Human parvovirus B19 (HPVB19) belongs to Parvoviridae, a genus of erythrovirus, and has been associated with various human diseases, and HPVB19 infection is one of the most important causes of refractory anemia after allogeneic hematopoietic stem cell transplantation (allo-HSCT). This study retrospectively analyzed 24 patients with HSCT combined with HPVB19 infection to collate and summarize the clinical presentation, treatment, and regression of patients with combined HPVB19 infection after allo-HSCT and provide experience in the management of HPVB19 infection after allo-HSCT. The median age of the patients with HPVB19 infection was 25 years, and the median time of infection occurrence was +107 days after transplantation, and 22 (91.7% ) had anemia with a median hemoglobin (HGB) level of 77.5 (46-149) g/L, and 13 (54.2% ) had new-onset anemia or persistent decline in HGB. The median length of hospital stay was 19 days. Among patients with new-onset anemia or persistent decline in HGB, the mean increase in HGB after treatment with intravenous immunoglobulin and/or antiviral therapy was 15.69 g/L, and treatment was effective in 10 (76.92% ) patients. HPVB19 infection should be alerted to the development of refractory anemia after HSCT; despite the lack of specific treatment, the overall prognosis of HPVB19-infected patients is good.

Objective:To investigate the potential of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in mitigating the adverse prognosis associated with central nervous system leukemia (CNSL) and to assess the significance of prophylactic intrathecal injection.Methods:A retrospective cohort analysis was conducted involving 30 patients with acute leukemia who had a history of CNSL who underwent allo-HSCT at Peking University People′s Hospital between September 2012 and March 2018 (referred to as the CNSL-positive group). In addition, 90 patients with acute leukemia were selected from the same period who underwent allo-HSCT without a history of CNSL (referred to as the CNSL-negative group) and a rigorous 1∶3 matching was performed based on disease type, disease status, and transplantation type to form the control group. The prognosis between the two groups was compared using Kaplan-Meier analysis and the high-risk factors for CNSL relapse post-transplant were identified through Cox proportional-hazards model.Results:The median age of patients in the CNSL-negative group was significantly higher than that of patients in the CNSL-positive group (32 years vs. 24 years, P=0.014). No significant differences were observed in baseline data, including sex, disease type, disease status at transplantation, donor-recipient relationship, and human leukocyte antigen consistency between the two groups. The median follow-up time was 568 days (range: 21-1 852 days). The 4-year cumulative incidence of relapse (71.4%±20.9% vs. 29.3%±11.5%, P=0.005) and the cumulative incidence of CNSL post-transplant (33.6%±9.2% vs. 1.2%±1.2%, P<0.001) were significantly higher in the CNSL-positive group than in the CNSL-negative group. Furthermore, the 4-year leukemia-free survival rate in the CNSL-positive group was significantly lower than that in the CNSL-negative group (23.1%±17.0% vs. 71.5%±11.6%, P<0.001). However, no significant differences were observed in the 4-year cumulative transplant-related mortality and overall survival rates between the two groups (both P>0.05). Multivariate analysis revealed that a history of CNSL before transplantation ( HR=25.050, 95% CI 3.072-204.300, P=0.003) was identified as high-risk factors for CNSL relapse post-transplant. Conversely, haploidentical transplantation was associated with a reduced risk of CNSL relapse post-transplant ( HR=0.260, 95% CI 0.073-0.900, P=0.034). Within the CNSL-positive group, seven patients received prophylactic intrathecal therapy after transplantation, and their CNSL relapse rate was significantly lower than that of the 23 patients who did not receive intrathecal therapy after transplantation (0/7 vs. 9/23, P=0.048). Conclusions:Patients with a history of CNSL have a higher risk of relapse and experience poorer leukemia-free survival following transplantation. The use of prophylactic intrathecal injection shows promise in mitigating CNSL relapse rates, although further validation through prospective studies is necessary to substantiate these observations.

Objective:To establish surgical difficulty scoring system of partial nephrectomy based on holographic imaging and explore its application value in partial nephrectomy.Methods:A total of 184 patients including 110 males and 74 females with renal tumors diagnosed as stage cT 1 to cT 2 before surgery in the First Affiliated Hospital of Xiamen University from October 2019 to January 2022 were included. Among the 184 patients, 141 patients were treated with partial nephrectomy and 43 patients were treated with radical nephrectomy (3 partial nephrectomies were finally changed to radical nephrectomies due to vascular and tumor location). 60 patients had hypertension. 24 patients had diabetes. 7 patients had hyperuricemia. The median age was 55(47, 62) years. The median BMI was 23.7(21.8, 26.4) kg/m 2. The median maximum tumor diameter was 3.9(2.9, 5.2) cm. The median preoperative eGFR was 99.7(83.4, 114.2) ml/(min·1.73m 2). The median R. E.N.A.L. score was 8(6, 9). The median PADUA score was 9(8, 10). 153 patients were diagnosed as stage cT 1 and 31 patients were diagnosed as stage cT 2. The hologram reconstruction was performed according to preoperative CT or MRI examination. The maximum diameter of the tumor in the kidney (D), the compression degree of the renal segmental vessels by tumor(C), the area of the renal sinus occupied by tumor(O) and the mass of exophytic rate(M) were comprehensively considered and finally constituted the difficulty scoring system named DCOM score for partial nephrectomy. The DCOM score divided the complexity of tumor surgery into mild (4-6 points), moderate (7-8 points) and high (≥ 9 points). Meanwhile, the MIC (surgical margins are negative, WIT is <20 min, and no major complications)was used to evaluate the overall surgical effect. The DCOM, R. E.N.A.L. and PADUA scores were performed on all patients and compared with each other to evaluate the surgical effect of DCOM score in partial nephrectomy. Results:All surgeries in this study were successfully completed, including 141 partial nephrectomies and 43 radical nephrectomies. The DCOM score was 10(9, 11) for radical nephrectomy and 6(5, 8) for partial nephrectomy, and the difference was statistically significant ( P=0.001). There were 23 patients (37.7%) in highly complex group, 39 patients (88.6%) in moderately complex group and 79 patients (100.0%) in mildly complex group underwent partial nephrectomy, respectively. According to multifactorial analysis, patients in highly and moderately complex group of DCOM score had 8.88 times ( P=0.001) and 1.76 times ( P=0.005) less reach MIC than those in mildly complex group, respectively. Patients in highly and moderately complex group of PADUA score had 4.86 times ( P=0.005)and 3.41 times ( P=0.006)less reach MIC than patients in mildly complex group of DCOM score, respectively. What’s more, patients in moderately complex group of R. E.N.A.L. score had 3.11 times ( P=0.003) less reach MIC than patients in mildly complex group of DCOM score. In the ROC curves to predict MIC achievement, the AUC values of R. E.N.A.L., PADUA and DCOM scores were 0.657, 0.655 and 0.746, respectively. Comparing:R. E.N.A.L. score with DCOM score, the AUC value was statistically significant ( P=0.025). Conclusions The surgical difficulty scoring system (DCOM score) based on holographic imaging can predict the outcome of partial nephrectomy, but further verification is needed.

In recent years, although the quantity of organ donation after citizen's death has been constantly increased, a large number of patients with end-stage renal diseases are waiting for kidney transplantation every year. The imbalance between donor and recipient is still one of the main problems affecting kidney transplantation in clinical practice. Therefore, it is of clinical significance to accurately evaluate the quality of donor kidney and fully utilize the expanded criteria donor kidney. Contrast-enhanced ultrasound has been gradually applied in the detection of multiple solid organs due to its safety, portability, real-time detection, quantification and other characteristics, and it also has promising application prospect in the evaluation of donor kidney quality. In this article, the advantages and limitations of current evaluation methods for donor kidney and current status and advantages of contrast-enhanced ultrasound in donor kidney evaluation were reviewed, and the application prospect of contrast-enhanced ultrasound in the evaluation of donor kidney quality was discussed, aiming to increase the methods and enhance the accuracy for donor kidney evaluation, and provide reference for rational use of expanded criteria donor kidney.

To investigate the feasibility ,safety and clinical effect of No touch liver pedicle microwave ablation . Methods T he clinical data of 229 patients with hepatocellular carcinoma treated in the Department of Hepatology ,Wuhan Tongji Hospital from M ay 2014 to October 2016 were retrospectively analyzed . T he patients were divided into 3 groups .In group A ,82 patients underwent ultrasound‐guided No touch liver pedicle microwave ablation ,69 patients in group B were treated with anatomical hepatectomy ,and 78 patients in group C underwent traditional microwave ablation . T he preoperative basic data ,intraoperative data ( treatment time , intraoperative blood loss ) and postoperative data ( postoperative liver function indicators ,complications ,hospitalization time ,local recurrence ,survival rate) were compared among the 3 groups . Results T he treatment time ,intraoperative blood loss ,postoperative liver function index and hospitalization time in group A and group C were significantly lower than those in group B( all P ＝0 .000) . T here was no difference in complete elimination rate ,between the two groups in group A and group B( P ＞0 .05) ,which was significantly better than those of group C ( P ＝ 0 .019 ) . T here was no significant difference in the local recurrence rate between the three groups after 1 year and 3 years . Conclusions No touch liver pedicle microwave ablation damage is safe and reliable ,in line with the principle of oncology treatment ,it worthes further promotion in the clinic .

To investigate the safety and feasibility of indocyanine green ( ICG ) fluorescence staining guided by laparoscopic ultrasound guiding portal branch puncture approach in anatomical segmentectomy of the liver . Methods The clinical data of 22 patients with malignant liver diseases underwent anatomical segmentectomy between February 2018 and M ay 2018 were retrospectively analyzed . ICG 0 .125～0 .250 mg was directly injected into the portal branches supplying blood flow to the tumor‐bearing hepatic segment , after puncturing of the target portal branch under intraoperative laparoscopic ultrasound guidance in all patients . T he fluorescence imaging system ( Pinpoint) was used for the resection procedure . Observation indicators :intraoperative conditions ( tumor diameter ,success rate of portal branches puncture ,success rate of staining the target hepatic segment ,intraoperative complications , time of operation ,volume of intraoperative blood loss , blood transfusion , and transit of laparotomy ) . Postoperative conditions :postoperative complications ,and length of hospital stay . Results Twenty‐two patients with liver tumors were all performed anatomical hepatectomy assisted by laparoscopic ultrasound guiding ICG injection for liver segment staining . All the liver tumors were hepatocellular carcinoma . ①Intraoperative conditions : T he portal branches puncture successful rate was 100% ( 22/22 ) . Eighteen patients achieved expected effect of ICG fluorescence staining ,with a satisfaction rate of 81 .8% (18/22) and 4 failed to get expected effect ,including 2 with uneven dying ,and 2 with adjacent hepatic segmental staining induced to unclear boundary . No complication such as allergy occurred in all patients after ICG injection . T he mean operation time was ( 209 ± 89 ) min ( range :97 ～ 325 min) and the target portal branches ICG puncture injection time under intraoperative laparoscopic ultrasound guidance was ( 11 ± 5) min ( range 3－25 min) . T here was no intraoperative blood transfusion or transit of laparotomy .Average tumor diameter was ( 3 .9 ± 1 .3) cm( range :2 .2－7 .0 cm ) . ②Postoperative conditions of 22 patients ,4 with grade Ⅰ － Ⅱ of Clavien‐Dindo classification were improved by drug treatments ( 1 with deep venous thrombosis of the lower extremities and 3 with pleural effusion ) , no patient had grade Ⅲ and above complications , and no perioperative death occurred . Average duration of hospital stay was ( 7 ± 2 ) days in 22 patients ( range :5 .0－14 .0 days) . Conclusions ICG fluorescence staining guided by laparoscopic ultrasound guiding portal branch puncture ,obtains accurate and lasting fluorescence markers on the liver surface and inside the parenchyma . ICG staining guides the selection of liver section in the operation of liver in real time ,and helps surgeons to perform laparoscopic anatomical segmentectomy of the liver .

Objective To explore the application and significance of intraoperative laparoscopic ultrasound( IOUS) in robot-assisted laparoscopic hepatectomy . Methods From February 2015 to February 2017 ,135 patients undergoing liver resection with robotic approach were enrolled in the study . All data about demographic ,surgical procedure and postoperative course were collected prospectively and analyzed . IOUS was routinely performed in these patients . To assist the localization and resection of liver tumor ,a four steps IOUS protocol in robotic liver surgery was proposed ,including exploration ,verification ,guidance , and confirmation . If necessary ,intraoperative laparoscopic ultrasound guided microwave ablation of liver tumor to complete the treatment . Results A total of 11 additional lesions in 11 patients were detected in 135 patients ,7 patients accepted strategic surgical modification : 4 cases were enlarged resection ,and 3 cases were treated with microwave ablation . There were only 17 patients lost blood more than 1000 ml in all patients . No patient suffered from any single or multiple organ dysfunctions ,and there was no mortality observed . Conclusions IOUS is indispensable to understand lesions and vessels ,confirm the complete resection of the tumor in robot-assisted laparoscopic hepatectomy . It is also a necessary tool for the microwave ablation of liver tumor .

Objective To evaluate and explore the diagnostic value of focal liver lesion ( FLL) ( ≤2 cm) undetectable on conventional ultrasound by image fusion with contrast-enhanced ultrasound(CEUS) . Methods A total of 50 patients with 65 lesions( ≤2 cm) were enrolled . All lesions were undetectable on conventional ultrasound but showed clearly in CT/MRI images . Ultrasound-CT/MRI image fusion with CEUS was performed ,and the nodule detection rate and enhancement perfusion mode were analyzed . Results All the 50 patients were matched successfully ,56 lesions (86 .2% ) were detected by image fusion combined with CEUS ,among which 27 lesions (41 .5% ) were significantly different from surrounding parenchyma on conventional ultrasound , 54 lesions ( 83 .1% ) showed different enhancement from the surrounding parenchyma on CEUS . There were 46 lesions that were eventually diagnosed by surgical pathology or clinical comprehensive diagnosis . The diagnostic accuracy of image fusion with CEUS was 91 .3% (42/46) . According to different groups of MRI matching sequences ,the detection rates of T 2 sequence group and enhanced sequence group were 87 .5% (28/32) and 91 .3% (21/23) ,respectively ,there was no statistically significant difference between the two groups ( P ＝0 .686) . Conclusions CT/MRI image fusion combined with CEUS has high detection rate and diagnosis accuracy for small FLL undetectable on conventional ultrasound .

Objective To explore the clinical value of the Liver Imaging Report and Data System ( LI-RADS) with contrast enhanced ultrasound(CEUS) in the diagnosis of hepatocellular carcinoma ( HCC) . Methods From October 2012 to July 2018 , the CEUS data of patients at high risk for HCC were retrospectively analyzed . A total of 197 lesions in 178 patients were classified with reference to the 2017 version of CEUS LI-RADS classification standard . Diagnostic reference standard was surgical pathology . The relationship between the LI-RADS classification and the pathological diagnosis was evaluated . Results One hundred and ninety-seven lesions ,with an average size of ( 2 .9 ± 1 .6)cm ,were pathologically confirmed to be 170 HCC ( 86 .3% ) ,17 non-HCC malignant lesions ( 8 .6% ) ,and 10 liver benign lesions ( 5 .1% ) . There were 6 (3 .0% ) ,37(18 .8% ) ,134 (68 .0% ) and 20 (10 .2% ) lesions classified into LR-3 ,LR-4 ,LR-5 and LR-M category ,respectively . Positive predictive values of HCC in LR-3 ,LR-4 and LR-5 category were 16 .7% (1/6) ,89 .2% (33/37) ,97 .0% (130/134) ,respectively . LR-5 category had high positive predictive value of HCC( 97 .0% ) ,but low sensitivity ( 76 .5% ) . If LR-5 category combined with LR-4 category were diagnosed as HCC ,the diagnostic accuracy was significantly higher than that of LR-5 category ( 92 .4% vs 77 .7% ) ,and the difference was statistically significant ( P ＜ 0 .05 ) . 95 .0% ( 19/20 ) lesions of LR-M category were malignant ,of which 30 .0% ( 6/20 ) lesions were HCC . 76 .9% ( 10/13 ) of intrathecal cholangiocarcinoma was characterized by LR-M . Conclusions The LI-RADS classification of CEUS has high application value for diagnosis and differentiation of HCC .

Objective Budd-Chiari syndrome is apt to be misdiagnosed,so we explore its diagnosis and treatment by liver transplantation.Methods We retrospectively analyzed the clinical data of two patients who underwent liver transplantation for Budd-Chiari syndrome.One patient was misdiagnosed before the transplantation and another was diagnosed correctly.Results Both patients were grouped to Child C category with decompensated liver cirrhosis.Patient 1 was diagnosed as recurrent hepatocellular carcinoma,but the etiology of liver disease was first unknown then suspected to be schistosomiasis.This patient underwent piggyback liver transplantation.Because there was significant swelling in the perineum and lower extremities after liver transplantation,we re-reviewed the preoperative imaging data and found communicant veins between hepatic veins,which proved that the patient was actually suffered from Budd-Chiari syndrome with hepatic vein and suprahepatic vena cava occlusion before the transplantation.After conservative treatment,the swelling of the lower body was alleviated,however,the long-term survival of the patient would be compromised.Learning from the first case,we found communicant veins between hepatic veins in imaging data of patient 2,resulting in correct diagnosis of Budd-Chiari syndrome with hepatic vein and retrohepatic vena cava diseases before the transplantation,so the patient underwent orthotopic liver transplantation,in which the liver and retrohepatic vena cava were resected,and recovered uneventfully.Liver function was normal during the follow up period of 7 months.Conclusion We should consider the possibility of Budd-Chiari syndrome in patients with unexplained end-stage liver diseases.Communicant veins between the hepatic veins shown in thin CT or MRI image are the characteristic sign for diagnosing Budd-Chiari syndrome.Simultaneously hepatic vein or cava vena disease determines the choice of various technique of liver transplantation.