Objective To investigate the correlation of the middle cerebral artery stenosis (MCAS) and the mild cognitive function impairment (MCI),and the clinical efficacy of statins in patients with MCI. Methods Six hundred and thirty-six patientse,who received transcranial color doppler ultrasound (TCD)assay, were enrolled in our hospital hospitalization or outpatients. The simple mental state examination (MMSE) and clinical dementia rating scale (CDR) were used as cognitive function assessment indexes. Forty-four cases of MCI with MCAS and 58 cases of MCI with NMCAS were used as the treatment group , who received the atorvastatin 20 mg every day , 56 cases of MCI with NMCAS were used as the control group , who only received the routine and basic diseases treatment. One yearlater,we determined the changes of MMSE and CDRagain. Results We detected 124 patients with MCAS, 512 patients with NMCAS, and 44 cases of MCAS patients with MCI, the prevalence was 35.5%,114 cases of NMCAS in patients with MCI, with the prevalence of 22.3%, the prevalence between the two groups was statistically different. One year later, the patients in the treatment group, MMSE score was improved, the score of MCI of the MCAS group improved more significantly. Conclusion The middle cerebral artery stenosis correlated with the occurrence of MCI. Atorvastatin could improve cognitive function in patients with MCI, especially for MCI which was caused by middle cerebral artery stenosis.

OBJECTIVE: To investigate the mechanism of the pulmonary injury in rats caused by chronic intermittent hypoxia (CIH) and to investigate the intervention effect of Edaravone. METHOD: Ninety-six male Wistar rats were divided into four groups randomly: the control group (NC), chronic intermittent hypoxia group (CIH), chronic intermittent hypoxia normal saline matched group (NS), chronic intermittent hypoxia edaravone treatment group (NE). The four groups were also divided into 1, 2, 3, 4 W time subgroups, and each time subgroup had 6 rats. After the experiment, sections of pulmonary were stained with hematoxylin-eosin (HE) and the level of SOD, MDA, PO2 and Ang II mRNA in rat homogenate pulmonary were measured. RESULT: Pulmonary histology revealed that the CIH group showed high levels of interstitial edema, alveolar atelectasis, inflammatory cell infiltration of alveolar epithelial cell, pulmonary injury were serious in 1, 2, 3, 4 W. But the pulmonary histology of the UC group and the NS group was normal. Compared with the NS group, pulmonary injury of NE group 1, 2, 3, 4 W, significantly decreased. Compared with the NC group, the levels of PO2 in the CIH group were decreased; while the compared with the NS group, the levels of PO2 in the NE group were increased. Compared with the UC group and NS group, the levels of Ang II mRNA in each time point in CIH group were increased gradually (P < 0.05), the content of MDA were increased in 1, 2, 3, 4 W (P < 0.05), they had reached the peak all at 4 W; while the SOD in each time point in CIH group were decreased gradually (P < 0.05) compared with that in UC group and NS group; The Ang II mRNA levels of CIH in pulmonary showed positive correlation with MDA [r = 0.782,P < 0.01]; while the Ang II mRNA levels of CIH in pulmonary showed negative correlation with SOD [r = - 0.904, P < 0.01]. CONCLUSION CIH can cause pulmonary injury through oxidative stress and activating Ang II, and Edaravone could prevent pulmonary injury induced by CIH through scavenging oxygen free radicals.
Angiotensin II ; metabolism ; Animals ; Antipyrine ; analogs & derivatives ; pharmacology ; Edaravone ; Free Radical Scavengers ; metabolism ; Hypoxia ; physiopathology ; Lung ; pathology ; Lung Injury ; physiopathology ; Male ; Malondialdehyde ; metabolism ; Oxidative Stress ; Rats ; Rats, Wistar ; Superoxide Dismutase ; metabolism

OBJECTIVETo evaluate the hemodynamic changes in the central branches of the middle cerebral artery in different stages of neonatal hypoxic-ischemic encephalopathy (HIE) and provide new evidence for clinical diagnosis of HIE.

METHODSFrom March, 2013 to July, 2013, a total of 136 newborn infants were diagnosed to have HIE in our center. We performed two-dimensional ultrasonography and color Doppler ultrasound for assessments of systolic velocity (Vs) and resistant index (RI) of the central branches of the middle cerebral artery. The data were compared with the results of a control group consisting of 251 normal full-term infants.

RESULTSInfants with mild HIE showed hyperechoic changes in the white matter around the ventricle, while in moderate and severe HIE, such hyperechoic changes were diffuse in both hemispheres with unclear echoes of the brain structures. Pulse Doppler assessments of hemodynamics of the central branches of the middle cerebral artery demonstrated a significant decrease in Vs and an increase in RI regardless of HIE severity (P<0.05). In addition, Vs and RI values in mild HIE infants differed significantly (P<0.05) from those in infants with moderate and severe HIE, who had comparable Vs and RI values (P>0.05).

CONCLUSIONTranscranial ultrasonography may provide dynamic information on cerebral blood flow in neonates and hemodynamic parameters of the central branches of the middle cerebral artery are valuable for clinical diagnosis and early intervention of HIE.

Brain ; blood supply ; Cerebrovascular Circulation ; Hemodynamics ; Humans ; Hypoxia-Ischemia, Brain ; diagnostic imaging ; Infant ; Infant, Newborn ; Middle Cerebral Artery ; diagnostic imaging ; Ultrasonography

Objective:To study the hepatic hemodynamics changes and pathophysiological mechanisms of the use of a functional shunt after auxillary liver transplantation to treat portal hypertension associated with a small-for-size graft.Methods:A retrospective analysis of the clinical data of patients with portal hypertension treated with functional shunting of small-volume grafts from a living donor liver at the Beijing Friendship Hospital, Capital Medical University from July 2014 to December 2018, and a total of 6 patients were included as the research objects, including 4 males and 2 females, with a median age of 35.5 (29.0-52.0) years old. Blood flow monitoring data were collected during and after operation, and the characteristics of liver hemodynamics were analyzed.Results:The portal venous blood flow of the remnant native liver gradually decreased to no flow. As a buffer response, the flow velocity of hepatic artery increased. The portal venous blood flow of the graft gradually increased in the early postoperative period and then gradually decreased from post-operation Day 5 to 10 due to gradual increase in portal venous resistance. However, the portal venous perfusion gradually increased from Day 10 after the operation, reached to a level and declined to a stable level about 1 month after the operation. The volume of abdominal drainage slowly decreased after the peak level at Day 5-10 after the operation, and disappeared completely at Day 30 after operation.Conclusions:When using auxiliary liver transplantation for functional shunting to treat portal hypertension, autologous residual liver can act as a guide buffer for the pressure gradient of portal vein hyperperfusion in liver transplantation, and reach a steady state of blood flow distribution about 1 month after surgery, while relying on autologous remnant liver hepatic artery buffer response prevents small liver syndrome.

Objective To Analyze the clinical outcomes of pediatric liver transplantation (LT) for liver-based metabolic disorders.Methods We conducted a retrospective analysis on 42 pediatric patients with liver-based metabolic disorders from June 2013 to March 2017,and analyzed the pediatric end stage liver disease model (PELD),growth and development,type of transplant,postoperative complications and prognosis of patients.Results There were 42 children with liver-based metabolic disorders (15.56%) out of all the 270 children who underwent LT.The median age was 51.0 months (range,3.4-160.9 months).Of the 42 children,19 received living donor liver transplantation (LDLT),18 cases received deceased donor liver transplantation (DDLT) and 5 cases received domino liver transplantation.1-,2-and 3-year cumulative survival rate of 42 recipients was 97.7%,93.6% and 93.6%,and that of the grafts was 95.3%,91.4% and 91.4%,respectively.As compared with the 194 children with biliary atresia who underwent LT,significant difference was found in PELD and weight Z-score between the two groups.Conclusion Liver transplantation is a valuable option for children with metabolic disorders,and it has gained a better prognosis.

OBJECTIVETo summarize the ultrasonography features of neonate corpus callosum agenesis for better diagnosis of this condition.

METHODSA total of 8563 neonates were screened by cerebral ultrasound in neonate care unit of our hospital from June 2010 to December 2012, and 37 cases of agenesis of the corpus callosum were identified. The diagnostic accuracy of ultrasonography and magnetic resonance imaging (MRI) for this condition was evaluated.

RESULTSThe sensitivity, specificity, and accuracy of ultrasound diagnosis for complete and incomplete absence of neonate corpus callosum were 100% and 90%, 90.9% and 94.1%, 94.6% and 91.9% in the 37 cases, respectively. The Kappa value of ultrasonography and MRI were 0.890 and 0.837, with a consistent rate of 91%.

CONCLUSIONUltrasonography and MRI show a high consistency in the diagnosis of neonatal agenesis of the corpus callosum.

Agenesis of Corpus Callosum ; diagnosis ; diagnostic imaging ; Female ; Humans ; Infant, Newborn ; Magnetic Resonance Imaging ; Retrospective Studies ; Ultrasonography, Doppler, Transcranial

Objective:To review our experience in the use of "Full right-Full left" split liver transplantation in adult-to adult or adult-to adult-size child.Methods:The clinical data of liver donors to 4 recipients of full right-full left split liver transplantation performed at Beijing Friendship Hospital of Capital Medical University from January to December 2019 were reviewed. The surgical methods of split liver transplantation, cold ischemia time, operation time, intraoperative blood transfusion, and postoperative complications and prognosis were analyzed.Results:The 4 recipients of complete right hepatic-left hepatic split liver transplantation included 3 adults and 1 heavy child (45 kg). Their ages ranged from 14 to 48 years, and body weight ranged from 45 to 61 kg. The end-stage liver disease model score were 21, 12, 41, and 30 points. The ratios of graft mass to recipient's body mass ranged from 0.85% to 1.35%. The cold ischemia time was 457-650 min, and the operation time was 460-575 min. Early liver function recovered smoothly in all the 4 patients after transplantation, and no small liver syndrome occurred. Patients were followed up to 6 months after operation. One patient developed anastomotic biliary leak, which was cured by endoscopic retrograde cholangiopancreatographic treatment. Another patient developed biliary stricture presenting with repeated biliary tract infection despite percutaneous transhepatic puncture biliary drainage. A third patient died six months from lung infection.Conclusion:In properly selected patients, using full right-full left hemiliver by split liver transplantation increased organ utilization and provided patients with increased treatment opportunities.

Objective To analyze the clinical characteristics, pathogenic causes and therapeutic experience of right diaphragmatic hernia after pediatric living donor liver transplantation. Methods Clinical data of 3 recipients with right diaphragmatic hernia after pediatric living donor liver transplantation were retrospectively analyzed. The clinical characteristics, diagnosis and treatment process and therapeutic experience were analyzed and summarized. Results The primary diseases of 3 children with diaphragmatic hernia after living donor liver transplantation were biliary atresia. The diaphragmatic hernia occurred at 4-6 months after liver transplantation. The contents of diaphragmatic hernia included the intraperitoneal and interperitoneal tissues and organs. Diaphragmatic defects were all located in the posterior medial area of the right diaphragm. The primary stage intermittently suturing repair was performed during intraoperative period. No diaphragmatic hernia recurred during long-term follow-up. Conclusions The clinical manifestations of right diaphragmatic hernia after pediatric living donor liver transplantation are diverse. The risk factors include malnutrition, low body weight, surgical trauma, chemical erosion caused by bile leakage, focal infection and pleural-peritoneal pressure gradient, etc. Surgical intervention is the preferred treatment strategy for diaphragmatic hernia after liver transplantation.

Objective To investigate the feasibility and technique of using the anterolateral thigh perforator flap pedicled with the lateral branch of the lateral circumflex femoral artery (LBLCFA) to repair soft tissue defect of extremities.Methods Eighty-six cases of anterolateral thigh perforator flap transplantation were performed from May,2014 to May,2018.A total of 37 cases of soft tissue defect of extremities were treated by anterolateral thigh perforator flap used the LBLCFA as vascular pedicle,of which there were 19 cases of upper limbs and 18 of lower limbs.There were 27 cases of defects caused by trauma,and 10 by soft tissue tumor resection.The flaps were designed centering around the point proximal to the midpoint of the iliac-patellar line.The dimensions of soft tissue defect were from 9.0 cm×6.0 cm to 26.0 cm×10.0 cm,and the flap were from 10.0 cm×7.0 cm to 27.0 cm×11.0 cm.The length of vascular pedicle ranged of 7.0-13.0 cm,with an average of 11.5 cm.The donor sites were directly sutured.All of the patients were followed-up regularly in the outpatient department.Results All the flaps survived and the donor sites were primarily healed.Of these 37 cases,2 trauma patients and 2 patients treated with local radiotherapy had poor wound healing,but still healed after multiple dressing changes.All the patients were followed-up for 3-26 months,with an average of 13 months.The texture,color and elasticity of the flap were similar to the surrounding tissue of the recipient sites,while only a linear scar remained at the donor sites.Ten tumor patients were treated with routine radiotherapy and chemotherapy after the repairation;there was no tumor recurrence during the follow-up period.Conclusion The LBLCFA gives off a relatively large and thick perforator proximal 5.0-7.0 cm of the iliacpatellar line,which locates in the upper lateral side,travels parallel to the vastus lateralis,and give off the skin and muscular perforators.The lateral branch can be used as pedicle to make into perforator flap or chimeric flap,which provides a novel selection of vascular pedicel for anterolateral thigh perforator flap.When the descending branch does not provide a thick and large perforator,the LBLCFA has important practical value and is worth utilizing in the clinic.

Objective To evaluate the effect of donor-derived infection on the clinical prognosis of the recipients undergoing liver transplantation. Methods Clinical data of 75 donors and recipients undergoing liver transplantation were retrospectively analyzed. According to the culture results of donor organ lavage fluid, all recipients were divided into the positive group (n=26) and negative group (n=49). Clinical parameters of the recipients during perioperative period were observed in the positive and negative groups. The sputum and peritoneal drainage fluid of the recipients undergoing liver transplantation were cultured. The incidence of postoperative infection of the recipients was observed. The 1.5-year survival curve of the recipients was analyzed by Kaplan-Meier method. Results In the positive group, the incidence of portal vein stenosis and thrombosis was significantly higher than that in the negative group (P < 0.05). Among 75 recipients undergoing liver transplantation, 33 cases (44%) developed postoperative infection mainly in the lung and abdominal cavity. The infection rate significantly differed between the positive group (77%) and negative group (27%, P < 0.05). In the positive group, sputum culture was positive in 10 recipients and peritoneal drainage culture was positive in 11 recipients. The sputum culture outcomes of 4 recipients were consistent with those of the organ lavage fluid culture of their donors. The peritoneal drainage culture results of 6 recipients were consistent with those of the organ lavage fluid culture of their donors. After anti-infection treatment, 2 recipients in the positive group died at postoperative 5 and 12 d, and the culture results of the remaining recipients were negative. In the negative group, 7 recipients were positive for sputum culture and 6 recipients were positive for peritoneal drainage culture. The culture results of all recipients were negative following anti-infection therapy. Two recipients died from graft failure at postoperative 1 month and 1 year. The 1.5-year survival rate did not significantly differ between the positive and negative groups (P > 0.05). Conclusions The effect of donor-derived infection on the early prognosis of liver transplant recipients cannot be neglected, whereas it exerts mild impact on the intermediate- and long-term clinical prognosis of the recipients.