Progress in perioperative management of ABO-incompatible pediatric liver transplantation / 中华外科杂志

ABO incompatible(ABO-I) liver grafts will affect the prognosis of liver transplantation. With the improvement of perioperative treatment,including plasma exchange,rituximab,splenectomy,etc.,the prognosis of ABO-I liver transplantation has been greatly improved. Because children's immune systems are not fully developed,the perioperative management of ABO-I pediatric liver transplantation is significantly different from that of adults. Reducing the perioperative anti-donor ABO antibody titer is the key to the perioperative management of ABO-I liver transplantation. This article summarizes literatures on the perioperative management of ABO-I pediatric liver transplantation, including the perioperative anti-rejection regimen in pediatric recipients of different ages, splenectomy, postoperative monitoring and postoperative complications, etc.

Review of risk evaluation scores for benign end stage liver diseases recipients / 中华外科杂志

Liver transplant is an unreplaceable method for benign end-stage liver disease. The risk evaluation for the waiting list recipients and for post-transplant survival could provide practical indication for organ allocation. In recent years, there are two major kinds of evaluation scores. The first kind of evaluation scores is based on model for end-stage liver disease(MELD) score,including SOFT/P-SOFT score,UCLA-FRS score and BAR score. The other evaluation system is based on the concept of acute-on-chronic liver failure,including CLIF-C-ACLF score,TAM score,AARC-ACLF score and COSSH-ACLF score. The scores based on ACLF have been shown superior power in predicting waiting list survival and post-transplant prognosis than MELD. This article reviews the two kinds of evaluation scores,aiming for the better allocation policy and the better prognosis of benign end-stage liver disease.

Review of risk evaluation scores for benign end stage liver diseases recipients / 中华外科杂志

Liver transplant is an unreplaceable method for benign end-stage liver disease. The risk evaluation for the waiting list recipients and for post-transplant survival could provide practical indication for organ allocation. In recent years, there are two major kinds of evaluation scores. The first kind of evaluation scores is based on model for end-stage liver disease(MELD) score,including SOFT/P-SOFT score,UCLA-FRS score and BAR score. The other evaluation system is based on the concept of acute-on-chronic liver failure,including CLIF-C-ACLF score,TAM score,AARC-ACLF score and COSSH-ACLF score. The scores based on ACLF have been shown superior power in predicting waiting list survival and post-transplant prognosis than MELD. This article reviews the two kinds of evaluation scores,aiming for the better allocation policy and the better prognosis of benign end-stage liver disease.

Prediction of postoperative pancreatic fistula using a nomogram based on the updated definition

PURPOSE@#The International Study Group on Pancreatic Fistula's definition of postoperative pancreatic fistula (POPF) has recently been updated. This study aimed to identify risk factors for POPF in patients having pancreaticoduodenectomy (PD) and to generate a nomogram to predict POPF.@*METHODS@#Data on 298 patients who underwent PD from March 2012 to October 2017 was retrospectively reviewed and POPF statuses were redefined. A nomogram was constructed using data from 220 patients and validated using the remaining 78 patients. Independent risk factors for POPF were identified using univariate and multivariate analyses. A predictive nomogram was established based on the independent risk factors and was compared with existing models.@*RESULTS@#Texture of the pancreas, size of the main pancreatic duct, portal vein invasion, and definitive pathology were the identified risk factors. The nomogram had a C-index of 0.793 and was internally validated. The nomogram performed better (C-index of 0.816) than the other most cited models (C-indexes of 0.728 and 0.735) in the validation cohort. In addition, the nomogram can assign patients into low- (less than 10%), intermediate- (10% to 30%), and high-risk (equal or higher than 30%) groups to facilitate personalized management.@*CONCLUSION@#The nomogram accurately predicted POPF in patients having PD.

Duct-to-mucosa versus invagination pancreaticojejunostomy after pancreaticoduodenectomy: a meta-analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Postoperative pancreatic fistula remains one of the most common and troublesome complications following pancreaticoduodenectomy. No consensus exists regarding the optimal pancreaticojejunostomy reconstruction technique to reduce this complication. We aimed to perform a systematic review comparing two commonly used techniques of pancreaticojejunostomy reconstruction (duct-to-mucosa versus invagination), by meta-analysis and assessment of evidence quality.</p><p><b>METHODS</b>Databases searched including The Cochrane Library, Medline, PubMed, Embase, etc. Randomized controlled trials (RCTs) comparing duct-to-mucosa and invagination pancreaticojejunostomy were included. Outcomes of interest were pancreatic fistula rate, mortality, morbidity, reoperation and hospital stay. Pooled estimates were expressed as risk ratio (RR) or mean difference.</p><p><b>RESULTS</b>From 321 identified abstracts, four RCTs (467 patients; duct-to-mucosa: 232; invagination: 235) were included. Pancreatic fistula rate (RR, 0.74; 95% confidence interval (CI): 0.24-2.28; P = 0.60), mortality (RR, 1.18; 95% CI: 0.39- 3.54; P = 0.77), morbidity (RR, 0.91; 95% CI: 0.69-1.21; P = 0.53), reoperation (RR, 1.09; 95% CI: 0.54-2.22; P = 0.81) and hospital stay (mean difference, -1.78; 95% CI: -4.60-1.04; P = 0.22) were similar between techniques.</p><p><b>CONCLUSIONS</b>Duct-to-mucosa and invagination pancreaticojejunostomy are comparable with regards to assessed parameters. High-quality, large-volume, multi-center RCTs with standard outcome definitions are required.</p>

Ecological-geographic landscapes of natural plague foci in China Ⅵ.biological characteristics of natural vectors of Yesinia pestis / 中华流行病学杂志

Objective To characterize the biological characteristics of natural vectors of Yesinia (Y.) pestis in China.Methods Species and genera of natural vectors of Y.pestis in China and their faunal distribution were characterized with modem insect taxonomic techniques.The ecological roles of natural vectors of Y.pestis in natural plague foci were determined according to insect ecological experiments.Results There were 63 species of natural vectors of Y.pestis including 28 major reservoirs and 35 secondary ones.Conclusion The biology characteristics of major vectors on Y.pestis and their roles in natural plague foci were defined.

Monitoring results and epidemic analysis of gerbil plague in northern Ningxia in 2009 / 中国地方病学杂志

Objective To analyze gerbil plague in northern Ningxia and the monitoring results,to master the plague epidemic dynamics,and to provide the basis for developmenting countermeasures.Methods Monitoring data of gerbil plague focus in northern Ningxia were collect in 2009,counted main host density,rate of dye fleas,flea body index and bacteriology,serology detect and analyzed the epidemic situation.Results An average density of main host was 1.74/hm2,the average rate of infected fleas was 28.60％,and the average rat body flea index was 0.76.Monitoring found 4 plagues from rat plague epidemic,plague bacteria were found in 16 strains,of which gerbils inspection bacteria 10 strains,Meriones unguiculatus 2 strains,the same type cheopis 2 strains,and bald disease fleas 2 strains.Indirect hemagglutination (IHA) was used to test 529 copies of samples,2 copies were found positive,and hemagglutination-positive rate was 0.38％; eight copies were examined by reverse indirect hemagglutination(RIHA),7 material were found positive,and hemagglutination-positive rate was 87.50％.Conclusions In recent years,the disease is active among animals in gerbil plague focus Ningxia.The density of rodents is higher,and local plague epidemic is found in rats.Monitoring efforts should be strengthened and scope of monitoring should be expanded.We should pay close attention to the epidemic dynamics,control the prevalence and spread of animal disease,and prevent the occurrence of human plague.

Deep inferior epigastric perforator (DIEP) free flap in immediate breast reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>In order to facilitate psychological rehabilitation of the women who underwent modified radical mastectomy for breast cancer, the DIEP free flap was used for immediate breast reconstruction in a series of patients. We present a review of the surgical outcomes.</p><p><b>METHODS</b>From December 2001 to January 2003, unilateral breast reconstruction was performed in 12 patients using the DIEP free flap at the same time of modified radical mastectomy in our department. The recipient vessels were the thoracodorsal artery and vein or the internal mammary artery and its venae concomitants.</p><p><b>RESULTS</b>Of the 12 DIEP flaps, 1 was vascularized by a single perforator, 3 were vascularized by two perforators, 6 by three perforators, 1 by four an 1 by five perforators. One flap failed totally, likely due to previous multiple lower abdominal operations. The eleven reconstructed breasts achieved almost the same size and shape as the healthy sides. The time of patient getting out of bed ranged from 3 to 7 days and the mean hospital stay was 8.8 days. All patients were satisfied with the outcome. No complications were observed in the abdominal wall, including weakness, abdominal bulge or hernia.</p><p><b>CONCLUSION</b>Immediate breast reconstruction facilitates the psychological rehabilitation and helps to avoid the dressing inconveniences resulted from total mastectomy. Free DIEP flap is a new and reliable technique for immediate breast reconstruction with autologous tissue. This flap offers the patients the same advantages as the TRAM flap and avoids its most important disadvantage of potential abdominal wall weakness, by preserving the continuity of the rectus abdominis muscle. The donor site morbidity is thus reduced and recovery is faster. The more complex nature of this procedure leads to increased operating time and requires more demanding surgical skills.</p>