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Objective To investigate the risk factors for early-stage complications among liver transplant recipients, and to establish and validate a risk prediction model for early-stage complications after transplantation. Methods A retrospective analysis was performed for the clinical data of 234 patients who underwent orthotopic liver transplantation in Department of Liver Transplantation, Tianjin First Central Hospital, from January 2016 to December 2018. According to the presence or absence of Clavien-Dindo grade ≥Ⅲ complications after liver transplantation, the patients were divided into complication group with 97 patients and non-complication group with 137 patients. The two groups were compared in terms of the indices including age, sex, body mass index (BMI), blood type, psoas muscle thickness/height (PMTH), Controlling Nutritional Status (CONUT) score, Model for End-Stage Liver Disease (MELD) score, total serum bilirubin, serum creatinine, international normalized ratio of prothrombin time, blood urea nitrogen, hemoglobin, white blood cell count, platelet count, amount of intraoperative red blood cell transfusion, amount of frozen plasma transfusion, blood loss, anhepatic phase, time of operation, donor age, donor BMI, cold ischemia time of donor liver, and warm ischemia time of donor liver. The independent samples t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. Univariate analysis and the binary logistic regression analysis were used to investigate the risk factors for early-stage complications after liver transplantation, and a risk prediction model for complications after liver transplantation was established based on the method for establishing a scoring system using the logistic model provided by Framingham Research Center. Internal validation of the model was performed by C-index, receiver operating characteristic (ROC) curve, calibration curve, and the Hosmer-Lemeshow test, and the decision curve was used to evaluate the clinical applicability of the model. The Kaplan-Meier method was used to compare the incidence rate of early-stage complications after liver transplantation between the patients with different risk scores. Results Compared with the non-complication group, the complication group had significantly higher MELD score, proportion of patients with low PMTH, total serum bilirubin, serum creatinine, blood urea nitrogen, CONUT score, amount of intraoperative red blood cell transfusion, and amount of frozen plasma transfusion, as well as a significantly lower level of hemoglobin (all P < 0.1). The multivariate binary logistic regression analysis showed that MELD score (odds ratio [ OR ]=1.104, 95% confidence interval [ CI ]: 1.057-1.154, P < 0.05), PMTH ( OR =2.858, 95% CI : 1.451-5.626, P < 0.05), and CONUT score ( OR =1.481, 95% CI : 1.287-1.703, P < 0.05) were independent risk factors for grade ≥Ⅲ complications in the early stage after liver transplantation. MELD score, PMTH, and CONUT score were included in a predictive model, and this model had the highest score of 24 points, a C-index of 0.828, an area under the ROC curve of 0.812( P < 0.001), a sensitivity of 0.792, and a specificity of 0.751, suggesting that this predictive model had good discriminatory ability. The calibration curve of this model was close to the reference curve, and the Hosmer-Lemeshow test obtained a chi-square value of 8.528( P =0.382), suggesting that this predictive model had a high degree of fitting. The decision curve showed that most patients were able to benefit from the predictive model and achieved a high net benefit rate, suggesting that this predictive model had good clinical applicability. The score of 11 was selected as the cut-off value according to the optimal Youden index of 0.507, and the patients were divided into low-risk (< 8 points) group with 55 patients, moderate-risk (8-10 points) group with 63 patients, high-risk (11-14 points) group with 67 patients, and extremely high-risk (≥15 points) group with 49 patients. These four groups had a 90-day cumulative incidence rate of early-stage postoperative complications of 3.6%, 28.6%, 59.7%, and 75.5%, respectively, and the incidence rate of complications increased with the increase in risk score ( P < 0.001). Conclusion MELD score, PMTH, and CONUT score are independent risk factors for early-stage complications among liver transplant recipients, and the risk prediction model established based on these factors has a high predictive value in high-risk patients.
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Thrombotic thrombocytopenic purpura (TTP) is a rare hematological disease with typical clinical manifestations of thrombocytopenic purpura, microangiopathic hemolytic anemia, neurological symptoms, fever and kidney damage. Two patients with TTP-associated cerebral infarction complicated with microhemorrhage and their shared specific imaging findings manifestations were reported. The magnetic resonance imaging of the 2 patients showed multiple cerebral infarctions at different stages. Susceptibility-weighted imaging showed cerebral microbleeds in the infarcted area. This special imaging feature can provide important clues for early identification and diagnosis of TTP nervous system injury.
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With the increasing demand for liver donors, more and more marginal donors have been used. How to use fatty liver grafts has become a new issue that physicians in the department of liver transplantation must face. Compared with the normal donor liver, fatty liver grafts have high incidence of postoperative complications and increase the difficulty of clinical cure. This review describes the measures to improve the prognosis of recipients of fatty liver transplantation, and points out that these measures can reduce the risk of fatty liver transplantation and thus increase the utilization of fatty liver grafts.
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Objective To investigate the relationship between drinking-water type of endemic arsenicosis and adult carotid artery atherosclerosis. Methods In 2009, 285 participants aged over 40 from drinking-water type of endemic arsenism areas and 293 residents aged over 40 from control areas were investigated in Yingxian county,Shanxi province. Portable-type B mode color ultrasound was used to examine the carotid artery of all participants.The carotid atherosclerosis were diagnosed and graded through the ultrasonograms. Content of water arsenic and hair arsenic of 10 people randomly selected in every villages were detected. Results A total of 5 villages with drinkingwater type of endemic arsenicosis as observation group and 5 villages without drinking-water type of endemic arsenicosis as control group were investigated. The prevalence rates of adult carotid atherosclerosis within observation group were 35.09%(20/57), 55.74%(34/61), 38.46%(20/52), 36.51%(23/63) and 46.15%(24/52), respectively,and standardized prevalence rates were 32.5%, 33.8%, 34.9%, 46.2% and 47.3%, respectively and the prevalence rates of adult carotid atherosclerosis within control group were 18.18%(10/55), 30.77%(16/52), 20.00%(10/50),18.67% (14/75) and 21.31% ( 13/61 ), respectively; the standardize prevalence rates were 22.4%, 17.7%, 10.7%,24.6%, 18.9%, respectively. The standardize prevalence rates were higher in observation group [39.50%(113/285) ]than that in control group[39.50%(113/285), T = 26, P ＜ 0.01 ]. The severity of adult carotid atherosclerosis (composition of 4 - 7 scores ) was compared between observation group [ 17.70%(20/113 )] and control group [ 14.06% (9/64) ], and the difference was insignificant(x2 = 0.26, P ＞ 0.05). Conclusions The prevalence rate of carotid atherosclerosis in drinking-water type of endemic arsenicosis areas is higher than that of the control areas.The study provides evidence that arsenic poisoning can cause atherosclerosis.
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Objective To investigate the disease situation of adult carotid atherosclerosis in water-related endemic fluorosis areas in Heilongjiang province in 2008 so as to explore the relationship between water-related endemic fluorosis and incidence of carotid atherosclerosis disease. Methods A total of 266 participants over the age of 40 from four villages in Zhaozhou county with water fluoride ≥ 1.0 mg/L in a fluorosis area and 283 residents over the age of 40 from four villages in Tailai county with water fluoride ＜ 1.0 mg/L in a nonfluorosis area were investigated. A portable-type B mode color ultrasound was used to examine the left carotid artery of all participants.The carotid atherosclerosis was diagnosed and graded through the ultrasonograms. Results The prevalence rates of carotid atherosclerosis in the 4 fluorosis villages(Xinfeng, Taipingshan, Baochan and Houzheng villages) were 47.3% (35/74), 63.5%(40/63), 73.3%(33/45) and 60.7%(51/84), respectively, and in the 4 nonfluorosis villages(Hala,Qianxing, Sanjia and Ailin villages) were 32.7% (17/52), 32.9% (24/73), 39.2% (31/79) and 30.4% (24/79),respectively. The prevalence rates of carotid atherosclerosis in every villages standardized by age were 47.3% ,63.5%,73.3% ,60.7% and 34.7% ,36.3% ,43.0% ,41.3%, respectively. Statistic method used was Wilcoxon two sample test and the differences were significant(T = 26, P ＜ 0.05 ). Total carotid atherosclerosis positive rate standardized by age in the 4 fluorosis villages was significantly higher than that in the 4 nonfluorosis villages[57.5%(153/266) ,37.8% (107/283), x2 = 21.36, P ＜ 0.01 ]. After standardized by age, the severity of carotid atherosclerosis was significantly different between fluorosis villages and nonfluorosis villages (x2 = 36.15, P ＜ 0.01 ). Conclusion The prevalence rate of carotid atherosclerosis in endemic fluorosis area is higher than that in nonfluorosis area.
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Objective To research the curative effect of chondroitin sulfate and glucosamine on Kashin-Beck disease(KBD). Methods According to Diagnosis for Kashin-Beck disease,80 patients of adult KBD were detected from Guanghui village Shangzhi city Heilongjiang province in July,2007,and they divided into treatment group and control group according to their condition,age and sex,40 person in each group. Treatment group was given chondroitin sulfate and glucosamine sulfate,and control group was given placebo(equivalent amount of starch). Bilateral knees X-ray films were shot before and after treatment (8th month),scale division magnifying glass was used to measure the width of joint space on X-ray films. Results The width of joint space respectively was (4.30±2.14) and (4.10±2.07)mm in control group before and after treatment,and treatment group respectively was (4.17±2.15),(4.16±2.11)mm. Medicine had no obviously role on joint space (F = 0.50,P > 0.05),Time and both of time and medicine had obvious role on joint space(F= 67.66,46.74,all P< 0.05). Joint space of treat group was thinner than control group(P < 0.05) before treatment,but thicker after treatment(P < 0.05). To compare with the width of before treatment,joint space width of control group became obviously narrow(P < 0.05). Conclusions Experimental group taking chondroitin sulfate and glucosamine sulfate alleviated knee joint space narrowing process of adults KBD patients compared with control group. It plays a protection role in articular cartilage and provides evidences for choosing drug and evaluating effect in the treatment of adults KBD.
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Objective To assess the prevalence of carotid atherosclerosis in adult patients with KaschinBeck disease(KBD) in endemic area, and to investigate the association between KBD and atherosclerosis. Methods B-mode ultrasound was used to investigate carotid atherosclerosis in patients with KBD over 40 years old in Shanhe farm and Shangzhi city and residents in Shuangcheng county in 2009. Ultrasonography images were saved and graded according to intima media morphology. Results The prevalence rates of carotid atherosclerosis in patients with KBD from the 5 villages affiliated to Shanhe farm were 50.0%(26/52),37.3%( 19/51 ),42.5%(30/71 ),58.2% (39/67) and 44.0% (22/50) , respectively. The prevalence rates of carotid atherosclerosis in patients with KBD from the 5 villages affiliated to Shangzhi city were 63.0% (34/54), 45.3% (24/53), 47.2% (25/53), 60.0% (30/50)and 51.9% (28/54), respectively. The prevalence rates of carotid atherosclerosis in people without KBD in the 5 control villages affiliated to Shuangcheng county were 63.9% (46/72),43.1% (31/72),57.1% (40/70),46.9% (30/64) and 53.0%(35/66), respectively. Ten villages in KBD endemic area and 5 villages in control area were investigated. The prevalence rates of carotid atherosclerosis in the 15 villages were standardized and compared by Wilcoxon test. The differences were not significant between two KBD endemic areas and one control( T = 25.0,24.5,all P ＞ 0.05). There was no significant difference in prevalence of atherosclerosis in the 3 areas(x2 = 0.36, P＞0.05). Comparing the severity of carotid atherosclerosis in 3 locations, the difference was statistically significant (x2 = 15.28, P ＜ 0.05) and there was significant difference statistically between the subjects in Shangzhi city and that in the control group(x2 = 8.92, P ＜ 0.05). There was no significant difference between the detection rate of atherosclerosis and the severity of KBD, and similar results in the grade of atherosclerosis and the severity of KBD were found (x2 = 1.88,5.07, all P ＞ 0.05). Conclusions The prevalence rate of carotid atherosclerosis in historical endemic area in Heilongjiang province is not higher than that in the control area.
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Objective To survey the prevalence rates of adult carotid atherosclerosis in water-sourceoriginated high iodine area in Shandong province in 2008 and discuss the relationship between water-sourceoriginated high iodine and carotid atherosclerosis occurrence. Methods Yuncheng county was chosen as observation area which included Dachenlou, Weigai, Liuyi and Ershilipu villages. Juye county was chosen as control that included Zhangxi, Bihainan, Xiaguan and Qiji villages. Two hundred and ninety-nine participants aged over 40 from water-source-originated high iodine areas and 323 residents aged over 40 from normal iodine areas were investigated.Portable-type B mode color Doppler was performed to examine the carotid artery of all participants. The adult carotid atherosclerosis was diagnosed and graded through the ultrasonograms. Results The prevalence rates of adult carotid atherosclerosis in the 4 water-source-originated high iodine villages of Dachenlou, Weigai, Liuyi and Ershilipu were 47.1% (33/70) ,62.2% (51/82) ,67.5% (52/77) and 58.6% (41/70), respectively and the prevalence rates of adult carotid atherosclerosis in the 4 normal iodine villages of Zhangxi, Bihainan, Xiaguan and Qiji were 40.7%(35/86),40.8% (31/76),38.2% (34/89) and 37.5% (27/72), respectively. The prevalence rates of adult carotid atherosclerosis standardized by age in the 4 high iodine villages and the 4 normal iodine villages were 45.81% ,58.18% ,61.63%,55.34% and 34.66%,36.25%,43.01% ,41.30%, respectively. The prevalence rates were higher in high iodine villages than that in control villages(T = 26, P ＜ 0.05 ). There were 136 people scored "0", 120 people scored "1 -3",43 people scored "4 - 7", and total 299 people. There were 201 people scored "0", 87 people scored "1 - 3", 35 people scored "4 - 7", and total 323 people. The expected prevalence rates and severity of adult carotid atherosclerosis was significantly different between high iodine area and normal iodine area (x2 = 17.54,18.42, all P ＜ 0.01).Conclusion The prevalence rate and severity of adult atherosclerosis in water-source-originatod high iodine area is higher than that in normal iodine area.
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Objective To observe and scale knee joint space of the patients who suffered adults' Kaschin-Beck disease (KBD) in Shangzhi City of Heilongjiang Province in order to acquire basic knowledge for upcoming intervention trial. Methods Clinical test was proceeded in adults aged above 40 in Guanghui Village of Shangzhi City in 2007. In typical patients, bilateral knee X-ray was taken and knee joint space was scaled. Three points were chosen on inner and outer epicondyle of each knee and results were recorded. Results There were 307 peoples over the age of 40 in the village. Two hundred eighty-two accepted clinical test, in a rate of 91.9%. Eighty out of 282 suffered KBD, accounting for 28.4%. When the patients' condition became more serious, measurements from flank, middle, inside points on outer epicondyle of joint space presented a narrowing trend [degree Ⅰ: (5.85±0.17), (4.84±0.17), (4.36±0.18)mm; degree Ⅱ: (5.11±0.43), (4.24±0.34), (3.48±0.28)nun; degree Ⅲ: (3.59± 0.78), (3.10±0.56), (2.14±0.62)mm; Fflank,middle,inside= 6.547,5.372,10.302, all P < 0.05], but those on inner epicondyle of joint space did not[degree Ⅰ:(3.66±0.17), (3.47±0.17), (3.73±0.18)mm; degree Ⅱ:(3.55± 0.34), (3.54±0.29), (4.35±0.35)mm; degree Ⅲ: (3.19±0.72), (3.92±0.66), (4.51±0.72)ram; Finside,middle,flank= 0.351,0.356,1.883, all P > 0.05]. Joint space < 5.00 mm were found in 618, among which 363 were measured on inner epieondyle, obviously greater than those measured on outer epicondyle of joint space(255), the difference being statistically signifieant(χ2=9.59, P<0.05). Conclusions Adult cases of KBD occur in Guanghui Village. Knee joint space of adult patients narrows obviously, the more serious, the narrower, especially occurring more obviously on outer epicondyle, but frequently on inner epicondyle.
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Objective To discover and discuss the charac ter and statistics of frequency distribution of thyroid volume (TV) in Chinese c hildren aged 8,9,10 years for setting up an effective strategy to control the endemic goiter in China.Methods The TV is measured by B-ultrasonography.The da ta of a great sample collected from all country are treated with computer centra lly in Chinese Research Center for Endemic Disease Control.Results ①In 1999,the statistics of TV(ml) of children aged 8,9,10 years in China are 3.6 of mean,3.4 of median,3.0 of mode,5.9 of 95% point and 7.9 of 99% point.②The values of 95% point in frequency distribution of TV in 8,9,10 years of boy in order are 4.8,5.6 and 6.3,and in girl they are 5. 2,5.8 and 6.5.③The disparity in medians of TV of children is very significant between the studied provinces;the lowest is Shanghai,the mediums are Anhui and Sh anxi,and the higher ones are Chongqing,Guizhou and Xinjiang,and the medians of the TV in these three categories are 1.2,3.7 and 4.0 in order.④Differential effe cts of palpation method in detection of TV are discussed carefully in this paper .Conclusions The cause inducing to the significant diffe rences of children TV in several regions in China is not known yet,but it is not the nutritional problem of iodine certainly.
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Objective To observe the characteristics and statistics in the bi-variable distribution of thyroid volume (ml) and urine iodine level (μg/L) of children aged 8,9,10 years in China,1999.Methods Classing analysis.Results ①Data of 12982 cases collected from all country are analyzed with cluster method and three clusters are delimitated as follows;②in first cluster,according to the calculation of median,the volume of thyroid gland is small (2.2ml) and the level of urinary iodine is high (369.1μg/L);③in second cluster,the volume of thyroid gland is middle size (3.4ml) but the level of urinary iodine is significantly lower (88.0μg/L) than that in the first cluster;④in third cluster,the thyroid volume is highest (4.1ml) and the level of urine iodine is high (363.4μg/L),too;⑤the meanings of the classifying results are discussed in detail.Conclusions The results of the cluster analysis reported here and the typical analyses of the previous papers suggested that no low iodine problems be found out but the correlation between the increasing of thyroid volume and the higher level of urine iodine be observed by us in the studies.