The Risk of Going Small: Lowering GRWR and Overcoming Small-For-Size Syndrome in Adult Living Donor Liver Transplantation.

OBJECTIVE: The aim of this study was to determine the outcomes of living donor liver transplantation (LDLT) according to various graft-to-recipient weight ratio (GRWR). BACKGROUND: The standard GRWR in LDLT is >0.8%. Our center accepted predicted GRWR ≥0.6% in selected patients. METHODS: Data from patients who underwent LDLT from 2001 to 2017 were included. Patients were stratified according to actual GRWR (Group 1:GRWR ≤0.6%; Group 2: 0.6%0.8%). RESULTS: There were 545 LDLT (group 1 = 39; group 2 = 159; group 3 = 347) performed. Pretransplant predicted GRWR showed good correlation to actual GRWR (R2 = 0.834) and these figures differed within a ±â€Š10%margin (P = 0.034) using an equivalence test. There were more left lobe grafts in group 1 (33.3%) than group 2 (10.7%) and 3 (2.9%). Median donor age was <35 years and steatosis >10% was rare.There was no difference in postoperative complication, vascular and biliary complication rate between groups. Over one-fifth (20.5%) of group 1 patients required portal flow modulation (PFM) and was higher than group 2 (3.1%) and group 3 (4%) (P = 0.001). Twenty-six patients developed small-for-size syndrome (SFSS): 5 of 39 (12.8%) in group 1 and 21 of 159 (13.2%) in group 2 and none in group 3 (P < 0.001). There were 2 hospital mortalities; otherwise, the remaining patients [24/26 (92.3%)] survive with a functional liver graft. The 5-year graft survival rates were 85.4% versus 87.8% versus 84.7% for group 1, 2, and 3, respectively (P = 0.718). GRWR did not predict worse survivals in multivariable analysis. CONCLUSIONS: Graft size in LDLT can be lowered to 0.6% after careful recipient selection, with low incidence of SFSS and excellent outcomes. Accurate graft weight prediction, donor-recipient matching, meticulous surgical techniques, appropriate use of PFM, and vigilant perioperative care is important to the success of such approach.

Advances in SARS-CoV-2: a systematic review.

OBJECTIVE: In December 2019, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection broke out in Wuhan, China. However, we still lack a comprehensive understanding of this emerging virus. In this manuscript, we collected relevant articles and reviewed the characteristics about SARS-CoV-2. MATERIALS AND METHODS: We performed an online search on PubMed and Web of Science with the keywords COVID-19, 2019-nCoV and SARS-CoV-2, and summarized the epidemiology, virology, clinical features and treatments of SARS-CoV-2 infection. RESULTS: We retrieved 157 published papers about SARS-CoV-2 from January, 2020 to April, 2020. We found that SARS-CoV-2 was a kind of virus with low mortality rate and high infectivity. This virus can enter human cells through angiotensin-converting enzyme 2 (ACE2) in alveoli and activate immune response in human body. SARS-CoV-2 infection can be classified as asymptomatic, mild, common, severe, and critical. We summarized antiviral drugs against SARS-CoV-2, such as remdesivir, hydroxychloroquine and favipiravir. Because the vaccine of SARS-CoV-2 is developing, more clinical studies are needed to verify the safety and efficacy of these treatments. CONCLUSIONS: SARS-CoV-2 is a novel coronavirus that has caused a global pandemic. We should pay more attention to prevent SARS-CoV-2 and try to control it sooner.

Breast Implant-associated Anaplastic Large Cell Lymphoma - a Systematic Review with Pooled Analysis.

The association of breast implants and anaplastic large cell lymphoma (BIA-ALCL) was first described in 1997. Such an association has aroused public health concerns on breast implant safety. A systematic review was carried out with a pooled analysis of data. In total, 674 non-duplicate articles were retrieved; 77 articles were included for data extraction; 395 patients were identified for analysis. The median age at the time of diagnosis was 52 years. Implant texture was described in 201 (50.9%) patients; all 201 patients had a textured implant. The median time from the last implant insertion to diagnosis was 7.5 years. Most patients presented with seroma (67.1%, n = 265), 20.5% of patients presented with breast mass (n = 81). Patients with a breast mass at presentation, lymphadenopathy and those without seroma had more disseminated disease (P < 0.001). 73.2% of patients (n = 289) opted for primary surgery, among which 68.6% (n = 271) received removal of the implant, 61% (n = 241) received capsulectomy and 2% (n = 8) received mastectomy. Of note, 5.3% (n = 21) had reinsertion of an implant after primary surgery. Non-surgical modalities included chemotherapy, radiotherapy and haematopoietic stem cell transplant. The median follow-up interval was 2 years (range 0-14.5 years). Seventeen patients (4.3%) had recurrence of BIA-ALCL and 195 patients (49.4%) did not. The median duration to first recurrence was 1 year (range 1-3 years). Long-term clinical outcome was not reported in 183 patients. BIA-ALCL is an indolent disease that presents with seroma after implant insertion. A high index of suspicion is needed for early diagnosis and treatment.

Knowledge and Perceptions of Child Protection and Mandatory Reporting: A Survey of Nurses in Hong Kong.

In the absence of a mandatory reporting (MR) structure, it is unclear how nurses perceive or exercise their role in child protection. This study examined knowledge and perceptions of child protection and MR among nurses working in Hong Kong. This cross-sectional web-based survey used the Child Abuse Report Intention Scale to measure nurses' child protection knowledge and attitudes, and their perceived norms, control, and intention to report suspected maltreatment. Nurses also indicated if they support MR and to provide an explanation for their preference. Quantitative data were described and analyzed using bivariate and regression analyses. Open-ended responses were analyzed using directed content analysis. A convenient sample of 91 nurses working in Hong Kong completed the survey. The majority (86%) were female with a mean of 9.5 years of nursing experience; their mean knowledge score was 6.64 out of 13 (range 2-10). Compared with other maltreatment types, sexual abuse was perceived to be most severe and most likely to be reported. Perceived severity and attitudes toward child maltreatment was significantly associated with nurses' intention to report. Over half (58%) supported MR; those against MR expressed concerns about lack of support from management. Although nurses working in Hong Kong still hold polarized views about MR, findings point to the importance of creating a supportive reporting culture, and designing training programs that focus on changing perceptions about child protection in order to improve their tendency to report.

Changing Paradigm in the Surgical Management of Hepatocellular Carcinoma With Salvage Transplantation.

OBJECTIVE: The objective of this study was to compare the long-term outcomes of primary and salvage liver transplantation for patients with hepatocellular carcinoma (HCC). METHOD: This was a 10-year retrospective analysis in a tertiary referral center. RESULTS: There were 184 patients recruited (primary liver transplantation [pLT]:salvage liver transplantation [sLT], 143:41). The median follow-up time was 79 months. Operation time was shorter in the pLT group than the sLT group (661 ± 164 minutes vs 754 ± 206 minutes; P = .01) and the blood loss was 3749 mL and 3545 mL for pLT and sLT, respectively (P = .735). The reoperation rate was 5.6% and 4.9%, respectively (P = 1.0). The 5-year overall and disease-free survival rates from the time of transplantation for pLT and sLT were 84.1% versus 70.2% (P = .01) and 82.2% versus 65.8% (P = .01), respectively. The 5-year overall survival rate from the time of primary treatment for sLT was 80.3% (P = .1). Subgroup analysis of sLT showed that young age (50 vs 56 year old; P = .004) was the only factor associated with poor overall survival. Young age (P = .004) and microvascular permeation (P = .008) in the recurrent tumor were associated with HCC recurrence. Young age stands out to be the only independent factor associated with HCC recurrence. CONCLUSION: sLT is the treatment of choice for patients with recurrent HCC in regions of graft shortage.

Effects of dietary supplementation of resveratrol on performance, egg quality, yolk cholesterol and antioxidant enzyme activity of laying hens.

1. This experiment was conducted to evaluate the effects of dietary supplementation of resveratrol on laying performance, egg quality, egg yolk cholesterol and antioxidant enzyme activities of laying hens. 2. A total of 360 Beijing PINK-1 laying hens (60 weeks old) were randomly distributed among five dietary treatments, each of which included 6 replicates of 12 hens. Dietary treatments were basal diet supplemented with 0 (control), 0.5, 1.0, 2.0 and 4.0 g/kg diet resveratrol. The study lasted for 9 weeks including 1 week of adaptation and 8 weeks of the main experimental period. 3. The results indicated that dietary resveratrol significantly improved feed conversion ratios during 5-8 weeks and 1-8 weeks of the trial. Increasing dietary concentrations of the resveratrol linearly improved Haugh unit and albumen height of eggs. 4. The content of total cholesterol (TC), total triglyceride (TG), low density lipoprotein cholesterol (LDL-C), very low density lipoprotein cholesterol (VLDL-C) in serum and cholesterol in yolk was significantly decreased by dietary resveratrol, and there were significant linear correlations between these indexes and resveratrol supplemental levels. 5. Dietary resveratrol supplementation significantly improved serum Glutathione peroxidase (GSH-Px) enzyme activity and decreased serum malondialdehyde (MDA) content in groups with 2.0 and 4.0 g/kg resveratrol as compared to the control, respectively. However, supplementation of resveratrol did not affect the activity of serum superoxide dismutase (SOD). 6. It is concluded that resveratrol supplementation has a positive effect on performance, lipid-related traits and antioxidant activity of laying hens.

[Progression of diagnosis and treatment for adenosquamous lung carcinoma].

Adenosquamous lung carcinoma (ASC) is an uncommon entity of the primary lung cancer, which is mixed by adenocarcinoma and squamous carcinoma cells. ASC not only possesses the malignant biological characteristics of adenocarcinoma and squamous cell carcinoma, but also exhibits special clinical features, such as the higher malignant degree and poorer prognosis. This paper is aimed to elaborate the research process of the pathological origin of ASC, the application of different diagnostic methods in ASC, various therapeutic strategies and its associated prognosis so as to help to develop the clinical strategies of ASC.

XRCC1 rs25487 polymorphism is associated with lung cancer risk in epidemiologically susceptible Chinese people.

Base excision repair (BER) plays an important role in maintaining genome integrity and anti-cancer drug resistance. Single nu-cleotide polymorphisms (SNPs) in BER genes were detected in 500 lung cancer patients and 500 cancer-free controls. A logistic regression model was applied to analyze the relationship between lung cancer susceptibility and BER SNPs coupled with a wide range of epidemiological factors in a Chinese population. SNPs including rs25487 in the X-ray repair cross-complementing group 1 gene, rs1052133 in the 8-oxoguanine DNA gly-cosylase gene, and rs1136410 in the poly (ADP-ribose) polymerase 1 gene were identified. Multivariate analysis showed that the rs25487-AG geno-type was associated with a higher incidence of lung cancer compared with the GG genotype. The rs25487 SNP was associated with the pathological distribution of lung cancer. Moreover, rs1052133-GG was associated with early age of lung cancer onset compared with the CC genotype. Our data demonstrated that the SNPs rs25487 and rs1052133 are risk factors for lung cancer in epidemiologically susceptible Chinese people.

Effect of p53 gene polymorphism on functions of prostate cancer cells.

Prostate cancer cells were transfected with plasmids [empty plasmids, wild-type pcDNA3.1-p53 (V/V), mutant type pcDNA3.1- p53 (G/G)] to analyze the effect of p53 gene polymorphisms on the proliferation, cycle, and apoptosis of prostatic cancer cells. Empty plasmids containing wild-type pcDNA3.1-p53 (V/V) and mutant type pcDNA3.1- p53 (G/G) were used to transfect PC3 and LNCaP cells, respectively. Cell proliferation was detected at 0, 24, 48, and 72 h using the MTT method. Cells were collected at 24 and 72 h. The distribution of cell cycles in various groups was detected using flow cytometry (propidium iodide staining method) and the apoptosis rate was detected using annexin V + propidium iodide double staining. Compared with the control group, wild-type pcDNA3.1-p53 (V/V) and mutant type pcDNA3.1-p53 (G/G) showed a significant inhibitory effect on cell proliferation (P < 0.05); the inhibitory effect of the mutant type was stronger than that of the wild-type. There was no significant difference between PC3 cells and LNCaP cells. After transfection with wild-type pcDNA3.1-p53 (V/V) and mutant type pcDNA3.1-p53 (G/G), PC3 and LNCaP cells were arrested in the G0/G1 stage. Transfection with pcDNA3.1-p53 (G/G) showed a more significant effect than transfection with pcDNA3.1-p53 (V/V). Both the wild-type pcDNA3.1-p53 (V/V) and mutant-type pcDNA3.1-p53 (G/G) led to an increased apoptosis rate of PC3 and LNCaP cells. The p53 gene polymorphism affects the proliferation, apoptosis, and cycle of prostate cancer cells and may serve as a reliable index for the diagnosis and treatment of prostate cancer.

Polymorphisms in the promoter of the CD14 gene and their associations with susceptibility to pulmonary tuberculosis.

Although the role of CD14 in recognizing Mycobacterium tuberculosis is well-understood, the possible role of polymorphisms in susceptibility to develop tuberculosis remains unclear. This study evaluates whether there is an association of polymorphisms within the promoter of the CD14 gene with susceptibility to pulmonary tuberculosis. In a case-control study, we genotyped the eight known single nucleotide polymorphisms SNPs within the promoter of the CD14 gene of 698 Han Chinese subjects. Statistically significant differences between tuberculosis patients and healthy controls were found for G-1619A, T-1359G, A-1145G, and C-159T. The haplotype-GGGT, composed of these four SNPs, exhibited a significant association with the disease. Furthermore, expression levels of soluble CD14 were significantly higher in tuberculosis patients with the GGGT haplotype than with other haplotypes, while IgE expression levels were significantly reduced. Our results suggest that these four SNPs within the promoter of the CD14 gene are associated with susceptibility to pulmonary tuberculosis.

If not appendicitis, then what else can it be? A retrospective review of 1492 appendectomies.

OBJECTIVE: To audit the appendectomies at our institute, and summarise atypical pathological results with a discussion of appropriate management. DESIGN. Retrospective study. SETTING: Regional hospital, Hong Kong. PATIENTS: All patients who underwent appendectomy for presumed acute appendicitis from June 2003 to June 2008 were recruited. Incidental appendectomy was excluded. Patient demographics, pathological findings, and surgical outcomes were analysed. RESULTS. The overall negative appendectomy rate was 18.2%. Female patients of reproductive age (11-50 years) conferred an independent risk for a higher negative appendectomy rate than other females (28.7% vs 11.5%; P<0.001). The overall perforation rate was 22.5%; the extremes of age (<11 or >70 years) conferred an independent risk of perforated appendicitis (25.2% vs 16.3%; P=0.002). Preoperative imaging was not associated with a lower negative appendectomy rate or rate for perforated appendicitis (P=0.205 and 0.218, respectively). Multivariate analysis suggested that a preoperative white cell count of less than 13.5 x 10(9) /L was an independent predictor of negative appendectomy (P<0.001); the body temperature and pulse rate of the patients with perforated appendicitis were higher than in those without perforation (P=0.004 and 0.003, respectively). Only 4.0% of the appendectomy specimens contained other appendiceal pathologies. Appendiceal diverticulitis was the most common inflammatory pathology, contributing to 2.7% of all appendectomies, followed by granulomatous appendicitis. In this series there were eight carcinoid tumours, three adenocarcinomas, two mucinous cystadenomas; tubular adenoma, metastatic deposition, mucinous cystadenocarcinoma and pseudomyxoma peritonei each occurred in one patient only. CONCLUSIONS: A more focused utilisation of preoperative imaging in females of reproductive age and patients at the extremes of age is suggested. Long-term follow-up should be offered to patients with granulomatous appendicitis and neoplastic appendiceal diseases.

Connexin43 suppresses proliferation of osteosarcoma U2OS cells through post-transcriptional regulation of p27.

Many lines of evidence indicate that connexin genes expressing gap junction (GJ) proteins inhibit tumor cell proliferation. However, the precise molecular mechanisms remain unclear. In this study, we show that overexpression of connexin43 (Cx43) suppressed proliferation of human osteosarcoma U2OS cells through inhibition of the cell cycle transition from G1 to S phase. This inhibition was attributed to a significant accumulation of the hypophosphorylated retinoblastoma (Rb) protein, which was causally related to decreases in the kinase activities of cyclin-dependent kinases (CDKs) 2 and 4. Enforced Cx43 expression markedly increased the level of the CDK inhibitor p27. This increase resulted from an increased synthesis and a reduced degradation of the p27 proteins, but not influence of the p27 mRNA. Moreover, we show that the Cx43-modulated GJ function was the main contributor to the elevation in p27 levels, in which cAMP was involved. These data suggest that Cx43 appears to inhibit proliferation of U2OS cells by increasing the levels of p27 proteins via post-transcriptional regulatory mechanisms.

Sun Yat-Sen (1866-1925), a man to cure patients and the nation - his early years and medical career.

"The top physician cures the nation first, and then the people." This is a saying recorded in the Guo Yu, the ancient Chinese book of history. Another saying is that one may choose "To be either a good prime minister or a good doctor", by Fan Zhong-Yan (989-1052), a high official. Such sayings reflect the aspirations of many Chinese literary men in the past. This aspiration to high office had been particularly popular among the Confucian physicians since the eleventh century AD, underlining the point of view that the curing of patients by a good physician was just like a good prime minister administering a nation. Hence, many Confucian scholars and men of letters took medicine either as a career or as a charitable exercise as well as a way to fulfil filial piety for preserving themselves and their families, especially if they had failed to be a candidate for an official position. Quite a few officials also followed suit, especially when they experienced difficulties in their posts, like being demoted, or sacked. However, none of them had ever become head of the nation, or a revolutionary, or exerted so profound an influence upon the history of China as Sun Yat-Sen, who started his career as a physician, became a democratic revolutionary and overthrew the Qing monarchy and founded the republic, is not only unique in the history of China, but in the history of medicine as well. The year 1996 is the hundred and thirtieth anniversary of his birth. This article marks this occasion.

Cardiovascular risk factors in chronic renal failure and hemodialysis populations.

Cardiovascular disease is the leading cause of death in patients with end-stage renal disease (ESRD). Risk factors for cardiovascular disease, including hypertension, lipid abnormalities, left ventricular hypertrophy (LVH), and glucose intolerance, are present more frequently in patients with chronic renal failure than in the general population, even before the onset of replacement therapy. The prevalence, pathogenesis, and significance of these factors in the uremic population are examined, and the potential roles of intervention are reviewed. Evidence suggests, but is not conclusive, that these factors are of predictive value for cardiovascular complications in patients with chronic renal failure. The effect of modification of these factors on cardiovascular morbidity and mortality in this population, especially in the early stages of renal failure, is an important area for further study.

Disseminated histoplasmosis in dialysis patients.

The unusual occurrence of disseminated histoplasmosis in two dialysis patients residing in a nonendemic area is described; one on chronic hemodialysis, the other on continuous ambulatory peritoneal dialysis (CAPD). They both presented with nonspecific febrile illness with splenomegaly and/or pancytopenia. Rapid diagnosis was made with bone marrow biopsies and cultures. In the second patient, peritonitis secondary to histoplasmosis was documented by culture of the dialysate and at autopsy. This is the first such description in a CAPD patient.

Comparison between bioactivity and immunoreactivity of serum prolactin in uraemia.

The lactogenic potency of sera from 24 male uraemic patients on regular haemodialysis and 14 control subjects was measured by Nb2 node rat lymphoma cell bioassay, and was compared to serum prolactin levels measured by radioimmunoassay. Sera with immunoreactive growth hormone levels exceeding 5 ng/ml were excluded from comparisons. The uraemic patients had a higher serum immunoreactive prolactin (48.2 +/- 10.5 ng/ml) than controls (13.3 +/- 1.3 ng/ml (P less than 0.01). Similarly the lactogenic potency of uraemic serum was higher than that of the control sera (25.5 +/- 3.9 vs 12.6 +/- 1.4 ng/ml, P less than 0.02). The ratio of immunoreactive serum prolactin to the lactogenic potency of the serum was significantly higher in the uraemic group (1.80 +/- 0.14 vs 1.10 +/- 0.10, P less than 0.01) suggesting decreased bioactivity of prolactin in uraemic serum. To examine whether low molecular weight inhibitory molecules were responsible for this discrepancy, the lactogenic potency of 8 uraemic sera was studied before and after 4 h of dialysis against 1 litre of haemodialysis medium. Two of the eleven sera studied showed a significant increment in lactogenic potency after dialysis (47% and 57%). We conclude that there is a disparity between the bioactive and the immunoreactive serum prolactin concentrations in patients with chronic renal failure and that a dialysable factor may be partly responsible for this discrepancy in some cases.

The effects of chronic renal failure and hemodialysis on human red and white cell calmodulin levels.

Red blood cell (RBC) and polymorphonuclear white blood cell (WBC) calmodulin levels were measured in 25 uremic patients on regular hemodialysis. Uremic patients had significantly higher RBC [11.45 +/- 0.66 (+/-SE) fg/cell] and WBC (590.5 +/- 110 fg/cell) calmodulin levels than normal subjects (8.62 +/- 0.37 and 130 +/- 30 fg/cell; P less than 0.05). An extremely high RBC calmodulin level (20.58 fg/cell) was found in a patient with sickle cell anemia. Uremic patients on dialysis for 2 yr or more had lower RBC (10.99 +/- 0.58 fg/cell) and WBC (390 +/- 50 fg/cell) calmodulin levels than those who were on dialysis for less than 2 yr (RBC, 12.30 +/- 1.56 fg/cell; WBC, 943 +/- 256 fg/cell; P less than 0.05). There were no statistically significant differences in calmodulin levels when different subgroups of uremic patients were compared, e.g. patients with diabetes mellitus or those receiving supplemental vitamin D, anabolic steroids, or antihypertensive medications. We conclude that calmodulin levels are elevated in uremic patients on regular hemodialysis.