In order to further standardize the diagnosis and treatment of long-term systemic complications in kidney transplant recipients,Branch of Organ Transplantation of Chinese Medical Association initiated the formulation of"Clinical Diagnosis and Treatment Guidelines for Long-term Systemic Complications in Kidney Transplant Recipients in China".Experts on organ transplantation were organized to summarize and integrate the latest progress in this field based on existing clinical guidelines,systematic evaluations,case studies,expert consensus.The guideline was formed after multiple rounds of discussion and reaching a consensus which included complications of hematological system,central nervous system,cardiovascular system,ocular,cutaneous and osteoporosis disorders.The full text focuses on 27 clinical problems and forms 40 recommendations,mainly involving the risk factors,classification,diagnosis,treatment and prevention of various complications.This guideline graded the quality of evidence and the strength of recommendation for each clinical issue using 2009 Oxford Centre for Evidence-Based Medicine(OCEBM)Grading and Strength of Recommendation criteria,so as to provide reference for the diagnosis and treatment of late complications,comprehensively improve the management capacity of clinicians to benefit kidney transplant recipients.

The diagnosis and treatment of digestive system complications of kidney transplant recipients is related to the long-term survival and quality of life of patients,which needs great attention.In order to further standardize its diagnosis and treatment,Branch of Organ Transplantation of Chinese Medical Association initiated the formulation of"Clinical Diagnosis and Treatment Guidelines for Digestive System Complications in Kidney Transplant Recipients in China",and organized experts in organ transplantation and related disciplines to summarize the new progress in diagnosis and treatment of digestive system complications of kidney transplant recipients at home and abroad in recent years based on existing clinical research,systematic evaluation,case study,expert consensus and existing guidelines,and reached a consensus after many discussions.This paper focuses on 11 clinical problems,forming 16 recommendations,and grading the evidence quality and recommendation strength of each clinical problem by the evidence grading and recommendation strength standard of Oxford University Evidence-based Medicine Center in 2009,in order to provide reference for the diagnosis and treatment of digestive system complications of kidney transplant recipients,comprehensively improve the management ability of digestive system complications of clinicians in an all-round way and benefit transplant recipients.

Objective:To understand the cognition and attitude of medical staff towards medical ethics review, analyze possible influencing factors, to put forward relevant suggestions for strengthening ethical management in the future.Methods:From November 2021 to May 2022, a self-designed questionnaire and general data questionnaire on the cognition and attitude of medical staff to ethical issues in clinical research were used to investigate 408 medical staff from two first-class ternary hospitals in Hunan Province, data was analyzed to explore the respondents′ cognition and attitude, as well as related influence factors.Results:The average cognitive score of medical staff was 65.41, and the average attitude score was 91.83. Many possible influence actors regarding the cognition were identified, including degree, technical title, professional field, number of clinical research projects engaged as investigators, number of clinical research projects conducted as principle investigators, whether the hospital has established an ethics committee, and research ethics training experiences. While the influence factors of attitude were experiences of conducting and engaging in clinical research, the construction of hospital ethics committee and research ethics trainings.Conclusions:Medical staffs have the willingness to explore more research ethics knowledge, while their cognition of research ethics should be improved. Root-cause analysis should be conducted to identify influencing factors for improvement. The research management department should strengthen the publicity and training of clinical research ethics of medical staff, to improve their clinical research ethics knowledge literacy, and ensure the well-functioning of clinical research ethics review.

Objective To discuss the clinical efficacy and safety of improved wire- maintaining technique in performing transcatheter closure of ventricular septal defects. Methods During the period from June 2011 to June 2013 at Changhai Hospital, percutaneous transcatheter closure of ventricular septal defect with improved wire-maintaining technique was carried out in 62 patients. According to the manipulation used , the patients were divided into traditional wire-maintaining technique group (group A, n = 30) and improved wire- maintaining technique group (group B, n = 32). The use of occluder during the procedure, the fluoroscopy time, the operation time and the complications were recorded. Follow-up examinations with ECG, echocardiogram and chest radiograph were performed at 24 hours and at 1 , 3 and 6 months after the procedure. The results were analyzed. Results No statistically significant differences in the use of occluder and in the incidence of complications existed between the two groups (P > 0.05). No severe complications occurred in both groups. The fluoroscopy time and the operation time in group A were (11.96 ± 3.63) min and (53.43 ± 14.48) min respectively, while the fluoroscopy time and the operation time in group B were (9.37 ± 2.77) min and (45.34 ± 10.38) min respectively, and the differences between the two groups were statistically significant (P < 0.05). Conclusion In performing transcatheter closure of ventricular septal defects, the practice.

Objective To explore the feasibility and effectiveness of interventional transcatheter destruction of the aortic valve to establish an animal model with acute aortic valve regurgitation. Methods Eight healthy goats were used for this study. A limited sternotomy approach was used to access the apex of the heart. Puncturing of the apex of the heart was performed to establish a wire track, then, under fluoroscopic guidance a 10 F sheath was inserted along this track of hard wire until to the ascending aorta above the aortic valve. The internal sheath was removed. Via the 10 F sheath a 10 mm occluder of ventricular septal defect (VSD) was introduced into the ascending aorta above the aortic valve. The sheath was pulled back to the left ventricle, while the occluder remained in the ascending aorta above the aortic valve. Then the occluder was quickly pulled back into the left ventricle in order to make some certain damage to the aortic valve. And an acute aortic valve regurgitation model was thus established. Angiography of ascending aorta above the aortic Among the 8 animals, two died of acute left ventricular failure on the spot due to excessive regurgitation blood flow after the operation. Macroscopically, damage of the aortic valve was seen. In the six survivors, angiography of ascending aorta above the aortic valve and Doppler echocardiography showed that moderate degree of regurgitation was detected in 5 and small amount of regurgitation in one. Two experimental goats with moderate degree of regurgitation died of heart failure separately at seven days and fifteen days after the operation. The remaining four experimental goats survived for more than three months. Follow- up checkups with echocardiography suggested the presence of mild- moderate degree of regurgitation. Conclusion Acute aortic valve regurgitation model in experimental goats can be established through transapical transcatheter damage of aortic valve by quickly pulling back a VSD occluder which has been placed in the ascending aorta above the aortic valve. This method is clinically feasible, technically simple and repeatable, the result is reliable, and the degree of regurgitation is controllable.

Objective To evaluate the feasibility and safety of a delivery pathway for the performance of percutaneous left atrial appendage (LAA) occlusion in experimental canine models. Methods Transseptal puncture was performed via femoral vein approach under fluoroscopic and angiographic guidance in 12 experimental dogs. A pigtail catheter was advanced into the left atrium (LA), which was followed by LA angiography. The diameters of the neck of LAA were measured on LAA angiogram obtained in appropriate projection. After the delivery sheath was advanced along the wire into LA, a pigtail catheter was inserted into the ostium of the LAA and the sheath was then advanced over the pigtail into the LAA. LAA angiography was then performed through the delivery sheath to confirm the position of the delivery sheath. One hour after the procedure both electrocardiography (ECG) and transthoracic echocardiography (TTE) were carried out in five dogs to check the results, immediately after which the five dogs were sacrificed to macroscopically observe the damages of the puncture site of inter-atrial septum as well as inside the LA and LAA. One hour and 2 weeks after the procedure TTE was conducted in the remaining 7 dogs and these dogs were followed up for one month. Results One dog died of pericardial tamponade during the operation. In 8 dogs the LAA was clearly displayed in the projection position of right anterior oblique (RAO) 30°/cranial (CRA) 20°,while in 3 dogs the LAA was well visualized in the projection position of RAO 30° , and in one dog in the projection position of RAO 30°/caudal (CAU) 20°. The diameter of LAA neck was (13.6 ± 5.2) mm. The delivery sheath was safely advanced into the LAA along the pigtail catheter in all dogs, and no air embolism, thrombus or pericardial tamponade occurred. Hematoma at puncture point of groin occurred in 2 dogs, which was absorbed through pressure dressing. Macroscopic examination of the heart performed immediately after the operation showed that no bloody pericardial effusion was found, and mild hematoma at posterior wall of LA was seen in one dog and mild damage of the upper-margin intima of LAA was noted in 2 dogs. The mean fluoroscopy time was (10.1 ± 2.5) minutes and the mean operation time was (58 ± 12) minutes. TEE showed no pericardial effusion 2 weeks after the procedure. During the follow-up period of one month no sudden death, stroke or infection occurred. Conclusion This method of placing the delivery sheath into the LAA is clinically safe and effective, and it can reliably establish a pathway to advance the LAA occluder into LAA.

Objective To explore the effect of small dose of fentanyl combined with midazo-lam on prevention of radial artery spasm.Methods 1086 patients with elective transradial percuta-neous coronary intervention were randomly divided into medicine group and control group.The medicine group was treated with conventional intravenous injection of fentanyl and midazolam.Inci-dence rate of radial spasm,vascular complications and mortality rate or re-hospitalization rate with-in 30 days were recorded and compared between two groups.Results Incidence rate of radial spasm in medicine group was 2.5%,which was significantly lower than 8.8% in the control group (P <0.001).There were no significant differences in aspects of VAS score,mortality rate and re-hos-pitalization rate between two groups.Multivariate analysis showed that there were obvious correla-tion between incidence of radial spasm and gender,height,obesity,smoking,numbers of tubes, surgical way and difficulty of operation.Conclusion Small dose of fentanyl combined with midazo-lam during transradial interventional procedures can significantly reduce the incidence of radial spasm and vascular complications,and it won’t cause increasing of mortality rate and re-hospitalization rate.

Objective To explore the effect of small dose of fentanyl combined with midazo-lam on prevention of radial artery spasm.Methods 1086 patients with elective transradial percuta-neous coronary intervention were randomly divided into medicine group and control group.The medicine group was treated with conventional intravenous injection of fentanyl and midazolam.Inci-dence rate of radial spasm,vascular complications and mortality rate or re-hospitalization rate with-in 30 days were recorded and compared between two groups.Results Incidence rate of radial spasm in medicine group was 2.5%,which was significantly lower than 8.8% in the control group (P <0.001).There were no significant differences in aspects of VAS score,mortality rate and re-hos-pitalization rate between two groups.Multivariate analysis showed that there were obvious correla-tion between incidence of radial spasm and gender,height,obesity,smoking,numbers of tubes, surgical way and difficulty of operation.Conclusion Small dose of fentanyl combined with midazo-lam during transradial interventional procedures can significantly reduce the incidence of radial spasm and vascular complications,and it won’t cause increasing of mortality rate and re-hospitalization rate.

Objective To compare proprotein convertase subtilisin/kexin type 9 (PCSK9) levels between premenopausal and postmenopausal women,and to investigate the relationship between serum PCSK9 and metabolic factors.Methods Totally 515 women were enrolled from the study on diabetes of prediction,prevention,and intervention in Nanjing in 2009.Survey,physical examinations,and determination of related metabolic indexes were performed.Serum PCSK9 level was measured by sandwich ELISA.Results Serum PCSK9 level was positively correlated with low density lipoprotein-cholesterol (LDL-C),total cholesterol (TC),triglyceride,fasting plasma glucose,body mass index,waist-hip ratio,and age in women (all P＜0.01).PCSK9 level was significantly lower in premenopausal women than that in postmenopausal women [(58.18 ± 25.44 vs 80.91 ± 33.74) ng/ml,P ＜0.01].Conclusion Higher level of PCSK9 exists in postmenopausal women compared with premenopausal women.The level of PCSK9 is closely correlated with age,TC,and LDL-C.

α-Galactosidase A (α-Gal A ) activities in plasma and peripheral blood granulocytes of 100healthy subjects and one patient with Fabry disease was determined by means of fluorogenic substrate.The results showed that the enzymatic activities of peripheral blood granulocytes and plasma in 100 subjects were (51.97 ± 15.24)and(148.08±26.30) nmol · h-1 · ml-1 respectively.The α-Gal A activities in plasma and granulocytes were positively correlated( r=0.533,P＜0.01 ).The enzymatic activities in peripheral blood granulocytes and plasma of the patients with Fabry disease were 1.05 and 10.06 nmol · h-1 · ml-1 respectively,both much lower than those of 100healthy subjects.These results suggest that α-Gal A activity in plasma and peripheral blood granulocytes can be used for diagnosis and screening of Fabry disease.