Background/Aims: Liver transplantation (LT) following total hepatectomy is a life-saving treatment for hepatocellular carcinoma (HCC). The HCC recurrence after LT hinders the effectiveness of the procedure. The objective of this study is to develop a pre-operative risk stratification model based on a liquid biopsy. Methods: We conducted a comprehensive multi-omics study of 260 HCC patients from three centers, including clinical data, low-coverage whole-genome sequencing of cell-free DNA (cfDNA) from plasma, as well as whole-exome, single-nucleus RNA, and spatial transcriptomics from matched tumor and non-tumor tissues. Results: We identified cfDNA-derived copy number alteration (CNA) signatures associated with post-transplant recurrence. By integrating cfDNA-derived CNA profiles with single-cell transcriptomic data, we traced recurrence-associated cfDNA to a distinct subpopulation of malignant cells within the primary tumor. These cells were embedded in a pro-metastatic microenvironment of specialized endothelial subtypes and cancer-associated fibroblasts. Notably, most recurrence-associated lesions were detectable in cfDNA prior to liver transplantation (LT). Building on these insights, we developed the ZJU Criteria based on CNA fragments and tumor markers, a pre-LT risk prediction tool that integrates conventional clinical factors with cfDNA-derived CNA signatures, and validated it using internal and independent external cohorts. Conclusion Our findings suggest that post-transplant recurrence commonly originates from advanced subclones that emerge late during tumor evolution. The ZJU Criteria provides an accurate, non-invasive strategy that significantly improves pre-LT risk stratification and clinical decision-making for patients with HCC.

Objective:To explore the relative factors for best ovarian response in patients undergoing assisted reproductive technology with follicular phase long-acting long protocol, and to establish a Nomogram prediction model of ovarian response.Methods:This retrospective cohort study analyzed the clinical data of 1289 patients who received assisted reproductive treatment in the Center for Reproductive Medicine of Fujian Maternity and Child Health Hospital from July 1, 2018 to July 30, 2019. According to the number of oocytes retrieved, there were 164 cases in the low ovarian response group (≤5 oocytes retrieved), 891 cases in the normal ovarian response group (the number of retrieved oocytes was >5, and ≤18), and 234 cases in the high ovarian response group (>18 oocytes retrieved). Independent factors affecting ovarian reactivity were screened by logistic regression, which were the model entry variables, and a Nomogram prediction model was established based on the regression coefficients in the model.Results:There were statistically significant differences in age, anti-Müllerian hormone (AMH) level and antral follicle count (AFC) among the three groups [32.43±3.99, 31.48±3.89, 29.91±3.73; (2.53±1.90) μg/L, (3.79±2.20) μg/L, (5.94±3.12) μg/L; 10.24±3.10, 14.50±3.29, 19.81±3.44; all P<0.001]. There were no significant differences in body mass index (BMI), duration of infertility and causes of tubal infertility (all P>0.05). The initial dosage of gonadotropin (Gn) used for ovarian hyperstimulation among the three groups was statistically different [(182.62±53.96) U, (166.79±48.20) U, (159.13±43.92) U, P<0.001], while the duration of Gn used and clinical pregnancy rate had no significant differences (all P>0.05). Multifactorial stepwise aggression analysis showed that female age [0.93(0.90-0.96), P=0.007], AFC [1.07(1.03-1.09), P=0.001], AMH [1.29(1.20-1.39), P=0.001], basal follicle-stimulating hormone [0.79(0.73-0.86), P=0.001], luteinizing hormone value [1.11(1.06-1.23), P=0.010], initial dosage of Gn used [1.00(1.00-1.01), P=0.003], total dosage of Gn usd [1.00(0.99-1.00), P=0.001] and the presence or absence of diagnosis of endometriosis [0.63(0.47-0.86), P=0.001] and polycystic ovary syndrome [0.30(0.22-0.91), P=0.030] were independent factors for the occurrence of different ovarian responses during ovarian hyperstimulation. The prediction model of ovarian reactivity was constructed based on the above factors, and the accuracy of predicting the optimal ovarian response state was 95%. The above model was verified with 306 patients' data from August 1, 2019 to October 30, 2019 in this center, and the predicted ovarian response (number of oocytes obtained) of a total of 279 patients was consistent with the actual situation, with a coincidence degree of 91.2%. The consistency index of the model was 0.71. Conclusion:We screened out the relevant factors affecting ovarian response in patients undergoing assisted reproductive technology with follicular phase long-acting long protocol, and established a Nomogram prediction model of ovarian response, which could effectively, intuitively and visually predict ovarian reactivity in hyperstimulation.

Objective:To explore the relative factors for best ovarian response in patients undergoing assisted reproductive technology with follicular phase long-acting long protocol, and to establish a Nomogram prediction model of ovarian response.Methods:This retrospective cohort study analyzed the clinical data of 1289 patients who received assisted reproductive treatment in the Center for Reproductive Medicine of Fujian Maternity and Child Health Hospital from July 1, 2018 to July 30, 2019. According to the number of oocytes retrieved, there were 164 cases in the low ovarian response group (≤5 oocytes retrieved), 891 cases in the normal ovarian response group (the number of retrieved oocytes was >5, and ≤18), and 234 cases in the high ovarian response group (>18 oocytes retrieved). Independent factors affecting ovarian reactivity were screened by logistic regression, which were the model entry variables, and a Nomogram prediction model was established based on the regression coefficients in the model.Results:There were statistically significant differences in age, anti-Müllerian hormone (AMH) level and antral follicle count (AFC) among the three groups [32.43±3.99, 31.48±3.89, 29.91±3.73; (2.53±1.90) μg/L, (3.79±2.20) μg/L, (5.94±3.12) μg/L; 10.24±3.10, 14.50±3.29, 19.81±3.44; all P<0.001]. There were no significant differences in body mass index (BMI), duration of infertility and causes of tubal infertility (all P>0.05). The initial dosage of gonadotropin (Gn) used for ovarian hyperstimulation among the three groups was statistically different [(182.62±53.96) U, (166.79±48.20) U, (159.13±43.92) U, P<0.001], while the duration of Gn used and clinical pregnancy rate had no significant differences (all P>0.05). Multifactorial stepwise aggression analysis showed that female age [0.93(0.90-0.96), P=0.007], AFC [1.07(1.03-1.09), P=0.001], AMH [1.29(1.20-1.39), P=0.001], basal follicle-stimulating hormone [0.79(0.73-0.86), P=0.001], luteinizing hormone value [1.11(1.06-1.23), P=0.010], initial dosage of Gn used [1.00(1.00-1.01), P=0.003], total dosage of Gn usd [1.00(0.99-1.00), P=0.001] and the presence or absence of diagnosis of endometriosis [0.63(0.47-0.86), P=0.001] and polycystic ovary syndrome [0.30(0.22-0.91), P=0.030] were independent factors for the occurrence of different ovarian responses during ovarian hyperstimulation. The prediction model of ovarian reactivity was constructed based on the above factors, and the accuracy of predicting the optimal ovarian response state was 95%. The above model was verified with 306 patients' data from August 1, 2019 to October 30, 2019 in this center, and the predicted ovarian response (number of oocytes obtained) of a total of 279 patients was consistent with the actual situation, with a coincidence degree of 91.2%. The consistency index of the model was 0.71. Conclusion:We screened out the relevant factors affecting ovarian response in patients undergoing assisted reproductive technology with follicular phase long-acting long protocol, and established a Nomogram prediction model of ovarian response, which could effectively, intuitively and visually predict ovarian reactivity in hyperstimulation.

Objective:To summarize the anesthesia management of living small bowel transplantation.Methods:Severn patients undergoing living and allogeneic small bowel transplantation for the first time were selected.The intraoperative hemodynamics, indexes of blood gas analysis, body temperature and blood transfusion and volume of liquid infused were analyzed.Postoperative outcomes were tracked.Results:Six cases survived and were successfully discharged from hospital successfully, and one patient died.In the operation room, 71% patients were successfully extubated after surgery.Compared with the values during anatomical separation period, Hb during vascular anastomosis and intestinal reconstruction periods and concentration of Ca 2+ during intestinal reconstruction period were significantly decreased, and the blood glucose concentration during vascular anastomosis period were increased ( P<0.05 or 0.01). Compared with the values during vascular anastomosis period, the blood glucose concentration was increased significantly during intestinal reconstruction period ( P<0.05). Crystalloid solution (57±30) ml/kg and colloid solution which mainly containing 20% albumin (15±13) ml/kg were infused mainly during anatomical separation and vascular anastomosis periods in all the patients. Conclusion:The condition of successful living small bowel transplantation is fully evaluation and preparation before surgery.Intravenous-inhalational anesthesia combined with transverses abdominis plane block and rational infusion of colloid solution with vasoactive drugs to maintain hemodynamics stability and monitor blood gas, body temperature, active adjustment of electrolytes and internal environment and stable body temperature can be helpful in maintaining perioperative stable vital signs during the perioperative period, removing the tracheal tube early at the end of surgery, and reducing the development of postoperative complications in patients undergoing living small bowel transplantation.

Objective:To investigate the application and problems existing in the implementation of the standard of "Assessment for Therapeutic Efficacy of Kashin-Beck Disease" (WS/T 79-2011, referred to as new standard), and to provide technical basis and suggestions for further improving the standard.Methods:In 2019, a questionnaire survey was conducted and analyzed in Sichuan, Shaanxi, Qinghai and Gansu provinces and Tibet Autonomous Region on basic information, standard implementation, publicity, training and application of scoring method of joint dysfunction index of Kashin-Beck disease prevention and control technicians.Results:One hundred and thirty-four questionnaires were distributed in this survey and 132 valid questionnaires were recovered, of which 88.64% (117/132) of Kashin-Beck disease prevention and control technicians received training in the new standard and 89.39% (118/132) used the new standard; 78.03% (103/132) thought that the standard terms were clear and easy to master; 71.97% (95/132) thought it was simple, convenient and easy to operate; 49.24% (65/132) thought that the standard evaluation results were consistent with the actual improvement of patients, and 50.75% (67/132) thought that it was generally consistent; 72.73% (96/132) thought that the design was scientific, reasonable and feasible. When using the scoring method of joint dysfunction index, more than 90% of the technicians thought that the five index terms of "joint rest pain", "joint movement pain", "morning stiffness", "maximum walking distance" and "limb activity ability" were easy to understand and ask questions. When patients with Kashin-Beck disease were investigated, the constituent ratios of easy to understand the five index terms were 96.21% (127/132), 83.33% (110/132), 90.15% (119/132), 78.79%(104/132), 90.15%(119/132) and the constituent ratios of easy to answer were 95.45% (126/132), 83.33% (110/132), 89.39% (118/132), 75.00% (99/132) and 89.39% (118/132), respectively.Conclusions:The new standard terms are clear, the design is scientific and reasonable, the operation is convenient and the feasibility is strong. The evaluation results are basically consistent with the actual improvement of patients. It is suggested to add objective evaluation indexes to the scoring method of joint dysfunction index.

Objective:To analyze the effectiveness and safety of assisted reproductive technology in the fertility needs of female patients with malignant tumors.Methods:A total of 37 female malignant tumor patients (case group) who underwent adjuvant reproductive therapy in Fujian Provincial Maternity and Children's Hospital from 2013 to 2018 were enrolled. Totally 74 non-tumor patients were matched as control group according to age and egg retrieval time using a 1：2 matching method. By analyzing the demographic data and the first pregnancy data, the clinical pregnancy rate and the implantation rate of the first transplant cycle were calculated, and the pregnancy outcomes of case group and control group were evaluated.Results:There was no significant difference in the demographic data between the two groups. There was no significant difference in the basic follicle-stimulating hormone (FSH) level, basic luteinizing hormone (LH) level, estradiol and progesterone levels on human chorionic gonadotropin (hCG) injection day during the first treatment period ( P>0.05). The differences of total amount of gonadotropin (Gn) used [(1 984.93±756.79) IU vs. (2 610.59±988.52) IU, P=0.001], duration of Gn used [(9.68±2.57) d vs. (11.64±2.47) d, P<0.001], high-quality embryo rate (49.56% vs. 58.94%, P=0.016) and the number of embryos transferred (1.4±0.5 vs. 1.8±0.4， P=0.001) between case group and control group were statistically significant. There was no significant difference in the clinical pregnancy rate and the implantation rate between the two groups ( P>0.05). Cumulative pregnancy rate, cumulative live birth rate, the number of egg retrieval cycles per live birth, the number of transplant cycles, the number of embryos, and the number of high-quality embryos were not statistically significant ( P>0.05). Tumor patients receiving assisted reproductive assistance have not been found so far recurrence or new tumor. Conclusion:Compared with control group, the pregnancy outcomes after assisted reproductive technology in female malignant tumor patients were not significantly different. Assisted reproductive technology can fulfill the fertility needs of female malignant tumors after surgery and is safety.

Objective:To analyze the effectiveness and safety of assisted reproductive technology in the fertility needs of female patients with malignant tumors.Methods:A total of 37 female malignant tumor patients (case group) who underwent adjuvant reproductive therapy in Fujian Provincial Maternity and Children's Hospital from 2013 to 2018 were enrolled. Totally 74 non-tumor patients were matched as control group according to age and egg retrieval time using a 1：2 matching method. By analyzing the demographic data and the first pregnancy data, the clinical pregnancy rate and the implantation rate of the first transplant cycle were calculated, and the pregnancy outcomes of case group and control group were evaluated.Results:There was no significant difference in the demographic data between the two groups. There was no significant difference in the basic follicle-stimulating hormone (FSH) level, basic luteinizing hormone (LH) level, estradiol and progesterone levels on human chorionic gonadotropin (hCG) injection day during the first treatment period ( P>0.05). The differences of total amount of gonadotropin (Gn) used [(1 984.93±756.79) IU vs. (2 610.59±988.52) IU, P=0.001], duration of Gn used [(9.68±2.57) d vs. (11.64±2.47) d, P<0.001], high-quality embryo rate (49.56% vs. 58.94%, P=0.016) and the number of embryos transferred (1.4±0.5 vs. 1.8±0.4， P=0.001) between case group and control group were statistically significant. There was no significant difference in the clinical pregnancy rate and the implantation rate between the two groups ( P>0.05). Cumulative pregnancy rate, cumulative live birth rate, the number of egg retrieval cycles per live birth, the number of transplant cycles, the number of embryos, and the number of high-quality embryos were not statistically significant ( P>0.05). Tumor patients receiving assisted reproductive assistance have not been found so far recurrence or new tumor. Conclusion:Compared with control group, the pregnancy outcomes after assisted reproductive technology in female malignant tumor patients were not significantly different. Assisted reproductive technology can fulfill the fertility needs of female malignant tumors after surgery and is safety.

Objective To study the change law of immunoglobulin (Ig) (IgG,IgA,IgM) and complement levels (C3,C4) in the peripheral blood of pilots by quantitative detection and to suggest the preventive measures.Methods IMMAGE800 instrument was used to detect the immunoglobulin and complement levels in 383 active pilots and 100 ground crews.Pilots were divided into bomber,transporter,helicopter and fighter groups by aircraft type.The ground crews were chosen as control group.Results Comparing to the control group,pilots showed lower peripheral blood IgG and IgM but higher C3 and C4 levels.Bomber group had lower IgG and higher C3 and C4 levels (P＜0.05).Transporter group had lower IgG and IgM but higher C3 and C4 levels (P＜0.05).Helicopter group showed lower IgG and IgM but higher C4 level (P＜0.05).Fighter group showed lower IgG but higher C3 and C4 levels (P＜0.05).Conclusions The changes on immunoglobulin and complement levels indicate the certain harmful effects on pilot's immune system.The environment factors may be the main reason led to pilot's lower IgG and IgM but higher C3 and C4 levels.The prevention of electromagnetic radiation in flight should be strengthened as the basic measures for maintaining pilot's immune functions.

Objective To study the change law of immunoglobulin (Ig) (IgG,IgA,IgM) and complement levels (C3,C4) in the peripheral blood of pilots by quantitative detection and to suggest the preventive measures.Methods IMMAGE800 instrument was used to detect the immunoglobulin and complement levels in 383 active pilots and 100 ground crews.Pilots were divided into bomber,transporter,helicopter and fighter groups by aircraft type.The ground crews were chosen as control group.Results Comparing to the control group,pilots showed lower peripheral blood IgG and IgM but higher C3 and C4 levels.Bomber group had lower IgG and higher C3 and C4 levels (P＜0.05).Transporter group had lower IgG and IgM but higher C3 and C4 levels (P＜0.05).Helicopter group showed lower IgG and IgM but higher C4 level (P＜0.05).Fighter group showed lower IgG but higher C3 and C4 levels (P＜0.05).Conclusions The changes on immunoglobulin and complement levels indicate the certain harmful effects on pilot's immune system.The environment factors may be the main reason led to pilot's lower IgG and IgM but higher C3 and C4 levels.The prevention of electromagnetic radiation in flight should be strengthened as the basic measures for maintaining pilot's immune functions.

Objective:To explore the diagnosis, treatment and curative effect of cervical cellulitis combineing mediastinal pleural abscess. Method:Clinical data of 37 patients with the cervical cellulitis and mediastinal pleural abscess were analyzed, all patients were confirmed using ultrasond, X-ray, CT, puncture and microbiology examination. The result will analysis the diagnosis, treatment and curative effect through the comparison of conservative treatment and surgical treatment. Result:Twenty-three cases of patients were underwent tracheotomy because of difficulty in breathing and successfully extubated after treatment. Nine cases of patients were given anti-infection treatment and recovered after conservative treatment. Twenty-one cases of neck multiple pus cavity were underwent cavity incision, full removal of necrotic tissue and pipe flushing; 7 cases of patients with neck and mediastinal abscess and within which 2 cases were with toxic shock were underwent adequate drainage of lavage and abscess incision through jugular joint path; the companion of pyothorax in 2 cases were underwent the chest closed drainage. All patients were giving sensitive antibiotic after drug sensitive test, anti-shock treatment and supportive treatment. All the patients were recovered and discharged. The average hospitalization days with conservative treatment of these patients were 15.7 days, and the average hospitalization days with surgical treatment of patients were 25.3 days. Conclusion:The condition of cervical cellulitis is complex, a few case can be cured with conservative treatment. The others progress rapidly when merging mediastinal pleural abscess can cause serious complications, surgical treatment is risky, fully abscess incision, lavage drainage and combine with sensitive antibiotics and supportive treatment are the keys to therapy.