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BACKGROUND Patients with critical coronavirus disease 2019 (COVID-19), characterized by respiratory failure requiring mechanical ventilation (MV), are at high risk of mortality. An effective and practical MV weaning protocol is needed for these fragile cases. CASE SUMMARY Here, we present two critical COVID-19 patients who presented with fever, cough and fatigue. COVID-19 diagnosis was confirmed based on blood cell counts, chest computed tomography (CT) imaging, and nuclei acid test results. To address the patients’ respiratory failure, they first received noninvasive ventilation (NIV). When their condition did not improve after 2 h of NIV, each patient was advanced to MV [tidal volume (Vt), 6 mL/kg ideal body weight (IBW); 8-10 cmH2O of positive end-expiratory pressure; respiratory rate, 20 breaths/min; and 40%-80% FiO2] with prone positioning for 12 h/day for the first 5 d of MV. Extensive infection control measures were conducted to minimize morbidity, and pharmacotherapy consisting of an antiviral, immune-enhancer, and thrombosis prophylactic was administered in both cases. Upon resolution of lung changes evidenced by CT, the patients were sequentially weaned using a weaning screening test, spontaneous breathing test, and airbag leak test. After withdrawal of MV, the patients were transitioned through NIV and high-flow nasal cannula oxygen support. Both patients recovered well. CONCLUSION A MV protocol attentive to intubation/extubation timing, prone positioning early in MV, infection control, and sequential withdrawal of respiratory support, may be an effective regimen for patients with critical COVID-19.

Aim This study investigated whether ischemic postconditioning (IPO) improved the outcome of organs from donors after cardiac death and had a synergistic effect with hypothermic machine perfusion (HMP) in a pig liver transplantation model. Methods A donor after cardiac death (DCD) model was developed in 48 healthy Bama miniature pigs randomly divided into four groups: simple cold storage group (SCS group), IPO group, HMP group, HMP-IPO group. The levels of serum alanine aminotransferase (ALT), total bilirubin, histopathological findings, apoptotic activity of hepatocytes, international normalized ratio (INR), tumor necrosis factor-α (TNF-α), and Malondialdehyde (MDA) were compared. Results All recipients in the SCS group died within 6 h after transplantation. The livers of the recipients in the IPO had 50% survival on day 5. HMP allowed 83.3% survival and HMP-IPO allowed 100% survival. After reperfusion, the recipients in the IPO and HMP-IPO group had lower ALT and total bilirubin levels, less Suzuki score, less apoptosis, and less injury to hepatocytes and biliary ducts and attenuated inflammatory response and oxidative load. Conclusions IPO improved the outcome of organs from donors after cardiac death and had a synergistic effect with HMP in the pig liver transplantation model.

Background We investigated whether the outcome of organs from donors after circulatory death (DCD) can be improved by the addition of mcc950 to the perfusate of the hypothermic machine perfusion (HMP) system and intravenous mcc950 injection after transplantation in a pig liver transplantation model. Methods Thirty-six healthy Bama mini pigs randomized into 3 groups. All the DCD livers were preserved in an HMP system after 2 hours of simple cold storage. In HMP-Postop group, mcc950 was added to the perfusate; in the control group and Postop group, the perfusate was normal LPS. After transplantation, the pigs in the Postop group and HMP-Postop group were intravenously administered 3 mg/kg mcc950, at the time of reperfusion and on day 2 and day 3 after transplantation. During the 3-day follow-up period, general operative characteristics, and serological markers and histological features related to ischemia reperfusion injury were examined. Results The HMP-Postop group suffer the lightest ischemia reperfusion injury (IRI), and functioned best after transplantation. Model for the Early Allograft Function Score (predictor of long-term survival), degree of injury in the hepatocytes and rate of apoptosis was lowest in the HMP-Postop group. Further, in the HMP-Postop group, the nucleotide-binding domain leucine-rich repeat containing family pyrin domain containing 3 inflammasome pathway activation was lowest, and the level of IL-1β was lowest. Postop group functioned better than control group, but not comparable with HMP-Postop group. Conclusions The outcome of DCD organs can be improved by the addition of mcc950 to the perfusate of the HMP system and intravenous injection of mcc950 after transplantation.

Background Hypothermic machine perfusion (HMP) improves the quality of donor livers for transplantation, both in animal models and in clinical practice. Treatment with SP600125, an inhibitor of c-Jun N-terminal kinase (JNK), can suppress the JNK signaling pathway to alleviate donor liver ischemia–reperfusion injury (IRI). We performed the present study with the objective of exploring the protective effects exerted by a combination of HMP and SP600125 on liver xenograft viability for donation after cardiac death (DCD) in a porcine model. Methods 54 adult BAMA mini-pigs were randomly assigned to 5 groups, including sham, cold storage for 4 h (CS 4 h), CS 4 h + SP600125, CS 2 h + HMP 2 h, and CS 2 h + HMP 2 h + SP600125 groups. Donor livers in the CS 4 h and CS 4 h + SP600125 groups were conventionally cold preserved for 4 h, whereas donor livers in the CS 2 h + HMP 2 h and CS 2 h + HMP 2 h + SP600125 groups were cold preserved for 2 h and then treated with HMP for 2 h. The preservation and perfusion solutions contained SP600125 (20 µM). Follow-up was conducted for 5 days after liver transplantation to compare the surgical outcomes by means of serological examination, pathological results, and survival rate. Results The most satisfactory outcome after liver transplantation was observed in the CS 2 h + HMP 2 h + SP600125 group, which presented with minimal damage of donor livers during 5 days’ follow-up. Additionally, serological examination, pathological results, and survival rate concurred in showing better results in the CS 2 h + HMP 2 h ± SP600125 group than in the CS 4 h ± SP600125 group. Conclusion HMP in combination with SP600125 has hepatoprotective properties and improves the quality and viability of porcine livers collected after DCD, thus improving prognosis after liver transplantation.

We report the clinical and laboratory findings and successful management of seven patients with critical coronavirus disease 2019 (COVID-19) requiring mechanical ventilation (MV). The patients were diagnosed based on epidemiological history, clinical manifestations, and nucleic acid testing. Upon diagnosis with COVID-19 of critical severity, the patients were admitted to the intensive care unit, where they received early noninvasive–invasive sequential ventilation, early prone positioning, and bundle pharmacotherapy regimen, which consists of antiviral, anti-inflammation, immune-enhancing, and complication-prophylaxis medicines. The patients presented fever (n = 7, 100%), dry cough (n = 3, 42.9%), weakness (n = 2, 28.6%), chest tightness (n = 1, 14.3%), and/or muscle pain (n = 1, 14.3%). All patients had normal or lower than normal white blood cell count/lymphocyte count, and chest computed tomography scans showed bilateral patchy shadows or ground glass opacity in the lungs. Nucleic acid testing confirmed COVID-19 in all seven patients. The median MV duration and intensive care unit stay were 9.9 days (interquartile range, 6.5–14.6 days; range, 5–17 days) and 12.9 days (interquartile range, 9.7–17.6 days; range, 7–19 days), respectively. All seven patients were extubated, weaned off MV, transferred to the common ward, and discharged as of the writing of this report. Thus, we concluded that good outcomes for patients with critical COVID-19 can be achieved with early noninvasive–invasive sequential ventilation and bundle pharmacotherapy.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has become an immense public health burden, first in China and subsequently worldwide. Developing effective control measures for COVID-19, especially measures that can halt the worsening of severe cases to a critical status is of urgent importance. CASE SUMMARY: A 52-year-old woman presented with a high fever (38.8 °C), chills, dizziness, and weakness. Epidemiologically, she had not been to Wuhan where COVID-19 emerged and did not have a family history of a disease cluster. A blood test yielded a white blood cell count of 4.41 × 10(9)/L (60.6 ± 2.67% neutrophils and 30.4 ± 1.34% lymphocytes). Chest imaging revealed bilateral ground-glass lung changes. Based on a positive nasopharyngeal swab nucleic acid test result and clinical characteristics, the patient was diagnosed with COVID-19. Following treatment with early non-invasive ventilation and a bundle pharmacotherapy, she recovered with a good outcome. CONCLUSION: Early non-invasive ventilation with a bundle pharmacotherapy may be an effective treatment regimen for the broader population of patients with COVID-19.

Background Warm ischemia jeopardizes graft quality and recipient survival in donation after cardiac death (DCD) transplantation. Currently, there is no system to objectively evaluate the liver quality from DCD. The present study tried to use energy metabolites to evaluate the donor liver quality. Methods We divided 195 Sprague-Dawley rats into five groups: the control (n = 39), warm ischemic time (WIT) 15 min (n = 39), WIT 30 min (n = 39), WIT 45 min (n = 39), and WIT 60 min (n = 39) groups. Three rats from each group were randomly selected for pretransplant histologic evaluation of warm ischemia-related damage. The remaining 36 rats were randomly divided into donors and recipients of 18 liver transplantations, and were subjected to postoperative liver function and survival analyses. Between cardiac arrest and cold storage, liver energy metabolites including glucose, lactate, pyruvate, and glycerol were measured by microdialysis. The lactate to pyruvate ratio (LPR) was calculated. Results The changes in preoperative pathology with warm ischemia were inconspicuous, but the trends in postoperative pathology and aminotransferase levels were consistent with preoperative energy metabolite measurements. The 30-day survival rates of the control and WIT 15, 30, 45, and 60 min groups were 100%, 81.82%, 76.92%, 58.33%, and 25.00%, respectively. The areas under the receiver operating characteristic curves of glucose, lactate, glycerol, and LPR were 0.87, 0.88, 0.88, and 0.92, respectively. Conclusion Glucose, lactate, glycerol, and LPR are predictors of graft quality and survival outcomes in DCD transplantation.

Hemorrhoid refers to soft vein mass formed by varicosity of submucosal veins around the end of the rectum and subcutanceous veins of the anal canal. It is the most common anorectal disease. This article summarized the regular patterns, features and advantages of Professor Yu Hai-Bo’s acupuncture-moxibustion therapy for hemorrhoids, in order to guide the acupuncture treatment for hemorrhoids.

As a promising energy-saving technique, the eco-friendly and low-cost solid-state white light-emitting diodes (WLEDs) based on quantum dots (QDs) have been widely studied. Herein, a WLED device prepared by core–shell structure nanocomposites based on Ag-In-S/ZnS@SiO2 quantum dots (AIS@SiO2) and carbon quantum dots (CDs) was successfully constructed. CDs were combined onto the surface of AIS@SiO2 QDs to synthesize Ag-In-S/ZnS@SiO2-Carbon quantum dots (AIS-CDs) nanocomposites with a white-light emission, which successfully overcome the quenching effect of CDs induced by conventional aggregation. The as-prepared AIS-CDs nanocomposites presented high stability and a photoluminescence quantum yield (PLQY) of 35%. Moreover, the corresponding AIS-CDs nanocomposites-based WLEDs demonstrated the color coordinate of (0.32, 0.33), which is comparable to the pure white light (0.33, 0.33); furthermore, the luminous efficiency of the as-prepared WLEDs showed 15.1 lm W−1. These results reported herein may open up a new avenue for the development of high-performance, low-cost, and environmentally-friendly WLEDs.

By summing up the basic conditions and production safety procedures in Chinese mines, the paper conducts an in-depth analysis of major types of disasters caused by gas, roof falls, fires, flooding, outbursts, dust, thermal harm, ground subsidence, and slope instability and blowouts in mines. From the perspective of prevention and control of coal and gas outbursts, rock outbursts, gob fires, and tailings pond failures and water inrush disasters, it addresses outcomes from the latest research in risk identification and disaster prevention and control techniques in Chinese mines. Finally, with respect to existing problems, the paper proposes risk identification, measures for disaster prevention and control in country’s mines and its development during the 13th Five-Year Plan period (2016–2020).

“Transplantation” (Volume 97, Number 8, April 27, 2014) published an open letter from Professor Delmonico along with other seven professors to Mr. Xi Jinping, President of the People's Republic of China: China's Fight Against Corruption in Organ Transplantation. The article sharply posed this concern, thus evoking great attention at home and abroad within the transplant community. To this end, we hereby state our views and declare our position with regard to the concerns mentioned in the open letter about China's organ transplant undertaking.

Using the micron alumina powder for the study, through the analysis of the ceramic suspension rheological, the generation and evolution and its mechanism of aggregates in the ceramic suspension were studied. The results showed that the number, size and intensity of aggregates will be effected by the gravitational potential or the barrier height between the particles in suspension as varying the process conditions. Generally, the formation of aggregates was corresponded to the interaction potential between particles, that is, the second potential well. Thus, their internal bonding strength is weak. In the flowing suspension, aggregates were meta-stability under shear forces, electrostatic repulsion and van der Waals potential. The variation of the aggregates was a reversible process as decomposition then reunion again.

As a nonlinear load, a large number of electric vehicle chargers inserted into power might bring many challenges, cause harmonic pollution to power grid. In this paper, a high-frequency charger is regarded as a researching object, the power characteristics of charger, harmonic current and impactive parameters are analyzed, and the harmonic analysis model of the charger accessed to power grid is built. Applying the Simulink and SimPowerSystems toolbox in Matlab and the simulation method facing the systems structure of electrical principle, the model is simulated. The harmonic generative rules and characteristics for a single high-frequency charger are present. The results might forecast the harmonic pollution of charge station, and provide the theory base for choosing harmonic control device and methods.

For the complexity of the distribution network and the particularity of single-phase grounding fault, intelligent distribution network grounding fault line selection model based on the Extreme Learning Machine (ELM) information integration is proposed in the paper. When a single-phase grounding fault happened, the relation functions for the wavelet packet decomposition, the fifth harmonic method and the traveling wave method are respectively determined, the fault estimate data of transient zero-sequence current are calculated. The fault line is accurately judged by the ELM networks information fusion. Through analyzing MATLAB simulation result about different ground fault line selection, the validity and accuracy of the method are verified.

Objectives This study aims to test the effects of TAK-242 on liver transplant viability in a model of swine Maastricht-category-III cardiac death. Methods A swine DCD Maastricht-III model of cardiac death was established, and TAK-242 was administered prior to the induction of cardiac death. The protein and mRNA level of TLR4 signaling pathway molecules and cytokines that are important in mediating immune and inflammatory responses were assessed at different time points following the induction of cardiac death. Results After induction of cardiac death, both the mRNA and protein levels of key molecules (TLR4, TRAF6, NF-ϰB, ICAM-1, MCP-1 and MPO), TNF-α and IL-6 increased significantly. Infusion of TAK-242 1 h before induction of cardiac death blocked the increase of immune and inflammatory response molecules. However, the increase of TLR4 level was not affected by infusion of TAK-242. Histology study showed that infusion of TAK-242 protect liver tissue from damage during cardiac death. Conclusions These results indicates that TLR4 signaling pathway may contribute to ischemia/reperfusion injury in the liver grafts, and blocking TLR4 pathway with TAk-242 may reduce TLR4-mediated tissue damage.

V2G technology achieves a two-way interaction of the grid and electric vehicles (EVs), it makes plug-in hybrid electric vehicle (PHEV) be able to access grid and participate in grid scheduling. By V2G technology, PHEVs can provide FM and spinning reserve ancillary services such as economic dispatch. With the extensive use of plug-in hybrid electric vehicles (PHEVs), its important impact on charge and discharge process will be the grid safe and economic operation. Firstly, the article proves the V2G discharge capacity of a normal distribution from the theory, and based on which to establish a stochastic economic dispatch model. The results which obtain by using the IEEE 14 node system simulation show that this conclusion of the constructed model is feasible and effective, and the conclusions that the V2G node optimal active output power and minimum scheduling cost expectations are proportional to the the V2G discharge capacity expectations are also obtained.

In this paper, the stress–strain, resistivity and acoustic emission simultaneous test of compression test for rock have been carried out to obtain the regression equation between the resistivity, and elastic modulus of rock under various damage state, then based on the rock damage theory, derived the changing regularity of rock damage variables and resistivity under loading condition. In accordance with the acoustic emission characteristic relative ratio, this paper has verified the feasibility of its changing regularity. By virtue of this relation equation, it is possible to online monitor the extent of surrounding rock progressive damage in mined-out regions, so as to bring forward the time for danger warning. Consequently, it is capable to take control measures in the initial stage of the development of disaster, which has very important significance for the prevention and management of mine dynamic disasters.

：This paper analyses characteristics of single-phase ground fault in distribution system. Now, most of the line selection methods have some limitations, which leads to the low accuracy of the fault line selection. In order to solve above problems, make use of the matlab software in this article to simulate and analyze the isolated neutral system and resonance neutral earthing system when they occur single-phase ground fault. Finally, the new method based on first half wave method and increment of residual current to improve the accuracy of fault line selection is proposed.

The semisolid slurry of A356 Al alloy was prepared by low superheat pouring and weak traveling-wave electromagnetic stirring (LSPWES), and then the slurry was further soaked for proper time and finally rheo-cast into a rheo-casting sample in this paper. The experimental results show that if the melt of A356 Al alloy is poured at 630-650°C and meanwhile stirred by weak electromagnetic field for a short time, the most primary α-Al grains solidified in the slurry are spherical and only a few are rosette-like. The shape of primary α-Al becomes more spheroidal and more homogeneous distribution in the microstructure by the process of the uniform temperature fields. The experimental results also show that the slurry temperature, injection pressure and speed have a great influence on filling ability. The higher the slurry temperature, injection pressure and speed, the higher the slurry filling ability, the more easily the die cavity is filled. With the given rheo-casting sample, if only the slurry temperature should be equal to or more than 585°C, or the injection pressure is equal to or more than 20 MPa, or the injection speed should be equal to or more than 0.24m/s, the rheo-casting sample die cavity can be filled completely. The microstructure of the castings indicates that the shape, size and numbers of the primary α-Al grains in different parts of the castings are highly consistent. After being held at 535 °C for 5 h and then aged at 160 °C for 16 h, the tensile strength, elongation rate and hardness of the rheo-casting samples with the above process are respectively 321.5 MPa, 8.03% and 105.9HB.

Author Affiliations: Department of Liver Surgery, Peking Union Medical College Hospital; National Organ Transplant Committee, Ministry of Health, Beijing 100000, China (Huang JF); The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, China (Zheng SS); The First Hospital of China Medical University, Shenyang 110001, China (Liu YF); Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong; China Organ Transplant Response System Research Center, Shenzhen 518000, China (Wang HB); Centre for Renal and Transplant Research, Westmead Millenium Institute, Sydney University, Sydney, Australia (Chapman J and O'Connell P); Section of Transplantation, Liver Transplantation and Hepatobiliary Surgery, University of Chicago, Chicago, IL, USA (Millis M); Department of General Surgery, Transplant Center, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA (Fung J) and Department of Surgery, Massachusetts General Hospital, Boston, MA, USA (Delmonico F)

Objective To study the serum protein fingerprint of patients with pancreatic cancer and to screen for protein molecules closely related to pancreatic cancer during the onset and progression of the disease using surface-enhanced laser desorption and ionization time of fight mass spectrometry (SELDI-TOF-MS).

OBJECTIVE To establish a serum protein pattern model for screening pancreatic cancer. METHODS Twenty-nine serum samples from patients with pancreatic cancer were collected before surgery, and an additional 57 serum samples from age and sex-matched individuals without cancer were used as controls. WCX magnetic beans and a PBS II-C protein chip reader (Ciphergen Biosystems Inc) were employed to detect the protein fingerprint expression of all serum samples. The resulting pro fi les comparing serum from cancer and normal patients were analyzed with the Biomarker Wizard system, to establish a model using the Biomarker Pattern system software. A double-blind test was used to determine the sensitivity and specificity of the model. RESULTS A group of 4 biomarkers (relative molecular weights were 5,705 Da, 4,935 Da, 5,318 Da, 3,243 Da) were selected to set up a decision tree to produce the classification model to effectively screen pancreatic cancer patients. The results yielded a sensitivity of 100% (20/20), specificity of 97.4% (37/38). The ROC curve was 99.7%. A double-blind test used to challenge the model resulted in a sensitivity of 88.9% and a specificity of 89.5%. CONCLUSION New serum biomarkers of pancreatic cancer have been identified. The pattern of combined markers provides a powerful and reliable diagnostic method for pancreatic cancer with high sensitivity and specificity.

Granular cell tumor is rare and accounts for approximately 0.5 % of all soft tissue tumors. The malignant granular cell tumor, especially cutaneous malignant granular cell tumor is extremely rare. The present case is the first patient of primary cutaneous malignant granular cell tumor reported from China in English. A review of the literature is performed, and the presentation, position, pathological diagnosis, treatment and prognosis of the patients with cutaneous malignant granular cell tumor of the reported cases before is analysed.

Aims We have compared hypothermic oxygenated machine perfusion (HOPE) with simple cold storage (SCS) in liver preservation with a porcine model of donor after cardiac death (DCD). Methods A DCD model was developed in 10 hybrid pigs by apnea. Livers were harvested after 30 min of warm ischemia (WI) and randomly preserved using HOPE (HOPE group, five pigs, dual perfusion via portal vein and hepatic artery) or SCS (SCS group, five pigs) methods. Levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), glucose, lactic acid, and pyruvic acid were measured by microdialysis analyzer. Results Histological morphology of liver tissue was significantly affected by 30 min of WI. HOPE significantly delayed histological morphology change and cell apoptosis. Release of ALT and AST was significantly higher in SCS group compared to HOPE group (p

Huaier aqueous extract, the main active constituent of Huaier proteoglycan, has antihepatocarcinoma activity in experimental and clinical settings. However, the potential and associated antihepatoma mechanisms of Huaier extract are not yet fully understood. Therefore, in this study, we aimed to elucidate the inhibitory proliferation effect of Huaier extract on apoptosis and cycle of HepG2 and Bel-7402 cells. Our data demonstrated that incubation with Huaier extract resulted in a marked decrease in cell viability dose-dependently. Flow cytometric analysis showed that a 48 h treatment of Huaier extract caused cell apoptosis. Typical apoptotic nucleus alterations were observed with fluorescence microscope after Hoechst staining. Immunoblot analysis further demonstrated that Huaier extract activated caspase 3 and PARP. Additionally, Huaier extract inhibited the activity of p-ERK, p-p38, and p-JNK in terms of MAPK. Furthermore, Huaier extract induced HCC cells arrest in S phase and decreased the cycle related protein expression ofβ-catenin and cyclin D1. Studies with JNK specific inhibitor, SP600125, showed that Huaier extract induced S phase arrest and decreasedβ-catenin and cyclin D1 expression via JNK signaling pathway. In conclusion, we verify that Huaier extract causes cell apoptosis and induces hepatocellular carcinoma cells arrest in S phase via JNK pathway, which advances our understanding on the molecular mechanisms of Huaier extract in hepatocarcinoma management.

This study aims to evaluate the ischemic injury of the liver in a porcine model of cardiac death assessed by in vivo microdialysis. A porcine model of cardiac death was established by the suffocation method. Metabolic indicators were monitored using the microdialysis technique during warm ischemia time (WIT) and cold ischemia time (CIT). Pathological changes in ischemic-injured livers were observed by haematoxylin–eosin staining. The predictive values of biochemical parameters regarding the liver donor were evaluated by receiver operating characteristic curve analysis. All statistical analyses were conducted using the SPSS 18.0 software (SPSS Inc, Chicago, Illinois, USA). The degree of warm ischemic injury of the livers increased with prolonged WIT. Serum glucose, glycerol, pyruvate, lactic acid levels and lactate-to-pyruvate (L/P) ratio increased gradually during WIT. Results from Pearson correlation analyses indicated that serum lactate level and L/P ratio were positively associated with the degree of warm ischemic injury of the livers. The degree of cold ischemic injury of the livers gradually increased after 12 h CIT. Serum glucose, lactic acid and L/P ratio achieved a peak after 6–8 h of CIT, but gradually decreased with prolonged CIT. The peak of glycerol occurred after 8 h of CIT, while no changes were found with prolonged CIT. Serum pyruvate level exhibited an increasing trend after 12 h CIT. Our results confirmed that serum glucose and lactate levels were negatively correlated with cold ischemic injury of the liver. However, serum glycerol and pyruvate levels showed positive correlations with cold ischemic injury of the liver. The liver donor was unavailable after 30 min WIT and 24 h CIT. The cut-off value of serum lactate level for warm ischemic injury of the livers was 2.374 with a sensitivity (Sen) of 90 % and specificity (Spe) of 95 %; while the L/P radio was 0.026 (Sen = 80 %, Spe = 83 %). In addition, the cut-off values of serum glucose, lactate, glycerol and pyruvate levels for cold ischemic injury of the livers were 0.339 (Sen = 100 %, Spe = 77 %), 1.172 (Sen = 100 %, Spe = 61 %), 56.359 (Sen = 100 %, Spe = 65 %) and 0.020 (Sen = 100 %, Spe = 67 %), respectively. Our findings provide empirical evidences that serum glucose, lactate levels and L/P ratio may be good indicators for the degree of warm ischemic injury of the livers after cardiac death; while serum glucose, lactate, glycerol and pyruvate levels may be important in predicting cold ischemic injury.

Background Expanded criteria donors (ECDs) are currently accepted as potential sources to increase the donor pool and to provide more chances of kidney transplantation for elderly recipients who would not survive long waiting periods. Hypothermic machine perfusion (HMP) is designed to mitigate the deleterious effects of simple cold storage (CS) on the quality of preserved organs, particularly when the donor is in a marginal status. Methods We compared the transplant outcomes in patients receiving ECD kidneys with either HMP or CS graft preservation. Articles from the MEDLINE, EMBASE and Cochrane Library databases were searched and all studies reporting outcomes from HMP versus CS methods of kidney preservation were included in this meta-analysis. The parameters analyzed included the incidence of delayed graft function (DGF), primary non-function (PNF) and one-year graft and patient survival. Results A total of seven studies qualified for the review, involving 2374 and 8716 kidney grafts with HMP or CS preservation respectively, all from ECD donors. The incidence of delayed graft function (DGF) was significantly reduced with an odd ratio(OR) of 0.59 (95% CI 0.54–0.66, P

Cerebral ischemia is one of the most common diseases treated by acupuncture therapeutics. Recent studies indicated that acupuncture treatment by needling the conception and governor vessels had positive effects in promoting neural regeneration in patients after cerebral ischemia injury. Acupuncture intervention could continuously promote the proliferation and differentiation of the neural stem cells in the brain, obviously up-regulate expression of growth factors, accelerate angiogenesis and inhibit apoptosis. Hence, it is necessary to present an exhaustive review on the mechanisms. The present review gives a detailed description of pathological changes of cerebral ischemia and acupuncture intervention applied to the conception and governor vessels, and proposes research prospects in the future.

BACKGROUND/AIMS There are studies that report that liver metastases rarely occur in patients with cirrhosis. This study evaluates the relationship between the incidence of liver metastases from colorectal cancer (CRC) and chronic hepatitis virus infection in patients. METHODOLOGY Three hundred and fifty-four cases of advanced CRC from our hospital were evaluated. The patients were divided into a chronic hepatitis virus infection group and a non-hepatitis virus infection group. The two groups were compared regarding the incidence of colorectal liver metastases and survival. The criterion of colorectal liver metastases was based on liver CT examination and intraoperative exploration results. RESULTS There were two cases with colorectal liver metastases among the seventy cases of the chronic hepatitis virus infection group. The rate of liver metastases was 2.86%. There were 48 cases with colorectal liver metastases among 284 cases of the non-hepatitis virus infection. The rate of liver metastases was 16.9%. The incidence of colorectal liver metastases between the two groups was significantly different (p

Background. Three commonly used sutures were tested in a pig model of bile duct anastomosis to assess their relative contributions to inflammation and scarring.Methods. Thirty pigs were randomised to bile duct division and anastomosis with either polyglyconate (Maxon), polyglactin 910 (Vicryl) or polypropylene (Prolene). Half the animals were sacrificed at two weeks and the remainder at 23 weeks. Anastomoses were assessed by cholangiography, scanning electron microscopy and light microscopy.Results. There was less short term histological reaction with the two monofilament materials, Prolene and Maxon, compared to the braided suture Vicryl. Maxon was associated with less long term inflammation than Prolene, was found to handle better, and has an advantage over Prolene by being absorbable.Conclusion. Maxon is an optimal suture for bile duct anastomoses. Its long term absorption characteristics make it suitable for situations where bile duct healing may be delayed.

General anesthetics are believed to induce amnesia. However, propofol can ameliorate cognitive deficits induced by electroconvulsive therapy (ECT), a treatment for mental disorders. This study aimed at investigating the possible molecular mechanism as well as the effects of propofol on learning-memory impairment in depressed rats induced by ECS (electroconvulsive shock, the analog of ECT to animals). Rats were treated with ECS (or sham ECS) pretreated with intraperitoneal injection of propofol (100 mg/kg) (or normal saline, 0.01 l/kg) after being treated with chronic unpredictable mild stresses to reproduce an animal model of depression. Sucrose preference test, open field test, and Morris water maze were used to assess behavioral changes. Hippocampal glutamate (Glu) and γ-aminobutyric acid (GABA) levels were measured with liquid chromatography, and glutamic acid decarboxylase 65 (GAD65) was assayed immunohistochemically. Additionally, rats undergoing ECS that were pretreated with pentobarbital sodium (45 mg/kg) were included for behavioral tests and electroencephalogram recording for comparison with rats undergoing ECS that were pretreated with propofol or normal saline. ECS rats pretreated with propofol or pentobarbital sodium exhibited similar decreased seizure durations as compared with ECS rats pretreated with normal saline. ECS pretreated with normal saline aggravated learning-memory deficits whereas ECS pretreated with propofol or pentobarbital sodium did not. Rats undergoing ECS pretreated with propofol showed better memory than those undergoing ECS after pretreatment with pentobarbital sodium. ECS pretreated with normal saline downregulated the ratio of Glu/GABA and upregulated GAD65 expression; all these molecular changes were nearly normalized to the level of control group by ECS pretreated with propofol. There were no significant differences of depressive behaviors between groups treated with ECS. The data suggest that propofol alleviated ECS-induced learning-memory impairment without interfering with the antidepressant efficacy of ECS, possibly by inhibiting excessive expression of GAD65 and maintaining the balance between glutamatergic and GABAergic amino acids neurotransmitters in the hippocampus.

To simulate the combustion species for direct-injection diesel engines, the new flamelet model is presented and used. The model is based on stoichiometric mixture fraction space, and a way of separating the numerical effort associated with the solution of the turbulent flow field from that of solving the chemistry is offered. The new species equations are carried out through coordinatesi¯ transformation. The results from the species equation are developed and three-dimension entity model with the mixture fraction is got. Then the boundary conditions are put into the new flamelet model. Furthermore the pollutions emissions are calculated and compared with the experimental data. It gives a new way to predict the pollutants for direct-injection diesel engine.

Evaluating the emission performance of a diesel engine, ESC testing is requisite. Traditional equipments are inefficient, special equipments are relatively expensive. In order to solve this problem, the author processed independent equipment into the node of a distributed network and developed an ESC testing system through virtual instrument technology. This system was used in the 4JB1 diesel engine calibration experiments. The results illustrated that ESC testing system realized automatization of the testing process, and its function of the data analysis could help the workers to optimize the calibration parameters.

ObjectiveTo observe clinical therapeutic effects of acupuncture combined with music therapy for treatment of cerebral palsy.MethodsSixty children with cerebral palsy were randomly divided into an acupuncture group (Group Acup.) and an acupuncture plus music group (Group Acup.+ M). Simple acupuncture was applied in Group Acup., and acupuncture at 5 groups of points plus music were applied in Group Acup. +M. The treatment was given once every two days with 3 treatments weekly, and 36 treatments constituted a therapeutic course. Therapeutic effects including movement improvement were observed for comparison after 3 courses of treatments.ResultsThe comprehensive functions were elevated in both groups, and the total effective rate in Group Acup. + M was obviously better than that in Group Acup (P

Background. Insulin keeps the liver in a metabolically vigorous state. However, organ preservation aims to decrease the metabolic rate. The objective of this study was to clarify the effect of insulin used in University of Wisconsin (UW) preservation solution on the liver graft. Methods. The liver grafts were preserved by UW solution with or without insulin for 7, 9, and 24 hr, respectively. The influence of insulin was studied by 7-day survival rate, liver function, morphology, and intragraft gene expression 24 hr after transplantation. Morphology was studied on the preserved grafts. Results. The morphology of the graft in the insulin group showed more severe ischemia-reperfusion injury. The 7-day graft survival rates of the 7-hr subgroups with and without insulin were 55% and 93%, respectively (P=0.02). In the 9-hr subgroups, the survival rates were 0% and 78%, respectively (P=0.002). The serum levels of aspartate aminotransferase (AST) (P=0.008) and alanine aminotransferase (ALT) (P=0.032) were higher in the 7-hr subgroup with insulin. The same trend was found in the 9-hr subgroups (AST, P=0.016; ALT, P=0.016). The expression level of 215 genes were much lower at 24 hr after transplantation in the grafts preserved with insulin than in those preserved without insulin, and most of the genes were related to metabolic activities. Conclusions. Insulin in UW solution may exacerbate graft ischemic injury and decrease the graft survival rate in rat liver transplantation. Insulin, in the absence of glucose in UW solution, may exhaust the metabolic activity of the liver graft. It is harmful rather than helpful for isolated rat liver grafts preserved in UW solution.

From 1962 to 1994, 1200 patients with periampullary carcinoma had laparotomy in our department. Of these cases, 320 underwent pancreatoduodenectomy (PD); the resection rate was 25.8%. Hospital mortality was 23 cases (7.19%), and hospital morbidity was 69 cases (21.9%). The 320 PD, 214 were men and 106 women, ranging in age from 26 to 73 years, with a median of 52.9 years. The lesions of the 320 cases were carcinoma in the head of pancreas (81 cases), in the common bile duct (85), in the ampulla of Vater (104), and in the duodenum (50). The method of resection we preferred is to follow the order of gallbladder, bile duct, stomach, proximal jejunum, and duodenum initially and leave the pancreas until last; this method provides excellent exposure of the uncinate process and controls bleeding easily. Gastrojejunual anastomosis was the retrocolic procedure. The end of the jejunum is brought into the upper abdomen in a retrocolic position, but anterior to the mesenteric vessels. Pancreatic fistula is a common and serious complication following PD. From 1962 to 1970, 43PDs with end-to-side anastomosis without pancreatic drainage were performed; the fistula occurred in 10 patients and 6 died; thus, we changed the method to end-to-end anastomosis between the pancreas and jejunum, and in 14 patients with internal drainage by use of a short tube, fistula occurred in 2 cases. We then changed to a long catheter for external drainage for 237 cases, and the fistula occurred only in 3 cases. Our data show that the postoperative survival rate is poor for pancreatic carcinoma. The 1-year survival rate is no more than 50%, and the 3-year rate is only 13.58%. However, for carcinoma of the ampulla of Vater and common bile duct, the result is better; the 5-year survival rate for carcinoma of the ampulla of Vater is 41.54%, which is the best result.

Background Although laparoscopic surgery has been available for a long time and laparoscopic cholecystectomy has been performed universally, it is still not clear whether open appendectomy (OA) or laparoscopic appendectomy (LA) is the most appropriate surgical approach to acute appendicitis. The purpose of this work is to compare the therapeutic effects and safety of laparoscopic and conventional "open" appendectomy by means of a meta-analysis. Methods A meta-analysis was performed of all randomized controlled trials published in English that compared LA and OA in adults and children between 1990 and 2009. Calculations were made of the effect sizes of: operating time, postoperative length of hospital stay, postoperative pain, return to normal activity, resumption of diet, complications rates, and conversion to open surgery. The effect sizes were then pooled by a fixed or random-effects model. Results Forty-four randomized controlled trials with 5292 patients were included in the meta-analysis. Operating time was 12.35 min longer for LA (95% CI: 7.99 to 16.72, p < 0.00001). Hospital stay after LA was 0.60 days shorter (95% CI: -0.85 to -0.36, p < 0.00001). Patients returned to their normal activity 4.52 days earlier after LA (95% CI: -5.95 to -3.10, p < 0.00001), and resumed their diet 0.34 days earlier(95% CI: -0.46 to -0.21, p < 0.00001). Pain after LA on the first postoperative day was significantly less (p = 0.008). The overall conversion rate from LA to OA was 9.51%. With regard to the rate of complications, wound infection after LA was definitely reduced (OR = 0.45, 95% CI: 0.34 to 0.59, p < 0.00001), while postoperative ileus was not significantly reduced(OR = 0.91, 95% CI: 0.57 to 1.47, p = 0.71). However, intra-abdominal abscess (IAA), intraoperative bleeding and urinary tract infection (UIT) after LA, occurred slightly more frequently(OR = 1.56, 95% CI: 1.01 to 2.43, p = 0.05; OR = 1.56, 95% CI: 0.54 to 4.48, p = 0.41; OR = 1.76, 95% CI: 0.58 to 5.29, p = 0.32). Conclusion LA provides considerable benefits over OA, including a shorter length of hospital stay, less postoperative pain, earlier postoperative recovery, and a lower complication rate. Furthermore, over the study period it was obvious that there had been a trend toward fewer differences in operating time for the two procedures. Although LA was associated with a slight increase in the incidence of IAA, intraoperative bleeding and UIT, it is a safe procedure. It may be that the widespread use of LA is due to its better therapeutic effect.

Several neural and hormonal factors are known to affect motility of sphincter of Oddi (SO). The major roles of SO are to regulate the flow of bile and pancreatic juice into the duodenum and to prevent the reflux of duodenal contents into the biliary and pancreatic duct. After pancreas transplantation, graft SO was denervated and graft pancreatitis might have relations to SO motility. The motility of SO after canine pancreas transplantation with bladder drainage was investigated.Normal canine SO manometry and pancreas graft SO manometry after pancreas transplantation with bladder drainage were performed in seven dogs respectively before and after cholecystokinin (CCK) administration. Data of SO basal pressure, contraction frequency, amplitude and motility index after transplantation and CCK administration were compared with that in controls and before CCK administration.SO showed regular contractions with a certain basal pressure in control dogs. After transplantation, the graft SO basal pressure and contraction frequency were higher than that in controls, but the amplitude decreased (P0.01). There was no great difference in SO motility index. CCK administration could relax normal SO but stimulate graft SO after pancreas transplantation with bladder drainage. After CCK administration, SO basal pressure, frequency and motility index were increased significantly (P0.05), in comparison with that before administration. The amplitude remained unchanged (P0.05), in comparison with that before CCK administration.After auto-pancreas transplantation with bladder drainage, canine SO motility was inhibited. Basal pressure and frequency increased but amplitude decreased. CCK administration after transplantation had an inhibitory effect on canine SO instead of a relaxation effect observed in normal canine SO. This will increase the resistance of SO to the pancreatic juice flow and induce pancreatic juice stagnation and can not prevent reflux of urine and duodenal contents when the bladder pressure is increased to a certain extent, which may cause graft pancreatitis.