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.

Objective To analyze the distribution features of the Bragg peak of carbon ion beams in materials using SRIM software, and to explore the use of computed tomography (CT) number to calculate the incident energy of carbon ion beams. Methods SRIM software was used to study the travel of carbon ion beams (100 to 300 MeV/u) in different equivalent materials, and analyze the effects of the incident energy of carbon ion beams and the type and thickness of equivalent materials on the depth of the Bragg peak of carbon ion beams. Origin 2017 was used to analyze the functional relationship between CT number and water-equivalent Bragg peak depth ratio (Di) through data fitting. Results The ratios of the Bragg peak depths in equivalent materials to that in water almost stayed constant with the increase in the incident energy of carbon ion beams. Through the functional relation between CT number and D_i, the Bragg peak depth of a carbon ion beam of a given energy in an equivalent material could be converted to the equivalent Bragg peak depth in water. Conclusion With the water-equivalent Bragg peak depth ratio D_i and CT number of different volume units of human tissues, the equivalent Bragg peak depth in water required for the Bragg peak to fall in the tumor can be accurately calculated, which can be used to reversely infer the needed incident energy of carbon ion beams.

Objective:To analyze the phenotype and genotype of two propositi with inherited hypodysfibrinogenaemia caused by compound heterozygous mutations, and investigate the molecular mechanism.Metheds:Two propositi and their family members(7 person in 3 generations and 10 person in 3 generations,respectively) were investigated. The activity of plasma fibrinogen (Fg:C) and thrombin time (TT) were analyzed by coagulation method, the antigen of plasma fibrinogen (Fg:Ag) was detected by immunoturbidimetry. All of the exons and flanking sequences of FGA,FGB,FGG of two propositi were amplified by PCR, followed by direct sequencing. The ClustalX-2, 1-win software was used to analyze the conservatism of mutated gene locus. PROVEAN and Mutation Taster were applied to analyze the pathogenicity of mutated amino acid. The changes of the protein spatial structure and intermolecular interaction were analyzed by Pymol.Results:Fg:C and Fg:Ag of proposita A and B were both significantly decreased (0.74 and 0.78 g/L, 0.96 and 0.94 g/L, respectively). Gene analysis revealed that proposita A and B both carried a heterozygous mutation c.2185G>A(p.AαGlu710Lys) in exon 6 of FGA. Furthermore, proposita A also carried a heterozygous mutation c.701G>T(p.γTrp208Leu) in exon 7 of FGG, and proposita B carried a heterozygous mutation c.1015A>C(p.γSer313Arg) in exon 8 of FGG. Phylogenetic analysis suggested that p.AαGlu710,p.γTrp208 and p.γSer313 were highly conserved among homologous species. All variants were predicted to be deleterious by two online bioinformatic softwares. The protein model analysis indicated that protein spatial structure and intermolecular hydrogen bonds were changed by these variants, which destroyed the stability of Fg.Conclusion:The compound heterozygous mutations of p.AαGlu710Lys and p.γTrp208Leu,p.AαGlu710Lys and p.γSer313Arg might account for the hypodysfibrinogenemia in two propositi.

Objective:To establish the norm of clinical nursing teachers' competency in tertiary first-class hospitals in northwest China.Methods:From August 2019 to February 2020, 1 077 clinical nursing teachers were selected from 12 tertiary first-class hospitals in northwest China by stratified, random and proportional sampling, and were investigated with the Clinical Nursing Teacher Competency Evaluation Scale. Descriptive statistics were carried out on the sample data, and univariate variance analysis and pairwise comparison were carried out on the multi-classification variables of age, nursing age, professional title, teaching years and the number of teachers per year. The verified data were exported to SPSS 26.0 for statistical analysis, variance analysis was used for multi-group comparison, and LSD test was used for pairwise comparison between groups.Results:①The corresponding mean norm was established by grouping the total score and the first-class index; the percentile norm was made with 5% spacing; P10, P30, P70 and P90 were selected as the grading demarcation points, and the demarcation norm was constructed. ②Factor analysis showed that there were statistical differences in personality characteristics among different ages, nursing ages and professional titles ( P<0.05), and also in professional attitudes among different nursing ages and professional titles ( P<0.05). Conclusion:The establishment of norm provides references for individuals or units to evaluate teachers' competence.

Objective:To investigate the application of local rotation flap with subcutaneous pedicle for breast conservation in central breast cancer.Methods:Retrospective analysis of clinical data of 14 patients with stage Ⅰor Ⅱ central breast cancer was performed. The local rotation flap with subcutaneous pedicle was used for breast conservation in Jiangxi Provincial Breast Specialist Hospital (Nanchang Third Hospital) from January 2017 to December 2018. The postoperative complications were recorded. One year after operation, the aesthetic result, satisfactory and comfort index were evaluated. Two years after operation, local tumor recurrence and metastasis were followed.Results:All patients were women, aged 37-75 years old with the median age as 47. First-stage healing was achieved in 12 patients. Wound infection happened in one case and necrotic in one case. They were all healed after secondary suture. Fourteen patients were followed up for 1 year, the suprasternal notch-nipple length was (22.27±2.38) cm at the operative side, and (23.33±2.22) cm at the healthy side, showing no statistical significance ( t=-1.253, P=0.242). The nipple-midsternal line length was(10.12±0.91) cm at the operative side, and (10.68±1.09) cm at the healthy side, showing no statistical significance ( t=-1.937, P=0.094). The nipple-inframammary fold length was (6.94±0.95) cm at the operative side, and (7.05±1.30) cm at the healthy side, showing no statistical significance ( t=-0.478, P=0.645). The patient’s breast satisfaction was 60.2±11.4 points before operation and 61.7±12.7 points after operation, with no difference between them ( t=-0.330, P=0.744). The overall postoperative comfort index was 62.05±4.40 points, which indicates a moderate comfort state. The physiological comfort index was 6.52±2.05 points, the mental and psychological comfort index was 15.13±2.56 points, the social comfort index was 19.09±1.57 points, and the environmental comfort index was 21.29±2.11 points. There was no local recurrence and no systemic metastasis 2 years after operation. Conclusions:The breast conservation in central breast cancer with local rotation flap with subcutaneous pedicle is less invasive with few complication and satisfactory results in cosmetic appearance. The moderate comfort index and good prognosis can be prospected.

Objective:To investigate the application of local rotation flap with subcutaneous pedicle for breast conservation in central breast cancer.Methods:Retrospective analysis of clinical data of 14 patients with stage Ⅰor Ⅱ central breast cancer was performed. The local rotation flap with subcutaneous pedicle was used for breast conservation in Jiangxi Provincial Breast Specialist Hospital (Nanchang Third Hospital) from January 2017 to December 2018. The postoperative complications were recorded. One year after operation, the aesthetic result, satisfactory and comfort index were evaluated. Two years after operation, local tumor recurrence and metastasis were followed.Results:All patients were women, aged 37-75 years old with the median age as 47. First-stage healing was achieved in 12 patients. Wound infection happened in one case and necrotic in one case. They were all healed after secondary suture. Fourteen patients were followed up for 1 year, the suprasternal notch-nipple length was (22.27±2.38) cm at the operative side, and (23.33±2.22) cm at the healthy side, showing no statistical significance ( t=-1.253, P=0.242). The nipple-midsternal line length was(10.12±0.91) cm at the operative side, and (10.68±1.09) cm at the healthy side, showing no statistical significance ( t=-1.937, P=0.094). The nipple-inframammary fold length was (6.94±0.95) cm at the operative side, and (7.05±1.30) cm at the healthy side, showing no statistical significance ( t=-0.478, P=0.645). The patient’s breast satisfaction was 60.2±11.4 points before operation and 61.7±12.7 points after operation, with no difference between them ( t=-0.330, P=0.744). The overall postoperative comfort index was 62.05±4.40 points, which indicates a moderate comfort state. The physiological comfort index was 6.52±2.05 points, the mental and psychological comfort index was 15.13±2.56 points, the social comfort index was 19.09±1.57 points, and the environmental comfort index was 21.29±2.11 points. There was no local recurrence and no systemic metastasis 2 years after operation. Conclusions:The breast conservation in central breast cancer with local rotation flap with subcutaneous pedicle is less invasive with few complication and satisfactory results in cosmetic appearance. The moderate comfort index and good prognosis can be prospected.

Objective Toexplorethecorrelationbetween MRIcharacteristicsandaxillarylymphnode metastasisofmass-type breastcancer.Methods MRIcharacteristicsandpathologicalresultsofpostoperativeaxillarylymphnode metastasisin187cases withmass-typebreastcancerwereanalyzedretrospectively.Accordingtothenumberoflymphnodemetastases,allofthepatients weredividedintothefourgroups:pN0,pN1,pN2andpN3.Thecorrelationbetween MRIsignsand N pathologicalstagesineach groupwereanalyzed.Results Therewere108casesinpN0group,33casesinpN1group,22casesinpN2groupand24casesinpN3 groupI.nthedifferentgroups,therewere15,5,1and1casewithroundmassrespectively;8,1,1and0casewithlobularmasserespectively;85, 27,20and23caseswithirregularmasserespectively.Theshapeswerenotsignificantlydifferentamongthedifferentgroups(P>0.05)I.nthe differentgroups,therewere7,0,1and0casewithclearmarginrespectively;69,14,7and8caseswithirregularmarginrespectively;32,19,14and16caseswithspiculatedmarginrespectively.Themarginsweresignificantlydifferentamongthedifferentgroups(P<0.05)I.nthe differentgroups,therewere55,16,14and18caseswithheterogenousenhancementrespectively;43,14,5and6caseswithringenhancement respectively;3,1,1and0casewithcentralenhancementrespectively;7,2,2and0casewithseptumenhancement.Theenhancement patternswerenotsignificantlydifferentamongthedifferentgroups (P>0.05).ThenumbersofthemasswithtypeⅠ,ⅡandⅢtime-signalcurvesandtheADCvalueswerenotsignificantlydifferentamongthedifferentgroups(P>0.05).Conclusion MRIfeaturesof mass-typebreastcancershavelimitedvalueindeterminingaxillarylymphnodemetastasis.However,thespiculatedmarginofmassis valuableindeterminingaxillarylymphnodemetastasis.

Objective To investigate the influence of preoperative splenectomy on the prognosis after liver transplantation.Methods The retrospective cohort study was conducted.The clinical data of 95 patients who underwent liver transplantation in the Third Affiliated Hospital of Sun Yat-sen University between January 2004 and January 2014 were collected.Thirty-five patients undergoing preoperative splenectomy and pericardial devascularization and 60 undergoing spleen-preserving liver transplantation were allocated into the study group and control group,respectively.All patients received modified piggyback liver transplantation by the same team.Observation indicators:(1) intra-and post-operative situations;(2) follow-up and survival.The follow-up using telephone interview and outpatient examination was performed once every a week within 3 months postoperatively,once every one month within 6 months postoperatively and once every 3 months after 1 year postoperatively up to January 2016,including routine blood test,plasma-drug concentration of immunosuppressive agent and function of liver and kidney.Ultrasound and abdominal CT were used to monitor the long-term complication and survival.The measurement data with normal distribution were represented as (x)±s,and comparison between groups was done by the t test.Comparison of count data was done by the chi-square test.Results (1) Intra-and post-operative situations:all patients underwent successful liver transplantation.The operation time,volumes of intraoperative blood loss and blood transfusion were (483 ± 136) minutes,(5 683±2 950) mL,(4 887±3 682) mL in the study group and (392± 103)minutes,(3 522± 1 885)mL,(3 455±2 630)mL in the control group,respectively,with statistically significant differences between groups (t=3.683,4.358,2.202,P＜0.05).Six patients in the study group had intraoperative portal vein thrombosis (PVT),including 4 in level 1,1 in level 2 and 1 in level 3,and no patients in the control group,showing a statistically significant difference between groups (x2 =1.979,P＜0.05).Five patients with PVT in level 1 or 2 underwent thrombectomy and then end-to-end anastomosis of PV.One patient with PVT in level 1 had PVT recurrence and was cured by postoperative thrombolytic therapy.One patient with PVT in level 3 received PV reconstruction using artificial blood vessels,and had PVT recurrence and then was cured.There was no PV stenosis between groups.The levels of platelet at 1,3 and 7 days postoperatively were (75±60)× 109/L,(71± 45)×109/L,(111±73)×109/L in the study group and (57±32) ×109/L,(52±46) ×109/L,(87±53)×109/L in the control group,respectively,with statistically significant difference between groups (t =1.909,1.957,1.848,P＜ 0.05).The levels of platelet at 14 and 30 days postoperatively were respectively (230± 152)× 109/L,(310± 140)× 109/L in the study group and (193± 125)× 109/L,(286±62)× 109/L in the control group,with no statistically significant difference between groups (t=1.284,1.199,P＞0.05).The cases with postoperative infection,acute rejection,new-onset PVT in level 1-2 and 3-4 and PV stenosis were respectively 23,0,2,0,2 in the study group and 35,1,2,0,1 in the control group,with no statistically significant difference between groups (x2 =1.171,0.590,0.547,1.184,P＞0.05).Patients with postoperative infection and acute rejection were improved by symptomatic treatment.Two patients in the study group with PVT underwent anticoagulant and thrombolytic therapy,including 1 receiving interventional thrombectomy therapy.Two patients in the control group with new-onset PVT were cured by anticoagulant and thrombolytic therapy.Three patients with PV stenosis underwent percutaneous transhepatic portography (PTA) for balloon dilation,including 1 in the study group with good improvement after stent implantation.(2) Follow-up and survival:95 patients were followed up for 3-24 months,with an average time of 18 months.During the follow-up,the rate of chronic rejection in study and control groups was 5.7％(2/35) and 5.0％(3/60),showing no statistically significant difference between groups (x2 =0.023,P＞0.05).The 1-and 2-year accumulative survival rates were respectively 91.4％ (32/35),82.9％ (29/35) in the study group and 93.3％ (56/60),76.7％(46/60) in the control group,with no statistically significant difference between groups (x2 =0.780,P＞0.05).Conclusion The splenectomy before liver transplantation is easy to form PVT,increase time and difficulty of transplantation surgery,however,it doesn't increase complication risk after transplantation and affect postoperative survival.

Objective To explore the effect of tetramethylpyrazine (TMP) on serum cytokines and cardiac function in patients with sepsis myocardial injury.Methods Fifty patients with sepsis myocardial injury were admitted in Hangzhou First People's Hospital from June 2015 to September 2016,and according to the computer generated random number,they were divided into conventional treatment group and TMP treatment group,25 cases in each group.The patients in the conventional treatment group were treated with antimicrobial agents,vasoactive drugs,fluid resuscitation and organ function support,etc.;TMP treatment group was treated with traditional Chinese medicine (TCM) TMP on the basis of routine treatment.TMP 120 mg was added to 250 mL normal saline (NS) for intravenous drip once a day for a therapeutic course of 10 days.Plasma N-terminal pro-B type natriuretic peptidec (NT-proBNP) and serum tmnor necrosis factor-oα (TNF-α) levels were measured before treatment and on 1,5 and 10 days after treatment.Left ventricular internal systolic dimension (LVIDs),fractional shortening (FS) and left ventricular ejection fraction (LVEF) were measured by cardiac ultrasound,3 cardiac cycles were measured and the average results were taken.The intensive care unit (ICU) hospital stay and mortality were calculated in the two groups.Results The levels of NT-proBNP and TNF-α in the two groups after treatment were lower than those before treatment,the differences in the levels were statistically significant between those before treatment and 5 days after treatment in the conventional treatment group [NT-proBNP (ng/L):334.25 ± 36.46 vs.577.72 ± 60.34,TNF-α (ng/L):388.48 ± 43.38 vs.507.74-± 31.63,both P ＜ 0.05],and in TMP treatment group,the levels from 1 day after treatment compared with those before treatment,there were statistical significant differences [NT-proBNP (ng/L):387.44 ± 36.39 vs.571.67-± 56.34,TNF-α(ng/L):403.79 ± 23.20 vs.505.82 ± 31.31,both P ＜ 0.05];the degrees of decrease in TMP treatment group were more obvious than those in conventional treatment group (all P ＜ 0.01).After treatment in the two groups,the LVIDs was decreased gradually,FS and LVEF were increased gradually,reaching the lowest or highest level on 10 days after treatment,and the changes of TMP treatment group were more significant than those in the conventional treatment group,LVIDs and LVEF of the two groups showed statistically significant differences on 5 days after treatment [LVIDs (mm):43.23 ± 5.57vs.48.21 ± 2.29,LVEF:0.47 ± 0.02 vs.0.41 ± 0.02,both P ＜ 0.05],FS on 1 day after treatment showed a statistically significant difference [FS:(23.92 ± 1.81)％ vs.(22.84 ± 1.79)％,P ＜ 0.05].The ICU stay in the TMP group was shorter than that in the conventional treatment group (days:13.16 ± 2.67 vs.16.48-± 3.08,P ＜ 0.05),and the mortality was lower than that of conventional treatment group [20％ (5/25) vs.36％ (9/25)],the difference being not statistically significant (P ＞ 0.05).Conclusions In septic myocardial injury,TNF-α plays an important role;after TMP treatment in patients with myocardial injury caused by viral myocarditis,the serum TNF-α level is decreased showing it has antagonizing TNF-α activity,thus it has protective effect on sepsis myocarditis,improves heart function and the disease prognosis.