Successful trans-blood liver transplantation after artificial liver support therapy in a patient with hepatic coma： A case report / 临床肝胆病杂志

This article reports a patient with hepatic coma who underwent artificial liver support therapy and liver transplantation successfully， and the patient recovered well in the later stage after active treatment. This article also discusses the timing of liver transplantation.

Genetic analysis of the false positive trisomy 7 and false negative trisomy 18 by NIPT-PLUS / 中华医学遗传学杂志

OBJECTIVE@#To explore the cause of inconsistency between the results of trisomy 7 by expanded non-invasive prenatal testing (NIPT-PLUS) and trisomy 18 by prenatal diagnosis.@*METHODS@#A pregnant woman who received genetic counseling at Jiaozuo Maternal and Child Health Care Hospital on July 5, 2020 was selected as the study subject. NIPT-PLUS, systematic ultrasound and interventional prenatal testing were carried out. The middle segment and root of umbilical cord, center and edge of the maternal and fatal surface of the placenta were sampled for the validation by copy number variation sequencing (CNV-seq).@*RESULTS@#The result of NIPT-PLUS indicated that the fetus has trisomy 7. Systematic ultrasound has shown multiple malformations including atrioventricular septal defect, horseshoe kidney, and rocker-bottom feet. However, QF-PCR, chromosomal karyotyping analysis, and CNV-seq of amniotic fluid samples all showed that the fetus was trisomy 18. Validation using multiple placental samples confirmed that the middle segment of the umbilical cord contains trisomy 18, the center of the placenta contained trisomy 7, and other placental sites were mosaicism for trisomy 7 and trisomy 18. Notably, the ratio of trisomy 18 became lower further away from the umbilical cord.@*CONCLUSION@#The false positive results of trisomy 7 and false negative trisomy 18 by NIPT-PLUS was probably due to the existence of placental mosaicism. Strict prenatal diagnosis is required needed aneuploidy is detected by NIPT-PLUS to exclude the influence of placental mosaicisms.

The impact of chronic comorbidity in elderly people on relatives’ physical and mental health during the nursing home confinement:A multiple mediator analysis / 西安交通大学学报(医学版)

【Objective】 To explore the relationship between chronic comorbidity and the physical and mental health of relatives of elderly people during the nursing home confinement, and to analyze the mediating effects of perceived stress and intolerance of uncertainty in this context. 【Methods】 A total of 568 family members of elderly people in nine elderly institutions in Shaanxi Province were selected. The survey included the short version of the Perceived Stress Scale, Intolerance of Uncertainty Scale, and The World Health Organization-5 Well-being Index. The data were analyzed with Stata for correlation and mediation effects. 【Results】 ① The comorbidities of chronic diseases was positively correlated with the perceived stress (r=0.16, P<0.001) and intolerance of uncertainty (r=0.11, P=0.006) of the family members, but negatively correlated with the physical and mental health of the family members (r=-0.13, P=0.002). ② The mediating effect of perceived stress between chronic disease co-morbidity and physical and mental health of family members in older adults was -0.023, accounting for 18.8% of the total effect; the mediating effect of intolerance of uncertainty between chronic disease co-morbidity and physical and mental health of family members in older adults was -0.041, accounting for 33.5% of the total effect. 【Conclusion】 During closed management in a nursing facility, the physical and mental health of family members of older adults with chronic co-morbidities is poorer than that of family members of non-chronic co-morbidities. And it can lead to a decline in physical and mental health of family members through increased perceived stress and intolerance of uncertainty.

Visual analysis of literature on intestinal flora and bone metabolism by Citespace / 西安交通大学学报(医学版)

【Objective】 To analyze the literature on the relationship between gut microbiota and bone metabolism, identify the current research hotspots and difficulties, and provide research ideas and directions for the clinical prevention and treatment of bone metabolism related diseases. 【Methods】 Based on the Citespace literature visualization analysis software, the co-occurrence and cluster analysis of keywords and other information of the included 394 literatures were performed, and the visual map was drawn. 【Results】 Among the included literatures, the keywords such as inflammatory bowel disease, T cells, dendritic cells, short-chain fatty acids, and chronic kidney disease appeared with high frequency. The cluster of intestinal alkaline phosphatase, metabolic osteoarthritis, dendritic cells, and signaling pathway was the current research hotspot. Recent years have witnessed a rapid increase in published articles in this field, with the United States as the leading origin. 【Conclusion】 The mechanism by which gut microbiota interferes with the immune system and regulates bone metabolism to maintain bone homeostasis is still the core of current research.

Protective effect of metformin on pulmonary fibrosis caused by paraquat through activating AMP-activated protein kinase pathway / 中华危重病急救医学

OBJECTIVE@#To observe whether metformin (MET) inhibits transforming growth factor-β1 (TGF-β1)/Smad3 signaling pathway by activating adenosine activated protein kinase (AMPK), so as to alleviate the pulmonary fibrosis caused by paraquat (PQ) poisoning in mice.@*METHODS@#Male C57BL/6J mice were randomly divided into the Control group, PQ poisoning model group (PQ group), MET intervention group (PQ+MET group), AMPK agonist group (PQ+AICAR group), and AMPK inhibitor group (PQ+MET+CC group), according to a random number table method. A mouse model of PQ poisoning was established by one-time peritoneal injection of 1 mL PQ solution (20 mg/kg). The Control group was injected with the same volume of normal saline. After 2 hours of modeling, the PQ+MET group was given 2 mL of 200 mg/kg MET solution by gavage, the PQ+AICAR group was given 2 mL of 200 mg/kg AICAR solution by intraperitoneal injection, the PQ+MET+CC group was given 2 mL of 200 mg/kg MET solution by gavage and then 1 mL complex C (CC) solution (20 mg/kg) was intraperitoneally injected, the Control group and PQ group were given 2 mL of normal saline by gavage. The intervention was given once a day for 21 consecutive days. The 21-day survival rate of ten mice in each group was calculated, and the lung tissues of remaining mice were collected at 21 days after modeling. The pathological changes of lung tissues were observed under light microscope after hematoxylin-eosin (HE) staining and Masson staining, and the degree of pulmonary fibrosis was evaluated by Ashcroft score. The content of hydroxyproline in lung tissue and oxidative stress indicators such as malondialdehyde (MDA) and superoxide dismutase (SOD) were detected. The protein expressions of E-cadherin, α-smooth muscle actin (α-SMA), phosphorylated AMPK (p-AMPK), TGF-β1 and phosphorylated Smad3 (p-Smad3) in lung tissue were detected by Western blotting.@*RESULTS@#Compared with the Control group, the 21 days survival rate was significantly reduced, lung fibrosis and Ashcroft score were significantly increased in PQ group. In addition, the content of hydroxyproline, MDA and the protein expressions of α-SMA, TGF-β1 and p-Smad3 in lung tissue were significantly increased, while the activity of SOD and the protein expressions of E-cadherin and p-AMPK were significantly decreased in PQ group. Compared with the PQ group, the 21 days survival rates of mice were significantly improved in the PQ+MET group and PQ+AICAR group (70%, 60% vs. 20%, both P < 0.05). The degree of pulmonary fibrosis and the Ashcroft score were significantly reduced (1.50±0.55, 2.00±0.63 vs. 6.67±0.52, both P < 0.05). The content of hydroxyproline and MDA in lung tissue, as well as α-SMA, TGF-β1 and p-Smad3 protein expressions were significantly reduced [hydroxyproline (mg/L): 2.03±0.11, 3.00±0.85 vs. 4.92±0.65, MDA (kU/g): 2.06±1.48, 2.10±1.80 vs. 4.06±1.33, α-SMA/GAPDH: 0.23±0.06, 0.16±0.06 vs. 1.00±0.09, TGF-β1/GAPDH: 0.28±0.03, 0.53±0.05 vs. 0.92±0.06 p-Smad3/GAPDH: 0.52±0.04, 0.69±0.06 vs. 1.11±0.10, all P < 0.05], SOD activity and the protein expressions of E-cadherin and p-AMPK were significantly increased [SOD (μmol/g): 39.76±1.35, 33.03±1.28 vs. 20.08±1.79, E-cadherin/GAPDH: 0.91±0.08, 0.72±0.08 vs. 0.26±0.04, p-AMPK/GAPDH: 0.62±0.04, 0.60±0.01 vs. 0.20±0.04, all P < 0.05]. However, these protective effects of MET were inhibited by the addition of AMPK inhibitor CC solution.@*CONCLUSIONS@#MET can effectively alleviate the degree of pulmonary fibrosis in mice poisoned with PQ, and its mechanism may be related to the activation of AMPK and inhibition of TGF-β1/Smad3 signaling pathway, which can be inhibited by AMPK inhibitor CC.

An oral vaccine for SARS-CoV-2 RBD mRNA-bovine milk-derived exosomes induces a neutralizing antibody response in vivo

The severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) that causes the coronavirus disease 2019 (COVID-19) has presented numerous challenges to global health. The vaccines, including lipid-based nanoparticle mRNA, inactivated virus and recombined protein, have been used to prevent SARS-CoV-2 infections in clinics and are immensely helpful against the epidemic. Here, we first present an oral mRNA vaccine based on bovine milk-derived exosomes (milk-exos), which encodes the SARS-CoV-2 receptor binding domain (RBD) as an immunogen. The results indicated that RBD mRNA delivered by milk-derived exosomes can produce secreted RBD peptide in 293 cells in vitro and stimulated neutralizing antibodies against RBD in mice. These results indicated that bovine milk-derived exosome-based mRNA vaccine could serve as a new strategy for preventing SARS-CoV-2 infection. Meanwhile, it also can work as a new oral delivery system for mRNA. Keywords: bovine milk-derived exosomes; SARS-CoV-2; receptor binding domain; mRNA; oral vaccines; neutralizing antibody

Changes in portal vein hemodynamics after liver transplantation and their clinical significance / 中华肝胆外科杂志

Objective:To evaluate the ultrasound diagnostic value of portal vein complications after liver transplantation by monitoring changes in portal vein hemodynamic parameters using the color Doppler ultrasound technology and to determine its clinical significance.Methods:The clinical data of 99 patients who underwent liver transplantation at the Organ Transplantation Center of the Affiliated Hospital of Qingdao University from July 2015 to December 2018 were analyzed retrospectively. There were 81 males and 18 females, aged (51±9) years old. These patients were divided into the portal vein complication ( n=23) and the non-portal vein complication ( n=76) groups, based on whether portal vein complications had developed within 2 years after surgery. In addition, 30 healthy volunteers at the Affiliated Hospital of Qingdao University, including 16 males and 14 females, aged (40±14) years old were selected to form the control group. The patients’ morphology of liver was studied using color Doppler ultrasound at days 1, 7, 14, 30, 180, 365 and 730 after liver transplantation, and the maximum portal vein blood flow velocity and portal blood flow were recorded. Results:Compared with the control group, the maximum portal venous flow velocity and portal venous blood flow significantly increased on days 1, 7, 14, 30, and 180 after liver transplantation in the non-portal complication group (all P<0.05). With time, these changes showed a decreasing trend. By day 365 after surgery, the differences between the maximum portal venous flow velocity and the portal venous blood flow between the two groups became not significant ( P>0.05). Of the 23 patients in the portal vein complication group, 9 developed portal vein stenosis (PVS) and 14 portal vein embolism. The 9 patients with PVS had a maximum portal flow velocity of 63.8 (46.0, 78.6) cm/s at 1 month after surgery, and this flow velocity was significantly higher than that in the non-portal complication group [35.0(29.6, 41.8) cm/s, Z=-3.35, P<0.001]. The portal blood flow was 993 (887, 1168) ml/min in the 9 patients with portal vein stenosis at 1 month after surgery, and it was significantly higher than those in the non-portal complication group [811(682, 1 018) ml/min, Z=-2.37, P=0.020]. Conclusions:After liver transplantation, both the portal venous blood flow velocity and the blood flow were at high levels in the early postoperative period and they returned to normal levels with time. Ultrasound dynamic monitoring of portal venous blood flow changes was of clinical significance in diagnosing portal vein stenosis and portal vein embolism after liver transplantation.

Research progress of S-nitrosoglutathione reductase inhibitors in the regulation of cerebral injury after cardiac arrest-cardiopulmonary resuscitation / 中华危重病急救医学

The cerebral ischemia-reperfusion injury (CIRI) after the cardiac arrest (CA)-cardiopulmonary resuscitation (CPR) was a complex pathophysiology process. Nitric oxide (NO) is a small molecule that mediates cell signal transduction in vivo and plays an important role in the regulation of brain function during ischemia/reperfusion (I/R). S-nitrosoglutathione reductase (GSNOR) inhibitor can regulate the synthesis and release of NO in vivo and has a protective effect on CIRI. Therefore, early administration of GSNOR to CA-CPR patients could be the main treatment method to improve the prognosis of those patients. A large number of studies have been done to improve the prognosis of CA-CPR in recent years. In order to provide reference for further research on the treatment and brain protection of CIRI after CA-CPR, the article reviewed the main mechanisms of brain injury after CA-CPR, the protective effect and mechanism of NO on cerebral I/R injury, the production and regulation of NO, in vivo, and the protective effect of GSNOR inhibitors on CIRI, especially the research progress of GSNOR inhibitors.

Advances in the study of optimum chest compression point for adult cardiopulmonary resuscitation / 中华危重病急救医学

Chest compressions are a key component of cardiopulmonary resuscitation (CPR). The determination of the optimal compression point (OCP) in adult CPR is an indispensable critical factor for high quality chest compressions (CCs). At present, the OCP for adult CPR is still controversial, which still needs further research and discussion. To provide theoretical reference for determining the OCP, this paper reviews the research progress of the OCP of adult CPR from the development process of compression point and hemodynamic mechanism, so as to improve the quality of CCs and the outcome of cardiac arrest (CA) patients.

Research progress on the relationship between diquat poisoning and nuclear factor E2-related factor 2 signaling pathway / 中华危重病急救医学

Since the production and use of paraquat was banned in China in 2016, the use of diquat (DQ) has been increasing and the clinical cases of DQ poisoning have also shown an increasing trend every year. The treatment of DQ poisoning is a worldwide medical problem, and there is no specific antidote. Studies have found that oxidative stress, lipid peroxidation, neurotoxicity, reproductive and developmental toxicity play an important role in DQ poisoning. Nuclear factor E2-related factor 2 (Nrf2) can inhibit oxidative stress, lipid peroxidation and inflammation by regulating the protein expression of upstream and downstream signaling molecules. Therefore, the role of Nrf2 signaling pathway in the poisoning and treatment of DQ has become a hot spot of attention for emergency critical care researchers in recent years. This paper reviews the relationship between Nrf2 signal pathway and DQ poisoning, in order to provide a theoretical basis for improving the treatment strategy for DQ poisoning.

Advances in the treatment of acute intermittent porphyria / 临床肝胆病杂志

Acute intermittent porphyria (AIP) is a rare disease caused by enzyme deficiency due to HMBS gene mutation and is often life-threatening during acute attack. This article introduces the traditional treatment methods for AIP, such as high-carbohydrate therapy and intravenous heme infusion, as well as several emerging therapies targeting the etiology of AIP, including enzyme replacement therapy and gene therapy with multiple strategies of DNA gene augmentation, mRNA gene augmentation, and RNAi gene silencing. It is worth noting that breakthroughs have been made in Givosiran, a drug based on RNAi gene silencing, and it has been used in clinical practice. Gene therapy targeting the etiology of AIP may become a new trend in the treatment of rare diseases in the future.

Finite sample properties of virtual reference feedback tuning with two degrees of freedom controllers.

Here the problem of designing two degrees of freedom controllers for an unknown plant based on input-output measurements is discussed. Virtual reference feedback tuning aims at minimizing a cost function of the L2-norm type by using a set of data, as no identification process is needed. When constructing this cost function, two model-matching problems are considered between closed loop transfer function and sensitivity function simultaneously. In model-matching procedures, we design virtual input and virtual disturb respectively. Further two filters used to reprocess the input-output measurements are derived to prove the equivalence between virtual reference feedback tuning and model reference control. After constructing one identification cost without any knowledge of the plant, we derive one bound on the difference between the expected identification cost and its sample identification cost under the condition that the number of data points is finite. Further the correlation property between the input and external noise is considered in deriving this bound. Then we continue to derive one probabilistic bound to quantify this difference through using some probability inequalities and knowledge of control theory. The number of data points is obtained by using generalization of independent block sequence. Finally two simulation examples have been performed to demonstrate the effectiveness of the theories proposed in this paper.

Value of FibroScan in liver grafts of brain-death donor prior to liver transplantation / 中华器官移植杂志

Objective:To explore the value of FibroScan in liver grafts from brain-dead donors (DBD) prior to liver transplantation (LT).Methods:Liver grafts from 52 DBD were examined using ultrasound and FibroScan before LT. The causes of death were cerebral hemorrhage ( n=25), brain trauma ( n=21) and ischemic-hypoxic cerebropathy ( n=6). Blood samples were tested before LT and a biopsy was performed pre- or intra-operation for determining pathology. The diagnostic accuracy of FibroScan results was compared with that of pathological examinations. The latter is a gold standard for evaluating liver grafts. The eligible donors were grouped by stage of liver fibrosis (F0-F4) and steatosis (S0-S3) based upon Kleiner's scoring system of nonalcoholic fatty liver disease. Results:The value of liver stiffness (LS) significantly rose in group F1 as compared with group F0 (8.74±1.32) kPa and (5.93±1.64) kPa respectively ( P<0.01). The value of LS had a significantly positive correlation with liver graft fibrosis stage ( r=0.73, P<0.01). The area under receiver operating characteristic curve (AUROC) was 0.93 for F1 stage fibrosis ( P<0.01). Significant differences existed in controlled attenuation parameter (CAP) among groups S0, S1 and S2 (173.30±38.36), (230.29±23.27) and (250.00±57.01) dB/m respectively ( F=12.41, P<0.01). CAP was correlated with liver graft steatosis stage ( r=0.64, P<0.01). And AUROC for S1/S2 stage steatosis in liver grafts was 0.89 ( P=0.002) and 0.83 ( P=0.007) respectively. Conclusions:With a high diagnostic accuracy, FibroScan quantifies fibrosis and steatosis in liver grafts from DBD and provides further imaging evidence for assessing liver grafts.

Anti-inflammatory effects of lipoxin A4 in cerebral ischemia / 国际脑血管病杂志

Lipoxin A4 (LXA4) is one of the metabolites of arachidonic acid, and it is an endogenous anti-inflammatory factor that can alleviate the inflammatory reaction through various pathways. Inflammatory response plays an important role in the process of cerebral ischemia. LXA4 can play a protective role on nerve cells by regulating proinflammatory cytokines, protecting blood-brain barrier, inhibiting activation and infiltration of leukocyte, alleviating local microcirculation inflammatory response, regulating inflammatory mediators such as leukotrienes and inflammasome, regulating the metabolism of inflammatory related enzymes, and alleviating oxidative stress injury. This article reviews the anti-inflammatory effects of LXA4 in cerebral ischemia.

Chromosomal microarray analysis for the causes of miscarriage or stillbirth / 中华医学遗传学杂志

OBJECTIVE@#To assess the value of chromosomal microarray analysis (CMA) for the analysis of 824 samples from miscarriage or stillbirth.@*METHODS@#Copy number variations (CNVs) in the abortic chorionic villi or stillbirth tissues were detected by CMA.@*RESULTS@#All specimens were successfully analyzed, among which 381 (46.2%) were diagnosed with chromosomal abnormalities, which included 312 (81.9%) numerical abnormalities, 66 (17.3%) structural abnormalities and 3 (0.8%) uniparental disomies. Among numerical chromosomal abnormalities, aneuploidies was most common (92.0%), with trisomy 16 and 45,X accounting for 41 (13.1%) and 63 (20.2%) of the cases, respectively. Among the 66 structural chromosomal aberrations, there were 26 (39.4%) CNVs duplications, 20 (30.3%) CNVs deletions, and 20 (30.3%) CNVs duplication and deletions. 33 CNVs were predicted as have a high chance to lead to a disease.@*CONCLUSION@#CMA is a reliable, robust, and high-resolution method for the analysis of miscarriage or stillbirth samples. Numerical aberrations, in particular chromosomal aneuploides, are the main cause for spontaneous abortions and stillbirths.

Genetic analysis of an infant with duplication of 22q12.1-q13.3 / 中华医学遗传学杂志

OBJECTIVE@#To explore the genetic basis for an infant with multiple malformations including congenital heart disease and cleft palate.@*METHODS@#The child and his parents were subjected to conventional chromosomal karyotyping and low-coverage massively parallel copy number variation sequencing (CNV-seq) analysis.@*RESULTS@#The infant was found to have a 46,X,add(Y)(q11.23) karyotype, and his CNV-seq result was seq [hg19] 22q12.1q13.3 (29 520 001-51 180 000)× 3. His parents were found to be normal by both methods.@*CONCLUSION@#The additional chromosomal material found on Yq, verified as duplication of 22q12.1-q13.3, may account for the abnormal phenotype in this infant. CNV-seq has provided a useful complement for the diagnosis and more accurate information for genetic counseling.

Clinical features and long-term outcomes of seizures associated with autoimmune encephalitis: A follow-up study in East China.

PURPOSE: To evaluate the clinical characteristics, treatment outcomes, prognosis and potential risk factors of patients in East China with seizure secondary to autoimmune encephalitis. METHODS: From February 2014 to June 2016, 113 patients diagnosed with autoimmune encephalitis in Huashan Hospital, Fudan University, were enrolled in our study. After at least two years of follow-up, we retrospectively analyzed the patients' clinical details, electroencephalograph performance, brain MRI findings, and the therapeutic outcome. Patients underwent clinical evaluation every 3 months. We compared the clinical characteristics and epileptic prognosis of autoimmune encephalitis per antibody type. The association of the epileptic prognosis and EEG abnormalities was evaluated. GTE (Grand Total EEG) Score was used to evaluate EEG abnormalities. Statistic methods included ANOVA, Bonferroni correction test. RESULTS: Treatment outcomes were assessabled in 103 patients (10 patients died or withdrew), including anti-GABABR encephalitis (11), anti-LGI1 encephalitis (16), anti-NMDAR encephalitis (73), Caspr2 antibody encephalitis (3). 83 patients had seizures, who underwent both immunotherapy and anti-epileptic drugs therapy. In terms of seizure type, 57 (68.7%) patients exhibited focal to bilateral tonic-clonic seizure (FBTCS), 51 (61.4%) patients exhibited focal-impaired awareness seizure (FIAS) or focal aware seizure (FAS). 18 (21.7%) patients developed to status epilepticus. 30 (36%) patients had multiple types of seizures. 39 (47%) patients had daily seizures. 80.7% (67/83) of patients with epilepsy had seizure remission. During the 24 months of follow-up, 11 (11%) patients had clinical relapses. GTE scores were significantly different between the group with seizure reduction < 75% and the group with seizure remission (p = 0.009). Imaging abnormalities existed in 53% of the patients in our cohort, but lacked specificity during the acute phase. CONCLUSION: Autoimmune encephalitis (AE) presents with large seizure burden with differing seizure semiology among different antibody types. Except for anti-GABAb receptor encephalitis, it may not be necessary for other AE types to apply long-term use of anti-epileptic drugs (AEDs). The GTE Score can be used to evaluate the EEG abnormalities and may be a predictor of seizure outcomes. MRI findings during the acute phase are non-specific. Long-term follow-up MRIs may be much more meaningful in evaluating prognosis.

Clinical treatment experience of thyroid cancer with heart disease / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the perioperative clinical treatment of thyroid cancer patients with heart disease.@*Methods@#A retrospective analysis was conducted on 39 thyroid cancer patients with heart disease admitted to the Department of Otorhinolaryngology Head and Neck Surgery, Beijing Anzhen Hospital,Capital Medical University from April 2014 to February 2018,including 25 males and 14 females, the age ranged from 59 to 75 years,with an average age of 67.3±6.2 years. Perioperative clinical monitoring indicators included cardiac ultrasound left ventricular ejection fraction (LVEF), degree of vascular stenosis revealed by coronary CT, hypersensitive troponin I (TNI), b-type natriuretic peptide (BNP), fibrinogen degradation products,and coagulation indexes. This panel of patients comprised 26 cases with 50% ≤ LVEF<60%,10 cases with 40% ≤ LVEF<50%, 3 cases with 36% ≤ LVEF<40%, 27 cases with 0≤BNP<100 ng/L, 7 cases with 100≤BNP<400 ng/L, and 5 cases with 400≤BNP<700 ng/L. Coronary CT showed no coronary artery stenosis>75%. The vascular graft was patent and the coronary artery after stenting was unobstructed. For 3 patients with LVEF<40% and 5 patients with BNP>400 ng/L,cardiotonic,diuretic,and nutritional myocardial therapy were used for 1 week. SPSS 17.0 software was used to analyze the data.@*Results@#All 39 patients successfully completed the operation under general anesthesia,including 32 cases of total thyroidectomy,7 cases of glandular lobe and isthmic resection,and 40 cases of lateral neck dissection. One patient developed heart failure three days after surgery and was discharged after two weeks of treatment. No other cardiac related events,cerebrovascular and pulmonary thrombosis occurred during the perioperative period. The anesthesia preparation time was significant different between the group with 0≤BNP<100 ng/L and 50%≤LVEF<60% and the group with 0≤BNP<100 ng/L and 36%≤LVEF<50%.@*Conclusions@#Multi-indicators were utilized to adequately assess cardiac function before surgery. According to the results of cardiac ultrasound and coronary CT examination, the corresponding treatment should be conducted to improve the cardiac function. After the perioperative risk assessment and management of thyroid cancer patients with heart disease,standardized thyroid cancer surgery can be performed safely.

Application values of shear wave elastography and ultrasonic grading in liver grafts from brain death donor / 中华器官移植杂志

Objective To explore the values of shear wave elastography (SWE) and ultrasonic grading in liver grafts from brain death donor (DBD).Methods Liver grafts of 39 DBD cases were examined preoperatively by ultrasonography (US) and SWE.Blood samples were tested preoperatively.Based upon early allograft function of liver recipients,the donors were classified into early allograft dysfunction (EAD) and early allograft function normal (non-EAD) groups.The SWE/ US grading results of EAD group were compared with those of non-EAD group.Receiver operating curve (ROC) was employed for analyzing the diagnostic accuracy of SWE/US grading in EAD.Results The SWE value of EAD group was significantly higher than that of non-EAD group [(6.65 ± 2.69)vs.(3.50 ± 1.27) kPa,P＜0.05].Ultrasonic grading of EAD group was also significantly higher than that of non-EAD group (P＜0.05).The area under ROC curve (AUROC) of SWE in EAD was 0.939,optimal cut-off value 4.56 kPa,AUROC of ultrasonic grading 0.806 (P =0.003) and optimal cut-off value level 3.5.Conclusions SWE quantifies fibrosis in liver grafts of DBD with a high diagnostic accuracy.There are significant correlations between EAD after liver transplantation and SWE value of liver grafts and ultrasonic grading.SWE and ultrasonic grading may improve the assessments of liver grafts of DBD.

In-situ split liver transplantation for pediatric recipient: a single-center experience / 中华器官移植杂志

Objective To evaluate the efficacy of in-situ split liver transplantation (ISSLT) in children.Methods From June 2015 to August 2018,10 liver grafts from DBD were split in-situ.All the donors were male,and the median age of the donors was 28.5 year old (18-48 year).One left half graft and 9 left lateral lobe grafts (including 2 reduced size grafts) were transplanted to 10 pediatric recipients.Four grafts were transplanted in our center,and the rest 6 grafts were shared to other two transplant center.The primary diseases of the recipients included biliary atresia (8/10),hepatic sinus obstruction syndrome (1/10) and Alagille syndrome (1/10).The median age of the recipients was 10 month (7 month-11 year),and the mean body weight was 9.8 ± 6.6 kg (5-28 kg).Results All liver grafts were split in-situ.The mean split time of liver grafts was 88.5 ± 18.9 min.The mean weight of split grafts was 336.7-± 85.4 g.All recipients were subjected to piggyback liver transplantation.Operation time was 542.5 ± 112.1 min.Anhepatic time was 52.0 ±-13.5 min.GRWR was (3.98 ±0.96)％.GRWR of two cases was more than 5％,so segment Ⅲ was partially reduced.During the follow-up period,9 cases were alive and 1 case died due to multiple organ failure 1 day after liver transplantation.Conclusions ISSLT can enlarge the graft pool for children and achieve good results.