During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Objective To evaluate the clinical efficacy of liver transplantation in children with Alagille syndrome (ALGS). Methods Clinical data of 12 children with ALGS were collected and retrospectively analyzed. Clinical characteristics of children with ALGS, pathological characteristics of liver tissues, characteristics of liver transplantation, postoperative complications and follow-up of children with ALGS were analyzed. Results JAG1 gene mutation and typical facial features was present in all 12 children. Jaundice was the most common initial symptom, which occurred at 7 (3, 40) d after birth. Upon liver transplantation, the Z scores of height and body weight were calculated as -2.14 (-3.11, -1.83) and -2.32 (-3.12, -1.12). Five children developed severe growth retardation and 4 children with severe malnutrition. Eight of 12 children were diagnosed with cardiovascular abnormalities. Pathological examination showed that the lobular structure of the diseased livers of 4 children was basically maintained, and 8 cases of nodular liver cirrhosis in different sizes including 1 case of single early moderately-differentiated hepatocellular carcinoma. Three children were misdiagnosed with biliary atresia and underwent Kasai portoenterostomy. Eight children underwent living donor liver transplantation, three children underwent cadaveric donor liver transplantation (two cases of split liver transplantation and one case of cadaveric total liver transplantation), and one child underwent domino liver transplantation (donor liver was derived from a patient with maple syrup urine disease). during the follow-up of 30.0(24.5, 41.7) months, the survival rates of the children and liver grafts were both 100%. During postoperative follow-up, the Z scores of height and body weight were calculated as -1.24 (-2.11, 0.60) and -0.83 (-1.65, -0.43), indicating that the growth and development of the children were significantly improved after operation. Conclusions Liver transplantation is an efficacious treatment for children with ALGS complicated with decompensated cirrhosis, severe itching and poor quality of life. For children with ALGS complicated with cardiovascular abnormalities, explicit preoperative evaluation should be delivered, and consultation with pediatric cardiologists should be performed if necessary.

Objective:To explore the feasibility of using vascular graft interposition for lowering the complications of portal vein during pediatric liver transplantation.Methods:From June 1, 2013 to May 31, 2018, clinical data were collected for 297 children undergoing liver transplantation, including basic demographics, general preoperative status, preoperative tests, imaging findings, graft related profiles, surgical procedures and postoperative follow-ups, etc. Then the authors analyzed the effect of using interposition vessels upon lowering postoperative complications of portal vein reconstruction.Results:With a median age of 12 months, there were 153 boys (51.5%) and 144 girls (48.5%). The primary disease was mostly biliary atresia ( n=222, 74.7%). The median diameter of portal vein was 5 mm. There were 19 cases (6.4%) using vascular interposition. Among 20 cases of portal vein complications, there were portal vein stenosis ( n=17, 5.7%) and portal vein thrombosis ( n=3, 1.0%). After univariate analysis, binary Logistic regression analysis revealed that diameter of recipient's portal vein was an independent risk factor for the occurrence of portal vein complications after liver transplantation. Statistical analysis of children with portal vein diameter <4 mm ( n=90) was carried on and the results showed that there was no inter-group statistical difference ( χ2=3.061, P=0.080)on the occurrence of portal vein complications. Conclusions:Diameter of portal vein is an important factor affecting the strategic choice of portal vein reconstruction during pediatric liver transplantation and an independent risk factor for portal vein complications after liver transplantation. When the diameter of portal vein is ≤4 mm, using interposition vascular anastomosis shows no significant difference with other conventional modes.

Objective:To study the hepatic hemodynamics changes and pathophysiological mechanisms of the use of a functional shunt after auxillary liver transplantation to treat portal hypertension associated with a small-for-size graft.Methods:A retrospective analysis of the clinical data of patients with portal hypertension treated with functional shunting of small-volume grafts from a living donor liver at the Beijing Friendship Hospital, Capital Medical University from July 2014 to December 2018, and a total of 6 patients were included as the research objects, including 4 males and 2 females, with a median age of 35.5 (29.0-52.0) years old. Blood flow monitoring data were collected during and after operation, and the characteristics of liver hemodynamics were analyzed.Results:The portal venous blood flow of the remnant native liver gradually decreased to no flow. As a buffer response, the flow velocity of hepatic artery increased. The portal venous blood flow of the graft gradually increased in the early postoperative period and then gradually decreased from post-operation Day 5 to 10 due to gradual increase in portal venous resistance. However, the portal venous perfusion gradually increased from Day 10 after the operation, reached to a level and declined to a stable level about 1 month after the operation. The volume of abdominal drainage slowly decreased after the peak level at Day 5-10 after the operation, and disappeared completely at Day 30 after operation.Conclusions:When using auxiliary liver transplantation for functional shunting to treat portal hypertension, autologous residual liver can act as a guide buffer for the pressure gradient of portal vein hyperperfusion in liver transplantation, and reach a steady state of blood flow distribution about 1 month after surgery, while relying on autologous remnant liver hepatic artery buffer response prevents small liver syndrome.

Objective:To review our experience in the use of "Full right-Full left" split liver transplantation in adult-to adult or adult-to adult-size child.Methods:The clinical data of liver donors to 4 recipients of full right-full left split liver transplantation performed at Beijing Friendship Hospital of Capital Medical University from January to December 2019 were reviewed. The surgical methods of split liver transplantation, cold ischemia time, operation time, intraoperative blood transfusion, and postoperative complications and prognosis were analyzed.Results:The 4 recipients of complete right hepatic-left hepatic split liver transplantation included 3 adults and 1 heavy child (45 kg). Their ages ranged from 14 to 48 years, and body weight ranged from 45 to 61 kg. The end-stage liver disease model score were 21, 12, 41, and 30 points. The ratios of graft mass to recipient's body mass ranged from 0.85% to 1.35%. The cold ischemia time was 457-650 min, and the operation time was 460-575 min. Early liver function recovered smoothly in all the 4 patients after transplantation, and no small liver syndrome occurred. Patients were followed up to 6 months after operation. One patient developed anastomotic biliary leak, which was cured by endoscopic retrograde cholangiopancreatographic treatment. Another patient developed biliary stricture presenting with repeated biliary tract infection despite percutaneous transhepatic puncture biliary drainage. A third patient died six months from lung infection.Conclusion:In properly selected patients, using full right-full left hemiliver by split liver transplantation increased organ utilization and provided patients with increased treatment opportunities.

Natural killer (NK) cells are essential in controlling cancer and infection. However, little is known about the dynamics of the transcriptional regulatory machinery during NK cell differen-tiation. In this study, we applied the assay of transposase accessible chromatin with sequencing (ATAC-seq) technique in a home-developed in vitro NK cell differentiation system. Analysis of ATAC-seq data illustrated two distinct transcription factor (TF) clusters that dynamically regulate NK cell differentiation. Moreover, two TFs from the second cluster, FOS-like 2 (FOSL2) and early growth response 2 (EGR2), were identified as novel essential TFs that control NK cell maturation and function. Knocking down either of these two TFs significantly impacted NK cell differentia-tion. Finally, we constructed a genome-wide transcriptional regulatory network that provides a bet-ter understanding of the regulatory dynamics during NK cell differentiation.

Objective To evaluate the effect of donor-derived infection on the clinical prognosis of the recipients undergoing liver transplantation. Methods Clinical data of 75 donors and recipients undergoing liver transplantation were retrospectively analyzed. According to the culture results of donor organ lavage fluid, all recipients were divided into the positive group (n=26) and negative group (n=49). Clinical parameters of the recipients during perioperative period were observed in the positive and negative groups. The sputum and peritoneal drainage fluid of the recipients undergoing liver transplantation were cultured. The incidence of postoperative infection of the recipients was observed. The 1.5-year survival curve of the recipients was analyzed by Kaplan-Meier method. Results In the positive group, the incidence of portal vein stenosis and thrombosis was significantly higher than that in the negative group (P < 0.05). Among 75 recipients undergoing liver transplantation, 33 cases (44%) developed postoperative infection mainly in the lung and abdominal cavity. The infection rate significantly differed between the positive group (77%) and negative group (27%, P < 0.05). In the positive group, sputum culture was positive in 10 recipients and peritoneal drainage culture was positive in 11 recipients. The sputum culture outcomes of 4 recipients were consistent with those of the organ lavage fluid culture of their donors. The peritoneal drainage culture results of 6 recipients were consistent with those of the organ lavage fluid culture of their donors. After anti-infection treatment, 2 recipients in the positive group died at postoperative 5 and 12 d, and the culture results of the remaining recipients were negative. In the negative group, 7 recipients were positive for sputum culture and 6 recipients were positive for peritoneal drainage culture. The culture results of all recipients were negative following anti-infection therapy. Two recipients died from graft failure at postoperative 1 month and 1 year. The 1.5-year survival rate did not significantly differ between the positive and negative groups (P > 0.05). Conclusions The effect of donor-derived infection on the early prognosis of liver transplant recipients cannot be neglected, whereas it exerts mild impact on the intermediate- and long-term clinical prognosis of the recipients.

Objective To investigate the safety and effectiveness of anatomical partial splenectomy during liver transplantation in pediatric patients to prevent postoperative refractory hypersplenism.Methods From January 2015 to August 2018,7 pediatric patients with preoperative severe hypersplenism underwent anatomical subtotal splenectomy together with liver transplantation at our institution.Clinical informations,including operative time,intraoperative bleedinh,postoperative hospital stay,postoperative complications,platelet counts,leukocyte counts and the length and thickness of spleen determined by abdominal ultrasound,were collected retrospectively and statistically analyzed.Results The median total operation time was 495 min (320-768 min),the median intraoperative blood loss was 350 mL (300-1300 mL) and the median hospital stay was 19 days (14-55 days).Patients were followed up for 7.0-36.6 months (median 20.1 months).The length and thickness of spleen were reduced immediately from (18.89 ± 1.77) to (11.13 ± 2.28) cm (P＜0.001)and from (6.31 ± 0.53) to (4.97 ± 1.29) cm (P＜0.05),respectively.During the follow-up period of the first week,the mean platelet counts and leukocyte counts increased from (46.71 ± 18.91) × 109/L to (173.71 ± 73.15) × 109/L (P＜0.001) and from (1.59 ± 0.42) × 109/L to (11.12 ± 4.17) × 109/L (P＜0.001),respectively.During the one-year follow-up period,there was no residual splenic regrowth,and the peripheral blood cell counts remained normal.All patients survived to date with no procedure-related complications.Conclusions The anatomical subtotal splenectomy during liver transplantation in pediatric transplant recipients with preoperative severe splenomegaly and hypersplenism is a feasible option for the prevention of posttransplant refractory hypersplenism.

Nowadays,with the rapid development of science and technology of medicine,the detection rate of obstructivc azoospermia increased gradually,clinically not uncommon.Surgical treatment of obstructive azoospermia is also improved from traditional vasovasostomy and epididymovasostomy to microsurgical vasovasos-tomy and microsurgical va-soepididymostomy,and from 3-suture intussusception vasoepididymostomy to 2-suture intussusception vasoepididymostomy,then our modified reverse single needle anastomosis,and finally to the robot assisted anastomosis.Therefore,the anastomosis is more precise,the recanalization rate and the pregnancy rate have a revolutionary improvement.The robot era is coming.The article focuses on surgical treatment of obstructive azoospermia,comparison of the advantages and disadvantages of each operation,and prediction of the future direction of development.

Objective To investigate the clinical efficacy of integrated Chinese and western medicine for the treatment of anovulatory dysfunctional uterine bleeding. Methods A total of 108 anovulatory dysfunctional uterine bleeding patients were evenly randomized into treatment group and control group. Both groups were given basic conventional treatment, estrogen-progestogen sequential therapy for 3 menstrual cycles for dysfunctional uterine bleeding patients at puberty and child-bearing period, and Marvelon for patients at menopause transition period after excluding uterine tumor by diagnostic curettage. Additionally, the treatment group was given Chinese herbal decoction of Radix Rehmanniae Preparata, Semen Cuscutae, Fructus Corni, Placenta Hominis, Herba Ecliptae, Fructus Schisandrae Chinensis, Rhizoma Alismatis, raw Rhizoma Dioscoreae, Rhizoma Atractylodis Macrocephalae, Rhizoma Cyperi, Radix Codonopsis, Radix Astragali, Radix Angelicae Sinensis, Radix Paeoniae Alba, Pericarpium Citri Reticulatae, and charred Herba Schizonepetae. Therapeutic effect, bleeding-arresting time, and recurrence rate during 3-month follow-up were observed in the two groups. Results ( 1) The treatment group had a total effective rate of 100.0%, higher than 94.4%in the control group, the difference being significant (P<0.05). (2) Bleeding-arresting time was (45.50 ± 13.0) hours in the treatment group and was (58.0 ± 15.0) hours in the control group, and the difference was statistically significant (P<0.05). (3) During the 3-month follow-up, the treatment group had the recurrence rate of 16.7% ( 9 cases) , lower than 29.6% ( 16 cases) in the control group, and the difference was statistically significant ( P<0.05). Conclusion Integrated Chinese and western medicine has certain effect for the treatment of anovulatory dysfunctional uterine bleeding, showing good prospects for extensive application in gynecological clinic.