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Objective:To explore the diagnostic efficacy of ultrasonography and follow-up outcomes of hepatic venous outflow obstruction after liver transplantation(LT)in children.Methods:From July 2017 to January 2022, 32 children diagnosed with outflow tract obstruction post-LT are designated as HVOO group and examined by digital subtraction angiography(DSA).All of them underwent balloon dilation.Thirty cases with no vascular complications are selected as control group.Color Doppler blood flow parameters are recorded, including peak systolic velocity(PSV), peak diastolic velocity(PDV), PSV/PDV(S/D), resistive index(RI), portal vein velocity(PVV), hepatic vein velocity(HVV), hepatic vein waveform, anastomotic velocity and waveform.Intravascular pressure values of DSA within 48h are recorded.The correlations between color Doppler flow parameters and intravascular pressure values are examined before and after tube expansion.The differences of color Doppler flow parameters before tube expansion between HVOO and control groups are compared.And receiver operating characteristic(ROC)curves are plotted for obtaining ultrasonic parameters' cut-off value.Patients with excellent recovery are selected for comparing the difference of color Doppler blood flow parameters before and after tube expansion and detect the trend of hemodynamics.Results:There is a positive correlation between anastomotic velocity of hepatic vein and inferior vena cava and DSA before and after tube expansion in HVOO group(r=0.483, 0.414, all P<0.05); S/D, RI and anastomotic velocity are higher in HVOO group than those in control group( Z=-3.275, P=0.001; t=3.437, P=0.001; Z=-5.677, P<0.01); PV and HVV are lower in HVOO group than those in control group( Z=-2.719, P=0.007; Z=-6.762, P<0.01); The waveforms of hepatic vein and anastomosis in HVOO group are mostly single-phase waves, accounting for 81.25%(26/32)and 53.12%(17/32).Control group is mostly of dual-phase wave.According to ROC curve analysis, area under curve(AUC)of HVV diagnosing HVOO is 0.996 with a critical value of 21.65 cm/s; AUC of hepatic vein anastomosis velocity is 0.92 with a critical value 162 cm/s and AUC of RI 0.76 with a critical value of 0.73.PVV and HVV values after tube expansion are higher than before tube expansion( Z=-2.233, P=0.026; Z=-4.45, P<0.01); Anastomotic velocity after tube expansion is lower than that before tube expansion( t=8.584, P<0.01).The waveforms of hepatic vein and anastomosis are mostly of single-phase waves(76.92%, 61.54%)before tube expansion and dual-phase wave(88.46%, 96.15%)after tube expansion. Conclusions:Color Doppler ultrasound is a preferred imaging modality for diagnosing HVOO and conducting postoperative follow-ups in children after LT because of its non-invasiveness, real-time, simplicity and rapidness.Furthermore, the diagnostic efficiencies of hepatic vein and anastomotic velocity are relatively high.
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Objective:To explore the characteristics of postoperative hemodynamic changes in patients with early allograft dysfunction (EAD), and to provide clinical imaging support for the early diagnosis of EAD.Methods:A total of 907 patients who underwent liver transplantation in Tianjin First Central Hospital from December 2012 to June 2021 were retrospectively selected, and they were divided into EAD group (361 cases) and non-EAD group (546 cases) according to EAD diagnostic criteria. The peak systolic velocity(PSV) of the hepatic artery, end-diastolic velocity(EDV) of the hepatic artery, resistance index(RI), S/D(PSV/EDV), diameter of the portal vein(PVD), velocity of the portal vein(PVV), diameter of the middle hepatic vein(MHVD), velocity of the middle hepatic vein(MHVV), the diameter of the right hepatic vein(RHVD), and the velocity of the right hepatic vein (RHVV) were collected from 1 to 7 days after operation (a total of 5 573 ultrasound examination results), and the differences in ultrasound hemodynamic parameters were compared between the two groups. The correlation of S/D<2, PSV<25 cm/s, PVV<15 cm/s, MHVV or RHVV<15 cm/s within 3 days after operation with the occurence of EAO were analyzed by multivariate Logistic regression analysis.Results:①The PSV and EDV of the hepatic artery in the EAD group and the non-EAD group showed a slow upward trend at 1-7 days after operation, while the hepatic artery RI and PVV showed a downward trend, the MHVV and RHVV did not fluctuate significantly. ②The hepatic artery in the EAD group showed low-resistance blood flow in the early postoperative period, and the EDV were significantly higher than that in the non-EAD group on 1 d, 2 d, 3 d and 5 d, RI was significantly lower than that of the non-EAD group (all P<0.05); At 4 d, 6 d and 7 d, there was no significant differences of EDV and RI between the two groups(all P>0.05). The PSV of the EAD group was higher than that of the non-EAD group on 3 d ( P<0.05). Among the parameters of portal vein blood flow, the PVV in the EAD group was significantly higher than that in the non-EAD group on 1 d ( P<0.05), and there was no significant difference of PVD between the two groups at day 1-7. Among the parameters of hepatic venous blood flow, the MHVV and RHVV in the EAD group were significantly lower than those in the non-EAD group (all P<0.05), there was no significant difference between the two groups of MHVD and RHVD at 1-7 days. ③The incidence of grafted hepatic artery S/D<2 within 3 days after operation in EAD group was higher than that in non-EAD group. Binary Logistic regression multivariate analysis showed that the occurrence of grafted hepatic artery S/D<2 within 3 days after operation was significantly correlated with the occurrence of EAD[Exp(B)=1.878, P<0.05]. Conclusions:Patients who develop EAD after liver transplantation show low-resistance blood flow in the hepatic artery during the perioperative period, and the occurrence of hepatic artery S/D<2 within 3 days after operation can early predict the occurrence of EAD.
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Objective:To obtain the normal reference range of ultrasound hemodynamic parameters after liver transplantation through big data query and statistical analysis, and to analyze its influencing factors.Methods:The clinical liver transplantation Ultrasound Image Database Software V1.0 developed by Tianjin First Center Hospital was used to query adult patients after liver transplantation from December 2012 to June 2021. The ultrasonic hemodynamic parameters including the diameter of portal vein (PVD), the flow velocity of portal vein (PVV), the peak flow velocity of hepatic artery (S), the end diastolic flow velocity of hepatic artery (D), the S/D of hepatic artery, the resistance index of hepatic artery (RI), the diameter of middle hepatic vein (MHVD), the flow velocity of middle hepatic vein (MHVV), the diameter of right hepatic vein (RHVD), the flow velocity of right hepatic vein (RHVV), in the first day (1D), the seventh day (7D), the first month (1M), the sixth month (6M), the first year (1Y), the fifth year (5Y) and the tenth year (10Y) after operation were analyzed statistically, and the 95% reference value range of each parameter was obtained.Results:A total of 1 740 patients with 12 242 monitoring results after adult liver transplantation were included, and the longest follow-up time was 22 years. There was no significant change in PVD. PVV decreased slightly from postoperative 1D to long-term follow-up. The S and D of hepatic artery were the highest in group 7D after liver transplantation, and then decreased gradually with the extension of postoperative time. Hepatic artery S/D was the lowest in group 7D after operation, with the extension of monitoring time after liver transplantation, it showed an upward trend, but fluctuated. Hepatic artery RI was the highest in postoperative 1D group, and fluctuated with the extension of monitoring time after liver transplantation. There was no significant change in MHVD and RHVD.MHVV and RHVV were the highest in group 7D after liver transplantation, with the extension of postoperative monitoring time, they showed a decreasing trend and fluctuated. The normal range of each parameter was estimated according to the range of 95% medical reference value. The influencing factors of blood flow monitoring of transplanted liver were analyzed, including the various factors in perioperative period, the surgery, the primary disease before operation, the source of donor, the postoperative infection, rejection, drug damage, individual differences and so on.Conclusions:This study obtains the trend of each parameter with the extension of follow-up time and the reference value range of each parameter after liver transplantation, which is of great clinical significance for early detection and diagnosis of postoperative vascular complications. However, the blood flow after adult liver transplantation is affected by many factors. In clinical monitoring, it is necessary to make judgment combined with the individual state of patients and conduct dynamic follow-up.
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Objective:To investigate the correlation between Doppler ultrasound parameters and pressure gradient of portal vein in pediatric liver transplant patients, and to analyze the diagnostic value of Doppler ultrasound for portal vein stenosis.Methods:This retrospective study involved the data from 92 pediatric liver transplant patients in Tianjin First Central Hospital from June 2014 to September 2021, who underwent pressure gradient measurement. The collected ultrasonic parameters included the diameter and flow velocity of the native portal vein, the portal vein anastomosis, and the donor portal vein. The anastomotic stenosis rate=(the native portal vein diameter–the portal vein anastomosis diameter)/the native portal vein diameter, the velocity ratio=the portal vein anastomosis velocity /the native portal vein velocity, the velocity difference=the portal vein anastomosis velocity–the native portal vein velocity. According to the diagnostic standard of portal vein stenosis, pressure gradient more than 5 mmHg was the portal vein stenosis group, and the pressure gradient less than 5 mmHg was the non-stenosis group. The correlation and differences between ultrasonic parameters and pressure gradient were analyzed. ROC curve was used to evaluate the diagnostic efficiency of each parameter.Results:Firstly, there was a positive correlation between pressure gradient and the portal vein anastomosis velocity, the velocity difference and the velocity ratio ( r=0.521, 0.531, 0.417; all P<0.001). And there was a negative correlation between pressure gradient and the anastomotic diameter ( r=-0.284, P=0.004). Secondly, the portal vein anastomotic velocity, velocity difference and velocity ratio in stenosis group were significantly higher than those in non-stenosis group [135.5(111.0, 169.0)cm/s vs 103.7(72.9, 118.7)cm/s, (112.2±40.3)cm/s vs (67.9±30.5)cm/s, 5.56(3.73, 7.26) vs 3.85(2.78, 4.70); all P≤0.001]; Furthermore, by ROC curve analysis, the cut-off value, the area under the ROC curve, Jordan index, accuracy, sensitivity and specificity of each parameter for the diagnosis of portal vein stenosis were: the anastomotic velocity 124.5 cm/s, 0.814, 0.592, 80.0%, 65.5% and 93.7%; velocity ratio 5.67, 0.760, 0.488, 73.0%, 48.8% and 100%; velocity difference 107.25 cm/s, 0.797, 0.511, 76.0%, 51.9% and 100%. Conclusions:The anastomosis velocity, velocity difference and velocity ratio of portal vein in pediatric liver transplant patients are correlated with the pressure gradient, and there is higher accuracy and specificity of each parameter for diagnosing portal vein stenosis, but the sensitivity is slightly lower.
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Objective:To investigate the role of combinational elastography in the dynamic quantitative evaluation of liver transplantation.Methods:From April to December 2019 in Tianjin First Central Hospital, 27 cases of the liver transplant patients and donors were examined by shear wave elastography and real-time tissue elastography, respectively on donor preoperative within 24 h and postoperative day 1, day 7, in order to obtain liver elastic modulus E, measured average relative strain value (MEAN), the index activity (A) and acoustic attenuation measurement (ATT), and to obtain pathologic specimens during operation, including: hydropic degeneration, inflammation, necrosis, steatosis. AST, ALT, TB, DB were detected by automatic biochemistry analyzeron postoperative day 1, day 7. Correlation analysis was performed for pathological parameters and ultrasonic parameters, E, MEAN, A, ATT were selected to plot ROC curve, to analyze ultrasonic parameters′ cut-off value and area under the curve(AUC). According to the pathological signs donor liver were divided into no or mildhydropic group and moderate-to-severehydropic group, non-inflammation group and inflammation group, non-steatosis group and steatosis group. Ultrasonic parameters of donor liver were compared between the two groups, and differences in liver function and ultrasonic parameters on postoperative day 7 were analyzed between the two groups. The change trends of ultrasonic parameters were analyzed from preoperative donor liver to postoperative day 1, day 7 of recipient. The changes of liver function were analyzed from the first day to 7th days. Correlation analysis was performed for liver function and ultrasonic parameters respectively on postoperative day 1, day 7.Results:①Correlation of the ultrasonic parameters of donor liver preoperative within 24 h and pathological parameters: E value and hydropic degeneration and inflammation of pathological signs were significantly and positively correlated( rs=0.597, 0.497; all P<0.05); MEAN and hydropic degeneration and inflammation of pathological signs were significantly and negatively correlated( rs=-0.601, -0.584; all P<0.05); A and inflammation of pathological signs was significantly and positively correlated( rs=0.452, P=0.016); ATT and steatosis of pathological signs was significantly and positively correlated ( rs=0.564, P=0.006). ②The differences of ultrasonic parameters of donor liver preoperative within 24h: E value of moderate-to-severehydropic group was significantly higher than that of the no or mild hydropicgroup ( P<0.001), MEAN value of moderate-to-severehydropic group was significantly lower than that of the no or mildhydropicgroup( P<0.001). E value of inflammation group was higher than that of non-inflammation group ( P=0.012), MEAN value of inflammation group was lower than that of non-inflammation group ( P=0.026). ATT of steatosis group was higher than that of non-steatosis group ( P=0.006). ③The ROC curve indicated that AUCs of E and MEAN diagnosing hydropic degeneration were 0.882, 0.875, and the critical value were respectively 8.72 kPa, 106.62; the AUC of diagnosing inflammation was 0.898, the critical values was 1.26; the AUC of diagnosing steatosis liver was 0.868, the critical value was 0.515 dB·cm -1·MHz -1. ④There were no statistically significant differences in liver function and ultrasonic parameters on postoperative day 7 between no or mildhydropic group and moderate-to-severehydropic group(all P>0.05). There were no statistically significant differences in liver function and ultrasonic parameters on postoperative day 7 between non-inflammation group and inflammation group(all P>0.05). There were no statistically significant differences in liver function and ultrasonic parameters on postoperative day 7 between non-steatosis and steatosis group (all P>0.05). ⑤E and A values of postoperative day 1 were higher than those of preoperative donor liver and postoperative day 7(all P<0.05), MEAN value of postoperative day 1 was lower than those of preoperative donor liver and postoperative day 7(all P<0.05). ATT of postoperative day 1 was lower than that of preoperative donor liver( P=0.027). ⑥ALT, AST, TB, DB of postoperative day 7 were lower than that of postoperative day 1, the difference was statistically significant ( P<0.05). ⑦On postoperative day 1: E value and ALT, AST, TB, DB were significantly and positively correlated( r=0.641, 0.673, 0.601, 0.575; all P<0.05); MEAN value and ALT, AST were significantly and negatively correlated( r=-0.690, -0.703; all P<0.001); A value and ALT, AST were significantly and positively correlated( r=0.459, 0.442; all P<0.05). On postoperative day 7: E value and ALT, AST, TB, DB were significantly and positively correlated ( r=0.616, 0.729, 0.505, 0.640; all P<0.05); MEAN value and ALT, AST were significantly and negatively correlated( r=-0.602, -0.585; all P<0.05); A value and ALT, AST were significantly and positively correlated( r=0.411, 0.495; all P<0.05). Conclusions:Combinational elastography can dynamically and quantitatively assess the hardness, inflammation, steatosis of liver transplantation, and ultrasonic parameters correlate significantly with pathological and liver function, and provides a certain imaging basis for clinical evaluation of liver quality.
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Objective:To investigate the whole genome of SARS-CoV-2 causing COVID-19 in Rongcheng city of Shandong Province in May 2022 and to further analyze the nucleotide and amino acid variations for source tracing.Methods:High-throughput sequencing was used to sequence the SARS-CoV-2 genome in 15 nasopharyngeal swab samples from COVID-19 cluster infections and three environmental samples related to an aquatic product import company. Whole-genome sequence splicing, variant site analysis and sequence typing were performed on the raw sequencing data using virus sequence and variant analysis software. A phylogenetic tree was constructed by evolutionary analysis software. Epidemiological investigation was used to trace the potential source of infection.Results:Thirteen whole genome sequences of SARS-CoV-2 with the length ranging from 29 653 bp to 29 780 bp were successfully obtained from the nasopharyngeal swab samples. The average sequencing depth was 1 756-6 565 X and the genome coverage was 99.20%-99.63%. The results of Pangolin typing showed that the 13 genomes belonged to the VOC/Gamma (P.1.15) evolutionary branch. Compared with the Wuhan reference strain (NC_045512.2), the 13 genome sequences had 40-41 nucleotide mutation sites. There were 23-24 amino acid variation sites in seven protein domains (ORF1a, ORF1b, S, ORF3a, ORF8, ORF9b and N proteins). Evolutionary analysis showed that the viral sequence was grouped to the same subclade as the reference strain from Argentina (EPI_ISL_4082233).Conclusions:In this study, the whole genome sequences of 13 Gamma variant strains were obtained from COVID-19 cluster infections associated with imported cold-chain aquatic products in Rongcheng city, and the imported seafood from South America in 2021 was found to be the source of the virus in a timely manner. This study provided reference for the SARS-CoV-2 variant analysis and case tracing and also suggested that the survival and transmission ability of SARS-CoV-2 on the surface of cold-chain products should not be underestimated and needed further investigation.
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Objective:To evaluate the effects of physician skills on the success rate of the external cephalic version (ECV) and investigate the learning curve for ECV.Methods:A retrospective study of 97 pregnant women who underwent ECV at the First Affiliated Hospital of Nanjing Medical University from March 2019 to August 2021 was performed. Patients were divided into multipara and primipara groups. The success rate of ECV and morbidity were compared between the two groups, and the learning curve for ECV was evaluated using cumulative sum analysis (CUSUM).Results:(1) Patients in the multipara group were older than those in the primipara group [(33.0±3.4) vs (29.2±3.0) years, t=－5.57, P<0.001]. No significant difference was found in other baseline data between the two groups. (2) The overall ECV success rate was 61.9% (60/97), and a higher success rate was observed in the multipara group [93.3% (28/30) vs 47.8% (32/67), χ 2=18.24, P<0.001]. Fetal heart rate deceleration (5.2%, 5/97), vaginal bleeding (1.0%, 1/97), premature rupture of membranes (1.0%, 1/97), and fetal distress (1.0%, 1/97) were the main complications. (3) The CUSUM analysis showed that it needed 53 primiparas for a physician to obtain a 50% consistent success rate ( R2=0.91, H=－3.27, Y=52.16) and seven multiparas to achieve a 70% consistent success rate ( R2=0.99, H=－1.635, Y=6.60). Conclusions:Parity and operator skills have a significant influence on the success of ECV. A physician with standardized training will manage non-anesthesia ECV skillfully in full-term and near-term pregnancies after practice on 50 primiparae or approximately ten multiparae. It is recommended to start with the multiparae for learning ECV to build up confidence and promote the implementation of ECV.
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Objective:To investigate the value of bedside transthoracic echocardiography(TTE) in volume reactivity assessment of children with septic shock.Methods:A total of 41 children aged from 1 to 5 years with septic shock requiring mechanical ventilation admitted to PICU from January 2017 to June 2020 were prospectively included.Under the condition of complete mechanical ventilation, full sedation and analgesia, and no spontaneous breathing(tidal volume 8 to 10 mL/kg), volume expansion was given to children.Hemodynamic indexs such as cardiac index(CI), stroke volume index(SVI) and stroke volume variability(SVV) were measured before and after volume expansion by noninvasive cardiac output monitoring(NICOM) and TTE.Moreover, aortic flow velocity time integral variable degrees(ΔVTI), inferior vena cava variability(ΔIVC) and inferior vena cava dilation index(dIVC) were also measured by TTE.Patients were considered to be responsive to volume expansion if SVI NICOMincreased≥15%.Based on the responsiveness of volume expansion, all the patients were divided into response group and non-response group.The value of SVV TTE, ΔVTI, ΔIVC, dIVC, ΔCVP and SVV NICOMin predicting volume responsiveness were analysed. Results:(1) There were 23 cases in response group and 18 cases in non-response group.Before volume expansion, there were no statistically significant differences in general hemodynamic indexes HR, MAP, CVP, EF, CI NICOM, and CI TTEbetween two groups( P>0.05). (2) In response group, HR, MAP, CI, SVI and CVP were all improved after volume expansion( P<0.001). In non-response group, only CVP was significantly increased after volume expansion, while other indexes were not improved( P>0.05). (3)Before the volume expansion, SVV TTE, ΔVTI, ΔIVC, and dIVC in response group were higher than those in non-response group( P<0.001). After volume expansion, these indicators were significantly reduced in response group.In non-response group, only ΔIVC significantly reduced after volume expansion.(4) The receiver-operating characteristic curve analysis showed that the area under the curve of SVV TTEand ΔVTI was 0.971, with 12.04% as the threshold, the sensitivity was 0.957 and the specificity was 0.944. The area under the curve of ΔIVC was 0.981, with 25.98% as the threshold, the sensitivity was 0.870 and the specificity was 1.000.The area under the curve of dIVC was 0.980, with 29.86% as the threshold, the sensitivity was 0.870 and the specificity was 1.000. The area under the curve of ΔCVP was 0.778, with 2.5 cmH 2O(1 cmH 2O=0.098 kPa) as the threshold, the sensitivity was 0.913 and the specificity was 0.556. The area under the curve of SVV NICOMwas 0.874, with 12.50% as the threshold, the sensitivity was 0.869 and the specificity was 0.778. Conclusion:The dynamic indexes SVV, ΔVTI, ΔIVC and dIVC monitored by TTE have good accuracy in evaluating children′s volume responsiveness, among which the accuracy of ΔIVC and dIVC is relatively the highest; the value of ΔCVP in predicting volume responsiveness is limited.
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【Objective】 To investigate the genotype of anti-HCV reactive blood donors by one ELISA assay and provide scientific basis for the reentry of anti-HCV false positive blood donors. 【Methods】 The data of 453 blood donors reactive to antibody to HCV(anti-HCV) with one ELISA assay(third generation) were extracted via the blood donor information system of Shaoguan Central Blood Station from January 1, 2014 to December 31, 2018. The subjects were recalled to the station for the serological retest, using a 4th generation ELISA reagent, and PCR qualitative test. The PCR reactive samples were sent to the genetic testing laboratory for HCV genotyping, in order to guide diagnosis and treatment in the future. Meanwhile, those PCR negative blood donors returned to be eligible again based on the Guidelines for the Return of Reactive Blood Donors for Blood Screening. 【Results】 70.2% (318/453) of the previous anti-HCV-reactive blood donors, using a third-generation ELISA assay responded to the HCV genotyping, of which 83.0%(264/318) were negative, and 17%(54/318) positive. The profile of HCV subtypes in positive donors was HCV2a>1b>3a=6a. A little bit high false positive rate was presented by the third, and former, generation reagent than the four generation(0.41% vs 0.06%), which was confirmed by HCV RNA qualitative and HCV genotyping tests.After two rounds of reentry testing, 98 eligible blood donors returned to the blood donor team, with the return rate at 21.63% (98 / 453). 【Conclusion】 NAT or (and) HCV genotyping for anti-HCV reactive blood donors screened out by the third, and former, generation, should be carried out to permanently shield the true positive donors and reenter the negative ones.
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Objective:To analyze hepatic hemodynamic parameters detected by Doppler ultrasound (DU) of uncomplicated children who underwent left lateral segment(LLS) LDLT (LLS-LDLT), explore their change trends over time and determine the normal reference intervals.Methods:This retrospective study involved the data from 261 pediatric LLS-LDLT cases in Tianjin First Central Hospital from June 2014 to January 2018. Hemodynamic parameters included peak systolic velocity (PSV), end diastolic velocity (EDV), resistivity index (RI), and pulsation index (PI) of hepatic artery (HA), and portal vein velocity (PVV) during intra-operative and on the 1st, 3rd, 5th and 7th days after operation were collected. Among whom, 232 cases with uncomplicated and normal recovery were finally involved in our study, with 200 cases who were collected from June 2014 to August 2017 as test group. Those collected from September 2017 to January 2018, totally 32 cases were set as validation group. The change trends and normal ranges of hemodynamic parameters over time were analyzed in test group, and the results were further tested in the validation group.Results:In the test group, PSV HA, EDV HA showed a similar change trend at one week after surgery, with an overall decrease-rise trend; RI HA, PI HA also changed similarly with an overall rise-decrease trend. PVV at surgery was lower than at all time points after surgery. In addition, this study provided the normal reference intervals of hemodynamic parameters for LDLT patients at early postoperative period, which at intra-operation they were PSV HA 18.4-98.3 cm/s, EDV HA 0-43.3 cm/s, RI HA 0.41-1.0, PI HA 0.51-2.0, PVV 19.0-83.7 cm/s. Within 1 week after surgery: PSV HA 21.0-97.7 cm/s, EDV HA 0-32.7 cm/s, RI HA 0.47-1.0, PI HA 0.62-2.0, PVV 23.0-92.0 cm/s. By using those results, the coincidence rate of Doppler parameter change trend was 84.3%(27/32), 84.3%(27/32), 78.1%(25/32), 78.1%(25/32), 87.5%(28/32) for PSV HA, EDV HA, RI HA, PI HA, PVV in the validation group, respectively. As for the normal reference intervals of blood flow parameters, RI HA and PI HA in one case in the validation group were lower than the lower limits of the normal reference intervals, accounting for 3.1% of the total. PSV HA in two cases was lower than the lower limit of normal reference interval, accounting for 6.2% of the total. Conclusions:The hepatic hemodynamic in post-transplanted children detected by DU has specific changing trends and normal ranges, which provides valuable reference values for ultrasonologists and pediatric transplant clinicians.
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Based on the specialties and needs of the eight-year program medical students of the Second Military Medical University, the teaching and research section of foreign languages has designed and implemented a new English for medical academic purposes (EMAP) curriculum, with the English Forum on Medical Humanities (EFMH) held annually as a bonding role, which has been developed into a comprehensive curriculum system with notable achievements. This paper offers an overall analysis of the EMAP curriculum system from needs analysis, course design, teaching philosophy, assessment methods to the effects of EFMH, hoping to shed substantial light on college ESP teaching.
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OBJECTIVE：To establish a method for simultaneous determination of calycosin glucoside ，ononin，calycosin， formononetin，astragaloside Ⅳ，isoastragaloside Ⅱ，cycloastragenol and isoastragaloside Ⅰ in Astragalus membranaceus before and after bidirectional solid fermentation with Cordyceps kyushuensis ，and to investigate the effects of fermentation on the contents of above 8 components in A. membranaceus . METHODS ：HPLC-DAD-ELSD was adopted. The determination was performed on Agilent 5 TC-C18 column with mobile phase consisted of 0.1％ formic acid aqueous solution-acetonitrile （gradient elution ）at the flow rate of 1 mL/min. The column temperature was set at 30 ℃. DAD detection wavelength was set at 260 nm，ELSD evaporation tube temperature was 100 ℃，atomizer temperature was 80 ℃，carrier gas flow rate was 1.6 L/min；injection volume was 15 μL. RESULTS：The eight components had a good linear relationship within their respective ranges of concentration （all R2＞0.999 0）； RSDs of precision ，stability and repeatability tests were all less than 3％（n＝3 or n＝6）；the recoveries was 97.88％-101.32％， and RSDs were 1.22％-2.39％（n＝6）. Setting the content of components in unfermented A. membranaceus as 100％，after bidirectional solid fermentation with C. kyushuensis ，the change rates of 8 components were －98.51％，－96.41％，－94.74％， －96.40％，289.20％，20.25％，－75.05％，562.46％，respectively. CONCLUSIONS ：After fermentation with C. kyushuensis ，the contents of active components as astragaloside Ⅳ，isoastragaloside Ⅰ and isoastragaloside Ⅱ can be increased significantly in A. membranaceus .
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This study selected the military English listening course that combined the production-oriented approach (POA) with small-scale online course, that is, it was guided by POA, combined advantages of online and offline hybrid learning, and completed with three stages of driving, promoting and evaluating. After a semester of experiment, the authors found that the curriculum research effectively integrated the language and subject content of military English. A multi-dimensional and multi-layered learning network was formed among students and their critical thinking ability was enhanced through cooperative learning. After studying students' reflection reports and teachers' reflection on action research, the researchers found the students' gains and problems in the course and gave advice on the practical application of the theory.
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Objective To investigate the application value of the tissue diffusion quantitative analysis technique of real-time elastic( RTE) imaging in evaluation of liver damage caused by brain death . Methods Fifty cases of brain dead donor liver were examined by ultrasound elastography ,at the same time , 11 parameters were obtained by the tissue dispersion quantitative analysis software ,included MEAN ( mean relative strain value within the ROI) ,SD( standard deviation of the relative strain value within the ROI) ,％AREA (area of low strain within the ROI) ,COMP(complexity of low strain area within the ROI) ,KURT (kurtosis) ,SKEW(skewness) ,CONT (contrast) ,ENT(entropy) ,IDM(inverse difference moment) ,ASM (angular second moment) ,CORR(correlation) ,and the pathologic specimens in the process of operating were obtained . According to pathological findings ,50 patients were divided into damaged group and non-damaged group ,and the results were compared and analyzed . The correlation analysis of electronic speculum results and RTE were carried out . According to the ROC curve ,the RTE parameters'cut-off value and AUC were obtained .Results Among 11 parameters of tissue diffusion analysis ,MEAN and IDM in damaged group were higher than those in non-damaged group( all P < 0 .05) ;and SKEW and ENT were lower in damaged group than those in non-damaged group ( all P <0 .05) ;there was no significant difference in the other parameters between the two groups(all P >0 .05) . The MEAN ,SKEW ,COMP ,ENT and IDM had correlativity with electronic speculum( r = -0 .633 , P =0 .000 ;r =0 .388 , P =0 .005 ;r =0 .315 , P =0 .026 ;r = 0 .324 , P = 0 .022; r = -0 .314 , P = 0 .026 ,respectively ) . The diagnostic efficiency and sensitivity of MEAN were the highest , the critical value of MEAN was 125 .84 , AUC was 0 .907 . Conclusions The tissue dispersion quantitative analysis technique is a noninvasive method to preliminary evaluation of liver damage caused by brain death . M EAN had the highest effectiveness in eleven parameters .
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This study selected the military English listening course that combined the production-oriented approach (POA) with small-scale online course, that is, it was guided by POA, combined advantages of online and offline hybrid learning, and completed with three stages of driving, promoting and evaluating. After a semester of experiment, the authors found that the curriculum research effectively integrated the language and subject content of military English. A multi-dimensional and multi-layered learning network was formed among students and their critical thinking ability was enhanced through cooperative learning. After studying students' reflection reports and teachers' reflection on action research, the researchers found the students' gains and problems in the course and gave advice on the practical application of the theory.
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Frequent earthquake,debris flow,mine disaster,landslides,explosions,car accident and other injuries often lead to the occurrence of crush syndrome.Its clinical manifestations include muscle injury in the injured area,usually combined with distant organ dysfunction,such as liver,kidney,heart,lung,gastro-intestinal tract,and even lead to hypovolemic shock,compartment syndrome,rhabdomyolysis,traumatic multiple organ failure.Due to the hidden pathological changes of secondary organ dysfunction,rapid progress, more dangerous prognosis,it can even lead to death.Therefore,the early identification,diagnosis and treat-ment of crush syndrome can significantly improve the prognosis,avoid complications and reduce mortality and disability rate.
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Objective To explore the application value of noninvasive cardiac output monitoring (NICOM) in children with sepsis. Methods A total of 51 children with sepsis admitted to pediatric inten-sive care unit in Chengdu Women and Children's Center Hospital were enrolled. They were divided into three groups:sepsis without cardiovascular functional disorder group( sepsis group,n＝16),septic shock compen-sation group (n＝22),septic shock decompensation group (n＝13). The cardiac function of the children was detected by NICOM and echocardiography at the time of admission 0 hours and 1 hours after admission re-spectively. Cardiac index (CI),stroke volume(SV) measured by NICOM and ejection fraction (EF),SV measured by echocardiography were recorded. The correlation between CI and EF at 0 hours and 1 hours after admission was analyzed,and the SV measured by the two methods were compared. Results (1) In the sep-sis group,the CI measured by NICOM was(3. 54 ± 0. 36) L/( min·m2) and EF measured by echocardio-graphy was (66. 9 ± 4. 4)%. There was a significant positive correlation between CI and EF(r＝0. 941,P<0.01).(2) In the septic shock compensation group,CI was (2.40 ±0.36) L/(min·m2) and EF was (51. 91 ± 4. 38)% at 0 hours after admission,and there was a positive correlation between CI and EF( r＝0. 751,P＝0. 023). CI was(2. 98 ±0. 37)L/(min·m2)and EF was(59. 41 ±4. 39)% at 1 hours after admis-sion,and there was a positive correlation between CI and EF (r＝0. 879,P＝0. 012). At 0 hours and 1 hours after admission,the value of SV measured by NICOM was very close to that measured by echocardiography, and there was no significant difference(P>0. 05). (3) In the septic shock decompensation group,CI was (1.26 ±0.28) L/(min·m2) and EF was (41.23 ±4.73)% at 0 hours after admission,and there was no positive correlation between CI and EF(r＝0. 515,P＝0. 121). CI was(1. 61 ± 0. 32)L/(min·m2)and EF was(47. 77 ± 6. 19)% at 1 hours after admission,and there was no positive correlation between CI and EF (r＝0. 531,P＝0. 085). There was significant difference between the value of SV measured by NICOM and that measured by echocardiography at 0 hours and 1 hours after admission (P<0. 05). Conclusion NICOM can accurately evaluate cardiac output when the hemodynamics is stable,but the results are not accurate when the hemodynamics is unstable. NICOM has certain application value in pediatric critical care.
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Objective To compare the efficacy of heparin and bivalirudin in patients with acute coronary syndrome undergoing emergency percutaneous coronary intervention ( PCI ) .Methods A total of 90 patients with acute coronary syndrome were included in this study .They were divided into the study group and control group according to the requirements of random envelope method ,45 cases in each group .The study group received bivalirudin during PCI,the control group was given heparin .The Fbg,APTT,TT and PT were detected in the two groups ,and the inci-dence of adverse reactions ( heart failure , cardiac death , platelet reduction , hemorrhage of digestive tract ) was analyzed.Results After treatment,there were no statistically significant differences between the two groups in various blood coagulation indicators (all P>0.05).The incidence rate of adverse events of the study group was 4.44％, which was significantly lower than 24.44％of the control group ,and the difference was statistically significant (χ2 =7.28,P<0.05).Conclusion Application of heparin and bivalirudin in PCI has similar efficacy ,but the safety of bivalirudin is higher ,which is worthy of clinical promotion .
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Reflective capacity is a very important tool of assessment for health professionals. Re-flective writing (RW) curriculum, aiming at promoting reflective capacity, is proliferating within American medical education. This paper generalizes the training process of RW capacity, its contents and evaluation tool. It discusses the meaningfulness of RW curriculum in improving doctor-patient relationship and profes-sionalism and developing academic goals. For better practice, the paper makes suggestions that we should reform our traditional medical education, develop interdisciplinary teams of teachers and evaluation tool and incorporate RW curriculum into continuing medical education.
ABSTRACT
How to improve medical English writing skill effectively is an urgent problem to be solved in medical English teaching.This study aimed to evaluate the effect of the Presentation-Assimilation-Discussion (PAD) Class Model combining the advantages of traditional teaching model and the current flip classroom teaching model in medical English writing course.The study of "abstract writing" was divided into three parts,i.e.Presentation,Assimilation and Discussion which respectively focused on teacher's presentation of the basic structure of abstract in class,students' assimilation of the files after class,students-teacher's discussion in class.The test results and questionnaire were analyzed at the end of the course.PAD class model can optimize the teaching efficiency of basic knowledge,increase students' ability to learn autonomously,and promote the transformation of teachers' role.However,higher requirements are placed on the assessment methods,curriculum design,and teaching procedures.