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Objective:To evaluate the short-term efficacy of split liver transplantation (SLT) in patients with acute-on-chronic liver failure (ACLF).Methods:The clinical data of 9 ACLF patients receiving SLT in our center from Mar 2021 to May 2022 were retrospectively analyzed to evaluate its safety and efficacy.Results:The preoperative APASL ACLF Research consortium (AARC) score of the 9 ACLF patients was 8 points in 1 case, 9 points in 3 cases, 10 points in 3 cases, 11 points in 1 case and 12 points in 1 case, 7 cases were in AARC-ACLF grade 2, and 2 cases in grade 3.In-situ liver splitting was performed in 9 deceased donors, including 4 classical split cases, 5 full size split cases. Among these 9 ACLF patients, 2 received left half liver transplantation, 3 received right half liver transplantation, and 4 received extended right lobe liver transplantation. After transplantation, all 9 recipients were discharged fully recovered, 1 case developed Clavien grade Ⅳa complication and 2 cases developed Clavien grade Ⅲb complication.After SLT treatment the median postoperative hospital stay was 27 days, the 1-year survival rate was 100%, and the organ survival rate was 88.9%.Conclusion:Split liver transplantation is a safe and feasible treatment method for ACLF patients.
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Objective:To evaluate and summarize the best evidence related to the management of cancer-related fatigue in children with leukemia and provide an evidence-based basis for clinical practice.Methods:The search for the relevant guidelines and evidence synthesis from UpToDate, JBI, Cochrane Library, Registered Nurses′ Association of Ontario, Guidelines International Network, National Institute for Health and Clinical Excellence, National Guideline Clearinghouse, YiMaiTong Guideline Network, National Comprehensive Cancer Network, PubMed, CINAHL, EMbase, China National Knowledge Infrastructure, Wanfang, China Biology Medicine from January 1st, 2012 to May 1st, 2022. Two researchers evaluated the quality of the literature independently according to the unified standard and extracted the best evidence.Results:A total of 13 literatures were extracted, including three clinical practice guidelines, two evidence summaries and eight systematic reviews. Finally, 22 pieces of evidence were summarized, involving six aspects which were environmental management, cancer-related fatigue assessment, exercise management, adventure therapy, sleep management and psychosocial interventions.Conclusions:Best evidence for the management of cancer-related fatigue in children with leukemia, which should be used in conjunction with the environment, the child's age, physical ability, medical condition and psychological acceptability to develop an individualized symptom management plan to improve the quality of care and the child′s quality of life.
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Objective:To explore the feasibility of technological modification and innovation of full-left/full-right liver splitting in situ for donors and examine the safety of clinical application for liver transplantation (LT).Methods:From March 2021 to June 2022, clinical and surgical data are retrospectively reviewed for 27 donors undergoing full-left/full-right liver splitting in situ and the corresponding 49 recipients undergoing full-left/full-right LT.According to the split liver technique used in donor liver surgery, they are divided into conventional split group(group A, 13 cases)and innovative split group(group B, 14 cases). The corresponding recipients are divided into two groups of recipient C(25 cases)and recipient D(24 cases). General profiles, intraoperative findings, type of vascular allocation and short-term outcomes in two groups are compared.After full-size split liver transplantation(fSLT), follow-ups continued until the end of September 2022.Results:There are 23 males and 4 females in donors.The causes of mortality for donors are traumatic head injury(12 cases)cerebrovascular accident(13 cases)and anoxia encephalopathy(2 cases). Baseline characteristics of two groups indicate that body weight and body mass index(BMI)are higher in group B and blood sodium level is lower than that in group A( P<0.05). No statistical differences exist for the others.Liver splitting time is significantly shorter in group B than that in group A(175 vs.230 min, P=0.022). No significant inter-group difference exists in type of vascular allocation.Retrohepatic inferior vena cava(IVC)is split in one case in group A and 10 cases in group B( P=0.001). Among 20 cases of right hemiliver requiring a reconstruction of segment Ⅴ/Ⅷ venous outflow, 12 cases in group A and 3 cases in group B are reconstructed with conventional independent bridging method(independent type)while another 5 cases in group B reconstruct with innovated technique by bridging Ⅴ/Ⅷ vein for splitting IVC with iliac vessel and molding all outflows as one for anastomosis(combined typ e). There is significant inter-group difference( P=0.004). No significant differences exist in operative duration, anhepatic phase or blood loss between groups C and B, except for T tube retaining in 7 cases of group A and 14 cases of group D( P=0.032). Twelve cases developed a total of 26 instances of≥Clavien-Dindo grade Ⅲ complications.Of which, 7 cases in group C and 5 cases in group D show no significant difference in postoperative morbidity.However, for serious biliary complications(≥Clavien Dindo grade Ⅲ), there are 6 cases in group C versus none in group D( P=0.016). Two cases died from postoperative complication with a postoperative mortality rate of 4.1%.Postoperative hospital stay is similar in two groups.And accumulates 6/12-month survivals were 95.9% and 87.7% for grafts and 95.9% and 92.4% for recipients respectively. Conclusions:Operative duration of full-left/full-right liver splitting in situ tends to shorten with an accumulation of a certain amount of cases.Technological modification and innovation in IVC splitting and segment Ⅴ/Ⅷ vein reconstruction should be further validated as both feasible and safe by short-term outcomes of the corresponding recipients.
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Objective:To explore the inner experience and influencing factors of caregivers′ decision-making process in children with hematological tumors treated by Chimeric antigen receptor T cells (CAR-T) cell clinical trial, so as to provide reference for children and caregivers treated with CAR-T cells to carry out targeted health education and psychological support.Methods:Using the phenomenological method of qualitative study, the caregivers of 11 children were interviewed by semi-structured interview, the data were analyzed by Colaizzi analysis method, and the text data were managed, explored and searched by NVivo10.0 software.Results:The caregivers of children with hematological tumors had three topics: complex psychological experience in the initial stage of CAR-T treatment decision-making process, consultation approach and experience in the decision-making process, and overall decision-making quality evaluation.Conclusions:Pay attention to and understand the psychological experience of caregivers in CAR-T cell clinical trials, provide diversified decision-making counseling for caregivers, and ensure the right of caregivers to participate in decision-making, so as to improve caregivers′ treatment and nursing compliance.
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Hepatocellular carcinoma is a common malignancy of digestive system. Tumor markers are important for the early diagnosis and prognosis of hepatocellular carcinoma. Protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-Ⅱ) is of high specificity and sensitivity in hepatocellular carcinoma diagnosis. In addition, previous studies suggested that PIVKA-Ⅱ played a role in proliferation, invasion and metastasis of hepatocellular carcinoma and could be used for prognosis of hepatocellular carcinoma. This article reviewed the recent advances in the underlying biological mechanism of PIVKA-Ⅱ in hepatocellular carcinoma and concluded the value of PIVKA-Ⅱ in hepatocellular carcinoma diagnosis and prognosis.
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Objective:To research the application of deliberated Teach-back combined with Internet+nursing clinical pathway on Gartland type Ⅲ supracondylar fractures.Methods:A total of 51 children with Gartland type III supracondylar fractures who were hospitalized from March 2018 to May 2018 were selected as the control group, and 46 children with Gartlnd type III supracondylar fractures who were hospitalized from June 2018 to August 2018 were selected as the experimental group. The control group was given the traditional perioperative care routines, and the experimental group was given the Internet + perioperative clinical pathway combined with Teach-back for perioperative period.The execute accuracy of fasting and banned drinking was checked between the two groups, the incidence of postoperative needle infection was compared between the two groups, the function of the elbow joint was evaluated according to the Flynn score, the hospitalization days and hospitalization expenses were compared between the two groups.Results:The execute accuracy of fasting and banned drinking was 64.71%(33/51), 58.82%(30/51) in the control group and 86.96%(40/46), 84.78%(39/46)in the experimental group, and there were statistically significant differences between the two groups( χ2 values were 6.431, 7.937, P<0.05 or 0.01). The incidence of postoperative needle infection was 35.29%(18/51) in the control group and 2.17%(1/46) in the experimental group, and there were statistically significant differences between the two groups( χ2 value was 16.844, P<0.01). The difference of Flynn scores after 4 weeks operation between the two groups was statistically significant( P<0.01), but there was no significant difference after 6 weeks operation between the two groups( P>0.05). The hospitalization days and hospitalization expenses were(2.03±0.04) d, (10 135.403±94.384) yuan RMB in the experimental group, and (4.94±0.14) d, (12 577.646±192.604) yuan RMB in the control group, and there were statistically significant differences between the two groups( t values were 21.256, 11.386, P<0.01 or 0.05). Conclusions:The use of Teach-back combined with Internet + nursing clinical pathway on the Gartland type III supracondylar fracture of the humerus can improve the accuracy of preoperative fasting and banned drinking execut and reduce postoperative needle infection. The elbow function of the affected limb is significantly improved 4 weeks after operation. The hospitalization days and hospitalization expenses are reduced and the effect is significantly better than regular care, Which has the value of further clinical research and promotion and application.
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Objective To study the safety,feasibility and efficacy of trans-diaphragm thoracoscopic hepatectomy for liver carcinoma.Methods Thoracoscopic hepatectomy was performed in 5 cases with single liver neoplasm from Jan 2016 to Aug 2018,including hepatocellular carcinoma (HCC) in 4 cases and metastatic liver cancer in 1 case.During the operation,the diaphragm just above the tumor was opened.Then we completely removed the tumor.After meticulous hemostasis of cut surface,the diaphragm was closed.A thoracic drain was placed.Results Thoracoscopic hepatectomy was performed successfully in all 5 cases,the median total operating time was 140 min (120-230 min),and the median blood loss was 300 ml (200-500 ml),Patients recovered quickly.One patient had pleural effusion and recovered after chest drainage.There were not other major post-operative complications.During 6 to 31 months' follow-up,one patient was lost to follow-up,two patients were survival with tumor recurrence,two patients were recurrence free.Conclusions Thoracoscopic hepatectomy is a safe and feasible operation in selected liver cancer patients and has advantages in post-operative recovery.
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Objective To evaluate the application of nutritional risk screening in children hospitalized in general surgery department,in order to provide the basis for selecting the screening tool.Methods Nutritional risk screening was performed on 123 children hospitalized in the general surgical department by using the Assessment of Malnutrition in Paediatrics (STAMP) and Paediatric Yorkhill Malnutrition Score (PYMS).The malnutrition prevalence based on the World Health Organization (WHO) child growth standards(WHO standards) was evaluated.The data of hospital stay and total hospital expenses were recorded and analyzed.Results By using the STAMP and PYMS,76.4％ (94/123 cases) and 85.4％ (105/123 cases) of the patients had low-moderate nutritional risk,23.6％ (29/123 cases) of the patients and 14.6％ (18/123 cases) had high nutritional risk,respectively.The malnutrition prevalence was 17.9％ (22/123 cases) based on WHO standards.Children with high nutritional risk screened by STAMP,PYMS and malnutrition evaluated by WHO standards had significantly longer hospital stay(days) and higher total hospital expenses(yuan) compared with those in low-moderate nutritional risk or non-malnutrition patients,and the differences were statictically significant (hospital stay:STAMP:M =8.50 ＞ 7.00,Z =-2.608,P =0.008;PYMS:M =8.00 ＞6.25,Z =-2.761,P =0.006;WHO standards:M =8.25 ＞6.75,Z =-2.812,P =0.005.Total hospital expenses:STAMP:M =4 970.46 ＞ 2 939.07,Z =-2.913,P =0.004;PYMS:M =5 486.57 ＞ 3 294.96,Z =-3.024,P =0.002;WHO standards:M =5 515.87 ＞ 3 170.04,Z =-3.098,P =0.002).According to WHO standards,the sensitivity,specificity,Youden index,positive predictive value and negative predictive value of STAMP and PYMS were 68.2％ vs.77.3％,86.1％ vs.99.0％,54.3％ vs.76.3％,51.7％ vs.94.4％,92.6％ vs.95.2％ respectively.Conclusion Both STAMP and PYMS can be used for nutritional risk screening in hospitalized children in general surgery department,while sensitivity and specificity of PYMS are better than those of STAMP.
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Objective To investigate the status of nutritional risk and clinical outcome in children hospitalized in the general surgical department, which can provide basis for clinical nutritional support and selecting the screening tool. Methods Nutritional risk screening was performed on 506 children hospitalized in the general surgical department by using the Paediatric Yorkhill Malnutrition Score (PYMS). The data on incidence of complications, parenteral nutritional support during hospitalization, length of hospital stay and total hospital expenses were recorded. Results Of the 506 cases, 64.6%(327/506) had low nutritional risk, 27.1%(137/506) had moderate nutritional risk, and 8.3%(42/506) had high nutritional risk. Hepatic and gall diseases were the most common types of moderate nutritional risk (55.2%, 16/29), intestinal obstruction were the most common types of high nutritional risk (23.1%, 6/26). The incidence of complications, parenteral nutritional support during hospitalization, length of hospital stay and total hospital expenses were 10.2%(14/137), 21.9%(30/137), (9.54±4.95) d, (6 899.13±3 281.18) yuan RMB and 21.4%(9/42), 35.7%(15/42), (10.60±7.25) d, (7 521.64±6 026.23) yuan RMB in moderate or high nutritional risk children, and 0.9%(3/327), 3.1%(10/327), (17.17 ± 4.17) d, (4 691.96 ± 3 114.43) yuan RMB in low nutritional risk children, and there were significant differences (χ2/F=18.665-64.554, P<0.05). Conclusions Moderate or high nutritional risk is seen in children hospitalized in the surgical department. High nutritional risk score is correlated with adverse clinical outcome. PYMS can be used for nutritional risk screening in hospitalized children.
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Objective To comprehend the awareness rate and the implementation of risk factors related to Helicobacter pylori (HP) infection in families with children of Helicobacter pylori infection.To analyze the existing problems and formulate effective methods of health education.Methods Totally 558 families infected with HP were investigated with a self-designed structured questionnaire by call-back.Results 527 did not use separate eating tools,350 did not use independent tablewares,14 drank unboiled water,14 did not use bath appliances separately,7 used tooth glasses together,4 did not wash hands before eating and after toilet,no one had mouth-to-mouth feeding.248 children with HP sleeped with their family members and 246 family members used to have HP infections or stomach troubles.Conclusions The families with HP do not establish correct ways of separate eating,so the hospital need to develop multi-channel education.Most families with HP infected children have satisfactory health habits.Nearly half of the children with HP do not sleep in their own beds.Caregivers of children with HP infection should be the capital objects of health education.