Objective:To explore the feasibility of technological modification and innovation of full-left/full-right liver splitting in situ for donors and examine the safety of clinical application for liver transplantation (LT).Methods:From March 2021 to June 2022, clinical and surgical data are retrospectively reviewed for 27 donors undergoing full-left/full-right liver splitting in situ and the corresponding 49 recipients undergoing full-left/full-right LT.According to the split liver technique used in donor liver surgery, they are divided into conventional split group(group A, 13 cases)and innovative split group(group B, 14 cases). The corresponding recipients are divided into two groups of recipient C(25 cases)and recipient D(24 cases). General profiles, intraoperative findings, type of vascular allocation and short-term outcomes in two groups are compared.After full-size split liver transplantation(fSLT), follow-ups continued until the end of September 2022.Results:There are 23 males and 4 females in donors.The causes of mortality for donors are traumatic head injury(12 cases)cerebrovascular accident(13 cases)and anoxia encephalopathy(2 cases). Baseline characteristics of two groups indicate that body weight and body mass index(BMI)are higher in group B and blood sodium level is lower than that in group A( P<0.05). No statistical differences exist for the others.Liver splitting time is significantly shorter in group B than that in group A(175 vs.230 min, P=0.022). No significant inter-group difference exists in type of vascular allocation.Retrohepatic inferior vena cava(IVC)is split in one case in group A and 10 cases in group B( P=0.001). Among 20 cases of right hemiliver requiring a reconstruction of segment Ⅴ/Ⅷ venous outflow, 12 cases in group A and 3 cases in group B are reconstructed with conventional independent bridging method(independent type)while another 5 cases in group B reconstruct with innovated technique by bridging Ⅴ/Ⅷ vein for splitting IVC with iliac vessel and molding all outflows as one for anastomosis(combined typ e). There is significant inter-group difference( P=0.004). No significant differences exist in operative duration, anhepatic phase or blood loss between groups C and B, except for T tube retaining in 7 cases of group A and 14 cases of group D( P=0.032). Twelve cases developed a total of 26 instances of≥Clavien-Dindo grade Ⅲ complications.Of which, 7 cases in group C and 5 cases in group D show no significant difference in postoperative morbidity.However, for serious biliary complications(≥Clavien Dindo grade Ⅲ), there are 6 cases in group C versus none in group D( P=0.016). Two cases died from postoperative complication with a postoperative mortality rate of 4.1%.Postoperative hospital stay is similar in two groups.And accumulates 6/12-month survivals were 95.9% and 87.7% for grafts and 95.9% and 92.4% for recipients respectively. Conclusions:Operative duration of full-left/full-right liver splitting in situ tends to shorten with an accumulation of a certain amount of cases.Technological modification and innovation in IVC splitting and segment Ⅴ/Ⅷ vein reconstruction should be further validated as both feasible and safe by short-term outcomes of the corresponding recipients.

Objective To investigate the association between milk fat globule-epidermal growth factor 8(MFG-E8)and Alzheimer disease(AD).Methods The Alzheimer's Disease Neuroimaging Initiative database was used,and a multiple linear regression analysis was used to investigate the association of MFG-E8 with the pathological markers of AD and brain structure and perform subgroup analyses.The mixed-effects model was used to investigate the longitudinal changes in MFG-E8 with AD pathological markers and brain structure,and a mediation analysis was used to investigate the potential association of MFG-E8 with AD pathology and brain structure.Results A total of 377 individuals were en-rolled in the study.The level of MFG-E8 was positively correlated with the concentrations of amyloid β-protein 42(Aβ42),tau protein,and phosphorylated tau protein in cerebrospinal fluid,and subgroup analyses showed that the correlation of MFG-E8 with the concentrations of AD pathological markers and lateral ventricular volume in male individuals,the elderly popula-tion,and the individuals carrying the APOE4 gene was consistent with that in the overall population.Longitudinal studies showed that during follow-up,the increase in MFG-E8 level was significantly associated with enlarged lateral ventricle volume.In addition,MFG-E8 could alter lateral ventricle volume by affecting the level of Aβ42.Conclusion MFG-E8 is associated with AD and may influence lateral ventricular volume through AD pathological markers.