Since Shaw et al,first reported the first case successfully treated by veno-venous bypass (VVB),there has been great controversy on the routine application of VVB during conventional liver transplantation and piggyback liver transplantation in recent decades.With the improvements on the surgical skills,surgical techniques and anesthesiology,only a small portion of patients have the indications for VVB in liver transplantation routinely.This article reviews the current publications in this topic,which may provide new insight into the liver transplantation in clinical practice.

ObjectiveTo analyze of the characteristics of cognitive function in major depressive disorder patients with suicidal ideation using repeatable battery for the assessment of neuropsychological status ( RBANS),and to explore the risk factors of suicidal ideation Methods 132 depressive patients with suicidal ideation and 162 depressive patients without suicidal ideation were evaluated by RBANS,Using SPSS13.0 to statistic the results,including t test,chi-square test and multiple logistic analysis.Results 1.There were no significant differences in age,gender,education level,marital status,total disease duration,whether for the first time episodes of depression,whether a positive family history of depression between the two groups (P ＞ 0.05 ).The HAMD and HAMA total score were greater in patients with suicide ideation than that without suicidal ideation(P ＜ 0.01 ).2.The score of attention was lower in patients with suicide ideation (98.56 ± 17.80) than in patients without suicide ideation (105.06 ± 14.34) (P =0.001 ).The score of delay memory was lower in patients with suicide ideation (80.39 ± 15.36) than in patients without suicide ideation (85.96 ± 12.55) (P=0.001 ).3.Logistic regression analysis showed that attention deficit and HAMD total score were the risk factor of suicide ideation in major depressive patients.ConclusionAttention deficit may exist in major depressive patients with suicide ideation,and attention deficit maybe one of the risk factor of suicide ideation.

ObjectiveTo explore the character of cognitive potential P300 in major depressive disorder ( MDD ) patients between with and without family history and compare the cognitive function between them.MethodsSixty-seven MDD patients with family history and sixty-seven MDD patients without family history were assigned to research group,sixty-seven healthy volunteers were assigned to control group,and ERP P300 detections were conducted in all subjects.Results①To compare with control group ( ( 189.33 ± 51.13 ) ms) and MDD without family history group( ( 193.55 ± 40.01 )ms),the N2 latency was prolonged more significantly in MDD with family history group ( ( 208.40 ± 33.05 ) ms ) (P ＜ 0.05 ).②Compared with control group ( ( 3.38 ± 5.52 ) μV ),the N2 amplitude was decreased more significantly in MDD without ( ( 2.47 ± 1.87 ) μV ) and with family history ( ( 2.36 ± 2.10) μV ),(P ＜ 0.05 ).ConclusionThere is an obvious cognitive function damaged in the MDD patients with and without family history and the MDD patients with family history are more serious.

Objective To investigate the feasibility of modified rapid Carba NP test for the detection of carbapenemase,and analyze the differences between the modified method and Carba NP test.Methods A total of 264 strains of gram-negative bacillus,including 164 carbapenem-resistant strains and 100 sensitive strains,were collected,and their carbapenemase were detected by Carba NP test and the modified rapid Carba NP test,respectively.The differences between the two tests were evaluated based on PCR as a reference.Results Among 164 carbapenem-resistant strains,carbapenemase gene was detected in 144 strains by PCR.The carbapenemase gene was negative in 100 sensitive strains.Among 164 carbapenem-resistant strains,135 were positive for the Carba NP test,while 130 for the modified rapid Carba NP test.One hundred of sensitive strains were negative for the two Carba NP tests.Compared with the results of PCR,the sensitivity,specificity and Kappa value of the Carba NP test were 91.7％ (132/144),97.5％ (117/120) and 0.886,respectively,while those of the modified rapid Carba NP test were 89.6％ (129/144),99.2％ (119/120) and 0.879,respectively.There was no significant difference in the positive rates between Carba NP test and the modified rapid Carba NP test (x2 =1.45,P ＞ 0.05).Conclusion The modified rapid Carba NP test which has high consistency with the PCR method,is faster and cheaper than the Carba NP test,and may be applied to epidemiologic survey and the early monitoring of nosocomial infections.

Objective To evaluate the application value of inhibitor enhanced modified carbapenemase inactivation method (imCIM) in the detection of class B carbapenemase.The differences between imCIM and EDTA disc potentiation test (EDPT) were comparatively analyzed.Methods A total of 181 strains of carbapenem insensitive strains were collected,among which there were 44 strains of Klebsiella pneumoniae,44 strains of Escherichia coli,43 strains of Acinetobacter baumannii and 50 strains of Pseudomonas aeruginosa.The 83 strains of carbapenem-sensitive strains were composed of 25 strains of Klebsiella pneumoniae,16 strains of Escherichia coli,25 strains of Acinetobacter baumannii and 17 strains of Pseudomonas aeruginosa.The class B carbapenemase in the 264 strains of pathogenic bacteria was screened by imCIM and EDPT,and PCR results were used as gold standard.The statistical analysis wasperformed with consistency check,related-sample Wilcoxon signed rank sum test,independent samples Kruskal-Wallis H test and ROC curve.Results Among the 181 strains of carbapenem insensitive strains,PCR results of 144 strains were positive for drug resistance gene.The samples of class A,B and D of carbapenemase were 39,77 and 28 strains respectively.The results of imCIM showed that 70 strains were positive,and the other 111 strains were negative.The imCIM results of 166 strains were consistent with those of PCR.The results of EDPT showed that 72 strains were positive,and the other 109 strains were negative.The EDPT results of 134 strains were consistent with those of PCR.The results of PCR,EDPT and imCIM of 83 carbapenem sensitive strains were negative.The sensitivity and specificity of imCIM were 85.71％ (66/77) and 97.86％ (183/187),and the value of Kappa was 0.859.The sensitivity and specificity of EDPT were 66.23 ％ (51/77) and 88.77 ％ (166/187),and the value of Kappa was 0.561.The difference of inhibition zone of imCIM (AdimCIM) was different from EDPT(AdEDPr) and the difference was statistically significant (Z =-6.941,P ＜ 0.05).In the imCIM detection,the AdimciM level of class B carbapenemase showed different population distribution position from class A and D carbapenemase with the statistically significant difference (x2 =108.887,P ＜ 0.05).The areas under the ROC curve of imCIM and EDPTwere 0.988 (95％CI:0.977 to0.999) and0.936 (95％CI:0.909 to0.963),respectively.Conclusion imCIM should be accurate,efficient and convenient for screening of carbapenem phenotype for its high sensitivity and specificity,and suitable for epidemiological monitoring.

Objective To study the efficacy and complications of total hip arthroplasty (THA) with rivet system for reconstruction of joint capsule and external rotator muscles.Methods Data of 170 patients managed with THA of femoral neck fracture between January 2009 and January 2012 were reviewed retrospectively.Hip fracture was the result of a fall and all were subcapital fractures.The fracture patterns were classified as Garden Ⅳ in 139 patients and Garden Ⅱ in 31 patients according to the degree of displacement.In all,85 patients (37 males and 48 females;age between 61 and 84 years,mean 73 years) underwent joint capsule as well as external rotator muscle reconstruction by rivet system (study group).The remaining 85 patients (36 males and 49 females;age between 64-87 years,mean 74 years) were served as control group.The MOS 36-item short form health survey (SF-36),dislocation rate and complications were evaluated at postoperative follow-up.Results Duration of follow-up was 36 to 60 months (mean,46 months).SF-36 questionnaire scale was (45.95 ±4.27)points in study group and (45.38 ± 4.67) points in control group before operation (P ＞ 0.05),while (83.67 ± 3.93) points in study group and (82.16 ± 3.21) points in control group at postoperative follow-up (P ＜ 0.05).Six patients in control group suffered from early prosthetic dislocation,but none in study control.Perioperative incidence of complications was comparable between the two groups (P ＞0.05).Conclusions Application of rivet system for reconstruction of joint capsule and external rotator muscles in THA of patients with femoral neck fracture can reduce incidence of prosthetic dislocation after operation.The operation is simple and will not increase the rate of perioperative complications.

Objective: To investigate the healthcare expenditures and self-payment among patients with lung cancer in Wenling City before and after implementation of diagnosis-related groups (DRGs), so as to provide the evidence for controlling medical costs and relieving burdens of patients with lung cancer. Methods: The basic data and healthcare expenditures of lung cancer patients that were definitively diagnosed from 2015 to 2019 and covered by medical insurance were captured from the cancer registration database of Wenling Center for Disease Control and Prevention and the database of chronic and specific diseases in Wenling Bureau of Medical Insurance. The changes of outpatient expenditures, inpatient expenditures and self-payments were compared before (2015-2016) and after implementation of DRGs (2018-2019) among lung cancer patients. Results: Totally 4 947 lung cancer patients covered by medical insurance were enrolled in this study, including 3 052 males (61.69%) and 1 895 females (38.31%), with a mean age of (64.88±11.64) years. The annual mean healthcare expenditure was 56 675.85 Yuan per capita during the period between 2015 and 2016, in which 14.48% were outpatient expenditures and 85.52% were inpatient expenditures, and the annual mean healthcare expenditure was 38 702.94 Yuan per capita during the period between 2018 and 2019 (a 31.71% reduction as compared to that in 2015 and 2016), in which 24.49% were outpatient expenditures and 75.51% were inpatient expenditures. The proportions of outpatient expenditures, inpatient expenditures and total self-payments consisted of 25.38%, 32.49% and 29.67% of total healthcare expenditures in 2018 and 2019, which were significantly lower than those (50.84%, 50.96% and 50.95%, respectively) in 2015 and 2016 (χ2=13.741, P<0.001; χ2=7.015, P=0.008; χ2=9.340, P=0.002). Conclusions The annual mean healthcare expenditures per capita and the proportion of self-payment reduce among lung cancer patients covered by medical insurance following implementation of DRGs.

Objective To explore the associations between vitamin D receptor ( VDR) Fok- Ⅰ and Apa- Ⅰ polymorphisms and myasthenia gravis (MG) in Chinese Han population.Methods Polymorphisms of VDR Fok- Ⅰ and Apa-Ⅰ were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.The frequencies of genotypes and hyplotypes were compared among 286 normal controls and 267 MG patients in different subgroups classified by gender,age of onset,presence of thymoma,and Osserman classification sat maximal severity in the follow-up.The association between the genotypes and maximal severity of MG and short-term glucocorticoid treatment were also investigated.Results There were no significant differences in frequencies of genotypes and hyplotypes of both Fok-Ⅰ and Apa-Ⅰ between MG group and control group,and among subgroups of MG.The Fok- Ⅰ showed no statistical difference between the patients with better and less improvement after short-term treatment of glucocorticoid.The frequency of Apa-Ⅰ alleles in the patients with better improvement (55/186,29.6% ) significantly differed from the less improved group ( 7/48,14.6%,OR = 2.46,95% CI 1.04-10.43,x2 = 4.400,P = 0.036).The patients with the genotype A A/Aa were more likely to improve better after the treatment(48/93,51.6%) than in the worse group(7/24,29.2%,OR =2.59,95% CI 0.98-14.60,x2 =3.858,P= 0.049).Conclusions Alleles and genotypes of VDR-Fok- Ⅰ and Apa-Ⅰ were not found to be related with MG onset and severity.MG patients with VDR-Apa-A allele may have better improvement short-term treatment of glucocorticoid.

Pancreatic duct stones are one of the benign pancreatic diseases. It is often combined with chronic pancreatitis. The disease will progress to pancreatic cancer without timely treatment, thus reducing the quality of life of patients and seriously affecting their physical and psychological health. In recent years, with the development of imaging technology, the detection rate of pancreatic duct stones has been increasing year by year. This article reviewed the etiology, diagnosis and treatment strategies for pancreatic duct stones in recent years.

Inherited retinal disease encompasses a range of congenital retinal neurodegenerative conditions,characterized by symptoms such as night blindness,progressive visual field defect,vision loss,and even blindness.The main cause of the disease is gene mutation.Through gene therapy,that is the application of exogenous nucleotides to replace or silence the disease-causing genes in the genetically defective cells,so that the cells can express the correct protein and restore the function of cells.Therefore,it is possible to cure the disease.The immune-privileged status of the eye makes it an ideal organ for gene thera-py.However,successful gene therapy requires delivery systems that can carry therapeutic nucleotides into the cells.This review focuses on the progress and challenges of gene therapy delivery systems for inherited retinal diseases,including viral and non-vi-ral vectors.