Clinical practice of endoscopic ultrasound-guided liver biopsy among the liver transplant recipients / 中华消化内镜杂志

Objective:To investigate the application of endoscopic ultrasound-guided liver biopsy (EUS-LB) to liver transplant recipients.Methods:In this retrospective cohort study, a total of 12 liver transplant recipients who underwent EUS-LB by the same endoscopist and specimens were diagnosed and reported by the same pathologist due to abnormal liver function or need to be evaluated for graft fibrosis in the Organ Transplantation Center of the Affiliated Hospital of Qingdao University were enrolled into the EUS-LB group from December 2021 to March 2022, meanwhile, a total of 23 patients whose PLB was completed by the same hepatologist and specimens were diagnosed by the same pathologist during the same period were enrolled in the PLB group. Acquisition of liver specimens and postoperative adverse events of the two groups were compared.Results:Patients in both groups were punctured 1-2 times on average, and the median total length of liver specimens in the EUS-LB group was significantly longer than that in the PLB group (61 mm VS 17 mm, Z=11.362, P=0.002). There was no significant difference in the length of the longest liver specimens between the two groups (17.6±6.9 mm VS 13.7±3.5 mm, t=2.382, P=0.086), while the number of liver specimens in the EUS-LB group was more than that in the PLB group (4.8±2.1 VS 2.3±1.2, t=9.271, P=0.001). The number of complete portal tracts was 11.3±4.6 in the EUS-LB group and 6.2±3.3 in the PLB group ( t=8.457, P=0.003). Abdominal pain was the only postoperative adverse event, and only 1 patient in the EUS-LB group had postoperative abdominal pain, which was fewer than that in the PLB group [8.3% (1/12) VS 43.5% (10/23), χ2=4.893, P=0.036]. Conclusion:Compared with PLB, EUS-LB delivers longer liver biopsy specimens with more complete portal tracts in liver transplant recipients, and fewer recipients complain about postoperative pain in EUS-LB group. Therefore, EUS-LB is a safer, more effective and more comfortable liver biopsy method.

Preliminary experience of metabolic syndrome in patients with de-novo non-alcoholic fatty liver disease after liver transplantation / 中华内分泌外科杂志

Objective:To analyze the clinical characteristics of patients with de-novo non-alcoholic fatty liver disease (de-novo NAFLD) and patients with de-novo NAFLD combined with metabolic syndrome (MS) after liver transplantation (LT) , and to determine the related risk factors.Methods:Patients who underwent LT at the Organ Transplantation Center, the Affiliated Hospital of Qingdao University, from Jan. 2016 to Oc. 2020 and were monitored until Oct. 2021 were gathered. The recipients were divided into the group with/without de-novo NAFLD, and LT recipients with de-novo NAFLD were divided into the group with/without combined MS. Clinical characteristics of the LT recipients with de-novo NAFLD combined with MS were analyzed. Logistic regression analyses were performed to identify the risk factors for LT recipients with de-novo NAFLD and those with combined MS.Results:A total of 324 LT recipients with a median follow-up of 2.9 years (range: 2.0-4.3 years) were included in the study. De-novo NAFLD was diagnosed in 21.0% (68/324) of the LT recipients, and MS was diagnosed in 44.1% (30/68) of these patients. Compared with LT recipients without de-novo NAFLD, those with de-novo NAFLD had higher preoperative body mass index (BMI) , blood glucose, glycated hemoglobin levels and lower platelet levels, and longer postoperative follow-up, higher BMI, waist circumference, albumin, triglycerides (TG) , low-density lipoprotein (LDL) , blood glucose, glycated hemoglobin levels, and the incidence of MS (all P<0.05) . Preoperative platelets, glucose, postoperative albumin, LDL and BMI were independent risk factors for predicting de-novo NAFLD after LT (all P<0.05) . Preoperative glucose performed well in predicting the occurrence of de-novo NAFLD (threshold: 5.5mmol/L, P<0.001, AUC=0.678) . The differences in Pre-LT blood glucose, post-LT BMI, waist circumference, prevalence of prediabetes or diabetes, fatty liver index (FLI) , and NAFLD fibrosis score (NFS) between de-novo NAFLD LT recipients with and without combined MS were significantly different (all P<0.05) . Conclusions:The incidence of de-novo NAFLD after LT is noteworthy, and LT recipients with de-novo NAFLD are more likely to have a combination with MS. In preoperative treatment, keeping blood glucose to 5.5 mmol/L or below trends helps to lower the risk of de-novo NAFLD following LT. LT recipients’ nutritional state and lipid levels require prompt care. High albumin levels might not be a desirable thing. De-novo NAFLD LT recipients with concomitant prediabetes or diabetes may imply an increased risk of developing comorbid MS during the post-LT follow-up. Controlling FLI levels in LT recipients with de-novo NAFLD may reduce the risk of developing comorbid MS.

Stress hyperglycemia after pancreaticoduodenectomy in patients following enhanced recovery programmes / 中国实用护理杂志

Objective To investigate the effect of enhanced recovery after surgery (ERAS) on stress hyperglycemia in patients after pancreaticoduodenectomy (PD). Methods Patients matched inclusion and exclusion standards were divided into two groups. The patients after PD before the implementation of ERAS programme were named as the control group (40 cases). The patients after PD with the implementation of ERAS programme were named as the experimental group (52 cases). The fast blood glucose (FBG) in postoperative day (POD) 1, 3, 7 and the volatility of capillary blood glucose during postoperative 3 days were compared between the two groups. Results The FBG in POD1, POD3, POD7 were (8.27 ± 1.99), (6.78 ± 1.22), (5.97 ± 1.21) mmol/L in the experimental group respectively, and the FBG in POD1, POD3, POD7 were (10.46 ± 5.17), (7.88 ± 2.98), (7.29 ± 2.94) mmol/L in the control group respectively, there were significant differences between two groups (t=2.545, 2.219, 2.683, all P 0.05), while significant differences were found in the volatility of capillary blood glucose in POD3 between the two groups (t=2.739, P<0.05). Conclusions It can be concluded that ERAS may be useful to decrease stress hyperglycemia and the volatility of capillary blood glucosein patients after PD, and accelerate the recovery of patients after PD.

Research advances in primary biliary cholangitis / 临床肝胆病杂志

Primary biliary cholangitis is a chronic intrahepatic cholestatic liver disease and has increasing incidence and prevalence rates, as is reported in the literature. Examination of specific antibodies including serum anti-mitochondrial antibody subtype M2 and liver histopathological examination help to make a definite diagnosis of this disease. Ursodeoxycholic acid (UDCA) is often used for the treatment of this disease, but patients with an unsatisfactory biochemical response to UDCA tend to have rapid disease progression. At present, there are no effective treatment methods for such patients. The addition of budesonide, fenofibrate, bezafibrate, or obeticholic acid may be effective in these patients, but this needs to be verified by further clinical studies.

Study on social discrimination and its influencing factors of patients with menial disorders / 中华行为医学与脑科学杂志

Objective To describe the public discrimination against patients with mental disorders,and to explore its influencing factors.Methods This study was a descriptive study.A total of 1 378 public received the survey.The survey instruments include general information questionnaire and assessment scale of discrimination against patients with mental disorders.Results The scores of the scale of discrimination against patients with mental disorders was (2.07± 0.61).The score of risk dimension was higher(2.17±0.87),and the ability dimension was lower(1.65±0.64).Multiple regression analysis showed that factors influencing the total score of the scale were type of investigation objects,age,gender,educational background,contact degree and life connection degree to the patients with mental disorders.Conclusion Because psychiatric patients had perceived stigma,and social demographic factors,clinical factors,social and psychological factors could influence their perceived stigma,so the nurse should pay more attention to discrimination against patients,and reduce or eliminate the discrimination toward the patients,then promote recovery of the patients.