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Yang Q, Yi SH, Fu BS, Zhang T, Zeng KN, Feng X, Yao J, Tang H, Li H, Zhang J, Zhang YC, Yi HM, Lyu HJ, Liu JR, Luo GJ, Ge M, Yao WF, Ren FF, Zhuo JF, Luo H, Zhu LP, Ren J, Lyu Y, Wang KX, Liu W, Chen GH, Yang Y. [Clinical application of split liver transplantation: a single center report of 203 cases]. Zhonghua Wai Ke Za Zhi 2024; 62:324-330. [PMID: 38432674 DOI: 10.3760/cma.j.cn112139-20231225-00297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
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.
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Affiliation(s)
- Q Yang
- Liver Surgery & Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Institute of Organ Transplantation, Sun Yat-sen University, Guangdong Organ Transplantation Research Center, Guangdong Transplantation Medical Engineering Laboratory, Guangdong Provincial Key Laboratory of Liver Diseases, Guangzhou 510630
| | - S H Yi
- Liver Surgery & Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Institute of Organ Transplantation, Sun Yat-sen University, Guangdong Organ Transplantation Research Center, Guangdong Transplantation Medical Engineering Laboratory, Guangdong Provincial Key Laboratory of Liver Diseases, Guangzhou 510630
| | - B S Fu
- Liver Surgery & Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Institute of Organ Transplantation, Sun Yat-sen University, Guangdong Organ Transplantation Research Center, Guangdong Transplantation Medical Engineering Laboratory, Guangdong Provincial Key Laboratory of Liver Diseases, Guangzhou 510630
| | - T Zhang
- Liver Surgery & Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Institute of Organ Transplantation, Sun Yat-sen University, Guangdong Organ Transplantation Research Center, Guangdong Transplantation Medical Engineering Laboratory, Guangdong Provincial Key Laboratory of Liver Diseases, Guangzhou 510630
| | - K N Zeng
- Liver Surgery & Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Institute of Organ Transplantation, Sun Yat-sen University, Guangdong Organ Transplantation Research Center, Guangdong Transplantation Medical Engineering Laboratory, Guangdong Provincial Key Laboratory of Liver Diseases, Guangzhou 510630
| | - X Feng
- Liver Surgery & Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Institute of Organ Transplantation, Sun Yat-sen University, Guangdong Organ Transplantation Research Center, Guangdong Transplantation Medical Engineering Laboratory, Guangdong Provincial Key Laboratory of Liver Diseases, Guangzhou 510630
| | - J Yao
- Liver Surgery & Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Institute of Organ Transplantation, Sun Yat-sen University, Guangdong Organ Transplantation Research Center, Guangdong Transplantation Medical Engineering Laboratory, Guangdong Provincial Key Laboratory of Liver Diseases, Guangzhou 510630
| | - H Tang
- Liver Surgery & Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Institute of Organ Transplantation, Sun Yat-sen University, Guangdong Organ Transplantation Research Center, Guangdong Transplantation Medical Engineering Laboratory, Guangdong Provincial Key Laboratory of Liver Diseases, Guangzhou 510630
| | - H Li
- Liver Surgery & Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Institute of Organ Transplantation, Sun Yat-sen University, Guangdong Organ Transplantation Research Center, Guangdong Transplantation Medical Engineering Laboratory, Guangdong Provincial Key Laboratory of Liver Diseases, Guangzhou 510630
| | - J Zhang
- Liver Surgery & Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Institute of Organ Transplantation, Sun Yat-sen University, Guangdong Organ Transplantation Research Center, Guangdong Transplantation Medical Engineering Laboratory, Guangdong Provincial Key Laboratory of Liver Diseases, Guangzhou 510630
| | - Y C Zhang
- Liver Surgery & Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Institute of Organ Transplantation, Sun Yat-sen University, Guangdong Organ Transplantation Research Center, Guangdong Transplantation Medical Engineering Laboratory, Guangdong Provincial Key Laboratory of Liver Diseases, Guangzhou 510630
| | - H M Yi
- Organ transplant Intensive Care Unit, the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630
| | - H J Lyu
- Organ transplant Intensive Care Unit, the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630
| | - J R Liu
- Organ transplant Intensive Care Unit, the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630
| | - G J Luo
- Anesthesia & Surgery Center, the Third Affiliated Hospital of Sun Yat-sen University ,Guangzhou 510630
| | - M Ge
- Anesthesia & Surgery Center, the Third Affiliated Hospital of Sun Yat-sen University ,Guangzhou 510630
| | - W F Yao
- Anesthesia & Surgery Center, the Third Affiliated Hospital of Sun Yat-sen University ,Guangzhou 510630
| | - F F Ren
- Liver Surgery & Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Institute of Organ Transplantation, Sun Yat-sen University, Guangdong Organ Transplantation Research Center, Guangdong Transplantation Medical Engineering Laboratory, Guangdong Provincial Key Laboratory of Liver Diseases, Guangzhou 510630
| | - J F Zhuo
- Organ transplant Intensive Care Unit, the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630
| | - H Luo
- Anesthesia & Surgery Center, the Third Affiliated Hospital of Sun Yat-sen University ,Guangzhou 510630
| | - L P Zhu
- Liver Surgery & Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Institute of Organ Transplantation, Sun Yat-sen University, Guangdong Organ Transplantation Research Center, Guangdong Transplantation Medical Engineering Laboratory, Guangdong Provincial Key Laboratory of Liver Diseases, Guangzhou 510630
| | - J Ren
- Ultrasound Department of the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630
| | - Y Lyu
- Ultrasound Department of the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630
| | - K X Wang
- Organ Donation Department of the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - W Liu
- Liver Surgery & Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Institute of Organ Transplantation, Sun Yat-sen University, Guangdong Organ Transplantation Research Center, Guangdong Transplantation Medical Engineering Laboratory, Guangdong Provincial Key Laboratory of Liver Diseases, Guangzhou 510630
| | - G H Chen
- Liver Surgery & Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Institute of Organ Transplantation, Sun Yat-sen University, Guangdong Organ Transplantation Research Center, Guangdong Transplantation Medical Engineering Laboratory, Guangdong Provincial Key Laboratory of Liver Diseases, Guangzhou 510630
| | - Y Yang
- Liver Surgery & Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Institute of Organ Transplantation, Sun Yat-sen University, Guangdong Organ Transplantation Research Center, Guangdong Transplantation Medical Engineering Laboratory, Guangdong Provincial Key Laboratory of Liver Diseases, Guangzhou 510630
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Sun YS, Lyu HJ, Zhao YR, Zhang SS, Bai YX, Shi BY. [Risk factors for central neck lymph node metastases of papillary thyroid carcinoma]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2017. [PMID: 28635213 DOI: 10.3760/cma.j.issn.1673-0860.2017.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the impact factors for central neck lymph node metastases(CLNM) of papillary thyroid carcinoma(PTC). Methods: A total of 498 patients with PTC who underwent total or hemi-thyroidectomy plus central neck lymph node dissection between January 2014 and July 2016 were included. Univariate and multivariate analyses were performed to identify clinicopathological characteristics, thyroid function parameters and US findings that associated with CLNM of PTC. A nomogram was developed to predict the probability of CLNM. The receiver operating characteristic curve(ROC) was used to estimate the efficiency of the nomogram. Results: Among 498 patients, 284 patients were affected by CNLM. The sensitivity and specificity of US in predicting PTC metastasis in the central neck were 31.3% and 88.3%, respectively. Univariate and multivariate analyses showed that gender, age, number and size of suspicious malignant nodules in thyroid, and suspicious lymph node metastasis detected by ultrasonography were independently correlated with CLNM. The ROC showed that the AUC was 0.748, with sensitivity of 80.8%, and specificity of 59.8%. Conclusions: Gender, age, number and size of suspicious malignant nodules in thyroid, suspicious lymph node metastasis were predictive factors for CLNM in patients with PTC. The nomogram developed based on related factors with CLNM is more sensitive than sonographic central neck lymph node features in predicting the probability of CLNM.
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Affiliation(s)
- Y S Sun
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - H J Lyu
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Y R Zhao
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - S S Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Y X Bai
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - B Y Shi
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
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Xu XH, Yu L, Chen Q, Huang Y, Sun HH, Yi LS, Xu SC, Lyu HJ, Qiu ZM. [Changes and implications of esophageal function in patients with chronic cough induced by gastroesophageal reflux]. Zhonghua Jie He He Hu Xi Za Zhi 2016; 39:850-855. [PMID: 27852360 DOI: 10.3760/cma.j.issn.1001-0939.2016.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the changes in the esophageal function and their association with the therapeutic outcome in patients with gastroesophageal reflux-induced chronic cough (GERC). Methods: One hundred thirty-five patients with definite GERC consecutively referred to our respiratory clinic were recruited into the study between January 2012 and August 2015.Cough was due to acid reflux in 81 patients and non-acid reflux in 54 patients, with the favorable response to the standard antireflux therapy in 88 patients and to the intensified antireflux treatment in 47 patients. The control groups included 26 patients with gastroesphageal reflux disease without cough and 22 healthy volunteers. All the subjects underwent an esophageal manometry from which the parameters were recorded, including the pressure, length and relaxation rate of lower esophageal sphincter, and the peristaltic contractive amplitude, wave velocity and contractive time of esophagus. The data were combined with the results of multi-channel intraluminal impedance combined with pH monitoring to analyze the changes of esophageal function in the patients with acid or non-acid GERC and their relation to the outcomes of antireflux therapy. Results: Compared with healthy volunteers, patients with GERC presented with a lower pressure [(11±5) mmHg vs (15±5) mmHg (1 mmHg=0.133 kPa), q=3.70, P=0.000], shorter overall length [(2.2±0.5) cm vs (3.0±1.0) cm, q=2.78, P=0.017] and similar relaxation rate of lower esophageal sphincter(q=1.14, P=0.258). Furthermore, they also showed a decrease in esophageal peristaltic contractive amplitude [(33±13) mmHg vs (45±11) mmHg, q=2.19, P=0.030] and wave velocity [(2.6±0.8) cm/s vs (3.4±0.6) cm/s, q=2.91, P=0.010] but an increase in esophageal contractive time of esophagus [(4.9±2.2) s vs (3.1±0.8) s, q=3.25, P=0.001] in addition to a linear negative correlation between esophageal peristaltic wave velocity and bolus clearance (r=-0.603, P=0.000). However, these parameters were not different between patients with GERC and gastroesophageal reflux disease without cough. The patients with GERC due to acid and non-acid reflux presented with a similar esophageal dysmotility but different variables reflecting the acidity of refluxates as indicated by multi-channel intraluminal impedance combined with pH monitoring. The esophageal peristaltic wave velocity was significantly lower in the patients with GERC responsive to the standard antireflux therapy than in those responsive to the intensified antireflux therapy [(2.2±0.6) cm/s vs (3.0±1.0) cm/s, t= 2.066, P= 0.041]. Conclusions: Esophageal dysfunction is present in patients with GERC. Its characteristics and severity are not associated with the types of gastroesophageal reflux inducing cough, but may predict the efficacy of medical antireflux therapy.
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Affiliation(s)
- X H Xu
- *Department of Respiratory Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
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Huang Y, Yu L, Xu XH, Chen Q, Lyu HJ, Jin XY, Qiu ZM. [Validation of the Chinese version of Hull airway reflux questionnaire and its application in the evaluation of chronic cough]. Zhonghua Jie He He Hu Xi Za Zhi 2016; 39:355-61. [PMID: 27180589 DOI: 10.3760/cma.j.issn.1001-0939.2016.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To validate the effectiveness, repeatability and treatment responsiveness of the Chinese version of Hull airway reflux questionnaire (HARQ), and to determine its clinical value. METHODS A standard Chinese version of HARQ was developed by an established translation procedure and its repeatability was assessed in a preliminary study involving 55 untreated patients with stable chronic cough. Thereafter, a total of 132 patients with chronic cough referred to our respiratory clinic were recruited into the study between May 2014 and April 2015. After their cough was evaluated with the HARQ, cough symptom score or cough reflex sensitivity to inhaled capsaicin and the correlations among them were analyzed, and the causes of chronic cough in all the patients were presumptively determined according to an established diagnostic protocol and finally confirmed with the subsequent therapy specific to the etiologies. After two weeks of effective treatment, HARQ, cough symptom score and cough reflex sensitivity to inhaled capsaicin were measured once more, and treatment responsiveness was calculated. The score of the HARQ in 132 patients with chronic cough were compared with that in 104 healthy volunteers. RESULTS The repeatability of the Chinese version of the HARQ was validated at a week interval with the intraclass correlation coefficients of 0.96 (95%CI: 0.93-0.98, P=0.00) for total score (n=55). No correlation was found between the HARQ and cough symptom score, and the HARQ showed a weak negative correlation with cough threshold C2 (rIgC2=-0.23, P=0.01) but not with C5. The value of HARQ was significantly higher in patients with chronic cough than in healthy volunteers[20.00(14.00, 28.00) vs 4.00 (2.00, 6.00), Z=-12.89, P=0.00], but no difference of HARQ in gender or age existed in chronic cough. Although all the patients with various etiologies of chronic cough had an increased value of HARQ, cough due to gastroesophageal reflux showed the highest HARQ score among them[28.50 (25.00, 32.25) vs 18.50 (14.00, 26.25), Z=4.43, P=0.00]. After two weeks of effective treatment, the HARQ score decreased from 20.00 (14.00, 28.00) pre-treatment to 10.00 (4.25, 17.75) post-treatment (Z=-6.06, P=0.00), with 52.04% of score change ratio, 1.38 of effect side and 1.97 of standard response mean respectively. CONCLUSION HARQ is a reliable and valid tool for the management of chronic cough with good treatment responsiveness, and may be used as an easy way to predict cough due to gastroesophageal reflux.
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Affiliation(s)
- Y Huang
- Department of Respiratory Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
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