Lung transplantation is an effective treatment for end-stage lung diseases in children, and the only treatment for children with no response to conservative treatment.However, merely a few transplantation centers at home and abroad can provide lung transplantation at present.The mortality of pediatric lung transplantation is high, and it is difficult for donor matching.Besides, it has many complications.In recent years, pediatric lung transplantation has made positive progress and technological breakthroughs in many aspects.In this article, research progress in pediatric lung transplantation at home and abroad was reviewed.

OBJECTIVEBased on the different physiological characteristics of the mastoid skin and soft tissue of Chinese congenital microtia malformation, the Nagata two-stage method was respectively applied for ear reconstruction, and the clinic experience were investigated in this study.

METHODAccording to the mastoid skin and soft tissue difference in the thickness and tightness, 280 patients diagnosed with congenital microtia were divided into four types: thin and tight, thin and loose, thick and tight, thick and loose type. 90 cases of thin and loose type accepted the Nagata method of ear reconstruction surgery.

RESULTSWith average 7.8 months follow up, 84.4% (76/90) cases using Nagata two-stage method were satisfied with the outcome of the reconstructed ear including three dimensional position and subunit appearance. There were no postoperative complication related to chest wall deformity or affected normal physical function.

CONCLUSIONSThe Nagata two-stage method is appropriate management choice for Chinese congenital microtia. Based on the different physiological characteristics of the mastoid skin and soft tissue, the selection of different operational should be beneficial to the ear reconstruction of Chinese congenital microtia malformation.

China ; Congenital Microtia ; surgery ; Ear, External ; surgery ; Humans ; Mastoid ; Otologic Surgical Procedures ; Reconstructive Surgical Procedures ; Skin ; Thoracic Wall

In view of the problems that conventional artificial cartilages have no bioactivity and are prone to peel off in repeated uses as a result of insufficient strength to bond with subchondral bone, we have designed and prepared a novel kind of PVA-BG composite hydrogel as bionic artificial articular cartilage/bone composite implants. The effects of processes and conditions of preparation on the mechanical properties of implant were explored. In addition, the relationships between compression strain rate, BG content, PVA hydrogels thickness and compressive tangent modulus were also explicated. We also analyzed the effects of cancellous bone aperture, BG and PVA content on the shear strength of bonding interface of artificial articular cartilage with cancellous bone. Meanwhile, the bonding interface of artificial articular cartilage and cancellous bone was characterized by scanning electron microscopy. It was revealed that the compressive modulus of composite implants was correspondingly increased with the adding of BG content and the augments of PVA hydrogel thickness. The compressive modulus and bonding interface were both related to the apertures of cancellous bone. The compressive modulus of composite implants was 1.6-2.23 MPa and the shear strength of bonding interface was 0.63-1.21 MPa. These results demonstrated that the connection between artificial articular cartilage and cancellous bone was adequately firm.
Biocompatible Materials ; chemistry ; Biomimetic Materials ; chemistry ; Bone Substitutes ; chemical synthesis ; chemistry ; Cartilage, Articular ; physiology ; surgery ; Compressive Strength ; Humans ; Hydrogel, Polyethylene Glycol Dimethacrylate ; chemistry ; Polyvinyl Alcohol ; chemistry ; Prostheses and Implants ; Prosthesis Design ; Stress, Mechanical

Objective: To explore a 1∶1 2D printing method of rib cartilage based on CT scanning in assisting ear framework fabrication for auricular reconstruction. Methods: From January 2016 to January 2017, 73 cases of microtia aging from 5 to 7 referred to our department. A 1∶1 2D printing of rib cartilage based on CT scanning was applied in preoperative assessment and measurments of bilateral sixth, seventh and eighth costal cartilage were completed before the surgery. Personalized rib cartilage ear framework fabrication was determined by the measurements. Results: Among the 73 cases, 58 cases received auricular reconstruction successfully. There were 15 patients whose rib cartilages did not meet the requirements and postponed the surgery. The patients who underwent auricular reconstruction were followed up for 6 to 12 months (average, 9 months). During the follow-up, 52 cases had satisfactory outcomes in size, shape, symmetry and details. No deformation of reconstructed ears or chest wall was found during the follow-up. Conclusions The 1∶1 2D printing based on CT scanning is a simple and timesaving way to evaluate the rib cartilage. It can be beneficial to save the amount of cartilage and improve the personalized ear framework fabrication.

Objective:To investigate the risk factors of early death after lung transplantation in patients with idiopathic pulmonary fibrosis (IPF) complicated with pulmonary arterial hypertension (PAH).Methods:A retrospective cohort study was conducted. The clinical data of 134 patients with IPF and PAH who underwent lung transplantation at Wuxi People's Hospital Affiliated to Nanjing Medical University from January 2017 to December 2020 were collected. The donor's gender, age, duration of mechanical ventilation, and cold ischemia time, the recipient's gender, age, body mass index (BMI), smoking, history of hypertension and diabetes, preoperative usage of hormones, mean pulmonary arterial pressure (mPAP), cardiac echocardiography and cardiac function, serum creatinine (SCr), N-terminal pro-brain natriuretic peptide (NT-proBNP) as well as surgical type, extracorporeal membrane oxygenation (ECMO) treatment, duration of operation, and plasma and red blood cell infusion ratio were collected. The cumulative survival rates of patients at 30, 60, and 180 days after lung transplantation were calculated by Kaplan-Meier method. The univariate and multivariate Cox proportional hazards regression models were used to analyze the effects of donor, recipient, and surgical factors on early survival in donors after lung transplantation.Results:The majority of donors were male (80.6%). There was 63.4% of the donors older than 35 years old, 80.6% of the donors had mechanical ventilation duration less than 10 days, and the median cold ischemia time was 465.00 (369.25, 556.25) minutes. The recipients were mainly males (83.6%). Most of the patients were younger than 65 years old (70.9%). Most of them had no hypertension (75.4%) or diabetes (67.9%). The median mPAP of recipients was 36 (30, 43) mmHg (1 mmHg≈0.133 kPa). There were 73 patients with single lung transplantation (54.5%), and 61 with double lung transplantation (45.5%). The survival rates of 134 IPF patients with PAH at 30, 60, 180 days after lung transplantation were 81.3%, 76.9%, and 67.4%, respectively. Univariate Cox proportional risk regression analysis showed that recipient preoperative use of hormone [hazard ratio ( HR) = 2.079, 95% confidence interval (95% CI) was 1.048-4.128], mPAP ≥ 35 mmHg ( HR = 2.136, 95% CI was 1.129-4.044), NT-proBNP ≥ 300 ng/L ( HR = 2.411, 95% CI was 1.323-4.392), New York Heart Association (NYHA) cardiac function classification Ⅲ-Ⅳ ( HR = 3.021, 95% CI was 1.652-5.523) were the risk factors of early postoperative death in patients with IPF complicated with PAH (all P < 0.05). In the multivariable Cox proportional risk regression analysis, recipient preoperative hormone usage (model 1: HR = 2.072, 95% CI was 1.044-4.114, P = 0.037; model 2: HR = 2.098, 95% CI was 1.057-4.165, P = 0.034), NT-proBNP ≥ 300 ng/L ( HR = 2.246, 95% CI was 1.225-4.116, P = 0.009) and NYHA cardiac function classification Ⅲ-Ⅳ ( HR = 2.771, 95% CI was 1.495-5.134, P = 0.001) were independent risk factors of early postoperative death in patients with IPF. Conclusions:Preoperative hormone usage, NT-proBNP ≥ 300 ng/L, NYHA cardiac function classification Ⅲ-Ⅳ are independent risk factors for early death in patients with IPF and PAH after lung transplantation. For these patients, attention should be paid to optimize their functional status before operation. Preoperative reduction of receptor hormone usage and improvement of cardiac function can improve the early survival rate of such patients after lung transplantation.

As a novel mode of cell death, pyroptosis plays an important role in nonalcoholic fatty liver disease (NAFLD), and the research on pyroptosis may help to explore new therapeutic targets for NAFLD. This article reviews the advances in pyroptosis from the research background and mechanism of pyroptosis and the role of pyroptosis in NAFLD and elaborates on the pyroptosis execution molecules such as GSDME and caspase-11 and the function of inflammasomes including AIM2.

An elderly female melanoma patient who experienced severe liver injury after treatment with pembrolizumab and axitinib,which improved with glucocorticoid therapy.Through medication analysis and adverse reaction scale evaluated,it was considered that severe liver injury was more closely related to the immune checkpoint inhibitor,pembrolizumab.After a comprehensive analysis of the relationship between liver injury and immunotherapy,as well as the benefits and risks of immunotherapy for patients,immunotherapy was rechallenged 40 days after discontinuation of pembrolizumab.Restarting treatment with pembrolizumab after immune-mediated hepatitis poses a risk of recurrence of hepatotoxicity.After reviewing related literature,it had been found that the incidence of severe hepatotoxicity caused by rechallenging treatment was low,and the overall safety was controllable.Pembrolizumab had brought therapeutic benefits to patients,with no further immune-mediated liver injury of 5 cycles medication.This case can provide a reference for rechallenging immunotherapy after immune-mediated hepatitis.