Split liver transplantation(SLT)has become an indispensable method for expanding the donor liver pool.However,advanced age in recipients can have significant adverse effects on prognosis.We report the case of an 82-year-old man with chronic liver failure and polycystic liver disease who underwent in vivo split right triple lobe donor liver transplantation on October 29,2021.The patient made a remarkable recovery and was discharged 1 month after surgery.To date,he has been followed up for 32 months,with favorable laboratory and imaging test results,and no significant abnormalities or complications.Currently,this patient may be the oldest SLT recipient in the world.With comprehensive preoperative evaluation,optimized surgical techniques,and individually tailored postoperative care,older adults can safely undergo SLT.Therefore,advanced age should not be considered an absolute contraindication for this procedure.

Objective To investigate the clinical efficacy of Yiqi Huoxue Prescription(derived from Shengyu Decoction)in the treatment of mild cervical spondylotic myelopathy(CSM)with qi deficiency and blood stasis type.Methods A total of 128 patients with mild CSM of qi deficiency and blood stasis type who admitted to Guangdong Provincial Hospital of Chinese Medicine from January 2022 to January 2024 were randomly divided into the control group and the trial group according to the random number table method,with 64 cases in each group.The control group was treated with oral administration of Mecobalamin Tablets,and the trial group was treated with Yiqi Huoxue Prescription orally on the basis of treatment for the control group.The two groups were all treated for four weeks,and then were followed up for three months after the completion of treatment.The CSM scores of the Japanese Orthopedic Association(JOA)and the traditional Chinese medicine(TCM)syndrome scores in the two groups were observed before treatment,after two weeks of treatment,after four weeks of treatment,and three months after the completion of treatment.And then the clinical efficacy,progression of CSM and the incidence of adverse reactions of the two groups were evaluated.Results(1)During the trial,two cases in the control group and three cases in the trial group fell off,and eventually a total of 123 cases were included,62 cases in the control group and 61 cases in the trial group.(2)Three months after the completion of treatment,the total effective rate of the trial group was 93.44%(57/61)and that of the control group was 82.26%(51/62),and the intergroup comparison(tested by chi-square test)showed that the efficacy of the trial group was significantly superior to that of the control group,the difference being statistically significant(P<0.05).(3)After two and four weeks of treatment as well as three months after the completion of treatment,JOA scores in the two groups were increased compared with those before treatment(P<0.05),and JOA scores of the trial group at various time points mentioned above were higher than those of the control group,the difference being statistically significant(P<0.05).(4)After two and four weeks of treatment as well as three months after the completion of treatment,TCM syndrome scores in the two groups were decreased compared with those before treatment(P<0.05),and TCM syndrome scores of the trial group at various time points mentioned above were lower than those of the control group,the difference being statistically significant(P<0.05).(5)During the follow-up period,there was none case of significant aggravation or progression to moderate-severe illness in the two groups,and there were no adverse events such as allergies and gastrointestinal reactions.Conclusion Yiqi Huoxue Prescription exerts certain efficacy in treating patients with mild CSM of the qi deficiency and blood stasis type,and the treatment method is effective on improving the spinal cord function and symptoms of qi deficiency and blood stasis type,and slowing down the progression of disease in the patients,with high safety.

Objective:To construct a debriefing and reflection training program for nursing undergraduate interns, and to provide a basis for implementing such a program and improve the practical clinical skills of the interns.Methods:Based on competency theory, the draft of the debriefing and reflection training program for undergraduate nursing interns was constructed through literature review and expert conference discussion. Delphi expert consultation was conducted from August to October 2024, and the final version of the program was established based on the experts' opinions. The weight of each indicator was determined using the analytic hierarchy process. Excel 2019 was used for data entry, and SPSS 19.0 was used for data analysis.Results:Two rounds of expert consultation were conducted, with a questionnaire recovery rate of 100.00% for both. The experts consulted in the second round had an authority coefficient of 0.861, a coefficient of variation for each index of 0.048 to 0.237, and a Kendall's concordance coefficient of 0.137 ( P<0.05). The final program included 5 primary indicators, 16 secondary indicators, and 73 tertiary indicators. Conclusions:The debriefing and reflection training program for undergraduate nursing interns proposed in this study has high scientifical validity and reliability. It can provide a reference for debriefing and reflection training of nursing undergraduate interns in China, thereby cultivating qualified clinical nursing talents.

Objective:To construct a debriefing and reflection training program for nursing undergraduate interns, and to provide a basis for implementing such a program and improve the practical clinical skills of the interns.Methods:Based on competency theory, the draft of the debriefing and reflection training program for undergraduate nursing interns was constructed through literature review and expert conference discussion. Delphi expert consultation was conducted from August to October 2024, and the final version of the program was established based on the experts' opinions. The weight of each indicator was determined using the analytic hierarchy process. Excel 2019 was used for data entry, and SPSS 19.0 was used for data analysis.Results:Two rounds of expert consultation were conducted, with a questionnaire recovery rate of 100.00% for both. The experts consulted in the second round had an authority coefficient of 0.861, a coefficient of variation for each index of 0.048 to 0.237, and a Kendall's concordance coefficient of 0.137 ( P<0.05). The final program included 5 primary indicators, 16 secondary indicators, and 73 tertiary indicators. Conclusions:The debriefing and reflection training program for undergraduate nursing interns proposed in this study has high scientifical validity and reliability. It can provide a reference for debriefing and reflection training of nursing undergraduate interns in China, thereby cultivating qualified clinical nursing talents.

OBJECTIVE To study the inhibitory effect of ethyl acetate extract from Mimosa pudica root （ethyl acetate extract for short） on acute myeloid leukemia in mice. METHODS Different concentrations of ethyl acetate extract （0.062 5， 0.125， 0.25， 0.5 mg/mL） were used to treat acute myelomonocytic leukemia cell lines WEHI-3， and their effects on cell viability were investigated. Fifty BALB/C mice were randomly divided into blank control group， model group， positive control group （5- fluorouracil， 13 mg/kg）， and ethyl acetate extract low-dose and high-dose groups （50， 200 mg/kg）， with 10 mice in each group. Except for the blank control group， the leukemia model was constructed by intraperitoneal injection of WEHI-3 cells in other groups， and from the second day of modeling， corresponding drugs/water were orally administered once a day for 14 consecutive days. After the last administration， the liver and spleen indexes of mice were measured， and liver tissue pathological morphology observation， hematological analysis， and white blood cell differentiation detection were performed； the levels of cytokine [interleukin-2 （IL-2）， IL-3， interferon-γ （IFN-γ）， tumor necrosis factor-α （TNF-α）] in serum were determined； the levels of leukocyte surface markers [cluster of differentiation 3 （CD3）， CD19， CD11b， CD107b （Mac-3）] in whole blood were all detected. RESULTS After treated with 0.062 5-0.5 mg/mL ethyl acetate， the inhibition rate of cell proliferation were increased significantly （P＜0.05）. After intervention with high-dose ethyl acetate， the liver and spleen index， serum level of TNF-α， the levels of CD11b and Mac-3 in blood were significantly reduced （P＜0.05）， while serum levels of IL-2， IL-3 and IFN-γ， and the levels of CD3 and CD19 in blood were increased significantly （P＜0.05）. Occasional lymphocyte infiltration was present in the liver parenchyma， with almost no infiltration of inflammatory cells； hematology improvement and weakened white blood cell differentiation were found. CONCLUSIONS The ethyl acetate extract of M. pudica root can inhibit the proliferation of WEHI-cells， and improve symptoms in acute myeloid leukemia mice， the mechanism of which may be associated with enhancing the immune function.

OBJECTIVE To study the inhibitory effect of ethyl acetate extract from Mimosa pudica root （ethyl acetate extract for short） on acute myeloid leukemia in mice. METHODS Different concentrations of ethyl acetate extract （0.062 5， 0.125， 0.25， 0.5 mg/mL） were used to treat acute myelomonocytic leukemia cell lines WEHI-3， and their effects on cell viability were investigated. Fifty BALB/C mice were randomly divided into blank control group， model group， positive control group （5- fluorouracil， 13 mg/kg）， and ethyl acetate extract low-dose and high-dose groups （50， 200 mg/kg）， with 10 mice in each group. Except for the blank control group， the leukemia model was constructed by intraperitoneal injection of WEHI-3 cells in other groups， and from the second day of modeling， corresponding drugs/water were orally administered once a day for 14 consecutive days. After the last administration， the liver and spleen indexes of mice were measured， and liver tissue pathological morphology observation， hematological analysis， and white blood cell differentiation detection were performed； the levels of cytokine [interleukin-2 （IL-2）， IL-3， interferon-γ （IFN-γ）， tumor necrosis factor-α （TNF-α）] in serum were determined； the levels of leukocyte surface markers [cluster of differentiation 3 （CD3）， CD19， CD11b， CD107b （Mac-3）] in whole blood were all detected. RESULTS After treated with 0.062 5-0.5 mg/mL ethyl acetate， the inhibition rate of cell proliferation were increased significantly （P＜0.05）. After intervention with high-dose ethyl acetate， the liver and spleen index， serum level of TNF-α， the levels of CD11b and Mac-3 in blood were significantly reduced （P＜0.05）， while serum levels of IL-2， IL-3 and IFN-γ， and the levels of CD3 and CD19 in blood were increased significantly （P＜0.05）. Occasional lymphocyte infiltration was present in the liver parenchyma， with almost no infiltration of inflammatory cells； hematology improvement and weakened white blood cell differentiation were found. CONCLUSIONS The ethyl acetate extract of M. pudica root can inhibit the proliferation of WEHI-cells， and improve symptoms in acute myeloid leukemia mice， the mechanism of which may be associated with enhancing the immune function.

Severe community-acquired pneumonia(SCAP) is one of the leading causes of death in children.Early identification of risk factors in children with SCAP,accurate assessment of disease conditions and reduction of mortality in children with SCAP are important tasks at present.The death risk factors of SCAP in children are affected by many factors,which are different among countries,regions and families.At present,the relevant prospective studies and retrospective studies are not comprehensive.This review summarized the literatures on the risk factors of SCAP death in children at home and abroad in recent years,to provide the basis for the diagnosis of childhood SCAP.

Objective:To investigate the safety and therapeutic effect of split liver transplantation (SLT) in clinical application.Methods:This is a retrospective case-series study. The clinical data of 203 consecutive SLT, 79 living donor liver transplantation (LDLT) and 1 298 whole liver transplantation (WLT) performed at the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to July 2023 were retrospectively analyzed. Two hundred and three SLT liver grafts were obtained from 109 donors. One hundred and twenty-seven grafts were generated by in vitro splitting and 76 grafts were generated by in vivo splitting. There were 90 adult recipients and 113 pediatric recipients. According to time, SLT patients were divided into two groups: the early SLT group (40 cases, from July 2014 to December 2017) and the mature SLT technology group (163 cases, from January 2018 to July 2023). The survival of each group was analyzed and the main factors affecting the survival rate of SLT were analyzed. The Kaplan-Meier method and Log-rank test were used for survival analysis.Results:The cumulative survival rates at 1-, 3-, and 5-year were 74.58%, 71.47%, and 71.47% in the early SLT group, and 88.03%, 87.23%, and 87.23% in the mature SLT group, respectively. Survival rates in the mature SLT group were significantly higher than those in the early SLT group ( χ2=5.560, P=0.018). The cumulative survival rates at 1-, 3- and 5-year were 93.41%, 93.41%, 89.95% in the LDLT group and 87.38%, 81.98%, 77.04% in the WLT group, respectively. There was no significant difference among the mature SLT group, the LDLT group and the WLT group ( χ2=4.016, P=0.134). Abdominal hemorrhage, infection, primary liver graft nonfunction,and portal vein thrombosis were the main causes of early postoperative death. Conclusion:SLT can achieve results comparable to those of WLT and LDLT in mature technology liver transplant centers, but it needs to go through a certain time learning curve.

Objective To investigate the diagnosis and treatment strategy of the portal vein complications in children undergoing split liver transplantation. Methods The clinical data of 88 pediatric recipients who underwent split liver transplantation were retrospectively analyzed. Intraoperative anastomosis at the bifurcating site of the portal vein or donor iliac vein bypass anastomosis was performed depending on the internal diameter and development of the recipient's portal vein. A normalized portal venous blood stream monitoring was performed during the perioperative stage. After operation, heparin sodium was used to bridge warfarin for anticoagulation therapy. After portal vein stenosis or thrombosis was identified with enhanced CT or portography, managements including embolectomy, systemic anticoagulation, interventional thrombus removal, balloon dilatation and/or stenting were performed. Results Among the 88 recipients, a total of 10 children were diagnosed with portal vein complications, of which 4 cases were diagnosed with portal vein stenosis at 1 d, 2 months, 8 months, and 11 months after surgery, and 6 cases were diagnosed with portal vein thrombosis at intraoperative, 2 d, 3 d (n=2), 6 d, and 11 months after surgery, respectively. One patient with portal vein stenosis and one patient with portal vein thrombosis died perioperatively. The fatality related to portal vein complications was 2% (2/88). Of the remaining 8 patients, 1 underwent systemic anticoagulation, 2 underwent portal venous embolectomy, 1 underwent interventional balloon dilatation, and 4 underwent interventional balloon dilatation plus stenting. No portal venous related symptoms were detected during postoperative long term follow up, and the retested portal venous blood stream parameters were normal. Conclusions The normalized intra- and post-operative portal venous blood stream monitoring is a useful tool for the early detection of portal vein complications, the early utilization of useful managements such as intraoperative portal venous embolectomy, interventional balloon dilatation and stenting may effectively treat the portal vein complications, thus minimizing the portal vein complication related graft loss and recipient death.

Objective:To investigate the safety and therapeutic effect of split liver transplantation (SLT) in clinical application.Methods:This is a retrospective case-series study. The clinical data of 203 consecutive SLT, 79 living donor liver transplantation (LDLT) and 1 298 whole liver transplantation (WLT) performed at the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to July 2023 were retrospectively analyzed. Two hundred and three SLT liver grafts were obtained from 109 donors. One hundred and twenty-seven grafts were generated by in vitro splitting and 76 grafts were generated by in vivo splitting. There were 90 adult recipients and 113 pediatric recipients. According to time, SLT patients were divided into two groups: the early SLT group (40 cases, from July 2014 to December 2017) and the mature SLT technology group (163 cases, from January 2018 to July 2023). The survival of each group was analyzed and the main factors affecting the survival rate of SLT were analyzed. The Kaplan-Meier method and Log-rank test were used for survival analysis.Results:The cumulative survival rates at 1-, 3-, and 5-year were 74.58%, 71.47%, and 71.47% in the early SLT group, and 88.03%, 87.23%, and 87.23% in the mature SLT group, respectively. Survival rates in the mature SLT group were significantly higher than those in the early SLT group ( χ2=5.560, P=0.018). The cumulative survival rates at 1-, 3- and 5-year were 93.41%, 93.41%, 89.95% in the LDLT group and 87.38%, 81.98%, 77.04% in the WLT group, respectively. There was no significant difference among the mature SLT group, the LDLT group and the WLT group ( χ2=4.016, P=0.134). Abdominal hemorrhage, infection, primary liver graft nonfunction,and portal vein thrombosis were the main causes of early postoperative death. Conclusion:SLT can achieve results comparable to those of WLT and LDLT in mature technology liver transplant centers, but it needs to go through a certain time learning curve.