Liver transplantation is the standard treatment for end-stage liver disease， but it has long been limited by the shortage of donor livers. In clinical practice， three types of donor liver （domino donor livers， small-for-size grafts， and steatotic donor livers） are limited due to issues such as metabolic defects， insufficient volume， and poor quality. This article systematically reviews the definition， clinical application， and bottlenecks of the above three types of donor livers and elaborates on the unique value and clinical practice advances of auxiliary liver transplantation （a special surgical procedure that retains part or all of the recipient’s own liver and superimposes donor liver function support） in avoiding small-for-size syndrome， compensating for metabolic defects， and expanding the application of marginal livers， in order to provide a targeted clinical practice reference for optimizing liver transplantation strategies for end-stage liver disease and improving donor liver utilization rate.

Limb spasticity is a common complication after stroke,with clinical manifestations such as increased muscle tone,limb stiffness and pain,which reduces the quality of patients'daily life and increases the economic burden.Currently,scales,surface electromyography and biomechanical methods are mostly used to assess limb spasticity in clinical practice,but clinical scales rely on experience and are highly subjective;surface electromyography is prone to compensations and test errors;and biomechanical methods are more restrictive.Musculoskeletal ultrasound is not only capable of detecting muscle parameters and providing quantitative information such as muscle hardness and elasticity,but also has the unique advantages of high-resolution and real-time imag-ing,which has been increasingly used in clinical diagnosis and treatment.In this paper,we review the evidence related to musculoskeletal ultrasound and limb spasticity assessment,with the aim of exploring a simple and reasonable quantitative assessment method,which will provide some thoughts for the future clinical assessment of limb spasticity.

Objective:To analyze the changes of peripheral blood CD 4+ T lymphocyte subsets caused by nanosecond pulse ablation in C57BL/6J liver cancer mice and its effect on the immunity of liver cancer mice. Methods:According to the randomallocation, 32 female C57BL/6J mice weighing 18-20 g and aged 8-10 weeks were divided into the blank control group (Group A), the liver cancer control group (Group B), the radical liver lobectomy group (Group C), and the nanosecond pulse ablation treatment group (Group D), with 8 mice in each group. The in situ liver cancer models for mice in groups B, C, and D were established using Hepa 1-6 hepatoma cell line. On the 7th day after modeling, group C underwent liver lobectomy, and group D underwent nanosecond pulse ablation. After 7 days of treatment, the subtypes Th1, Th2, Th17 and Treg cell levels of CD 4+ T cells in the peripheral blood of the four groups of mice were detected by flow cytometry. Results:Flow cytometry was used to detect and analyze the proportions of CD 4+ T cell subsets Th1, Th2, Th17 and Treg in the peripheral blood of four groups of mice. Comparisons of each index among the groups showed statistically significant differences (all P<0.001). The proportion of Th1 cells detected by flow cytometry was (8.4±1.1) % in group A, (8.5±1.5)% in group D, (3.5±0.5)% in group B, and (2.4±0.5)% in group C. Both group A and Group D were higher than group B and group C, and the differences were statistically significant (all P<0.001). The proportion of Th2 cells detected by flow cytometry was (5.1±0.8)% in group A, (5.1±1.3)% in Group B, (5.4±0.9)% in group C, and (3.6±0.9)% in group D. The proportion of Th2 cells in groups A, B, and C was higher than that in group D, and the differences were statistically significant (all P<0.05). The proportion of Th17 cells detected by flow cytometry was (1.5±0.6)% in group A, (8.6±1.3)% in group B, (8.2±1.5)% in group C, and (1.7±0.3)% in group D. The proportion of Th17 cells in both group B and group C was higher than that in group A and group D, and the differences were statistically significant (all P<0.001). The proportion of Treg cells detected by flow cytometry was (7.0±0.9)% in group B, (6.8±0.9)% in group C, (3.8±0.8)% in group D, and (0.9±0.2)% in group A. The proportion of Treg in group B and group C was higher than that in group A and group D, and the difference was statistically significant (all P<0.001). Conclusion:Nanosecond pulse ablation for liver cancer in mice can regulate CD 4+ T cell subsets in peripheral blood, enhance the immune response of Th1 cells, inhibit the expression of Th2, Th17 and Treg cells, and improve the immunosuppressive state caused by liver cancer.

Objective To investigate the changes in coagulation system in acute decompensated cirrhosis(ADC)patients with or without sepsis and the association of these changes with short-term prognosis.Methods A prospective study was conducted among 116 ADC patients who were hospitalized in Nanfang Hospital from January 2021 to July 2023,among whom there were 86 patients with sepsis and 30 patients without sepsis,and 54 patients with sepsis alone who had no chronic liver disease were enrolled as control group.Thromboelastography(TEG)and other conventional coagulation parameters were used to comprehensively evaluate the coagulation function of patients.The data including TEG results and short-term prognosis were collected,and a correlation analysis was performed.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.The Spearman correlation coefficient was calculated to investigate the correlation between different variables.The Logistic regression model was used to perform the univariate and multivariate analyses.Results For the ADC patients with sepsis,the lungs and bloodstream were the main infection sites,and bacteria were the main pathogenic microorganism.TEG results showed that compared with the patients with sepsis alone,the patients with ADC and sepsis had a significant reduction in median maximum amplitude(MA),a significant increase in coagulation time(K time),and a significant reduction in α angle(all P<0.05);the patients with ADC and sepsis had a significantly longer reaction time(R time)than those with ADC alone(P=0.02),and the patients with sepsis alone had a significantly longer R time than those with ADC and sepsis(P=0.04).There was no correlation between MA and platelet count in the patients with ADC and sepsis(r=-0.133,P=0.057),while there was a significant correlation between MA and platelet count in the patients with sepsis alone(r=0.595,P=0.001).SOFA score was negatively correlated with MA in sepsis patients with or without ADC(r=-0.503 and-0.561,both P<0.001),and for the patients with ADC and sepsis,R time,K time,and α angle were weakly correlated with SOFA score and had a relatively strong correlation with APTT(all P<0.05).The patients with ADC alone all survived within 90 days,and compared with the death group,the patients with sepsis alone who survived had significantly higher values of MA and α angle(all P<0.05);there was a significant difference in α angle on day 90 between the survival group and the death group,no matter whether the patients were comorbid with ADC or not(both P<0.01),while for the patients with ADC and sepsis,there was no significant difference in MA value on day 90 between the survival group and the death group(P>0.05).Conclusion For ADC patients comorbid with sepsis,coagulation function assessment and monitoring should be taken seriously in clinical practice,and TEG parameters and SOFA score should be monitored when necessary to develop individualized treatment regimens.

OBJECTIVE: To report the blood group antigen and antibody specificity identification methods for a patient with high-frequency antibodies, and the process of finding and providing compatible blood for the patient. METHODS: A patient sent from the Blood Transfusion Department of Shanxi Provincial People's Hospital to Blood Transfusion Technology Research Laboratory of Taiyuan Blood Center in November 2022 was selected for the study. Classical serological methods were used to determine the patient's blood type, screen for unexpected antibodies, identify antibodies, and perform crossmatching. High-frequency antibody identification was carried out using red blood cells treated with various enzymes. Blood group genotyping was conducted using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF) and Sanger sequencing. Multiple strategies were employed to address the patient's blood source problem. The study was approved by the Medical Ethics Committee of Taiyuan Blood Center [Ethics No. 2024 Ethics Review No.(2)]. RESULTS: The patient's blood type was B, RhD positive. Initial screening of the patient's serum with multiple screening cells and antibody identification cells in saline medium was negative, but positive in antiglobulin medium. The patient's serum showed varying reaction intensities with red blood cells treated with different enzymes. MALDI-TOF mass spectrometry and Sanger sequencing revealed a homozygous nonsense variant c.376C>T (p.Gln126Ter) in the ABCG2 gene, resulting in the Jr(a-) phenotype. During family donor selection, the patient's son was found to have a heterozygous variant c.376C>T (p.Gln126Ter), and another heterozygous variant c.421C>A (p.Gln141Lys), which predicted a Jr(a+w) phenotype. Crossmatch tests confirmed the compatibility of blood from the patient's son, which was used to address the urgent blood requirement. Later, rare blood from a Jr(a-) donor from the Guangzhou Blood Center was used for the patient's ongoing treatment, saving the patient's life. CONCLUSION Combining classic serological testing with blood group gene typing techniques successfully identified the rare Jr(a-) blood type and high-frequency anti-Jra antibodies. Enzyme-treated red blood cell identification methods confirmed the presence of anti-Jra antibodies. By searching within the family and seeking help from other blood centers, compatible blood was found. This approach may provide insights for resolving similar complex blood matching problems in the future.
Humans ; Blood Grouping and Crossmatching/methods* ; Blood Group Antigens/immunology* ; Blood Transfusion ; Male ; Isoantibodies/blood* ; Female ; Genotype

OBJECTIVE: To explore the regulatory mechanisms underlying the weak expression of ABO blood group antigens due to variants in the non-coding regions of the ABO gene. METHODS: From June 2014 to October 2023, a total of 29 samples from the Taiyuan Blood Center and local hospitals, which were serologically identified as having weak ABO antigen expression without detectable coding region mutations, were selected for this study. Full-length ABO gene sequencing was performed using third-generation long-read sequencing technology (Pacific Biosciences) to obtain complete haplotype sequences of the ABO gene. Variants in the non-coding regions were compared and identified to infer their regulatory effects on weak antigen expression. The procedures followed in this study were in accordance with the ethical standards of the World Medical Association's Declaration of Helsinki (2013 revision). The Medical Ethics Committee of Taiyuan Blood Center has granted an exemption from ethical review. RESULTS: 18 bp deletions in the -35 to -18 region of the promoter were identified in 7 samples. Variants in intron 1 (+5.8 kb) were detected in 7 samples, including ABO*A (28+5792_5793delCT (1 case) and ABO*B (28+5793T>C) located in the GATA binding region; ABO*B (28+5808C>T) (1 case) in the E-box region; and ABO*B (28+5875C>T) (4 cases) in the RUNX1 binding region. Nucleotide variants at splice sites were detected in 2 samples, namely ABO*B (C.98+1G>A) and ABO*B (C.204-2A>C). CONCLUSION Variants in the non-coding regulatory sequences of the ABO gene are a significant factor contributing to weak ABO antigen expression. In clinical ABO sequencing, it is essential to screen not only the conventional coding regions but also the flanking sequences, introns, and splice sites of the ABO gene to facilitate precise blood transfusion.
ABO Blood-Group System/genetics* ; Humans ; Alleles ; Promoter Regions, Genetic ; Haplotypes ; Introns

Crown lengthening is one of the common periodontal surgeries for the purposes of function,aesthetic and periodontal health.In recent years,with the continuous development of minimally invasive concept,flapless crown lengthening surgery has been re-ceiving increasing attention in clinical practice.With the help of laser,piezosurgery and other tools,flapless crown lengthening surgery is used to remove alveolar bone through gingival sulcus without open-flap approach and suture.This minimally invasive flapless ap-proach can avoid direct exposure of alveolar bone,and has the advantages of less bleeding,less trauma,fast healing,simple operation and high patients'comfort.The review demonstrates surgical methods,indication selection and clinical application results of flapless crown lengthening,aiming at providing reference for clinicians to carry out this novel technique.

Objective To explore the mechanism of Tongdu Xingshen acupuncture,the clinical efficacy,systemic inflammatory response,blood-brain barrier and intestinal flora in patients with cognitive impairment after ischemic stroke(IS)were studied.Methods Thirty patients(3 cases shedding)with cognitive impairment after IS were included as the disease group,including patients before treatment as the disease group,patients after Tongdu Xingshen acupuncture treatment as the electroacupuncture group,and 30 healthy controls(3 cases shedding)were included as the healthy group.In the electroacupuncture group,on the basis of the basic treatment,Tongdu Xingshen acupuncture was applied,which was 30 min each time,once a day for 14 days.The MMSE,MoCA and MBI scores of the three groups were observed.The fecal and serum samples from all study subjects were collected,and 16S rDNA sequencing technology and ELISA were used to detect the changes of proinflammatory factors IL-6,IL-1β,TNF-α and S100β in serum in intestinal flora and feces.Results Compared with the healthy group,the MMSE,MoCA,and MBI score of patients in the disease group decreased significantly(P<0.05),serum proinflammatory factors and S100β protein content increased significantly(P<0.05),and the Shannon index(P<0.01)and Simpson index(P<0.001)increased significantly.Compared with the disease group,the MMSE,MoCA,and MBI score of the EA group increased significantly(P<0.05),the serum levels of proinflammatory factors and S100β decreased significantly(P<0.05),Shannon index and Simpson index decreased(P>0.05).The dominant bacterial flora in the healthy group mainly included Bacteroides,Bifidobacterium,Bacteroides,Faecalibacterium,Bifidobacteriaceae,Ruminococcaceae,and Bacteroides and other beneficial bacteria(P<0.05).The dominant flora in the disease group included Proteobacteria,Enterobacteriaceae,Escherichia,Klebsiella and other opportunistic bacteria(P<0.05),while the dominant flora in the EA group was consistent with the healthy group,the relative abundance of beneficial bacteria increased significantly(P<0.05),and the relative abundance of opportunistic bacteria decreased significantly(P<0.05).Spearman correlation analysis found that beneficial bacteria were positively correlated with clinical efficacy related indicators,but with serum proinflammatory factors and the content of S100β was negatively correlated.Conclusion Tongdu Xingshen acupuncture can regulate the diversity of intestinal flora to increase the abundance of Bacteroides,Bifidobacterium,Faecalibacterium,and other beneficial bacteria,regulate the intestinal microecological balance,Thereby regulating systemic inflammation and blood-brain barrier function,which plays a role in improving cognitive function.

Objective:To investigate the current status of treatment delay and analyze its influencing factors in patients with breast cancer-related lymphedema.Methods:Using convenience sampling, 218 patients with breast cancer-related lymphedema from The First Affiliated Hospital of Zhengzhou University between April 2024 and January 2025 were enrolled. The General Information Questionnaire, Lymphedema Self-Management Support Scale for Breast Cancer Survivors (LSMS-BCs), Brief Illness Perception Questionnaire for Breast Cancer-related Lymphedema (BIPQ-BCRL), Perceived Barriers to Health Care-Seeking Decision-Chinese (PBHSD-C), and Health Literacy Scale for Chronic Patients (HLSCP) were used to conduct a cross-sectional survey. Logistic regression identified predictors of treatment delay, with model fit assessed by the Hosmer-Lemeshow test. Discriminative ability was evaluated using receiver operating characteristic (ROC) curve analysis.Results:The study included 218 female BCRL patients, aged (58.31 ± 10.54) years. Among 218 patients, 76 experienced treatment delay, the incidence of treatment delay was 34.8% (76/218). Independent risk factors included junior high school education or below, no regular arm circumference measurement, low self-management support scores, low illness perception scores, high perceived barriers to healthcare-seeking scores, and low health literacy scores (Wald χ2 values were 7.75-15.15, all P<0.05). The Hosmer-Lemeshow test indicated good model fit ( χ2=6.21, P>0.05). The combined predictive model demonstrated significantly better discrimination than individual factors, the area under the curve of ROC was 0.846 ( P<0.01). Conclusions:The incidence of treatment delay is relatively high among breast cancer-related lymphedema patients. Nursing staff should pay special attention to patients with a junior high school education or below, no regular arm circumference measurement, low LSMS-BCs scores, low BIPQ-BCRL scores, high PBHSD-C scores and low HLSCP scores, implement timely interventions to reduce treatment delay in lymphedema patients.

Objective:To report the blood group antigen and antibody specificity identification methods for a patient with high-frequency antibodies, and the process of finding and providing compatible blood for the patient.Methods:A patient sent from the Blood Transfusion Department of Shanxi Provincial People′s Hospital to Taiyuan Blood Center in November 2022 was selected for the study. Classical serological methods were used to determine the patient′s blood type, screen for unexpected antibodies, identify antibodies, and perform crossmatching. High-frequency antibody identification was carried out using red blood cells treated with various enzymes. Blood group genotyping was conducted using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF) and Sanger sequencing. Multiple strategies were employed to address the patient′s blood source problem. The study was approved by the Medical Ethics Committee of Taiyuan Blood Center [Ethics No. 2024 Ethics Review No.(2)].Results:①The patient′s blood type was B, RhD positive. Initial screening of the patient′s serum with multiple screening cells and antibody identification cells in saline medium was negative, but positive in antiglobulin medium. The patient′s serum showed varying reaction intensities with red blood cells treated with different enzymes. ②MALDI-TOF mass spectrometry and Sanger sequencing revealed a homozygous nonsense variant c. 376C>T (p.Gln126Ter) in the ABCG2 gene, resulting in the Jr(a-) phenotype. During family donor selection, the patient′s son was found to have a heterozygous variant c. 376C>T (p.Gln126Ter), and another heterozygous variant c. 421C>A (p.Gln141Lys), which predicted a Jr(a+ w) phenotype. ③Crossmatch tests confirmed the compatibility of blood from the patient′s son, which was used to address the urgent blood requirement. Later, rare blood from a Jr(a-) donor from the Guangzhou Blood Center was used for the patient′s ongoing treatment, saving the patient′s life. Conclusion:Combining classic serological testing with blood group gene typing techniques successfully identified the rare Jr(a-) blood type and high-frequency anti-Jra antibodies. Enzyme-treated red blood cell identification methods confirmed the presence of anti-Jra antibodies. By searching within the family and seeking help from other blood centers, compatible blood was found. This approach may provide insights for resolving similar complex blood matching problems in the future.