• <tr id="yyy80"></tr>
  • <sup id="yyy80"></sup>
  • <tfoot id="yyy80"><noscript id="yyy80"></noscript></tfoot>
  • 99热精品在线国产_美女午夜性视频免费_国产精品国产高清国产av_av欧美777_自拍偷自拍亚洲精品老妇_亚洲熟女精品中文字幕_www日本黄色视频网_国产精品野战在线观看 ?

    Delayed introduction of immunosuppressive regimens in critically ill patients after liver transplantation

    2017-10-09 01:35:53YingLuoWenBinJiWeiDongDuanXianJieShiandZhiMingZhao

    Ying Luo, Wen-Bin Ji, Wei-Dong Duan, Xian-Jie Shi and Zhi-Ming Zhao

    Beijing, China

    Delayed introduction of immunosuppressive regimens in critically ill patients after liver transplantation

    Ying Luo, Wen-Bin Ji, Wei-Dong Duan, Xian-Jie Shi and Zhi-Ming Zhao

    Beijing, China

    METHODS: From March 2009 to February 2014, 225 consecutive liver recipients in our institute were included.e delayed administration of immunosuppressive regimens was attempted in 11 liver recipients with multiple severe comorbidities.

    (Hepatobiliary Pancreat Dis Int 2017;16:487-492)

    infection;

    immune monitoring;

    liver transplantation;

    immunosuppression;

    critical care;

    Immuknow assay

    Introduction

    Due to the lack of donor organs, a large proportion of patients with advanced chronic liver disease or acute liver failure develop multiple organ dysfunction before liver transplantation.[1-3]With respect to the post-transplant critical care of these patients, we have to weigh in two different biological systems, the newly implanted allograand the critically ill patient. On the one hand, the immunosuppressive strategies are mandatory in order to protect the allografrom rejection. On the other hand, the numerous adverse events associated with immunosuppressive regimens, such as infections,renal toxicity, neurologic toxicity etc,[4-6]significantly increased the risks of morbidities in these critically ill patients. Since the early 2009, we have attempted to delay the administration of immunosuppressive regimens in the critically ill patients aer liver transplantation under immune monitoring with ImmuKnow assay. In the present study, we aimed to evaluate the outcomes of this strategy in liver transplantation.

    Methods

    Patients

    From March 2009 to February 2014, 225 consecutive liver recipients in our institute were included. Eleven deceased donor liver recipients developed severe infection or multiple organ failure aer transplantation, including acute renal failure, severe encephalopathy, or respiratoryfailure. To avoid the adverse effects of immunosuppression, we attempted to delay the administration of immunosuppressive regimens in these critically ill patients.Demographics of the patients are shown in Table.ere were 7 males and 4 females, with an average age of 47.9 years (range 32-67). Two of them were alcoholic liver cirrhosis, 9 were acute-on-chronic liver failure (ACLF)rooted by hepatitis B virus (HBV) infection.e average score of model for end-stage liver disease (MELD) was 35 (range 18-45) before transplantation.e major reasons of delayed administration of immunosuppressive drugs are intra-abdominal infection, sepsis, acute renal failure and hepatic encephalopathy (n=1), sepsis and acute renal failure (n=1), acute renal failure and pulmonary infection (n=6), acute renal failure, encephalopathy,pulmonary infection and sepsis (n=3). Before transplantation, 3 patients developed hepatic encephalopathy of grade 3 (n=2) or grade 4 (n=1) requiring intubation and mechanical ventilation.e patient, who developed post-transplant intra-abdominal infection, sepsis, acute renal failure and encephalopathy, had been treated in another institute for decompensated alcoholic liver cirrhosis and primary peritonitis at 1 month before liver transplantation.e diagnosis of sepsis was based on the clinical manifestations, significantly increased levels of C-reactive protein and procalcitonin, and subsequent positive results of blood culture.e definitions and classifications of hepatic encephalopathy and acute renal failure were based on the West Haven criteria[7]and the risk, injury, failure, loss, and end-stage kidney disease criteria,[8]respectively.

    ImmuKnow assay

    For the early detection of acute allograrejection,continuous intensive monitoring of hepatic biochemistry was mandatory during the non-immunosuppression period, including serum aminotransferase, alkaline phosphatase, glutamyltranspeptidase, and bilirubin levels. CD4 T lymphocyte function assay (ImmuKnow, Catalogue No. 4400, Cylex Inc., Columbia, MD, USA) was routinely performed every three days, in addition to any occasion when there was a significant increase in liver enzyme levels.e assay's ability to discern between immune profiles of overimmunosuppression and underimmunosuppression has been reported in previous studies.[9-12]Briefly,100 μL whole blood (1:4 dilution) was added into wells of a 96-well microtiter plate in quadruplicate, and was incubated overnight (15-18 hours) in a 5% CO2incubator at 37 ℃ with or without phytohemagglutinin (PHA, 2.5 μg/mL) as a stimulant. Anti-human CD4 monoclonal antibody coated magnetic particles (Dynal, Oslo, Norway)were added to immunoselect CD4 cells from both the stimulated and nonstimulated wells. Aer washing the selected CD4 cells, a lysing reagent was added to release intracellular adenosine triphosphate (ATP). A luciferin/luciferase mixture was then added to the cell lysate.Within 10 minutes aer addition of enzyme, the bioluminescent product was measured in a luminometer.e amount of light emitted was compared with a calibration curve generated with ATP calibrators (0, 1, 10, 100 and 1000 ng/mL).e concentration of ATP (ng/mL) in each sample was then calculated from the calibration curve. According to the instruction of Cylex Immu-Know assay, the cut-offlevels are ≤225 ng/mL for low immune cell response, 226-524 ng/mL for moderate immune cell response, and ≥525 ng/mL for strong immune cell response, respectively. Twenty liver recipients with stable clinical status and 20 healthy people were included in the study as control groups.e median time aer liver transplantation was 22.3 months (range 18-56) in the liver recipient with stable status.

    Perioperative management

    Statistical analysis

    Nonparametric tests were used for statistical analysis.e Mann-WhitneyUtest and Wilcoxon test were used to compare continuous variables, and proportionswere compared by Chi-square test (SPSS/PC+; SPSS, Inc.,Chicago, IL, USA). APvalue of less than 0.05 was considered statistically significant.

    Results

    Clinical outcomes

    All transplants were performed with ABO-compatible whole gras.ere was 1 perioperative death.e patient died of multiple organ failure with concurrent confirmed sepsis 14 days aer liver transplantation, and the remaining patients were in good status and had normal grafunction during a median follow-up period of 43 months (range 8-64).e median length of intensive care unit (ICU) and hospital stay were 17 days (range 11-32) and 27 days (range 14-65), respectively (Table).e prolonged mechanical ventilation was required in all patients due to unstable mental status and/or respiratory failure secondary to infection or adult respiratory distress syndrome.e median duration of mechanical ventilation was 8 days (range 2-28), and tracheostomy was performed in 2 patients. Of the 11 patients, 10 received continuous renal replacement therapy (CRRT) due to acute renal failure.e median length of CRRT was 9 days (range 2-26).

    All of the 11 patients had culture-proven infections during the early period aer liver transplantation.e major morbidity was pulmonary infection (81.8%, 9/11),which may be resulted from liver failure, prolonged mechanical ventilation, and the complexity and urgent status of surgical procedure. Five patients developed systemic sepsis withStaphylococcus aureus(n=2),Enterococcus(n=1),Enterobacter(n=1), andEnterobacterandAspergillusspecies (n=1). Antimicrobial treatment was adjusted in 4 patients based on susceptibility testing,including vancomycin, tigecycline, carbapenems with or without trimethoprim sulfamethoxazole. In those patients receiving CRRT, the daily doses of antibiotics were based on local practice guidelines and published recommendations,[13]and each antibiotic was administered as a prolonged infusion of 4-6 hours. One patient developed intra-abdominal abscess, and was treated with percutaneous drainage guided by ultrasonography.

    Table.e demographic data of liver transplant recipients

    Table.e demographic data of liver transplant recipients

    LT: liver transplantation; HBV: hepatitis B virus; MELD: model for end-stage liver disease; ICU: intensive care unit; CRRT: continuous renal replacement therapy.

    CharacteristicsData (n=11)Average age (yr)47.9 (32-67)Gender (male/female) 7/4 Underlying liver diseases before LT Alcoholic liver cirrhosis 2 Acute liver failure on chronic HBV infection 9 Average MELD score before LT35 (18-45)Comorbidities aer LT Intra-abdominal infection 1 Sepsis 5 Pulmonary infection 9 Acute renal failure11 Encephalopathy 4 Median ICU stay (d)17 (11-32)Median hospital stay (d)27 (14-65)Median duration of mechanical ventilation (d) 8 (2-28)Median duration of CRRT (d) 9 (2-26)Median duration of non-immunosuppression (d)12 (5-58)

    T cell-mediated immune response

    Before transplantation, these critically ill patients presented a significantly lower ATP level of 286±101 ng/ mL as compared with healthy people with ATP level of 421±145 ng/mL in ImmuKnow assay (P<0.05), and then, the ATP level decreased to 64±35 ng/mL at day 3 post-transplant when all of the patients showed symptoms of infection (Fig. 1).e sequential tests showed that there was a distinct increase in the ATP level aer the system infections were controlled and the general status of patients were improved (Figs. 2 and 3). More importantly, the increase of ATP level was followed by the development of acute rejection against the allogras(Fig. 3).e average ATP level measured just before the development of acute rejection was 271±115 ng/mL(Fig. 1). A continuous distinct elevation of both ATP and glutamyltranspeptidase levels was a strong indication of the occurrence of acute rejection.e highest Immu-Know value was 510±173 ng/mL during the episodes of acute rejection, and was significantly higher than thatof the post-transplant recipients with clinical stability(247±123 ng/mL,P<0.05).e median non-immunosuppressed duration was 12 days (range 5-58) in the 11 patients aer transplantation (Table). Grade I or II acute grarejection was identified in all of these patients by pathological analysis based on BanffSchema. Aer the administration of immunosuppressive agents, the acute rejection was completely reversed in the 10 patients who survived perioperatively.

    Fig. 1.ImmuKnow measurements in healthy people, liver recipients with clinical stability, and critically ill patients at different time points. LT: liver transplantation; AR: acute rejection. *:P<0.05, compared with healthy control; #:P<0.05, compared with stable recipients.

    Fig. 2.Serial changes of ImmuKnow value in 11 critically ill patients aer liver transplantation.

    Fig. 3.A 60-year-old female patient, who underwent liver transplantation for acute liver failure on chronic HBV infection, developed pulmonary infection, sepsis, encephalopathy and acute renal failure at the early stage after transplantation. Blood and sputum culture tests showedEnterobacter,AspergillusandStreptococcusspecies infection. She was mechanically ventilated because of hepatic encephalopathy before transplantation, and received continuous renal replacement therapy (CRRT) immediately after transplantation. The duration of mechanical ventilation and CRRT were 28 and 17 days, respectively.e immunosuppressive regimens including cyclosporine and mycophenolate mofetil were administered at day 30 aer transplantation.A: Serial changes of ImmuKnow and hepatic biochemistry levels aer liver transplantation;B: Chest X-ray at different time points aer liver transplantation. ALT: alanine aminotransferase; γ-GT: glutamyltranspeptidase; ATP: adenosine triphosphate.

    Discussion

    Despite the fact that the graand patient survival aer liver transplantation has significantly improved during the past decades, the perioperative care of recipients with multiple comorbidities and organ dysfunction remains challenging.[14-17]Infectious complications are leading causes of morbidity and mortality in these recipients. Effective critical care during the immediate posttransplant recovery period results in good outcomes. A better understanding and application of immunosuppressive strategies plays an important role in the posttransplant intensive care of the critically ill patients. As these critically ill patients are vulnerable to infections and organ injury,the delayed administration or dose reduction of immunosuppressive drugs is oen required in clinical practice.[18]However, the duration of non-immunosuppression or low-dose immunosuppressives remains empirical.e transplant specialists have to balance between comorbidities and immunosuppressive therapy, especially in recipients with infectious complications. For minimizing the adverse effects of immunosuppressive drugs, criteria are needed to treat the critically ill patients individually according to their own immune status.

    It has been reported that the Cylex ImmuKnow assay,which was approved by the USA Food and Drug Administration in 2002, has the potential to serve as an index of the immune status of organ transplant recipients receiving immunosuppressive therapy.[9,19-22]e assay quantifies the cell-mediated immunity by measuring the concentration of ATP from circulating CD4 T cells aerin vitrostimulation with PHA.e present study assessed the clinical relevance and reliability of the ImmuKnow assay as an immune monitoring tool in the critically ill patients aer liver transplantation. We found that the ImmuKnow ATP values can represent the level offunctional immunity of the patients. At the early stage aer transplantation, all of these critically ill recipients showed a significantly low degree of global immune response.is phenomenon may be associated with the development of infectious diseases. Importantly, there were no any signs of allograrejection in these patients.erefore, the immunosuppressive regimens were not administered in all of them during the early period aer transplantation in order to avoid the drug toxicity and the exacerbation of infectious diseases due to the immunosuppression.e median duration of non-immunosuppression was 12 days (5-58).is gives the ICU physicians very valuabletime to treat the recipients with multiple comorbidities and organ dysfunction.

    In addition, the longitudinal ImmunKnow assay provided a reliable depiction of the dynamics offunctional immunity throughout the clinical course of the patients.We found that a continuous distinct elevation of both ATP and glutamyltranspeptidase levels was a strong indication of the development of acute rejection.is is very helpful in optimizing a favorable timing of introduction of the immunosuppressive therapy. Fig. 3 described a 60-year-old female patient who suffered from pulmonary infection, sepsis, encephalopathy and acute renal failure at the early stage aer transplantation.e longitudinal immune monitoring with ImmuKnow assay showed a significant correlation with the clinical episodes of the patient. Both the amelioration of comorbidities and the development of acute rejection were parallel to the distinct changes of the ImmuKnow value. Another 32-yearold male patient with alcoholic cirrhosis, who developed intra-abdominal infection, sepsis, acute renal failure and encephalopathy aer liver transplantation, had significantly low ImmuKnow ATP levels and nearly normal hepatic biochemistry during the early period aer transplantation. His ATP level started to increase significantly aer 50 days of liver transplantation.e immunosuppressive regimens were administered at day 58 aer transplantation when the acute allograrejection was identified (data not shown).ese results are comparable with the other reports, suggesting that the ImmuKnow assay could serve as an immune monitoring tool in organ transplant recipients.[9,10,19,20]In previous studies, the investigators have attempted to stratify patient's immune status using ImmuKnow assay.[9,19]In our experiences,however, both the inter-individual and the intra-individual deviations of ImmuKnow measurements were large.e serial longitudinal ImmuKnow measurements and analyses of the changes of ATP levels over time were more informative in identification of clinical adverse events including infectious diseases or acute rejection than a single measurement.

    In conclusion, the present study shows that the delayed introduction of immunosuppressive regimens is safe and effective in management of critically ill patients aer liver transplantation.e longitudinal immune monitoring with ImmuKnow assay may be helpful in optimizing the timing of introduction of immunosuppression by providing the status of the functional immunity of a given critically ill recipient.

    Contributors:LY proposed and performed the study, and wrote the dra. JWB performed the study and revised the paper. DWD performed the study and collected the data. SXJ performed the study. ZZM collected the data. All authors contributed to the design and interpretation of the study and to further dras. LY is the guarantor.

    Funding:None.

    Ethical approval:e study was conducted according to theDeclaration of Helsinkiand was approved by the Ethics Committee of Chinese PLA General Hospital, Beijing, China.

    Competing interest:No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

    1 Findlay JY, Fix OK, Paugam-Burtz C, Liu L, Sood P, Tomlanovich SJ, et al. Critical care of the end-stage liver disease patient awaiting liver transplantation. Liver Transpl 2011;17:496-510.

    2 Keegan MT, Kramer DJ. Perioperative care of the liver transplant patient. Crit Care Clin 2016;32:453-473.

    4 Umbro I, Tinti F, Scalera I, Evison F, Gunson B, Sharif A, et al.Acute kidney injury and post-reperfusion syndrome in liver transplantation. World J Gastroenterol 2016;22:9314-9323.

    5 Pedersen M, Seetharam A. Infections aer orthotopic liver transplantation. J Clin Exp Hepatol 2014;4:347-360.

    6 Derle E, Kibaro?lu S, ?cal R, K?rnap M, Can U, Benli S, et al.Neurologic complications aer liver transplant: experience at a single center. Exp Clin Transplant 2015;13:327-330.

    7 Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K,Blei AT. Hepatic encephalopathy--definition, nomenclature,diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna,1998. Hepatology 2002;35:716-721.

    8 Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute Dialysis Quality Initiative workgroup. Acute renal failure -definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative(ADQI) Group. Crit Care 2004;8:R204-212.

    9 Israeli M, Klein T, Sredni B, Avitzur Y, Mor E, Bar-Nathen N,et al. ImmuKnow: a new parameter in immune monitoring of pediatric liver transplantation recipients. Liver Transpl 2008;14:893-898.

    10 Xue F, Zhang J, Han L, Li Q, Xu N, Zhou T, et al. Immune cell functional assay in monitoring of adult liver transplantation recipients with infection. Transplantation 2010;89:620-626.

    11 Ravaioli M, Neri F, Lazzarotto T, Bertuzzo VR, Di Gioia P,Stacchini G, et al. Immunosuppression modifications based on an immune response assay: results of a randomized, controlled trial. Transplantation 2015;99:1625-1632.

    12 Sugiyama K, Tsukaguchi M, Toyama A, Satoh H, Saito K, Nakagawa Y, et al. Immune monitoring with a lymphocyte adenosine triphosphate assay in kidney transplant recipients treated with a calcineurin inhibitor. Exp Clin Transplant 2014;12:195-199.

    13 Trotman RL, Williamson JC, Shoemaker DM, Salzer WL. Antibiotic dosing in critically ill adult patients receiving continuous renal replacement therapy. Clin Infect Dis 2005;41:1159-1166.

    14 Niemann CU, Kramer DJ. Transplant critical care: standards for intensive care of the patient with liver failure before and aer transplantation. Liver Transpl 2011;17:485-487.

    15 Razonable RR, Findlay JY, O'Riordan A, Burroughs SG, Ghobrial RM, Agarwal B, et al. Critical care issues in patients aer liver transplantation. Liver Transpl 2011;17:511-527.

    16 Carton EG, Plevak DJ, Kranner PW, Rettke SR, Geiger HJ,Coursin DB. Perioperative care of the liver transplant patient:Part 2. Anesth Analg 1994;78:382-399.

    17 Feltracco P, Barbieri S, Galligioni H, Michieletto E, Carollo C, Ori C. Intensive care management of liver transplanted patients. World J Hepatol 2011;3:61-71.

    18 Sood S, Testro AG. Immune monitoring post liver transplant.World J Transplant 2014;4:30-39.

    19 Israeli M, Ben-Gal T, Yaari V, Valdman A, Matz I, Medalion B,et al. Individualized immune monitoring of cardiac transplant recipients by noninvasive longitudinal cellular immunity tests.Transplantation 2010;89:968-976.

    20 Uemura T, Riley TR, Khan A, Hollenbeak C, Schreibman I,Ghahramani N, et al. Immune functional assay for immunosuppressive management in post-transplant malignancy. Clin Transplant 2011;25:E32-37.

    21 Mendler M, Kwok H, Franco E, Baron P, Weissman J, Ojogho O. Monitoring peripheral blood CD4+ adenosine triphosphate activity in a liver transplant cohort: insight into the interplay between hepatitis C virus infection and cellular immunity. Liver Transpl 2008;14:1313-1322.

    22 Hooper E, Hawkins DM, Kowalski RJ, Post DR, Britz JA,Brooks KC, et al. Establishing pediatric immune response zones using the Cylex ImmuKnow assay. Clin Transplant 2005;19:834-839.

    September 7, 2016

    Accepted after revision May 25, 2017

    Author Affiliations: Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China (Luo Y, Ji WB, Duan WD, Shi XJ and Zhao ZM)

    Ying Luo, MD, Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China (Tel: +86-10-66938334; Fax: +86-10-68241383; Email: luoyingly@hotmail.com)

    ? 2017, Hepatobiliary Pancreat Dis Int. All rights reserved.

    10.1016/S1499-3872(17)60050-X

    Published online August 8, 2017.

    国产精品免费大片| 一级毛片电影观看| 国产一区有黄有色的免费视频| 国产成人a∨麻豆精品| 亚洲国产欧美在线一区| 日韩人妻精品一区2区三区| 久久久精品免费免费高清| 性色av一级| 精品少妇久久久久久888优播| 少妇人妻久久综合中文| 黄片无遮挡物在线观看| 久久99精品国语久久久| 国产成人精品久久二区二区91 | 韩国高清视频一区二区三区| 精品第一国产精品| 菩萨蛮人人尽说江南好唐韦庄| 高清黄色对白视频在线免费看| 天天躁夜夜躁狠狠久久av| 99re6热这里在线精品视频| 欧美精品高潮呻吟av久久| 欧美亚洲日本最大视频资源| 日日摸夜夜添夜夜爱| 大码成人一级视频| 国产精品一国产av| av.在线天堂| 1024香蕉在线观看| 高清在线视频一区二区三区| 中文乱码字字幕精品一区二区三区| 91老司机精品| 国产激情久久老熟女| 男人操女人黄网站| 天堂中文最新版在线下载| 欧美激情 高清一区二区三区| 精品亚洲成a人片在线观看| 国产有黄有色有爽视频| 美女中出高潮动态图| 亚洲精品一区蜜桃| e午夜精品久久久久久久| 免费不卡黄色视频| 亚洲一级一片aⅴ在线观看| bbb黄色大片| 中国三级夫妇交换| 一边亲一边摸免费视频| 成人影院久久| 制服人妻中文乱码| 欧美另类一区| svipshipincom国产片| 精品一区二区三区av网在线观看 | 国产成人欧美| 女性被躁到高潮视频| 色视频在线一区二区三区| 国产成人啪精品午夜网站| 男女边摸边吃奶| 一本一本久久a久久精品综合妖精| 一边摸一边抽搐一进一出视频| 国产视频首页在线观看| 丝袜人妻中文字幕| 无遮挡黄片免费观看| 日本爱情动作片www.在线观看| 高清黄色对白视频在线免费看| 久久av网站| 国产精品嫩草影院av在线观看| 国产亚洲最大av| 日日撸夜夜添| 日韩av在线免费看完整版不卡| 久久久精品免费免费高清| 夜夜骑夜夜射夜夜干| 日本vs欧美在线观看视频| 日韩精品免费视频一区二区三区| 欧美人与性动交α欧美软件| 男女边吃奶边做爰视频| 亚洲人成77777在线视频| 乱人伦中国视频| 最近2019中文字幕mv第一页| 99久久99久久久精品蜜桃| 久久午夜综合久久蜜桃| 人人妻人人澡人人看| 欧美日韩综合久久久久久| 免费黄网站久久成人精品| 亚洲国产欧美网| 成年女人毛片免费观看观看9 | 99精国产麻豆久久婷婷| 亚洲图色成人| 九色亚洲精品在线播放| av卡一久久| 多毛熟女@视频| 如日韩欧美国产精品一区二区三区| 亚洲国产看品久久| 自线自在国产av| 精品少妇一区二区三区视频日本电影 | 极品少妇高潮喷水抽搐| 天堂8中文在线网| 日本色播在线视频| 99re6热这里在线精品视频| 亚洲成人一二三区av| 一区二区三区四区激情视频| 只有这里有精品99| 国产精品久久久久久人妻精品电影 | 精品久久蜜臀av无| 91国产中文字幕| 99国产综合亚洲精品| 国产日韩欧美在线精品| 一边摸一边抽搐一进一出视频| 熟女少妇亚洲综合色aaa.| 成人亚洲欧美一区二区av| 日韩人妻精品一区2区三区| 久久精品人人爽人人爽视色| 午夜福利一区二区在线看| 亚洲欧美日韩另类电影网站| 久久99热这里只频精品6学生| 91aial.com中文字幕在线观看| 高清视频免费观看一区二区| 亚洲精品国产区一区二| 亚洲国产欧美在线一区| 亚洲欧美精品自产自拍| 午夜福利视频在线观看免费| 水蜜桃什么品种好| 夜夜骑夜夜射夜夜干| 免费在线观看视频国产中文字幕亚洲 | 最近中文字幕高清免费大全6| 亚洲情色 制服丝袜| 卡戴珊不雅视频在线播放| 亚洲精品国产av成人精品| 国产亚洲av高清不卡| 激情视频va一区二区三区| 另类精品久久| 亚洲精品国产区一区二| 在线亚洲精品国产二区图片欧美| 少妇精品久久久久久久| 不卡视频在线观看欧美| 欧美黑人欧美精品刺激| 人妻 亚洲 视频| 美女中出高潮动态图| 巨乳人妻的诱惑在线观看| 两个人免费观看高清视频| 亚洲精品一二三| 在线天堂中文资源库| 国产有黄有色有爽视频| 美女大奶头黄色视频| av网站免费在线观看视频| 男女免费视频国产| 亚洲激情五月婷婷啪啪| 十八禁人妻一区二区| 伊人亚洲综合成人网| 亚洲人成电影观看| av又黄又爽大尺度在线免费看| 两个人看的免费小视频| 一本大道久久a久久精品| 日韩 亚洲 欧美在线| 亚洲自偷自拍图片 自拍| 亚洲综合色网址| 国产熟女午夜一区二区三区| 国产成人精品无人区| 久久99精品国语久久久| 啦啦啦在线观看免费高清www| 精品一区二区三区av网在线观看 | 精品国产露脸久久av麻豆| 亚洲第一区二区三区不卡| 人成视频在线观看免费观看| 又大又黄又爽视频免费| 精品第一国产精品| 国产免费一区二区三区四区乱码| 亚洲欧美中文字幕日韩二区| 日韩制服丝袜自拍偷拍| 午夜福利乱码中文字幕| 日韩精品免费视频一区二区三区| 在线观看免费视频网站a站| 亚洲av日韩精品久久久久久密 | 国产深夜福利视频在线观看| 精品国产一区二区三区四区第35| 国产毛片在线视频| 亚洲国产精品一区二区三区在线| 操出白浆在线播放| 日韩中文字幕视频在线看片| 欧美另类一区| 人人澡人人妻人| 91精品伊人久久大香线蕉| 一区二区三区乱码不卡18| 我要看黄色一级片免费的| 亚洲欧美中文字幕日韩二区| 亚洲欧美激情在线| 激情视频va一区二区三区| 18禁观看日本| 九九爱精品视频在线观看| 国产亚洲av片在线观看秒播厂| 午夜影院在线不卡| 另类亚洲欧美激情| 亚洲在久久综合| 90打野战视频偷拍视频| 叶爱在线成人免费视频播放| 高清黄色对白视频在线免费看| 汤姆久久久久久久影院中文字幕| 亚洲美女黄色视频免费看| 99精品久久久久人妻精品| 国产成人免费观看mmmm| 高清不卡的av网站| 曰老女人黄片| 亚洲av综合色区一区| 国产色婷婷99| 亚洲精华国产精华液的使用体验| 成人免费观看视频高清| 人成视频在线观看免费观看| 欧美人与性动交α欧美精品济南到| 精品国产一区二区久久| www.精华液| 久久99热这里只频精品6学生| 一本大道久久a久久精品| 久热爱精品视频在线9| 中文字幕制服av| 熟女av电影| 日韩熟女老妇一区二区性免费视频| 国产免费福利视频在线观看| 精品国产乱码久久久久久小说| 国产精品欧美亚洲77777| 卡戴珊不雅视频在线播放| 2021少妇久久久久久久久久久| 亚洲精品中文字幕在线视频| 十八禁高潮呻吟视频| 人妻 亚洲 视频| 天天添夜夜摸| 亚洲一区二区三区欧美精品| 亚洲国产av新网站| 国产精品 欧美亚洲| 女人爽到高潮嗷嗷叫在线视频| 国产黄色视频一区二区在线观看| 自线自在国产av| 精品国产一区二区三区四区第35| 久久毛片免费看一区二区三区| 亚洲精品美女久久久久99蜜臀 | 18禁国产床啪视频网站| 黄频高清免费视频| 免费观看a级毛片全部| 日本猛色少妇xxxxx猛交久久| 嫩草影院入口| 性色av一级| 纯流量卡能插随身wifi吗| 在线观看一区二区三区激情| 亚洲国产精品999| 中文字幕另类日韩欧美亚洲嫩草| 亚洲精品久久久久久婷婷小说| 色婷婷av一区二区三区视频| 制服人妻中文乱码| 最近手机中文字幕大全| 婷婷色av中文字幕| 一级爰片在线观看| 日韩,欧美,国产一区二区三区| 国产免费福利视频在线观看| 99精品久久久久人妻精品| 大片电影免费在线观看免费| 天天躁日日躁夜夜躁夜夜| 女的被弄到高潮叫床怎么办| 亚洲男人天堂网一区| 国产精品 国内视频| 日本vs欧美在线观看视频| 欧美日韩视频高清一区二区三区二| 亚洲欧美清纯卡通| 成年av动漫网址| 九草在线视频观看| 国产熟女欧美一区二区| 91国产中文字幕| 夫妻午夜视频| 又黄又粗又硬又大视频| 欧美成人午夜精品| 欧美黑人精品巨大| 你懂的网址亚洲精品在线观看| 亚洲欧洲国产日韩| 日日爽夜夜爽网站| 日韩中文字幕欧美一区二区 | 国产精品99久久99久久久不卡 | 久久久精品国产亚洲av高清涩受| 啦啦啦中文免费视频观看日本| 日韩一区二区三区影片| 国产亚洲av片在线观看秒播厂| 日本黄色日本黄色录像| 亚洲精品,欧美精品| 亚洲欧洲精品一区二区精品久久久 | 成年女人毛片免费观看观看9 | 国产日韩欧美在线精品| 久久国产精品大桥未久av| 日韩av在线免费看完整版不卡| 超色免费av| 国产极品粉嫩免费观看在线| 丰满乱子伦码专区| 高清欧美精品videossex| 美女视频免费永久观看网站| 亚洲视频免费观看视频| 欧美亚洲 丝袜 人妻 在线| 欧美另类一区| 亚洲五月色婷婷综合| 蜜桃在线观看..| 亚洲人成电影观看| 两个人看的免费小视频| 精品少妇一区二区三区视频日本电影 | 亚洲少妇的诱惑av| 成年人免费黄色播放视频| 最黄视频免费看| 日日摸夜夜添夜夜爱| 久久精品国产a三级三级三级| 国产在线视频一区二区| 大话2 男鬼变身卡| 成人国产麻豆网| 午夜免费鲁丝| 水蜜桃什么品种好| 涩涩av久久男人的天堂| 国产熟女欧美一区二区| 七月丁香在线播放| 欧美日韩国产mv在线观看视频| 黑人巨大精品欧美一区二区蜜桃| 日本黄色日本黄色录像| 亚洲色图 男人天堂 中文字幕| 精品少妇久久久久久888优播| 三上悠亚av全集在线观看| 亚洲第一青青草原| 亚洲国产欧美一区二区综合| 亚洲免费av在线视频| 午夜日韩欧美国产| 女的被弄到高潮叫床怎么办| 国产毛片在线视频| 一级,二级,三级黄色视频| 狂野欧美激情性xxxx| xxxhd国产人妻xxx| 在线观看免费高清a一片| 国产亚洲av高清不卡| 亚洲欧美激情在线| 两个人免费观看高清视频| 久久99一区二区三区| 一本—道久久a久久精品蜜桃钙片| 中文字幕av电影在线播放| 悠悠久久av| 人人妻人人爽人人添夜夜欢视频| 亚洲人成电影观看| svipshipincom国产片| 一边摸一边抽搐一进一出视频| 久久国产精品男人的天堂亚洲| 最近中文字幕2019免费版| 亚洲国产av新网站| 午夜福利视频精品| 纯流量卡能插随身wifi吗| 国产精品二区激情视频| 欧美日韩成人在线一区二区| 欧美少妇被猛烈插入视频| 亚洲三区欧美一区| 午夜福利,免费看| 国产精品一国产av| 日本爱情动作片www.在线观看| 久久久久久免费高清国产稀缺| 深夜精品福利| 婷婷色综合大香蕉| 国产1区2区3区精品| 亚洲av在线观看美女高潮| 男女之事视频高清在线观看 | 国产一级毛片在线| 岛国毛片在线播放| 国产男女内射视频| 日韩中文字幕欧美一区二区 | 宅男免费午夜| 国产极品天堂在线| 久久久久久久久免费视频了| 一区二区三区激情视频| 宅男免费午夜| 亚洲色图 男人天堂 中文字幕| 久久精品久久精品一区二区三区| 青春草国产在线视频| 深夜精品福利| 亚洲国产av影院在线观看| 无限看片的www在线观看| 午夜影院在线不卡| 久久天躁狠狠躁夜夜2o2o | 亚洲欧洲精品一区二区精品久久久 | a 毛片基地| 国产精品二区激情视频| 精品国产一区二区久久| 亚洲四区av| 亚洲精品久久成人aⅴ小说| 男的添女的下面高潮视频| 成人影院久久| 欧美日韩亚洲高清精品| 国产探花极品一区二区| 国产极品粉嫩免费观看在线| 午夜日韩欧美国产| 丝袜喷水一区| 大话2 男鬼变身卡| 国产精品免费大片| 曰老女人黄片| 少妇被粗大的猛进出69影院| a级毛片在线看网站| 男女边吃奶边做爰视频| 国产 精品1| 伦理电影大哥的女人| svipshipincom国产片| 18禁观看日本| videosex国产| 最新在线观看一区二区三区 | 日本色播在线视频| 国产精品久久久久成人av| 午夜福利乱码中文字幕| 中文欧美无线码| 色播在线永久视频| 午夜福利乱码中文字幕| 成人国产麻豆网| 亚洲欧美精品综合一区二区三区| 亚洲成av片中文字幕在线观看| 亚洲av成人精品一二三区| 夜夜骑夜夜射夜夜干| 午夜免费观看性视频| 成人手机av| 99久久99久久久精品蜜桃| 天天影视国产精品| a级毛片在线看网站| 久久久久久久久免费视频了| 久久久久久人妻| 中文字幕人妻丝袜制服| 国产男女内射视频| 国产精品久久久久久久久免| 亚洲人成77777在线视频| 啦啦啦在线观看免费高清www| 色婷婷久久久亚洲欧美| 亚洲第一青青草原| bbb黄色大片| av女优亚洲男人天堂| 国产精品二区激情视频| 精品一区二区三区四区五区乱码 | 亚洲av成人精品一二三区| 亚洲自偷自拍图片 自拍| 久久久欧美国产精品| 最黄视频免费看| 亚洲自偷自拍图片 自拍| 另类亚洲欧美激情| 别揉我奶头~嗯~啊~动态视频 | 中文天堂在线官网| 国产成人a∨麻豆精品| avwww免费| 日本午夜av视频| 中文字幕精品免费在线观看视频| 亚洲人成网站在线观看播放| 成人国产麻豆网| 丝袜脚勾引网站| 黄色视频不卡| 亚洲国产中文字幕在线视频| 久久久久久人人人人人| 国产女主播在线喷水免费视频网站| 两个人看的免费小视频| 国产亚洲av片在线观看秒播厂| 黄片无遮挡物在线观看| 欧美人与性动交α欧美软件| 欧美黑人欧美精品刺激| 国产男人的电影天堂91| 丝袜在线中文字幕| 男女下面插进去视频免费观看| 亚洲精品av麻豆狂野| 欧美黑人精品巨大| 日韩制服骚丝袜av| 亚洲欧美精品综合一区二区三区| 黄色一级大片看看| 国产男女内射视频| 伊人久久大香线蕉亚洲五| 91国产中文字幕| 男人爽女人下面视频在线观看| 精品酒店卫生间| 黑人猛操日本美女一级片| 亚洲专区中文字幕在线 | 男女边摸边吃奶| 久久97久久精品| 秋霞伦理黄片| 精品久久久久久电影网| 侵犯人妻中文字幕一二三四区| 亚洲欧美成人精品一区二区| 少妇人妻 视频| 日韩免费高清中文字幕av| 宅男免费午夜| 2018国产大陆天天弄谢| 国产爽快片一区二区三区| 亚洲国产精品一区二区三区在线| 黄色怎么调成土黄色| 久久毛片免费看一区二区三区| 免费人妻精品一区二区三区视频| 精品少妇内射三级| 国产精品久久久人人做人人爽| 亚洲色图 男人天堂 中文字幕| 中文字幕精品免费在线观看视频| 宅男免费午夜| 爱豆传媒免费全集在线观看| 建设人人有责人人尽责人人享有的| 亚洲人成77777在线视频| 国产片内射在线| 亚洲精品一区蜜桃| 亚洲av国产av综合av卡| 亚洲婷婷狠狠爱综合网| 久久av网站| 国产亚洲午夜精品一区二区久久| 欧美精品高潮呻吟av久久| av免费观看日本| 在线免费观看不下载黄p国产| 欧美xxⅹ黑人| av卡一久久| 久久精品国产亚洲av涩爱| 国产精品三级大全| tube8黄色片| 亚洲av成人精品一二三区| 如何舔出高潮| 最新的欧美精品一区二区| 日本欧美国产在线视频| 五月开心婷婷网| 搡老乐熟女国产| 午夜影院在线不卡| 极品人妻少妇av视频| 超碰97精品在线观看| 满18在线观看网站| 啦啦啦视频在线资源免费观看| 国产精品国产av在线观看| 成人国产av品久久久| 久久ye,这里只有精品| 免费黄频网站在线观看国产| 国产熟女午夜一区二区三区| 狂野欧美激情性bbbbbb| 男女下面插进去视频免费观看| 精品久久久精品久久久| 看十八女毛片水多多多| 国精品久久久久久国模美| 免费在线观看完整版高清| 亚洲欧洲日产国产| 亚洲伊人色综图| 一区二区av电影网| 亚洲美女搞黄在线观看| 亚洲欧洲国产日韩| 纯流量卡能插随身wifi吗| 成人黄色视频免费在线看| 麻豆精品久久久久久蜜桃| 亚洲精品aⅴ在线观看| 一区二区三区乱码不卡18| 伦理电影大哥的女人| 国产成人av激情在线播放| 精品一品国产午夜福利视频| 一本—道久久a久久精品蜜桃钙片| 久久精品国产a三级三级三级| 婷婷色麻豆天堂久久| 午夜激情av网站| 51午夜福利影视在线观看| 老司机深夜福利视频在线观看 | 日韩成人av中文字幕在线观看| 18禁国产床啪视频网站| 久久久久人妻精品一区果冻| 免费看不卡的av| 国产亚洲最大av| 日韩一区二区视频免费看| 亚洲av男天堂| 精品亚洲成国产av| 少妇的丰满在线观看| 国产精品麻豆人妻色哟哟久久| 国产麻豆69| 欧美日韩亚洲高清精品| 18在线观看网站| 亚洲精品日本国产第一区| 丝袜美腿诱惑在线| 91精品伊人久久大香线蕉| 不卡视频在线观看欧美| 成人漫画全彩无遮挡| av视频免费观看在线观看| 男女边吃奶边做爰视频| 欧美av亚洲av综合av国产av | 亚洲欧美中文字幕日韩二区| 天堂中文最新版在线下载| 国产在视频线精品| 女性生殖器流出的白浆| 我的亚洲天堂| 捣出白浆h1v1| 观看美女的网站| 亚洲,欧美精品.| 欧美中文综合在线视频| 一个人免费看片子| 精品一区二区三区四区五区乱码 | 丰满乱子伦码专区| 精品一区二区三卡| 中文字幕色久视频| videos熟女内射| 亚洲成国产人片在线观看| 国产一区有黄有色的免费视频| 日日撸夜夜添| 亚洲专区中文字幕在线 | 下体分泌物呈黄色| 亚洲国产精品一区二区三区在线| 国产在视频线精品| 精品国产一区二区三区久久久樱花| 高清不卡的av网站| 日韩,欧美,国产一区二区三区| av国产精品久久久久影院| 美女高潮到喷水免费观看| 热re99久久国产66热| 免费女性裸体啪啪无遮挡网站| 老司机深夜福利视频在线观看 | 无限看片的www在线观看| 国产精品av久久久久免费| 天天躁日日躁夜夜躁夜夜| 欧美日韩一区二区视频在线观看视频在线| 一本久久精品| 最近最新中文字幕大全免费视频 | 色婷婷久久久亚洲欧美| 永久免费av网站大全| 久久久久精品性色| 精品福利永久在线观看| 水蜜桃什么品种好| 最新的欧美精品一区二区| 美女视频免费永久观看网站| 美女主播在线视频| 免费黄网站久久成人精品| e午夜精品久久久久久久| 欧美97在线视频| 9色porny在线观看| 亚洲国产日韩一区二区| 午夜福利视频精品| 国产高清不卡午夜福利| 欧美人与性动交α欧美软件| 国产成人精品久久二区二区91 | 在线观看一区二区三区激情| 免费久久久久久久精品成人欧美视频|