Objective To study the risk factors for dose wearing off (WO)in PD patients .Methods One hundred and thirty-three PD patients were recruited in this study according to the UKPDBB criteria .Their dose WO was diagnosed according to the Wo questionnaire 9 (WOQ-9) .The pa-tients were divided into WOQ-9 (+ ) group (n=111) and WOQ-9 (-) group (n=22) .The pa-tients in WOQ-9 (+) group were further divided int WO (+ ) group (n=59) and WO (-) group (n=52) .The difference in their clinical and therapeutic parameters was compared .Results The dose WO was observed in 83 .5% of the 133 PD patients ,53 .2% of which accorded with the dose WO clinical definition .T he disease onset age ,disease course ,maximal levodopa daily dose and ac-cumulated levodopa dose differed greatly in WOQ-9 (+ ) group and WOQ-9 (-) group (P<005) . The disease course ,H-Y stage ,UPDRS score ,tetany score ,maximal levodopa daily dose ,levodopa dose per body weight and accumulated drug use time differed greatly in WOQ-9 (+ ) group and WOQ-9 (-) group (P< 0 .01) .The major risk of dose WO was the levodopa dose per body weight (OR=1.364 ,P<0 .05) .Conclusion Dose WO is related with the progress of disease and the use of levodopa .Levodopa dose per body weight is an independent risk factor for dose WO .

Objective To explore the risk factors of dyskinesias in Parkinson' s disease (PD) patients.Methods Patients with PD who had taken levodopa at least 1 month were recruited according to the United Kingdom Brain Bank (UKBB) Criteria..All patients were divided into dyskinesias group and non-dyskinesias group according to the clinical definition of dyskinesia.The parameters including gender,age,age onset,duration,body weight,UPDRS scale score,and treatment parameter,such as the maximum daily dose of levodopa,the cumulative time of medication of levodopa,levodopa dose per weight of patients with dyskinesias were recorded.Multivariate logistic regression analysis was used to analyze risk factors of dyskinesias.The patients were divided into dyskinesias and no dyskinesias groups based on presence of motor complications.Results The incidence rate of dyskinesias was 7.8％ (11/142) in all 142 patients.Of which,9 cases were with peak-dose dyskinesia,and 2 cases with both wearing-off and dyskinesia.There were statistically significant difference between dyskinesias group and non-dyskinesias group in terms of sex,weight,the maximum daily dose of levodopa and levodopa dose per weight(P ＜ 0.05).The same results appeared between wearing-off group and wearing-off with dyskinesia group (P ＜ 0.05).Multivariate Logistic regression analysis showed that total dose of levodopa(OR =1.846,95％ CI:1.234-2.762,P =0.003) and levodopa dose per weight were independentriskfactors(OR=0.991,95％CI:0.984-0.999,P=0.033).Conclusion The risk factors of dyskinesias in Parkinson's disease is closely linked to total dose of levodopa and levodopa dose per weight.

Objective To investigate effective approach to decrease portal venous hypertension and high perfusion of portal vein caused by small-for-size (SFS) liver graft transplantation with the aim of improving hepatocellular microcirculation.Methods Rat models with SFS liver graft (n =62) were well estab lished and divided into SFS group and trans-portal intrabepatic portosystemic shunt (TPIPSS) group.Hemodynamic parameters,histopathologically morphologic changes,postoperative complications,accumulated survival rate were recorded and analyzed.Venous filling time after liver reperfusion,hemodynamic parameters were evaluated using t test and Kruskal-Wallis test.Kaplan-Meier method was performed for survival analysis.Results Venous filling time after liver reperfusion was remarkably prolonged with the application of multihole cone-shaped tubes.Compared with SFS group,the filling time was 4-second longer in TPIPSS.At each endpoints of reperfusion within 90 mins,the portal vein pressures were lowered in the TPIPSS group than those of SFS group.Liver grafts were present with more regular structures in TPIPSS group,with no sign of hepatic sinusoid congestion or irregular clearance extension.In the aspect of postoperative complications,all the rat receivers showed ascites in the SFS group.Nevertheless,there was no ascites observed in TPIPSS rats,and 50％ rats (5/10) experienced clinical manifestations of hepatic encephalopathy.Persistent fever over 7 days was showed in 10％ rats (1/10) of SFS group and 40％ rats (4/10) of TPIPSS group,respectively.The mean survival was superior in TPIPSS group (37.2 ± 23.5) d than SFS group (17.7 ± 13.5) d,P ＜ 0.05.Conclusion TPIPSS could be a safe and feasible approach to improve portal venous hypertension caused by SFS liver graft and hepatocellular reperfusion.

Objective:To explore the application of microteaching combined with hierarchical training in the teaching of standardized training for nurses in the department of endocrinology.Methods:A total of 80 nurses in the endocrinology department from February 2020 to February 2021 were selected and randomly divided into a control group and a study group, with 40 ones in each group. The control group adopted traditional teaching and the research group adopted microteaching combined with hierarchical training. After the standardized training, the two groups of nurses were subjected to theoretical assessment, practical skills assessment, clinical practice ability improvement, the satisfaction of the assessment team and inpatients with the nurses, and the incidence of adverse events during the standardized training of the two groups of nurses. SPSS 22.0 was performed for t test and chi-square test. Results:After the training, the research group's theoretical and practical skills assessment scores were better than those of the control group, with statistically significant differences ( P<0.001); the improvement of clinical practice ability of the research group was better than that of the control group, with statistical significance ( P<0.001); the satisfaction rate of nurses in the research group (assessment group and patients) was better than that of the control group, and the differences were statistically significant ( P<0.001). During the standardized training of nurses, there were statistically significant differences in the incidence of adverse events between the two groups of nurses ( χ2=5.165, P=0.023). Conclusion:The application of microteaching combined with hierarchical training can help improve the level of theoretical and practical skills of nurses in the endocrinology department, improve nurses' clinical work ability and patient satisfaction rate, effectively reduce the incidence of adverse events, and build a harmonious relationship between doctors, nurses and patients.

Objective:To investigate the safety and therapeutic effect of split liver transplantation (SLT) in clinical application.Methods:This is a retrospective case-series study. The clinical data of 203 consecutive SLT, 79 living donor liver transplantation (LDLT) and 1 298 whole liver transplantation (WLT) performed at the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to July 2023 were retrospectively analyzed. Two hundred and three SLT liver grafts were obtained from 109 donors. One hundred and twenty-seven grafts were generated by in vitro splitting and 76 grafts were generated by in vivo splitting. There were 90 adult recipients and 113 pediatric recipients. According to time, SLT patients were divided into two groups: the early SLT group (40 cases, from July 2014 to December 2017) and the mature SLT technology group (163 cases, from January 2018 to July 2023). The survival of each group was analyzed and the main factors affecting the survival rate of SLT were analyzed. The Kaplan-Meier method and Log-rank test were used for survival analysis.Results:The cumulative survival rates at 1-, 3-, and 5-year were 74.58%, 71.47%, and 71.47% in the early SLT group, and 88.03%, 87.23%, and 87.23% in the mature SLT group, respectively. Survival rates in the mature SLT group were significantly higher than those in the early SLT group ( χ2=5.560, P=0.018). The cumulative survival rates at 1-, 3- and 5-year were 93.41%, 93.41%, 89.95% in the LDLT group and 87.38%, 81.98%, 77.04% in the WLT group, respectively. There was no significant difference among the mature SLT group, the LDLT group and the WLT group ( χ2=4.016, P=0.134). Abdominal hemorrhage, infection, primary liver graft nonfunction,and portal vein thrombosis were the main causes of early postoperative death. Conclusion:SLT can achieve results comparable to those of WLT and LDLT in mature technology liver transplant centers, but it needs to go through a certain time learning curve.

Objective:To investigate the safety and therapeutic effect of split liver transplantation (SLT) in clinical application.Methods:This is a retrospective case-series study. The clinical data of 203 consecutive SLT, 79 living donor liver transplantation (LDLT) and 1 298 whole liver transplantation (WLT) performed at the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to July 2023 were retrospectively analyzed. Two hundred and three SLT liver grafts were obtained from 109 donors. One hundred and twenty-seven grafts were generated by in vitro splitting and 76 grafts were generated by in vivo splitting. There were 90 adult recipients and 113 pediatric recipients. According to time, SLT patients were divided into two groups: the early SLT group (40 cases, from July 2014 to December 2017) and the mature SLT technology group (163 cases, from January 2018 to July 2023). The survival of each group was analyzed and the main factors affecting the survival rate of SLT were analyzed. The Kaplan-Meier method and Log-rank test were used for survival analysis.Results:The cumulative survival rates at 1-, 3-, and 5-year were 74.58%, 71.47%, and 71.47% in the early SLT group, and 88.03%, 87.23%, and 87.23% in the mature SLT group, respectively. Survival rates in the mature SLT group were significantly higher than those in the early SLT group ( χ2=5.560, P=0.018). The cumulative survival rates at 1-, 3- and 5-year were 93.41%, 93.41%, 89.95% in the LDLT group and 87.38%, 81.98%, 77.04% in the WLT group, respectively. There was no significant difference among the mature SLT group, the LDLT group and the WLT group ( χ2=4.016, P=0.134). Abdominal hemorrhage, infection, primary liver graft nonfunction,and portal vein thrombosis were the main causes of early postoperative death. Conclusion:SLT can achieve results comparable to those of WLT and LDLT in mature technology liver transplant centers, but it needs to go through a certain time learning curve.