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Cold ischemia time in liver transplantation:An overview
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作者 Manuela Cesaretti Alessandro Izzo +2 位作者 Roberta Anna Pellegrino Alessandro Galli Orestes Mavrothalassitis 《World Journal of Hepatology》 2024年第6期883-890,共8页
The standard approach to organ preservation in liver transplantation is by static cold storage and the time between the cross-clamping of a graft in a donor and its reperfusion in the recipient is defined as cold isch... The standard approach to organ preservation in liver transplantation is by static cold storage and the time between the cross-clamping of a graft in a donor and its reperfusion in the recipient is defined as cold ischemia time(CIT).This simple definition reveals a multifactorial time frame that depends on donor hepatectomy time,transit time,and recipient surgery time,and is one of the most important donor-related risk factors which may influence the graft and recipient’s survival.Recently,the growing demand for the use of marginal liver grafts has prompted scientific exploration to analyze ischemia time factors and develop different organ preservation strategies.This review details the CIT definition and analyzes its different factors.It also explores the most recent strategies developed to implement each timestamp of CIT and to protect the graft from ischemic injury. 展开更多
关键词 Cold ischemia time Liver transplantation Organ donation Donation after cardiac death Warm ischemia time Machine perfusion
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Surgical Video Review of Warm Ischemia Time during Laparoscopic Partial Nephrectomy and Impact on Positive Surgical Margins and Postoperative Complications
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作者 Ovidiu Spiru Barnoiu Alf Ole Tysland Aage Waldemar Andersen 《Open Journal of Urology》 2023年第1期9-17,共9页
Introduction: A surgical video review is an emerging tool for quality improvement, especially in complex surgeries such as laparoscopic partial nephrectomy (LPN). Assessing and measuring the warm ischemia time (WIT) d... Introduction: A surgical video review is an emerging tool for quality improvement, especially in complex surgeries such as laparoscopic partial nephrectomy (LPN). Assessing and measuring the warm ischemia time (WIT) during LPN by dividing it into the time used for resection (ResT), time used for reconstruction (RecT) and intermediate time (IntT) has not been performed before. This study aimed to analyze the factors that can influence all these surgical times and assess their impact on positive surgical margins (PSM) and complication rates. Methods: We evaluated 36 surgical video recordings from patients who underwent LPN and measured WIT, ResT, RecT and IntT with a stopwatch. Factors such as tumor characteristics and surgeon experience were also recorded. SPSS software was used to identify the predictor factors for all these surgical times and to correlate the ResT with PSM and RecT with the complication rate. Results: We recorded a mean WIT of 887 seconds. The mean ResT, RecT and IntT were 240 (27.2% of WIT), 473 (52.6% of WIT) and 173 s (20.2% of WIT), respectively. We found a moderate correlation between the WIT (p = 0.030), IntT and the R.E.N.A.L. score (p = 0.019). The surgeon with less than 100 LPN had significantly longer WIT, ResT, and RecT values, with means of 977 (p = 0.015), 268 (p = 0.019) and 530 seconds (p = 0.015), respectively. No correlation was found between ResT and PSM (p = 0.418);however, a strong correlation was found between RecT and the probability of developing complications (p = 0.012). Conclusion: The surgeon’s experience influences WIT, ResT, and RecT, but not IntT, which depends on tumor complexity. RecT affects the probability of developing complications. IntT represents a fifth of the WIT and efforts to reduce the WIT should focus on reducing the IntT for complex tumors, by improving surgical planning. 展开更多
关键词 Surgical Video Laparoscopic Partial Nephrectomy Warm ischemia time
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Biliary tract injury caused by different relative warm ischemia time in liver transplantation in rats 被引量:24
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作者 Zhao, Hong-Feng Zhang, Guo-Wei +3 位作者 Zhou, Jie Lin, Jian-Hua Cui, Zhong-Lin Li, Xiang-Hong 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2009年第3期247-254,共8页
BACKGROUND: There is a controversy over the degree of liver and biliary injury caused by the period of secondary warm ischemia. A liver autotransplantation model was adopted because it excludes the effects of infectio... BACKGROUND: There is a controversy over the degree of liver and biliary injury caused by the period of secondary warm ischemia. A liver autotransplantation model was adopted because it excludes the effects of infection and immunological rejection on bile duct injury. This study was undertaken to assess biliary tract injury caused by relative warm ischemia (secondary warm ischemia time in the biliary tract) and reperfusion. METHODS: One hundred and two rats were randomly divided into 5 groups: group I (control); groups 11 to V, relative warm ischemia times of 0 minute, 30 minutes, I hour and 2 hours. In addition to the levels of serum alkaline phosphatase, and total bilirubin, pathomorphology assessment and TUNEL assay were performed to evaluate biliary tract damage. RESULTS: Under the conditions that there were no significant differences in warm ischemia time, cold perfusion time and anhepatic phase, group comparisons showed statistically significant differences. The least injury occurred in group H (portal vein and hepatic artery reperfused simultaneously) but the most severe injury occurred in group V (biliary tract relative warm ischemia time 2 hours). CONCLUSIONS: Relative warm ischemia is one of the factors that result in bile duct injury, and the relationship between relative warm ischemia time the bile injury degree is time-dependent. Simultaneous arterial and portal reperfusion is the best choice to avoid the bile duct injury caused by relative warm ischemia. (Hepatobiliary Pancreat Dis Int 2009; 8: 247-254) 展开更多
关键词 liver transplantation bile duct ischemia-reperfusion injury relative warm ischemia time models animal RAT
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Warm ischemia time and elevated serum uric acid are associated with metabolic syndrome after liver transplantation with donation after cardiac death 被引量:2
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作者 Liang-Shuo Hu Yi-Chao Chai +6 位作者 Jie Zheng Jian-Hua Shi Chun Zhang Min Tian Yi Lv Bo Wang Ai Jia 《World Journal of Gastroenterology》 SCIE CAS 2018年第43期4920-4927,共8页
AIM To describe the prevalence of posttransplant metabolic syndrome(PTMS) after donation after cardiac death(DCD) liver transplantation(LT) and the pre-and postoperative risk factors.METHODS One hundred and forty-seve... AIM To describe the prevalence of posttransplant metabolic syndrome(PTMS) after donation after cardiac death(DCD) liver transplantation(LT) and the pre-and postoperative risk factors.METHODS One hundred and forty-seven subjects who underwent DCD LT from January 2012 to February 2016 were enrolled in this study. The demographics and the clinical characteristics of pre-and post-transplantation were collected for both recipients and donors. PTMS was defined according to the 2004 Adult Treatment Panel-Ⅲ criteria. All subjects were followed monthly for the initial 6 mo after discharge, and then, every 3 mo for 2 years. The subjects were followed every 6 mo or as required after 2 years post-LT.RESULTS The prevalence of PTMS after DCD donor orthotopic LT was 20/147(13.6%). Recipient's body mass index(P = 0.024), warm ischemia time(WIT)(P = 0.045), and posttransplant hyperuricemia(P = 0.001) were significantly associated with PTMS. The change in serum uric acid levels in PTMS patients was significantly higher than that in non-PTMS patients(P < 0.001). After the 1 s t mo, the level of serum uric acid of PTMS patients rose continually over a period, while it was unaltered in non-PTMS patients. After transplantation, the level of serum uric acid in PTMS patients was not associated with renal function.CONCLUSION PTMS could occur at early stage after DCD LT with growing morbidity with the passage of time. WIT and post-LT hyperuricemia are associated with the prevalence of PTMS. An increased serum uric acid level is highly associated with PTMS and could act as a serum marker in this disease. 展开更多
关键词 Posttransplant metabolic syndrome Liver transplantation Donation after cardiac death Uric acid Warm ischemia time
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Normothermic regional perfusion mobile teams in controlled donation after circulatory death pathway: Evidence and peculiarities
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作者 Chiara Lazzeri Manuela Bonizzoli +1 位作者 Giuseppe Feltrin Adriano Peris 《World Journal of Transplantation》 2024年第4期78-83,共6页
To facilitate the implementation of controlled donation after circulatory death(cDCD)programs even in hospitals not equipped with a local Extracorporeal Membrane Oxygenation(ECMO)team(Spokes),some countries and Italia... To facilitate the implementation of controlled donation after circulatory death(cDCD)programs even in hospitals not equipped with a local Extracorporeal Membrane Oxygenation(ECMO)team(Spokes),some countries and Italian Regions have launched a local cDCD network with a ECMO mobile team who move from Hub hospitals to Spokes for normothermic regional perfusion(NRP)implantation in the setting of a cDCD pathway.While ECMO teams have been clearly defined by the Extracorporeal Life Support Organization,regarding composition,responsibilities and training programs,no clear,widely accepted indications are to date available for NRP teams.Although existing NRP mobile networks were developed due to the urgent need to increase the number of cDCDs,there is now the necessity for transplantation medicine to identify the peculiarities and responsibility of a NRP team for all those centers launching a cDCD pathway.Thus,in the present manuscript we summarized the character-istics of an ECMO mobile team,highlighting similarities and differences with the NRP mobile team.We also assessed existing evidence on NRP teams with the goal of identifying the characteristic and essential features of an NRP mobile team for a cDCD program,especially for those centers who are starting the program.Differences were identified between the mobile ECMO team and NRP mobile team.The common essential feature for both mobile teams is high skills and experience to reduce complications and,in the case of cDCD,to reduce the total warm ischemic time.Dedicated training programs should be developed for the launch of de novo NRP teams. 展开更多
关键词 Controlled donation after circulatory death Extracorporeal membrane oxygenation Normothermic regional perfusion Mobile teams Warm ischemia time
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肾部分切除术后急性肾损伤及其对手术侧肾脏的远期影响
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作者 张志凌 《现代泌尿外科杂志》 CAS 2024年第9期766-770,共5页
肾部分切除术是治疗局限性小肾癌的首选方法,但手术过程中通常需要暂时阻断肾动脉,不可避免地引发缺血再灌注损伤,严重者甚至发生急性肾损伤。肾部分切除术后急性肾损伤的诊断常采用急性肾损伤网络标准(AKIN)和风险、损伤、失败、损失... 肾部分切除术是治疗局限性小肾癌的首选方法,但手术过程中通常需要暂时阻断肾动脉,不可避免地引发缺血再灌注损伤,严重者甚至发生急性肾损伤。肾部分切除术后急性肾损伤的诊断常采用急性肾损伤网络标准(AKIN)和风险、损伤、失败、损失、终末期肾脏疾病标准(RIFLE),但使用总肌酐升高水平来评估单侧肾损伤显然不够准确;另外,肾部分切除术中会丢失部分正常肾组织,也导致血肌酐升高。为避免上述因素对诊断造成干扰,笔者首先改良了孤立肾肾部分切除术后急性肾损伤诊断分级方法,提出了诊断肾部分切除术后的急性肾损伤需要考虑到正常肾组织丢失引起的血肌酐升高。接着采用“极端值法”量化了非孤立肾患者手术侧肾脏急性肾损伤的程度。最后还探讨了急性肾损伤对手术侧肾脏的远期影响以及减轻肾部分切除术中缺血再灌注肾损伤的潜在方法。 展开更多
关键词 肾癌 肾部分切除术 缺血时间 肾功能 急性肾损伤 急性肾损伤网络标准(AKIN) 风险、损伤、失败、损失、终末期肾脏疾病标准(RIFLE)
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基于3D Slicer软件的局限性肾癌供血动脉解剖分布研究
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作者 高珂 万紫妍 +4 位作者 张娅 张慧 杨小杰 种铁 付德来 《现代泌尿外科杂志》 CAS 2024年第4期298-301,共4页
目的利用3D Slicer软件分析局限性肾癌供血动脉进入肿瘤的位置、数目与分布规律,为肾部分切除术中精准缝合提供解剖依据。方法收集2021年1月—2022年6月西安交通大学第二附属医院泌尿外科因肾癌行肾部分切除术的患者资料,将患者术前肾... 目的利用3D Slicer软件分析局限性肾癌供血动脉进入肿瘤的位置、数目与分布规律,为肾部分切除术中精准缝合提供解剖依据。方法收集2021年1月—2022年6月西安交通大学第二附属医院泌尿外科因肾癌行肾部分切除术的患者资料,将患者术前肾动脉计算机断层扫描(CT)血管成像资料以DICOM格式导入3D Slicer软件,从水平面、矢状面和冠状面对肿瘤-血管的相对位置进行重建,分析各平面中肿瘤供血动脉的数目及分布特点。结果共收集112例(男59例、女53例)肾癌患者相关资料,肿瘤均为单发,RENAL评分为4~10分,肿瘤分期T1a 58例、T1b 48例、T2a 6例。其中38例(33.93%)有1条肿瘤供血动脉、53例(47.32%)有2条肿瘤供血动脉、21例(18.75%)有3条肿瘤供血动脉。这207条肿瘤供血动脉中有22条(10.63%)经肿瘤-肾脏接触面(肿瘤床)浅部进入肿瘤,有185条(89.37%)经肿瘤床深部进入肿瘤。结论在局限性肾癌中,近90%的供血动脉由肿瘤床深部进入肿瘤,为肾部分切除术中精准肿瘤切除及创面缝合提供了解剖依据。 展开更多
关键词 肾肿瘤 肿瘤血管 肾部分切除术 热缺血时间 3D Slicer软件
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冷缺血时间对不同疾病类型肝组织质量的影响
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作者 马婷婷 毕森盛 +4 位作者 曹磊 印志琪 段可然 王政禄 郑虹 《中国医药生物技术》 2024年第1期13-21,共9页
目的 高质量的肝脏组织样本对肝脏疾病的研究至关重要,冷缺血时间(CIT)是影响组织样本质量的关键因素,探讨冷缺血时间与不同疾病类型肝组织样本质量的相关性,为获得高质量肝组织样本提供标准。方法 选取天津市第一中心医院进行手术治疗... 目的 高质量的肝脏组织样本对肝脏疾病的研究至关重要,冷缺血时间(CIT)是影响组织样本质量的关键因素,探讨冷缺血时间与不同疾病类型肝组织样本质量的相关性,为获得高质量肝组织样本提供标准。方法 选取天津市第一中心医院进行手术治疗的肝癌(HCC)和胆道闭锁(BA)患者各30例,手术切除肝组织后,室温放置0、0.25、0.5、1、2、3、5和6 h后,分别从基因水平、蛋白水平及形态学水平对组织质量进行检测,提取总RNA及基因组DNA,分别检测浓度、纯度及完整性(RIN/DIN值),荧光定量PCR检测组织样本冷缺血0、6 h后ALB基因表达水平;免疫组化方法检测组织样本冷缺血0、6 h后Hep Par1、CK19、CD34、Vimentin蛋白表达情况,Westernblot检测组织样本冷缺血0、6h后ALB蛋白表达水平;HE染色观察组织样本冷缺血0、6 h后组织及细胞形态学变化。结果 DNA产量、RNA纯度和RNARIN随时间变化,时间效应具有统计学意义。组间效应不显著,表明肝癌和胆道闭锁组间没有差异。DNA产量和RNA RIN的交互效应有统计学意义,说明时间的影响随着组别不同而有所不同。与冷缺血0 h相比,肝癌、胆道闭锁组织样本冷缺血6 h后ALB基因表达水平降低,差异具有统计学意义(P <0.05);免疫组化方法检测组织样本冷缺血0、6h后Hep Par1、CK19、CD34、Vimentin蛋白表达情况均无变化,Western blot检测显示组织样本冷缺血0、6 h后ALB蛋白表达水平无显著变化;石蜡切片HE染色显示样本冷缺血0、6 h后组织及细胞形态学无变化。结论 冷缺血时间对肝组织样本中核酸质量具有显著影响,缩短冷缺血时间可获得高质量肝组织样本。 展开更多
关键词 冷缺血时间 肝细胞癌 胆道闭锁 肝组织质量 RNA完整性 DNA完整性
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脑缺血/再灌注损伤后大鼠不同时间点神经细胞的动态变化
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作者 邹旭欢 兰瑞 +6 位作者 付雪琴 王玮玮 王漫漫 唐琛 刘双 李泓宇 沈晓明 《中国药理学通报》 CAS CSCD 北大核心 2024年第6期1056-1066,共11页
目的通过建立脑缺血/再灌注损伤模型,探讨急性CIRI后不同时间点神经细胞的动态变化规律。方法将SPF级雄性SD大鼠随机分为6组,分别为假手术组(Sham)和脑缺血/再灌注损伤(IR)不同时间点组。采用大脑中动脉线栓法(MCAO)建立局灶性脑缺血/... 目的通过建立脑缺血/再灌注损伤模型,探讨急性CIRI后不同时间点神经细胞的动态变化规律。方法将SPF级雄性SD大鼠随机分为6组,分别为假手术组(Sham)和脑缺血/再灌注损伤(IR)不同时间点组。采用大脑中动脉线栓法(MCAO)建立局灶性脑缺血/再灌注损伤模型,采用Longa评分法评估大鼠神经行为评分,模型制备成功后,常规方法制作石蜡切片,进行TUNEL染色和免疫组织化学染色观察细胞凋亡,采用NeuN抗体进行免疫染色观察神经元细胞存活率,采用免疫组织化学法对星形胶质细胞标志物GFAP、小胶质细胞标志物IBA-1、内皮细胞标志物CD31进行染色,在不同时间点观察各组不同细胞的变化规律。结果假手术组的大鼠神经细胞在不同时间点未见明显变化,在脑缺血/再灌注损伤不同时间点组,细胞凋亡在IR3h被激活,且随着时间的延长,凋亡细胞数量增多且伴随形态学的破坏;NeuN+神经元在IR3h后出现缺血损伤的迹象,细胞形态异常,在24 h时最为严重;GFAP+星形胶质细胞在IR3h后急剧减少,IR6h标记不良星形胶质细胞数增加,到24、48 h星形胶质细胞在梗死区基本消失。IR3h IBA-1+小胶质细胞阳性细胞数减少,IR6h IBA-1+小胶质细胞体积增大,IR12h梗死区小胶质细胞死亡。CD31+内皮细胞在IR3h后在梗死周围皮层和纹状体明显增加,并持续到48 h。结论脑缺血/再灌注损伤后,凋亡细胞的数量随着时间延长而增加,NeuN+神经元细胞在24 h损伤最重;梗死周围皮层GFAP+星形胶质细胞、小胶质细胞随着时间增长而逐渐死亡;CD31+内皮细胞数量在再灌注3 h后在梗死周围皮层和纹状体明显增加,并持续到48 h。 展开更多
关键词 脑缺血/再灌注 不同时间点 动态变化 凋亡细胞 神经元细胞 星形胶质细胞 小胶质细胞 内皮细胞
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羟基红花黄色素A通过调控环氧合酶2/前列腺素E_(2)信号通路减轻大鼠脑缺血再灌注损伤
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作者 杨迎春 杨莹 +4 位作者 张小良 高赛红 姜庆良 李宇凤 贾书雨 《解剖学报》 CAS CSCD 2024年第4期468-474,共7页
目的观察羟基红花黄色素A(HSYA)对环氧合酶2(COX-2)/前列腺素E_(2)(PGE_(2))信号通路的影响,探讨HSYA对脑缺血再灌注损伤(CIRI)的保护机制。方法90只雄性SD大鼠随机分为假手术组(S组)、手术组(CIRI组)、HSYA组和塞来昔布组(C组),HSYA组... 目的观察羟基红花黄色素A(HSYA)对环氧合酶2(COX-2)/前列腺素E_(2)(PGE_(2))信号通路的影响,探讨HSYA对脑缺血再灌注损伤(CIRI)的保护机制。方法90只雄性SD大鼠随机分为假手术组(S组)、手术组(CIRI组)、HSYA组和塞来昔布组(C组),HSYA组进一步分为HSYA低剂量组(HSYA-L组)、HSYA中剂量组(HSYA-M组)和HSYA高剂量组(HSYA-H组),每组15只。线栓法制备脑缺血再灌注损伤模型。各组大鼠于术前30 min腹腔注射给药,HSYA各组分别给予HSYA 10、15、25 mg/kg,C组给予塞来昔布40 mg/kg,S组和CIRI组给予等量的生理盐水。各组大鼠模型制作苏醒后立刻进行神经功能学评分,再灌注24 h时进行脑梗死体积检测,同时Nissl染色观察神经细胞损伤,Real-time PCR和Western blotting检测COX-2 mRNA和蛋白的变化,ELISA检测PGE_(2)、肿瘤坏死因子α(TNF-α)和白细胞介素(IL)-1β的变化。结果与S组比较,CIRI组神经功能学评分显著升高(P<0.05),脑梗死体积显著增加(P<0.05),神经细胞损伤较重,数目显著降低(P<0.05),COX-2 mRNA和蛋白的表达显著增多,同时PGE_(2)、TNF-α和IL-1β的表达也显著增多(P<0.05);与CIRI组比较,HSYA组及C组神经功能学评分明显降低(P<0.05),脑梗死体积明显减少(P<0.05),神经细胞损伤减轻,数目明显增加(P<0.05),COX-2 mRNA和蛋白及PGE_(2)、TNF-α和IL-1β的表达均明显下降(P<0.05),且HSYA各组之间及HSYA-L组和HSYA-M组与C组比较差异均较显著(P<0.05),而HSYA-H组与C组比较差异无显著性(P>0.05)。结论HSYA减轻缺血性脑卒中再灌注损伤可能与抑制COX-2/PGE_(2)信号通路有关。 展开更多
关键词 羟基红花素A 脑缺血再灌注损伤 环氧合酶2/前列腺素E_(2)信号通路 实时定量聚合酶链反应 免疫印迹法 大鼠
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针刺治疗心肌缺血再灌注损伤介入时机的研究探析
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作者 孙千惠 古春凌 +4 位作者 杨守亲 杨智文 戴兴业 仇兴华 程凯 《针灸临床杂志》 2024年第1期93-96,共4页
当前对于心肌缺血再灌注损伤(MIRI)的研究主要集中在电针预处理可以减轻再灌注损伤,但是急性心肌梗死往往发病急骤,不具备临床可预见性,除了重视预处理外,在发病中和发病后进行干预同样具备临床适用性。通过查阅针刺治疗心肌缺血再灌注... 当前对于心肌缺血再灌注损伤(MIRI)的研究主要集中在电针预处理可以减轻再灌注损伤,但是急性心肌梗死往往发病急骤,不具备临床可预见性,除了重视预处理外,在发病中和发病后进行干预同样具备临床适用性。通过查阅针刺治疗心肌缺血再灌注损伤的文献,对不同的针刺介入时机进行探讨,将介入时机分为预处理和后处理,预处理对应前驱期即缺血前,后处理对应缺血后,分为再灌注前及再灌注后。旨在明确不同介入时机治疗心肌缺血再灌注损伤的有效性,为针刺治疗方案的选择提供依据。 展开更多
关键词 心肌缺血再灌注损伤 针刺 介入时机 预处理 后处理
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腹腔镜供肝获取手术的发展与展望
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作者 李书乐 陆录 《外科理论与实践》 2024年第2期121-125,共5页
近年来,得益于微创外科技术的进步,腹腔镜供肝获取手术(LLDH)得到了迅速的发展。从2002年该项技术首次报道以来,各大移植中心一直在不断探索发展和积累经验。相比于传统的开放手术,该项技术有着创伤小、术中出血少、术后并发症发生率低... 近年来,得益于微创外科技术的进步,腹腔镜供肝获取手术(LLDH)得到了迅速的发展。从2002年该项技术首次报道以来,各大移植中心一直在不断探索发展和积累经验。相比于传统的开放手术,该项技术有着创伤小、术中出血少、术后并发症发生率低等优点。但同时,在热缺血时间管理、克服学习曲线、避免胆道并发症以及出血控制等方面存在着一定的难点,仍需更多的探索以解决这些问题。一些新技术和新方法的应用也使该项技术更加安全、高效。本文从LLDH的发展历程、手术难点和并发症、技术改进等三个方面进行讨论,并展望该项技术的未来前景和发展方向。 展开更多
关键词 腹腔镜供肝获取 活体肝移植 热缺血时间 胆道并发症
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原位肝移植患者术后发生早期移植物功能不全的危险因素及其列线图模型构建
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作者 杨杰杰 肖晶晶 +3 位作者 吕超 刘徐洋 杜君 谷化剑 《贵州医科大学学报》 CAS 2024年第10期1506-1513,共8页
目的探讨原位肝移植(OLT)患者术后发生早期移植物功能不全(EAD)的危险因素并建立相关的列线图模型。方法选取行肝移植患者受体106例,根据术后是否发生EAD分为EAD组(n=42)和非EAD组(n=64),收集两组受体术前一般临床资料[年龄、性别、终... 目的探讨原位肝移植(OLT)患者术后发生早期移植物功能不全(EAD)的危险因素并建立相关的列线图模型。方法选取行肝移植患者受体106例,根据术后是否发生EAD分为EAD组(n=42)和非EAD组(n=64),收集两组受体术前一般临床资料[年龄、性别、终末期肝病模型(MELD)评分、美国麻醉医师协会(ASA)分级、Child-Pugh评分、肝恶性肿瘤病史、白细胞(WBC)、中性粒细胞百分比、淋巴细胞百分比、中性粒细胞与淋巴细胞比值(NLR)、谷草转氨酶(AST)、谷丙转氨酶(ALT)及总胆红素(TBIL)]及供体术前一般临床资料[年龄、性别、体质量指数(BMI)、死亡原因、是否行心肺复苏术、是否使用体外膜肺氧合(ECMO)、供受体血型是否相合、是否合并病毒性肝炎、冷缺血时间(CIT)、热缺血时间(WIT)、供肝获取时间、重症监护室(ICU)住院时间、捐献前最近1次的白蛋白(ALB)、AST、ALT、钠离子浓度及凝血酶原时间(PT)],同时收集受体术中相关变量(有无脾切除、手术时长、术中失血量、血小板输注量、红细胞输注量、血浆输注量及无肝期时间),采用单因素和多因素logistic回归分析受体发生EAD的危险因素;通过计算机产生随机数方法将受体以3∶1分为训练集(n=79)及验证集(n=27),基于训练集数据建立相关列线图模型,并用验证集进行模型内部验证。结果EAD组受体的MELD评分、术中红细胞输注量及供体BMI、ALT、CIT水平高于非EAD组,差异有统计学意义(P<0.05);多因素logistic回归分析显示,受体MELD评分及供体BMI、ALT、CIT是术后EAD的独立危险因素(P<0.05);在预测OLT术后发生EAD风险的训练集(n=79)中,列线图受试者工作特征(ROC)的曲线下面积(AUC)=0.906、95%CI为0.849~0.963;验证集(n=27)对EAD预测有相似的预测价值(AUC=0.91,95%CI为0.847~0.974),校准曲线对EAD预测发生率和实际发生率具有较好的一致性,决策曲线分析(DCA)显示其具有良好的临床净获益。结论受体MELD评分偏高及供体BMI偏大、ALT水平升高、CIT较长与OLT患者术后EAD的发生相关,以此建立的列线图模型对EAD预测效果好。 展开更多
关键词 肝移植 危险因素 列线图 原位肝移植 早期移植物功能不全 冷缺血时间 供体 受体
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长时间热缺血手指末节完全离断断指再植20例
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作者 袁虹豪 刘承伟 弓贺炜 《实用手外科杂志》 2024年第1期23-24,28,共3页
目的探索对长时间热缺血手指末节完全离断伤行断指再植的临床疗效。方法2018年5月-2020年12月,对20例共26指热缺血时间超过6 h的手指末节完全离断伤行急诊断指再植术,断指热缺血时间为6~15 h,平均为9.1 h。结果术后20例26指,断指成活15... 目的探索对长时间热缺血手指末节完全离断伤行断指再植的临床疗效。方法2018年5月-2020年12月,对20例共26指热缺血时间超过6 h的手指末节完全离断伤行急诊断指再植术,断指热缺血时间为6~15 h,平均为9.1 h。结果术后20例26指,断指成活15例20指。术后48 h内11例12指出现血管危象,其中4例4指经挑拨、抗血管痉挛对症处理后断指成活;2例2指经急诊手术探查解除血管痉挛后断指成活;5例6指术后缺血坏死。再植成功15例20指术后获得6~12个月随访,再植指外观满意,指甲生长良好,远侧指尖关节活动良好,再植指指腹部两点辨别觉9~12 mm。结论对于热缺血时间超过6 h的手指末节完全离断伤,根据断指条件可予试行断指再植术,手术仍有较高成功率及满意手指功能。 展开更多
关键词 末节 热缺血时间 断指再植
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Real time RT-PCR定量检测BDNF mRNA表达水平方法的建立 被引量:1
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作者 杨克红 许冰莹 +3 位作者 葛树星 闫俊岭 卢珊珊 吴兰鸥 《昆明医学院学报》 2007年第2期34-38,共5页
目的建立real time逆转录聚合酶链反应(RT-PCR)检测BDNF mRNA基因表达的方法.方法提取脑缺血组织的总RNA,进行RT-PCR扩增BDNF mRNA特异性片段,扩增产物重组到质粒上并测序,建立real time RT-PCR检测BDNF mRNA表达水平方法.结果重组的质... 目的建立real time逆转录聚合酶链反应(RT-PCR)检测BDNF mRNA基因表达的方法.方法提取脑缺血组织的总RNA,进行RT-PCR扩增BDNF mRNA特异性片段,扩增产物重组到质粒上并测序,建立real time RT-PCR检测BDNF mRNA表达水平方法.结果重组的质粒经酶切和测序,目的片段已插入到载体内,得到real time RT-PCR动力学曲线.结论成功建立real time RT-PCR检测BDNF mRNA基因表达的方法. 展开更多
关键词 BDNF MRNA 脑缺血 REAL time RT-PCR
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不同时相缺血预处理对游离皮瓣缺血再灌注损伤的影响
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作者 王建新 凤旭东 +1 位作者 孔二亮 王秀环 《临床研究》 2024年第8期68-72,共5页
目的观察不同时相缺血预处理(IPC)对游离皮瓣缺血再灌注损伤的影响。方法选取2022年12月至2023年7月中国人民解放军联勤保障部队第九八八医院收治的90例肢体损伤患者,全身麻醉下行择期股前外侧游离皮瓣移植术,采用随机数字表法分为A组(... 目的观察不同时相缺血预处理(IPC)对游离皮瓣缺血再灌注损伤的影响。方法选取2022年12月至2023年7月中国人民解放军联勤保障部队第九八八医院收治的90例肢体损伤患者,全身麻醉下行择期股前外侧游离皮瓣移植术,采用随机数字表法分为A组(术前1 h IPC),B组(术前24 h IPC),C组(术前不进行IPC),每组30例。IPC采用3次短暂循环缺血/再灌注;在术前24 h(T_(0))、手术开始(T_(1))、术后1 h(T_(2))、术后12 h(T_(3))、术后24 h(T_(4))分别取静脉血检测氧化应激指标[丙二醛(MDA)、诱导型一氧化氮合酶(iNOS)]、炎症因子指标[肿瘤坏死因子α(TNF-α)和P-选择素]水平,并统计术后7 d内皮瓣血管危象发生率和失活率。结果三组术后7 d血管危象发生率和皮瓣失活率比较,差异无统计学意义(P>0.05)。三组患者MDA、iNOS、TNF-α、P-选择素水平相比,差异有统计学意义(P<0.05);不同时间点的4个生化指标相比,差异具有统计学意义(P<0.05);不同组别与不同时间之间具有交互作用,差异具有统计学意义(P<0.05)。组内比较:与本组T_(0)比较,各组T_(2)~T_(4)的4个生化指标均升高,差异有统计学意义(P<0.05);与本组T_(2)比较,各组T_(3)~T_(4)时4个生化指标均降低,差异有统计学意义(P<0.05)。组间比较:T_(2)和T_(3)两个时间点,A组、B组分别与C组4个生化指标比较,差异有统计学意义(P<0.05),T_(2)、T_(3)时,A组与B组的4个生化指标比较,差异有统计学意义(P<0.05)。结论不同时相缺血预处理均能抑制氧化应激和炎症因子指标表达,对游离皮瓣有保护作用。 展开更多
关键词 不同时相 缺血预处理 缺血再灌注损伤 游离皮瓣
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5-hydroxymethyl-2-furfural prolongs survival and inhibits oxidative stress in a mouse model of forebrain ischemia 被引量:6
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作者 Bailiu Ya Lan Zhang +2 位作者 Li Zhang Yali Li Lin Li 《Neural Regeneration Research》 SCIE CAS CSCD 2012年第22期1722-1728,共7页
In the present study, we hypothesized that 5-hydroxymethyl-2-furfural could attenuate ischemic brain damage by reducing oxidative injury. Thus, mice were subjected to bilateral common carotid artery occlusion to estab... In the present study, we hypothesized that 5-hydroxymethyl-2-furfural could attenuate ischemic brain damage by reducing oxidative injury. Thus, mice were subjected to bilateral common carotid artery occlusion to establish a model of permanent forebrain ischemia. The mice were intraperitoneally injected with 5-hydroxymethyl-2-furfura130 minutes before ischemia or 5 minutes after ischemia. The survival time of mice injected with 5-hydroxymethyl-2-furfural was longer compared with untreated mice. The mice subjected to ischemia for 30 minutes and reperfusion for 5 minutes were intraperitoneally injected with 5-hydroxymethyl-2-furfural 5 minutes prior to reperfusion, which increased superoxide dismutase content and reduced malondialdehyde content, similar to the effects of Edaravone, a hydroxyl radical scavenger used for the treatment of stroke. These findings indicate that intraperitoneal injection of 5-hydroxymethyl-2-furfural can prolong the survival of mice with permanent forebrain ischemia. This outcome may be mediated by its antioxidative effects. 展开更多
关键词 5-hydroxymethyl-2-furfural forebrain ischemia survival time oxidative stress SUPEROXIDEDISMUTASE MALONDIALDEHYDE MOUSE
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Therapeutic window of Qingkailing injection for focal cerebral ischemia/reperfusion injury 被引量:3
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作者 Fafeng Cheng Wenting Song +5 位作者 Xianggen Zhong Yi Lu Shaoying Guo Dong Wang Weipeng Zhao Qingguo Wang 《Neural Regeneration Research》 SCIE CAS CSCD 2011年第21期1605-1611,共7页
The time window in which a drug is effective varies between drugs. The present study investigated the therapeutic window of Qingkailing injection for focal cerebral ischemia/reperfusion in mice. Animals underwent midd... The time window in which a drug is effective varies between drugs. The present study investigated the therapeutic window of Qingkailing injection for focal cerebral ischemia/reperfusion in mice. Animals underwent middle cerebral artery occlusion and were injected with Qingkailing (1.5, 3, 6 mL/kg). Infarct volume and neurological function were assessed after 24 hours of ischemia. In addition, to establish the therapeutic time window, mice were injected with 3 mL/kg Qingkailing at 0, 1, 3, 4, 6, 9 and 12 hours after occlusion. Results revealed that Qingkailing injection significantly reduced infarct volume and improved neurological function in model mice after cerebral infarction for up to 9 hours, demonstrating that the therapeutic window of Qingkailing injection can extend to 9 hours for cerebral ischemia/reperfusion in mice. 展开更多
关键词 focal cerebral ischemia Qingkailing injection time window infarct volume
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To Optimize the Therapeutic Dose and Time Window of Picroside II in Cerebral Ischemic Injury in Rats by Orthogonal Test 被引量:1
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作者 Hui Huang Li Sun +3 位作者 Ling Wang Lei Fang Li Zhao Yan Li 《Neuroscience & Medicine》 2013年第3期166-171,共6页
The paper aims to optimize the therapeutic dose and time window of picroside II by orthogonal test in cerebral ischemic injury in rats. The forebrain ischemia models were established by bilateral common carotid artery... The paper aims to optimize the therapeutic dose and time window of picroside II by orthogonal test in cerebral ischemic injury in rats. The forebrain ischemia models were established by bilateral common carotid artery occlusion (BCCAO) methods. The successful models were randomly divided into sixteen groups according to orthogonal experimental design and treated by injecting picroside II intraperitonenally at different ischemic time with different dose. The concentrations of neuron-specific enolase (NSE), neuroglial marker protein S100B and myelin basic protein (MBP) in serum were determined by enzyme linked immunosorbent assay to evaluate the therapeutic effect of picroside II in cerebral ischemic injury. The results indicated that best therapeutic time window and dose of picroside II in cerebral ischemic injury were ischemia 1.5 h with 20 mg/kg body weight according to the concentrations of NSE, S100B and MBP in serum. It is concluded that according to the principle of lowest therapeutic dose with longest time window, the optimized therapeutic dose and time window are injecting picroside II intraperitonenally with 20 mg/kg body weight at ischemia 1.5 h in cerebral ischemic injury in rats. 展开更多
关键词 Picroside II CEREBRAL ischemia THERAPEUTIC DOSE time WINDOW RATS
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Assessment of Warm and Cold Ischemia on Functions of the Operated Kidney with <sup>99m</sup>Tc-DMSA in Renal Masses: A Prospective and Randomized Study
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作者 Abdullah Demirtas Numan Baydilli +3 位作者 Nurettin Sahin Oguz Ekmekcioglu Deniz Demirci Atila Tatlisen 《Open Journal of Urology》 2013年第2期62-67,共6页
Objective: To examine the effect of warm and cold ischemia on functions of the operated kidney in cases with a normal contralateral kidney undergoing nephron sparing surgery. Methods: This study enrolled 40 patients w... Objective: To examine the effect of warm and cold ischemia on functions of the operated kidney in cases with a normal contralateral kidney undergoing nephron sparing surgery. Methods: This study enrolled 40 patients with a normal contralateral kidney and without a renal function threatening risk factor, who were operated with NSS. The patients were randomized at admission. They were divided into 2 equal groups as warm and cold ischemia. An ice application for 10 minutes was done to cold ischemia group after clamping renal artery. Renal functions were evaluated with Technesium-99m-Dimercaptosuccinic Acid (DMSA) and serum creatinine at the preoperative and postoperative (day 1, day 15, month 6, and month 12) period. Statistical analysis was done with Mann Whitney U test, Wilcoxon Signed Rank test, and Fredman test. A p value below 0.05 was considered statistically significant. Results: There were no significant differences between the groups in terms of age, body mass index, ischemia time, tumor size, amount of hemorrhage, and procedure time. Both groups had a significantly higher DMSA uptake at the preoperative period compared with the postoperative period (postoperative day 1, day 15, month 6, and month 12) (p 0.001). However, both groups had similar DMSA uptake results at the postoperative period. Preoperative and postoperative creatinine levels were not significantly different from each other in both groups. Conclusion: Based on tumor localization, nephron sparing surgery without use of superficial cooling appears as a viable option for small renal masses. 展开更多
关键词 Cold ischemia timeS NEPHRON Sparing Surgery Renal Cancer Technetium-99m-Dimercaptosuccinic Acid WARM ischemia timeS
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