Objective:To summarize the nursing experience of a patient with diarrhea associated with Clostridium difficile infection after liver transplantation.Methods:To make individualized nursing plan for patients with diarrhea associated with Clostridium difficult infection after liver transplantation. Nursing measures were carried out from the aspects of prevention and control of infection, adjustment of immunosuppression program, collection and delivery of samples, perianal skin care, predictive first aid nursing, enteral and parenteral nutrition support, rehabilitation activity guidance, psychological nursing and so on.Results:After 22 days of careful treatment and nursing, the patient's condition improved, the yellow soft stool was discharged once or twice a day, the results of laboratory fecal bacterial culture turned negative and the isolation was lifted.Conclusions:The main points of nursing for such patients include prevention and control of infection, reasonable adjustment of immunosuppressive program during severe recurrent diarrhea, vigilance of rejection, correct collection and delivery of samples to ensure correct culture results, close monitoring of defecation, implementation of structured skin care program, improvement of condition warning level, predictive first aid nursing, combined with enteral and parenteral nutrition support to enhance resistance. Formulate individual activity plans to promote rehabilitation; use the concept of shared decision-making to guide the whole process of psychological counseling.

Objective To explore the value of contrast-enhanced ultrasound in the diagnosis and classification of traumatic spleen rupture , as compared with enhanced CT. Methods The manifestations of contrast-enhanced ultrasound on surgically or clinically confirmed spleen rupture in 40 patients were retrospectively analyzed. The performance of contrast-enhanced ultrasound on diagnosis and classification was compared with that of enhanced CT. Results For 40 patients with traumatic spleen rupture , the of accuracy of enhanced CT and contrast-enhanced imaging in the diagnosis of traumatic spleen rupture was 97.5%, with no significant statistical differences (chi-square = 0, P = 1). On contrast-enhanced ultrasound examination, 14 patients were diagnosed as true splenic rupture , 9 as subcapsular spleen rupture , and 16 as central splenicrupture, with a accuracy rate of 92.5% (37/40); and accuracy rate for enhanced CT was 90.0% (36/40), there was no significant statistical difference (chi-square = 1.97, P > 0.05). Conclusions Contrast-enhanced and enhanced CT have good consistency in the diagnosis and classification of traumatic spleen rupture. Contrast-enhanced ultrasound can accurately determine the scope and degree of spleen damage , resulting in more accurate classification; and it has values in the diagnosis of traumatic spleen rupture and choice of therapies.

Objective To explore the influence of nursing intervention on the social support and compliance of parents of severe β-Mediterranean anemia children. Methods A total of 100 cases of Mediterranean anemia children’s parents were surveyed with the Social Support Rating Scale (SSRS) and self-made compliance questionnaires, the investigation was performed before the intervention,6 months, 1 year after the intervention. Results The scores of objective support, subjective support and supporting availability after the intervention were all higher than those before intervention (F=269.04, 125.12, 243.04, all P<0.01). In the pairwise comparison tests, the ranks of objective support score and subjective support score were:1 year after intervention>6 months after intervention>before intervention (P<0.01);the score of supporting availability was lower than the scores of 6 months and 1 year after intervention (P<0.01). The compliance of blood transfusion on time and taking deferoxamine on time before and after the interventions had statistical meanings (Hc=100.40,70.53, all P<0.01). In the pairwise comparison tests, the compliance score before intervention was lower than the score after intervention (P < 0.01). Conclusions Nursing intervention can improve the social support and compliance of the parents with severe Mediterranean anemia children.

Objective:To explore the nursing points of pneumocystis carinii pneumonia after liver transplantation in infants.Methods:Strengthened artificial airway management for children to improve dyspnea. Adopted nasal high-flow humidifying oxygen therapy to correct hypoxemia. Implemented individual temperature management to effectively control high fever. Strengthened children′s medication management, predictive skin management, using the protective isolation and psychological nursing.Results:After timely treatment and careful nursing, the condition of the three children was improved, SpO 2 was maintained at 0.95-1.00, and the patients were discharged successfully. One patient with respiratory failure died of multiple organ failure due to the deterioration of the condition after receiving extracorporeal membrane oxygen and supportive treatment. Conclusions:The infants with pneumocystis carinii pneumonia after liver transplantation should strengthen airway management, correct hypoxia. At the same time to do a good job of symptomatic care, strengthen the observation of the condition, can promote the rehabilitation.

Selecting high-quality patient report outcome measures for patients with liver transplantation may properly assess health condition from their perspective, assist nurses in identifying patients′ reports of health issues, and deliver targeted nursing care for them. This paper reviewed the current status of researches on measurement tools for patient reported outcomes in liver transplantation both domestically and internationally, including the content, characteristics, disadvantages and situation recommendations of the generic and specific measurement tools. The purpose is to provide a reference for choosing patient reported outcomes measurements, symptom management as well as the caring strategies in liver transplantation.

To summarize the perioperative nursing experience of a child with erythropoietic protoporphyria who underwent liver transplantation and splenectomy.The key points of preoperative care include implementing diversified interventions to reduce the accumulation of porphyrin in the body;actively controlling pain and improving the comfort of children;early debridement and treatment,and good care of solar allergic dermatitis.The key points of postoperative care include protecting the transplanted liver and preventing the deposition of protoporphyrin;strengthening respiratory management to control lung infection;psychological counseling throughout the process to reduce negative emotions;individualized follow-up management to prepare for bone marrow transplantation.After careful treatment and nursing,the child recovered smoothly and was discharged from the hospital.A follow-up visit after 1 month discharge showed a good recovery.

Objective:To summarize the nursing experience of liver transplantation in a patient with acute liver failure, renal injury, shock, hepatic encephalopathy and hyperlactic acidemia caused by K-amine poisoning.Methods:A case of severe K-amine poisoning admitted to the First Affiliated Hospital of Zhejiang University Medical College on June 29, 2022 was treated by multidisciplinary team cooperation. The treatment scheme of blood purification combined with liver transplantation was adopted, individualized nursing measures were implemented, including fluid resuscitation, blood purification, prevention and treatment of complications such as brain edema and infection of hepatic encephalopathy, immunosuppressive treatment after liver transplantation, occupational protection, health education and follow-up management.Results:After careful treatment and nursing, the liver and kidney function of the patient recovered smoothly and was discharged on the 33rd day after liver transplantation.Conclusions:In view of the rapid progress of acute liver failure caused by K-amine poisoning and the involvement of multiple organs, blood purification combined with liver transplantation successfully saved the lives of patients under the cooperation of multidisciplinary teams. Do a good job in disease monitoring and individualized nursing to improve the long-term survival rate of patients.

To summanze the nursing points of enterostomy among 6 children with small intestinal transplantation,which could provide references for clinical nursing.Key points:to set up a multidisciplinary team and develop an observation plan about enterostomy;to monitor the blood circulation of enterostomy closely,so as to identify the vascular complications as soon as possible;to closely observe the excrement of enterostomy and being vigilant for rejection reaction;to select reasonable nursing supplies based on the situation of enterostomy;to treat the abdominal incision fluid leakage timely,and pay attention to protect the skin around the enterostomy and take measures to control infection;furthermore,to attach great importance to continuous nursing care and improve the quality of home care.After above careful treatment,all the 6 children survived;they were discharged from hospital 3～4 months later after the operation of enterostomy restoration.Followed up 2～4 months,6 children recovered well.

Objective To explore the molecular pathogenesis of 3 Glanzmann's thrombasthenia pedigree by using bioinformatics software and provide evidence for in vitro experiments. Methods The genetic analysis of 3 pedigree diagnosed as Glanzmann's thrombasthenia was carried out. Clustalx-2.1 win software was used to analyze the conservatism of mutant sites in homologous sequences. Bioinformatics software such as PolyPhen-2, PROVEAN, SIFT and Mutationtaster was used to analyze the biological effect of mutation. SPDBV software constructed the molecular structure model of mutant protein and evaluated the influence of mutation on protein structure. Results The "new mutations" found in 3 Glanzmann's thrombasthenia pedigree were ITGA2B:c. 814G>C (p. Val272Leu), ITGA2B:c. 432G>A (p. Trp144Ter) and ACTN1:c. 2458A>G (p. Ile820Val). All three mutations were highly conserved among homologous species. Mutationtaster software showed that 3 new mutations were likely pathogenic. PolyPhen-2 and PROVEAN software showed ITGA2B p.Val272Leu and ACTN1 p.Ile820Val were benign and SIFT software showed that ITGA2B p. Val272Leu were likely pathogenic, while ACTN1 p. Ile820Val is benign. The result of SPDBV software showed that the Val272 of ITGA2B was transformed to Leu, neutralizing all the original hydrogen bond. The Trp144 of ITGA2B is transformed to Ter, resulting in the truncated proteins with only 113 amino acid residues. All these mutations affected the molecular structure of GPⅡb, resulting in a decrease ofGPⅡb/Ⅲa expression. When the Ile820 of ACTN1 is transformed to Val, onlyretained the hydrogen bond of Ile820 and Asp822, neutralized the rest hydrogen bond, whichaffected the molecular structure and protein function of ACTN1. Conclusion The mutations of ITGA2B:c.814G>C (p.VAL272LEU), ITGA2B:c.432G>A (p.Trp144Ter) and ACTN1:c.2458A>G (p.Ile820Val) are pathogenic.

Objective:To summarize the nursing points of a patient with enterococcus faecalis infection after living relative small bowel transplantation.Methods:To strengthen the observation and nursing of transplanted enterostomy, to guard against acute rejection. To closely monitor the signs of infection and effectively prevent and control infection.Make reasonable nutrition plan to promote the recovery of transplanted intestinal function. Prophylactic rejection with a combined immunosuppressive regimen. Implement individual psychological intervention to alleviate patients′ bad mood; Electronic follow-up records were established to dynamically monitor the changes of the condition after discharge.Results:The postoperative enterostomy was rosy, the intestinal function recovered well, and there was no rejection reaction. Enterococcus faecalis positive in ascites culture, infection signs were controlled after early detection, active treatment and nursing. Gradually return to normal eating through the mouth, walking rehabilitation discharge. The patient was followed up for 6 months and is now in good condition.Conclusion:For this patient, enhanced observation and nursing care, close monitoring of infection signs, reasonable nutrition plan and combined use of immunosuppression program are effective means to ensure the success of the operation and the safety of postoperative patients.