Objective:To summarize and investigate the ultrasound manifestations, clinical characteristics, causes, and prognosis of hepatic portal vein gas (HPVG) after liver transplantation in children.Methods:A case series study. Clinical data of 9 pediatric recipients diagnosed with HPVG by ultrasound after liver transplantation between January 2012 and August 2023 were collected, and the ultrasound manifestations, causes, clinical features, and prognosis of HPVG were analyzed.Results:A total of 1,850 pediatric liver transplantations were performed during the same period in Tianjin First Central Hospital, among which 9 cases (0.48%) developed HPVG; 6 cases occurred within 1 month after surgery, and 3 cases occurred more than 1 month after surgery; the duration ranged from 2 to 15 days, with a median of 7 (4.5, 9.0) days. HPVG was first detected by ultrasound in all cases, with common ultrasound manifestations including bubble-like or punctate strong echoes flowing with blood in the portal vein, and patchy strong echoes with unclear borders in the liver parenchyma. Among the 9 patients, 3 had diarrhea with intestinal flora imbalance, 2 had abdominal distension with incomplete intestinal obstruction, 1 had colonic fistula with repeated replacement of Li's tube and concurrent abdominal distension, 1 was experiencing acute T-cell-mediated rejection of the transplanted liver, and the remaining 2 were asymptomatic. Patients with diarrhea and intestinal dysbiosis were treated with Bifidobacterium Lactobacillus triple viable tablets to regulate flora and montmorillonite powder to relieve diarrhea, which gradually subsided. Patients with abdominal distension and incomplete intestinal obstruction were treated with fasting, intravenous nutrition, and enema, and the obstruction gradually resolved, along with disappearance of HPVG.Conclusion:HPVG after liver transplantation has characteristic ultrasound manifestations, and its occurrence may be related to intestinal gas, obstruction, dysbiosis, or mucosal damage. Treatment may be conservative or surgical depending on the underlying cause and severity.

Cerebral small vessel disease (CSVD) and large artery atherosclerosis (LAA) are two types of cerebrovascular diseases. Their pathogenesis is closely related, with common risk factors, but there are differences. Early detection and effective management of common risk factors, while taking into account differentiated risk factors, are of great significance for stroke prevention. This article reviews the similarities and differences in the major risk factors between CSVD and LAA.

Objective To study the hemodynamic characteristics of autologous arteriovenous fistula(AVF)and provide a theoretical basis for reducing its stenosis rate.Methods Bidirectional fluid-structure interaction(FSI)simulations were conducted on a modified AVF model.Flow field and wall shear stress(WSS)distributions in the internal fistula at different periods and angles in a cardiac cycle were analyzed for retrograde flow(confluence)and anterograde flow(shunt)modes in models with varying anastomosis angles.Results Under confluence modes,the WSS＜1 Pa area in the 60° anastomosis angle model was the smallest(7.027 mm2),while the 45°,60°,and 90° models showed no significant differences in eddy current size and intensity.Under shunt modes,the 45° anastomosis angle model had the smallest WSS＜1 Pa area(9.079 mm2),but the 60° model exhibited the lowest eddy current intensity and distribution area.In addition,the difference in the WSS＜1 Pa area between the 60° and 45° models was only 2.661 mm2.Conclusions Under both confluence and shunt flow modes,establishing an AVF with 60° anastomosis angle is conducive to reducing the risk of vascular stenosis in arteriovenous fistula.

Objective To study the hemodynamic characteristics of autologous arteriovenous fistula(AVF)and provide a theoretical basis for reducing its stenosis rate.Methods Bidirectional fluid-structure interaction(FSI)simulations were conducted on a modified AVF model.Flow field and wall shear stress(WSS)distributions in the internal fistula at different periods and angles in a cardiac cycle were analyzed for retrograde flow(confluence)and anterograde flow(shunt)modes in models with varying anastomosis angles.Results Under confluence modes,the WSS＜1 Pa area in the 60° anastomosis angle model was the smallest(7.027 mm2),while the 45°,60°,and 90° models showed no significant differences in eddy current size and intensity.Under shunt modes,the 45° anastomosis angle model had the smallest WSS＜1 Pa area(9.079 mm2),but the 60° model exhibited the lowest eddy current intensity and distribution area.In addition,the difference in the WSS＜1 Pa area between the 60° and 45° models was only 2.661 mm2.Conclusions Under both confluence and shunt flow modes,establishing an AVF with 60° anastomosis angle is conducive to reducing the risk of vascular stenosis in arteriovenous fistula.

Objective:To summarize and investigate the ultrasound manifestations, clinical characteristics, causes, and prognosis of hepatic portal vein gas (HPVG) after liver transplantation in children.Methods:A case series study. Clinical data of 9 pediatric recipients diagnosed with HPVG by ultrasound after liver transplantation between January 2012 and August 2023 were collected, and the ultrasound manifestations, causes, clinical features, and prognosis of HPVG were analyzed.Results:A total of 1,850 pediatric liver transplantations were performed during the same period in Tianjin First Central Hospital, among which 9 cases (0.48%) developed HPVG; 6 cases occurred within 1 month after surgery, and 3 cases occurred more than 1 month after surgery; the duration ranged from 2 to 15 days, with a median of 7 (4.5, 9.0) days. HPVG was first detected by ultrasound in all cases, with common ultrasound manifestations including bubble-like or punctate strong echoes flowing with blood in the portal vein, and patchy strong echoes with unclear borders in the liver parenchyma. Among the 9 patients, 3 had diarrhea with intestinal flora imbalance, 2 had abdominal distension with incomplete intestinal obstruction, 1 had colonic fistula with repeated replacement of Li's tube and concurrent abdominal distension, 1 was experiencing acute T-cell-mediated rejection of the transplanted liver, and the remaining 2 were asymptomatic. Patients with diarrhea and intestinal dysbiosis were treated with Bifidobacterium Lactobacillus triple viable tablets to regulate flora and montmorillonite powder to relieve diarrhea, which gradually subsided. Patients with abdominal distension and incomplete intestinal obstruction were treated with fasting, intravenous nutrition, and enema, and the obstruction gradually resolved, along with disappearance of HPVG.Conclusion:HPVG after liver transplantation has characteristic ultrasound manifestations, and its occurrence may be related to intestinal gas, obstruction, dysbiosis, or mucosal damage. Treatment may be conservative or surgical depending on the underlying cause and severity.

Objective To observe and compare of the effects of esketamine and sufentanil induction for general anesthesia on postoperative analgesia in obese patients undergoing laparoscopic sleeve gastrectomy.Methods Patients scheduled for elective laparoscopic sleeve gastrectomy between March 2023 and March 2024,irrespective of gender,aged between 20 and 50 years,with a BMI ranging from 30.0 to 50.0 kg/m2 and ASA Ⅰ or Ⅱ classification,were randomly allocated into two groups:the esketamine group(Group E)and the sufentanil group(Group S),each consisting of 32 cases.During anesthesia induction,Group E received a dose of esketamine at 0.5 mg/kg while Group S received sufentanil at a dosage of 0.5 μg/kg;the remaining protocol remained unchanged.Heart rate(HR),mean arterial pressure(MAP),and SpO2 were recorded at various time points:upon arrival(T0),prior to anesthesia induction(T1),immediately after induction(T2),during intubation(T3),at the conclusion of anesthesia adminis-tration(T4),and during extubation(T5).Postoperative pain scores using the Numeric Rating Scale(NRS)were assessed at specific intervals following surgery:one hour post-surgery(P0),six hours post-surgery(P1),twelve hours post-surgery(P2),twenty-four hours post-surgery(P3)and forty-eight hours post-surgery(P4).Additionally,intraoperative remifentanil consumption as well as the number of presses on the analgesic pump within forty-eight hours after surgery in both patient groups were documented along with any occurrences of adverse reactions.Results During the surgery,there was no statistically significant difference in mean arterial pressure(MAP)and heart rate(HR)between the two patient groups at T0～T5(P>0.05).At T2,both groups exhibited lower MAP and HR compared to T0;specifically,group S had a MAP of(91.81±8.94)mmHg and HR of(81.75±13.37)beats/min,while group E had a MAP of(93.69±9.96)mmHg and HR of(80.38±13.2)beats/min,with group E showing values closer to baseline levels.At T3,both groups experienced a transient increase in MAP and HR(P<0.05);specifi-cally,group S had a MAP of(97.56±8.96)mmHg and HR of(86.47±13.84)beats/min,while group E had a MAP of(101.03±8.29)mmHg and(89.41±15.32)times/min,with S group closer to baseline values.There was no statistically significant difference in the amount of remifentanil used during surgery between group S and group E(P>0.05),which were(2071.88±717.63)μg and(2093.75±718.39)μg,respectively.Compared with the postoperative conditions of the two groups,the NRS scores of group E(0.41±0.61±1.870.75,2.47±0.62)at P0,P1 and P2 were lower than those in group S(0.88±0.71,2.47±0.72,2.97±0.54),and the difference was statisti-cally significant(P<0.05).The number of intravenous analgesia pump presses was significantly reduced in group E after surgery(P<0.05),with the postoperative analgesic pump compressions occurring 11.25±2.70 times in group S and 8.56±2.23 times in group E.The incidence of postoperative nausea and vomiting(PONV)and hypotension in Group E(21.88%,15.63%)was lower than that observed in group S(46.88%,37.50%),demonstrating statistical significance(P<0.05).Conclusion In comparison to sufentanil induction,the utilization of esketamine anesthesia induction is deemed safe for laparoscopic sleeve gastrectomy in obese patients,effectively mitigating postoperative acute pain and reducing the incidence of PONV.

Objective:To obtain the normal reference range of hemodynamic ultrasound parameters after pediatric liver transplantation through big data query and statistical analysis, and compare their changes with age.Methods:The clinical liver transplantation ultrasound imaging database software V1.0 independently developed by Tianjin First Central Hospital was used to query the ultrasound hemodynamic parameters of 0-14 years old pediatric patients after parental liver transplantation from December 2012 to December 2022, including portal vein diameter (PVD) on the 1st day, 7th day, 1st month, 6th month, 1st year, 5th year, and 10th year after surgery. The changes in ultrasound blood flow parameters such as portal vein velocity (PVV), hepatic artery peak velocity (S), hepatic artery end diastolic velocity (D), and left hepatic vein velocity (LHVV) with postoperative time in different age groups were analyzed, the differences between age groups were compared, and statistical analysis was perform to obtain the 95% reference value range for each parameter.Results:A total of 731 pediatric patients aged 0-14 years who underwent parental liver transplantation were included in this study, with a total of 5 283 monitoring results. The ultrasound hemodynamic parameters PVV, hepatic artery S, D, and LHVV were highest at 7th day after surgery, and gradually showed a sustained and slightly decreasing trend with the prolongation of postoperative time. At the same time, there was no statistically significant difference in PVV, hepatic artery S, D, and LHVV among different age groups (all P>0.05). Conclusions:This study obtains the trend of ultrasound hemodynamic parameters after pediatric liver transplantation with prolonged follow-up time, and compared them among different age groups.After pediatric liver transplantation, there is no significant change in liver hemodynamic parameters with increasing age. Obtaining reference value ranges for various parameters in different age groups is of great clinical significance for early detection and diagnosis of postoperative vascular complications. Pediatric liver transplantation is more complex than adult liver transplantation, and in clinical monitoring, more attention should be paid to the dynamic changes of transplanted liver blood flow, combining with individual patient status, to provide imaging support for clinical diagnosis.

Objective:To explore the ultrasonic hemodynamic characteristics of early allograft dysfunction after left lateral lobe liver transplantation in children with biliary atresia.Methods:A total of 546 children with biliary atresia who underwent related left lateral lobe liver transplantation at Tianjin First Central Hospital from December 2012 to June 2021 were retrospectively selected, according to the early functional recovery of the transplanted liver, it was divided into a normal function recovery group (non-EAD group) and an early allograft dysfunction group (EAD group). The hepatic artery peak systolic flow velocity (PSV), end-diastolic flow velocity (EDV), resistance index (RI), portal vein diameter (PVD), portal vein flow velocity (PVV), portal vein flow (PVF), left hepatic vein diameter (LHVD) and left hepatic vein velocity (LHVV) were measured 1 to 7 days after surgery (a total of 3 703 ultrasound examination results), and the differences in ultrasound hemodynamic parameters between the two groups were compared. Binary logistic regression analysis was used to determine the correlation between hepatic artery RI=1.0, PSV<25 cm/s, PVV<15 cm/s, LHVV<15 cm/s and the occurrence of EAD within 7 days after surgery.Results:① Among the 546 children with biliary atresia, 262 children developed EAD after liver transplantation, and 284 children did not develop EAD. ②The portal vein flow of children in the EAD group was lower than that of the non-EAD group on 3 days, 4 days, 6 days and 7 days after surgery [3 days: 783 (560, 1 170) ml/(min·100 g) vs 942 (597, 1 381) ml/(min·100 g), P=0.006; 4 d: 862(594, 1 443) ml/(min·100 g) vs 1 068(748, 1 606) ml/(min·100 g), P=0.001; 6 d: 1 024 (631, 1 447) ml/(min·100 g) vs 1 141 (777, 1 709) ml/(min·100 g), P=0.005; 7 d: 937 (619, 1 408) ml/(min·100 g) vs 1 066 (670, 1 557) ml/(min·100 g), P=0.018]. The hepatic artery blood flow parameter RI was higher than that in the non-EAD group 7 days after surgery [0.72 (0.65, 0.79) vs 0.70 (0.63, 0.76), P=0.025]. There were no statistically significant differences in hepatic venous blood flow parameters between the two groups from 1 to 7 days (all P>0.05). ③Both the PVV and PVF in the EAD group and the non-EAD group showed an overall upward trend over time from 1 to 7 days after surgery, but compared with the non-EAD group, the portal vein flow in the EAD group increased more slowly from 3 to 7 days [PVF change rate: 0.01 (-0.25, 0.62)% vs 0.06 (-0.41, 0.41)%, P=0.003], while PSV, EDV and LHVV had no significant fluctuations. ④In the ultrasound hemodynamic abnormality index, the EAD group has a higher probability of transplanted hepatic artery RI=1.0 than the non-EAD group. Binary logistic regression analysis showed that hepatic artery RI=1.0 within 7 days after surgery was correlated with the occurrence of EAD [Exp(B)=2.413, P=0.005]. Conclusions:After left lateral lobe liver transplantation in children with biliary atresia, the portal vein of children with EAD showed a relatively low flow state.Abnormal ultrasound hemodynamic index hepatic artery RI=1.0 in children within 7 days after surgery can indicate the occurrence of EAD. Ultrasound examination can provide hemodynamic basis for early clinical detection of the presence of EAD.

Objective:To explore the ultrasonic hemodynamic characteristics of early allograft dysfunction after left lateral lobe liver transplantation in children with biliary atresia.Methods:A total of 546 children with biliary atresia who underwent related left lateral lobe liver transplantation at Tianjin First Central Hospital from December 2012 to June 2021 were retrospectively selected, according to the early functional recovery of the transplanted liver, it was divided into a normal function recovery group (non-EAD group) and an early allograft dysfunction group (EAD group). The hepatic artery peak systolic flow velocity (PSV), end-diastolic flow velocity (EDV), resistance index (RI), portal vein diameter (PVD), portal vein flow velocity (PVV), portal vein flow (PVF), left hepatic vein diameter (LHVD) and left hepatic vein velocity (LHVV) were measured 1 to 7 days after surgery (a total of 3 703 ultrasound examination results), and the differences in ultrasound hemodynamic parameters between the two groups were compared. Binary logistic regression analysis was used to determine the correlation between hepatic artery RI=1.0, PSV<25 cm/s, PVV<15 cm/s, LHVV<15 cm/s and the occurrence of EAD within 7 days after surgery.Results:① Among the 546 children with biliary atresia, 262 children developed EAD after liver transplantation, and 284 children did not develop EAD. ②The portal vein flow of children in the EAD group was lower than that of the non-EAD group on 3 days, 4 days, 6 days and 7 days after surgery [3 days: 783 (560, 1 170) ml/(min·100 g) vs 942 (597, 1 381) ml/(min·100 g), P=0.006; 4 d: 862(594, 1 443) ml/(min·100 g) vs 1 068(748, 1 606) ml/(min·100 g), P=0.001; 6 d: 1 024 (631, 1 447) ml/(min·100 g) vs 1 141 (777, 1 709) ml/(min·100 g), P=0.005; 7 d: 937 (619, 1 408) ml/(min·100 g) vs 1 066 (670, 1 557) ml/(min·100 g), P=0.018]. The hepatic artery blood flow parameter RI was higher than that in the non-EAD group 7 days after surgery [0.72 (0.65, 0.79) vs 0.70 (0.63, 0.76), P=0.025]. There were no statistically significant differences in hepatic venous blood flow parameters between the two groups from 1 to 7 days (all P>0.05). ③Both the PVV and PVF in the EAD group and the non-EAD group showed an overall upward trend over time from 1 to 7 days after surgery, but compared with the non-EAD group, the portal vein flow in the EAD group increased more slowly from 3 to 7 days [PVF change rate: 0.01 (-0.25, 0.62)% vs 0.06 (-0.41, 0.41)%, P=0.003], while PSV, EDV and LHVV had no significant fluctuations. ④In the ultrasound hemodynamic abnormality index, the EAD group has a higher probability of transplanted hepatic artery RI=1.0 than the non-EAD group. Binary logistic regression analysis showed that hepatic artery RI=1.0 within 7 days after surgery was correlated with the occurrence of EAD [Exp(B)=2.413, P=0.005]. Conclusions:After left lateral lobe liver transplantation in children with biliary atresia, the portal vein of children with EAD showed a relatively low flow state.Abnormal ultrasound hemodynamic index hepatic artery RI=1.0 in children within 7 days after surgery can indicate the occurrence of EAD. Ultrasound examination can provide hemodynamic basis for early clinical detection of the presence of EAD.

Objective:To explore the comparative study of video laryngoscopy combined with bronchial blocker and video laryngoscopy combined with double-lumen tube in the teaching of endotracheal intubation in thoracic surgery in the standardized residency training of anesthesia.Methods:The trainees of the standardized residency training were randomly divided into control group and experimental group for clinical teaching, with 25 ones in each group. The experimental group was treated with visual laryngoscopy combined with bronchial blocker, while the control group was treated with visual laryngoscopy combined with double-lumen tube group. The intubation time, intubation success rate, positioning time, hemodynamic changes, and complication incidence during intubation, as well as student assessment results were recorded. GraphPad Prism 6.0 was used for t test and Chi-square test. Results:The time of endotracheal intubation [(95.3±10.1) vs. (137.5±13.5)] and positioning time [(100.8±11.7) vs. (155.4±15.3)] in the experimental group were both shorter than those of the control group ( P< 0.001), the hemodynamic changes in patients with immediate intubation were smaller ( P<0.001), the success rate of intubation was higher (92% vs. 68%) ( P<0.001), the complication incidence was lower ( P<0.001) and the students' performance was higher ( P<0.001). Conclusion:In the anesthesia teaching of thoracic surgery, bronchial blocker can reduce the time of endotracheal intubation, lower the hemodynamic changes during intubation, cut down the incidence of complications, improve the success rate of endotracheal intubation and enhance the confidence of students.