Objective To explore the cause and treatment strategy of chronic graft rejection characteristic of jaundice in patients with liver transplantation. MethodsPrimary disease, immunosuppressive protocol were reviewed in nine cases surviving more than 1 year after liver transplantation. The pathology examination, choledochoscopy and ultrasound examination were performed. The dosage of immunosuppressive agent was adjusted. Four cases underwent operation. Results Chronic rejection was well controlled in 6 out of the 9 cases with total bilirubin level decreased from 200 ?mol/L to less than 100 ?mol/L. Bile flocculus and bile slush became less obvious or disappeared after flushing and dilataltion of the common bile duct. Three cases died in spite of aggressive therapy. ConclusionsInsufficient immunosuppressive strength is one of the most important causes for chronic rejection. Immunological injury results in hepatocellular damage, bile slush, inflamed thick bile duct.

Objective To determine the long-term results after combined pancreas-kidney transplantation at a single-center institution.Methods Fifty-three consecutive patients with insulin-dependent diabetes mellitus and end-stage nephropathy were followed up for more than three years after combined pancreas-kidney transplantation. Immunosuppressive protocol consisted of tacrolimus ( TAC ),mycophenolate mofetil (MMF),and steroids,and antithymocyte globulin or anti-CD25 receptor mAb.The impact of different risk factors was analyzed on long term patient and graft survival.Results The 3-,5- and 8-year survival rate in recipients was 90.1％,89.1 ％ and 80.0％,respectively.The 3-,5- and 8-year survival rate of pancreas grafts was 84.9％,84.8％ and 60.0％,and that of kidney grafts was 83.0％,82.6％ and 53.3％,respectively.Principal causes of death were Infection (n =4),renal failure (n =2),cardiovascular events (n =1 ),and cerebrovascular accident (n =1 ).Graft failure for the pancreas was caused by death with a functioning graft (n =6),rejection (n =2),thrombosis (n =1 ) and pancreatitis (n =1 ).Graft failure for the kidney was due to rejection (n =9),and death with a functioning graft (n =9).Conclusion This series representing the largest experience with long-term follow up in China confirms an excellent long-term survival.Infection,rejection and surgical complication were the major risk factors leading to deaths and graft loss.

Objective To report the modified technique and the short-term results of simultaneous pancreaticoduodenum-kidney transplantation (SPK) with the enteric drainage (ED) of exocrine secretions. Method Between June 2000 and Jan 2006, thirty-five patients with diabetes and uremia underwent SPK. The pancreas graft is placed intraperitoneally with its exocrine secretions drained into the proximal jejunum without Roux-en-Y procedure. The mean cold ischemic times of kidney was 6. 92?2. 17 hours and that of pancreas, 9. 65?2. 02 hours. Quadruple immunosuppressive therapy with antilymphocyte globulin or antiCD25 monoclonal antibody ( Zenapax ) , tacrolimus, mycophenolate mofetil and steroids was adopted. Results Postoperative patient and graft survival rates were 97. 3%. All patients achieved insulin-free euglycemia at 8.3?4.5 days postoperatively. Preoperative patient's mean fasting insulin and C-peptide values were 7.45?7. 35 mU/L and 5. 68?4. 66 mU/L. After operation, patients had fasting insulin and C-peptide values of 11. 9?5.70 mU/L and 5. 57?4. 90 mU/L, respectively, which peaked to an insulin level of 57. 9?46.6 mU/L and a C-peptide level of 11.75?6.99 mU/L with stimulation. The pancreas grafts also functioned well as evidenced also by normal serum amylase values of 92. 10?12. 24 U/L on 10th postoperative day. There were five cases of delayed renal graft function. All other patients achieved immediate renal graft function. No graft losses occurred due to leakage or intra-abdominal infection. The most commn surgical complications were wound infection (n - 11) , enteric anastomostic hemorrage ( n = 5) , and peri-renal hemorrage (n =2). Conclusions SPK is a effective treatment option for patients with diabetes mellitus and uremia. Enteric exocrine drainage by direct side-to-side anastomosis (without Roux-en-Y loop) seems to be a simple and reliable technique.

Objective:To explore the distribution of pelvic lymph node (PLN) metastasis and the correlative dangerous factors in early cervical cancer patients.Methods:The medical records of 508 patients who underwent extensive hysterectomy and lymphadenectomy for International Federation of Gynecology and Obstetrics (FIGO) stage Ⅰb-Ⅱb cervical cancer in Guizhou Provincial People`s Hospital were reviewed retrospectively.Results:There were 278 patients with stage Ⅰb cervical cancer, 204 patients with stage Ⅱa cervical cancer and 26 patients with stage Ⅱb cervical cancer; the positive rate of lymph node metastasis was 16.7%(85/508), and obturator lymph node metastasis was the most common (56.6%); there were 19 patients with bilateral lymph node metastasis, accounting for 22.35%(19/85); lymph node metastasis occurred 104 times (two times for bilateral simultaneous transfer), and jumping lymph node metastasis accounted for 37.5%(39/104); common iliac lymph node metastasis accounted for 18.3%(19/104). The metastasis rate of patients with stage Ⅱa and Ⅱb (including parametrial, lymph node, ovarian and oviduct metastasis) was higher than that of patients with stage Ⅰb, and the odd ratio ( OR) was 2.30 and 2.48 respectively ( P<0.05); the metastasis rate of patients with moderately differentiated tumors was significantly higher than that of patients with well differentiated and poorly differentiated tumors ( P<0.05). There was no significant difference in the positive rate of pelvic lymph node metastasis among patients with different ages and histological types ( P>0.05); the positive rate of pelvic lymph node metastasis in patients with stage Ⅱa and Ⅱb was higher than that in patients with stage Ⅰb with statistically significant difference ( P<0.05); the positive rate of pelvic lymph node metastasis in patients with moderately differentiated tumors was higher than that in patients with well differentiated and poorly differentiated tumors, with statistically significant difference ( P<0.05). Conclusions:Obturator lymph node metastasis is the most common in cervical cancer. The risk of lymph node metastasis is increased in patients with stage Ⅱa or moderately differentiated tumors. Jumping metastasis is also a common way of metastasis, which suggests that standard and complete lymph node resection is an important measure to ensure the curative effect.

Objective:To discuss the atypical radiological features of posterior Monteggia fracture and appropriate treatment of the fracture.Methods:A retrospective study was conducted of the 12 patients who had been treated for posterior Monteggia fracture with atypical radiological features at Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital from July 2019 to December 2020. They were 7 males and 5 females, aged from 18 to 65 years (mean, 46.5 years). Their elbow X-ray and CT scan features included unidentified upper ulnoradial dislocation, presence of triangular or quadrilateral butterfly fracture pieces in front of the fracture end at the level of ulnar coronal process, normal humeroradial joint or forward dislocated radial head, comminuted fracture or anterior edge fracture of the radial head, or backward angulated fracture of the radial neck. The proximal ulnar fractures were fixated with olecranon anatomical locking compression plate or with assistant kirschner wire and tension band fixation; the ulnar coronoid process fractures were fixated with kirschner wire or lag screws or a mini-plate; the radial head fractures were fixated with headless compressing screws or a mini-plate or treated with radial head replacement; the severe injury to the radial collateral ligament was repaired with a suture anchor. Fracture union time, complications and range of elbow motion at the final follow-up were recorded. Elbow function was assessed by Mayo elbow performance score (MEPS).Results:All patients were followed up for 6 to 28 months (mean, 16.4 months). All fractures achieved bony union after 12 to 19 weeks (14.6 weeks). The final follow-ups revealed the following: the range of elbow flexion and extension ranged from 75° to 145°, averaging 100.5°; the range of forearm rotation ranged from 80° to 155°, averaging 132.0°; the MEPS ranged from 50 to 100 points, averaging 86.2 points and yielding 5 excellent, 4 good, 2 fair and 1 poor cases. Elbow stiffness developed in 3 cases.Conclusion:Understanding the atypical radiological features of posterior Monteggia fracture can promote better diagnosis and treatment of the posterior Monteggia fracture in clinic.

Objective:To investigate the efficacy of personalized family doctor contract services on risk factors of atherosclerotic cardiovascular disease (ASCVD) in high-risk population.Methods:Ten matched-community health centers of Shenzhen Luohu district were divided into intervention group and control group by cluster randomiztion. Subjects with high risks of ASCVD were screened out as intervention group from contracted residents who visited these centers and had complete data of the China-PAR model from August 2018 to April 2019. The control group received conventional general family doctor contract services. The individualized management were given to the intervention group after fully understanding patients′ ideas, concerns, and expectations (ICE). After 2-year intervention, score changes of ASCVD risk factors within and between groups were compared.Results:A total of 571 patients were enrolled, including 288 in the intervention group and 283 in the control group. After 2 years of intervention, 7 and 18 were lost to follow-up in two groups, respectively. Finally, 281 in the intervention group and 265 in the control group were included in the study. At baseline, there was no significant difference in ASCVD scores between the intervention group and the control group [(13.33±3.54) vs. (13.09±3.54) points; t=0.84, P=0.403], and the scores in both groups decreased significantly after the intervention [(10.89±4.01), (11.62±4.11) points], while the intervention group decreased more significantly (both P<0.05). Among the risk factors at baseline, HDL-C and diastolic blood pressure in the intervention group were lower than those in the control group, and there were no significant differences in other factors between the two groups. After the intervention, the levels of total cholesterol, systolic blood pressure and diastolic blood pressure in the two groups decreased significantly, and the number of people taking antihypertensive drugs increased significantly ( P<0.001 and P<0.05); HDL-C decreased in the control group ( P=0.023). After the intervention, compared to control group the intervention group had a higher proportion of patients taking antihypertensive drugs, with lower systolic and diastolic blood pressure ( P<0.05). After the intervention, the increase rate of HDL-C in the intervention group was more than that in the control group, and the decrease rate was less than that in the control group (χ 2=6.65, P=0.036). Conclusion:Family doctor contract services can reduce the risk factors of ASCVD, and personalized family doctor contract services can further improve the effects in the prevention and control of ASCVD. However, the effects might be insignificant and inconsistent for the ASCVD risk factors with deeper management requirements or no specific management measures, which highlights the complexity and diversity of ASCVD prevention and control, calling for multi-level and multi-faceted thinking and exploration.

Objective To analyze the safety of renal transplant from donors with primary central nervous system (CNS) tumors.Methods We retrospectively analyzed the clinical data of 33 donors with primary CNS tumors and the 63 corresponding renal recipients between January 2013 and December 2016 in Tongji Hospital.Results The mean period from diagnosis as primary CNS tumor to donation was about (21.8± 46.4) months (range:0.5 to 192.0 months).The pathological classification of these tumors included gliomas,meningioma,medulloblastoma,etc.Besides,there were 10 donors with high-grade CNS malignancies.Eleven donors have ever been through at least one of the four treatments (craniotomy,V-P/V-A shunt,radiotherapy and chemotherapy),14 donors have undergone none,and the clinical data of rest were unavailable.All the 63 recipients got well renal function after transplant.During an average follow-up of (15.9 ± 8.2) months (range:2.7 to 35.5 months),one recipient got donor-derived rhabdoid tumor 4 months posttransplant,underwent comprehensive treatments,including allograft nephrectomy,radiotherapy,chemotherpy and returned to hemodialysis,while the 62 cases got no donor-derived tumors.Conclusion Tumor transmission of renal allograft from donors with primary CNS tumors is inevitable but with low risk,which means this kind of donors can be used with careful assessment,full informed consent and good balance between wait-list death and tumor transmission.

Objective To compare the clinical outcomes between open reduction and fixation with cannulated screws via the modified Burks-Schaffer approach versus arthroscopic EndoButton plating for avulsion fracture of the tibial attachment of the posterior cruciate ligament(PCL).Methods From February 2013 to August 2017,41 patients with acute displaced avulsion fracture of the tibial PCL attachment were treated operatively at Department of Trauma Surgery,The Affiliated Hospital to Qingdao University.They were 24 men and 17 women,aged from 18 to 65 years (average,39 years).The lefi knee was injured in 22cases and the right knee in 19.They were divided into 2 groups according to their different fixation methods.The open reduction and fixation group (23 cases) received open reduction and fixation with cannulated screws via the modified Burks-Schaffer approach while the arthroscopic group (18 cases) arthroscopic Endobutton plating.The 2 groups were compared in terms of operation time,bleeding,objective knee scores and knee range of motion (ROM) after operation.Results All the 41 patients were followed up from 23 to 40months (average,27.2 months).Their follow-up revealed no incision infection,malunion,nonunion or loosening of the implants.Their knee X-ray films at the final follow-ups showed bony union of all the avulsion fractures.There were significant differences between the open reduction and fixation group and the arthroscopic group in operation time (52.6±7.3 min versus 86.8±9.2 min) and bleeding (63.9±12.7 mL versus 19.7 ± 10.2 mL) (P ＜ 0.05).There was no significant difference in the objective knee scores or knee ROM between the 2 groups (P ＞ 0.05).Conclusions Both open reduction and cannulated screw fixation via the modified Burks-Schaffer approach and arthroscopic EndoButton plating can achieve satisfactory clinical outcomes in the treatment of avulsion fracture of the tibial PCL attachment.Although the 2 methods make no significant differences in stability of the knee joint or in clinical scores,the latter leads to less bleeding and the former shorter operation time.

Objective To investigate the feasibility and safety of the single kidney transplantation from pediatric donors to adult recipients.Methods From May 2013 to January 2017,a total of 50 single kidney transplants from pediatric donation after citizen death (DCD) donors of age between 3 to 12 years to adult recipients were performed and the data were summarized.Results The average age of donors was 6.4 ± 2.5 years with an average donor weight of 19.1 ± 5.9 kg,and the average kidney length was 6.3 ± 0.6 cm.For the 50 adult recipients,the average age was 38.5 ± 12.1 years,the average body weight was 56.1 ± 13.1 kg,and the number of female patients was 26 (52％).All except 3 of these patients were transplanted for the first time.Delayed graft function (DGF) was observed in 15 patients (30％).The average value of eGFR among all the patients was rapidly increased in the first 3 months after transplantation and then steadily increased to (82.3 ± 13.4) mL· min-1·1.73 m-2 at 1 st year,followed by (83.8 ± 22.5) mL· min-1·1.73 m-2 at 2nd year.Four renal grafts developed acute rejection (8％),and 3 of them were successfully reversed by the treatment.Pulmonary infection occurred in 4 recipients,and 2 died.During a follow-up period of 19 months,uncensored grafts survival was 94％,and patients survival was 96％.Conclusion Excellent intermediate-term transplant outcome can be achieved by using single kidneys from pediatric donors elder than 3 years,which may shorten the waiting time in adult recipients and alleviate the contradictions in the absence of suitable pediatric recipients.

Objective:To summarize the transplant outcomes of pediatric kidney transplantation at a single center and discuss probable measures of improving the outcomes.Methods:A total of 111 pediatric renal transplantation were performed from September 2002 to September 2019. They were divided into adult-donor group ( n=41) and pediatric-donor group ( n=70). Adult-donor group consisted of two subgroups based upon donor sources: living-donor group ( n=19) and deceased-donor group ( n=22). Pediatric-donor group consisted of two subgroups based upon surgical types: single kidney group ( n=48) and en bloc kidney group ( n=22). Clinical data and outcomes of grafts and recipients were retrospectively analyzed. Results:The average age of recipients was (15.6±1.9) years in adult-donor group. None developed delayed graft function (DGF) in living-donor group whereas 6 patients (27.3%) had DGF in deceased-donor group ( P<0.05). During a follow-up period of 22-181 months, 1-year and 5-year graft survivals were 100% vs 94.1% and 93.8% vs 94.1% in living-donor and deceased-donor groups respectively. There were no statistical differences. In pediatric-donor group, the age of donors was significantly lower in en bloc subgroup than that in single kidney subgroup (median: 0.5 vs 6 months, P<0.05). The age of recipients was similar between two subgroups: (9.5±5.3) years in single kidney group vs. 11.5± 1.8 years in en bloc kidney group. In addition, 7 cases of single kidney were transplanted for infant recipients aged under 1 year. Vascular thrombosis occurred in 3 patients (6.3%) of single kidney group, less than that in 5 patients (22.7%) of en bloc kidney group ( P=0.06). During a follow-up period of 4-54 months, 1-year and 2-year graft survivals were 85% and 80% in single kidney group whereas 75% and 70% in en bloc kidney group. However, there was no statistically significant difference. One-year survival was 98% in single kidney group and 95% in en bloc kidney group. Conclusions:For elder pediatric recipients, excellent kidney transplant outcomes may be achieved with grafts from adult donors. For pediatric kidney recipients, transplant outcomes can be further improved with careful assessments and cautious usage of small grafts, particularly those form neonatal donors.