Effect of posture on total hip arthroplasty through direct anterior approach / 中国骨伤

OBJECTIVE@#To investigate the effect of different postures on direct anterior approach(DAA) total hip arthroplasty.@*METHODS@#Total of 94 patients who underwent DAA total hip arthroplasty from July 2016 to June 2020 were retrospectively analyzed. They were divided into two groups according to different positions during the operation, including 45 cases in lateral position and 49 cases in supine position (with the aid of stent). The general data such as gender, affected limb, body mass index(BMI), incision length, operation time, intraoperative bleeding volume, drainage volume 24 hours after operation, hemoglobin difference before and after operation, first landing time after operation, postoperative hospitalization time, postoperative complications, visual analogue scale(VAS) at 1 day, 1, 2 weeks, 1, 3 and 6 months after operation, Harris score at 1, 2 weeks, 1, 3 and 6 months after operation were observed and compared between the two groups.@*RESULTS@#Patients in both groups were followed up for 6 to 12 months with an average of (8.31±2.22) months. There was no significant difference between two groups in gender, affected limb, age, height, weight, body mass index(BMI), preoperative VAS score and preoperative Harris score(P>0.05). The incision length, operation time, intraoperative bleeding volume, 24-hour drainage volume, hemoglobin difference before and after operation, first time to the ground and postoperative hospitalization time of patients in supine position (assisted by stent) group were all better than those in lateral position group(P<0.05);There was no significant difference in the number of blood transfusions during and after operation(P=0.550). There was no significant difference in anteversion angle and abduction angle in the supine position(with the aid of stent) group during and after operation (P=0.825, P=0.066);There was significant difference in anteversion angle and abduction angle in the lateral position group during and after operation(P<0.05). VAS of patients in supine position (assisted by stent) group were lower than those in lateral position group at 1 day, 1, 2 weeks and 1 month after operation(P<0.05), and there was no statistical difference between two groups at 3 and 6 months after operation(P>0.05). Harris scores of patients in supine position(assisted by stent) group were higher than those in lateral position group at 1 week, 1 month and 3 months after operation(P<0.05), and there was no significant difference between two groups at 6 months after operation(P>0.05).@*CONCLUSION@#Compared with the lateral position, the supine position DAA total hip arthroplasty has the advantages of small incision, short operation time, less bleeding, early landing time, short hospitalization time, and small intraoperative acetabular cup position judgment error. It has the advantage of fast postoperative recovery, but the recovery of hip joint function is the same after 6 months.

Management experience of brain metastasis after liver transplantation for hepatocellular carcinoma / 中华器官移植杂志

Objective:To explore the pathogenesis and prognostic factors of brain metastasis of hepatocellular carcinoma(HCC)after liver transplantation(LT).Methods:Retrospective review was performed for 17 HCC cases with brain metastasis after liver transplantation from 2000 to 2020.All cases were diagnosed as hepatitis B cirrhosis complicated with HCC.All of them were beyond the Milan Criteria.The immunosuppressive regimen consisted of baliximab + mycophenolate mofetil + calcineurin inhibitors(CNIs)+ corticosteroids in early postoperative period with a gradual tapering of corticosteroids and mycophenolate mofetil.Three patients received sirolimus immunotherapy after tumor recurrence and withdrew CNIs.One of three cases received sorafenib.Results:Other organ involvements included lung metastasis( n=16, 94.1%), bone metastasis( n=5, 29.4%)and liver metastasis( n=6, 35.3%). The median survival time after brain metastasis was 7 months and the 1-year cumulative survival rate 29.4%.The median survival time post-LT was 14 months and the 1-year cumulative survival rate 64.7%.Among 7 patients with a resection of brain metastasis, two deaths at Month 1 post-operation were due to cerebral hemorrhage.The longest survival time was 214 months and the median survival time 9 months. Conclusions:The prognosis of brain metastasis post-LT remains poor.However, early detection and reasonable treatment can prolong patient survival time and even achieve long-term survival.Most brain metastases are accompanied by lung metastases.And the finding of lung metastatic tumor hints at a presence of intracranial lesions.

Study on endpoint determination method of tablet coating based on 3σ criteria and logic regression / 中国中药杂志

This paper explores the statistical distribution characteristics of coating film thickness, so as to present a new method for determining coating endpoint based on 3σ criterion and logic regression. Firstly, the spectrum and thickness of 4 batch samples were collected. Secondly, the spectral range of normal products was obtained by 3σ criterion, with the spectral feature NI as the number of test spectrum in the above range. Then, the model based on 3σ criterion and logic regression was built according to the best condition in K-fold cross-validation and the determined threshold of qualified rate in the coating endpoint. Finally, the qualified rate of test set samples at different time points was calculated by the above model, and the above change trend and the threshold value were combined to determine the coating endpoint. The results of KS analysis showed the distribution of thickness of the qualified products followed the normal distribution(P=0.081>0.05). The accuracy of the coating endpoint determination was as high as 100% by the model based on 3σ criterion and logic regression when the determined threshold of qualified rate was 90%. Therefore, the 3σ criterion was feasible to the research of coating eligibility. This paper reveals certain random phenomena in the coating process, and the method features a high accuracy, quick analysis and a good interpretability, which provides a reference for online detection and qualify evaluation in future.

Comparative study on infection and degradation of Armillaria gallica and Phallus impudicus to fungus-growing materials / 中国中药杂志

The phenomenon that waste of fungus-growing materials in the planting process of Gastrodia elata is very common. It has been proved by practice that the used fungus-growing materials planted with G. elata can be used to plant Phallus impudicus. But the mechanism is unclear. In this study, we compared the different infested-capacity of Armillaria gallica and Phallus impudicus by morphological anatomy of the used fungus-growing materials. We also compared the differences on the two fungi consumed the main contents of fungus-growing materials, cellulose, lignin and hemicellulose, by using nitric acid-95% ethanol method, sulfuric acid method and tetrabromide method respectively, so that to explore the mechanism of A. gallica and P. impudicus recycle the fungus-growing materials, and to provide scientific basis for recycling the used fungus-growing materials of G. elata. The results showed that A. gallica had a strong ability to invade some parts outside the vascular cambium, but it had a weak ability to invade some parts inside the vascular cambium, while P. impudicus had a strong ability to invade the same parts. The contents of lignin and cellulose, which from inside and outside the vascular cambium of fungus-growing materials were significantly different. In the parts of outside the vascular cambium of fungus-growing materials, A. gallica degraded more lignin and cellulose, while P. impudicus degraded more hemicellulose. In the parts of inside the vascular cambium of fungus-growing materials, A. gallica degraded more cellulose, while P. impudicus degraded more hemicellulose. The present results suggested that A. gallica and P. impudicus made differential utilization of the carbon source in the fungus-growing materials to realize that P. impudicus recycle the used fungus-growing materials of G. elata. A. gallica used lignin and cellulose as the main carbon source, while P. impudicus used hemicellulose as the main carbon source.

Effect of Gastrodiae elata-Phallus impudicus sequential planting pattern on soil microbial community structure / 中国中药杂志

Gastrodia elata is a heterotrophic plant that needed to be symbiotic with Armillaria. The obstacle of continuous cropping in G. elata is serious during the G. elata cultivation, and the mechanism of obstacle in G. elata continuous cropping had not been solved. The planting of G. elata-Phallus impudicus is a new sequential planting pattern adopted in Guizhou province, but the effect of the cultivation on soil microbial community structure is still unclear. In this study, we collected four soil samples for the research including the soil without planted G. elata as control(CK), rhizosphere soil samples tightly adhering to the G. elata surface(GE), rhizosphere soil samples tightly adhering to Armillaria which was symbiotic with G. elata(AGE), the rhizosphere soil of P. impudicus planting after G. elata cultivation(PI). In order to explore the mechanism, the research study on the soil of G. elata-P. impudicus by using ITS and 16 S rDNA high-throughput sequencing technologies to detect soil microbial community structure including fungi and bacteria in the soil of CK, AGE, GE and PI. OTU clustering and PCA analysis of soil samples showed that the soil microbial diversity was relatively similar in AGE and GE. And the soil microbial in PI and CK clustered together. The results showed that AGE and GE had similar soil microbial diversity, as well as PI and CK. Compared with CK, the soil microbial diversity and abundance in AGE and GE were significantly increased. But the microbial diversity and abundance decreased in PI compared with AGE and GE. The annotation indicated that the abundance of Basidiomycota, Acidobacteria and Chloroflexi decreased, and that of Ascomycota, Zygomycota and Proteobacteria increased in AGE and GE compared with CK. In contrast to AGE and GE, PI was the opposite. The abundance of Basidiomycota, Acidobacteria and Chloroflexi increased in PI compared with AGE and GE. The abundance of microorganisms in the soil of PI and CK was similar. In addition, the co-culture of Armillaria and P. impudicus indicated that P. impudicus had obvious antagonistic effects on the growth of Armillaria. Therefore, it is speculated that the mechanism of G. elata-P. impudicus planting pattern related to the change of soil microbial. And we supposed that P. impudicus might inhibit the growth of Armillaria and change the soil microbial community structure and the abundance of soil microbial. And the soil microbial community structure was restored to a state close to that of uncultivated G. elata. Thus, the structure of soil microbial community planting G. elata could be restored by P. impudicus planting.

Ecological benefits of Gastrodia elata-Phallus impudicus sequential planting pattern / 中国中药杂志

Gastrodia elata is a kind of precious traditional Chinese medicine. In the process of cultivation of G. elata, due to the influence of continuous cropping obstacles and other factors, the fungus materials and land that have been planted with G. elata are often abandoned, resulting in a great waste of resources. Based on the planting characteristics of G. elata and Phallus impudicus and the previous research experience in ecological agriculture, this paper analyzed the ecological adaptability characteristics of G. elata and P. impudicus, and summarized the key techniques of the G. elata-P. impudicus sequential planting pattern. Keeping track of the planting area, fungus-growing materials consumption and market sales of G. elata-P. impudicus sequential planting pattern, the ecological benefits of G. elata-P. impudicus sequential planting pattern from the aspects of utilization rate of fungus-growing materials were analyzed, the value of land resources per unit area, ecological environmental protection, labor cost and economic benefits were consi-dered. The technical principle of G. elata-P. impudicus sequential planting pattern was expounded according to their ecological habit, the season of harvest and planting, the difference of composition of fungus-growing materials, and the microbial ecology. The sequential planting pattern of G. elata-P. impudicus not only realized the double production of medicinal materials and edible fungi, reduced the waste of old fungus-growing materials, but also transformed the energy from nutrition-supplied fungi to edible and medicinal fungi, which guaranteed the ecological recycling and utilization of G. elata in the process of cultivation.

Isolation and Identification of Mycena of Pleurotus in Wumeng Mountain Area and Optimization of Its Production Conditions / 中国实验方剂学杂志

Objective:Isolate and identify Mycena, expand the resources of geminating fungus of Gastrodia elata and optimize the culture conditions of Mycena，in order to provide information and guidance for the production of geminating fungus of G. elata. Method:Juvenile tuber tissue mass transfer separation and purification technology was used for the separation and purification of strains，traditional morphology microscopy was used to isolate the colony mycelia spores morphological characteristics, such as identification，polymerase chain reaction（PCR） amplification rDNA （Ribosomal DNA） internal transcribed spacer（ITS） was used for sequencing analysis and further homology with NCBI database retrieval，MEGA6 software was used to establish Phylogenetic tree by the Maximum likelihood method （MaximumLikelihood，M-L）, so as to classify and identify isolated strains. At the same time，orthogonal test was used to optimize the optimal growth conditions of Mycena. Result:A total of 86 strains were isolated, which belong to 21 species in 12 genera. WMMFJ，SHXG，WMM-21 and MFJ8103 were identified as M. purpureofusca, and ZT01-6 and ZT01-8 were identified as M. cf. purpureofusca. The growth rate of Mycena in wheat bran medium was significantly higher than in PDA medium. The optimal medium composition for the growth of germinating bacteria was 100 g potato，150 g wheat bran and 20 g corn flour，100 g glucose. And 1，3，5-Trihydroxybenzene significantly promoted the growth of WMMFJ，and played a role in promoting the growth of WMM-21 and ZT01-6，and 2-Methoxyphenol promoted the growth of WMMFJ. Conclusion:Six strains of Mycena were isolated and identified，four of them are M. purpureofusca，and two of them are M. cf. Purpureofusca. The separation method improved the separation effect of germinating bacteria.

Association Study Between Rhizoma Gastrodia elata Brown-rot and Soil Microbial Communities / 中国实验方剂学杂志

Objective:To study the microbial community composition and diversity of brown-rot Gastrodia elata and its surface soil，in order to explain the relationship between brown-rot G. elata and soil microflora in G. elata planting process and provide theoretical basis for revealing the reasons of G. elata brown-rot disease. Method:Used internal transcribed spacer region（ITS） and 16S rDNA high-throughput sequencing technologies to detect the microbial diversity，community structure composition and community structure similarity of fungi and bacteria in healthy tuber，Brown-rot tuber，healthy soil and Brown-rot soil. Result:Compared with health groups，the number of fungi and bacteria operational taxonomic units（OTUs） was increased in brown-rot G. elata and its soil， and the abundance and diversity of fungi and bacteria in brown-rot G. elata soil were significantly decreased. The diversity of fungi in the tubers of brown-rot G. elata was significantly reduced，while the diversity of bacteria was significantly decreased. At the genus level， Mortierella was dominant fungi genus in healthy tuber and healthy soil，which was reduced 7.62% and 15.75% respectively in brown-rot tuber and brown-rot soil. And the dominant bacteria genus was Bradyrhizobium and Burkholderia-Paraburkholderia respectively. Ilyonectria was dominant fungi genus in brown-rot tuber and brown-rot soil，the dominant bacteria genus was Serratia and Bradyrhizobium respectively. Conclusion:The fungal flora in the tuber of brown-rot G. elata had a very high degree of similarity to that in the surrounding soil. These results indicated that the change of soil microbial fungal community caused the occurrence of G. elata brown-rot disease to a certain extent. And the pathogenic fungal Ilyonectria was dominant genus in fungi community of brown-rot tuber and brown-rot soil. Ilyonectria may have the main G. elata brown-rot disease pathogen.

Analysis of ecological recycling modes for Gastrodia elata cultivation / 中国中药杂志

Gastrodia elata is a kind of precious traditional Chinese medicine. In artificial cultivation, it has not got rid of its dependence on forest resources. In order to maintain the balance of the ecological system and reduce the waste of resources as much as possible, based on the information from field investigation at many places, this paper introduced the new ecological circulation planting patterns of G. elata, such as "forest-G. elata" supporting planting, G. elata-edible mushroom rotation, forest-G. elata-edible mushroom three-dimensional planting, fungus material classification planting technology, and so on. In this paper, we expounded the ecological problems solved by several planting patterns in G. elata production and analyzed their shortcomings. Finally, based on the exis-ting models, a complete ecological planting system of G. elata was summarized. This planting system emphasizes: ① The follow-up forests should be started before the planting of G. elata. And the economic forests were used to cultivation of G. elata. ② The classified utilization of fungus-growing materials. The leaves were used to cultivate germination bacteria of G. elata, the small branches were used to cultivate protocorm and juvenile tuber, the large branches were used to cultivate immature tuber, and the tree trunk was used to cultivate mature tuber. ③ Recycle utilization G. elata fungus material. The old fungus materials were used to produce strains or cultivate edible fungus. This design project not only solves the problems of the source of G. elata fungus material, the efficient utilization of fungus material and land resources, but also enriches the industrial structure. Using limited time and land resources to obtain greater economic benefits. It has certain guiding significance for poverty alleviation and ecological improvement.

Diagnostic Utility of Interferon-Gamma Release Assay in Tuberculous Lymphadenitis / 中国医学科学杂志(英文版)

Objective The aim of this study was to evaluate the diagnostic performance of T-SPOT.TB for tuberculous lymphadenitis. Methods Suspected tuberculous lymphadenitis patients between September 2010 and September 2018 who had both peripheral blood T-SPOT.TB test and lymph node biopsy were retrospectively enrolled in this study. The cutoff value of T-SPOT.TB test for peripheral blood was set as 24 spot forming cell (SFC)/10 6 periphreral blood monocyte cell (PBMC) according to the instruction of testing kits. The gold standard for diagnosis of TBL was the combination of microbiology results, histopathology results and patient's response to anti-TB treatment. Diagnostic efficacy of T-SPOT.TB was evaluated, including sensitivity, specificity, accuracy, predictive values, and likelihood ratio. Results Among 91 patients who met the inclusion criteria, we excluded 8 cases with incomplete clinical information and 6 cases who lost to follow-up. According to the gold standard, there were 37 cases of true TBL (9 confirmed TBL and 28 probable TBL), 30 cases of non-TBL, and 10 cases of clinically indeterminate diagnosis who were excluded from the final analyses. The T-SPOT.TB tests yielded 43 cases of positive response and 24 cases of negative response. The sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) of peripheral blood T-SPOT.TB for diagnosing TBL were 89.2%, 66.7%, 79.1%, 76.7%, 83.3%, 2.68 and 0.16, respectively. The number of SFCs of T-SPOT.TB in TBL patients [432(134-1264)/10 6 PBMCs] was higher than that in non-TBL patients [0 (0-30) /10 6PBMCs] with a significant difference (Z=-5.306, P <0.001). Conclusion T-SPOT.TB is a rapid and simple diagnostic test for TBL with a high sensitivity and negative predictive value.

A twenty-year review of clinical liver transplantation / 中华危重病急救医学

OBJECTIVE@#To review the development of adult and pediatric liver transplantation in Tianjin First Center Hospital, and to enhance academic exchanges, improve technological innovation, and jointly promote the progress and maturity in the field of liver transplantation.@*METHODS@#The development of liver transplantation in Tianjin First Center Hospital was analyzed. The clinical data of adult and pediatric liver transplantation from September 1998 to September 2018 were collected. The important events and technological innovation achievements of liver transplantation during the 20 years were summarized.@*RESULTS@#The first clinical liver transplantation was attempted in Tianjin First Central Hospital in April 1980. The first long-term survival adult liver transplantation in China was completed in 1994 (11 years survival after the operation). The specialized team of liver transplantation was formally established in September 1998. The 20-year clinical exploration and progress reflected the characteristics of era changes and technological innovation during the rapid development of liver transplantation in China. Our center performed liver re-transplantation in January 1999, reduced-size pediatric liver transplantation in August 2000. In May 2001, we organized the formulation for the preventive and treatment plan for hepatitis B recurrence after liver transplantation. We performed combined liver and kidney transplantation in July 2002, split liver transplantation (SLT) in April 2004, the first domino liver transplantation (DLT) in August 2005. Pediatric living donor liver transplantation (LDLT) was initiated in October 2006, adult LDLT was carried out in August 2007. In September 2007, the first living donor combined liver and kidney transplantation from the same donor in Asia was performed. The first domino+living donor double grafts liver transplantation in the world was performed in January 2009. In March 2011, we performed laparoscopically assisted right hepatic lobe liver transplantation (LDLT) with middle hepatic vein. In May 2014, living donor laparoscopic left lateral lobe procurement was successfully established. In April 2016, simultaneous liver, pancreas and kidney multi-organ transplantation was completed. Domino donor-auxiliary liver transplantation was performed in February 2017. In December 2017, extracorporeal membrane oxygenation (ECMO)-supported liver transplantation in a patient with severe pulmonary hypertension was successfully completed. Liver transplantation combined with partial splenectomy was established in April 2018. Cross-domino liver transplantation (hypersensitive kidney transplantation with auxiliary liver transplantation+pediatric liver transplantation) was performed in May 2018. During the 20 years, the team has performed or assisted other centers in Beijing, Shanghai, Guangzhou and Shenzhen to carry out more than 10 000 cases of liver transplantations. A total of 7 043 cases of various types of liver transplantation were performed in the single center of the hospital (6 005 adult liver transplantations and 1 038 pediatric liver transplantations). Concerning adult liver transplantation, the cumulative 1-year, 3-year and 5-year survival rate from September 1998 to March 2003 were 83.1%, 73.0% and 69.0%, from April 2003 to March 2009 were 85.3%, 76.2% and 72.1% and from April 2009 to September 2018 were 87.5%, 79.2% and 75.1%, respectively. The cumulative 1-year, 3-year and 5-year survival rate for pediatric liver transplantation were 93.5%, 92.2% and 90.2%, respectively. The nucleoside (acid) analogue combined with low dose hepatitis B immunoglobulin (HBIG) was developed to prevent the recurrence of hepatitis B after liver transplantation, this plan has reduced the recurrence rate of hepatitis B and the 5-year re-infection rate of hepatitis B virus (HBV) after liver transplantation significantly. The risk assessment system for tumor recurrence after liver transplantation was established and individual treatment method was established based on this assessment system. Continuous exploration and improvement of liver transplantation for liver cancer, liver re-transplantation, liver transplantation with portal vein thrombosis, SLT, DLT and multi-organ combined transplantation have significantly improved the clinical efficacy of patients and the post-operative survival rate.@*CONCLUSIONS@#The liver transplantation team of Tianjin First Center Hospital has carried out a scientific and technological exploration on the key problems and technical difficulties of clinical liver transplantation. This work strongly has initiated and promoted the rapid development of liver transplantation in China. The restrictive barrier of hepatitis B recurrence after liver transplantation has been overcome. The risk prevention and control system of tumor recurrence after liver transplantation has been established. A series of innovative achievements that can be popularized have been achieved in the field of complex liver transplantation and expansion of donor liver source. The iterative progress and sustainable development of liver transplantation have been realized.

A twenty-year review of clinical liver transplantation / 中华危重病急救医学

Objective To review the development of adult and pediatric liver transplantation in Tianjin First Center Hospital, and to enhance academic exchanges, improve technological innovation, and jointly promote the progress and maturity in the field of liver transplantation. Methods The development of liver transplantation in Tianjin First Center Hospital was analyzed. The clinical data of adult and pediatric liver transplantation from September 1998 to September 2018 were collected. The important events and technological innovation achievements of liver transplantation during the 20 years were summarized. Results The first clinical liver transplantation was attempted in Tianjin First Central Hospital in April 1980. The first long-term survival adult liver transplantation in China was completed in 1994 (11 years survival after the operation). The specialized team of liver transplantation was formally established in September 1998. The 20-year clinical exploration and progress reflected the characteristics of era changes and technological innovation during the rapid development of liver transplantation in China. Our center performed liver re-transplantation in January 1999, reduced-size pediatric liver transplantation in August 2000. In May 2001, we organized the formulation for the preventive and treatment plan for hepatitis B recurrence after liver transplantation. We performed combined liver and kidney transplantation in July 2002, split liver transplantation (SLT) in April 2004, the first domino liver transplantation (DLT) in August 2005. Pediatric living donor liver transplantation (LDLT) was initiated in October 2006, adult LDLT was carried out in August 2007. In September 2007, the first living donor combined liver and kidney transplantation from the same donor in Asia was performed. The first domino+living donor double grafts liver transplantation in the world was performed in January 2009. In March 2011, we performed laparoscopically assisted right hepatic lobe liver transplantation (LDLT) with middle hepatic vein. In May 2014, living donor laparoscopic left lateral lobe procurement was successfully established. In April 2016, simultaneous liver, pancreas and kidney multi-organ transplantation was completed. Domino donor-auxiliary liver transplantation was performed in February 2017. In December 2017, extracorporeal membrane oxygenation (ECMO)-supported liver transplantation in a patient with severe pulmonary hypertension was successfully completed. Liver transplantation combined with partial splenectomy was established in April 2018. Cross-domino liver transplantation (hypersensitive kidney transplantation with auxiliary liver transplantation+pediatric liver transplantation) was performed in May 2018. During the 20 years, the team has performed or assisted other centers in Beijing, Shanghai, Guangzhou and Shenzhen to carry out more than 10 000 cases of liver transplantations. A total of 7 043 cases of various types of liver transplantation were performed in the single center of the hospital (6 005 adult liver transplantations and 1 038 pediatric liver transplantations). Concerning adult liver transplantation, the cumulative 1-year, 3-year and 5-year survival rate from September 1998 to March 2003 were 83.1%, 73.0% and 69.0%, from April 2003 to March 2009 were 85.3%, 76.2% and 72.1% and from April 2009 to September 2018 were 87.5%, 79.2% and 75.1%, respectively. The cumulative 1-year, 3-year and 5-year survival rate for pediatric liver transplantation were 93.5%, 92.2% and 90.2%, respectively. The nucleoside (acid) analogue combined with low dose hepatitis B immunoglobulin (HBIG) was developed to prevent the recurrence of hepatitis B after liver transplantation, this plan has reduced the recurrence rate of hepatitis B and the 5-year re-infection rate of hepatitis B virus (HBV) after liver transplantation significantly. The risk assessment system for tumor recurrence after liver transplantation was established and individual treatment method was established based on this assessment system. Continuous exploration and improvement of liver transplantation for liver cancer, liver re-transplantation, liver transplantation with portal vein thrombosis, SLT, DLT and multi-organ combined transplantation have significantly improved the clinical efficacy of patients and the post-operative survival rate. Conclusions The liver transplantation team of Tianjin First Center Hospital has carried out a scientific and technological exploration on the key problems and technical difficulties of clinical liver transplantation. This work strongly has initiated and promoted the rapid development of liver transplantation in China. The restrictive barrier of hepatitis B recurrence after liver transplantation has been overcome. The risk prevention and control system of tumor recurrence after liver transplantation has been established. A series of innovative achievements that can be popularized have been achieved in the field of complex liver transplantation and expansion of donor liver source. The iterative progress and sustainable development of liver transplantation have been realized.

The role of physical examination, pulse oximetry screening, and perfusion index in screening of neonatal congenital heart disease / 临床儿科杂志

Objective To find a reliable, simple, and easily-operated method for the screening of neonatal congenital heart disease (CHD). Methods A total of 7 105 neonates born from January 2017 to July 2017 were selected. The validity and reliability of physical examination, pulse oximetry screening (POS), and perfusion index (PI) in the screening of neonatal CHD were evaluated according to the diagnosis made by color Doppler echocardiography. Results When physical examination, POS or PI was used separately in screening for CHD, the sensitivities were in the range of 13.11%~73.77%, specificities 50.20%~99.34%, Youden indexes 0.12~0.70, the total coincidence rates 50.40%~98.86%, positive predictive values 1.27%~40.70%, and negative predictive values 99.29%~99.70%. When physical examination, POS and PI were combined (two or three indexes were positive) for screening, the sensitivities and Youden indexes were 85.25% and 0.82 respectively, which were higher than those of single indicators and suggested that the combination had higher authenticities. The total coincidence rate of the combination was 97.07%, and, although it was lower than POS group (98.86%) and PI screening group (98.58%), it still had a good reliability. Conclusions The combination of physical examination, POS and PI has a certain clinical value in neonatal CHD screening.

Application of modified eversion thrombectomy for portal vein thrombosis in patients undergoing liver transplantation / 中华器官移植杂志

Objective To discuss the modified eversion thrombectomy for portal vein thrombosis (PVT) in liver transplantation and the curative effectiveness.Methods All 613 cases complicated with PVT preoperation were given modified eversion thrombectomy,and there were 179,236,182 and 16 cases of PVT Yerdel grade Ⅰ,Ⅱ,Ⅲ and Ⅳ respectively.Results All 415 PVT patients of grade Ⅰ and Ⅱ received modified eversion thrombectomy and success rate was 100％.Among 182 PVT patients of grade Ⅲ received modified eversion thrombectomy (success in 176 cases,and failure in 6 cases).Sixteen PVT patients of grade Ⅳ received modified eversion thrombectomy (success in 13 cases and failure in 3 cases).The 1-year survival rate of PVT patients after surgical operation was 93.6％,and that of non-PVT patients was 94.6％ (P＞0.05).Conclusion Modified eversion thrombectomy could be adopted in PVT patients regarding to different Yerdel grades.

Role of Urine ErbB3 Protein in Early Diagnosis of Clear Cell Renal Cell Carcinoma / 中山大学学报(医学科学版)

[Objective]To explore the diagnostic value of urine ErbB3 protein in clear cell renal cell carcinoma.[Methods]We collected 31 urine samples of clear cell renal cell carcinoma patients who received operations in the Urology Department of the First Affiliated Hospital of Sun Yat-Sen University from April 2,2016 to August 31,2016.Meanwhile we collected 50 urine samples of normal people as control.We tested the expression of urine ErbB3 protein in experimen-tal group and control group,and analyzed the differences between the two groups.Then we established the ROC curve of which diagnosing clear cell renal carcinoma by urine ErbB3 protein. Also,we analyzed the relation between ErbB3 pro-tein in urine and the patients'BMI,preoperative creatinine,tumor diameter and underlying diseases such as hyperten-sion and hyperglycemia.[Results]①The expression of urine ErbB3 protein in clear cell renal cell carcinoma group was significantly lower than normal group(P<0.001). ② When diagnosing clear cell renal carcinoma by ErbB3 protein,the AUC of ROC was 0.802(P<0.001). When setting the cutoff as 13.98 pg/mL,the max Youden index was 0.525,the sensitivity was 0.645 and the specificity was 0.880. The Kappa value of diagnostic test was 0.542(P<0.001). ③ There was no correlation between the ErbB3 content and patients'BMI,tumor diameter or preoperative creatinine by correlation analysis. Also,there was no correlation between the urine ErbB3 protein content and blood pressure or blood glucose.[Conclusion]The urine ErbB3 protein of clear cell renal cell carcinoma was significantly lower than normal people,and it is meaningful for applying urine ErbB3 protein to early diagnosis of clear cell renal cell carcinoma.

Analysis of long term biliary complications and survival of liver transplantation from organ donation after citizen's death / 中华器官移植杂志

Objective To evaluate the clinical effect,the incidence of postoperative biliary complications and the survival of liver transplantation from Chinese donation after citizen's death (DCD).Methods The clinical characteristics of donors and recipients,survival of allografts and recipients,and postoperative biliary complications of 169 cases of DCD liver transplantation from October 2013 to June 2015 were analyzed retrospectively.Results The overall biliary complication rate was 8.28％ (14/169).There were 6 cases of ischemic cholangiopathy [3.55％ (6/169)].In 37 cases receiving donation after brain death liver transplantation,the incidence of biliary complications was 8.11％ (3/37),and ischemic biliary disease occurred in 1 case with the incidence being was 2.70％.In 132 cases of donation after cardiac death liver transplantation,biliary complication rate was 8.33 ％ (11/132),and there were 5 cases of ischemic biliary disease with the incidence being 3.79 ％.There was no significant difference in the incidence of bile duct complications of the recipients between brain death and cardiac death organ donation (P＞ 0.05).The 1-,2-,and 3-year survival rate of patients and grafts of donation after brain death was 94.5％,89.2％ and 83.7％,and 94.5％,86.5％ and 81.1％,respectively.The 1-,2-,and 3-year survival rate of patients and grafts of donation after cardiac death was 93.9％,88.6％ and 83.3％,and 91.7％,86.4％ and 80.3％,respectively.There was no significant difference in survival of recipients and grafts between brain death and cardiac death organ donation (P＞0.05).The mean warm and cold ischemia time of donation after cardiac death was 13.59 min and 3.32 h respectively.Conclusion The outcome of DCD liver transplantation is satisfactory.The incidence of overall biliary complications and ischemic biliary disease of cardiac death donor liver transplantation was close to that of brain death donor liver transplantation.

Investigation of the affordability of chronic diseases drug use in families from three provinces in Western China / 中国卫生政策研究

Objective:To investigate the affordability of chronic diseases and drug use in families three prov-inces in western China. Methods: Questionnaire survey was conducted in 6 cities in 3 west provinces of China—Guangxi,Shanxi and Sichuan. In each province,one provincial capital city and one medium-sized city were select-ed. 2 community health service centers,2 secondary hospitals and 2 tertiary hospitals were selected from each city as the survey sites. Questionnaire was designed and pre-tested in advance,and delivered to sample patients'families in survey sites by face-to-face interview. Results:Totally 900 questionnaires were sent out,and 838 were effectively re-ceived with effective recovery of 93.11%. 97.85% of patients participated in various medical insurance. The aver-age health expenditure of households was 1 364.84 yuan per month and accounted for 37.43% of the total expendi-ture;chronic diseases expenditure was 700.34 yuan per month and accounted for 51.31% of the total health expend-iture. The average monthly drug expenditure was 628.74 yuan and represented 16.73% of the total household ex-penditure. Surveyed family members mainly suffered from chronic diseases,hypertension and diabetes,and the heav-iest disease burden in families came from ischemic heart disease and chronic kidney disease. Different provinces, provincial capitals and non-provincial cities,and different levels of medical institutions have a greater difference in drug burden. Patients have experienced the effect of medical reform,but not familiar with the specific health care reform poli-cies. Conclusions and Suggestions:The surveyed patients'families were basically involved in the Medicare,but the burden of family medication for patients with chronic diseases was still heavy. Therefore,government should take further measures to improve the proportion of chronic diseases outpatient and reduce the burden of medication costs.

Effect of flurbiprofen administration on postoperative inflammatory factors in patients undergoing laparoscopic acute suppurative appendicitis / 中国生化药物杂志

Objective To investigate the effect of flurbiprofen administration time on inflammatory factors in patients with acute suppurative appendicitis after laparoscopic resection. Methods 60 patients with acute suppurative appendicitis resection treated in our hospital from January 2015 to March 2017 were divided into two groups according to the different administration time. The control group received flurbiprofen at the time of operation, and the observation group received flurbiprofen before operation induction; The changes of the indexes of operation and inflammatory factors before and after the operation were compared between the two groups. Results There were no significant differences between the two groups in each operation index; The level of inflammatory factors in the observation group was better than that in the control group 24 hours after the operation, the difference was statistically significant (P<0.05). Conclusion The effect of flurbiprofen is significant before the induction of anesthesia, and the control effect of inflammatory factors is good after the operation, and the time will not affect the postoperative analgesia.

Liver transplantation for benign liver tumors / 中华普通外科杂志

Objective To evaluate the indications and results of liver transplantation ior benign liver tumors.Methods From Jan 2001 to Dec 2014,16 patients of inoperable severely symptomatic benign liver tumors underwent liver transplantation in our department.There were 10 cases of polycystic liver disease,2 cases of hepatic epithelioid hemangioendothelioma,1 case of hepatic cavernous hemangioma,1case of liver mesenchymal hamartoma,1 case of hilar bile duct mucinous cystadenoma,1 case of hepatic adenoma.Results 3 cases were dead in the perioperative period.The remaining patients were alive and discharged with normal perioperative liver and kidney function.One case of polycystic liver lost to follow-up,the remaining 12 patients were all alive at the end of a follow-up of 17 to 161 months,with fully active life style.Conclusions Liver transplantation is an effective and sometimes the only treatment option for unresectable and symptomatic benign liver lesion.

Surgical options for delayed osteoporotic vertebral collapse / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the surgical options and clinical effects of delayed osteoporotic vertebral collapse.</p><p><b>METHODS</b>From May 2010 to October 2014, 19 patients (20 vertebrae) with delayed osteoporotic vertebral collapse(Kümmell's disease) were enrolled in this study. There were 7 males and 12 females, aged from 65 to 87 years old with a mean of (73.5±5.62) years. According to Li staging system of Kümmell's disease, 3 cases were stage II, 13 cases (14 vertebrae) were stage III without spinal cord injury, 3 cases were stage III with spinal cord injury. Patients were respectively treated with percutaneous vertebroplasty(PVP) or percutaneous kyphoplasty(PKP) on the basis of the degree of postural reduction during operation. Injected cement volume, cement leakage, vertebral height restoration and local kyphotic reduction were observed. Visual analogue scale (VAS) and Oswestry Disability Index(ODI) were respectively used to assess the pain and function before and after operation. Frankel grade were used to evaluate neurological status.</p><p><b>RESULTS</b>Seven vertebrae with satisfactory postural reduction were treated with PVP, 13 vertebrae with unsatisfactory postural reduction were treated with PKP, 3 patients with spinal cord injury were treated with decompression and posterior short segment fixation at the same time. All patients were followed up from 10 to 48 months with an average of 21.2 months. Cement leakage occurred in 4 cases with no symptom, 1 cases in PVP group and 3 cases in PKP group, there was no significant difference between two groups(=0.561). The priming volume of cement was (6.40±0.94) ml in PVP group and (5.46±1.09) ml in PKP group (>0.05). Three days after operation vs preoperation, the vertebral height restoration and kyphotic improvement was(31.71±11.35)%, (9.79±4.64)° in PVP group and (24.77±8.51)%, (8.15±2.97)° in PKP. There was no significant difference between two groups(>0.05). Three days after operation, VAS of low back pain and ODI in all patients were improved than preoperative data(<0.05), but there was no significant difference between two groups or between postoperative at 3 d and final follow up(>0.05). Nerve function of 3 patients underwent decompression and fixation from Frankel D to E.</p><p><b>CONCLUSIONS</b>According to Li staging system and the degree of introperative postural reduction, individualized surgical treatment for Kümmell's disease can obtain good clinical results. Bad postural reduction during operation maybe a risk factor of cement leakage.</p>