AIM To observe the clinical efficacy of Maixuekang Capsules (hirudin) combined with female progestational hormone treating blood-stagnated cryptogenic hypomenorrhea and their mechanism of action.METHODS Ninty eligible patients were randomly and equally divided into treatment group (Maixuekang Capsules combine with female progestational hormone) and control group (female progestational hormone),treated for three menstrual cycles,the menstrual blood volume,blood D-dimer,maximum platelet aggregation rate,the thickness of endometrium,spiral artery blood flow peak systolic velocity (PSV),resistance index (RI) and pulsatility index (PI) were recorded during the three months period.RESULTS The menstrual blood volume of the two groups were all increased post-treatments (P ＜ 0.05),the treatment group was superior to the control group (P ＜ 0.05);blood D-dimer and maximum platelet aggregation rate of the treatment group had reduced post-treatments (P ＜ 0.05),there was no difference in the two values of the control group between post-treatment and pre-treatment (P ＞ 0.05);the thickness of endometrium of the two groups were both increased after the treatment (P ＜ 0.05),while there was no remarkable statistical difference between the two groups (P ＞ 0.05);RI in the treatment group had remarkable reduction post-treatments (P ＜ 0.05),but there was no remarkable difference of RI in the control group (P ＞ 0.05);there was no statistical difference of PSV and PI in both groups before and after the treatment (P ＞ 0.05).CONCLUSION The combination treatment of Maixuekang Capsules and female progestational hormone can obviously increase menstrual blood volume,improve uterine blood perfusion and endometrial microcirculation.It has more advantages than use hormones alone.

BACKGROUND:The mechanical valves used in the adult Luo-Ye pump have a large size and great destruction to blood, which are not suitable for infant ventricular assist pump. Therefore, designing and producing a high molecular valve with smal size and low incidence of thrombosis is a research hotspot. OBJECTIVE:To design and produce a valve of 20 mL infant Luo-Ye pump, and to test its basic functions and fatigue properties. METHODS:The size and shape of valve was designed with MASTERCAM software, polyurethane valve was obtained through producing the valve model and plastic injection;the static leakage, pressure drop and fatigue resistance of polyurethane valve were tested according to the ISO5840 requirements. RESULTS AND CONCLUSION:The polyurethane trefoil valve was produced, but the failure rate of plastic injection was high;the basic function of the trefoil valve met the ISO5840 requirements bascial y;after continuously operated 1.0×107 times, stroke volume of 20 mL Luo-Ye pump was changed 5.2%, and two polyurethane valves and valve leaflets did not change and damage. Polyurethane trefoil valve was designed and produced successful y;polyurethane valves could meet the needs of 20 mL Luo-Ye pump, which already have the ability to clinical trials.

Enhanced recovery after surgery (ERAS) refers to adopting a series of perioperative optimization measures to prevent or reduce the inflammatory stress response, promote rapid postoperative recovery of patients, shorten the length of hospital stay, reduce the incidence of postoperative complications, readmission rate and mortality rate. As the only effective treatment for end-stage liver disease, liver transplantation is characterized with difficult operation, long operation time, large amount of blood transfusion during operation and complicated postoperative management, etc. Postoperative recovery of liver transplantation is facing great challenges. In this article, research progresses on the application of ERAS in the perioperative period of liver transplantation and the suggestions for the implementation of ERAS during this period were introduced.

Background and aim:Hepatitis B virus(HBV)-related gestational acute-on-chronic liver failure(ACLF)is a severe condition with limited treatment options.This study aimed to evaluate the efficacy and ideal timing of plasma exchange and continuous renal replacement therapy(CRRT)in managing pregnant women with HBV-related ACLF. Methods:This study retrospectively analyzed 51 eligible patients with HBV-related gestational ACLF between 2009 and 2020.Patients admitted to the study were divided into a conventional treatment group and a new treatment group according to whether they received the new management protocol,which included more aggressive plasma exchange(PE)and CRRT strategies.All 19 pregnant women with hepatic encephalopathy(HE)were divided into an early treatment group and a non-early treatment group according to whether PE therapy was initiated within three days.Our study had two primary objectives.Firstly,we aimed to evaluate the impact of PE and CRRT on puerperal survival.Secondly,we sought to assess the effects of early PE and CRRT regimens on puerperal survival in women with HE. Results:The levels of total bilirubin on the second day postpartum(D3),the third day postpartum(D4),and the fifth day postpartum(D6)were significantly lower in the new treatment group compared to the conventional treatment group(P=0.02,0.01,and 0.02,respectively).The ALT of D3 was significantly elevated in the new treatment group compared to the conventional treatment group(P=0.02).The incidence of HE overall increased from prenatal to postpartum D4,peaked on D4,and then gradually decreased from the fourth day postpartum(D5)(P=0.027).The first week after delivery revealed a significant difference in survival rate between the two groups,the conventional treatment group had statistically higher mortality rates compared to the new treatment group(P=0.002).Similarly,the entire puerperal period mortality rate of the conventional treatment group was statistically higher than the new treatment group(P=0.002).Moreover,among all patients with HE,the non-early treatment group showed significantly higher puerperal mortality rates compared to the early treatment group(P=0.006). Conclusions:Early PE and CRRT conducted within three days post-childbirth,enhance puerperal prog-nosis for HBV-related gestational ACLF.

Liver transplantation(LT)is the only effective treatment for hepatopulmonary syndrome(HPS).Moreover,perioperative refractory hypoxemia(pRH)is a prevalent life-threatening condition and has extremely limited treatment options.Here,we report three patients with HPS who experienced pRH after LT and were consecutively treated with different salvage therapies,ephedrine inhalation,intravenous use of methylene blue with nitric oxide(NO)inhalation,and NO inhalation alone.The results showed that unresolved severe hypoxia may induce fatal morbidity such as early biliary leakage and acute kidney injury.Early initiation of NO inhalation,rather than ephedrine,can significantly improve oxygenation in patients with pRH and may help prevent hypoxia-related complications.Therefore,based on the response to these exploratory salvage treatments,we further demonstrate the unique ventilation-perfusion mismatch pathophysiology in specific lung regions during pRH in HPS.We propose that early inhalation of NO is an important treatment option to rescue severe hypoxia in patients with HPS during the perioperative period of LT.

Objective To investigate the rationality and efficacy of enhanced recovery after surgery (ERAS) in liver transplant recipients. Methods Clinical data of 465 liver transplant recipients were retrospectively analyzed. All recipients were divided into the ERAS group (n=163) and control group (n=302) according to whether they received ERAS. The severity of disease in the ERAS group was worse than that in the control group. Operation situations including the operation time, anhepatic phase and intraoperative blood transfusion volume of the liver transplant recipients were observed and recorded. Postoperative recovery conditions including the length of intensive care unit (ICU) stay, total length of hospital stay, total ventilator removal time at postoperative 28 d and postoperative re-intubation rate were recorded. The survival rates at 90 d, 180 d and 1 year after liver transplantation were calculated. The influencing factors of survival rate of liver transplant recipients were analyzed. Results The anhepatic phase in the ERAS group was 45 (39, 53) min, significantly longer than 40 (32, 48) min in the control group (P < 0.05). The volume of erythrocyte infusion in the ERAS group was 10 (7, 13) U, significantly less than 18 (10, 28) U in the control group (P < 0.05). The length of postoperative ICU stay and total length of hospital stay in the ERAS group were 135 (84, 212) h and 24 (18, 33) d, significantly shorter than 154 (103, 253) h and 34 (20, 50) d in the control group (both P < 0.05). Total ventilator removal time at postoperative 28 d was 26 (25, 27) d, significantly longer than 26 (23, 27) d in the control group (P < 0.05). The postoperative re-intubation rate in the ERAS group was 11.0%, significantly lower than 20.8% in the control group (P < 0.05). The 90 d, 180 d and 1-year survival rates in the ERAS group were 92.8%, which were significantly higher than 81.1%, 78.1% and 75.7% in the control group (all P < 0.05). ERAS and operation time were the independent influencing factors of survival rate of liver transplant recipients (both P < 0.05). Conclusions ERAS after liver transplantation can improve the survival rate of recipient, shorten the length of hospital stay, reduce the re-intubation rate and accelerate the rehabilitation after liver transplantation.

Objective To summarize the treatment experience of sepsis after liver transplantation.Methods The clinical features and treatment methods of 1 patient developing sepsis after liver transplantation, who was admitted and treated in the Surgical Intensive Care Unit of the Third Affiliated Hospital of Sun Yat-sen University in September 201 4,were retrospectively studied.The interpretation of International Guidelines for Management of Severe Sepsis and Septic Shock (SSC Guidelines)and relevant literature were reviewed.Results One male patient at the age of 50 years old developed high fever and decrease of blood pressure at 1 d after liver transplantation,and was diagnosed as septic shock.The symptoms were relieved after the appropriate treatment like goal-directed fluid resuscitation,anti-infection and blood purification,etc.And the patient was discharged in stable conditions.Conclusions It is easy to develop infection after liver transplantation and the fatality rate of sepsis caused by infection is high.Once the sepsis occurs,clinicians must perform early goal-directed therapy and bundle therapy according to the SSC Guidelines positively,and select the appropriate drugs according to the pathogen culture results in order to reduce the fatality rate.

Objective To investigate the therapeutic effect and safety of plasma exchange in the treatment of patients with severe liver disease in pregnancy. Methods Clinical data of 28 patients with severe liver disease in pregnancy in Surgical Intensive Care Unit (SICU), the Third Afifliated Hospital of Sun Yat-sen University from March 2009 to October 2013 were analyzed retrospectively. According to the therapeutic schedule, the patients were divided into treatment group (n=12, age range:21 to 28 years old, median age:25 years old) and control group (n=16, age range:18 to 29 years old, median age:24 years old). The informed consents of all patients were obtained and the ethical committee approval was received. All patients were transferred to SICU after childbirth and received treatments of anti-infection, anti-virus, liver protection, reducing jaundice, supplying human albumin and gamma globulin, infusing blood coagulation and so on. And patients in treatment group received the treatment of exchange of homotype fresh plasma on the basic of the above treatments. The differences between 2 groups in clinical examination indicators and therapeutic effect were compared. The adverse reactions after plasma exchange in treatment group were observed. The examination indicators of 2 groups were compared using t test and the ratios were compared using Chi-square test. Results The blood total bilirubin (TB), albumin (ALB) , serum creatinine (Scr), fasting blood glucose (FPG) , prothrombin time activity (PTA) and arterial lactic acid (Lac) were (197±69)μmol/L, (30±7)g/L, (111±42)μmol/L, (5.7±2.4)mmol/L, (55±24)%, (2.3±0.6)mmol/L respectively in treatment group and were (299±113)μmol/L, (24±6)g/L, (165±82)μmol/L, (3.7±1.7)mmol/L, (33±11)%, (4.4±1.5)mmol/L respectively in control group. The indicators in treatment group were signiifcantly improved compared with those in control group (t=-3.453, 2.389,-4.892, 2.798, 6.079, -3.339; P<0.05). The effective rate in treatment group (92%,11/12) was signiifcantly higher than that in control group (56%,9/16) ( χ2=4.215, P<0.05). One case in treatment group suffered transitional hypotension after plasma infusion and the blood pressure returned to normal 1 h later after giving a small dose of vasoactive drugs. Conclusions Plasma exchange can improve the clinical examination indicators and therapeutic effect of patients with severe liver disease in pregnancy. It is a safe and effective treatment.

ObjectiveTo investigate the drug sensitivity ofAcinetobacter baumannii in organ transplantation patients.MethodsClinical data of 66 patients detected withAcinetobacter baumannii in the Third Affiliated Hospital of Sun Yat-sen University between June 2012 and June 2015 were retrospectively studied. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 66 patients, 55 were males and 11 were females with the average age of (47±12) years old. Among the 66 patients, 11 cases were before liver transplantation, 52 were after liver transplantation, 1 was after kidney transplantation and 2 were in liver transplantation state. Sputum, urine, blood, wound secretion and drainage liquid of the patients were collected for bacterial culture and drug sensitivity test.ResultsA total of 73 strains ofAcinetobacter baumannii cultured from the specimens of 66 patients and the drug resistance rate to 13 antibiotics was respectively 78% to piperacillin sodium, 75% to cefotaxime sodium, 74% to ceftazidime, 73% to ceftriaxone sodium, 74% to cefepime, 73% to meropenem/imipenem-cilastatin sodium, 75% to ticarcillin sodium-clavulanate potassium, 73% to ciprolfoxacin, 71% to levolfoxacin, 73% to tobramycin, 73% to gentamycin, 73% to amikacin and 69% to trimethoprim/sulfadiazine. The resistance rate ofAcinetobacter baumannii cultured between 2014 and 2015 to the aforementioned antibiotics was higher than that cultured between 2012 and 2013. The resistance rate to carbapenems was 17% in 2012, 33% in 2013, 86% in 2014 and 92% in 2015.ConclusionThe infection incidence of multi-drug resistantAcinetobacter baumannii in organ transplantation patients trends to increase year by year, which shall be paid attention to during the treatment.