Objective:To study the relationship between intraoperative portal venous pressure gradient (PVPG) changes and clinical outcomes of meso-Rex bypass in pediatric patients with extrahepatic portal vein obstruction (EHPVO).Methods:Clinical data of 76 children with EHPVO undergoing Rex shunt at Guangzhou Women and Children’s Medical Center, Affiliated to Guangzhou Medical University from April 2018 to October 2021 were retrospectively analyzed, including 49 males and 27 females, aged 62.0 (42.0, 102.5) months. Logistic regression was used to identify prognostic factors. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficacy of PVPG variations. The association between pre-/postoperative PVPG differences and clinical outcomes (resolution of hypersplenism/splenomegaly, improvement of gastroesophageal varices, and vascular complications) were systematically assessed.Results:All 76 pediatric patients underwent the Rex shunt successfully. Postoperative vascular complications occurred in 14 cases (18.4%), including six cases of bypass graft thrombosis (7.9%) and eight cases of anastomotic stenosis (10.5%). Logistic regression analyses revealed that graft type ( OR=0.03, 95% CI: 0-0.30, P=0.003) and PVPG gradient ( OR=1.65, 95% CI: 1.07-2.53, P=0.022) were associated with esophagogastric varices resolution after Rex shunt. Graft type also correlated with splenomegaly/hypersplenism improvement ( OR=0.08, 95% CI: 0.01-0.80, P=0.032). PVPG gradient showed association with anastomotic stenosis ( OR=0.69, 95% CI: 0.51-0.93, P=0.014). The area under ROC curves of PVPG gradient are 0.786 and 0.815 for predicting varices resolution and anastomotic stenosis, respectively. Conclusion:An increased intraoperative PVPG gradient could serve as a protective factor for an improved outcome of Rex shunt in EHPVO children and reduced risk of anastomotic stenosis.

Objective:To study the relationship between intraoperative portal venous pressure gradient (PVPG) changes and clinical outcomes of meso-Rex bypass in pediatric patients with extrahepatic portal vein obstruction (EHPVO).Methods:Clinical data of 76 children with EHPVO undergoing Rex shunt at Guangzhou Women and Children’s Medical Center, Affiliated to Guangzhou Medical University from April 2018 to October 2021 were retrospectively analyzed, including 49 males and 27 females, aged 62.0 (42.0, 102.5) months. Logistic regression was used to identify prognostic factors. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficacy of PVPG variations. The association between pre-/postoperative PVPG differences and clinical outcomes (resolution of hypersplenism/splenomegaly, improvement of gastroesophageal varices, and vascular complications) were systematically assessed.Results:All 76 pediatric patients underwent the Rex shunt successfully. Postoperative vascular complications occurred in 14 cases (18.4%), including six cases of bypass graft thrombosis (7.9%) and eight cases of anastomotic stenosis (10.5%). Logistic regression analyses revealed that graft type ( OR=0.03, 95% CI: 0-0.30, P=0.003) and PVPG gradient ( OR=1.65, 95% CI: 1.07-2.53, P=0.022) were associated with esophagogastric varices resolution after Rex shunt. Graft type also correlated with splenomegaly/hypersplenism improvement ( OR=0.08, 95% CI: 0.01-0.80, P=0.032). PVPG gradient showed association with anastomotic stenosis ( OR=0.69, 95% CI: 0.51-0.93, P=0.014). The area under ROC curves of PVPG gradient are 0.786 and 0.815 for predicting varices resolution and anastomotic stenosis, respectively. Conclusion:An increased intraoperative PVPG gradient could serve as a protective factor for an improved outcome of Rex shunt in EHPVO children and reduced risk of anastomotic stenosis.

Direct secretory expression of active microbial transglutaminase (MTG) using heterologous hosts is a promising strategy, although its production level still needs to be improved for industrial production. Pichia pastoris is one of the most efficient expression systems developed in recent years. In this study, secretory expression of active MTG was successfully achieved by co-expressing the pro sequence and mature MTG genes in P. pastoris. Furthermore, we optimized the copy number of pro/MTG expression cassettes and the fermentation conditions. MTG production level reached 7.3 U/mL in 1-liter fermentor through high density fermentation, providing the feasiblity for industrial scale preparation of MTG.
Fermentation ; Genetic Vectors ; genetics ; Pichia ; enzymology ; genetics ; metabolism ; Recombinant Proteins ; biosynthesis ; genetics ; Streptomyces ; enzymology ; Transglutaminases ; biosynthesis ; genetics

Clinical intemship is an important part of medical education.Medical eduezlion for foreign individuals in China has been initiated for a few years.Given the cultural and language background of foreign medical students,It is necessary to study and accumulate experience in developing an effective systern to manage their clinical intemship.We are here to present our approaches,such as teaching with both Chinese and English,arranging for Chinese students and foreign students to work together,to impmve surgical internship for foreign medical students in West China Medical School

AIM: To evaluate the prophylactic effect of aminophylline on the pulmonary hypertension rebound reaction to exposure to NO in the hypoxic pigs. METHODS: The 10 pigs undergone Swan-Ganz catheter, the mPAP was measured with a Physio-recording instrument and PaO 2 was measured with a blood gas analyzer, when breathing NO for 30 minutes and suddenly stopping breathing NO, administing aminophylline 0.25 g, followed by 30 minutes with room air. The respiratory rate and heart rate were also monitorried with a Hewlett-Packard portable monitor. RESULTS: The mPAP of the acute hypoxic pig was induced significantly after breathing 10 -5 NO. When suddenly stopping breathing NO, the induced mPAP became more and more high, the level of the mPAP in 5 minutes was similar to the values before absorbing NO, the mPAP in 10 minutes was higher than values before absorbing NO, while the level of PaO 2 was lower than the values before absorbing NO; but suddenly stopping breathing NO, administing aminophylline, although the induced mPAP became high, the speed was slower than the controls, the level of the mPAP in 30 minutes still was lower than the values before absorbing NO. CONCLUSION: Aminophylline has preventive effects on the pulmonary hypertension rebound reaction to exposure to NO in the hypoxic pigs.