Venous thrombosis is one of the common and serious complications after pancreas transplantation. The organ transplantation center of Shanxi Bethune hospital innovatively improved the previous surgical method of ligating the splenic artery and splenic vein to perform end-to-end anastomosis between the splenic artery and splenic vein in the tail of the pancreas and retain the effective diameter of the splenic artery of about 2 mm to increase the blood flow of splenic vein to prevent thrombosis. The center has successfully completed 2 cases, and the operation effect is good. Postoperative monitoring of abdominal vascular CT angiography showed that the splenic vein reflux was unobstructed. This operation can effectively increase the blood flow of splenic vein and reduce the risk of thrombosis.

Objective To explore the correlation between body fat estimation formula of Navarra University(CUN-BAE)and bone mineral density(BMD)in patients with type 2 diabetes mellitus(T2DM)and its predictive value for osteoporosis(OP).Methods A total of 428 patients with T2DM who were hospitalized in the Department of Endocrinology and Metabolism,Affiliated Hospital of Jiangsu University were enrolled in this study between October 2017 and October 2023.All the patients were divided into simple T2DM group(n=226),osteopenia(OT,n=126)group and OP group(n=76)according to BMD.The general data and biochemical indexes were compared between the two groups.The value of CUN-BAE was calculated,and the BMD value was testedby dual-energy X-ray method.The correlation between CUN-BAE and other indexes was evaluated by Spearman correlation,and the influencing factors for OP was evaluated by Logistic regression in T2DM patients.The diagnostic efficacy of CUN-BAE was explored by receiver operating characteristic(ROC)curve in T2DM patients complicated with OP.Results CUN-BAE was higher in OP group than in T2DM and OT group(P<0.05).Spearman correlation analysis showed that CUN-BAE was negatively correlated with the values of L1,L2,L3,L4,L1～L4,L2～L4,femoral neck BMD,wards triangle BMD,greater trochanter BMD,total hip BMD and L1～L4 BMD T value(P<0.05).Logistic regression analysis showed that CUN-BAE was a influencing factor for OP in T2DM patients.ROC curve analysis showed that the area under the curve predicted by CUN-BAE for T2DM patients complicated with OP was 0.672.Conclusions CUN-BAE value were significantly elevated in T2DM patients with OP.CUN-BAE was valuable for predicting OP in T2DM patients.

Objective To explore the correlation between body fat estimation formula of Navarra University(CUN-BAE)and bone mineral density(BMD)in patients with type 2 diabetes mellitus(T2DM)and its predictive value for osteoporosis(OP).Methods A total of 428 patients with T2DM who were hospitalized in the Department of Endocrinology and Metabolism,Affiliated Hospital of Jiangsu University were enrolled in this study between October 2017 and October 2023.All the patients were divided into simple T2DM group(n=226),osteopenia(OT,n=126)group and OP group(n=76)according to BMD.The general data and biochemical indexes were compared between the two groups.The value of CUN-BAE was calculated,and the BMD value was testedby dual-energy X-ray method.The correlation between CUN-BAE and other indexes was evaluated by Spearman correlation,and the influencing factors for OP was evaluated by Logistic regression in T2DM patients.The diagnostic efficacy of CUN-BAE was explored by receiver operating characteristic(ROC)curve in T2DM patients complicated with OP.Results CUN-BAE was higher in OP group than in T2DM and OT group(P<0.05).Spearman correlation analysis showed that CUN-BAE was negatively correlated with the values of L1,L2,L3,L4,L1～L4,L2～L4,femoral neck BMD,wards triangle BMD,greater trochanter BMD,total hip BMD and L1～L4 BMD T value(P<0.05).Logistic regression analysis showed that CUN-BAE was a influencing factor for OP in T2DM patients.ROC curve analysis showed that the area under the curve predicted by CUN-BAE for T2DM patients complicated with OP was 0.672.Conclusions CUN-BAE value were significantly elevated in T2DM patients with OP.CUN-BAE was valuable for predicting OP in T2DM patients.

Venous thrombosis is one of the common and serious complications after pancreas transplantation. The organ transplantation center of Shanxi Bethune hospital innovatively improved the previous surgical method of ligating the splenic artery and splenic vein to perform end-to-end anastomosis between the splenic artery and splenic vein in the tail of the pancreas and retain the effective diameter of the splenic artery of about 2 mm to increase the blood flow of splenic vein to prevent thrombosis. The center has successfully completed 2 cases, and the operation effect is good. Postoperative monitoring of abdominal vascular CT angiography showed that the splenic vein reflux was unobstructed. This operation can effectively increase the blood flow of splenic vein and reduce the risk of thrombosis.

Objective::To evaluate the feasibility, safety, and effectiveness of a novel edge-to-edge mitral valve repair system (the NovoClasp system) in patients with severe mitral regurgitation.Methods::In this prospective, single-arm, first-in-human study conducted at Beijing Anzhen Hospital, data were collected from patients undergoing transcatheter edge-to-edge repair using the NovoClasp system. The study candidates were patients exhibiting a mitral regurgitation severity of 3+ or more and were at high-risk or contraindicated for surgical intervention. Technical success and device success according to the Mitral Valve Academic Research Consortium definitions were used as primary outcomes. Other safety and efficacy outcomes were prospectively assessed at device implantation, discharge, and 30 d, 6 months, and 12 months post-procedure.Results::Between October 1, 2021, and January 31, 2022, 11 patients were treated for moderate-to-severe (grade 3+) or severe (grade 4+) mitral regurgitation using the NovoClasp system. All patients had a baseline New York Heart Association functional class of III-IV, with 7/11 exhibiting complex mitral valve disease. All patients achieved the primary endpoints of technical and device success, with a post-operative 30-d mitral regurgitation grade reduction to 2+ or lower, which was maintained at 12 months. One patient had minor bleeding and hematoma at the access site before discharge, and 2 patients were readmitted due to fast atrial fibrillation within 12 months post-discharge. No additional cases of death, adverse cerebral or cardiovascular events, or device-related complications was observed during the follow-up.Conclusion::This study suggested the potential feasibility and safety of the NovoClasp system, showing a promising technical and device success rate, along with a decrease in mitral regurgitation severity. A further pivotal study is needed to assess the procedural and long-term outcomes.

Objective::To evaluate the feasibility, safety, and effectiveness of a novel edge-to-edge mitral valve repair system (the NovoClasp system) in patients with severe mitral regurgitation.Methods::In this prospective, single-arm, first-in-human study conducted at Beijing Anzhen Hospital, data were collected from patients undergoing transcatheter edge-to-edge repair using the NovoClasp system. The study candidates were patients exhibiting a mitral regurgitation severity of 3+ or more and were at high-risk or contraindicated for surgical intervention. Technical success and device success according to the Mitral Valve Academic Research Consortium definitions were used as primary outcomes. Other safety and efficacy outcomes were prospectively assessed at device implantation, discharge, and 30 d, 6 months, and 12 months post-procedure.Results::Between October 1, 2021, and January 31, 2022, 11 patients were treated for moderate-to-severe (grade 3+) or severe (grade 4+) mitral regurgitation using the NovoClasp system. All patients had a baseline New York Heart Association functional class of III-IV, with 7/11 exhibiting complex mitral valve disease. All patients achieved the primary endpoints of technical and device success, with a post-operative 30-d mitral regurgitation grade reduction to 2+ or lower, which was maintained at 12 months. One patient had minor bleeding and hematoma at the access site before discharge, and 2 patients were readmitted due to fast atrial fibrillation within 12 months post-discharge. No additional cases of death, adverse cerebral or cardiovascular events, or device-related complications was observed during the follow-up.Conclusion::This study suggested the potential feasibility and safety of the NovoClasp system, showing a promising technical and device success rate, along with a decrease in mitral regurgitation severity. A further pivotal study is needed to assess the procedural and long-term outcomes.

Objective:To introduce a newly modified surgical approach and explore the clinical efficacy of en bloc kidney transplantation from deceased infant donors to adults.Methods:Four cases of en bloc kidney transplantation from deceased infant donor to adult were performed with a new modified surgical approach in renal transplantation and dialysis center of the Second People's Hospital of Shanxi Province from January 2017 to September 2019. All 4 cases were cardiac death donors. There were 3 males and 1 female donors, aged (54 ± 22.69) d and weighing (5.6 ± 0.79) kg. There were 1 male and 3 female recipients, aged (41.5 ± 5.97) years and weighing (45 ± 3.56) kg. For lowering operative difficulties and preventing hemodynamic disturbances, bilateral kidneys were sutured and fixed during trimming. Then end-to-side anastomosis was performed between donor kidney abdominal aortic valve and recipient external iliac artery and between donor renal inferior vena cava valve and recipient external iliac vein.Results:All operations were successful without vascular or urinary complication. The average duration of donor kidney repair was 20 min and the average duration of transplantation 68.75 min. The functions of transplanted kidney recovered well during a follow-up period of 12 months. The long-term survivals of recipient and transplanted kidney were satisfactory.Conclusions:The newly modified surgical approach of en bloc kidney transplantation from deceased infant donor to adult has optimized operative handling. With a higher success rate, vascular complications are lowered. A wider popularization is recommended.

Objective:To summarize the clinical experiences of 9 ABO-incompatible kidney transplantation at our center and explore its clinical application value.Methods:Methods From April 2016 to December 2019, there were 9 living kidney transplants of ABO incompatible relatives, including type A to type B (n=3), type B to type O (n=3), type B to type A (n=1) and type AB to type B (n=2). Immunosuppressant plus single membrane plasmapheresis (PE) and/or double filtration plasmapheresis (DFPP) and rituximab were employed for pretreating recipients. Adverse reactions of recipients were observed during and after pretreatment. Blood group antibody titer, complications and other related parameters were recorded before and after transplantation before and after monitoring pretreatment.Results:After pretreatment, IgM, IgG and total titer of blood group antibodies were ≤1: 4 on the day of transplantation and the titer of non-blood group antibodies rebounded within 2 weeks (≤1: 8). During preconditioning, 2 patients experienced oral numbness and involuntary dithering during plasmapheresis and there was 1 case of infusion reaction after rituximab dosing. The early recovery of renal function was all excellent. Renal biopsy was performed in 4 patients with slow elevation of serum creatinine and 1 case developed acute antibody-mediated rejection. The survival rate of all recipients at the last follow-up was 100%.Conclusions:Live kidney transplantation of ABO-incompatible relatives is both safe and feasible so that it may help alleviate some shortage of donor kidney.

Objective To evaluate the efficacy and safety of converting traditional triple immunosuppressive regimen into quadruple immunosuppressive regimen of low-dose tacrolimus plus sirolimus plus mycophenolic acid plus hormone in expanded criteria donor (ECD) renal transplant recipients .Methods A retrospective analysis was conducted for 39 patients undergoing extended standard kidney transplantation with conversion therapy from January 2015 to June 2018 .Renal function ,liver function ,blood lipid ,bone marrow suppression ,positive rate of urinary protein ,positive rate of urinary BK virus and other adverse reactions were analyzed .Results A total of 39 recipients fulfilled the inclusion criteria ,including 28 boys and 11 girls with an average age of (37 .69 ± 11 .07) years and a median postoperative conversion time of 6 months .As compared with pre-conversion therapy ,renal function and estimated glomerular filtration rate improved significantly at 1 month ,3 months ,6 months and 1 year (P<0 .05) .No significant difference existed in the level of blood lipid ,whole blood leukocyte or hemoglobin at pre and post-conversion ( P>0 .05) .No significant difference existed between AST and ALT at pre and post-conversion (P< 0 .05) . After conversion , the positive rates of urinary protein and BK virus urine declined . Subacute rejection occurred in 1 case after conversion .Addition of sirolimus was curative .No severe adverse reactions such as infection and diarrhea occurred in the remaining cases .Conclusions T he quadruple immunosuppressive regimen of low-dose tacrolimus plus sirolimus plus mycophenolic acid and hormone is both safe and effective for ECD recipients of renal transplantation .