The technology of xenogeneic organ transplantation, as one of the core strategies to address the current contradiction between the supply and demand of transplant organs, has achieved significant breakthroughs from basic research to clinical application driven by factors such as the innovation of gene modification technology, the injection of research capital and the expansion of clinical trials, especially with the first actual clinical application of a pig heart-to-human transplant. China is also at the forefront of this field. This article intends to summarize the international research trends of xenogeneic organ transplantation (including financial support, the evolution of research stages and global clinical trial cases), and analyze the evolution and optimization of xenogeneic transplantation immunosuppression schemes, as well as the breakthroughs and unresolved scientific issues in current key clinical application technologies. The aim is to comprehensively present the progress of this field from basic research to clinical transformation, and provide references for promoting the rapid development of China's xenogeneic transplantation technology and subsequent clinical transformation and research directions.

Objective:To analyze the value of marginal donor livers in liver transplantation for patients with acute-on-chronic liver failure (ACLF).Methods:Clinical data of 58 patients with ACLF undergoing liver transplantation at the First Affiliated Hospital of Guangxi Medical University from January 2020 to June 2023 were retrospectively analyzed, including 33 males and 25 females, aged (40.4±14.4) years. According to the source of donor (marginal or standard), recipients were divided into the marginal group ( n=28), and standard group ( n=30). The preoperative model for end-stage liver disease (MELD) score, cold/warm ischemia time, intraoperative blood loss, postoperative tracheal intubation time, intensive care unit (ICU) stay, liver function, renal function, coagulation function, postoperative complications, and survival situation were compared between the groups. Results:The MELD score, cold/warm ischemia time, intraoperative blood loss, postoperative tracheal intubation time, length of ICU stay, alanine transaminase, aspartate transaminase, total bilirubin, serum creatinine, blood urea nitrogen, estimated glomerular filtration rate, fibrinogen, postoperative infection, primary graft nonfunction, biliary complications, and vascular complications were compared between the groups (all P>0.05). The incidence of delayed graft function (DGF) recovery was 28.6%(8/28) in marginal group, higher than that in standard group 6.7%(2/30) ( χ2=5.13, P=0.038). The one-year cumulative survival rates were 89.3% and 93.3% in marginal group and standard group, respectively ( P=0.580). Conclusion:The therapeutic effect of marginal donor liver in ACLF recipients is comparable to that of standard donor liver. The incidence of DGF is higher in recipients with marginal donor liver.

Objective:To analyze the value of marginal donor livers in liver transplantation for patients with acute-on-chronic liver failure (ACLF).Methods:Clinical data of 58 patients with ACLF undergoing liver transplantation at the First Affiliated Hospital of Guangxi Medical University from January 2020 to June 2023 were retrospectively analyzed, including 33 males and 25 females, aged (40.4±14.4) years. According to the source of donor (marginal or standard), recipients were divided into the marginal group ( n=28), and standard group ( n=30). The preoperative model for end-stage liver disease (MELD) score, cold/warm ischemia time, intraoperative blood loss, postoperative tracheal intubation time, intensive care unit (ICU) stay, liver function, renal function, coagulation function, postoperative complications, and survival situation were compared between the groups. Results:The MELD score, cold/warm ischemia time, intraoperative blood loss, postoperative tracheal intubation time, length of ICU stay, alanine transaminase, aspartate transaminase, total bilirubin, serum creatinine, blood urea nitrogen, estimated glomerular filtration rate, fibrinogen, postoperative infection, primary graft nonfunction, biliary complications, and vascular complications were compared between the groups (all P>0.05). The incidence of delayed graft function (DGF) recovery was 28.6%(8/28) in marginal group, higher than that in standard group 6.7%(2/30) ( χ2=5.13, P=0.038). The one-year cumulative survival rates were 89.3% and 93.3% in marginal group and standard group, respectively ( P=0.580). Conclusion:The therapeutic effect of marginal donor liver in ACLF recipients is comparable to that of standard donor liver. The incidence of DGF is higher in recipients with marginal donor liver.

Objective:To explore the application value of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in preoperative screening of different residual types of atrial septal defect (ASD) occlusion.Methods:A retrospective analysis was conducted on the clinical data of 120 ASD patients who received interventional treatment for atrial septal defect at the Second People′s Hospital of Liaocheng from January 2020 to December 2021. Patients underwent TTE and TEE examinations before surgery, and were divided into two groups based on the results of the preoperative TTE examination: those with strong echogenicity of the defect margin and swing amplitude<5 mm were classified as group A ( n=60); Patients with fine echoes and a swing amplitude of ≥5 mm at the defect margin were classified as group B ( n=60). The study compared the differences in measuring the maximum diameter of atrial septal defect between two groups of patients using TTE and TEE, and evaluated the correlation between the maximum diameter of the defect measured by these two methods and the waist diameter of the occluder. Results:There was no statistically significant difference in the maximum diameter of atrial septal defect measured by TTE and TEE in group A ( P>0.05), while there was a statistically significant difference in group B ( P<0.01). In group A patients, the correlation between the maximum diameter of ASD measured by TTE and TEE and the diameter of the occluder waist was good ( r=0.993, 0.991); In group B patients, the correlation between the maximum diameter of ASD measured by TEE and the diameter of the occluder waist was higher ( r=0.995), significantly greater than the correlation with TTE measurements ( r=0.897). The difference between the waist diameter of the occluder and the values measured by TTE and TEE in group A patients was small and not statistically significant ( P>0.05); The difference between the waist diameter of the occluder and the TEE measurement value in group B patients was significantly smaller than the difference with the TTE measurement value ( P<0.01). Conclusions:For patients with atrial septal defect with strong residual echo and small amplitude of oscillation, TTE and TEE have considerable application value and can be used instead of TEE in case screening; For patients with atrial septal defect with thin residual echoes and large oscillation amplitude, further TEE examination is needed to help surgeons more accurately select suitable occluders.

Objective:To investigate the clinical features of 17q12 microdeletion cases before and after delivery, and provide a reference for prenatal diagnosis and genetic counseling.Methods:A retrospective analysis was conducted on five fetuses diagnosed with 17q12 microdeletion by single nucleotide polymorphism array in Quanzhou Women's and Children's Hospital between April 2020 and June 2023. Clinical data including prenatal ultrasonography findings, genetic causes, parental clinical features, and postnatal outcomes were summarized and analyzed using descriptive statistical analysis.Results:The five fetuses had normal results of karyotype analysis of amniotic fluid, but carried a microdeletion of 1.4 to 1.8 Mb in the 17q12 region of the chromosome, involving 20 genes listed in the Online Mendelian Inheritance in Man database. Pedigree verification was performed on all five cases and the results indicated one maternally inherited case with the mother having polycystic kidneys complicated by left hydronephrosis, one de novo case, and three paternally inherited cases with one father having multiple cysts in both kidneys and two fathers showing no abnormalities. Multiple abnormalities were found in the five fetuses by prenatal ultrasonography, including enhanced renal parenchymal echogenicity in four cases and pyelectasis in one case. Two cases chose to terminate the pregnancies, while the other three continued the pregnancies to full term. Postnatal follow-ups showed that one case was normal in growth and development with no abnormalities by renal ultrasound; one case developed polycystic kidney; one case with normal renal ultrasound findings had a speech disorder and symptoms of suspected autism at the age of three. Conclusions:The main manifestation of 17q12 microdeletion is enhanced renal parenchymal echogenicity in the fetal stage and postnatal polycystic kidney. In prenatally diagnosed cases, pedigree verification is necessary as an objective and scientific genetic counseling is helpful in pregnancy decision-making.

Objective To investigate the correlation between lipid accumulation index (LAP),visceral fat index (VFI) and insulin resistance (IR) in healthy check-up population.Methods A total of 9121 subjects who underwent physical examination in the Health Management Center of the First Affiliated Hospital of Ar-my Medical University from October 2016 to June 2023 were selected as the study subjects,including 5988 males and 3133 females.The age,waist circumference (WC),body mass index (BMI),LAP,VFI,blood lipid, blood glucose and homeostasis model assessment of insulin resistance (HOMA-IR) were compared between different genders.Obesity was assessed according to BMI.LAP,VFI and HOMA-IR were compared between obese (BMI≥28 kg/m2) and non-obese patients (BMI<28 kg/m2).Pearson correlation analysis was used to analyze the relationship between LAP,VFI and HOMA-IR in all healthy subjects.Multiple logistic regression analysis was used to analyze the independent influencing factors of HOMA-IR in all healthy subjects. Results The age and high-density lipoprotein cholesterol (HDL-C) of male healthy subjects were significant-ly lower than those of female,while WC,BMI,triglyceride (TG),total cholesterol (TC),low-density lipopro-tein cholesterol (LDL-C),LAP,VFI,fasting blood glucose (FBG),fasting insulin (FINS),glycosylated hemo-globin (HbA1c) and HOMA-IR were significantly higher than those of female (P<0.05).There were 1733 cases of obesity in all healthy subjects,accounting for 19％.The LAP,VFI and HOMA-IR of obese people were significantly higher than those of non-obese people (P<0.05).Pearson correlation analysis showed that HOMA-IR was positively correlated with WC,BMI,TG,TC,LDL-C,LAP and VFI,and negatively correlated with HDL-C (P<0.05).The correlation coefficient r value of LAP was the highest,reaching 0.367,followed by WC,BMI,TG and VFI.Multivariate logistic correlation analysis showed that BMI,LAP and VFI were in-dependent influencing factors of HOMA-IR in all healthy subjects (P<0.05).Conclusion Obesity should not be ignored in health check-up population.LAP and VFI are associated with IR,especially LAP,which can reliably evaluate body fat accumulation and blood glucose metabolism.

Objective To summarize the diagnosis and treatment experience of adenine phosphoribosyltransferase deficiency after kidney transplantation. Methods Clinical data of 1 patient with adenine phosphoribosyltransferase deficiency after kidney transplantation were retrospectively analyzed. Clinical characteristics, diagnosis, treatment and prognosis of adenine phosphoribosyltransferase deficiency were summarized by literature review. Results Renal biopsy showed that salt crystallization was found in most renal tubule lumen and positive results were observed under polarized light microscopy. After allopurinol, hemodialysis and anti-crystallization treatment, the graft function was gradually recovered. After postoperative 1-year follow-up, the patient's renal function was properly recovered. Conclusions Adenine phosphoribosyltransferase deficiency after kidney transplantation may lead to delayed graft function or graft dysfunction. Early detection, diagnosis and treatment may delay disease progression and improve renal function.

Objective:To explore the effects of the LAmbre device and mitral annulus(MA), as well as left atrium(LA) in patients with non-valvular atrial fibrillation(NVAF) after left atrial appendage closure (LAAC) using real-time-three-dimensional transesophageal echocardiography (3D TEE).Methods:Fity-six consecutive patients who underwent LAAC with the LAmbre device in Zhongshan Hospital of Fudan University from June 2019 to March 2023 were retrospectively enrolled, with no or less than moderate mitral regurgitation (MR). All patients underwent pre-operative and follow-up two-and three-dimensional transesophageal echocardiography (2D TEE, 3D TEE) at 60 days after the operation. The quantitative parameters of MA and LA were obtained by offline analysis using QLab 13.0 (Philips Healthcare, Andover, MA). Importantly, mitral annular measurements were made at seven time points throughout the cardiac cycle: early diastole, mid-diastole, late diastole, mitral valve closure, early systole, mid-systole, and late systole, which facilitates constructing the dynamic model of MA to assess the annular morphology and dynamics.Results:The values of AP diameter (APD), AL-PM diameter (ALPMD), 3D annulus circumference (3DAC), 3D annulus area (3DAA) decreased significantly compared with pre-operative values at all time points of the cardiac cycle (all P<0.05), while non-planar angle (NPA) and AH/CD were not apparently changed (all P>0.05 ). Throughout the cardiac cycle, MA showed regular changes, gradually increased in systole with the saddle shape deepened, and gradually decreased in diastole with the saddle shape shallowed.During systole, there was an increase in the rate of change of AP in MA [pre-operative (3.01±2.64)%, post-operative (3.81±3.51)%, P=0.037] after LAAC, with no significant difference in the rate of change of ALPM, 3DAC, and 3DAA.Meanwhile, we observed an evident reduction in LA minimal volume (LAVmin) [pre-operative (78.36±25.16)ml, post-operative (70.73±22.78)ml, P=0.004] and an obvious increase in LA ejection function [pre-operative (22.88±10.09)%, post-operative (31.41±12.28)%, P<0.05] during follow-up. Conclusions:3D TEE can accurately assess the impact of LAAC on the MA and LA. The LAmbre device can affect the morphology of MA, as well as the structure and function of LA, while the change of the dynamics of MA is not so prominent.

Transcatheter tricuspid valve intervention is the new frontier of interventional cardiology. The LuX-Valve is a radial force-independent orthotopic tricuspid valve replacement device developed in China. The LuX-Valve Plus transcatheter tricuspid valve replacement (TTVR) system is changed from the trans-atrial to the transjugular approach, which further reduces trauma and pulmonary complications compared with the first generation LuX-Valve. The first-in-human study has been completed at Zhongshan Hospital, Fudan University and an exploratory multicentre clinical study is underway. Echocardiography plays an important role in pre-TTVR screening, intraoperative guidance and postoperative evaluation and follow-up, especially two-dimensional transoesophageal echocardiography (2D-TEE) and three-dimensional transoesophageal echocardiography (3D-TEE). However, there is a lack of appropriate intraoperative guidance and assessment protocols. In this study, we briefly described the protocols and imaging considerations for intraoperative 2D-TEE and 3D-TEE to ensure the successful implantation of TTVR.

Objective To explore the relationship between Nestin expression level and prognosis in osteosarcoma,and to provide a new idea for treatment.Methods Thirty patient with osteosarcoma who had received treatment were included this study according to the criteria.HE staining was applied to evaluate the response to chemotherapy,meanwhile immunohistochemistry was applied to evaluate Nestin expression levels before and after chemotherapy.Kaplan Meier survival curve was drawn to analyze the outcomes.Results The response of chemotherapy was good in 17 patients and poor in 13.24 cases were strongly positive in Nestin staining,five were weakly positive,and one was negative.The expression level of Nestin in osteosarcona was correlated to the chemotherapy response and prognosis (P ＜ 0.05),while higher level of Nestin expression referred to poorer response of chemotherapy and lower overall survival rate.Conclusions The expression level of Nestin in osteosarcoma tissue is associated with the effect of chemotherapy and prognosis;higher expression level of Nestin indicates poorer prognosis and efficacy of chemotherapy.