Objective To explore the value of combined ultrasound parameters, including the hepatorenal index (HRI) and renal resistance index (RRI), with cystatin C (CysC) in monitoring early acute kidney injury (AKI) after liver transplantation. Methods Perioperative data from 121 liver transplant recipients who received organs from donation after brain death were collected. The HRI and RRI of the recipients were measured on postoperative days 1-7 and at 1 month, and the CysC levels were measured on postoperative day 1. The recipients were divided into the AKI group (n=53) and the non-AKI group (n=68) based on whether AKI occurred within 7 days after operation. The data of the two groups were compared, and the ultrasound parameters before and after recovery in the AKI group were analyzed. The value of combined HRI, RRI and CysC in monitoring AKI was also analyzed. Results AKI occurred in 53 recipients, with an incidence rate of 43.8%, including 30 cases of stage 1, 18 cases of stage 2, and 5 cases of stage 3. Among them, 49 cases occurred on postoperative day 1, and 4 cases occurred on postoperative day 2. Of these, 43 cases recovered within 7 days after surgery, 8 cases recovered within 2 months after surgery, 1 case was lost to follow-up, and 1 case received renal replacement therapy. The body mass index and preoperative CysC levels were higher in the AKI group than in the non-AKI group, and the operative time was longer in the AKI group than in the non-AKI group (all P < 0.05). The HRI on postoperative day 1 was lower in the AKI group than in the non-AKI group, while the RRI and CysC levels were higher (all P < 0.05). When AKI occurred, the HRI was lower than the baseline level, and the RRI was higher than the baseline level. As AKI recovered, the HRI gradually increased, and the RRI gradually decreased. The receiver operating characteristic curve analysis showed that the sensitivity and specificity of HRI ≤ 1.12 for predicting AKI were 0.623 and 0.878, respectively, with an area under the curve (AUC) of 0.801. The sensitivity and specificity of RRI ≥ 0.65 for predicting AKI were 0.878 and 0.676, respectively, with an AUC of 0.825. The sensitivity and specificity of CysC ≥ 1.38 mg/L for predicting AKI were 0.736 and 0.882, respectively, with an AUC of 0.851 (all P<0.01). The combination of HRI and CysC (AUC=0.897, P<0.01), RRI and CysC (AUC=0.910, P<0.01), and all three parameters combined (AUC=0.934, P<0.01) were more effective than using each parameter alone. Conclusions HRI and RRI may be used to monitor the occurrence and recovery of early AKI after liver transplantation. The combination of these two parameters with CysC has a high application value in monitoring early AKI after liver transplantation.

Objective:To explore the value of 18F-fibroblast activation protein inhibitor (FAPI) PET/CT in the assessment of early-stage graft fibrosis (S1-S2) after liver transplantation (LT). Methods:From November 2021 to April 2022, 17 adult liver transplant recipients (12 males and 5 females; age (52.6±7.9) years) in the Affiliated Hospital of Qingdao University were enrolled retrospectively in this study. All 17 patients received laboratory examinations, FibroScan, 18F-FAPI PET/CT and liver biopsy. According to the Scheuer scoring system, hepatic tissue was divided into no fibrosis (S0) and early fibrosis (S1-S2). Independent-sample t test was used to compare SUV max between two groups, and Mann-Whitney U test was used to compare liver stiffness measurement (LSM). ROC curve analysis was used to evaluate the diagnostic efficacy of LSM and SUV max in the early fibrosis of liver grafts. Delong test was used to compare the difference of AUCs. Results:Among 17 adult LT recipients, 11 were in stage S0, 5 were in stage S1, and 1 was in stage S2. There were significant differences in LSM and SUV max between no fibrosis group and early fibrosis group (LSM: 5.4(4.7, 6.6) vs 12.9(5.6, 19.9) kPa, z=-2.01, P=0.044; SUV max: 1.7±0.8 vs 3.9±1.6, t=-3.14, P=0.019). The threshold value of LSM in predicting early-stage graft fibrosis was 8.2 kPa and the AUC was 0.80 (95% CI: 0.54-0.95), which was 2.0 and 0.92 (95% CI: 0.78-1.00) for SUV max respectively. There was no significant difference in AUC between the two tools ( z=0.80, P=0.421). Conclusion:18F-FAPI PET/CT can precisely evaluate the early fibrosis of allografts, with the similar diagnostic efficacy with FibroScan (LSM), which is expected to be a new non-invasive diagnostic tool for predicting the early-stage of graft liver fibrosis.

Acute kidney injury is a common complication after liver transplantation, which severely affects clinical prognosis of liver transplant recipients. Multiple factors before, during and after liver transplantation may cause kidney injury. If not properly treated, it may progress into chronic kidney diseases, which significantly increases postoperative fatality and negatively affects clinical efficacy of liver transplantation. Therefore, prevention, diagnosis and treatment of acute kidney injury after liver transplantation is a hot topic for clinicians. In this article, the definition, diagnosis, risk factors, prevention and treatment of acute kidney injury after liver transplantation were reviewed, and potential risk factors and related therapeutic strategies during different stages of acute kidney injury after liver transplantation were analyzed, aiming to lower the risk of acute kidney injury after liver transplantation and further improve clinical prognosis of liver transplant recipients by optimizing treatment regimens.

Objective To investigate the effect and underlying mechanism of SULT2B1 in the de-velopment of atherosclerosis(AS).Methods Twelve 8-week-old apolipoprotein E-knockout(apoE-/-)male mice were subjected and fed with a high-fat diet for 12 weeks,and then randomly divided into adeno-associated virus(AAV)-GFP and AAV-shSULT2B1 groups,with 6 animals in each group.In 4 weeks after AAV injection via tail vein,the mice were sacrificed for assessing aortic and aortic root plaque formation by oil red O staining and detecting serum levels of inflam-matory factors and blood lipids.RAW264.7 cells were transfected with adenovirus(Ad)-GFP and Ad-SULT2B1,respectively(n=3).RNA sequencing was performed to detect downstream RNA changes.Then LncRNA gga3-204 was selected for downstream study.After RAW264.7 cells were divided into si-NC group,si-SULT2B1 group,si-Lncgga3-204 group and si-SULT2B1+si-Lncg-ga3-204 group(n=3),and the IL-1β and IL-6 levels were detected in these transfected cells.Results There was no statistically difference in body weight in the mice from the AAV-GFP and AAV-shSULT2B1 groups after high-fat feeding(P＞0.05).Significantly lower serum levels of TC,TG and LDL-C,reduced aortic plaque area[(8.38±1.33)％vs(11.83±1.04)％,P=0.000],and decreased TG content within the aortic root plaque[(12.29±1.54)％vs(17.67±1.53)％,P=0.000]were observed in the AAV-shSULT2B1 group than those in the AAV-GFP group.Ser-um IL-1β and IL-6 levels in the mice of the AAV-shSULT2B1 group than those in the AAV-GFP group(P＜0.01).The AAV-shSULT2B1 group also had obviously lower serum levels of I L-1 βand IL-6 than the AAV-GFP group(P＜0.01).In the RAW264.7 cells from the si-SULT2B1 group,the mRNA levels of IL-1β and IL-6 were notably lower than those in the si-NC group(P＜0.01).LncRNA gga3-204 expression was significantly higher in the Ad-shSULT2B1 group than the Ad-GFP group(P＜0.01).While,the si-SULT2B1 group had statistically higher Lncgga3-204 level than the si-NC group(2.32±0.60 vs 1.19±0.21,P=0.036).The si-Lncgga3-204 group had significantly higher IL-1β and IL-6 mRNA levels than the si-NC group(P＜0.01).The si-SULT2B1+si-Lncgga3-204 group had significantly higher IL-1β and IL-6 mRNA levels than the si-SULT2B1 group(P＜0.05).Conclusion SULT2B1 affects the macrophage inflammatory response via Lncgga3-204,and then affects the progression of AS.

Objective:To investigate the application value of triangular modal construed for planning approach of laparoscopic local resection of liver tumors located in superior part of central liver lobe.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 10 patients who underwent local laparoscopic resection of liver tumors located in superior part of central liver lobe at the Affiliated Hospital of Qingdao University from January to June 2020 were collected. There were 6 males and 4 females, aged from 41 to 63 years, with a median age of 54 years. Preoperative triangular model was constructed for all patients to plan approach of laparoscopic local resection of liver tumors located in superior part of central liver lobe. Observation indicators: (1) preoperative general situations of patients; (2) surgical situations; (3) follow-up. Follow-up was conducted by outpatient examination or telephone interview to detect tumor recurrence and survival of patients up to February 2021. Measurement data with normal distribution were expressed as Mean± SD. Count data were expressed was absolute numbers. Results:(1) Preoperative general situations of patients: hepatocellular carcinoma was found in 7 cases, inthahepatic cholangiocarcinoma was found in 2 cases and ovarian cancer with liver metastasis was found in 1 case. Three cases had tumors located in S4a segment, 2 cases had tumors located in ventral subsegment of S8 segment, 2 cases had tumors located in dorsal subsegment of S8 segment, and 3 cases had tumors across the ventral segment of S4a+S8. The diameter of tumors was (3.4±1.0)cm. (2) Surgical situation: all the 10 patients underwent R 0 resection successfully, with no intraoperative blood transfusion or conversion to open surgery. The operation time of 10 patients was (149±59)minutes, the volume of intraoperative blood loss was (294±163)mL, the minimum surgical margin of specimen was (1.1±0.2)cm. The alanine aminotransferase was (324±151)U/L on the postoperative first day, the aspartic aminotransferase was (401±113)U/L on the postoperative first day, and the duration of postoperative hospital stay was (9±4)days. No bile leakage, hemorr-hage, reoperation or other complications occurred in all patients. (3) Follow-up: 10 patients were followed up for 7?13 months, with a median follow-up time of 11 months. All patients had no margin recurrence or distant metastasis. Conclusion:It is safe and feasible to construct triangular modal for planning approach of local laparoscopic resection of liver tumors located in superior part of central liver lobe.

Objective:To analyze the complications and outcomes during the hospitalization of extremely premature infants (EPI) and extremely low birth weight infants (ELBWI).Methods:Clinical data of 168 cases of EPI and ELBWI admitted to 4 hospitals of grade three in Shaanxi Province between January 1, 2015 and December 31, 2017 were retrospectively analyzed.The information of general data, prenatal care, complications and outcomes were summarized.Outcomes of different groups were compared according to birth weight and gestational age.Results:A total of 168 cases of EPI and ELBWI were collected.The rate of delivery in tertiary hospitals was 86.9% (146/165 cases), 86 patients (57.7%) received prenatal Dexamethasone.The mean gestational age was (27.9±1.7) weeks, and the mean birth weight was (951.6±148.9) g. The highest rates of pregnancy complications included gestational hypertension (44/149 cases, 29.5%), premature rupture of membranes (43/149 cases, 28.9%) and gestational diabetes (16/149 cases, 10.7%). The first three neonatal complications were neonatal respiratory distress syndrome (16/168 cases, 95.2%), bronchopulmonary dysplasia (73/110 cases, 66.4%) and retinopathy of prematurity (65/110 cases, 59.1%). The survival rate of EP and ELBWI in 168 cases was 61.9% (104/168 cases), the abandonment rate was 27.4% (46/168 cases), and the mortality in hospital was 10.7% (18/168 cases). According to birth weight and gestational age, there were no statistically significant differences in survival, abandonment and hospital mortality among different birth weight groups( χ2=4.361, 5.104, 1.630, all P>0.05), while there were statistically significant differences in survival, abandonment and hospital mortality among different gestational age groups( χ2=21.650, 8.164, 13.490, all P<0.05). Conclusions:There are many complications of EPI and ELBWI and the outcomes are closely related to the gestational age of birth.Improving the perinatal management level and the professional diagnosis and treatment level of neonatology are helpful to improve the survival rate and prognosis.

Objective:To study the clinical course and underlying causes of early severe neurological complication (ESNC) after pediatric liver transplantation.Methods:A retrospective study was conducted on 309 pediatric liver transplantation recipients treated at Tianjin First Central Hospital from January 2018 to December 2018. ESNC occurred in 15 patients (4.8%, 15/309) within 1 month after liver transplantation. There were 7 males and 8 females, aged from 6 to 46 months. Liver transplantation was carried out for biliary atresia ( n=12), fulminant liver failure ( n=1), Niemann-Pick disease ( n=1) and Alagille syndrome ( n=1). The causes of ESNC and the prognosis were analyzed. Results:The onset of ESNC was 10.7 (0-28) d after liver transplantation. Twelve patients developed encephalopathy with epilepsy in 2 patients. Four of these patients were caused by severe infection, 4 by heart failure combined with respiratory failure which led to ischemic hypoxic encephalopathy, 2 by transplant liver failure, 1 by intracranial infection, and 1 by severe brain swelling which led to brain death. Epilepsy occurred in 3 patients, 2 caused by neurotoxicity of calcineurin inhibitors, and 1 caused by reversible posterior leukoencephalopathy syndrome. Three children with ESNC died after operation, including 1 brain death, 1 due to severe heart failure and 1 due to severe infection.Conclusions:ESNC occurred in 4.8% of patients which seriously affected long-term prognosis of patients. Measures to reduce the incidence of ESNC include prevention of postoperative infection and drug toxicity, and good control of cardiac insufficiency.

Respiratory distress syndrome(RDS) remains a significant problem for preterm babies, although management has evolved gradually over the years.Since 2006, neonatal experts from many European countries have reviewed the latest literature every 3 years to reach consensus on the prevention and treatment of premature infants at risk of RDS or RDS, aiming at improving neonatal prognosis in Europe.The guidelines update the previous for guidelines after critical examination of the most recent evidence available in late 2018.

Objective: To investigate the epidemiological data of nosocomial sepsis of premature infants with gestational age less than 34 weeks and the distribution characteristics of pathogenic bacteria in Shaanxi province. Methods: A retrospective analysis of clinical data of premature infants born with gestational age < 34 weeks born between January 1 and December 30, 2018 in Neonatal Intensive Care Units(NICU) in 4 Grade A Class Three hospitals in Shaanxi province was performed.The high risk factors and pathogenic bacteria were analyzed by using chi-square test and t test for statistical analysis. Results: Totally 823 infants were included in this study, among whom, 73 patients developed nosocomial sepsis, and the incidence was 8.9%.The mean gestational age of the 73 patients with nosocomial sepsis was (30.6±2.2) weeks and mean birth weight was (1 320.3±450.5) g. The rate of invasive ventilator was 23.4%(52/222 cases). The rate of peripherally inserted central catheter (PICC) was 20.1% (61/303 cases). The rate of early antibiotic use was 8.1% (39/481 cases) and breast feeding rate was 9.3% (63/675 cases). The rate of PICC and ventilator use were statistically different between the non-infection group and the infection group(all P<0.05). There were 31 strains of pathogenic bacteria, among which gram-negative bacilli was the most common (22 strains, 70.9%), which mainly were klebsiella pneumoniae strains (15 strains, 48.4%), and 6 strains(19.4%) of Fungus was detected. Conclusions The incidence of nosocomial sepsis in NICU in Shaanxi province is higher, gram-negative bacilli was the most common pathogenic bacteria, among which, klebsiella pneumoniae was main, it is necessary to strengthen the regular monitoring and analysis of nosocomial infection in NICU in order to reduce the incidence of nosocomial infection and sepsis.

Objective: To study the use of high flow nasal cannula oxygenation (HFNCO) on the respiratory function of patients with acute lung injury after liver transplantation. Methods: This is a randomized controlled interventional study. Among 200 adults who underwent liver transplantation from Jan 2015 to Dec 2015 in the Department of Transplant Surgery, Tianjin First Central Hospital, 80 patients who did not meet the criteria for acute lung injury were excluded. Of the remaining 120 patients who were included in the study, they were divided into the HFNCO group and the nasal catheter group by the random number table method, with 60 patients in each group. The respiratory rate (RR), oxygenation index (PaO₂/FiO₂) and PaCO₂ were recorded immediately after extubation, 2 h after extubation, 1st day after extubation and 2nd day after extubation. The reintubation rate and duration of ICU stay were compared. Results: The incidence of acute lung injury after liver transplantation was 60.0%(120/200). There was no reintubation in the HFNCO group, and 6 patients (10.0%) in the nasal catheter group were reintubated. The difference between the two groups was statistically significant (P<0.05). The RR of the HFNCO group was lower than that of the nasal catheter group [(19.4±4.5) breaths/min vs. (21.7±5.1) breaths/min], [(18.9±4.2) breaths/min vs. (22.5±4.4) breaths/min], [(19.0±3.7) breaths/min vs. (23.2±4.7) breaths/min] (all P<0.05) 2 h after extubation, on the 1st and 2nd day after extubation. The oxygenation index of the HFNCO group was significantly higher than that of the nasal catheter group [(242.6±65.0)mmHg vs. (206.6±44.2)mmHg], [(245.6±70.4)mmHg vs. (211.1±62.8)mmHg], [(238.2±62.8)mmHg vs. (210.4±57.1)mmHg] (all P<0.05). There was no statistically difference in the PaCO₂ and the duration of ICU stay between the two groups (P>0.05). Conclusions Compared with the conventional nasal catheter oxygen inhalation, HFNCO was more effective in improving oxygenation index, reducing RR, improving respiratory function and reducing reintubation rate in patients with acute lung injury after liver transplantation. HFNCO is a more suitable oxygen therapy for patients with acute lung injury after liver transplantation.