Objective To assess the feasibility of laparoscopic hepatic lobe procurement for living donor liver transplantation. Methods The technique included pneumoperitoneum with CO2,ports placement, porta hepatis dissection, laparoscopic ultrasound mapping, mobilization of the liver,and transection of the parenchyma into right and left lobes. The vascular structures were stapled and sectioned just prior to removal of the specimen. Results Hepatic lobectomies were successfully performed laparoscopically in 9 adult pigs. One pig was dead due to bleeding in IVC and following gas embolism during the parenchymal transection. The operative time was 208±25 min. The duration of warm ischemia was 8 ± 2. 3 min. The blood loss was 313 ± 75 mL. The vascular and biliary structures were preserved to allow for subsequent transplantation. Conclusion Laparoscopic living donor procurement for liver transplantation in a porcine model is safe and feasible.

Acute lung injury(ALI) and acute respiratory distress syndrome(ARDS) are common,life-threatening causes of acute respiratory failure that arise from a variety of local and systemic insults.The pathogenesis of ALI/ARDS is complicated and not yet completely interpreted today.The role of altered coagulation and fibrinolysis in the pathogenesis of ALI/ARDS has been investigated.This review will summarize the current understanding of coagulation and fibrinolysis in human ALI/ARDS with emphasis on pathways that could be potential therapeutic targets.These pathways include the tissue factor pathway,the protein C pathway and modulation of fibrinolysis via plasminogen activator inhibitor-1.

Objective To investigate the clinical and prognosis characteristics of SLE patients whose initial clinical presentations were Sj(o)gren's syndrome (SS).Methods Medical charts of 41 consecutive SS/SLE inpatients admitted to Peking Union Medical College Hospital (PUMCH) from February 1998 to February 2008 were systematically reviewed,including demographic data,clinical features,laboratory findings,treatment as well as prognosis.Two hundred and fourteen cases were randomly selected as controls from 2331 non SS-onset lupus (NSs/SLE) inpatients weated in PUMCH at the same time period.Results There were significant differences between SS/SLE and NSS/SLE patients in the following aspects (P＜0.05):①gender composition:(F/M) (41/0 vs 184/30),age at the diagnosis of SLE [(43±41) yrs vs (32±31) yrs)],disease duration L(114±84) mollths vs (45±18) months];②clinical features:xerostomia (85.3% vs 6.1%),xerophthalmia (75.6% vs 2.3%),faeial rash (9.8% vs 46.3%),renal tubular acidosis (21.9% vs 0),nephrotic syndrome (7.3% vs 31.3%),central nervous system invoivement (4.9% vs 19.6%),interstitial lung disease (12.2% vs 2.8%);③labratory findings:ESR[(65±75) mm/1 h vs (46±34) mm/1 h)],patients with elevated IgG level (56.4% vs 29.9%) and IgA level (38.5% vs 20.4%),RF,prevalence of anti-SSA and anti-SSB antibodies (70.8% vs 20.3%,82.9% vs 43.4% and 39.0% vs 7.9%);④SLEDAI score (8±8 vs 10±10),glucocorticosteroid treatment (methylprednisolone bolus/1～2 mg·kg-1·d-1 prednisone/1 mg·kg-1·d-1 prednisone)(8/26/7 vs 91/102/21),and rate of death and/or severe irreversible organ failure (2.4% vs 14.9%).SS/SLE patients were followed up for (33±34) months,40 cases remained stable and only one patient died of acute pulmonary embolism.Conclusion Compared to NSS/SLE,SS/SLE patients ale older and have more insidious disease course.They have higher prevalence rate of anti-SSA and anti-SSB antibodies,renal tubular acidosis and interstitial lung disease,but less severe neuropsychiatric and renal involvements and much better prognosis.

Objective To study the characteristics of cognitive development of newborns with auditory event related potentials (aERP).Methods Thirty full-term neonates who were admitted to Changzhou Children's Hospital and met the inclusion criteria, those with neonatal neural behavioral score over 37 and both ears passed the hearing screening, and exclusion criteria, those who suffered from perinatal brain injury, were sclccted randomly.Thcy wcre divided into three groups according to the days of age (group 1 : 1-10 days;group 2:11-20 days;group 3:21-28 days).aERP was recorded with auditory Oddball paradigm.The data were collected and analyzed by Brain Electrical Source Analysis software.Relationship between N2latencies/areas among the three groups and their age was researched with Pearson correlation analysis.Results During the neonatal period, there was a significant negative correlation between N2 latency and neonatal age in days (r=-0.609, P ＜ 0.05), while significant positive correlation was shown between N2 area and the age (r=0.689, P ＜ 0.05).In Fz and Cz leads, the total average waveform diagram of the three groups showed spacious flat, less smoothed curve, and mostly jagged pattern.N2 area in group 1 showed a complex plurality of peaks, and regular, soaring waves, which changed into single wave thereafter, in group 2 and 3.The N2 latencies tended to shorten gradually.Conclusions Neonatal cognitive competence, including concentration and discrimination ability, would be improved with their growth.

Objective To investigate the characteristics of cognitive development in different aged neonates.Methods Sixty-two newborns were randomly selected from relatively normal full-term babies in Changzhou Children's Hospital from December 2013 to September 2015.Electroencephalogram (EEG) and event-related potentials (ERP) were recorded with the auditory Oddball paradigm.Cognitive EEG delta power and the N2 wave area of different ages (1-10,11-20 and 21-28 days) were compared.Paired t test,analysis of variance and the LSD test were used for statistical analysis.Results (1) Delta power in the resting and cognition state:neonatal cognitive delta power in the 11-20 and 21-28 days old groups was (268.22± 132.09) and (236.01±97.40) μ V2,respectively,significantly higher than the resting delta power of the same groups [(175.80 ± 80.80) and (178.78 ± 104.74) μ V2,t=2.539 and 2.845,P=0.020 and 0.010,respectively].(2) Cognitive delta power in different aged neonates:cognitive delta power in the 11-20 and 21-28 days old groups was (268.22± 132.09) and (236.01 ±97.40) μ V2,respectively,higher than that of the 1-10 days old group [(116.70± 56.70) μV2],with statistically significant difference (LSD test,both P＜0.05).(3) Neonatal ERP:ERP of the 1-10 days old group presented with multiple peaks of a flat composite wave,in the 11-20 and 21-28 days old groups,the N2 wave showed a regular and rising trend,gradually to a single wave,and became gradually mature.The N2 wave area in the 11-20 and 21-28 days old groups was (6 435.08±2 212.34) and (6 536.75± 1 969.86) ms · μ V,respectively,which was larger than that in the 1-10 days old group [(4 230.04± 1 550.55) ms · μ V] (LSD test,both P＜0.05).Conclusions Neonatal cognitive development is enhanced with age and there may be a period of more rapid cognitive development,especially at 11-20 days of age.

Objective To explore the value of bone marrow megakaryocyte counts in predicting clinical response of thrombocytopenia (TP) in systemic lupus erythematosus (SLE) patients. Methods Thirty-one patients of SLE with severe TP (platelet ≤50×109/L) from Peking Union Medical College Hospital during 2007 to 2014 with appreciable bone marrow aspiration results were retrospectively analyzed. Their therapeutic responses were stratified and the correlation with clinical and laboratory findings including the megakaryocyte counts in bone marrow were evaluated with logistic multivariate regression. Results Totally fifteen patients obtained complete response (CR), eight patients obtained partial response (PR) and eight no response (NR). Megakaryocyte counts in bone marrow were (101±26)/slide, (156±48)/slide and (34±15)/slide respectively with statistically significant difference (χ2=6.632, P=0.036). Those NR patients had less megakaryocytes in their bone marrow compared with those with clinical response (CR+PR) (Z=-2.438, P=0.015). By ROC curve method, we found 20/slide might be a good cutoff of megakaryocyte counts in bone marrow for determining the therapeutic response of immunotherapy with a sensitivity of 91% and a specificity of 63% and a AUC (area under the curve) of 0.793. Those with 20/slide or less megakaryocytes in bone marrows only had a clinical effective response rate of 29% verse a response rate of 88% in those with more megakaryocytes in bone marrow. Conclusion Megakaryocyte counts in bone marrow may provide predictive value for therapeutic response of severe TP in SLE patients. Those patients with equal or less than 20/slide megakaryocytes in their bone marrow tend to have poor therapeutic response.

Objective To compare the blood high mobility group box-1 (HMGB-l) versus N-terminal prohormone of brain natriuretic peptide (NT-proBNP) for assessment of cardiac dysfunction in the patients with severe sepsis.Methods Ninety-eight patients of both sexes,aged 18-75 yr,were divided into 3 groups according to left ventricular ejection fraction (LVEF):non-cardiac dysfunction group (LVEF ≥ 50 ％,n =43),mild cardiac dysfunction group (30％ ≤ LVEF ＜ 50％,n =41),and severe cardiac dysfunction group (LVEF ＜ 30％,n =14).Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was performed.Venous blood samples were obtained for determination of the concentrations of HMGB-1 and NT-proBNP.Days of hospitalization and the survival rates within 28 days after admission to hospital were recorded.Pearson correlation between blood HMGB-l,NT-proBNP concentrations and LVEF was analyzed.Results Compared with non-cardiac dysfunction group,LVEF was significantly decreased,APACHE Ⅱ score and blood HMGB-1 and NT-proBNP concentrations were increased,days of hospitalization were prolonged,and the survival rates were decreased in mild and severe cardiac dysfunction groups,and the changes in the parameters mentioned above were more obvious in severe cardiac dysfunction group.The correlation coefficient between blood HMGB-1 concentration and LVEF was -0.639 and between blood NT-proBNP concentration and LVEF was-0.521,showing significant difference.Conclusion Blood HMGB-1 concentration provides higher reliability than blood NT-proBNP concentration in assessing the degree of cardiac dysfunction in the patients with severe sepsis.

Objective To investigate the characteristics of cognitive development of newborn's cerebral hemispheres with event related potential (ERP). Methods Forty-five healthy full-term newborns and 11 infants of 29-60 days in the Department of Newborns, Changzhou Children's Hospital between December 2013 and October 2015 were randomly included in this study. They fulfilled all inclusion/exclusion criteria. An auditory oddball paradigm was used with frequently occurring standand tones at 1 000 Hz with 90% probability and infrequent deviant tones at 2 000 Hz with 10% probability. Waveforms were recorded at Fz, Cz, F3, F4, C3 and C4 scalp locations. And a comparative study of area and latency of N2 was done at F3, F4, C3 and C4 scalp locations in the two hemispheres. Results N2 wave of 1-28 days neonatal at C3, C4 scalp locations: area (ms·μV) was 5 193.68±2 137.45 vs 4 324.51±1 334.73, with statistically significant difference (t=2.288, P=0.025);latency (ms) was 764.27±216.60 vs 878.29±294.06, also with statistically significant difference (t=2.185, P=0.031). N2 wave of 1-28 days neonatal at F3,F4 scalp locations: area (ms·μV) was 5 739.44±2 271.03 vs 5 614.87±2 280.83, without statistically significant difference;latency (ms) was 876.20±316.02 vs 860.45±289.04, also without statistically significant difference. N2 wave of 29-60 days infants at F3, F4 scalp locations: area (ms·μV) was 7 681.35±1 723.49 vs 5 993.55±735.63, with statistically significant difference (t=2.848, P=0.011);latency (ms) was 571.60±1.2248 vs 733.40±232.73, without statistically significant difference though F3 was shorter than F4. Conclusions The newborn's auditory perception cognition in the left side of central lobe is superior to the right side. With the growth of the newborn, the left side of the frontal lobe is also superior to that of the right side. Dominant hemisphere has appeared in the neonatal period. Proper stimulation can promote the newborn's cognitive development.

Objective To describe the immunological characteristics of refractory primary biliary cirrhosis compared with the typical patients for more than 1 year's administration of UDCA.Methods Sixty patients treated with UDCA for more than 1 year in our clinic were enrolled into this study.According to the response to UDCA by Paris criteria,patients were divided into refractory group (23 patients) and typical groups (37 patients).The recent peripheral lymphocyte subsets and cytokines of the two groups were tested and analyzed.One-way ANOVA and t test were used for statistical analysis.Results ① One-year treatment after diagnosis,there were no differences between the two groups in the distribution of peripheral lymphocytic subsets,meanwhile,the two groups had higher percentage of B cells,CD4+T cells,CD4+CD28+T cells and CD8+ CD28-T cells than healthy controls respectively.② The serum levels of IL-6 [(0.8±0.9) pg/ml vs (0.3±0.4) pg/ml] and HGF were higher in the refractory group than other groups.Conclusion During the plateau phase,refractory PBC patients have higher serum levels of IL-6 and HGF,which probably suggest that the refractory PBC patients may have severe immunologic disturbance in vivo.

Objective To evaluate the safety and efficacy of anti -CD20 monoclonal antibody (rituximab) in treating refractory connective tissue disease (CTD) patients. Methods Seven inpatients with refractory CTD from Peking Union Medical College Hospital (PUMCH) including four cases of SLE, one for primary SS,one for undifferentiated CTD and one for antiphospholipid syndrome (APS), who had been admitted in recent 3 years (Jan 2005～Feb 2008) were treated with rituximab in combination with corticosteroid and immunosuppressive agents. Responses to treatment as well as outcomes were investigated. Results Six patients were female and one was male with the age ranged from 21 to 58 yr. Disease duration ranged from 3 months to 20 years. Rituximab resulted in significant improvement in clinical manifestations such as lupus nephritis, autoimmune hemolytic anemia and thrombocytopenia. Four patients developed secondary infection including lung infections,herpes and septicemia during B cell depletion, and three patients died of severe lung infections and respiratory failure. Conclusion Our study has shown promising efficacy of rituximab therapy in refractory CTD patients, though it increases the risk of fatal infections, especially when in combination with immunosuppressive agents.