Background and aim:Hepatitis B virus(HBV)-related gestational acute-on-chronic liver failure(ACLF)is a severe condition with limited treatment options.This study aimed to evaluate the efficacy and ideal timing of plasma exchange and continuous renal replacement therapy(CRRT)in managing pregnant women with HBV-related ACLF. Methods:This study retrospectively analyzed 51 eligible patients with HBV-related gestational ACLF between 2009 and 2020.Patients admitted to the study were divided into a conventional treatment group and a new treatment group according to whether they received the new management protocol,which included more aggressive plasma exchange(PE)and CRRT strategies.All 19 pregnant women with hepatic encephalopathy(HE)were divided into an early treatment group and a non-early treatment group according to whether PE therapy was initiated within three days.Our study had two primary objectives.Firstly,we aimed to evaluate the impact of PE and CRRT on puerperal survival.Secondly,we sought to assess the effects of early PE and CRRT regimens on puerperal survival in women with HE. Results:The levels of total bilirubin on the second day postpartum(D3),the third day postpartum(D4),and the fifth day postpartum(D6)were significantly lower in the new treatment group compared to the conventional treatment group(P=0.02,0.01,and 0.02,respectively).The ALT of D3 was significantly elevated in the new treatment group compared to the conventional treatment group(P=0.02).The incidence of HE overall increased from prenatal to postpartum D4,peaked on D4,and then gradually decreased from the fourth day postpartum(D5)(P=0.027).The first week after delivery revealed a significant difference in survival rate between the two groups,the conventional treatment group had statistically higher mortality rates compared to the new treatment group(P=0.002).Similarly,the entire puerperal period mortality rate of the conventional treatment group was statistically higher than the new treatment group(P=0.002).Moreover,among all patients with HE,the non-early treatment group showed significantly higher puerperal mortality rates compared to the early treatment group(P=0.006). Conclusions:Early PE and CRRT conducted within three days post-childbirth,enhance puerperal prog-nosis for HBV-related gestational ACLF.

Objective To investigate the rationality and efficacy of enhanced recovery after surgery (ERAS) in liver transplant recipients. Methods Clinical data of 465 liver transplant recipients were retrospectively analyzed. All recipients were divided into the ERAS group (n=163) and control group (n=302) according to whether they received ERAS. The severity of disease in the ERAS group was worse than that in the control group. Operation situations including the operation time, anhepatic phase and intraoperative blood transfusion volume of the liver transplant recipients were observed and recorded. Postoperative recovery conditions including the length of intensive care unit (ICU) stay, total length of hospital stay, total ventilator removal time at postoperative 28 d and postoperative re-intubation rate were recorded. The survival rates at 90 d, 180 d and 1 year after liver transplantation were calculated. The influencing factors of survival rate of liver transplant recipients were analyzed. Results The anhepatic phase in the ERAS group was 45 (39, 53) min, significantly longer than 40 (32, 48) min in the control group (P < 0.05). The volume of erythrocyte infusion in the ERAS group was 10 (7, 13) U, significantly less than 18 (10, 28) U in the control group (P < 0.05). The length of postoperative ICU stay and total length of hospital stay in the ERAS group were 135 (84, 212) h and 24 (18, 33) d, significantly shorter than 154 (103, 253) h and 34 (20, 50) d in the control group (both P < 0.05). Total ventilator removal time at postoperative 28 d was 26 (25, 27) d, significantly longer than 26 (23, 27) d in the control group (P < 0.05). The postoperative re-intubation rate in the ERAS group was 11.0%, significantly lower than 20.8% in the control group (P < 0.05). The 90 d, 180 d and 1-year survival rates in the ERAS group were 92.8%, which were significantly higher than 81.1%, 78.1% and 75.7% in the control group (all P < 0.05). ERAS and operation time were the independent influencing factors of survival rate of liver transplant recipients (both P < 0.05). Conclusions ERAS after liver transplantation can improve the survival rate of recipient, shorten the length of hospital stay, reduce the re-intubation rate and accelerate the rehabilitation after liver transplantation.

Objective To study chemical ingredients and angiogenesis effects for different compatibility proportions ofDanggui Buxue Decoction.Methods For chemical components, HPLC was performed to study the ingredients (Ferulic Acid, Calycosin-7-glusosido, Calycosin, Formononetin) inDanggui Buxue Decoction. For angiogenesis effects, transgenosis zebrafish model was incubated with different proportions ofDanggui Buxue Decoction.Results With the raise of Astragali Radix content, the synthetic scores of four ingredients in different compatibility proportions increased. When the Astragali Radix content to Angelicae Sinensis Radix content was 8 to 2 and 5 to 1, the scores were the highest. For zebrafish vascular injury model, vessel recoveries in top three were 5:1, 6:1 and 2:1 (Astragali Radix: Angelicae Sinensis Radix).Conclusion From comprehensive analysis of chemical composition and angiogenesis, the best compatibility ratio of Astragali Radix to Angelicae Sinensis Radix is 5:1.

Objective To summarize the treatment experience of sepsis after liver transplantation.Methods The clinical features and treatment methods of 1 patient developing sepsis after liver transplantation, who was admitted and treated in the Surgical Intensive Care Unit of the Third Affiliated Hospital of Sun Yat-sen University in September 201 4,were retrospectively studied.The interpretation of International Guidelines for Management of Severe Sepsis and Septic Shock (SSC Guidelines)and relevant literature were reviewed.Results One male patient at the age of 50 years old developed high fever and decrease of blood pressure at 1 d after liver transplantation,and was diagnosed as septic shock.The symptoms were relieved after the appropriate treatment like goal-directed fluid resuscitation,anti-infection and blood purification,etc.And the patient was discharged in stable conditions.Conclusions It is easy to develop infection after liver transplantation and the fatality rate of sepsis caused by infection is high.Once the sepsis occurs,clinicians must perform early goal-directed therapy and bundle therapy according to the SSC Guidelines positively,and select the appropriate drugs according to the pathogen culture results in order to reduce the fatality rate.

Objective: To study the effects of different origins, collection and processing methods on the quality of Taraxacum mongolicum. Methods:The HPLC fingerprints of Taraxacum mongolicum were established. Totally 11 batches of Taraxacum mongoli-cum were analyzed by similarity evaluation and cluster analysis. Results:According to the results of HPLC, 11 batches of Taraxacum mongolicum had good baseline separation and showed 5 common peaks. Based on the established HPLC method, the quality of different batches of Taraxacum mongolicum showed difference according to the results of similarity evaluation and cluster analysis. The quality of batch 121231-1 was the best. Conclusion:The origin, collection and processing method show notable influence on the quality of Ta-raxacum mongolicum, and the comprehensive score method can be applied in the quality evaluation of Chinese herbs.

ObjectiveTo investigate the drug sensitivity ofAcinetobacter baumannii in organ transplantation patients.MethodsClinical data of 66 patients detected withAcinetobacter baumannii in the Third Affiliated Hospital of Sun Yat-sen University between June 2012 and June 2015 were retrospectively studied. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 66 patients, 55 were males and 11 were females with the average age of (47±12) years old. Among the 66 patients, 11 cases were before liver transplantation, 52 were after liver transplantation, 1 was after kidney transplantation and 2 were in liver transplantation state. Sputum, urine, blood, wound secretion and drainage liquid of the patients were collected for bacterial culture and drug sensitivity test.ResultsA total of 73 strains ofAcinetobacter baumannii cultured from the specimens of 66 patients and the drug resistance rate to 13 antibiotics was respectively 78% to piperacillin sodium, 75% to cefotaxime sodium, 74% to ceftazidime, 73% to ceftriaxone sodium, 74% to cefepime, 73% to meropenem/imipenem-cilastatin sodium, 75% to ticarcillin sodium-clavulanate potassium, 73% to ciprolfoxacin, 71% to levolfoxacin, 73% to tobramycin, 73% to gentamycin, 73% to amikacin and 69% to trimethoprim/sulfadiazine. The resistance rate ofAcinetobacter baumannii cultured between 2014 and 2015 to the aforementioned antibiotics was higher than that cultured between 2012 and 2013. The resistance rate to carbapenems was 17% in 2012, 33% in 2013, 86% in 2014 and 92% in 2015.ConclusionThe infection incidence of multi-drug resistantAcinetobacter baumannii in organ transplantation patients trends to increase year by year, which shall be paid attention to during the treatment.

Objective:To establish a method for the determination of asperosaponinⅥin Dieda Cuyu tablets by HPLC. Methods:A Hypersil C18(250 mm ×4.6 mm,5 μm)column was used. The mobile phase was acetonitrile-water(30∶70) with a flow rate of 1.0 ml·min-1 . The detection wavelength was 212 nm, the column temperature was room temperature,and the injection volume was 10μl. Results:AsperosaponinⅥ showed a good linear relationship within the range of 0. 04-0. 32 μg(r=0. 999 6). The average recovery was 97. 84%(RSD=1. 70%, n=6). Conclusion:The method is simple,accurate and reproducible, which can be used in the deter-mination of asperosaponinⅥ in Dieda Cuyu tablets.

Objective To establish a HPLC method for the determination of baicalin and berberine hydrochloride in Com-pound Qinbo Granules. Methods The gradient elution was performed on a Diamonsil C18 column using method-water (0. 05 % phosphate acid and 0. 1% trithylamine) as mobile phase, and the detection wavelength was 276 nm. Results The linear calibration curve of baicalin was obtained in the range of 10. 08～201.6 mg·L-1 with an average recovery of 98. 1% (RSD=1.11%). The linear calibration curve of berberine hydrochloride was in the range of 4. 08～81.6 mg·L-1 with an average re-covery of 97.9 % (RSD=1.24 %). Conclusion The method is simple and reproducible. It can be used for the quality con-trol of Compound Qinbo Granules.