Objective To study the clinical characteristics of the adult onset Still's disease(AODS),its concomitant symptoms,and misdiagnosis.Methods To analyze retrospectively 12 adults who were diagnosed bosh by clinical treatment and laboratory examination as AODS patients.Results 12 cases suffered from fever,9 cases from dermatitis and arthralgia,3 cases from muscle pains,3 cases from enlarged liver,4 cases from enlarged spleen,3 cases from enlarged liver and spleen,and 3 cases from abdomen pain.Conclusion AODS does not have special symptoms in its early stage.Its complexity often results in a missdiagnosis.

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.