP operational parameters were not predictive of EAD,L-GrAFT7 or 90-day outcomes.The early group had significantly less MPT and cold ischemia time than the late group(553 minutes vs 850 minutes,P<0.001)and(127.5 minutes vs 154 minutes,P=0.025),respectively.MPT had no impact in either group.CONCLUSION Increased MPT of DCD liver grafts had no adverse recipient results for the times utilized in this population,indicating its upper limits,likely beyond 24 hours,are not demonstrated within this study.Future studies are necessary to determine whether longer MPT is beneficial or detrimental to graft function and,if the latter,what is the maximum safe duration.Further studies of the effect of normothermic machine perfusion pump duration on long-term outcomes are also needed.
基金supported by the Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences(CIFM)[NO.2016-12M-3-001]the China Medical Board“Strengthen Capacity of Study and Application on Burden of Disease in Health Care System of China-Establishment and Development of Chinese Burden of Disease Research and Dissemination Center”[NO.15-208]。
文摘Objective To analyze the association between exposure to second-hand smoke(SHS) and 23 diseases,categorized into four classifications, among the Chinese population.Methods We searched the literature up to June 30, 2021, and eligible studies were identified according to the PECOS format: Participants and Competitors(Chinese population), Exposure(SHS),Outcomes(Disease or Death), and Study design(Case-control or Cohort).Results In total, 53 studies were selected. The odds ratio(OR) for all types of cancer was 1.79(1.56–2.05), and for individual cancers was 1.92(1.42–2.59) for lung cancer, 1.57(1.40–1.76) for breast cancer, 1.52(1.12–2.05) for bladder cancer, and 1.37(1.08–1.73) for liver cancer. The OR for circulatory system diseases was 1.92(1.29–2.85), with a value of 2.29(1.26–4.159) for stroke. The OR of respiratory system diseases was 1.76(1.13–2.74), with a value of 1.82(1.07–3.11) for childhood asthma. The original ORs were also shown for other diseases. Subgroup analyses were performed for lung and breast cancer. The ORs varied according to time period and were significant during exposure in the household;For lung cancer, the OR was significant in women.Conclusion The effect of SHS exposure in China was similar to that in Western countries, but its definition and characterization require further clarification. Studies on the association between SHS exposure and certain diseases with high incidence rates are insufficient.
文摘<strong>Background:</strong> Allometric scaling is a well-known research tool used for the metabolic rates of organisms. It measures the living systems with fractal physiology. The metabolic rate versus the mass of the living species has a definite scaling and behaves like a four-dimensional phenomenon. The extended investigations focus on the mass-dependence of the various physiological parameters.<strong> Objective: </strong>Proving the length of vascularization is the scaling parameter instead of mass in allometric relation. <strong>Method:</strong> The description of the energy balance of the ontogenic growth of the tumor is an extended cell-death parameter for studying the mass balance at the cellular level. <strong>Results:</strong> It is shown that when a malignant cellular cluster tries to maximize its metabolic rate, it changes its allometric scaling exponent. A growth description could follow the heterogenic development of the tumor. The mass in the allometric scaling could be replaced by the average length of the circulatory system in each case. <strong>Conclusion:</strong> According to this concept, the dependence of the mass in allometric scaling is replaced with a more fundamental parameter, the length character of the circulatory system. The introduced scaling parameter has primary importance in cancer development, where the elongation of the circulatory length by angiogenesis is in significant demand.
文摘Portal hypertension is a clinical syndrome which leads to several clinical complications, such as the formation and rupture of esophageal and/or gastric varices, ascites, hepatic encephalopathy and hepato-renal syndrome. In cirrhosis, the primary cause of the increase in portal pressure is the enhanced resistance to portal outflow. However, also an increase in splanchnic blood flow worsens and maintains portal hypertension. The vasodilatation of arterial splanchnic vessels and the opening of collateral circulation are the determinants of the increased splanchnic blood flow. Several vasoactive systems/substances, such as nitric oxide, cyclooxygenase-derivatives, carbon monoxide and endogenous cannabinoids are activated in portal hypertension and are responsible for the marked splanchnic vasodilatation. Moreover, an impaired reactivity to vasoconstrictor systems, such as the sympathetic nervous system, vasopressin, angiotensin II and endothelin-1, plays a role in this process. The opening of collateral circulation occurs through the reperfusion and dilatation of preexisting vessels, but also through the generation of new vessels. Splanchnic vasodilatation leads to the onset of the hyperdynamic circulatory syndrome, a syndrome which occurs in patients with portal hypertension and is characterized by increased cardiac output and heart rate, and decreased systemic vascular resistance with low arterial blood pressure. Understanding the pathophysiology of splanchnic vasodilatation and hyperdynamic circulatory syndrome is mandatory for the prevention and treatment of portal hypertension and its severe complications.
基金supported by the National Natural Science Foundation of China,No.81401084(to XHW)the Beijing Municipal Administration of Hospital Ascent Plan in China,No.DFL20150802(to TLW)+2 种基金the Beijing 215 High Level Healthcare Talent Plan Academic Leader in China,No.008-0027(to TLW)the Beijing Municipal Commission of Health and Family Planning in China,No.PXM2017_026283_000002(to TLW)the Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support in China,No.ZYLX201706(to TLW),303-01-005-0137-11(to TLW),65683.00(to TLW)
文摘Using deep hypothermic circulatory arrest, thoracic aorta diseases and complex heart diseases can be subjected to corrective procedures. However, mechanisms underlying brain protection during deep hypothermic circulatory arrest are unclear. After piglet models underwent 60 minutes of deep hypothermic circulatory arrest at 14°C, expression of microRNAs(miRNAs) was analyzed in the hippocampus by microarray. Subsequently, TargetScan 6.2, RNA22 v2.0, miRWalk 2.0, and miRanda were used to predict potential targets, and gene ontology enrichment analysis was carried out to identify functional pathways involved. Quantitative reverse transcription-polymerase chain reaction was conducted to verify miRNA changes. Deep hypothermic circulatory arrest altered the expression of 35 miRNAs. Twenty-two miRNAs were significantly downregulated and thirteen miRNAs were significantly upregulated in the hippocampus after deep hypothermic circulatory arrest. Six out of eight targets among the differentially expressed miRNAs were enriched for neuronal projection(cyclin dependent kinase, CDK16 and SLC1 A2), central nervous system development(FOXO3, TYRO3, and SLC1 A2), ion transmembrane transporter activity(ATP2 B2 and SLC1 A2), and interleukin-6 receptor binding(IL6 R)– these are the key functional pathways involved in cerebral protection during deep hypothermic circulatory arrest. Quantitative reverse transcription-polymerase chain reaction confirmed the results of microarray analysis. Our experimental results illustrate a new role for transcriptional regulation in deep hypothermic circulatory arrest, and provide significant insight for the development of miRNAs to treat brain injuries. All procedures were approved by the Animal Care Committee of Xuanwu Hospital, Capital Medical University, China on March 1, 2017(approval No. XW-INI-AD2017-0112).
基金Supported by Grant-in-Aid for Scientific Research, No. 17590669
文摘AIM： To investigate whether adrenomedullin, a potent vasodilator peptide, plays a role in the circulatory disturbance in cirrhosis. METHODS： Cirrhosis was induced in rats by weekly gavage of carbon tetrachloride. Hemodynamic studies were performed in vivo using radioactive microspheres and in vitro using isolated aortic rings. The adrenomedullin concentrations were measured by radioimmunoassay. RESULTS： Acute administration of adrenomedullin to the control rats reduced the systemic arterial pressure along with an increase of serum levels of the stable metabolite of nitric oxide （NOx）, in a dose-dependent manner. Chronic infusion of adrenomedullin reduced the vascular resistance and increased the blood flow in the systemic and splanchnic circulation. Intravenous administration of anti-adrenomedullin antibody did not affect any hemodynamic parameters in the cirrhotic rats, whereas this antibody ameliorated the blunted contractile response to phenylephrine, o-adrenergic receptor agonist, in the aortic rings of the cirrhotic rats. The adrenomedullin concentrations in the aorta were higher in the cirrhotic rats than in the controls, and correlated with the mean arterial pressure in the cirrhotic rats. Moreover, adrenomedullin blunted the contractile response to phenylephrine in both of the control aorta and cirrhotic aorta, but not in the presence of NG-nitro L-arginine methyl ester, an NO synthase inhibitor. CONCLUSION： Adrenomedullin overproduced in the vascular wall may contribute to the circulatory disturbance in cirrhosis as a local regulator of the vascular tonus rather than a circulating hormone.
文摘AIM: To investigate the role of prostacyclin (PGI2) and nitric oxide (NO) in the development and maintenance of hyperdynamic circulatory state of chronic portal hypertensive rats. METHODS: Ninety male Sprague-Dawley rats were divided into three groups: intrahepatic portal hypertension (IHPH) group by injection of CCI4, prehepatic portal hypertension (PHPH) group by partial stenosis of the portal vein and sham-operation control (SO) group. One week after the models were made, animals in each group were subdivided into 4 groups: saline controlled group (n = 23), Nω-nitro-L-arginine (L-NNA)group (n = 21) group, indomethacin (INDO) group (n = 22) and high-dose heparin group (n = 24). The rats were administrated 1mL of saline, L-NNA (3.3 mg/kg-d) and INDO (5 mg/kg·d) respectively through gastric tubes for one week/then heparin (200 IU/Kg/min) was given to rats by intravenous injection for an hour. Splanchnic and systemic hemodynamics were measured using radioactive microsphere techniques. The serum nitrate/nitrite(NO2-/NO3-) levels as a marker of production of NO were assessed by a colorimetric method, and concentration of 6-keto-PGF1α, a stable hydrolytic product of PGI2, was determined by radioimmunoassay. RESULTS: The concentrations of plasma 6-keto-PGFla (pg/mL) and serum NO2-/NO3- (μmol/L) in IHPH rats (1123.85±153.64, 73.34±4.31) and PHPH rats (891.88±83.11, 75.21±6.89) were significantly higher than those in SO rats (725.53±105.54, 58.79±8.47) (P<0.05). Compared with SO rats, total peripheral vascular resistance (TPR) and spanchnic vascular resistance (SVR) decreased but cardiac index (CI) and portal venous inflow (PVI) increased obviously in IHPH and PHPH rats (P<0.05). L-NNA and indomethacin could decrease the concentrations of plasma 6-keto-PGFla and serum NO2/7NO3-in IHPH and PHPH rats (P<0.05) .Meanwhile, CI, FPP and PVI lowered but MAP, TPR and SVR increased(P<0.05). After deduction of the action of NO, there was no significant correlation between plasma PGI2 level and hemodynamic parameters such as CI, TPR, PVI and SVR. However, after deduction of the action of PGI2, NO still correlated highly with the hemodynamic parameters, indicating that there was a close correlation between NO and the hemodynamic parameters. After administration of high-dose heparin, plasma 6-keto- concentrations in IHPH, PHPH and SO rats were significantly higher than those in rats administrated vehicle (P<0.05). On the contrary, levels of serum NO2-/NO3- in IHPH, PHPH and SO rats were significantly lower than those in rats administrated Vehicle (P<0.05). Compared with those rats administrated vehicle, the hemodynamic parameters of portal hypertensive rats, such as CI and PVI, declined significantly after administration of high-dose heparin (P<0.05), while TPR and SVR increased significantly (P<0.05). CONCLUSION: It is NO rather than PGI2 that is a mediator in the formation and maintenance of hyperdynamic circulatory state of chronic portal hypertensive rats.
基金the Ethics Committee of the First Affiliated Hospital of Zhejiang University School of Medicine(2013-0022).
文摘Background:Grafts from older donors after circulatory death were associated with inferior outcome in liver transplants in the past.But it has seemed to remain controversial in the last decade,as a result of modified clinical protocols,selected recipients,and advanced technology of organ perfusion and preservation.The present study aimed to examine the impact of older donor age on complications and survival of liver transplant using grafts from donation after circulatory death(DCD).Methods:A total of 944 patients who received DCD liver transplantation from 2015 to 2020 were included and divided into two groups:using graft from older donor(aged≥65 years,n=87)and younger donor(age<65 years,n=857).Propensity score matching(PSM)was applied to eliminate selection bias.Results:A progressively increased proportion of liver transplants with grafts from older donors was observed from 1.68%to 15.44%during the study period.The well-balanced older donor(n=79)and younger donor(n=79)were 1:1 matched.There were significantly more episodes of biliary nonanastomotic stricture(NAS)in the older donor group than the younger donor group[15/79(19.0%)vs.6/79(7.6%);P=0.017].The difference did not reach statistical significance regarding early allograft dysfunction(EAD)and primary non-function(PNF).Older livers had a trend toward inferior 1-,2-,3-year graft and overall survival compared with younger livers,but these differences were not statistically significant(63.1%,57.6%,57.6%vs.76.9%,70.2%,67.7%,P=0.112;64.4%,58.6%,58.6%vs.76.9%,72.2%,72.2%,P=0.064).The only risk factor for poor survival was ABO incompatible transplant(P=0.008)in the older donor group.In the subgroup of ABO incompatible cases,it demonstrated a significant difference in the rate of NAS between the older donor group and the younger donor group[6/8(75.0%)vs.3/14(21.4%);P=0.014].Conclusions:Transplants with grafts from older donors(aged≥65 years)after circulatory death are more frequently associated with inferior outcome compared to those from younger donors.Older grafts from DCD are more likely to develop NAS,especially in ABO incompatible cases.
文摘AIM: To investigate the effects of 1400W-a selective inducible nitric oxide synthase(iN OS) inhibitor in a model of donation after circulatory death(DCD) kidneys. METHODS: Porcine kidneys were retrieved after 25 min warm ischemia. They were then stored on ice for 18 h before being reperfused ex vivo with oxygenated autologous blood on an isolated organ perfusion system. The selective i NOS inhibitor 1400W(10 mg/kg) was administered before reperfusion(n = 6) vs control group(n = 7). Creatinine(1000 μmol/L) was added to the system, renal and tubular cell function and the level of ischemia reperfusion injury were assessed over 3 h of reperfusion using plasma, urine and tissue samples. RESULTS: Kidneys treated with 1400 W had a higher level of creatinine clearance(CrC l) [area under the curve(AUC) CrC l: 2.37 ± 0.97 mL /min per 100 g vs 0.96 ± 0.32 mL /min per 100 g, P = 0.004] and urine output [Total: 320 ± 96 mL vs 156 ± 82 mL, P = 0.008]. There was no significant difference in levels of fractional excretion of sodium(AUC, Fr ex Na+: Control, 186.3% ± 81.7%.h vs 1400 W, 153.4% ± 12.1%.h, P = 0.429). Levels of total protein creatinine ratio were significantly lower in the 1400 W group after 1 h of reperfusion(1h Pr/Cr: 1400 W 9068 ± 6910 mg/L/mmol/L vs Control 21586 ± 5464 mg/L/mmol/L, P = 0.026). Levels of 8-isoprostane were significantly lower in the 1400 W group [8-iso/creatinine ratio: Control 239 ± 136 pg/L/mmol/L vs 1400 W 139 ± 47 pg/L/mmol/L, P = 0.041].CONCLUSION: This study demonstrated that 1400 W reduced ischaemia reperfusion injury in this porcine kidney model of DCD donor. Kidneys had improved renal function and reduced oxidative stress.
基金supported by the NIHR Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trustthe University of Birmingham
文摘AIM To review the clinical impact of machine perfusion(MP) of the liver on biliary complications post-transplantation, particularly ischaemic-type biliary lesions(ITBL). METHODS This systematic review was performed in accordance with the Preferred Reporting Systematic Reviews and MetaAnalysis(PRISMA) protocol. The following databases were searched: PubMed, MEDLINE and Scopus. The keyword "liver transplantation" was used in combination with the free term "machine perfusion". Clinical studies reporting results of transplantation of donor human livers following ex situ or in situ MP were analysed. Details relating to donor characteristics, recipients, technique of MP performed and post-operative biliary complications(ITBL, bile leak and anastomotic strictures) were critically analysed.RESULTS Fifteen articles were considered to fit the criteria for this review. Ex situ normothermic MP was used in 6 studies, ex situ hypothermic MP in 5 studies and the other 4 studies investigated in situ normothermic regional perfusion(NRP) and controlled oxygenated rewarming. MP techniques which have per se the potential to alleviate ischaemia-reperfusion injury: Such as hypothermic MP and NRP, have also reported lower rates of ITBL. Other biliary complications, such as biliary leak and anastomotic biliary strictures, are reported with similar incidences with all MP techniques. There is currently less clinical evidence available to support normothermic MP as a mitigator of biliary complications following liver transplantation. On the other hand, restoration of organ to full metabolism during normothermic MP allows assessment of hepatobiliary function before transplantation, although universally accepted criteria have yet to be validated.CONCLUSION MP of the liver has the potential to have a positive impact on post-transplant biliary complications, specifically ITBL, and expand extended criteria donor livers utilisation.
文摘BACKGROUND Spontaneous bacterial empyema(SBE)occurs when a hepatic hydrothorax becomes infected and runs a course similar to spontaneous bacterial peritonitis(SBP).It remains underdiagnosed as patients with cirrhosis do not routinely undergo diagnostic thoracentesis.Current understanding is limited by small cohorts,while studies reporting its association with ascites/SBP are conflicting.AIM To explore the incidence of SBE,to determine its association with ascites,and to summarize what is known regarding treatment and outcomes for patients with SBE.METHODS Major databases were searched until June 2021.Outcomes include the incidence of SBE in pleural effusions,SBP in peritoneal fluid,and SBE in patients without ascites within our cohort of patients with cirrhosis.We performed a meta-analysis using a randomeffects model with pooled proportions and 95%confidence intervals(CI).We assessed heterogeneity using I^(2)and classic fail-safe to determine bias.RESULTS Eight studies with 8899 cirrhosis patients were included.The median age ranged between 41.2 to 69.7 years.The majority of the patients were Child-Pugh B and C.Mean MELD score was 18.6±8.09.A total of 1334 patients had pleural effusions and the pooled incidence of SBE was 15.6%(CI 12.6-19;I^(2)50).Amongst patients diagnosed with SBE,the most common locations included right(202),left(64),and bilateral(8).Amongst our cohort,a total of 2636 patients had ascites with a pooled incidence of SBP of 22.2%(CI 9.9-42.7;I^(2)97.8).The pooled incidence of SBE in patients with cirrhosis but without concomitant ascites was 9.5%(CI 3.6-22.8;I^(2)82.5).CONCLUSION SBE frequently occurs with concurrent ascites/SBP;our results suggest high incidence rates of SBE even in the absence of ascites.The pleura can be an unrecognized nidus and our findings support the use of diagnostic thoracentesis in patients with decompensated cirrhosis after exclusion of other causes of pleural effusion.Thoracentesis should be considered particularly in patients without ascites and when there is a high suspicion of infection.The need for diagnostic thoracentesis will continue to be important as rates of multi-drug resistant bacterial infections increase and antibiotic susceptibility information is required for adequate treatment.
