Objective A classification for hepatic venous outflow obstruction after piggyback liver transplantation (PBLT) and its clinical significance.Methods We conducted a retrospective study on 248 patients who underwent liver transplantation from May 2000 to August 2006.The aims were to elucidate the causes and treatment of postoperative venous outflow obstruction.Results Venous outflow obstruction occurred in 38 patients after transplantation.Among those,2 (5.26％) had superior hepatic inferior vena cava (IVC) stenosis,13 (34,21％) had the hepatic vein anastomosis twisted at an angle,7 (18.42％) had IVC stenosis at the posthepatic segment,and 16 (42.10％) had outflow obstruction at the hepatic veins.In these 38 patients,34 underwent PBLT,2 underwent APBLT,and 2 COLT.Most patients with hepatic venous outflow obstruction improved with surgical treatment and interventional therapy.Conclusions Hepatic vein outflow obstruction was associated with the technique of hepatic vein anastomosis,the type of cavocaval anastomosis and graft size mismatch between the donor and the recipient.Performing piggyback liver transplantation according to the classification of hepatic vein and appropriate treatments could improve the prognosis of venous outflow obstruction in clinical practice.

Objective: To examine effects of Platycodon grandiflorum (JG), Glycyrrhiza uralensis Fisch (GC) or the compound of JG with GC on the growth of cariogenic and periodontopathic bacteria in vitro . Methods: JG,GC and the compound were extracted with ?=65% ethanol respectively. The minimal inhibitory concentration(MIC)and minimal bactericidal concentration (MBC) of JG, GC or compound against S.mutans MT818, S. sobrinus 6715, P.gingivalis 381 and B.forsythus 43037 were measured by drug sensetivity test.Results: JG showed no effect on the growth of oral pathogens tested;GC inhibited S.mutans MT 8418 and S.sobrinus 6715 with MIC of 3.91 mg/ml.The compound inhibited the microorganisms with the MIC of 1.96 mg/ml against S.mutans MT8148 or S.sobrinus 6715, 3.91 mg/ml against P.gingivalis 381, 7.81 mg/ml against B.forsythus 43037 respectively.Conclusion: The compound of JG and GC has stronger inhibition and bactericidal effects on oral pathogens than the single medicine.

Marginal liver donor,a way to expand the liver pool,has been maximized in the unique position due to the shortage of donors.But the definition of marginal donor liver varies from center to center and the standard is very complex.With the enhancement of organ perfusion solution,preservation methods and surgical techniques,the edge donor criteria are also gradually expanding.What decision should we make,facing such clinical controversies.This paper makes a review on the marginal liver donor in the donation after citizen deceased,so as to improve its clinical application.

The exposure of lead in environment has caused a major public health problem all over the globe.Because of rapid industrialization and constant existence of lead in environment,it is necessary to screen,monitor and intervene in the content of lead of human body during a long time.The toxical and harmful influence of lead on human body,especially on children are expounded.The content index of lead in the body set by international and national standards as well as its evaluation basis are included.The most frequently used testing method of blood lead is also described: atomic absorption spectrometry and its operative process.

Objective To evaluate the clinical characteristics, diagnosis and treatment procedures for adrenal pheochromocytoma and adrenal ganglioneucoma.Methods Thirty-two cases of adrenal pheochromocytoma and 14 cases of adrenal ganglioneucoma surgical treated between 1999—2005 were analysed, The average of ganglioneucoma was 39 years old (16～63). tumor size ranged from 2.5 cm to 15 cm. The mean age of pheochromocytoma was 42 years old (19～74), tumor size ranged from 2cm to 16 cm. Tumor located in the adrenal area. All cases accepted surgical operation and were confirmed by pathology. Results Most cases of adrenal ganglioneucoma did not have any symptom but were founded incidentally. Differentials were obviously between ganglioneucoma and pheochromocytoma. Conclusion Both adrenal ganglioneucoma and pheochromocytoma are rare diseases.CT、urinary CA and 131I-MIBG are good methods for diagnosis.The final diagnosis depends on the pathology, surgical resection of tumor is a preferred choice.

Objective To investigate the diagnosis and treatment of renal neoplasm with calcification .Methods Retrospectively summarized the clinical data of the 2 patients with calcific renal neoplasm admitted in our hospital from the May to July in 2014, then analyzed and discussed the clinical manifestations , diagnosis and treatment com-bined with the literatures .Results The two cases were both suspected of renal malignant tumor preoperatively .The case 1 was a 32-year-old male , laparoscopic partial resection of the left kidney was performed , and the postoperative pathology was clear cell carcinoma (Fuhrman levelⅠ).The case 2 was a 18-year-old male, partial resection of the right kidney was performed because of the tumor size , and the postoperative pathology was adult nephroblastoma . Conclusions The calcific renal neoplasm is a rare disease , the property determination depends on postoperative pa-thology, and as to the choice of surgical method , the patients'age, the tumor size and the tumor location should be taken into consideration , and intraoperative frozen should be performed when necessary .

Objective: To review and discuss the experience of diagnosis and treatment of adrenal ganglioneuroma. Methods: Clinical data of 80 cases of adrenal ganglioneuroma undergoing surgery during January 1982 to May 2017 at Peking Union Medical College Hospital were retrospectively analyzed. There were 36 male and 44 female patients. Age ranged from 8 to 69 years old (mean 37.7 years old). The tumor diameter were 1.5 to 18.0 cm (mean 4.3 cm). There were 61 cases of adrenal ganglioneuroma diagnosed by imaging examination. All patients underwent adrenalectomy. Results: All procedures were performed successfully without serious complication. Including 15 open surgery and 64 retroperitoneal laparoscopic surgery. One laparoscopic case conversion to open surgery. The pathological diagnosis was adrenal ganglioneuroma. Fifteen cases were mixed with other tumor components. No recurrence or metastasis was observed during the follow-up of 2 months to 35 years. Conclusions The diagnostic techniques for adrenal ganglioneuroma are helpful to judge the tumor property before operation. The laparoscopic surgery has become the current method for resecting tumors. It shows advantages of small trauma and speedy recovery. The relationship between tumor and surrounding tissues should be understand clearly before operation. Full preparation must be made before operation if adrenal ganglioneuroma mixed with other tumor components.

Objective:To optimize the paper-roasted technology of Aucklandiae Radix. Methods:With methanol-water (65: 35) as the mobile phase, the contents of costunolide and dehydrocostuslactone were determined by HPLC. Senna was used to make diarrhea model in mice, and the sample decoction was administered for the mice by i. g at the dose of 10 g·kg-1 and the diarrhea index was de-termined. The paper-roasted technology of Aucklandiae Radix was optimized by L9 (34 ) orthogonal design taking the contents of cost-unolide and dehydrocostuslactone, and the diarrhea index in mice as the indices with the paper-roasted time, the paper-roasted temper-ature and the layer number as the influencing factors. Results:The variance analysis results show that the layer number and the paper-roasted temperature has the significant impact on the contents of costunolide and dehydrocostuslactone and the diarrhea index in mice. The best paper-roasted technology of Aucklandiae Radix was as follows:a layer of paper was covered by 4mm Aucklandiae Radix and repeated the same operation 5 times, and put them in drying baker at 120℃ for about 2 hours. After the essential oil of Aucklandi-ae Radix permeated on the paper with burnt flavor and dark brown in color, Aucklandiae Radix could be taken out. Conclusion:The optimum paper-roasted technology of Aucklandiae Radix is reasonable and feasible, which can provide reference for the establishment of the quality standard for paper-roasted Aucklandiae Radix pieces and the expanding of the clinical application.

Objective:To analyze the incidence and risk factors of postoperative new-onset atrial fibrillation(POAF) after lobectomy.Methods:A monocentric ambispective cohort study was conducted. The retrospective cohort included 1 902 patients who underwent lobectomy in our hospital between January 2017 and December 2019. The prospective cohort included 692 patients who underwent lobectomy in our hospital between August 2020 and July 2021. A total of 2 594 patients were enrolled in this study. The median age of enrolled patients was 61 years(interquartile range, 54-67 years), and the cohort consisted of 1 384(51.97%) females and 1 246(48.03%) males. Baseline and perioperative clinical data of enrolled patients were collected. Univariate and multivariate logistic regression analyses were performed to identify the risk factors related to POAF. Results:There was no patient died in hospital after surgery. A total of 111 cases of POAF were followed up during the postoperative hospital period, and the incidence of POAF was 4.28%. Multivariate regression analysis found that the elderly patients(aged 60 and above)( OR=1.58, 95% CI: 1.01-2.47, P=0.044), history of percutaneous coronary intervention( OR=2.50, 95% CI: 1.04-6.03, P=0.041), history of arrhythmia excluding atrial fibrillation/flutter( OR=3.96, 95% CI: 1.95-8.00, P<0.001), left upper lobectomy( OR=1.73, 95% CI: 1.11-2.68, P=0.015), low preoperative albumin level( OR=1.07, 95% CI: 1.00-1.14, P=0.048) and large cell neuroendocrine carcinoma( OR=4.70, 95% CI: 1.38-15.98, P=0.013) were independent risk factors for POAF after lobectomy. Conclusion:The incidence of POAF after lobectomy is 4.28% in this study. Elderly patients(aged 60 and above), history of percutaneous coronary intervention, history of arrhythmia excluding atrial fibrillation/flutter, left upper lobectomy, low preoperative albumin level, and large cell neuroendocrine carcinoma are the independent risk factors related to POAF after lobectomy.

Objective:To analyze the correlation between 1H-MRS in hippocampus and peripheral blood cytokines and T lymphocyte subsets in patients with temporal lobe epilepsy, and to explore the relationship between immune dysfunction and the degree of neuronal injury. Methods:Fifty patients with temporal lobe epilepsy were selected from Affiliated Hospital of Xuzhou Medical University from October 2020 to July 2021.Clinical data of all patients were collected and they were divided into two groups according to MRI results of epileptic sequence: abnormal hippocampal MRI group ( n=20) and normal hippocampal MRI group ( n=30). Bilateral 1H-MRS scanning of hippocampal and detection of T lymphocyte subsets and cytokines in peripheral blood during interictal period were performed in both groups. The levels of hippocampal metabolites NAA, NAA/(Cr+ Cho), T lymphocyte subsets and cytokines in peripheral blood of the two groups were compared.At the same time, the levels of NAA and NAA/ (Cr+ Cho) in the hippocampus on the abnormal side and the normal side in the abnormal hippocampal MRI group were compared within the group. Finally, the correlation between the levels of metabolites NAA, NAA/ (Cr+ Cho) in the hippocampus on the abnormal side obtained by 1H-MRS scanning and T lymphocyte subsets and cytokines in the abnormal group of MRI was analyzed. The data were statistically analyzed by SPSS 26.0 software. Independent sample t-test or Mann-Whitney U test was used for comparison between the two groups. Paired sample t-test was used for intra group comparison of different sides. Spearman correlation analysis was used to analyze the correlation between each index. Results:The NAA and NAA/(Cr+ Cho) values of the abnormal MRI group(normal side NAA: (1.22±0.37), NAA/(Cr+ Cho): (0.56±0.15). abnormal side NAA: (1.02±0.34), NAA/(Cr+ Cho): (0.48±0.13)) were significantly lower than those of the normal MRI group (NAA: (1.51±0.36), NAA/(Cr+ Cho): (0.73±0.19))(NAA: t=2.705, 4.800, both P<0 05; NAA/(Cr+ Cho): t=3.394, 4.914, both P<0 05). The values of NAA and NAA/(Cr+ Cho) in the abnormal side in the MRI abnormal group were significantly lower than those in the normal side( t=6.467, P<0 05). The levels of IL-1β(11.19(3.56, 20.98)pg/ml), IL-5 (3.12(1.86, 6.41)pg/ml), TNF-α(2.55(1.19, 8.28)pg/ml), CD4+ T lymphocytes((43.13±6.82)%) and Th/Ts((1.96±0.66)) in the hippocampal MRI abnormal group were significantly higher than those in normal MRI group (IL-1β: 3.27(1.63, 6.17)pg/ml, IL-5: 1.15(0.96, 2.96)pg/ml, TNF-α: 1.34(1.02, 2.36)pg/ml, CD4+ T: (38.01±7.21)%, Th/Ts: (1.48±0.53))( Z=-3.041, -2.516, -2.496, all P<0.05; t=2.511, 2.810, both P<0 05). The level of CD8+ T ((23.48±5.33)%) in peripheral blood of abnormal MRI group was significantly lower than that of normal group CD8+ T((27.18±6.08)%)( t=2.210, P<0.05). In the abnormal MRI group, the levels of NAA and NAA/ (Cr+ Cho) in the abnormal hippocampus were negatively correlated with the levels of IL-1β, IL-5 and TNF- α ( r=-0.612--0.463, all P<0.05), and positively correlated with CD8+ T lymphocytes ( r=0.537, 0.478, P<0.05). Conclusion:There is neuronal damage and dysfunction in the abnormal hippocampal region of patients with temporal lobe epilepsy with abnormal hippocampal formation, and the degree of neuronal damage is highly correlated with CD8+ T lymphocytes, IL-5, IL-1β and TNF-α in peripheral blood. The imbalance of interictal lymphocyte subsets and chronic inflammatory response may play an important role in the pathogenesis of epilepsy and neuronal injury .