Utilizing ultra-small volume graft in auxiliary liver transplantation for portal hypertension / 中华外科杂志

Objective: To examine the clinical effect of auxiliary liver transplantation with ultra-small volume graft in the treatment of portal hypertension. Methods: Twelve cases of portal hypertension treated by auxiliary liver transplantation with small volume graft at Liver Transplantation Center,Beijing Friendship Hospital, Capital Medical University between December 2014 and March 2022 were studied retrospectively. There were 8 males and 4 females,aged 14 to 66 years. Model for end-stage liver disease scores were 1 to 15 points and Child scores were 6 to 11 points. The grafts was derived from living donors in 9 cases,from split cadaveric donors in 2 cases,from whole cadaveric liver of child in 1 case. The graft recipient body weight ratios of 3 cadaveric donor livers were 0.79% to 0.90%, and of 9 living donor livers were 0.31% to 0.55%.In these cases, ultra-small volume grafts were implanted. The survivals of patient and graft, complications, portal vein blood flow of residual liver and graft, abdominal drainage and biochemical indexes of liver function were observed. Results: All the grafts and patients survived. Complications included outflow tract torsion in 2 cases, acute rejection in 1 case, bile leakage in 1 case, and thyroid cancer at the later stage of follow-up in 1 case, all of which were cured. The torsion of outflow tract was attributed to the change of anastomotic angle after the growth of donor liver. After the improvement of anastomotic method, the complication did not recur in the later stage. There was no complication of portal hypertension. The measurement of ultrasonic portal vein blood flow velocity showed that the blood flow of residual liver decreased significantly in the early stage after operation, and maintained a very low blood flow velocity or occlusion in the long term after operation, and the blood flow of transplanted liver was stable. Conclusions: Auxiliary liver transplantation can implant ultra-small donor liver through compensation of residual liver. This method may promote the development of living donor left lobe donation and split liver transplantation. However, the auxiliary liver transplantation is complex, and it is difficult to control the complications. Therefore, this method is currently limited to centers that are skilled in living related liver transplantation and that have complete ability to monitor and deal with complications.

Awareness of HPV and HPV vaccine and willingness to be vaccinated among parents of children aged 9-14 / 公共卫生与预防医学

Objective To investigate the HPV vaccination status of children aged 9-14 years, parents’ vaccine-related cognition, willingness to vaccinate children and their influencing factors. Methods From January to April 2021, the convenience sampling method was used to collect data based on the online platform and the Department of Pediatrics and Adolescent Gynecology of the Children's Hospital of Zhejiang University School of Medicine. The data were analyzed by descriptive analysis, Chi-square test, and logistic regression. Results A total of 864 questionnaires were collected, and 846 valid questionnaires were obtained after screening, with an effective rate of 97.9%. 13.57% of mothers and 3.09% of girls were vaccinated, and the vaccine awareness rate was 68.43%. 87.22% of parents were willing to bring their children for vaccination. Risk perception (OR=4.79, 95% CI: 2.22-10.35), willingness to vaccinate themselves (OR =29.01, 95% CI: 12.62-66.69), awareness of sex education (OR =3.73, 95% CI: 1.08-12.83) and whether the vaccines were free (P<0.001) were related to whether parents were willing to vaccinate their children. Conclusion Parents of children aged 9-14 have high awareness of HPV and HPV vaccine and are willing to vaccinate their children with HPV vaccine , but the vaccination rate in children is low. Disease perception, willingness to vaccinate, awareness of sex education, and whether vaccines are free are all the factors influencing parents' willingness to vaccinate children.

Analysis of clinical phenotype and genotype of Chinese children with disorders of sex development / 中华儿科杂志

Objective: To explore the heterogeneity and correlation of clinical phenotypes and genotypes in children with disorders of sex development (DSD). Methods: A retrospective study of 1 235 patients with clinically proposed DSD in 36 pediatric medical institutions across the country from January 2017 to May 2021. After capturing 277 DSD-related candidate genes, second-generation sequencing was performed to analyzed the heterogeneity and correlation combined with clinical phenotypes. Results: Among 1 235 children with clinically proposed DSD, 980 were males and 255 were females of social gender at the time of initial diagnosis with the age ranged from 1 day of age to 17.92 years. A total of 443 children with pathogenic variants were detected through molecular genetic studies, with a positive detection rate of 35.9%. The most common clinical phenotypes were micropenis (455 cases), hypospadias (321 cases), and cryptorchidism (172 cases) and common mutations detected were in SRD5A2 gene (80 cases), AR gene (53 cases) and CYP21A2 gene (44 cases). Among them, the SRD5A2 mutation is the most common in children with simple micropenis and simple hypospadias, while the AMH mutation is the most common in children with simple cryptorchidism. Conclusions: The SRD5A2 mutation is the most common genetic variant in Chinese children with DSD, and micropenis, cryptorchidism, and hypospadias are the most common clinical phenotypes. Molecular diagnosis can provide clues about the biological basis of DSD, and can also guide clinicians to perform specific clinical examinations. Target sequence capture probes and next-generation sequencing technology can provide effective and economical genetic diagnosis for children with DSD.

Hepatocellular carcinoma recurrence in living and deceased donor liver transplantation: a systematic review and meta-analysis / 中华医学杂志(英文版)

Background@#Although a number of technical problems and donor safety issues associated with living donor liver transplantation (LDLT) have been resolved, some initial clinical studies showed an increased risk of hepatocellular carcinoma (HCC) recurrence in LDLT. This meta-analysis was conducted to assess differences in tumor recurrence between LDLT and deceased donor liver transplantation (DDLT).@*Methods@#After systematic retrievals of studies about LDLT and DDLT for HCC, articles were selected with a rationale of emphasizing inter-group comparability. Results from multivariate analyses were combined and discussed together with univariate analyses. In subgroup analysis, the impact of organ allocation policy was taken into consideration.@*Results@#Seven articles were included in the meta-analysis. Overall, a salient result that emerged from the seven studies was a significant increased risk of HCC recurrence in the LDLT group than in the DDLT group (P = 0.01). The most significant increase in hazard ratio was found in studies where organs tended to be allocated to non-tumor patients.@*Conclusions@#An increased risk for HCC recurrence in LDLT as compared with DDLT patients was found. The relatively shorter preoperative observation windows in LDLT may lead to fewer cases of HCC with invasive features being screened out, which may provide a possible explanation for the high rates of HCC recurrence.

Comparision between portosystemic shunts and endoscopic therapy for prevention of variceal re-bleeding: a systematic review and meta-analysis / 中华医学杂志(英文版)

Background:@#Portosystemic shunts, including surgical portosystemic shunts and transjugular intra-hepatic portosystemic shunt (TIPS), may have benefit over endoscopic therapy (ET) for treatment of variceal bleeding in patients with cirrhotic portal hypertension; however, whether there being a survival benefit among them remains unclear. This study was to compare the effect of three above-mentioned therapies on the short-term and long-term survival in patient with cirrhosis.@*Methods:@#Using the terms "variceal hemorrhage or variceal bleeding or variceal re-bleeding" OR "esophageal and gastric varices" OR "portal hypertension" and "liver cirrhosis," the Cochrane Central Register of Controlled Trials, PubMed, Embase, and the references of identified trials were searched for human randomized controlled trials (RCTs) published in any language with full texts or abstracts (last search June 2017). Risk ratio (RR) estimates with 95% confidence interval (CI) were calculated using random effects model by Review Manager. The quality of the included studies was evaluated using the Cochrane Collaboration’s tool for the assessment of the risk of bias.@*Results:@#Twenty-six publications comprising 28 RCTs were included in this analysis. These studies included a total of 2845 patients: 496 (4 RCTs) underwent either surgical portosystemic shunts or TIPS, 1244 (9 RCTs) underwent either surgical portosystemic shunts or ET, and 1105 (15 RCTs) underwent either TIPS or ET. There was no significant difference in overall mortality and 30-day or 6-week survival among three interventions. Compared with TIPS and ET, separately, surgical portosystemic shunts were both associated with a lower bleeding-related mortality (RR = 0.07, 95% CI = 0.01–0.32; P < 0.001; RR = 0.17, 95% CI = 0.06–0.51, P < 0.005) and rate of variceal re-bleeding (RR = 0.23, 95% CI = 0.10–0.51, P < 0.001; RR = 0.10, 95% CI = 0.04–0.24, P < 0.001), without a significant difference in the rate of postoperative hepatic encephalopathy (RR = 0.52, 95% CI = 0.25–1.00, P = 0.14; RR = 1.09, 95% CI = 0.59–2.01, P = 0.78). TIPS showed a trend toward lower variceal re-bleeding (RR = 0.46, 95% CI = 0.36–0.58, P < 0.001), but a higher incidence of hepatic encephalopathy than ET (RR = 1.78, 95% CI = 1.34–2.36, P < 0.001).@*Conclusions:@#The overall analysis revealed that there seem to be no short-term and long-term survival advantage, but surgical portosystemic shunts are with the lowest bleeding-related mortality among the three therapies. Surgical portosystemic shunts may be the most effective without an increased risk of hepatic encephalopathy and TIPS is superior to ET but at the cost of a higher incidence of hepatic encephalopathy. However, some of findings should be interpreted with caution due to the lower level of evidence and the existence of significant heterogeneity.

Hepatocellular carcinoma recurrence in living and deceased donor liver transplantation: a systematic review and meta-analysis / 中华医学杂志(英文版)

BACKGROUND@#Although a number of technical problems and donor safety issues associated with living donor liver transplantation (LDLT) have been resolved, some initial clinical studies showed an increased risk of hepatocellular carcinoma (HCC) recurrence in LDLT. This meta-analysis was conducted to assess differences in tumor recurrence between LDLT and deceased donor liver transplantation (DDLT).@*METHODS@#After systematic retrievals of studies about LDLT and DDLT for HCC, articles were selected with a rationale of emphasizing inter-group comparability. Results from multivariate analyses were combined and discussed together with univariate analyses. In subgroup analysis, the impact of organ allocation policy was taken into consideration.@*RESULTS@#Seven articles were included in the meta-analysis. Overall, a salient result that emerged from the seven studies was a significant increased risk of HCC recurrence in the LDLT group than in the DDLT group (P = 0.01). The most significant increase in hazard ratio was found in studies where organs tended to be allocated to non-tumor patients.@*CONCLUSIONS@#An increased risk for HCC recurrence in LDLT as compared with DDLT patients was found. The relatively shorter preoperative observation windows in LDLT may lead to fewer cases of HCC with invasive features being screened out, which may provide a possible explanation for the high rates of HCC recurrence.

Comparision between portosystemic shunts and endoscopic therapy for prevention of variceal re-bleeding: a systematic review and meta-analysis / 中华医学杂志(英文版)

BACKGROUND@#Portosystemic shunts, including surgical portosystemic shunts and transjugular intra-hepatic portosystemic shunt (TIPS), may have benefit over endoscopic therapy (ET) for treatment of variceal bleeding in patients with cirrhotic portal hypertension; however, whether there being a survival benefit among them remains unclear. This study was to compare the effect of three above-mentioned therapies on the short-term and long-term survival in patient with cirrhosis.@*METHODS@#Using the terms "variceal hemorrhage or variceal bleeding or variceal re-bleeding" OR "esophageal and gastric varices" OR "portal hypertension" and "liver cirrhosis," the Cochrane Central Register of Controlled Trials, PubMed, Embase, and the references of identified trials were searched for human randomized controlled trials (RCTs) published in any language with full texts or abstracts (last search June 2017). Risk ratio (RR) estimates with 95% confidence interval (CI) were calculated using random effects model by Review Manager. The quality of the included studies was evaluated using the Cochrane Collaboration's tool for the assessment of the risk of bias.@*RESULTS@#Twenty-six publications comprising 28 RCTs were included in this analysis. These studies included a total of 2845 patients: 496 (4 RCTs) underwent either surgical portosystemic shunts or TIPS, 1244 (9 RCTs) underwent either surgical portosystemic shunts or ET, and 1105 (15 RCTs) underwent either TIPS or ET. There was no significant difference in overall mortality and 30-day or 6-week survival among three interventions. Compared with TIPS and ET, separately, surgical portosystemic shunts were both associated with a lower bleeding-related mortality (RR = 0.07, 95% CI = 0.01-0.32; P < 0.001; RR = 0.17, 95% CI = 0.06-0.51, P < 0.005) and rate of variceal re-bleeding (RR = 0.23, 95% CI = 0.10-0.51, P < 0.001; RR = 0.10, 95% CI = 0.04-0.24, P < 0.001), without a significant difference in the rate of postoperative hepatic encephalopathy (RR = 0.52, 95% CI = 0.25-1.00, P = 0.14; RR = 1.09, 95% CI = 0.59-2.01, P = 0.78). TIPS showed a trend toward lower variceal re-bleeding (RR = 0.46, 95% CI = 0.36-0.58, P < 0.001), but a higher incidence of hepatic encephalopathy than ET (RR = 1.78, 95% CI = 1.34-2.36, P < 0.001).@*CONCLUSIONS@#The overall analysis revealed that there seem to be no short-term and long-term survival advantage, but surgical portosystemic shunts are with the lowest bleeding-related mortality among the three therapies. Surgical portosystemic shunts may be the most effective without an increased risk of hepatic encephalopathy and TIPS is superior to ET but at the cost of a higher incidence of hepatic encephalopathy. However, some of findings should be interpreted with caution due to the lower level of evidence and the existence of significant heterogeneity.

Outcomes of Liver Transplantation Using Pediatric Deceased Donor Livers: A Single-Center Analysis of 102 Donors / 中华医学杂志(英文版)

<p><b>Background</b>The outcome of pediatric deceased donor liver transplantation (LT) has not been well studied, especially pediatric deceased donor livers used in adult transplantation. This study aimed to evaluate the efficacy of LT using pediatric deceased donor livers and compare the outcomes between pediatric-to-pediatric LT and pediatric-to-adult LT.</p><p><b>Methods</b>A retrospective review of LT using pediatric deceased donor livers from June 2013 to August 2016 was performed. The patients were divided into the pediatric-to-pediatric LT group and pediatric-to-adult LT group based on the ages of the recipients. The survival and incidence of early vascular complications (VCs) were observed between the two groups. We also analyzed the risk factors of early VCs in pediatric LT and the effect of donor hypernatremia on the prognosis of recipients.</p><p><b>Results</b>There were 102 cases of LT using pediatric deceased donor livers in our hospital from June 2013 to August 2016, 83 pediatric-to-pediatric LT (recipients' age ≤13 years) and 19 pediatric-to-adult LT (recipients' age ≥19 years). The ratio of early VC was similar in the two groups (19.3% vs. 10.6%, P = 0.514). Low body weight of recipient was an independent risk factor of early VC in pediatric LT (odds ratio: 0.856, 95% confidence interval: 0.752-0.975, P = 0.019). The 1-year cumulative survival rates of grafts and patients were 89.16% and 91.57% in pediatric-to-pediatric LT and 89.47% and 94.74% in pediatric-to-adult LT, respectively (all P > 0.05). In all cases, patients using donors with hypernatremia (serum sodium levels ≥150 mmol/L) had worse graft survival (χ=4.330, P = 0.037).</p><p><b>Conclusions</b>Pediatric-to-pediatric LT group has similar graft and patient survival rates with those of pediatric-to-adult LT group. Low body weight of recipients is an independent risk factor of early VC in pediatric LT. Patients using donors with hypernatremia have worse graft survival.</p>

Risk Factors for Carbapenem-resistantInfection and Mortality ofInfection / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Klebsiella pneumoniae (KP) is a pathogen commonly causing nosocomial infection. Carbapenem-resistant KP (CRKP) is more resistant to multiple antimicrobial drugs than carbapenem-susceptible KP (CSKP) isolates. The aim of the present study was to identify the risk factors for CRKP infection and the predictors of mortality among KP-infected adult patients.</p><p><b>METHODS</b>Patients with CRKP and CSKP infection were categorized as the case group and control group, respectively, and we conducted a 1:1 ratio case-control study on these groups. The CRKP isolates collected were tested for antimicrobial susceptibility and presence of KP carbapenemase (KPC) gene. Clinical data were collected to identify risk factors for CRKP infection and mortality of KP infection. Risk factors were analyzed under univariable and multivariable logistic regression model.</p><p><b>RESULTS</b>The independent risk factors for CRKP infection were admission to Intensive Care Unit (odds ratio [OR]: 15.486, 95% confidence interval [CI]: 3.175-75.541, P < 0.001); use of β-lactams and β-lactamase inhibitor combination (OR: 4.765, 95% CI: 1.508-15.055, P = 0.008); use of cephalosporins (OR: 8.033, 95% CI: 1.623-39.763, P = 0.011); fluoroquinolones (OR: 6.090, 95% CI: 1.343-27.613, P = 0.019); and indwelling of urethral catheter (OR: 6.164, 95% CI: 1.847-20.578, P = 0.003). However, older age (OR: 1.079, 95% CI: 1.005-1.158, P = 0.036), Charlson comorbidity index (OR: 4.690, 95% CI: 2.094-10.504, P = 0.000), and aminoglycoside use (OR: 670.252, 95% CI: 6.577-68,307.730, P = 0.006) were identified as independent risk factors for patient deaths with KP infection. The mortality of CRKP group was higher than that of the CSKP group. KPC gene did not play a role in the CRKP group. CRKP mortality was high.</p><p><b>CONCLUSION</b>Implementation of infection control measures and protection of the immunefunction are crucial.</p>

Brief introduction to progress of national census of Chinese medicine resources (pilot) / 中国中药杂志

Since the beginning of 2011, with the strong support of the Ministry of Finance, the State Administration of Traditional Chinese Medicine has organized the pilot work on the census of traditional Chinese medicine resources (hereinafter referred to as the "pilot work"). At all levels of Chinese medicine management departments under the joint efforts of the pilot work has achieved initial results. For the fourth national comprehensive implementation of traditional Chinese medicine resources, the technical methods have been optimized, the working teams have been professionally trained, and the experiences are accumulated. All of these laid a solid foundation for the work. As of August 2017, through the "National Resources Survey Information Management System". The initial summary of the Chinese medicine resourcesdisplayed more than 200 million collected data, more than 500 million photos, and more than 20 million copies of dried specimens and other physical materials.Furthermore more than 40 species of new species were found by the participant workers participate in the relevant Chinese medicine resources survey. During the pilot work, a central platformhas initially formed, 28 provincial-level traditional Chinese medicine raw material quality monitoring technical service center, 66 county-level monitoring stations of Chinese medicine resources dynamic monitoring information and technical service system were established.The information monitoring services of 190 kinds of Chinese herbal medicine prices, circulation and planting area of six major categories of, Chinese herbal medicine quality, field management and other 10 categories of technical services were launched. In the 20 provinces (autonomous regions and municipalities), the construction of 28 Chinese herbal medicine seed breeding base were arranged, nearly 160 kinds of Chinese herbal medicine seed breeding production were carried out. And in Hainan and Sichuan province, two Chinese herbal medicine germplasm resources bases were established, preserve the germplasm resources collected in traditional Chinese medicine resources census work were preserved.

Probe into monitoring mechanism of Chinese materia medica resources / 中国中药杂志

Focusing on the problems of Chinese materia medica resources,and combining with the national Chinese materia medica resources survey, the paper probes into monitoring mechanism of Chinese materia medica resources. The establishment of the monitoring mechanism needs one organization and management agencies to supervise and guide monitoring work, one network system to gather data information, a group of people to perform monitoring work, a system of technical methods to assure monitoring work scientific and practical, a series of achievements and products to figure out the methods for solving problems, a group of monitoring index system to accumulate basic data, and a plenty of funds to keep normal operation of monitoring work.

Key content and formulation of national Chinese materia medica resources survey at county level / 中国中药杂志

According to National Census for Water, National Population Census, National Land and Resources Survey, and work experience of experimental measures for national Chinese materia medica resources(CMMR) survey,the national CMMR survey at the county level is the key point of whole survey, that includes organization and management, field survey, sorting data three key links. Organization and management works of national CMMR survey needs to finish four key contents, there are definite goals and tasks, practicable crew, preparation directory, and security assurance. Field survey works of the national CMMR survey needs to finish five key contents, there are preparation works for field survey, the choice of the key survey area (samples), fill in the questionnaire, video data collection, specimen and other physical collection. Sorting data works of the national CMMR survey needs to finish tree key contents, there are data, specimen and census results.

Formulation of technical specification for national survey of Chinese materia medica resources / 中国中药杂志

According to the process of the technical specification (TS) design for the fourth national survey of the Chinese materia medica resources (CMMR), we analyzed the assignment and objectives of the national survey and pointed out that the differences about CMMR management around China, the distribution of CMMR and their habitat, the economic and technological level, and even enthusiasm and initiative of the staff, etc. are the most difficult points for TS design. And we adopt the principle of combination of the mandatory and flexibility in TS design. We fixed the key points which would affect the quality of national survey first, then proposed the framework of TS which including 3 parts of organization and 11 parts of technique itself. The framework will serve and lead the TS preparation, which will not only provide an action standard to the national survey but will also have a profound influence to the popularization and application of the survey technology of CMMR. [Key words]

Prognosis analysis of hepatitis B virus recurrence after liver transplantation: a single-center study of 38 cases / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To analyze the prognosis of hepatitis B virus (HBV) recurrence after liver transplantation.</p><p><b>METHODS</b>Thirty-eight patients (37 males; 1 female) with HBV-related end-stage liver disease underwent liver transplantation at our institute between December 1998 and November 2009 and experienced HBV recurrence. Clinical data from pre-transplant and follow-up examinations were retrospectively retrieved from medical records, and included serologic indices of HBV (HBV DNA, markers of liver function) and histological findings from liver biopsy.</p><p><b>RESULTS</b>The median follow-up time was 45.1 months. The median time to HBV recurrence after transplantation was 31.8 months (range: 0.3 to 72.8 months) for histologically benign cases and 13.7 months (range: 0.3 to 66.6 months) for malignant cases. HBV DNA gene mutations were detected in 21% (8/38) of cases. Eighteen patients were treated with entecavir or adefovir, with respect to gene mutations, and HBV DNA fell below 103 copies/ml and liver function became normal. Twenty-two patients died, and causes of death included hepatocellular carcinoma (HCC, n=18), organ failure (n=2), or infection (n=1).</p><p><b>CONCLUSION</b>HBV gene mutations and HCC recurrence were important risk factors for HBV recurrence in our study population. In addition, patients with benign liver diseases who received salvage therapy with adefovir or entecavir achieved a satisfactory prognosis.</p>

Adult-to-adult living donor liver transplantation with 94 cases report / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the donor evaluation, surgical protocol, and the complication for the adult-to-adult living donor liver transplantation (AALDLT).</p><p><b>METHODS</b>There were 94 cases of AALDLT were performed by the same surgical team from January 2007 to August 2010. Patients aged from 18 to 74 years. Donors aged from 19 to 60 years. All the 94 cases' operation protocol as following, 2 cases with left lobe liver graft, 92 cases with right lobe graft, 44 cases with middle hepatic vein (MHV) harvested, and 48 cases without MHV. Assessment methods of donors, postoperative complications and the current survival were analyzed.</p><p><b>RESULTS</b>All the donors were discharged with good recovery, complication incidence of donor was 7.4%. Median time of follow-up was 37 months. Eight patients were died during follow-up, 1-year patient survival rate was 95.7%, and graft survival rate was 94.4%. One case complicated with small-for-size syndrome, 1 case was performed re-transplantation for acute hepatic necrosis, 24 patients (25.5%) showed biliary anastomotic stenosis defined cholangiography or magnetic resonance cholangiopancreatography examination, and 9 patients (9.6%) showed abnormal liver function.</p><p><b>CONCLUSIONS</b>Living donor liver transplantation is an effective treatment method for end-stage liver disease, with accurate evaluation preoperative, a reasonable surgical approach, whether using the left or right lobe liver graft, with or without middle hepatic vein in AALDLT can effectively ensure the donor and recipient safety.</p>

A method of measuring the displacement of the distal radioulnar joint on the three-dimensional CT imaging / 中华外科杂志

<p><b>OBJECTIVES</b>To establish a clinical method for measuring the displacement of the distal radioulnar joint (DRUJ) precisely irrespective of ulnar variance, and to derive normal population translation references with palmar and dorsal stress.</p><p><b>METHODS</b>Thirty-seven normal distal forearms were scanned with computed tomography using an apparatus designed by Pirela-Cruz. Each extremity was scanned in two positions: maximal ulnar palmar and dorsal stress. The digital imaging and communications in medicine (DICOM) CT images were then imported into Mimics 10.0 for three-dimensional reconstruction. On the DRUJs 3D images, choose the most prominent point of the palmar and dorsal margins of the sigmoid notch and the excavate ulna fovea as the reference points A, B and C. A perpendicular line was then drawn from the point C to a line connecting points A and B with the intersection D. Calculate the ratio of AD/AB and DB/AB. Two observers measured all the DRUJs independently and one repeated the measurements one month later to determine the interobserver and intraobserver reliability.</p><p><b>RESULTS</b>The mean ratio values of palmar (AD/AB) and dorsal (DB/AB) translation were 0.39 ± 0.07 and 0.37 ± 0.07, and the normal references (x(-) ± 2 s) were from 0.25 to 0.50 and from 0.23 to 0.50, respectively. No significant differences were observed in terms of positions, genders and dominant hands. The intraclass correlation coefficient (ICC) values for interobserver and intraobserver reliability (DB/AB, AD/AB) were 0.84, 0.80, 0.93 and 0.92, respectively.</p><p><b>CONCLUSIONS</b>This new method could accurately measure the displacement of DRUJs with acceptable reliability, even with ulna positive or negative variance. Instability of DRUJ may be indicated when AD/AB is less than 0.25 or BD/AB is less than 0.23.</p>

Long-term complications after liver transplantation / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the long-term complications after liver transplantation.</p><p><b>METHODS</b>Totally 85 living patients who received liver transplantation from December 30th 1998 to May 28th 2002 in Tianjin First Central Hospital were followed up till October 2007. Liver and kidney functions, blood drug levels, blood pressure, blood sugar, and blood fat were recorded and ultrasound imaging was performed during follow-up.</p><p><b>RESULTS</b>At the end of the study, most patients had experienced one or more complications of prolonged immunosuppressant treatment, including posttransplantation diabetes mellitus (21.18%, 18/85), hypertension (10.59%, 9/85), renal impairment (8.24%, 7/85), hyperlipemia (7.06%, 6/85), hyperuricaemia (7.06%, 6/85), denovo malignancy (2.35%, 2/85), new-onset hepatitis C (7.06%, 6/ 85), recurrent hepatitis B (5.56%, 4/72).</p><p><b>CONCLUSION</b>Recipients of liver transportation often suffers long-term complications, which should be carefully managed to improve their quality of life.</p>

Effect of Earlier Nasal Continuous Positive Airway Pressure Applying on Pulmonary Function in Neonates with Pulmonary Dyspnea / 实用儿科临床杂志

Objective To explore the influence of earlier nasal continuous positive airway pressure(NCPAP) applying on pulmonary function,and evaluate the clinical results of the early application of NCPAP.Methods Ninety newborn infants with pulmonary dynspnea treated with face mask from Jan.2000 to Nov.2002 were selected as control group.One hundred and ten patients treated with NCPAP from Dec.2002 to Dec.2006 were selected as treatment group.Treatment group applied KD-300 CPAP oxygen therapy equipment NCPAP delivering oxygen.Setting up and adjusting parameter: the beginning flow volume 6-8 L/min,the oxygen therapy bulk(FiO2)30%-50%,the NCPAP pressure was 0.195-0.488 kPa,parameter was adjusted according to the sickness and detecting the transcutancous oxygen saturation(TcSO2).If nasal cannulae Oxygen therapy couldn′t keep the TcSO2 in 85%-93%,the patients in control group were used face mask,small face mask,the oxygen flow vo-lume was 6 L/min,three holes,average FiO2 was 59%.The artery blood oxygen partial pressure [pa(O2)],artery blood carbon dioxide partial pressure [pa(CO2)],oxygenation index(OI),respiration rate(RR) of 2 groups after therapy 4,24 and 72 h were observed,also the difference of recovery rate between the 2 groups were analyzed.Results Compared with the control group,pa(O2) and OI after the application of NCPAP in treatment group were obviously improved(Pa