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.

Objective To evaluate the diagnosis and treatment of early-stage hepatic artery thrombosis(HAT) after adult liver transplantation.Methods387 consecutive adult patients who underwent liver transplantation from June 2007 to October 2010 by the same surgery team in the Transplant Center,First Affiliated Hospital of Sun Yat-sen University were retrospectively studied.Hepatic arterial blood flow was monitored by color Doppler ultrasound (DUS) daily during the first week after transplantation.Ultrasonic contrast or hepatic artery angiography was performed on recipients with suspected HAT.Results10 patients developed HAT on 7(2-18)d after operation.The incidence of HAT was 2.6％ (10/387).Interventional therapy was performed in 2 patients with one patient who received a stent because of hepatic artery stricture.Three patients underwent emergent hepatic artery revascularization combined with intra-arterial urokinase thrombolysis treatment.One developed a rethrombosis and died.The remaining 2 patients received re-transplantation.Three patients died of liver failure and severe infection.The mortality rate was 40％ (10/387).ConclusionsIt is essential to diagnoses HAT by monitoring the artery flow by Doppler ultrasound screening in the early period after operation.Interventional therapy,emergent hepatic artery revascularization and re-transplantation are effective rescue treatments.Prevention of HAT is most important.

ObjectiveTo summarize the clinical experience of simultaneous pancreas and kidney transplantation (SPK) after liver transplantation for patients with diabetes and uremia.MethodsThe clinical data of two patients who received SPK after liver transplantation were retrospectively analyzed.The two male patients had type 2 diabetes mellitus before liver transplantation,and suffered from endstage uremia due to diabetic nephropathy and immunosuppressant-induced toxicity.Rapid technique for combined abdominal multiple viscera procurement was performed.Kidneys,pancreas,duodenum segment and spleen were procured.Renal allograft was placed in the left iliac fossa,whereas pancreas allograft in the right iliac fossa. The pancreatic allograft exocrine secretion was drained into the proximal jejunum via a side-to-side duodenojujunostomy. Quadruple immunosuppressive regime including IL2 receptor monoclonal antibody induction,tacrolimus (Tac),mycophenolate mofetil (MMF) and steroid were used in case 1,and ATG and methylprednisolone were used in case 2.ResultsSPK was successfully applied to these two patients without serious surgical complications such as pancreatitis,graft and pancreatic fistula. The immunosuppressive regimen was based on tacrolimus with ATG induction,MMF and steroids.In the second case,serum creatinine level was decreased to the normal range within 1 week after the operation and then elevated continuously even he received empirical anti rejection treatment,Tac was tampered and rapamycin was used when the renal graft biopsy indicated drug toxicity,and creatinine level was decreased 3 weeks after the operation and recovered to the normal range at 5th week post-transplant. Both of the two patients achieved euglycemia with insulin independence about 10 days after the operation.And now these two patients have been followed up for 36 and 9 months,and the grafts function of the liver,kidney and pancreas was normal. Conclusion Immunologic reaction in patients undergoing simultaneous pancreas and kidneytransplantationafterlivertransplantationseemsmorecomplex, andareasonable immunosuppressive regimen is important to improVe the outcome.

Objective To investigate the effects of ischemic preconditioning on the cholesterol content and the activity of Na+-K+-ATPase of hepatocytes following cold preservation in rats.Methods Twenty-five rats were randomly divided into five groups,including control group (C),cold preservation group (Ⅰ),ischemic preconditioning group (ⅠP),atorvastatin (30 μmol/L) treatment group (A30),and atorvastatin (100 μmol/L) treatment group (A100).The cholesterol content and the activity of Na+ -K+ -ATPase were assessed.Results The cholesterol contents on the rat liver tissue cell membrane in the C group,Ⅰ group,ⅠP group,A30 group and A100 group were (310.4 ± 27.5),(187.7±13.1),(394.3±25.9),(201.8±14.6) and (122.6±7.7) nmol/mg protein,and activity of the Na+ -K+ -ATP enzyme was (46.55 ± 3.20),(27.4 ± 2.81),(52.71 ± 3.02),(30.67 ±2.78) and (19.64 ± 2.11) μmol Pi/hr mg protein,respectively (P＜0.05).There was no significant difference in the plasma membrane phospholipid content among the five groups (P＞0.05).Conclusion Reduction of cholesterol content and Na+ K+ -ATPase activity on the liver cytoplasmic membrane is one of the factors causing donor liver cold preservation injury,but ischemic preconditioning can significantly improve cell membrane Na+ -K+ -ATPase activity and increase cytoplasmic membrane cholesterol content. Use of atorvastatin statins can reduce cytoplasmic membrane cholesterol synthesis,and significantly decrease Na+ -K+ -ATPase activity,thereby alleviating the donor liver cold preservation injury.