Objective To analyze three-dimensional imaging characteristics and advantages for severe portal vein stenosis after liver transplantation, and to evaluate clinical efficacy of portal vein stent implantation. Methods Clinical data of 10 patients who received portal vein stent implantation for severe portal vein stenosis after liver transplantation were retrospectively analyzed. Imaging characteristics of severe portal vein stenosis, and advantages of three-dimensional reconstruction imaging and interventional treatment efficacy for severe portal vein stenosis were analyzed. Results Among 10 patients, 3 cases were diagnosed with centripetal stenosis, tortuosity angulation-induced stenosis in 2 cases, compression-induced stenosis in 2 cases, long-segment stenosis and/or vascular occlusion in 3 cases. Three-dimensional reconstruction images possessed advantages in accurate identification of stenosis, identification of stenosis types and measurement of stenosis length. All patients were successfully implanted with portal vein stents. After stent implantation, the diameter of the minimum diameter of portal vein was increased [(6.2±0.9) mm vs. (2.6±1.7) mm, P<0.05], the flow velocity at anastomotic site was decreased [(57±19) cm/s vs. (128±27) cm/s, P<0.05], and the flow velocity at the portal vein adjacent to the liver was increased [(41±6) cm/s vs. (18±6) cm/s, P<0.05]. One patient suffered from intrahepatic hematoma caused by interventional puncture, which was mitigated after conservative observation and treatment. The remaining patients did not experience relevant complications. Conclusions Three-dimensional visualization technique may visually display the location, characteristics and severity of stenosis, which is beneficial for clinicians to make treatment decisions and assist interventional procedures. Timely implantation of portal vein stent may effectively reverse pathological process and improve portal vein blood flow.

Objective:To investigate the prognostic factors for liver transplantation for hepatocellular carcinoma beyond UCSF criteria but without macrovascular invasion.Methods:A retrospective analysis was performed for the clinical data of the hepatocellular carcinoma patients without macrovascular invasion beyond UCSF criteria who underwent liver transplantation at our center from Jan 2018 to Jun 2023. The receiver operating characteristic curve analysis was performed to assess the predictive power of potential prognosis factors.Results:With this criteria, the 1-, 3-year overall survival rates were 94.1% and 75.0%, respectively, and the 1-, 3-year tumor free survival rates were 82.4% and 38.1%, respectively. The maximum tumor size, number of tumors, AFP, PIVKA-Ⅱ before transplantation, and whether undergo pretransplant down-stage therapy were significant prognostic factors ( P<0.05). Combining the above prognostic factors to construct the receiver operating characteristic curve yielded an area under the curve of 0.967, with a sensitivity and specificity of 0.932, 0.952, respectively. Further, the differentiation, MVI and Ki-67 were significant prognostic factors ( P<0.05). Combining pathological factors to construct the receiver operating characteristic curve yielded an area under the curve of 0.927, with a sensitivity and specificity of 0.769, 1, respectively. Conclusion:The maximum tumor diameter, number of tumors, AFP, PIVKA-Ⅱ before transplantation, and pretransplant down-stage therapy and tumor differentiation, MVI and Ki-67 are all prognostic factors of liver transplantation for hepatocellular carcinoma without macrovascular invasion beyond UCSF criteria.

Objective To summarize the diagnosis and treatment experience of portal vein aneurysm after liver transplantation. Methods Clinical data of two recipients with portal vein aneurysm after liver transplantation were retrospectively analyzed. Clinical features, diagnosis, treatment and prognosis were summarized based on literature review. Results Both two cases were diagnosed with intrahepatic portal vein aneurysm complicated with portal vein thrombosis and portal hypertension after liver transplantation. Case 1 was given with targeted conservative treatment and he refused to undergo liver retransplantation. Physical condition was worsened after discharge, and the patient eventually died from liver graft failure, kidney failure, lung infection, and septic shock. Case 2 received high-dose glucocorticoid pulse therapy, whereas liver function was not improved, and the patient was recovered successfully after secondary liver transplantation. Conclusions Long-term complication of portal vein aneurysm (especially intrahepatic type) after liver transplantation probably indicates poor prognosis. Correct understanding, intimate follow-up and active treatment should be conducted. Liver retransplantation may be a potential treatment regimen.

Objective To investigate the renoprotective effects of a Sichuan dark tea-based medicated dietary formula(alternatively referred to as Qing,or clarity in Chinese)on mice with diet-induced obesity(DIO)and to explore the specific mechanisms involved.Methods Male C57BL/6 mice were randomly assigned to three groups,a control group,a DIO group,and a Qing treatment group,or the Qing group,with 8 mice in each group.The mice in the control group were given normal maintenance feed and purified water,and the other two groups were fed a high-fat diet for 12 weeks to establish the DIO model.After that,high-fat diet continued in the DIO group,while the Qing group was given Qing at the same time for 12 weeks,during which period the weight of the mice was monitored and recorded every week.The mice were sacrificed after 12 weeks.Serum samples were collected and the levels of triglyceride(TG),total cholesterol(TC),alanine aminotransferase(ALT),aspartate aminotransferase(AST),and albumin were measured to evaluate liver function.In addition,renal lipids were extracted to determine the levels of TG and TC in the kidney and periodic acid-Schiff(PAS)and oil red O stainings were performed to evaluate kidney pathological injury.Western blot was performed to determine the phosphorylated AMPK(pAMPK)/AMPK ratio in the kidney tissue.RT-qPCR and Western blot were used to determine the expression of proteins related to fatty acid oxidation,including acetyl-CoA carboxylase 1(ACC1),carnitine acyltransferase 1(CTP1),peroxisome proliferators-activated receptor γ(PPARγ),peroxisome proliferators-activated receptor-1 α(PPAR1α),sterol-regulatory element binding proteins(SREBP-1),and key proteins related to lipid synthesis,including fatty acid synthase(FASN)and stearoyl-coenzyme A desaturase 1(stearoyl-CoA desaturase)in the kidney tissue.16SrRNA and metabolomics were applied to analyze the gut microbiota in the intestinal contents and its metabolites.Results Compared with those of the control group,the levels of liver mass(P=0.000 3),serum ALT(P＜0.000 1)and AST(P=0.0001),and kidney TC(P=0.0191)and TG(P=0.0101)of the DIO group were significantly increased and there was lipid deposition in the kidney.Compared with those of the DIO group,mice in the Qing group showed effective reduction in liver mass(P=0.0316)and improvements in the abnormal serum levels of AST(P=0.0012)and ALT(P=0.002 7)and kidney TC(P=0.0200)and TG(P=0.0499).In addition,mice in the Qing group showed significant improvement in lipid deposition in the kidney.Qing group showed increased pAMPK/AMPK ratio in comparison with that of the DIO group.In comparison with those of the control group,mice in the DIO group had upregulated expression of lipid synthesis-related genes and proteins(SREBP-1,FASN,and SCD1).As for the fatty acid oxidation-related genes and proteins,DIO mice showed upregulated expression of ACC1 and downregulated expression of CPT1A,PPARy,and PGC1α in comparison with those of the control group.In the Qing goup,improvements in regard to all these changes were observed.The Qing group demonstrated improvement in the disrupted homeostasis of the gut microbiota.Short-chain fatty acids in the cecal contents,especially isovaleric acid and propionic acid,were also restored.Conclusion Sichuan dark tea-based medicated dietary formula may improve renal lipid metabolism by regulating gut microbiota and the levels of intestinal short-chain fatty acids,thereby protecting obesity-related kidney injury.Isovaleric acid and propionic acid may be the metabolites key to its regulation of gut microbiota.

Objective:Lung ultrasound (LUS) has been used in the diagnosis of neonatal respiratory distress syndrome(RDS) successfully, but there have been no multicenter prospective studies to verify its reliability or determine how to grade RDS with LUS findings.This study aimed to discuss the necessity and feasibility of using LUS findings to determine RDS grades through a multicenter prospective study.Methods:Every researcher participated in the National Neonatal Lung Ultrasound Training Course and receiving 3-6 months of lung ultrasound system training at the National Neonatal Lung Ultrasound Training Center.Patients between June 2018 and May 2020 who met the RDS ultrasound diagnostic criteria and had full available clinical data were included in this study.The LUS examination was completed immediately after the patients were admitted to the hospital.Some of them also underwent chest X-ray examination.Arterial blood gas analysis was completed immediately before or after the LUS ultrasound examination.RDS grading was performed according to the LUS findings and whether the patient had serious complications.Results:A total of 275 qualifying cases were included in this study, which included 220 premature infants and 55 full-term infants, and the primary RDS occurred in 117 cases (42.5%), and secondary RDS occurred in 158 cases (57.5%). LUS manifestations of RDS patients can be divided into three categories: (1)A ground-glass opacity sign: which could be found among 50 infants when they were admitted to the hospital (that was, at their first LUS examination). Twenty-eight of these infants were considered to have wet lungs and were not sent for special management on admission, but LUS showed typical snowflake-like lung consolidation within 0.5 to 4 hours.Twenty-two of them were given mechanical ventilation with exogenous pulmonary surfactant; Eighteen cases were controlled within 6-12 hours, but the lung lesions became more severe in the other 4 infants (due to severe intrauterine infection). (2)Snowflake-like lung consolidations: the first LUS on admission showed typical snowflake-like lung consolidation involving areas ranging from 1-2 intercostal spaces to 12 lung divisions in 204 cases.Thirty-eight infants among them the lung consolidation only had involvement of 1-2 intercostal spaces at the time of admission; Fifteen of them received invasive respiratory support and recovered within 4-12 hours.Twelve patients received noninvasive respiratory support; Seven of them recovered, while five cases developed severe lung illness.The remaining 11 patients who were not given any form of ventilator support developed severe conditions within 1-4 hours.Thirty of them showed snowflake signs involving 12 lung regions at admission.The remaining 136 patients had lung consolidation degree between the two degree above condition.(3)Snowflake-like sign with complications: Twenty-one patients had severe complications such as pneumothorax, pulmonary hemorrhage or/and persistent pulmonary hypertension of the newborn or large area atelectasis, etc, although snowflake lung consolidation did not involve all lung regions.Conclusion:(1) LUS is reliable and accurate for diagnosing RDS.RDS has the same characteristics on ultrasound for both preterm and full-term infants, both primary and secondary RDS.(2) To facilitate the management of RDS, it is necessary to classify RDS according to the ultrasound findings and the presence of severe complications.(3) Based on the results of this study, it is recommended that RDS can be divided into mild, moderate and severe degrees.The exact standards for grading are as follows: Mild RDS: the early stage of RDS, in which lung consolidation shows as a ground-glass opacity sign on ultrasound; Moderate RDS: lung consolidation shows a snowflake sign on ultrasound, not all of the lung fields are involved; Severe RDS meets one or more of the following criteria: lung consolidation shows as a snowflake sign on ultrasound and all lung regions are involved, or regardless of its degree and extent, lung consolidation has caused serious complications, such as pulmonary hemorrhage, pneumothorax, persistent pulmonary hypertension of the newborn, or/and a large area of pulmonary atelectasis.

Objective: To investigate the application value of augmented reality (AR) technology in pancreatoduodenectomy (PD). Methods: The retrospective and descriptive study was conducted. The clinicopathological data of 3 male patients who underwent PD in Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital from June 2018 to February 2019 were collected. The 3 patients were aged from 52 to 63 years, with a median age of 57 years. Digital imaging and communication standard format data of enhanced computed tomography (CT) scan were collected, the three-dimensional (3D) images of abdominal arteries, portal vein, descending duodenum, pancreatic body and tail, pancreatic head, common bile duct, and pancreatic duct were reconstructed. The results were imported into the AR software. Optical tracking based on two-dimensional codes and manual interactive rigid registration were adopted for intraoperative navigation. Observation indicators: (1) surgical and postoperative conditions; (2) postoperative pathological examination; (3) follow-up. Follow-up using outpatient examination or telephone interview was conducted to detect survival of patients and tumor metastasis and recurrence up to June 2019. The measurement data with skewed distribution were expressed as M (range). Count data were expressed as absolute numbers. Results: (1) Surgical and postoperative conditions: all the 3 patients underwent PD with AR technology as intraoperative navigation successfully. The operation time, volume of intraoperative blood loss, and duration of postoperative hospital stay were 6 hours (range, 5-8 hours), 700 mL (range, 300-900 mL), 11 days (range, 9-12 days). There was no perioperative death or complication occured. After surgery, the patients who underwent PD combined with superior mesenteric vein (SMV) resection and reconstruction had patent SMV on the enhanced computed tomography examination. (2) Postoperative pathological examination: results of pathological examination showed 1 case of intraductal papillary mucinous neoplasm (IPMN) of the pancreas with invasive adenocarcinoma (neoplasm invading SMV), 1 case of insulinoma, and 1 case of periampullary neuroendocrine carcinoma, respectively. (3) Follow-up: 3 patients were followed up for 4-12 months, with a median follow-up time of 6 months. During the follow-up, the patient with IPMN of the pancreas and invasive adenocarcinoma had liver metastasis at 3 months after surgery, and received chemotherapy at other hospital. After 4 cycles of chemotherapy, the metastatic nodule shrank, and the patient was still in follow-up up to deadline of follow-up. Other 2 patients had no recurrence or metastasis. Conclusion AR technique assisted PD is safe and feasible, which is helpful to indentify vascular branches and tracks.

Objective To explore the diagnostic value of serum procalcitonin ,C‐reactive protein and white blood cell count in children with different diseases .Methods Retrospective analysis 94 cases of pathogenic infectious children from June 2013 to May 2014 in our hospital ,according to the results of pathogen detection was divided into bacterial infection 36 cases ,mycoplasma infec‐tion group 28 cases ,30 cases of viral infection ,detection and analysis serum PCT ,CRP and WBC levels .Results Bacterial infection group serum PCT ,CRP and WBC were (2 .41 ± 0 .94)ng/mL ,(47 .91 ± 18 .26)mg/L and (13 .18 ± 6 .03) × 109/L ,significantly higher than the mycoplasma infection and viral infection group (F=133 .4 ,F=60 .1 ,F=8 .5 ,P<0 .05);diagnosis of bacterial in‐fections ,PCT sensitivity and specificity were 92 .11% and 91 .05% ,positive and negative predictive value of 89 .84 % and 94 .01%were significantly higher than CPR and WBC ,Mycoplasma infection as the control group ,PCT ,CRP and WBC in the diagnosis of bacterial infections ,the area of under the ROC curves were 0 .816 ,0 .728 and 0 .614 ,respectively .Conclusion Serum PCT for the i‐dentification of bacterial infections has a high diagnostic value ,worth generalizing and applying .