BACKGROUND:The effect of anterior controllable anteriodisplacement and fusion on the biomechanics of cervical spine is still unclear.Previous studies have majorly focused on surgical techniques,the medium-and long-term efficacy,and postoperative complications of anterior controllable anteriodisplacement and fusion. OBJECTIVE:To analyze the biomechanical effects of anterior controllable anteriodisplacement and fusion on vertebrae-ossification of posterior longitudinal ligament complex and implants of the cervical spine using finite element method. METHODS:A healthy male volunteer was recruited for CT scanning of the entire cervical spine.Using the finite element analysis software,a normal whole cervical spine model was constructed and its validity was verified by comparison with the previous articles.Subsequently,a preoperative model of continuous posterior longitudinal ligament ossification involving C4,C5,and C6 was constructed.Based on the preoperative model,a three-dimensional finite element model of anterior controllable anteriodisplacement and fusion was created.After constrain of the lower surface of the C7 vertebral body of the two models,an axial force of 50 N and a moment of 1.0 N·m were applied to the upper surface of the C1 cone body.Under forward flexion,posterior extension,left/right bending,and left/right rotation conditions,the effects of anterior controllable anteriodisplacement and fusion on vertebrae-ossification of posterior longitudinal ligament complex and implants were further analyzed. RESULTS AND CONCLUSION:(1)From the preoperative model,it was found that the ossification stress was mainly concentrated in the C4/5 segment;the maximum stresses of vertebrae-ossification of posterior longitudinal ligament complex under the conditions of forward flexion,posterior extension,left bending,right bending,left rotation and right rotation were 10.1,148.6,68.9,74.8,83.8,and 85.1 MPa,respectively.(2)After anterior controllable anteriodisplacement and fusion,the distribution area of stress concentration at the vertebrae-ossification of posterior longitudinal ligament complex did not change significantly,but the values were decreased obviously;in addition to the increase of stress(+44.7%)in the anterior flexion at the surgical model of anterior controllable anteriodisplacement and fusion,when compared with the preoperative one,the anterior controllable anteriodisplacement and fusion stress was significantly lower than that in the preoperative model under the other five working conditions,in which the value was decreased by-74.1%at the posterior extension position.Under the left bending,right bending,left rotation and right rotation,the ossification stress was decreased by 62.2%,63.3%,66.4%,and 67.9%,respectively.(3)The stress of titanium plate and screw was mainly concentrated at the both ends;the largest posterior extension stress was 149.5 MPa while the smallest forward flexion stress was 43.3 MPa.The stress of the four intervertebral cages was mainly concentrated at the C3/4 and C6/7 ones;and the stress was mainly distributed around the upper and lower surfaces of the fusion device,its value ranging from 30.8 MPa(the largest extension stress)to 11.5 MPa(the lowest forward flexion stress).The stress of the implants(titanium plate,screw,and intervertebral cage)was mainly concentrated at the two ends with the largest values,which would lead to the fracture of the titanium plate screw and the loosening of the screws.(4)In conclusion,anterior controllable anteriodisplacement and fusion was able to significantly reduce the stress of vertebrae-ossification of posterior longitudinal ligament complex,and may help prevent excessive proliferation and compression of nerves.After surgery,much attention should be paid to the occurrence of loosening of the screws,or displacement and fracture of titanium plates at the both ends.

Objective:To investigate the safety and therapeutic effect of split liver transplantation (SLT) in clinical application.Methods:This is a retrospective case-series study. The clinical data of 203 consecutive SLT, 79 living donor liver transplantation (LDLT) and 1 298 whole liver transplantation (WLT) performed at the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to July 2023 were retrospectively analyzed. Two hundred and three SLT liver grafts were obtained from 109 donors. One hundred and twenty-seven grafts were generated by in vitro splitting and 76 grafts were generated by in vivo splitting. There were 90 adult recipients and 113 pediatric recipients. According to time, SLT patients were divided into two groups: the early SLT group (40 cases, from July 2014 to December 2017) and the mature SLT technology group (163 cases, from January 2018 to July 2023). The survival of each group was analyzed and the main factors affecting the survival rate of SLT were analyzed. The Kaplan-Meier method and Log-rank test were used for survival analysis.Results:The cumulative survival rates at 1-, 3-, and 5-year were 74.58%, 71.47%, and 71.47% in the early SLT group, and 88.03%, 87.23%, and 87.23% in the mature SLT group, respectively. Survival rates in the mature SLT group were significantly higher than those in the early SLT group ( χ2=5.560, P=0.018). The cumulative survival rates at 1-, 3- and 5-year were 93.41%, 93.41%, 89.95% in the LDLT group and 87.38%, 81.98%, 77.04% in the WLT group, respectively. There was no significant difference among the mature SLT group, the LDLT group and the WLT group ( χ2=4.016, P=0.134). Abdominal hemorrhage, infection, primary liver graft nonfunction,and portal vein thrombosis were the main causes of early postoperative death. Conclusion:SLT can achieve results comparable to those of WLT and LDLT in mature technology liver transplant centers, but it needs to go through a certain time learning curve.

Objective:To investigate the safety and therapeutic effect of split liver transplantation (SLT) in clinical application.Methods:This is a retrospective case-series study. The clinical data of 203 consecutive SLT, 79 living donor liver transplantation (LDLT) and 1 298 whole liver transplantation (WLT) performed at the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to July 2023 were retrospectively analyzed. Two hundred and three SLT liver grafts were obtained from 109 donors. One hundred and twenty-seven grafts were generated by in vitro splitting and 76 grafts were generated by in vivo splitting. There were 90 adult recipients and 113 pediatric recipients. According to time, SLT patients were divided into two groups: the early SLT group (40 cases, from July 2014 to December 2017) and the mature SLT technology group (163 cases, from January 2018 to July 2023). The survival of each group was analyzed and the main factors affecting the survival rate of SLT were analyzed. The Kaplan-Meier method and Log-rank test were used for survival analysis.Results:The cumulative survival rates at 1-, 3-, and 5-year were 74.58%, 71.47%, and 71.47% in the early SLT group, and 88.03%, 87.23%, and 87.23% in the mature SLT group, respectively. Survival rates in the mature SLT group were significantly higher than those in the early SLT group ( χ2=5.560, P=0.018). The cumulative survival rates at 1-, 3- and 5-year were 93.41%, 93.41%, 89.95% in the LDLT group and 87.38%, 81.98%, 77.04% in the WLT group, respectively. There was no significant difference among the mature SLT group, the LDLT group and the WLT group ( χ2=4.016, P=0.134). Abdominal hemorrhage, infection, primary liver graft nonfunction,and portal vein thrombosis were the main causes of early postoperative death. Conclusion:SLT can achieve results comparable to those of WLT and LDLT in mature technology liver transplant centers, but it needs to go through a certain time learning curve.

Standardization is the universal language of the world, and standardization of traditional Chinese medicine (TCM) is essential for its communication in China and globally. However, the principles and methods of TCM acupuncture standardization have been unclear and inadequate in the early stages. Based on an investigative approach to understanding the current status, identifying problems, and finding solutions, our team has established basic principles of TCM acupuncture that embody Chinese wisdom, evaluated the international strategic environment systematically, proposed the principle of “importance of harmony and exercise of impartiality”, and established basic working principles. A series of methods for TCM acupuncture standard development and evaluation have been constructed, including general standards for the revision of TCM acupuncture standards, the first TCM acupuncture clinical research management specification, a shared full chain technology platform, a data center, and an evaluation research base for TCM acupuncture clinical research. Evaluation criteria for ancient literature and expert experience, a recommendation method for the “three main and three auxiliaries” TCM guideline for prevention were established, and quantifiable assessment methods of TCM standard applicability were proposed. These findings provide methodological guidance for TCM acupuncture standardization.

Although widely applied in treating hematopoietic malignancies, transplantation of hematopoietic stem/progenitor cells (HSPCs) is impeded by HSPC shortage. Whether circulating HSPCs (cHSPCs) in steady-state blood could be used as an alternative source remains largely elusive. Here we develop a three-dimensional culture system (3DCS) including arginine, glycine, aspartate, and a series of factors. Fourteen-day culture of peripheral blood mononuclear cells (PBMNCs) in 3DCS led to 125- and 70-fold increase of the frequency and number of CD34⁺ cells. Further, 3DCS-expanded cHSPCs exhibited the similar reconstitution rate compared to CD34⁺ HSPCs in bone marrow. Mechanistically, 3DCS fabricated an immunomodulatory niche, secreting cytokines as TNF to support cHSPC survival and proliferation. Finally, 3DCS could also promote the expansion of cHSPCs in patients who failed in HSPC mobilization. Our 3DCS successfully expands rare cHSPCs, providing an alternative source for the HSPC therapy, particularly for the patients/donors who have failed in HSPC mobilization.
Antigens, CD34/metabolism* ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Leukocytes, Mononuclear/metabolism* ; Peptides/metabolism*

Biliary atresia is a rare congenital disease of children with unknown pathogenesis and biliary obstruction, which is mainly manifested with progressive inflammation and fibrous obstruction of the biliary system inside and outside the liver, and subsequently develop into cholestatic cirrhosis and liver failure. Although biliary atresia is rare, it is the most common cause of cholestasis during the infancy period. If surgical treatment were not performed (such as Kasai operation and liver transplantation), children may die in a short period of time. Kasai operation can improve biliary drainage, whereas it fails to change the outcomes of children with biliary atresia. Most of them will still suffer from persistent liver injury due to cholestasis, and eventually require liver transplantation. At present, there is no consensus on whether Kasai operation should be performed prior to liver transplantation. In this article, research progress on the diagnosis and surgical treatment of biliary atresia was reviewed, aiming to provide reference for clinical diagnosis and treatment of biliary atresia and improve the survival of children with biliary atresia.

Objective To evaluate the clinical value of ultrasonography in the diagnosis of carotid plaque neovascularization .Methods 32 patients with carotid artery plaques diagnosed by conventional ultrasonography were enrolled.The patients were followed up for contrast-enhanced ultrasonography (CEUS) and ultrasonography micro-vascular imaging(SMI),and the results of the two-dimensional detection of carotid plaque and plaque neovasculariza-tion were compared .Results A total of 63 plaques were detected by SMI , including 39 hypoechoic plaques , 19 episodes of echo patches ,58 of plaques ,and 17 hypoechoic plaques .The diagnostic rate of neovascularization was 10.34％.Among the 113 carotid plaques,48 carotid plaques were detected by SMI ,46 carotid plaques were detected by CEUS.The distribution of neovascularization was similar to that of CEUS ,and the neovascularization of SMI and CEUS was better(Kappa=0.669,P<0.001).Conclusion For the diagnosis of carotid plaques ,ultrasonography can accurately detect the number , location and neovascularization of plaques , and the accuracy of carotid plaques is effective.It provides a radiographic basis for the diagnosis and early intervention of patients ,which has great signifi-cance to the prevention of stroke and cardiovascular and cerebrovascular adverse events .It is worthy of popularizing and application .

BACKGROUND: Because of the non-homology of protein and gene between human and animals, to promote osteogenesis or spinal fusion of animals by construction of tissue-engineered bone with the human gene has influenced the experimental validation.OBJECTIVE: To construct the seed cell line for bone tissue engineering with stable expression of human bone morphogenetic protein 2 (hBMP2).METHODS: The full-length hBMP2 gene was cloned from human muscle tissues by nested RT-PCR and transfected to human bone marrow mesenchymal stem cells (hBMSCs) with lipidosome. The transfected hBMSCs were cultured with G418 in vitro to screen and purify the cells. A series of analyses such as RT-PCR, dot-ELISA, immunohistochemstry and alkaline phosphatase activity analysis were performed to evaluate the situation of hBMP2 expression and secretion at 48 hours and 3 weeks after the transduction. hBMSCs transduced with empty plasmid and the normal hBMSCs served as positive control and blank control groups, respectively, which were used for observation of cell growth, proliferation and biological characteristics of transfected cells. RESULTS AND CONCLUSION: The transfected hBMSCs appeared in small groups or clusters, and had a good proliferation after subculture in vitro. Some G418-resistance cell clones and calcium nodules were found when cultured with G418 in vitro. No significant difference was noted in the cell proliferation between the hBMP2 transfection group and two control groups. The ALP activity in the hBMP2 transfection group remained significantly higher than that in the two control groups (P < 0.01). At 48 hours and 3 weeks after transduction, hBMSCs could express actively hBMP2 by RT-PCR monitoring, and had a positive reaction of dot-ELISA and immunohistochemical analysis. The expression of hBMP2 gene in the experiment group at 48 hours was significantly higher than that at 3 weeks after transduction while there was no expression of hBMP2 gene in the two control groups. The above results show that the hBMSCs transfected by hBMP2 gene not only have potentials of normal proliferation and osteogenic differentiation, but also can stably express hBMP2.

Objective To investigate the donor-related risk factors for long-term biliary complications after liver transplantation (LT) from organ donation by citizens after death.Methods The clinical data of 140 donors who donated the organs after death for LT in the Third Affiliated Hospital of Sun Yat-sen University between April 2016 and April 2017 were retrospectively analyzed.The incidence of long-term biliary complications after LT in the recipients was observed,and the relationship between the incidence and the clinical indexes of the donors was analyzed.The influencing factors for long-term biliary complications after LT were analyzed using univariate and multivariate logistic regression analysis.Results The incidence of long-term biliary complications after LT in the recipients was 9.29％ (13/140).The incidence of donation after cardiac death (DCD) group and donation after brain death (DBD) group was 9.68％ (6/62) and 8.97％ (7/78) respectively.There was no significant difference between the two groups.Univariate logistic regression analysis revealed the long-term biliary complications after LT was related with cerebrovascular accident cause,the second warm ischemia time,steatosis of liver,history of cardiopulmonary resuscitation,dosage of dopamine before procurement and hypoproteinemia.Multivariate logistic regression analysis (removing warm ischemia time) revealed the independent influencing factors for long-term biliary complications after LT from organ donation were the second warm ischemia time (OR =1.106,95％ CI:1.034-1.181;P＜0.05),steatosis of liver (OR =5.319,95％ CI:1.020-27.752;P＜0.05) and dosage of dopamine before procurement (OR =1.279,95％ CI:1.021-1.601;P ＜ 0.05).Conclusion Postoperative long-term biliary complication is one of the major complications after LT from organ donation.The independent risk factors should be strictly controlled,as the second warm ischemia time,steatosis of liver and dosage of dopamine before procurement are contributed to the incidence of long-term biliary complications.

Objective To evaluate the influence of devascularization and shunt on liver transplantation in patients diagnosed with portal hypertension. Methods Clinical data of 182 patients diagnosed with cirrhosis,portal hypertension complicated with hemorrhages caused by esophageal and gastric varices rupture undergoing liver transplantation in the Third Affiliated Hospital of Sun Yat-sen University from January 2007 to December 201 1 were retrospectively analyzed. Nineteen patients undergoing splenectomy plus pericardial devascularization were assigned into the devascularization group,5 receiving distal spleen-renal vein shunt into the shunt group,and the remaining 158 cases with no history of devascularization or shunt into the control group. Preoperative incidence of pylethrombosis,operation time,intraoperative hemorrhage volume,the maximal blood flow velocity (Vmax )of portal vein anastomotic stoma at postoperative 1 month,postoperative incidence of pylethrombosis and 3-year survival rate were statistically compared among three groups. Results In the devascularization group,preoperative incidence of pylethrombosis was significantly higher compared with that in the control group(P<0.01).Compared with the control group,operation time of liver transplantation in the devascularization and shunt groups was significantly longer (both P<0.05 ). The incidence of pylethrombosis at postoperative 1 month was considerably enhanced in the devascularization group (P <0.05 ). The 3-year survival rates of devascularization group and shunt group were dramatically decreased compared with that of control group (both P<0.05 ). Intraoperative hemorrhage volume and Vmax of portal vein anastomotic stoma did not significantly differ among three groups (all P>0.05 ). Conclusions The medical history of devascularization or shunt will not cause severe difficulty or surgical risk to subsequent liver transplantation in patients with portal hypertension.