Recipient artery dissection during extracranial-intracranial bypass surgery:Two case reports

BACKGROUND Superficial temporal artery to middle cerebral artery(STA-MCA)bypass is a valuable treatment for preventing ischemia and hemorrhage in occlusive cerebrovascular disease.Anastomosis site dissection is rarely reported among the various bypass-related complications.CASE SUMMARY In this case report,we describe two patients,who were 63-and 59-years-old with middle cerebral artery occlusion treated by STA-MCA bypass.During bypass surgery,the recipient M4 artery intima was dissected.We sacrificed the dissecting portion,and no complications occurred during the follow-up period.Postoperative brain imaging revealed improved brain perfusion.We report rare cases of recipient artery dissection located in the extracranial to intracranial bypass site,and we suggest atherosclerotic changes in the recipient artery and insufficient puncture as the causes.CONCLUSION Appropriate recipient artery selection is critical,and if dissection occurs,it is essential to sacrifice the dissecting portion quickly.

Supportive care in transplantation: A patient-centered care model to better support kidney transplant candidates and recipients

Kidney transplantation(KT),although the best treatment option for eligible patients,entails maintaining and adhering to a life-long treatment regimen of medications,lifestyle changes,self-care,and appointments.Many patients experience uncertain outcome trajectories increasing their vulnerability and symptom burden and generating complex care needs.Even when transplants are successful,for some patients the adjustment to life post-transplant can be challenging and psychological difficulties,economic challenges and social isola-tion have been reported.About 50%of patients lose their transplant within 10 years and must return to dialysis or pursue another transplant or conservative care.This paper documents the complicated journey patients undertake before and after KT and outlines some initiatives aimed at improving patient-centered care in transplantation.A more cohesive approach to care that borrows its philosophical approach from the established field of supportive oncology may improve patient experiences and outcomes.We propose the"supportive care in transplantation"care model to operationalize a patient-centered approach in transplantation.This model can build on other ongoing initiatives of other scholars and researchers and can help advance patient-centered care through the entire care continuum of kidney transplant recipients and candidates.Multi-dimensionality,multi-disciplinarity and evidence-based approaches are proposed as other key tenets of this care model.We conclude by proposing the potential advantages of this approach to patients and healthcare systems.Core Tip:Kidney transplant recipients and candidates face several uncertainties in their care journey and have several expressed unmet healthcare needs.We recommend a structured and comprehensive approach to transplant care across the entire continuum of a transplant patient’s journey similar to what has been developed in the field of oncology.The supportive care in transplantation model can operationalize patient-centered care and build on the efforts of other researchers in the field.We postulate that such a model would significantly improve care delivery and patients’experiences and outcomes and potentially decrease healthcare utilization and cost.INTRODUCTION Patients with kidney failure benefit from(KT)[1,2],and experience improved survival rates when compared with dialysis[3-6].KT studies,using validated instruments,have also consistently demonstrated that kidney transplant recipients(KTRs)experience better health-related quality of life and several improvements in other disease-specific domains when compared with dialysis[7].In countries where dialysis is out of reach for many,the diagnosis of kidney failure would be futile without KT[8].Thus,increasing KT has been a priority for the nephrology and transplant communities.This priority has been reflected in recent global trends:Of the 79 countries where data were available,the International Society of Nephrology’s Global Kidney Atlas reported that the prevalence of KTRs in 2023 was 279 per million population which represented an increase of 9.4%from the data published four years prior[8].Despite this growth,KT can be a challenging journey for many patients and it is sometimes regarded as a‘cure’,which does not conform with the reality that many patients experience[9-13].KTRs must maintain a life-long treatment regimen of medications,lifestyle changes,self-care and medical appointments[14-17].As poignantly stated by a young female transplant recipient,“I thought everything would change once I got my kidney.I thought I would be healthy again”but after experiencing multiple side effects of immunosuppressive medications and graft loss,she stated,“I am just a different kind of patient now”[18].Indeed,a significant proportion of patients experience graft failure and return to dialysis;it is estimated that over 50%return to dialysis within 10 years of KT[19-23].Patients are often not prepared for this outcome and report several psychosocial and physical ramifications of graft failure[24,25].Overall,high symptom burden,adverse effects of immunosuppressants,risk of graft rejection or failure and mortality,contribute to complex needs,vulnerability and uncertainties for patients,increasing their care needs and treatment burden[26-30].In this paper,we highlight the complex journey that KTRs and candidates undertake that can generate varied outcome trajectories and complex healthcare needs.We highlight the need for a comprehensive patient-centered approach to care and conclude with a proposal for a“supportive care in transplantation”care model.

Impact of COVID-19 on liver transplant recipients: A nationwide cohort study evaluating hospitalization, transplant rejection, and inpatient mortality

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has posed a major public health concern worldwide.Patients with comorbid conditions are at risk of adverse outcomes following COVID-19.Solid organ transplant recipients with concurrent immunosuppression and comorbidities are more susceptible to a severe COVID-19 infection.It could lead to higher rates of inpatient complications and mortality in this patient population.However,studies on COVID-19 outcomes in liver transplant(LT)recipients have yielded inconsistent findings.AIM To evaluate the impact of the COVID-19 pandemic on hospital-related outcomes among LT recipients in the United States.METHODS We conducted a retrospective cohort study using the 2019–2020 National Inpatient Sample database.Patients with primary LT hospitalizations and a secondary COVID-19 diagnosis were identified using the International Classi-fication of Diseases,Tenth Revision coding system.The primary outcomes included trends in LT hospitalizations before and during the COVID-19 pandemic.Secondary outcomes included comparative trends in inpatient mortality and transplant rejection in LT recipients.RESULTS A total of 15720 hospitalized LT recipients were included.Approximately 0.8% of patients had a secondary diagnosis of COVID-19 infection.In both cohorts,the median admission age was 57 years.The linear trends for LT hospitalizations did not differ significantly before and during the pandemic(P=0.84).The frequency of in-hospital mortality for LT recipients increased from 1.7% to 4.4% between January 2019 and December 2020.Compared to the pre-pandemic period,a higher association was noted between LT recipients and in-hospital mortality during the pandemic,with an odds ratio(OR)of 1.69[95% confidence interval(CI):1.55-1.84),P<0.001].The frequency of transplant rejections among hospitalized LT recipients increased from 0.2%to 3.6% between January 2019 and December 2020.LT hospitalizations during the COVID-19 pandemic had a higher association with transplant rejection than before the pandemic[OR:1.53(95%CI:1.26-1.85),P<0.001].CONCLUSION The hospitalization rates for LT recipients were comparable before and during the pandemic.Inpatient mortality and transplant rejection rates for hospitalized LT recipients were increased during the COVID-19 pandemic.

Optimizing growth in pediatric renal transplant recipients: An update

Growth retardation is a significant complication observed in pediatric renal transplant recipients,originating from a multifactorial etiology.Factors contributing to growth impairment encompass pre-transplant conditions such as primary kidney disease,malnutrition,quality of care,growth deficits at the time of transplantation,dialysis adequacy,and the use of recombinant human growth hormone.Additionally,elements related to the renal transplant itself,such as living donors,corticosteroid usage,and graft functioning,further compound the challenge.Although renal transplantation is the preferred renal replacement therapy,its impact on achieving final height and normal growth in children remains uncertain.The consequences of growth delay extend beyond the physi-ological realm,negatively influencing the quality of life and social conditions of pediatric renal transplant recipients,and ultimately affecting their educational and employment outcomes.Despite advancements in graft survival rates,growth retardation remains a formidable clinical concern among children undergoing renal transplantation.Major risk factors for delayed final adult height include young age at transplantation,pre-existing short stature,and the use of specific immunosuppressive drugs,particularly steroids.Effective management of growth retardation necessitates early intervention,commencing even before transplantation.Strategies involving the administration of recombinant growth hormone both pre-and post-transplant,along with protocols aimed at minimizing steroid usage,are important for achieving catch-up growth.This review provides a comprehensive outline of the multifaceted nature of growth retardation in pediatric renal transplant recipients,emphasizing the importance of early and targeted interventions to mitigate its impact on the long-term well-being of these children from birth to adolescence.INTRODUCTION Children with chronic kidney disease(CKD)endure frequent hospitalizations and ongoing treatment,which significantly affect their quality of life.One of the most noticeable effects of CKD in children is poor growth,with stunted height being a common sign of chronic malnutrition.Growth assessment involves regularly measuring weight and height/length and comparing these against z-score charts,along with other anthropometric indicators like head circumference and mid-upper arm circumference.Data from the North American Pediatric Renal Trials and Collaborative Studies(NAPRTCS)registry shows that over 35%of children enrolled had stunted growth at the time of admission,with growth impairment being more severe in younger children(58%in those aged under 1 year,compared to 22%in those aged over 12 years).Additionally,the same data revealed that growth impairment worsens as the severity of the disease increases.Although recent advances in science have enabled better outcomes for children with CKD,in resource-limited settings,numerous children are still deprived of achieving optimal growth owing to the disease and its related factors.Stunting is a key indicator of chronic growth impairment in children.A study by Wong et al[1]in the United States Renal Data System found that each SD decrease in height among children with stage V CKD is linked to a 14%increase in the risk of death[1].Similarly,research by Furth et al[2]using data from the NAPRTCS indicated that children with a height standard deviation score(SDS)of-2.5 face a relative hazard of death of 2.07.Stunting also correlates with increased hospitalizations.A study in the United States followed 1112 pediatric patients with end-stage renal disease from 1990 to 1995.It showed that children with severe or moderate growth failure had higher hospitalization rates compared to those with normal growth.Specifically,the relative risk for hospitalization was 1.14(95%CI:1.1-1.2)for those with moderate growth failure and 1.24(95%CI:1.2-1.3)for those with severe growth failure,even after adjusting for age,sex,race,cause,and duration of end-stage renal disease,and treatment type[2](dialysis or transplant).The growth of a child significantly affects his/her psychological and overall well-being as an adult.Short children are often embarrassed by peers,and it has been observed that height influences employment status,with unemployment being more prevalent among stunted individuals.Further,marital opportunities can be fewer among stunted individuals[3].Hence,all measures to achieve adequate growth should be attempted in children with CKD,regardless of whether they undergo transplantation.

Diagnosis,treatment protocols,and outcomes of liver transplant recipients infected with COVID-19

Several cases of fatal pneumonia during November 2019 were linked initially to severe acute respiratory syndrome coronavirus 2,which the World Health Organization later designated as coronavirus disease 2019(COVID-19).The World Health Organization declared COVID-19 as a pandemic on March 11,2020.In the general population,COVID-19 severity can range from asymptomatic/mild symptoms to seriously ill.Its mortality rate could be as high as 49%.The Centers for Disease Control and Prevention have acknowledged that people with specific underlying medical conditions,among those who need immunosuppression after solid organ transplantation(SOT),are at an increased risk of developing severe illness from COVID-19.Liver transplantation is the second most prevalent SOT globally.Due to their immunosuppressed state,liver transplant(LT)recipients are more susceptible to serious infections.Therefore,comorbidities and prolonged immunosuppression among SOT recipients enhance the likelihood of severe COVID-19.It is crucial to comprehend the clinical picture,immunosuppressive management,prognosis,and prophylaxis of COVID-19 infection because it may pose a danger to transplant recipients.This review described the clinical and laboratory findings of COVID-19 in LT recipients and the risk factors for severe disease in this population group.In the following sections,we discussed current COVID-19 therapy choices,reviewed standard practice in modifying immunosuppressant regimens,and outlined the safety and efficacy of currently licensed drugs for inpatient and outpatient management.Additionally,we explored the clinical outcomes of COVID-19 in LT recipients and mentioned the efficacy and safety of vaccination use.

Cryptococcosis in kidney transplant recipients:Current understanding and practices

Cryptococcosis is the third most commonly occurring invasive fungal disease in solid organ transplant recipients(SOT).It is caused by encapsulated yeast,Cryptococcus species,predominantly Cryptococcus neoformans and Cryptococcus gattii.Though kidney transplant recipients are at the lowest risk of cryptococcosis when compared to other solid organ transplant recipients such as lung,liver or heart,still this opportunistic infection causes significant morbidity and mortality in this subset of patients.Mortality rates with cryptococcosis range from 10%-25%,while it can be as high as 50%in SOT recipients with central nervous system involvement.The main aim of diagnosis is to find out if there is any involvement of the central nervous system in disseminated disease or whether there is only localized pulmonary involvement as it has implications for both prognostication and treatment.Detection of cryptococcal antigen(CrAg)in cerebrospinal fluid or plasma is a highly recommended test as it is more sensitive and specific than India ink and fungal cultures.The CrAg lateral flow assay is the single point of care test that can rapidly detect cryptococcal polysaccharide capsule.Treatment of cryptococcosis is challenging in kidney transplant recipients.Apart from the reduction or optimization of immunosuppression,lipid formulations of amphotericin B are preferred as induction antifungal agents.Consolidation and maintenance are done with fluconazole;carefully monitoring its interactions with calcineurin inhibitors.This review further discusses in depth the evolving developments in the epidemiology,pathogenesis,diagnostic assays,and management approach of cryptococcosis in kidney transplant recipients.

Risk stratification of renal transplant recipients using routine parameters: Implication of learning from SARS-CoV-2 into transplant follow-up program

BACKGROUND Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is a global pandemic that is associated with a high risk of morbidity and mortality among recipients of solid organ transplantation.In the course of acute SARS-CoV-2 infection,various laboratory markers have been identified as predictors for high risk of mortality.AIM To risk stratify renal transplant recipients(RTxR)using general demographic parameters,comorbidities and routine laboratory markers for the severity of the disease and its outcomes.We believe that learning about these routinely monitored parameters can help us plan better strategies for the RTxR follow-up program.METHODS This present study includes RTxR who acquired SARS-CoV-2 infection from March 2020 to February 2021.We recorded the basic demographics,comorbidities and routine laboratory markers.We investigated the impact of SARS-CoV-2 infection on RTxRs and risk-stratified the progression of disease severity and outcomes in terms of recovery or mortality.RESULTS From 505 RTxRs in our renal transplant follow-up program,29(7.75%)RTxRs had PCR-positive SARS-CoV-2 infection.We recorded 8 deaths from SARS-CoV-2 infection giving an overall mortality rate of 1.6%but a significant 27.6%mortality in SARS-CoV-2 positive recipients.Age more than 68 years,non-Caucasian ethnicity and male gender were associated with a significant drop in survival probability;P≤0.001.<0.001 and<0.0001 respectively.87.5%of the deceased were diabetic;P≤0.0.0001.Estimated glomerular filtration rate of less than 26 mL/min/1.73 m2,serum albumin less than 20 g/L,Hemoglobin less than 9.6 g/L and serum calcium less than 1.70 mmol/L were all associated with significantly increased risk of mortality;P=0.0128,<0.001,<0.0001 and 0.0061 respectively.CONCLUSION This study has identified some routinely used modifiable parameters in predicting a higher risk of mortality and morbidity.This knowledge can be used in RTxR follow-up programs by addressing these parameters early to help reduce the morbidity and mortality in RTxRs.

肺移植受者术后抑郁调查及影响因素分析

目的纵向追踪肺移植受者术后抑郁情绪水平的动态变化并分析其影响因素,为临床开展精准心理护理提供参考。方法于2022年10月—2023年12月,便利抽取广州市某三级甲等医院肺移植受者,采用自编一般资料问卷、患者健康问卷、移植症状发生和症状困扰量表,于术后出院前1 d(T0)、术后3个月(T1)、术后6个月(T2)3个时间点开展调查。结果共62例肺移植受者完成3个时间点调查,其抑郁情绪得分在T0、T1、T2时点的中位数分别为9.00(4.00,14.00)、5.00(1.75,10.00)和3.00(0.00,9.00),呈下降趋势(Z=38.174,P<0.001)。线性混合模型分析结果显示,肺移植受者年龄增长(β=0.012,P=0.043)、术后住院时间延长(β=0.006,P=0.025)、症状发生频率及严重程度越高(β=0.038,P<0.001)是其抑郁情绪的危险因素,轻度经济负担(β=-0.469,P=0.005)是其抑郁情绪的保护因素。结论肺移植受者抑郁情绪术后随时间推移呈逐渐降低趋势。医护人员应重点关注高龄、经济条件差、伴随多种症状的肺移植受者,及时提供个性化精准心理护理,促进其身心全面康复。

儿童肝移植受者重返重症监护室的危险因素分析

目的探讨儿童肝移植受者重返重症监护室(ICU)的危险因素,为儿童肝移植术后临床决策提供参考。方法回顾性分析2019至2021年上海交通大学医学院附属仁济医院接受肝移植手术后所有转入ICU患儿的临床资料,统计住院期间重返ICU的情况,以及重返的原因。以1∶3比例匹配未发生重返ICU的患儿作为对照组,比较两组患儿基本信息、移植后转出ICU当天的生命体征及各项实验室指标、免疫抑制剂种类及药物浓度等。采用多因素Logistic回归分析探讨儿童肝移植受者重返ICU的危险因素。结果儿童肝移植术后ICU重返率为4.36%,其中48 h内重返率为16.00%,主要原因包括呼吸系统并发症、腹腔感染和肝血管栓塞。多因素Logistic回归分析显示,术后输注红细胞(OR=4.554,95%CI=1.743~11.901,P=0.002)、高血尿酸(OR=1.005,95%CI=1.001~1.009,P=0.014)是重返ICU的危险因素;高舒张压(OR=0.922,95%CI=0.885~0.960,P<0.001)和高总蛋白水平(OR=0.937,95%CI=0.891~0.986,P=0.012)是重返ICU的保护因素。结论术后输注红细胞、高血尿酸水平是儿童肝移植受者重返ICU的独立危险因素。

40例肾移植受者感染新型冠状病毒的治疗药物分析

目的为肾移植受者感染新型冠状病毒制订治疗方案提供参考。方法回顾性分析安徽省某三甲医院肾移植病区2022年12月6日至2023年1月5日入院且已符合出院标准的40例患者的用药情况,统计药品金额、用药剂量,计算用药频度(DDDs)和药物利用指数(DUI),分析其用药特点。结果40例患者的药费共244.29万元,约占总住院费用的63.71%,其中抗菌药物费用共142.09万元,约占总药费的58.16%。DDDs排前10位的药品为糖皮质激素、质子泵抑制剂和抗菌药物,100.00%的患者联用2种及以上抗菌药物,最多共使用6种。服用奈玛特韦利托那韦(Paxlovid)或阿兹夫定的患者39例(97.50%),其中两药联用16例(40.00%)。22例(55.00%)患者发生药品不良反应,以腹泻(42.50%)、头晕(37.50%)、转氨酶升高(32.50%)为主。结论肾移植受者感染新型冠状病毒住院期间用药复杂,联用药物较多,应加强病原学送检及培养,根据病原学检测结果进行抗感染治疗。注意药物的相互作用和药品不良反应,实现个体化用药治疗。

缓和医疗存在的争议

关于缓和医疗,一直以来主要存在两方面争议:一是缓和医疗照护对象范围是否应扩大,二是缓和医疗的介入时机是否应提前。目前对于上述争议已达成的基本共识包括:缓和医疗照护对象应扩大至身患严重疾病、遭受重大痛苦的所有年龄段患者;缓和医疗应早期整合至严重疾病的治疗全过程。然而,缓和医疗照护对象范围的扩大及介入时机的提前同时带来了新的挑战,亟待制定新的战略计划并加以实施,以加快探索适合我国国情的缓和医疗发展之路。重新认识缓和医疗照护对象及介入时机,有助于加快我国缓和医疗的发展。本文从缓和医疗发展史、定义更新、现有证据及研究进展三方面,结合临床实际需求,针对该两大焦点问题展开论述,以期为我国缓和医疗实践提供参考。

多米诺肝移植临床效果分析(附2例报告)

目的探讨多米诺肝移植(DLT)的临床疗效,为肝移植手术扩大供肝来源提供借鉴。方法收集我院2021年完成的2例DLT患者的临床资料,并进行文献复习。结果供者1为健康人,受者1(DLT供者)为鸟氨酸氨甲酰基转移酶缺乏症(OTCD)患者,受者2(DLT受者)为Cirgler-Najiar综合征患者;供者2为国际标准化脑死亡捐献者,受者3(DLT供者)为家族性高胆固醇血症(FH)患者,受者4(DLT受者)为肝脏恶性肿瘤患者。所有患者的肝功能均于术后1周左右基本恢复正常,住院治疗2~4周后均顺利出院。其中受者2(DLT受者)术后第4天发现门静脉左支血栓形成,行急诊溶栓加药物抗凝治疗,门静脉血流得到有效改善,未造成严重后果,胆红素于术后1周恢复正常。受者4(DLT受者)术后出现高脂血症,联合应用阿托伐他汀+依折麦布调脂治疗,随访至今未出现其他并发症。结论采用DLT可有效扩大肝移植手术供肝来源。

出土墓志所见唐翰林学士承旨崔汪事迹补考

崔汪,唐昭宗朝翰林学士、承旨。其入翰林院事迹,岑仲勉《补唐代翰林两记》、傅璇琮《唐翰林学士传论·晚唐卷》均有考论。然而,由于资料缺失,崔汪入院、出院时间、在院期间职官变迁等,阙疑者甚多。今据新见崔澄《唐故太子宾客崔公墓志铭并序》,结合传世典籍考定崔汪约大顺二年以兵部郎中充翰林学士入院,旋加知制诰、承旨,历中书舍人、户部侍郎、尚书右丞、兵部侍郎,于景福二年十月稍后出院。在院时间,前后约三年。又,据出土石刻,亦可以考定崔汪家世、生卒年、入翰林院前及出院后的仕历、其文学影响以及墓志撰者崔澄事迹等。拈出此等,以为附论。

公民器官捐献供体质量对肝移植术后受体生存率的影响

目的探讨心脏死亡器官捐献(donation after cardiac death,DCD)供体质量对肝移植术后受体生存率的影响。方法回顾性分析2018年1月至2021年1月解放军总医院第三医学中心DCD肝移植手术患者100例,移植术后进行为期1年的随访调查,观察肝移植受者的生存状态,对相关危险因素加以分析。结果100例肝移植受者术后1年病死率为3%(3/100),其死亡因素与供体冷缺血时间、供体脂肪肝、术中出血量、供体白蛋白及总胆红素水平、肝细胞水肿密切相关(P<0.05)。多因素Logistic回归分析发现,供体冷缺血时间≥840 min、脂肪肝是影响肝移植受者生存状态的独立危险因素(P<0.05)。肝移植术后感染率为26%(26/100),其肝移植术后感染率与受体肝功能Child-Pugh评分、术前血红蛋白水平、血小板计数、术中输血量、术后重症监护病房(intensive care unit,ICU)留观时间密切相关(P<0.05)。结论DCD供体质量对肝移植术后受体生存率具有显著影响,供体冷缺血时间、供体脂肪肝对肝移植术后受体生存状态具有重要影响。

影响羊供体超数排卵与受体移植受胎率的因素分析

为了研究影响羊供体超数排卵效果及胚胎移植受体受胎率的因素,试验选取萨福克羊和东弗里升羊2个供体品种,受体羊为本地阿勒泰羊,对促卵泡素(FSH)不同批次、长途运输应激因素、不同输精方式、技术员的熟练程度以及受体同期化时间差等5个方面的影响因素开展了相关研究。结果表明:FSH的不同批次对萨福克和东弗里升2种供体羊可用胚率无显著影响(P>0.05);长途运输组供体羊,无论是萨福克羊还是东弗里升羊,胚胎数和受胎率均极显著低于对照组(P<0.01);不同输精方式,子宫角+常规输精的获胚率极显著高于常规输精、子宫角输精(P<0.01),子宫角输精显著高于常规输精(P<0.05);胚胎移植操作熟练组受胎率显著高于对照组(P<0.05);受体羊撤栓时间不同,发情时间相差±12 h,两组受体羊受胎率均无显著差异(P>0.05)。本试验结果可为从事胚胎移植工作的科研工作者和技术员提供借鉴。

儿童肝移植受者父母家庭复原力现况及其影响因素研究

目的 探讨儿童肝移植受者父母家庭复原力现况及其影响因素,为制订相关家庭干预策略提供参考依据。方法 2023年5-8月,采用便利抽样法选取在上海某院肝脏外科行儿童肝移植术后坚持定期随访的儿童肝移植受者父母216例为调查对象,采用家庭复原力评估量表、Zarit照顾者负担量表和过渡期护理质量测评量表等对其进行线上问卷调查。结果 儿童肝移植受者父母家庭复原力、照顾者负担、过渡期护理质量评分分别为(134.56±24.04)分、(26.90±5.71)分、(56.56±9.14)分。不同移植术后并发症种数、移植术后因并发症住院次数、照护者文化程度、家庭月收入、照护者工作状态、家庭类型以及是否获公益基金资助的儿童肝移植受者父母家庭复原力差异均有统计学意义(均P<0.05)。患儿父母家庭复原力与过渡期护理质量呈正相关(r=0.771,P<0.001);与照护者负担呈负相关(r=-0.231,P<0.001)。家庭月收入、父母工作状态、照顾负担、过渡期护理质量是儿童肝移植受者父母家庭复原力的影响因素(均P<0.05)。结论 儿童肝移植受者父母家庭复原力处于中上水平,需加强关注低家庭月收入、父母无工作、照顾负担重及低过渡期护理质量的患儿家庭,采取针对性措施以提高其家庭复原力水平。

Influence of sex on outcomes of liver transplantation for hepatocellular carcinoma:a multicenter cohort study in China

Objective:Sex-specific differences are observed in various liver diseases,but the influence of sex on the outcomes of hepatocellular carcinoma(HCC)after liver transplantation(LT)remains to be determined.This study is the first Chinese nationwide investigation of the role of sex in post-LT outcomes in patients with HCC.Methods:Data for recipients with HCC registered in the China Liver Transplant Registry between January 2015 and December 2020 were analyzed.The associations between donor,recipient,or donor-recipient transplant patterns by sex and the post-LT outcomes were studied with propensity score matching(PSM).The survival associated with different sex-based donor-recipient transplant patterns was further studied.Results:Among 3,769 patients enrolled in this study,the 1-,3-,and 5-year overall survival(OS)rates of patients with HCC after LT were 96.1%,86.4%,and 78.5%,respectively,in female recipients,and 95.8%,79.0%,and 70.7%,respectively,in male recipients after PSM(P=0.009).However,the OS was comparable between recipients with female donors and male donors.Multivariate analysis indicated that male recipient sex was a risk factor for post-LT survival(HR=1.381,P=0.046).Among the donor-recipient transplant patterns,the male-male donor-recipient transplant pattern was associated with the poorest post-LT survival(P<0.05).Conclusions:Our findings highlighted that the post-LT outcomes of female recipients were significantly superior to those of male recipients,and the male-male donor-recipient transplant pattern was associated with the poorest post-LT survival.Livers from male donors may provide the most benefit to female recipients.Our results indicate that sex should be considered as a critical factor in organ allocation.

异种移植存在的问题及国内发展现状

异种移植作为一种解决器官短缺问题的潜在途径,因基因编辑技术的进步得到快速发展。许多猪到非人灵长类动物的临床前研究已证实,经过基因改造的供体猪在抑制异种移植超急性排斥、急性排斥、凝血紊乱、炎症反应等方面都有显著效果,移植受体的生存期也不断取得突破。同时,以脑死亡患者为受体的亚临床试验说明异种肾脏、心脏用于临床移植具有可行性,而2例异种心脏移植的临床试点更加速了异种移植走向临床应用的步伐。本文就异种移植涉及的器官短缺、发展简史及前沿进展、存在的主要问题、国内发展动态等方面进行论述,旨在为学科建设提供指导。

智力障碍儿童对不同对象的分享行为:心理理论的作用

本研究旨在考察智力障碍儿童对不同对象(朋友和陌生人)的分享行为,同时探讨心理理论对不同对象分享行为的预测作用。研究共选取了82名智力障碍儿童作为被试,并通过言语能力分数匹配了82名典型发展儿童作为对照,结果发现:(1) 7~17岁(儿童中期和青少年期)的智力障碍儿童和心理年龄相匹配的典型发展儿童一样,对朋友的分享都显著高于对陌生人的分享;(2)心理理论预测了智力障碍儿童对陌生人的分享行为,但不能显著预测对朋友的分享行为。这些结果表明相比于陌生人,智力障碍儿童和典型发展儿童对朋友表现出更多的分享,且智力障碍儿童偏爱朋友分享的现象从儿童中期持续到了青少年期;心理理论是智力障碍儿童对陌生人分享的相关因素。

双向视角下受助者心理困境及其化解路径

利他行为由助人者发起,旨在使受助者获益。受助者的获益是衡量利他行为有效性的关键指标。然而,并非所有利他行为都使受助者获益。助人者帮助受助者解决现实难题,但若其帮助行为伴随对受助者心理的负性影响,受助者将陷入现实和心理的双重困境。从助人者和受助者双向视角出发,有助于分析受助者心理困境的成因,发掘来自助人者和受助者两个视角的影响因素,并提出化解受助者心理困境的两条路径。未来研究可进一步厘清不同帮助类型对受助者心理的影响,增加对受助者个体和群体差异的关注,丰富对受助后人际互动和长期结果的探索。双向视角的观点也为提升公益和慈善实践的有效性提供启发。