Objective To discuss the causes of acute hematogenesis disorder after liver trans-plantation. Methods A retrospective analysis was performed to identify 6 patients with high fever,skin rash and acute haematogenesis disorder during 2005-2006 in our center. Results The 6 patients had viral infection, immunity damage, intake of marrow toxicity medicine and multiple organ dysfunc-tion syndrome after the operation. These might cause the disorder. Conclusion Infection, virus,drugs, graft versus host disease and immunity damage are the main reasons for acute hematogenesis disorder after liver transplantation.

Objective To investigate the etiology, diagnosis and treatment of pneumocystis cari-nii pneumonia (PCP) at early stage after orthotopic liver transplantation (OLT). Method The clinical data of 276 patients undergoing OLT were retrospectively analyzed and those of 6 cases complicated with PCP were summarized from January 2005 to December 2005. Results The morbidity of PCP in our group was 2.17% and occurred in early stage after OLT. The average time on set was (11.17?2.50) days and uneasily controlled hypoxemia was the main manifestation. The diagnosis of PCP was established by clinical symptoms, chest X-ray, chest CT, pneumocystis carinii PCR detection and visualization of PC encysts from sputum samples under a microscope. SMZco was the initial choice of treatment combined with immunosuppressive regimen regulation. Five cases were cured and 1 case died from septic shock. Conclusion PCP can occur among OLT patients in the early stage, and aggressive early diagnosis and treatment were critical to improve the prognosis.

Both the snail number and the detection rate of living snails by means of snail screening in soil layer were higher than those of snail survey on soil surface. It is indicated that snail screening in soil layer can make up the shortage of survey on soil surface and improve the efficiency of snail control.

Objective To evaluate retrospectively the hemiarthroplasty in the treatment of severe comminuted intraarticular fractures of the proximal humerus.Method Thirty one patients suffered from severe comminuted intraarticular fractures of the proximal humerus were treated with shoulder hemiarthroplasty through Thompson approach from March 2000 to October 2004.The results were graded into the excellent,the good,the fair and the poor according to the scoring system-modification for hemiarthroplasty(SSMH) of Los Angeles California,USA(UCLA) basing on shoulder paining,functional status muscle strength and range of motion.Rusults The average operative time cost 65 minutes(ranged from 40 to 90 minutes),average amount of bleeding during operation were 280 ml(ranged from 200 to 350 ml).The patients exercised early postoperatively.After an average duration of 14.1 months of follow-up(ranging from 5 to 42 months),there were no infection and/or nerve damage occurred postoperatively,and the position of the prosthesis was confirmed to be excellent,moreover no lessening prosthesis,prosthesis dislocation,and/or prosthesis milieu fractures occurred radiographically.The outcomes of the treatment were excellent in 13,good in 14,fair in 3 and poor in 1 out of the 31 cases. The rate of both the excellent and the good were 87.10%.Conclusion Shoulder hemiarthroplasty is a preferable technique in the treatment of severe comminuted intraarticular fractures of the proximal humerus.

Objective To summarize the clinical course of acute interstitial pneumonitis (AIP) associated pediatric acute respiratory distress syndrome (PARDS) in 8 recipients after liver transplantation,and further discuss the potential risk factors and therapeutic highlights.Methods A total of 476 pediatric patients received liver transplantation in Tianjin First Center Hospital from January 2012 to September 2016.Among them,8 cases of AIP associated PARDS in ICU were recruited in this study.Medical data including clinical presentation,ICU management and outcomes were analyzed retrospectively.Results The onset time-window of AIP associated PARDS was (2.67 ± 0.77) months after liver transplantation,and the time interval between initial symptom and ICU administration was (6.75 ± 5.82) days.Five cases had the history of acute rejection therapy,and 5 cases had CMV and/or EBV viremia history.All 8 cases received mechanical ventilation,2 cases given nasal non-invasive ventilation and the rest 6 cases given invasive ventilation,3 of which were switched to high frequency oscillatory ventilation (HFOV) combined with inhaled nitric oxide.At the stage of hypoxic climax,the fraction of inspired oxygen (FiO2) was up-regulated to 1.0 to maintain the oxygenation index (OI) of (25.24 ± 5.94).Temporary replacement of immunosuppressants with intravenous glucocorticoids was implemented in all 8 cases without acute rejection episode.Of 8 cases,2 cases died from PARDS,1 case died from portal thrombosis associated hepatic failure,and the rest 5 cases survived.Conclusion AIP associated PARDS is a critical complication with high mortality in pediatric patients after liver transplantation.Excessively strong immunosuppression therapy at early post-transplant stage shows a risk factor for AIP.Lung protective ventilation strategy and HFOV are recommended to reduce ventilator induced lung injury in pediatric patients.Temporary intravenous glucocorticoids may reduce acute inflammatory reaction in PARDS patients without increasing the risk of acute rejection.

Objective: To investigate the characteristics of breakthrough cases of varicella in Haishu District, Ningbo City, Zhejiang Province from 2017 to 2022, so as to provide the evidence for varicella prevention and control. Methods: Information on reported cases of varicella and vaccination in Haishu District from 2017 to 2022 were collected through the China Infectious Disease Reporting Management Information System and the Immunization Program Information Management System of Zhejiang Province. The breakthrough cases who had received 1 or 2 doses of varicella vaccine 42 days before the onset of disease were selected. The distribution of sex, age, region and the interval between onset and last immunization were descriptively analyzed. Results: A total of 1 563 varicella cases were reported from 2017 to 2022. There were 928 breakthrough cases (59.37%), of which 660 cases with 1-dose immunization history (42.23%) and 268 cases with 2-dose immunization history (17.15%). The proportion of 1-dose breakthrough cases in total annual cases showed a decreasing trend (P<0.05) from 2017 to 2022, while there was no significant tendency on the proportion of cases with 2-dose immunization history (P>0.05). There were 392 males (59.39%) and 268 females (40.61%) with 1-dose immunization history. There were 150 males (55.97%) and 118 females (44.03%) with 2-dose immunization history. Breakthrough cases with 1- and 2- dose immunization history had an median age of 13.00 (interquartile range, 4.00) and 9.00 (4.00) years, respectively, and the difference was statistically significant (P<0.05). The regional distribution of the breakthrough cases with 1- and 2- dose immunization history was mainly in the rural-urban fringe, with 319 cases (48.33%) and 137 cases (51.12%), respectively, and the difference was statistically significant (P<0.05). The median interval between onset and last immunization was 12.00 (interquartile range, 3.00) and 4.00 (3.00) years, respectively, and the difference was statistically significant (P<0.05). Conclusions The breakthrough cases of varicella in Haishu District from 2017 to 2022 were mainly cases with 1-dose immunization history, males, and residents in rural-urban fringe. The age was older and the interval between onset and the last immunization was longer in cases with 1-dose immunization history than in cases with 2-dose immunization history.

ObjectiveTo explore the clinical application of ultrasound guided percutaneous right internal jugular vein catheterization in hemodialysis,and to analyze the methods,precautions and prevention of complications of puncture.MethodsTotally 297 patients of chronic renal insufficiency with uremia underwent ultrasound guided percutaneous right internal jugular vein catheterization according to technical points of increasing the success rate of puncture.ResultsThe total successful rate of puncture was 100％.The first puncture succeeded in 244 patients (244/297,82.15 ％),the second in 30 (30/297,10.10％) and the third in 23 (23/297,7.74％) patients.The complication rate was 15.15％ (45/297).Poor adherence of catheter led to cited blood difficultly and inadequate flow in 31 patients.ConclusionUltrasound guidance can greatly improve the success rate of puncture in percutaneous right internal jugular vein catheterization,while reduce the incidence of complications.

Objective To assess the clinical application of Cylex ImmuKnow assay in patients with renal dysfunction after liver transplantation for individualized immunosuppressive therapy.Method Twenty adult patients undergoing liver transplant between January 2009 and December 2011 received regular ImmuKnow assay monitoring combined with determination of serum tacrolimus trough concentration to guide immunosuppressive regimens,all of whom showed sustained renal dysfunction 6 months after transplant with normal and stable liver function.Clinical data were collected to observe the changes of renal function in those patients after treatment.Results The recipients were followedup for 15-54 months,received ImmuKnow assay 61 times and the results fluctuated 33-943 μg/L [median 282 μg/L,interquartile range (IQR) 267 μg/L].After ImmuKnow monitoring,serum creatinine level in patients was decreased significantly from median 151.8 μmol/L with IQR 44.9 μmol/L to median 114.9 μmol/L with IQR 35.3 μmol/L (Z =-3.845,P =0.000),and estimated glomerular filtration rate (eGFR) was increased significantly from median 0.746 mL/s with IQR 0.025 mL/s to median 1.005 mL/s with IQR 0.454 mL/s (Z =-3.771,P =0.000).ImmuKnow results showed a linear correlation with the white blood cell count in patients (Spearman correlation coefficient r =0.429,P =0.001),but no linear correlation with the patients' age,primary disease before transplantation,postoperative time,serum tacrolimus trough concentration,lymphocyte count,CD3+ T lymphocyte count,CD4+ T lymphocyte count or CD4+/CD8+ T lymphocyte ratio (P＞ 0.05).Conclusion Cylex IrmmuKnow assay can be applied in patients with renal dysfunction after liver transplantation for individualized immunosuppressive therapy monitoring,which is of certain clinical value.

Objective To observe the survival and reproduction of Oncomelania hupensis snails and their susceptibility to schistosome in schistosomiasis non-endemic area of the Yangtze River estuary in Southern Jiangsu.Methods The soil and water from the Yangtze River estuary of Southern Jiangsu were used for the experiment.The snails reproduced in the same year were collected from the upper reaches of the Yangtze River and raised in the laboratory.The snail survival and reproduction rates and schistosome infection of the snails were observed.The soil collected from schistosomiasis endemic area was used in the control group.Results There was no significant difference between the experimental and control groups for the snail survival rates both in 6 and 12 months (X~2= 0.727 8,P > 0.05 and X~2 = 0.416 1,P > 0.05).Each female snail reproduced 67.69 eggs in average (95 % CI:24.026 0-110.097 4).The average hatchability rate of snail eggs was 83.60%,and there was no significant difference between the 2 groups (X~2= 9.131 8,P > 0.05).The schistosome infection rate of the second generation snails was 1.40% (5/356) 60 days after the infection in the laboratory.Conclusions The snails collected from the upper reaches of the Yangtze River marshland can survival and reproduce in the soil and water from schistosomiasis non-endemic area of the Yangtze River estuary of Southern Jiangsu,and the second generation of the snails can be infected with schistosome in the laboratory.

Objective To analyze the curative effects and survival results of combined liver kidney transplantation (CLKT).Methods From 2002 to 2011,the clinical data of 36 Chinese patients who underwent CLKT were retrospectively analyzed in our centre.The age of recipients was 47.4 ±13.1 years.Four patients had undergone liver transplantation and 7 patients kidney transplantations before CLKT, respectively. The complications and the survival were analyzed. Results The survival patients were followed up for 47.9 months (29.1 - 115.7).The cumulative 1-,3 and 5-year patient survival rate was 88.7％,85.4％ and 81.4％; The 1,3- and 5-year survival rate of liver graft was 79.8％,76.3％ and 72.3％; The 1-,3- and 5 year survival rate of kidney graft was 85.7％,82.4％ and 78.2％.Three patients underwent liver re-transplantation due to severe biliary complications,and one patient kidney re-transplantation due to renal allograft dysfunction.Conclusion CLKT is a effective treatment for end-stage liver disease with renal insufficiency and achieves excellent results.