Objective:To analyze the clinical characteristics of monkeypox patients.Methods:The clinical data and laboratory findings of 4 patients with monkeypox patients diagnosed at Yiwu Central Hospital in July 2023 were analyzed. Herpes fluid and skin tissue samples were collected, the viruses were isolation and cultured in African green monkey kidney cells (Vero) and identified with whole gene sequencing.Results:All four patients were male, aged 24-35 years. All patients had male-to-male behavior within 21 days before onset of the disease. Among them, one patient has AIDS and one patient has syphilis. Four patients presented with perineal skin lesions with itching, and 3 patients were found to have enlarged lymph nodes upon admission. Laboratory testing: lymphocyte abnormality (4.57×10 9/L) in 1 case; increased procalcitonin (0.25 ng/mL) in 1 case; elevated IL-10 levels ( 7.11 ng/L and 9.42 ng/L) in 2 cases; increased IL-6 (66 ng/L) and IL-4 (3.24 ng/L) in 1 case, respectively. One case had abnormal myocardial zymogram with a elevated lactate dehydrogenase level of 313 U/L. The monkeypox virus was isolated from lesion tissue and herpes fluid, and the whole gene sequencing identified it as the B. 1.3 subtype of the IIb evolutionary branch, exhibiting typical pathological effects on Vero cells. Conclusion:The clinical manifestations of the 4 monkeypox patients confirmed in Zhejiang province are mild, patients had a definitive history of male-to-male sexual behavior and the virus strains belong to the B. 1.3 lineage of the IIb evolutionary branch.

Objective:To investigate the effectiveness and safety of fully-covered self-expandable metal stent (FCSEMS) with plastic stent over the treatment of post liver transplantation anastomotic biliary stricture (AS).Methods:The clinical data of AS patients after liver transplantation admitted to the First Affiliated Hospital of Sun Yat-sen University from January 2014 to April 2018 was collected for the retrospective study. According to different implanted stents, patients were divided into FCSEMS group and plastic stent group. The general information of the two groups of patients, surgical success rate, postoperative complications, the number of endoscopic retrograde cholangiopancreatography (ERCP), the number of indwelling stents and other indicators were compared and analyzed.Results:A total of 54 patients were enrolled, including 41 males and 13 females, with a median age of 48 (34-65) years. A total of 23 cases were included in the FCSEMS group and 31 cases were included in the plastic stent group. The overall technical success rate of the operation was 98.3% (176/179). In the FCSEMS group, there were 21 patients recovered and 2 patients were relieved; in the plastic stent group, 29 patients were recovered, 1 case was relieved, and 1 case failed. There were no statistically significant differences in the efficacy and complication rate between the two groups (all P>0.05). The median stent indwelling time, ERCP times, and the number of indwelling stents in the FCSEMS group were 5.9 months, 2 times, and 1, respectively, and in the plastic stent group were 9.5 months, 4 times, and 8 respectively. There were statistical differences between the two groups (all P<0.05). Conclusions:FCSEMS for treatment of AS showed less duration of stenting, numbers of stents and endoscopic treatment sessions with the similar efficacy as plastic stents. It’s indicated that it’s necessary to pay attention to the probability of stent migration and pancreatitis.

Objective To learn customer satisfaction for health management centers at public hospitals in Hangzhou. Methods From July to September 2015, 660 customers from the health management centers of 6 public hospitals in Hangzhou were randomly selected for questionnaire survey. The survey included their satisfaction for the technical attitude, service content design, waiting time, environment facilities, management regulations, and service charges. Univariate analysis was carried out on the satisfaction scores of customer demographics. Two-class logistic regression was used to analyze the factors affecting customer satisfaction. Results The average customer satisfaction score was 3. 62 ± 0. 55. Their satisfaction with technical attitude, service content design, environmental facilities and management regulations was higher. They were less satisfied with waiting time(3. 20 ± 0. 85) and service charge(3. 36 ± 0. 71). Conclusions Overall satisfaction of customers for such centers is high. In the future, we should further strengthen the information management and procedures of these centers, and link health management services with commercial insurance, for less economic burden on the people.

Objective To investigate the correlation between the elastographic characteristics of liver and postoperative function of liver allografts.Methods Forty-eight cases of liver transplantation from The First Affiliated Hospital of Sun Yat-sen University were analyzed,Shear wave elastography (SWE) was performed before operation or at one week or one month post-operation.Liver function was evaluated by measuring alanine aminotransferase (ALT),aspartate transaminase (AST),total bilirubin (TBIL),γ-glutamine transferase (GGT),albumin (ALB),alkaline phosphatase (ALP),prothrombin time (PT),activated partial thromboplastin time (APTT),and international normalized ratio (INR).Early allograft dysfunction (EAD) was also analyzed with reference to SWE among liver transplant recipients.Results SWE at one week after transplantation was significantly correlated with TBIL (r=0.525 6,P<0.01),APTT (r=0.668 3,P<0.000 1),PT (r=0.593 7,P=0.000 1),INR (r=0.609 6,P<0.000 1) and prealbumin (r=-0.464 1,P<0.01).However,no significant correlation was observed between pre-operative SWE and parameters of post-operative liver function.SWE in EAD patients was higher than that of patients without EAD (17.60±1.09 kPa vs.13.38±0.99 kPa,P<0.01).The optimal cut-off value of SWE at one week post-operation was 14.85 kPa.Conclusion Postoperative SWE is significantly correlated with postoperative liver function tests and EAD,suggesting SWE is a potential test for evaluating the quality of liver allografts.

Acute Disease ; Glucocorticoids ; Graft Rejection ; Heart Rate ; Humans ; Hyperglycemic Hyperosmolar Nonketotic Coma ; Liver Transplantation

Objective To investigate the methods and techniques for organ procurement from donation after cardiac death (DCD),and to evaluate post-transplant outcomes.Methods In this retrospective study,clinical data of 26 cases of DCD organ procurements were analyzed through either epigastric multivisceral organ harvesting or solitary organ harvesting.Results Twenty livers,44 kidneys and 2 multivisceral grafts were procured,followed by 24 cases of liver transplantation,42 cases of kidney transplantation,and 2 cases of multivisceral transplantation.The operations were successful and all transplanted organs were satisfactorily recovered with no primary nonfunction or other complications observed.Conclusion Our methods and techniques for organ procurement from DCD donors require experienced surgery skills,while can maximatily shorten donor organ ischemic time,guarantee procurement of high quality of organs and ensure a favourable transplant outcomes.

Objective To analyze the risk factors for the outcomes of recipients after orthotopic liver transplantation using donation after cardiac death (DCD) donors.Method A retrospective study was performed to observe the available clinical data of 60 patients who had receiced hepatic allografts of DCD donors from July 2007 to December 2012 in our hospital and a 3-year follow-up was conducted to investigate outcome.In the patients whose ALT and/or AST levels were more than 1500 U/L within 72 h following surgery,early allograft dysfunction (EAD) was defined.Potential risk fators right before surgery included donor and recipient age,donor ALT AST,TBIL and WIT,and recipient creatine,TBIL,INR,albumin,MELD,BMI and recipient CIT.Kaplan-meier method was used to calculate the cumulative survival rate.Log-rank test and Cox regression model were performed to analyze donors and recipients related risk factors by univariate and multivariate analysis respectively.All statistical data were analyzed by using SPSS 19.0.Results The overall cumulative survival rate of 1 and 3 years was 76％ and 62％ respectively.Donor ALT,AST and WIT,and recipient Cre,MELD,CIT and EAD were significant risk fators in univariate analysis.However,the multivariate analysis revealed that donor WIT was the only independent risk factor affecting survival in our study.Conclusion By identifying and controlling certain characteristics,the outcomes of DCD liver transplant recipients could be dramaticly improved.

ObjectiveTo investigate a reasonable perioperative nutrition support therapy for combined ‘en bloc’ liver/pancreas transplants (CLPT).MethodThe clinical data of 10 patients,5 with gastrointestinal malignancy and liver metastasis and the other 5 with end-stage liver cirrhosis complicated with insulin-dependent type 2 diabetes mellitus ( T2DM),who had undergone CLPT in our center from May 2004 to September 2010 were retrospectively analyzed.All these patients received preioperative nutrition support,including normal food combined with nutrient solution before surgery,and total parenteral nutrition (TPN) to parenteral nutrition (PN) +enteral nutrition ( EN ) and to EN after surgery.The intestinal absorption,nutritional status,laboratory test results,and complications were recorded.ResultsAll recipients experienced a smooth recovery from the procedure,with normal or almost normal liver,pancreas,and duodenum graft functions.Three patients suffered from intestinal fistula,and all of them received TPN therapy; two patients died of multiple organ failure and one recovered from the complication.The remaining seven patients had smooth transition from TPN to EN.Of the 5 patients with malignancies,three died of multiple organ failure and 2 died of cancer recurrence.Of the 5 patients with liver cirrhosis and T2DM,four patients survived and 1 patient died of graft-verse-host disease.ConclusionRational perioperative nutrition support is important for the successful recovery after CLPT.

Objective To study the impact of various donor hepatectomy techniques on clinical rehabilitation and postoperative liver regeneration on living donor liver transplant (LDLT) donors.Methods The data of 13 consecutive LDLT carried out from May 2006 to May 2011,including the surgical techniques,postoperative liver function,and liver regeneration in the donors were retrospectively studied.Results The donor operations included 8 right hepatectomies without the middle hepatic vein,2 right hepatectomies with the middle hepatic vein and 3 left hepatectomies.Hepatic function and blood coagulation function returned to normal within two weeks of hepatectomy in all the donors.There was no severe complication and no death.There was a significant positive correlation between the donor liver volume as measured preoperatively on CT and the resected liver weight as measured intraoperatively (r=0.838,P＜0.01).The volume of the remnant liver increased soon after transplantation.The liver regenerated significantly faster in right than in lefft liver donors.The remnant liver of the right liver donors with middle hepatic vein preservation grew faster than the right liver donors without middle hepatic vein preservation.However,there was no significant difference in the recovery of the liver function between the three groups.Conclusions Donor hepatectomy is safe.The postoperative liver regeneration is affected by multiple factors including the remnant liver volume and blood supply of the remnant liver.

Objective To explore the clinical efficacy of the upper abdomen organ transplantation in the treatment of end stage liver disease and type 2 diabetes mellitus (T2DM).Methods The clinical data of 7 cases receiving liver-duodeno-pancreatic organ cluster transplantation in patients with end-stage liver disease and T2DM were retrospectively analyzed.The pancreas and the whole digestive tract of the recipients were reserved during operation,simple liver excision was executed,and abdominal multiple organs including pancreas,duodenum and part of jejunum were transplanted.The liver and kidney functions,blood glucose,C peptide,infection,rejection,vascular complications,biliary complications and other indicators were monitored postoperatively.Results No insulin was used in all the patients 1-7 days after operations,the blood glucose levels returned to almost normal, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin became normal after 1 week,and C peptide levels reached the normal range in 1 to 2 weeks.Among 7 patients,one died of graft-versus-host disease 1 month after operation,one got acute renal failure,one suffered from pulmonary infection, one had pancreatic leakage but recovered after unobstructed drainage,and no obvious complications were observed in the remaining patients.So far 6 live recipients were followed up for 1-39 months,the functions of the liver and pancreatic grafts were normal without hepatitis B and tumor recurrence, and the quality of life in the patients was satisfactory.Conclusion Liver-duodeno-pancreatic organ cluster transplantation is technically feasible and an effective method for the treatment of end-stage liver disease with T2DM.