Background AIDS (acquired immune deficiency syndrome) has become the most devastating disease which humankind has ever encountered. Human immune-deficiency virus (HIV) is transmitted through blood, sexual behavior and mother-to-baby, with more efficient transmission through blood transfusion. HIV risk among blood transfusion was severe due to lack of effective and correctly applied screening method and rigorous management, especially in some developing countries. Since the first HIV screening reagent was approved by FDA to screen the blood in 1985, the fourth generation test has been produced till now. Initially, HIV test was primarily used to screen the blood supply, it also became an important aspect of HIV prevention, especially screening among people donating blood. Today, HIV testing is seen as an integral part of both the nation’s prevention and treatment efforts. Objective To assess the effectiveness of any intervention tests for HIV screening among people donating blood, and find appropriate tests for HIV screening to decrease the risk of HIV transmission by blood transfusion. Search strategy MEDLINE, Cochrane Controlled Trials Register (CENTRAL/CCTR), AIDSLINE, EMBASE, CBM were be searched with the terms: "HIV", "AIDS", "screening", "test", "blood donor", "blood bank" and the detailed screening method. The websites of WHO, UNAIDS, CDC, FDA, and their related links were searched. Letters were mailed to various agencies and experts in this field to acquire unpublished reports. Inclusion criteria RCT and CCT for screening HIV among blood. donors will be included. Observational studies such as cohort studies, cased-control studies, and historical controlled studies will be used for sensitivity analysis. Method of the review According to the principles of Cochrane Review, selection of trials for inclusion, quality assessment of studies, data extraction and syntheses were conducted by reviewers.
To discuss renovascular reconstruction during l iving related donor kidney transplantation (LDKT). Methods Seventy-seven cases of LDKT from April 2006 to March 2008 were retrospectively analyzed, including 63 cases in single renal artery group and 14 cases in multi ple artery group. In multi ple artery group, there were 3 cases of three arteries and 11 cases of double arteries; 9 cases of donated left kidneys and 5 cases of donated right kidneys. Potential donors underwent fully medical evaluation before operation, including donor-reci pient human leucocyte antigen matchingand a cross match test. The donor’s operation of the incision either underneath the 12th rib approaching the dorsal lumbar was performed and the transplantation operation adopted the extraperitoneal approach in the contralateral fossa il iac. The arteries in the multiple artery group were implanted onto the external (or common) il iac artery different from the orthodox method. Results In multiple artery group, no blood transfusion during operation was performed, no compl ication occurred after operation and all donors were discharged after 7-9 days of postoperation. After a follow-up of 3 months to 1 year, all the recipients kept normal kidney function without renal tubule necrosis, renal artery embol ism, vascular stenosis, urinary fistula and ureter necrosis. The ultrasound examination showed that the transplanted kidney had good blood supply. There was no significant difference in the time of urine secretion, serum creatinine level after 1 week of operation, length of hospital ization between the multiple artery group and the single artery group (P gt; 0.05). Conclusion The accurate treatment of multiple artery anastomosis are critical for the safety of the LDKT.
Objective To explore the feasibility and effectiveness of perforator propeller flap sequential transfer technique in repair of soft tissue defect of distal lower extremity. Methods Between July 2015 and July 2021, 10 patients with soft tissue defect of distal lower extremity were treated with perforator propeller flap sequential transfer technique. There were 8 males and 2 females, with a median age of 47 years (range, 6-71 years). The etiologies included malignant tumor in 5 cases, trauma in 3 cases, postburn scar contracture in 1 case, and diabetic foot ulcer in 1 case. The defects were located at the pretibial area in 1 case, the distal lower extremity and Achilles tendon in 3 cases, the dorsum of foot and lateral malleolar area in 4 cases, the heel in 1 case, and the plantar foot in 1 case. The size of the defect ranged from 5 cm×3 cm to 8 cm×8 cm. Peroneal artery perforator propellor flaps (the 1st flap) in size of 14 cm×4 cm to 29 cm×8 cm were used to repair the defects of distal lower extremity. The donor site defects were repaired with the other perforator propeller flaps (the 2nd flap) in size of 7 cm×3 cm to 19 cm×7 cm. The donor site of the 2nd flap was directly closed. ResultsAll the operations were successfully completed and all of the 2nd flaps were elevated within 1 hour. Eight the 1st flaps survived completely; 2 had venous congestion. Among the 2 patients with venous congestion, 1 had necrosis of the distal end of the flap, and the secondary wound was repaired by skin grafting; 1 recovered spontaneously after 7 days. The 2nd flaps totally survived. No complication such as hematoma or infection occurred. Primary closure was achieved in all the recipient and donor sites. All patients were followed up 2-39 months, with a median of 15.5 months. The color, texture, and thickness of the flaps matched well with those of recipient sites. The normal contour of the leg was preserved. During follow-up, no recurrence of malignance or ulcer was observed. The scar contracture was completely released. All patients were satisfied with the reconstructive outcomes. Conclusion The application of the perforator propeller flap sequential transfer technique can improve the repair ability of the lower extremity perforator propeller flap while ensuring the first-stage closure of the donor site, thereby improving the effectiveness.
Liver transplantation plays a pivotal role in the field of treating end-stage liver diseases. It is currently the only treatment method that can effectively save patients’ lives and has been fully verified as effective in clinical practice. However, the problem of postoperative infection has become one of the key factors impeding the favorable prognosis of patients. Among them, donor-derived infections, due to their uniqueness and complexity, are gradually becoming a research hotspot in both clinical and scientific research fields. Through a systematic and comprehensive analysis of a large number of existing studies, we deeply analyzed the overall current situation of infections after liver transplantation, clarified the specific types of donor-derived infections and their respective characteristics. On this basis, the potential risks of such infections were thoroughly explored, and preventive strategies such as the prophylactic use of antibiotics and vaccination were put forward in a targeted manner, aiming to improve the prognosis of patients after liver transplantation to the greatest extent and enhance the quality of life of patients.
Objective To discuss the criteria of recipient selection，surgical approach，and complications and its theray by using of pediatric donation after cardiac death liver graft in adult recipient. Methods The clinical data of one case of pediatric donation after cardiac death liver to adult recipient was analyzed retrospectively and the literatures were reviewed. Results A 6-year-old girl pronounced brain death due to drowning and on the basis of cardiopulmonary criteria donated the organ．The liver graft weight was 598 g and the warm ischemic time was 10 min. The liver donor was transplanted to a 64-year-old woman，the graft to recipient weight ratio was 1.09%，the graft volume/estimated standard liver volume was 61.8%．The classic orthotopic liver transplantation without bypass was underwent，the postoperative recovery was smooth after the liver transplantation．The CT scan showed that the liver graft volume was 1 003cm3 on day 14 after operation．The patient was discharged on 45 d after orthotopic liver transplantation and the liver function was normal when followed-up 3 months after the operation. Conclusions Pediatric donation after cardiac death liver graft can be successfully utilized to adult recipient．Recipient selection and surgical approach should be decided by conditions of both donor and graft．
Objective To investigate the effectiveness of free vascularized fibula grafting with unilateral fibula as donor in treatment of bilateral avascular necrosis of femoral head (ANFH). Methods Between June 2007 and January 2008, 14 patients with bilateral ANFH were treated with free vascularized fibula grafting with unilateral fibula as donor. There were 12males and 2 females with an average age of 36.6 years (range, 17-57 years). The necrosis was caused by use of steroids in 3 cases, consumption of alcohol in 4 cases, and idiopathic condition in 7 cases. According to Steinberg system, 16 hips were classified as stage II, 10 hips as stage III, and 2 hips as stage IV. The preoperative Harris hip scores were 77.50 ± 4.19, 69.70 ± 2.76, 59.50 ± 0.50 in patients at stages II, III, and IV, respectively. The duration of operation and the bleeding volume were recorded. The X-ray examination, the Harris hip score, and the compl ications were used to evaluate the effectiveness. Results The duration of the fibula osteotomy was 10-32 minutes (mean, 20 minutes). The duration of the total operation was 100-240 minutes (mean, 140 minutes). The bleeding volume was 200-500 mL (mean, 280 mL). All patients achieved heal ing of incision by first intention. The patients were followed up 12-40 months (mean, 24 months). One case had numbness and hyperthesia of the anterolateral thigh; 1 case had abnormal sensation of the dorsal foot; 1 case had discomfort of the ankle; and they restored to normal at 1 year after operation. According to X-ray films 1 year after operation, the improvement was achieved in 23 hi ps (82.1%) and no deterioration in 5 hips (17.9%). At 1 year after operation, the Harris hip scores were 93.90 ± 4.84, 88.50 ± 8.13, and 78.00 ± 0.00 inpatients at stages II, III, and IV, respectively, showing significant differences when compared with preoperative ones (P lt; 0.05). Conclusion Unilateral free vascularized fibula grafting has lots of virtues, such as short surgical time, less bleeding volume, l ittle injury, and good results of function recovery. It could be an effective and safe method in treating bilateral ANFH.
The quality control of lung transplantation involves many aspects, such as team building, selection of recipients, preoperative diagnosis and evaluation of recipients, maintenance of brain-dead donors, evaluation and acquisition of donors, surgical operation, postoperative management and postoperative follow-up. Precision management is the core concept of operation quality control. Only by normalizing the operation quality control of lung transplantation to provide basic guarantee for multi-team cooperation and development of lung transplantation management in the future, building a complete lung transplantation database to excavate data resources and improve the quality of transplantation, and comprehensively building a Chinese lung transplantation quality control system with multi-team participation and cooperation, can we improve the overall level of surgical diagnosis and treatment of lung transplantation in China.
Objective To discuss venous drainage types of median hepatic lobe and their guiding significances on the selection of grafts. Methods Between April 2005 and March 2009, 109 potential living donors underwent 3-dimensional reconstruction of computed tomography (CT) and the volume of graft was determined in the center of organ transplantation of Ruijin Hospital. The venous drainage types of median hepatic lobe of each donor were analyzed by the computer-based liver operation-planning system in detail to assign middle hepatic vein (MHV) types according to Marcos classification and venous types of Ⅳb segment according to Nakamura classification. Results The branching pattern of MHV was divided into 3 types: Type Ⅰ and Ⅱwere relatively more accounting for 44.0% （48/109）, 37.6% （41/109）, and type Ⅲ was fewest 〔18.3% （20/109）〕. There were no significant differences in volume of whole liver, volume of left liver or left liver/total liver volume ratio among various types of MHV of the donor (Pgt;0.05). Ⅳb vein was also divided into 3 types: The most common was type Ⅰ, accounting for 72.4% (79/109); Type Ⅱ 〔12.8% （14/109）〕, type Ⅲ 〔14.7% （16/109）〕 were relatively fewer. At last, 37 donors provided right liver, for Marcos Ⅰ, Ⅱ, and Ⅲ type of donors, donors remained with MHV was 12/17, 8/11, and 5/9; for Nakamura Ⅰ, Ⅱ, and Ⅲ type of donors, those number were 16/26, 4/6, and 5/5. Conclusion In adult-to-adult living donor liver transplantation, there may be great significances in accordance with Marcos and Nakamura typing results to harvest right lobe liver graft with or without MHV.
Lung transplantation has developed in China for nearly half a century. The Wuxi lung transplant team completed our first lung transplantation on September 28, 2002. By the year of 2021, the total number of lung transplantation in China has been increased to 775, while 49 medical centers have been qualified to perform lung transplantation. During the past two decades, we vigorously promoted lung transplantation technique, cooperated and communicated with colleagues in relevant specialties. Thus, more and more patients with end-stage lung diseases could be evaluated and transplanted to save their lives, with the support of medical insurance and funds. The full-process monitoring and staged objective management, have been well established regarding to donor evaluation standards and acquisition procedures, the green channel for organ transportation, postoperative intensive care unit management, prevention of rejection and infection, as well as long-term follow-up of recipients. Based on the classical lung transplantation surgical techniques, technical breakthroughs have been made while the public’s acknowledgement of lung transplantation has been also enhanced. In the future, lung transplantation techniques will be increasingly challenged by new technologies and ethics, bringing diversified opportunities and challenges to the lung transplantation team collaboration.
ObjectiveTo investigate the feasibility and effectiveness of the latissimus dorsi myocutaneous flap in repair of large complex tissue defects of limb and the relaying posterior intercostal artery perforator flap in repair of donor defect after latissimus dorsi myocutaneous flap transfer.MethodsBetween January 2016 and May 2017, 9 patients with large complex tissue defects were treated. There were 8 males and 1 female with a median age of 33 years (range, 21-56 years). The injury caused by traffic accident in 8 cases, and the time from post-traumatic admission to flap repair was 1-3 weeks (mean, 13 days). The defect in 1 case was caused by the resection of medial vastus muscle fibrosarcoma. There were 5 cases of upper arm defects and 4 cases of thigh defects. The size of wounds ranged from 20 cm×12 cm to 36 cm×27 cm. There were biceps brachii defect in 2 cases, triceps brachii defect in 3 cases, biceps femoris defect in 2 cases, quadriceps femoris defect in 2 cases, humerus fracture in 2 cases, brachial artery injury in 2 cases, and arteria femoralis split defect combined with nervus peroneus communis and tibia nerve split defect in 1 case. The latissimus dorsi myocutaneous flaps were used to repair the wounds and reconstruct the muscle function. The size of the skin flaps ranged from 22 cm×13 cm to 39 cm×28 cm; the size of the muscle flaps ranged from 12 cm×3 cm to 18 cm×5 cm. The wounds were repaired with pedicle flaps and free flaps in upper limbs and lower limbs, respectively. The donor sites were repaired with posterior intercostal artery perforator flaps. The size of flaps ranged from 10 cm×5 cm to 17 cm×8 cm. The second donor sites were sutured directly.ResultsAll the flaps survived smoothly and the wounds and donor sites healed by first intention. All patients were followed up 10-19 months (mean, 13 months). At last follow-up, the flaps had good appearances and textures. The muscle strength recovered to grade 4 in 5 cases and to grade 3 in 4 cases. After latissimus dorsi myocutaneous flap transfer, the range of motion of shoulder joint was 40-90°, with an average of 70°. The two-point discrimination of latissimus dorsi myocutaneous flap was 9-15 mm (mean, 12.5 mm), and that of posterior intercostal artery perforator flap was 8-10 mm (mean, 9.2 mm). There were only residual linear scars at the second donor sites.ConclusionThe latissimus dorsi myocutaneous flap combined with posterior intercostal artery perforator flap for the large complex tissue defects and donor site can not only improve the appearance of donor and recipient sites, but also reconstruct muscle function, and reduce the incidence of donor complications.