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Objective To explore the causes and nursing strategies of red blood cell spillage in apheresis platelet donors, so as to avoid adverse reactions to blood donation and platelet discarding and improve blood donation services. Methods A nursing flowchart for red blood cell spillage was developed based on literature. One case of red blood cell spillage in a apheresis platelet donor as attached, and corresponding literature review was conducted. Results After the nursing intervention through the nursing flowchart of red cell spillage, platelet apheresis was successfully conducted. The donor felt good and did not experience any adverse reaction to blood donation, and with no more red blood cell spillage. By reviewing relevant literature, the incidence, principles, causes, treatments, prevention of adverse reactions to blood donation and psychological care methods of red blood cell spillage were systematically summarized. Conclusion Red blood cell spillage in apheresis platelet donors occurs occasionally, and a flowchart of care for red blood cell spillage can help blood station staff quickly identify the cause and handle it correctly to avoid mishandling whicn can result in adverse reactions or discarding of platelets.

Since the 20th century, organ transplantation has become a breakthrough technology to effectively save the lives of patients with end-stage organ failure, which has significantly enhanced the quality of life of patients. Organ donation is an important source of organ transplantation. Improving the quality of donor organ procurement is the key to promote the translation of donor organs and improve the prognosis of organ transplantation recipients. The United States, Spain and other countries have put forward a series of policies and standards in the quality management and control of donor organ procurement and achieved positive results. In this article, related concepts of medical quality management and control, advanced strategies and models of international donor organ procurement quality management, and quality control measures of Organ Procurement Organization, donors and donor organs were reviewed, aiming to provide reference for establishing a quality management and control system of donor organs with "Chinese characteristics" and advancing high)speed and high-quality development of donor organ procurement. [ABSTRACT FROM AUTHOR]

Objective To explore the effect IKAP health education model in nursing care of hematopoietic stem cell donors. Methods A total of 96 hematopoietic stem cell donors hospitalized in the hospital from June 2020 to September 2021 were selected and divided into observation group and control group according to random number method. The control group adopted the routine health education, and the observation group adopted the IKAP health education mode. The anxiety degree of the two groups on admission and the night before collection was measured and compared, the incidence of venous re-puncture during collection was compared, and the satisfaction degree with nursing service was evaluated and compared between the two groups. Results The anxiety status of donors in both groups were alleviated at night before collection, and the score of Self-rating Anxiety Scale (SAS) in observation group was lower than that of the control group (P＜0. 01). The re-puncture rate of the observation group was significantly lower than that of the control group (2. 08% vs 16. 67%, P＜0. 05). The satisfaction rate in the observation group was significantly higher than that of the control group (97. 92% vs 81. 25%, P＜0. 05). Conclusion IKAP health education model has a good effect to relieve the anxiety and ensure the safety of among hematopoietic stem cell donors during the hematopoietic stem cells collection. (目的 探讨基于IKAP健康教育模式的护理干预在造血干细胞供者中的应用效果。方法 选取2020年6月—2021年9月住院的96例造血干细胞移植供者, 采用随机数字法分为观察组和对照组, 各48例。对照组采用传统健康教育模式进行干预, 观察组采用IKAP健康教育模式。评估和对比两组入院时和采集前一晚的焦虑程度, 记录两组采集时发生的静脉再次穿刺发生率, 评估两组满意度。结果 采集前一晚, 两组焦虑自评量表评分(SAS)较入院时缓解, 且观察组SAS评分低于对照组, 差异有统计学意义(P＜0. 01)。两组采集时再次穿刺率比较, 观察组再次穿刺率低于对照组(2. 08% vs. 16. 67%, P＜0. 05)。两组满意度比较, 观察组优于对照组(97. 92% vs. 81. 25%, P＜0. 01)。结论 基于IKAP健康教育模式的护理干预能够有效改善造血干细胞供者的焦虑程度, 提升采集流程安全。)

Objective To analyze the demographic characteristics of National Human Brain Bank for Development and Function ( CAMS/PUMC Human Brain Bank ) and provide the management experience of the brain bank. Methods From December 2012 to December 2020, the number of donation registrations, body donations, and brain donations from CAMS/ PUMC Human Brain Bank were counted, and demographic characteristics of the donors who completed the brain donation were analyzed. Results Until December 2020, CAMS/PUMC Human Brain Bank collected a total of 346 human brain samples. Donors over 80 years old accounted for 59. 8 % . Donors who were undergraduate or junior college accounted for 3 7. 0%, and donors who had a master's degree or above accounted for 4. 9%. Malignancies ( 29. 2% ) and cardiovascular and cerebrovascular diseases ( 28. 3 % ) accounted for a high proportion, and nervous system diseases accounted for only 8. 7% of all brain donors. Postmortem delay was relatively short, 56. 1 % within 12 hours and 85. 8% within 24 hours. Conclusions This article summarizes the demographic characteristics of brain donors to CAMS/PUMC Human Brain Bank, which can reflect the current status of the construction and operation of the human brain bank in China, and can also be referenced to target potential donors and facilitate the construction of the brain bank. This article provides the management experience of the brain bank, which mainly includes the publicity towards registrants and donors, self-management and strengthening cooperation, which may benefit the China Brain Project. [ABSTRACT FROM AUTHOR]

Objective To summarize the experience of organ donation after citizen's death during the novel coronavirus pneumonia (COVID-19) epidemic. Methods Eleven cases of potential donors of organ donation after citizen's death during the COVID-19 epidemic were retrospectively analyzed, and the workflow and key points of infection prevention and control were summarized. Results Among 11 cases of potential donors, 6 cases failed to implement organ donation. Five donors who were successfully performed organ donation had no respiratory symptoms before the onset of encephalopathy. CT scan of the lungs upon the onset of encephalopathy showed that one case was diagnosed with aspiration pneumonia, and the remaining four cases obtained negative results. During hospitalization, all of the 5 donors showed fever symptom and repeated chest CT scan detected lung inflammation. Bronchoalveolar lavage fluid or blood samples tested for novel coronavirus nucleic acids were all negative. No confirmed or suspected cases appeared among all staff and recipients who were in close contact with organ donors. Conclusions Targeted formulation of the workflow and prevention and control measures, in combination with selection and implementation of infection risk classification can effectively reduce the risk of COVID-19 infection and carry out organ donation after citizen's death in a safe and organized manner. [ABSTRACT FROM AUTHOR]

Organ transplantation is the most effective method to treat end-stage organ failure. As the increase of transmission risk of donor-derived diseases, the quality, safety and selection criteria of transplanted organs become more and more important. Chapter 7 of the European Union's Guide to the Quality and Safety of Organs for Transplantation (6th Edition) proposed basic requirements in terms of donor and organ quality assessment, selection criteria and procedures, which were worthy of study and practice in clinical practice. [ABSTRACT FROM AUTHOR]

As China enters the era of organ donation after the citizen's death, the organ donation cases with potential malignant tumor history increase gradually. Guide to the Quality and Safety of Organs for Transplantation (6th Edition) by European Committee was translated into Chinese in 2019. This article interprets Chapter 9 of the guideline "Risk of Malignant Tumor Transmission" to assist organ donation coordinator and transplant team in screening donors at risk of malignant tumor transmission in our country and to reduce the risk of donor-derived tumor transmission. [ABSTRACT FROM AUTHOR]

Objective To investigate the individualized pretreatment of kidney transplant recipients with ABO-incompatible (ABOi) recipients of living donor. Methods Ten patients with ABO-incompatible relatives were enrolled in Zhongshan Hospital from Apr.2016 to Apr.2019,including 9 males and 1 female.There were 5 cases A to O,3 cases B to O,1 case AB to A,and 1 case B to A.There were 6 high blood antibody titer (≥ 1:128) recipients and 4 low blood antibody titer (<1:128) recipients.The recipients got individual pretreatment (rituximab plus plasma exchange),and their changes of blood antibody titer and other indicators were detected after transplantation. Results The blood antibody IgM and IgG titers of the 10 recipients reached the target level before transplant surgeries.High titer recipients got 4.33 times of plasma exchange,while low titer recipients got 1.25 times in average.Peripheral blood CD19+ cells were decreased to 0 after rituximab administration.During pretreatment,2 recipients got skin rashes and faded after 2-3 days,1 got heart failure and recovered after treatment,and 1 got diarrhea.The others had no postoperative adverse events.The 10 recipients showed good genernal condition and graft function during follow-up. Conclusions In ABOi kidney transplantation,individualized pretreatment protocols could be developed according to the recipient's condition and result in good prognosis,even in recipients with high antibody titers [ABSTRACT FROM AUTHOR]

Objective To evaluate the effect of donor-derived infection on the clinical prognosis of the recipients undergoing liver transplantation. Methods Clinical data of 75 donors and recipients undergoing liver transplantation were retrospectively analyzed. According to the culture results of donor organ lavage fluid, all recipients were divided into the positive group («=26) and negative group (n=49). Clinical parameters of the recipients during perioperative period were observed in the positive and negative groups. The sputum and peritoneal drainage fluid of the recipients undergoing liver transplantation were cultured. The incidence of postoperative infection of the recipients was observed. The 1.5-year survival curve of the recipients was analyzed by Kaplaa-Meier method. Results In the positive group, the incidence of portal vein stenosis and thrombosis was significantly higher than that in the negative group (P<0.05). Among 75 recipients undergoing liver transplantation, 33 cases (44%) developed postoperative infection mainly in the lung and abdominal cavity. The infection rate significantly differed between the positive group (77%) and negative group (27%, P<0.05). In the positive group, sputum culture was positive in 10 recipients and peritoneal drainage culture was positive in 11 recipients. The sputum culture outcomes of 4 recipients were consistent with those of the organ lavage fluid culture of their donors. The peritoneal drainage culture results of 6 recipients were consistent with those of the organ lavage fluid culture of their donors. After anti-infection treatment, 2 recipients in the positive group died at postoperative 5 and 12 d, and the culture results of the remaining recipients were negative. In the negative group, 7 recipients were positive for sputum culture and 6 recipients were positive for peritoneal drainage culture. The culture results of all recipients were negative following anti¬infection therapy. Two recipients died from graft failure at postoperative 1 month and 1 year. The 1,5-year survival rate did not significantly differ between the positive and negative groups (P>0.05). Conclusions The effect of donor-derived infection on the early prognosis of liver transplant recipients cannot be neglected, whereas it exerts mild impact on the intermediate- and long-term clinical prognosis of the recipients. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effect of hypernatremia in donors on perioperative recovery of liver function in the recipients undergoing liver transplantation. Methods Clinical data of 73 liver transplant recipients were analyzed retrospectively. According to the serum levels of sodium in donors, all recipients were divided into hypernatremia group (donor serum sodium ≥150 mmol/L, n=19) and non-hypernatremia group (donor serum sodium < 150 mmol/L, n=54). Serum alanine aminotransferase(ALT), aspartate aminotransferase (AST), model for end-stage liver disease (MELD) score, albumin, total bilirubin (TB), serum creatinine, prothrombin time and hepatocyte growth factor (HGF) in the recipients were detected at 1, 3, 7, 14 and 21 d after liver transplantation. The time of postoperative use of liver-protecting drugs in the recipients, the length of intensive care unit (ICU) stay, the average length of hospital stay and the incidence rate of postoperative complications were statistically compared and analyzed. Results Compared with the non-hypernatremia group, the serum levels of TB, ALT, AST, HGF and MELD scores of the recipients in the hypernatremia group at the postoperative 1, 3 and 7 d were significantly higher (all P<0.05), whereas the serum albumin level was significantly decreased (P<0.05). The prothrombin time in the hypernatremia group was significantly longer than that in the non-hypernatremia group at 3 and 7 d after operation (both P<0.05). In the hypernatremia group, the time of postoperative use of liver-protecting drugs and the length of ICU stay were 9 (7-13) d and 11 (8-13) d, significantly longer than 4 (3-9) d and 7 (3-9) d in the non-hypernatremia group (both P<0.05). The average length of hospital stay, serum creatinine level and incidence rate of postoperative complications did not significantly differ between two groups (all P>0.05). All recipients were recovered and discharged. Conclusions The hypernatremia in donors exert no significant effect on the perioperative liver function of the recipients, whereas it can prolong the postoperative recovery time of liver function of the recipients. [ABSTRACT FROM AUTHOR]

Objective: To assess the feasibility of using donors with novel coronavirus disease 2019 (COVID-19) for allogeneic hematopoietic stem cell transplantation (allo-HSCT) when there are no other available donors and allo-HSCT cannot be delayed or discontinued. Methods: Seventy-one patients with malignant hematological diseases undergoing allo-HSCT between December 8, 2022, and January 10, 2023, were included. Of these, 16 received grafts from donors with mild COVID-19 (D-COVID(+) group) and 55 received grafts from donors without COVID-19 (D-COVID(-) group). The graft compositions were compared between the two groups. Engraftment, acute graft-versus-host disease (aGVHD), overall survival (OS), and relapse were also evaluated. Results: There were no serious side effects or adverse events in the D-COVID(+) group. The mononuclear cell dose and CD34(+) cell dose were comparable between the two groups, and no additional apheresis was required. There were no significant differences in the lymphocyte, monocyte, and T-cell subset doses between the two groups. The median natural killer cell dose in the D-COVID(+) group was significantly higher than that in the D-COVID(-) group (0.69×10(8)/kg vs . 0.53×10(8)/kg, P =0.031). The median follow-up time was 72 (33-104) days. All patients achieved primary engraftment. The 60-day platelet engraftment rates in the D-COVID(+) and D-COVID(-) groups were 100% and (96.4±0.2) %, respectively ( P =0.568). There were no significant differences in neutrophil ( P =0.309) and platelet ( P =0.544) engraftment times. The cumulative incidence of grade 2-4 aGVHD was (37.5±1.6) % vs. (16.4±0.3) % ( P =0.062), and of grade 3-4 aGVHD was 25.0% ±1.3% vs . 9.1% ±0.2% ( P =0.095) in the D-COVID(+) and D-COVID(-) groups, respectively. The probabilities of 60-day OS were 100% and 98.1% ±1.8% ( P =0.522) in the D-COVID(+) and D-COVID(-) groups, respectively. There was no relapse of primary disease during the study period. Conclusion: When allo-HSCT cannot be delayed or discontinued and no other donor is available, a donor with mild COVID-19 should be considered if tolerable. Larger sample sizes and longer follow-up periods are required to validate these results.

Objective To evaluate the effect of warm ischemia time of donor liver from donation after cardiac death(DCD) on transplant liver in rats. Methods The rat models of orthotopic liver transplantation of DCD donor liver were established. According to the time of cardiac arrest before obtaining the donor livers, 54 recipient rats were evenly divided into three groups: control group(W0 group, no warm ischemia, n=18), 10 min warm ischemia group(W10 group, n=18) and 20 min warm ischemia group(W20 group, n=18). At 1, 3, and 7 d after operation, serum liver function [alanine aminotransferase(ALT) and aspartate aminotransferase(AST)] were quantitatively measured in rats of each group, liver cells and its organelles were observed by electron microscopy and the expression levels of cytochrome C(Cyt C) and apoptosis inducing factor(AIF) proteins in liver tissues were detected by Western blot in rats of each group. Results The serum levels of ALT and AST in each group were significantly increased at 1 d after liver transplantation along with the prolongation of warm ischemia time. Compared with the W0 group, the serum levels of ALT and AST in the W10 and W20 groups were increased significantly(all P<0.05). At postoperative 3 d, the serum levels of ALT and AST in each group were slightly decreased. Compared with the W0 group, the serum levels of ALT and AST in the W10 and W20 groups were significantly higher(all P<0.05). At 7 d after operation, the serum levels of ALT and AST in each group were elevated again. Compared with the W0 group, the serum levels of ALT and AST in the W10 and W20 groups were remarkably increased(all P<0.05). Electron microscope showed that along with the prolongation of warm ischemia time, the degree of hepatocyte edema was gradually aggravated, the endoplasmic reticular expansion was steadily increased and the degree of mitochondrial damage was aggravated, especially in the W20 group. At postoperative 1 d, the expression level of AIF and Cyt C proteins in the liver tissues did not significantly differ among three groups(all P>0.05). At 3 and 7 d after operation, compared with the W0 group, the expression levels of AIF and Cyt C proteins were significantly up-regulated in the W10 and W20 groups(all P<0.05), and the expression levels of AIF and Cyt C proteins in the W20 group were significantly higher than those in the W10 group(both P<0.05). Conclusions The warm ischemia of the DCD donor liver mainly leads to liver cell injury. Along with the extension of warm ischemia time, significant changes occur in the morphology of mitochondria and other organelles and the expression level of mitochondrial apoptosis-related proteins in transplanted liver cells. [ABSTRACT FROM AUTHOR]

Objective To explore the skills and summarize the experience in the establishment of orthotopic liver transplantation rat models from donation after cardiac death (DCD). Methods According to the time of warm ischemia, 120 rats were divided into 3 groups: group A (warm ischemia for 0 min, n=40 pairs), group B (warm ischemia for 10 min, n=40 pairs) and group C (warm ischemia for 20 min, n=40 pairs). Orthotopic liver transplantation was performed by the modified two-cuff technique in 3 groups. The time of each stage of surgery was recorded in 3 groups. The survival rate at the end of surgery, 24 h, 72 h and 7 d after surgery was recorded in 3 groups. The dead rats were immediately subject to anatomical examination to identify the cause of death. Results The cold ischemia time of donor liver, anhepatic phase and operation time of the recipients did not significantly differ among three groups (all P>0.05). In groups A, B and C, the survival rate at the end of surgery was 97%, 97%, and 100% respectively. The survival rate at postoperative 24 h was 92%, 90% and 92% respectively. The survival rate at postoperative 72 h was 90%, 80% and 77% respectively. The survival rate at postoperative 7 d was 85%, 70% and 57% respectively. The survival rate at the end of surgery, postoperative 24 h and 72 h did not significantly differ among 3 groups (all P>0.05). At postoperative 7 d, the survival rate in group C was significantly lower than that in group A (P<0.05). Surgical operation was the major cause of intraoperative and postoperative 24 h death. Bile leakage and ischemic hepatic failure were the causes of death at postoperative 72 h. Biliary duct complications were the main causes of death at postoperative 7 d. The quantity of rats developing with biliary duct complications was increased along with the prolongation of warm ischemic time. Conclusions The success of stable establishment of rat models with orthotopic liver transplantation from DCD depends upon the protection of the liver and biliary function. The difficulty lies in the anastomosis of the suprahepatic inferior vena cava and the shortening of anhepatic phase. [ABSTRACT FROM AUTHOR]

Objective To evaluate the clinical efficacy of en-bloc kidney transplantation from pediatric organ donation after death. Methods Clinical data of donors and recipients undergoing en-bloc kidney transplantation from pediatric donor kidneys were retrospectively analyzed. The 1-year survival rates of the recipient and grafted kidney were calculated. The recovery of renal function at postoperative 1 year was observed. The changes in the length of grafted kidney and incidence of postoperative adverse events were monitored. Results The 1-year survival rate of the recipients was 8/9, and 72% for the grafted kidney. During 1-year follow-up, the serum creatinine (Scr) level was down-regulated from (747± 170) μmol/L before transplantation to (83±27) μmol/L post-transplantation, the blood urea nitrogen concentration was decreased from (24.5±4.9) mmol/L to (6.8±2.0) mmol/L, and the length of transplanted kidney was increased from (61.1±9.8) mm to (100.3±1.7) mm. Two recipients suffered from delayed graft function(DGF) and restored after hemodialysis. Two cases developed acute rejection and healed after methylprednisolone shock therapy. One recipient presented with lung fungal infection at postoperative 2 weeks after transplantation, and was treated by the withdrawal of immunosuppressive agents and antibacterial treatment with poor clinical efficacy. Then the recipient died at 3rd month. One case had renal arterial thrombosis at postoperative 7 d, underwent nephrectomy at postoperative 10 d and returned to hemodialysis. At postoperative 1st month, one recipient suffered from thrombosis of unilateral renal artery. The grafted kidney in other side normally functioned and significantly grew in size at postoperative 6 months. In addition, two cases had ureterostenosis of the transplanted kidney, albuminuria in 2, abdominal aortic stenosis in 1 and urinary fistula in 1. All these symptoms were cured or alleviated after corresponding treatment. Conclusions The incidence of perioperative complications is relatively high in en-bloc kidney transplantation from pediatric organ donation after death, whereas the clinical efficacy of such kidney transplantation can be gradually increased along with the accumulation of clinical experience. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess the safety and efficacy of a second allogeneic hematopoietic stem cell transplantation (allo-HSCT) with reduced-intensity conditioning (RIC) in patients with hematological malignancies who had relapsed after the first allo-HSCT. Methods: Between April 2018 and June 2021, 44 patients with hematological malignancies (B-ALL 23, T-ALL/T-LBL 4, AML15, and MDS 2) were enrolled and retrospectively examined. Unrelated donors ( n =12) or haploidentical donors ( n =32) were used. Donors were replaced in all patients for the second allo-HSCT. Hematological and immunological germline predisposition genes and hematopoietic and immune function tests were used to select the best-related donor. Total body irradiation (TBI) /fludarabine (FLU) -based ( n =38), busulfan (BU) /FLU-based ( n =4), total marrow irradiation (TMI) /FLU-based ( n =1), and BU/cladribine-based ( n =1) were the RIC regimens used. For graft versus host disease (GVHD) prevention, cyclosporine, mycophenolate mofetil, short-term methotrexate, and ATG were used. Eighteen (40.9%) of 44 patients with gene variations for which targeted medications are available underwent post-transplant maintenance therapy. Results: The median age was 25 years old (range: 7-55). The median interval between the first and second HSCT was 19.5 months (range: 6-77). Before the second allo-HSCT, 33 (75%) of the patients were in complete remission (CR), whereas 11 (25%) were not. All patients had long-term engraftment. The grade Ⅱ-Ⅳ GVHD and severe acute GVHD rates were 20.5% and 9.1%, respectively. Chronic GVHD was found in 20.5% of limited patterns and 22.7% of severe patterns. CMV and EBV reactivation rates were 29.5% and 6.8%, respectively. Hemorrhage cystitis occurred in 15.9% of cases, grade Ⅰ or Ⅱ. The 1-yr disease-free survival (DFS), overall survival (OS), and cumulative recurrence incidence (RI) rates of all patients were 72.5% (95% CI , 54.5%-84.3%), 80.6% (95% CI , 63.4%-90.3%), and 25.1% (95% CI , 13.7%-43.2%), respectively, with a median follow-up of 14 (2-39) months. There were eight deaths (seven relapses and one infection). The rate of non-relapse mortality (NRM) was only 2.3%. The CR patients' 1-yr RI rate was significantly lower than the NR patients (16.8% vs 48.1%, P =0.026). The DFS rate in CR patients was greater than in NR patients, although there was no statistical difference (79.9% vs 51.9%, P =0.072). Univariate analysis revealed that CR before the second allo-HSCT was an important prognostic factor. Conclusion: With our RIC regimens, donor change, and post-transplant maintenance therapy, the second allo-HSCT in relapsed hematological malignancies after the first allo-HSCT is a safe and effective treatment with high OS and DFS and low NRM and relapse rate. The most important factor influencing the prognosis of the second allo-HSCT is the patient's illness condition before the transplant.

Objective To summarize the experience of quality evaluation and function maintenance of donor liver from organ donation after citizen's death. Methods Clinical data of 93 donors and 87 patients undergoing liver transplantation in the Third Affiliated Hospital of Sun Yat-sen University form July 2012 to June 2015 were retrospectively analyzed. The experience of quality evaluation and function maintenance of donor liver was briefly introduced. The procurement and utilization of donor organs and the recovery of recipients undergoing donor liver transplantation were summarized. Results The mean warm ischemia time of donor organ was 8 min (1-12 min). The organ procurement surgery was successfully performed with an average duration of 32 min (20-52 min). In total, 93 donor livers were obtained, 87 utilized for liver transplantation and 6 discarded (3 cases of severe fatty liver disease, 2 of hepatic fibrosis and 1 of hepatic tearing injury). Two patients underwent combined liver and kidney transplantation. The function of liver graft recovered well. Merely 1 case presented with primary liver graft non-function. Conclusions Early and accurate evaluation and maintenance of donor livers from organ donation after citizen's death can enhance the quality of organ graft and improve the transplantation efficacy. [ABSTRACT FROM AUTHOR]

Objective To explore the feasibility of ultra-long distance transport of lung from donation after cardiac death (DCD) or donation after brain death (DBD) by civil aviation for lung transplantation. Methods Clinical data of 6 cases with lung transplantation through ultra-long distance transport of lung from donors by civil aviation in Wuxi People's Hospital Affiliated to Nanjing Medical University from February to March in 201 5 were analyzed retrospectively. Results There were 6 donors who were DBD or DCD. It spent 5.0 ~8.5 h from lung removal, transport to lung transplantation in the operation room, including 2.0 ~3.0 h (mileage > 1 500 km) for flight. Five cases received sequential double lung transplantation. One case received right single lung transplantation. The operation was conducted successfully, with the lung's cold ischemia time of 7-1 2 h. After operation, all patients received ventilator assisted breathing, and suspended after 2-4 d. As of the date of submission, 6 cases recovered well. Conclusions Long distance transport is feasible in the case of conducting sequential double lung transplantation with donor lung from DCD or DBD, if there are direct flights between the two cities of the donor and recipient, and the flight time is within 3 h. [ABSTRACT FROM AUTHOR]

Objective To study the pathological changes of renal grafts from elderly donor in young recipients and to investigate the safety of kidney transplantation from elderly donors. Methods Fourteen elderly kidney donors (with the age > 55 years old) and fourteen young recipients (with the age < 30 years old) underwent living related donor renal transplantation at the Department of Transplantation of the Second Affiliated Hospital of Guangzhou Medical University from January 2008 to December 2008 were enrolled as the object of study. Every elderly donor kidney was performed time-zero biopsy and every young recipient was performed routine renal graft biopsy 6 months after transplantation. The pathological and structural changes of kidney tissues after renal transplantation from elderly donors were observed. Results The histopathological changes occurred at 6 months after transplantation from elderly kidney donors to young recipients. Compared with those before transplantation, the severity of renal arteriolar lesion and the index of renal arteriolar sclerosis alleviated after transplantation (P < 0. 05), and the ratio of glomerulosclerosis did not change after transplantation (P > 0. 05). The expression of fibronectin (FN) decreased after transplantation, but the difference had no statistical significance (P > 0. 05). The expression of laminin( LN) decreased after transplantation (P < 0. 05). Conclusions The histopathological structure of renal graft from elderly donors in young recipients has improved. [ABSTRACT FROM AUTHOR]

Objective To analyze the correlation between the status of the donation after brain and cardiac death (DBCD) donors and postoperative recovery of the organ function in the liver and renal transplant recipients. Methods The assessment data and organ protection measures of 12 DBCD donors admitted to the Organ Transplantation Center in Sichuan Provincial People’s Hospital from August 2011 to November 2013 were retrospectively analyzed. The parameters of postoperative recovery of 12 liver and 22 renal transplant recipients were also assessed. The correlation between the parameters of the donors and postoperative recovery of the liver and renal transplant recipients was statistically analyzed. Results Among 12 liver transplant recipients, 1 patient had primary non-function (PNF) (1/12,8%) and 11 cases developed delayed graft function (DGF) after renal transplantation (11 /22,50%). Intensive care unit (ICU) period, liver function, maintaining systolic blood pressure (SBP), blood coagulation function, blood glucose level and electrolyte (Na+/K+) were significantly correlated with postoperative recovery of the liver and kidney function in the recipients (all in P <0.05 ). Age, cause of brain death, maintaining diastolic blood pressure (DBP), activated partial thromboplastin time (APTT) and pH of arterial blood gas (ABG) were associated with postoperative recovery of the liver function. Total bilirubin and white blood cell count (WBC) were correlated with postoperative recovery of kidney function. Conclusions DBCD donors cater to the specific conditions in China. The incidence of postoperative PNF in liver recipients is relatively low whereas and the incidence of DGF after renal transplantation is relatively high. Assessment of the DBCD donors and organ protection measures should be specifically taken to enhance the clinical efficacy of liver and renal transplantation from DBCD donors. [ABSTRACT FROM AUTHOR]

Hydrogen sulfide is one of the most important signal transduction molecules in the body. Its anabolism and catabolism in the gastrointestinal tract(GT) are extremely high, and its role in the physiological and pathological process of the GT is fairly complicated. The study reviewed recent literature on hydrogen sulfide and GT, and proposed that hydrogen sulfide exerted dual modulating effects in the GT; specifically, it promoted the functions of the GT at low concentrations while damaged the GT at high concentrations. Hydrogen sulfide donors or metabolic modifiers exerted their therapeutic effects by restoring the metabolic homeostasis of hydrogen sulfide, and extended their efficacy to other tissues through hydrogen sulfide related gut-axis. Additionally, drugs could deviate hydrogen sulfide metabolism from the normal state due to their instability of structure, local over exposure and/or excessive pharmacological effects, thus inducing toxic and side effects or transforming therapeutic effects into toxic and side effects. This study provided references for the deep research on physiological and pathological mechanisms of hydrogen sulfide and facilitated the development of hydrogen sulfide-related drugs and discovery of their toxicity and efficacy mechanism.

Objective: To examine the association between the clinical efficacy of fecal microbiota transplantation (FMT) in recipients and the choice of donor, and to observe the characteristics of intestinal flora and metabolites among different donors. Methods: A retrospective case-control study was conducted. Donor whose feces was administrated for more than 30 recipients was enrolled. Data of 20 FMT donors and corresponding recipients at Intestinal Microecology Diagnosis and Treatment Center of the Tenth People's Hospital from October 2018 to December 2019 were collected retrospectively. During follow-up, the efficacy of each recipient 8-week after FMT treatment was recorded and analyzed. Based on the efficacy of each donor, the donors were divided into three groups: high efficacy group (effective rate >60%, 10 donors), moderate efficacy group (effective rate 30%-60%, 6 donors) and low efficacy group (effective rate <30%, 4 donors). The structure of the bacterial flora and the content of fecal short-chain fatty acids in each group of donors were detected and compared among groups. Association of the efficacy of each donor group with the morbidity of complications, and association of efficacy of recipients with donors were analyzed. The evaluation indicators of FMT efficacy included objective clinical effectiveness and/or subjective effectiveness. Objective effectiveness indicated clinical cure plus clinical improvement, and subjective effectiveness indicated marked effectiveness plus medium effectiveness through questionnaire during follow-up. Results: A total of 1387 recipients were treated by 20 donors, including 749 cases of chronic constipation, 141 cases of chronic diarrhea, 107 cases of inflammatory bowel disease (IBD), 121 cases of irritable bowel syndrome (IBS), 83 cases of autism, and 186 cases of other diseases, such as radiation bowel injury, intestinal pseudo-obstruction, paralytic intestinal obstruction, functional bloating and allergic diseases. There were 829 cases, 403 cases, and 155 cases in high efficacy group, moderate efficacy group and low efficacy group respectively. Baseline data among 3 groups were not significantly different (all P > 0.05). In comparison of bacterial abundance (operational taxonomic unit, OTU) among different effective donor groups, the high efficacy group was the highest (330.68±57.28), the moderate efficacy group was the second (237.79±41.89), and the low efficacy group was the lowest (160.60±49.61), whose difference was statistically significant ( F =16.910, P <0.001). In comparison of bacterial diversity (Shannon index), the high efficacy group and the moderate efficacy group were higher (2.96±0.36 and 2.67±0.54, respectively), and the low efficacy group was lower (2.09±0.55), whose difference was statistically significant ( F =5.255, P =0.017). In comparison of butyric acid content among three groups, the high efficacy group had the highest [(59.20±9.00) μmol/g], followed by middle efficacy group [(46.92±9.48) μmol/g], and the low efficacy group had the lowest [(37.23±5.03) μmol/g], whose difference was statistically significant ( F =10.383, P =0.001). The differences of acetic acid and propionic acid among three groups were not statistically significant (all P >0.05). A total of 418 cases developed complications (30.1%). Morbidity of complication in low efficacy group, moderate efficacy group and high efficacy group was 40.6% (63/155), 30.0% (121/403) and 28.2% (243/829) respectively, and the difference was statistically significant (χ(2)=9.568, P =0.008). The incidence of diarrhea in low efficacy group, moderate efficacy group and high efficacy group was 7.1% (11/155), 4.0% (16/403) and 2.8% (23/829) respectively, and the difference was statistically significant (χ(2)=7.239, P =0.027). Comparing the incidences of other types of complications, no statistically significant differences were found (all P >0.05). Follow up began 8 weeks after the FMT treatment. The total follow-up rate was 83.6% (1160/1387). The overall effective rate 58.3% (676/1160). Effective rates of various diseases were as follows: chronic constipation 54.3% (328/604), chronic diarrhea 88.5% (115/130), IBD 56.1% (55/98), IBS 55.1% (59/107), autism 61.6% (45/73), and other diseases 50.0% (74/148). Comparing the effective rate of three groups of donors for different diseases, there was no statistically significant difference in chronic diarrhea ( P >0.05); there was a positive correlation trend in IBD, IBS and autism, but the differences were not statistically significant (all P >0.05). For chronic constipation and other diseases, high efficacy group had the highest effective rate [65.0% (243/374) and 63.2% (55/87)], followed by moderate efficacy group [49.4% (86/174) and 38.1% (16/42)], and low efficacy group had the lowest [16.1% (9/56) and 15.8% (3/19)], whose differences were significant (all P <0.05). Conclusions: Different donors have different efficacy in different diseases. Chronic constipation, radiation bowel injury, etc. need to choose donors with high efficacy. IBD, IBS and autism may also be related to the effectiveness of donors, while chronic diarrhea is not associated to the donor. The efficiency of the donor is negatively correlated to the morbidity of complications. The abundance and diversity of intestinal flora and the content of butyric acid may affect the efficacy of the donor.

Objective: To summarize the clinical data of pre-implantation biopsy donors in our hospital and explore the clinical characteristics of those donors in pathological high-risk, and to provide references for the selective histological evaluation of extended criteria donor kidneys. Methods: We retrospectively reviewed the clinical data and pre-implantation renal pathologic score of donors from January 1, 2015 to May 1, 2017.During this period, 247 cases of donation after citizen's death (DCD) occurred.After clinical evaluation and selective machine perfusion( Lifeport) evaluation, 30 cases of pre-implantation pathological evaluation were performed.According to Remuzzi scores, donors were divided into low-risk and high-risk group.Nine cases of low-risk group (bilateral kidney's Remuzzi score ≤3) and 16 cases of high-risk group (bilateral or unilateral kidney's Remuzzi score ≥4, severe glomerular micro-thrombi or severe tubular necrosis) were included.Five cases of donors were excluded due to only unilateral renal pathological result available.Both high-risk and low-risk groups' clinical data, including sex, age, height, body weight, body mass index, proteinuria, hematuria, urinary glucose, baseline or admission serum creatinine, serum creatinine before procurement, history of hypertension and/or diabetes mellitus, cardiopulmonary resuscitation or not, with or without the history of shock, urine output prior to acquisition, macroscopical manifestations of donor kidney, cause of death were statistically analyzed. Results: The donors' baseline serum creatinine/upper limit of normal serum creatinine range in high-risk group were significantly higher than that in low-risk group [(129.8±42.2)% vs(92.4±30.5)%, P =0.029]. The poor macroscopical manifestations of donor kidneys were significantly more frequent in high-risk group than that in low-risk group (12/16 vs 0/9, P = 0). No significant differences between two groups were found regarding their age, height, weight, BMI, proteinuria, hematuria, urine glucose, pre-procure creatinine level, history of hypertension and/or diabetes mellitus, cause of death and so on ( P >0.05). Conclusions: After clinical evaluation and selective Lifeport evaluation, donor grafts of whose baseline serum creatinine levels increased beyond normal range and of whose grafts' macroscopical manifestations were poor, should undergo pre-implantation pathological evaluation further.Also, it is reasonable to perform pre-implantation biopsy in cases of equivocal results after Lifeport evaluation.This will be beneficial to identify histological high-risk donors and also be predictive to allocate the grafts.

Objective: To assess the operation status of human milk banks in the mainland of China. Method: This retrospective study included a consecutive series of 14 human milk banks in the mainland of China from March 2013 to December 2016. The opened date, condition of donated breast milk, characteristics of donors and clinical application of donated breast milk were analyzed. Result: There were 14 human milk banks successively founded in mainland China from March 2013 to December 2016. The number of human milk banks, the amount of donated breast milk, the number of eligible donors and the times of donation had increased each year. Howere, the operation status among these milk banks varied greatly. Among them, one human milk bank has newly opened without relevant data, 6 banks could accept frozen breast milk, and the remaining 7 banks could only collect breast milk by the nurses in the bank. Among the 3 121 eligible donors, 1 404 (45.0%) donated less than 3 times, 2 553 (81.8%) aged 25 to 35 years, 2 828 (90.6%) had term delivery, 2 409 (77.2%) began donation one month after birth, 1 798 (57.6%) were company employees and housewives and 1 891 (60.6%) had bachelor or higher degree. The use of donor breast milk, the number of recipients and the average received amount of breast milk every person varied greatly among these banks. Conclusion: The human milk banking developed quickly in the mainland of China. Howere, the number of donors and the amount of donated breast milk which could not meet the clinical demands should be improved. And it was urgent to establish the standards or guidelines of the human milk banking as soon as possible in China.

Objective: To investigate the pregnancy outcomes of assisted reproductive technology (ART) with cryopreserved donor sperm and the safety of the offspring thus conceived., Methods: The Human Sperm Bank of CITIC Xiangya Hospital provided cryopreserved donor semen to 31 reproductive centers in China between January 2006 and December 2012, with which 50247 ART cycles were accomplished. We compared the rates of birth defects and spontaneous abortion of intracervical insemination (ICI), intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI)., Results: A total of 39 047 ART cycles were performed by artificial insemination with cryopreserved donor sperm, including 36 674 cycles of ICI and 2 372 cycles of IUI. Among the 8 612 clinical pregnancies achieved by ICI, there were 917 cases of spontaneous abortion (at <28 gestational wk) (10.6%) and 6133 live births, with 43 cases of birth defect (0.70%). Of the 547 clinical pregnancies achieved by IUI, there were 41 cases of spontaneous abortion (7.5%) and 426 live births, with 2 cases of birth defect (0.47%). Totally, 11 200 cycles of IVF and ICSI were accomplished with cryopreserved donor sperm. Of the 5 860 clinical pregnancies achieved by IVF, there were 456 cases of spontaneous abortion (7.8%) and 5089 live births, with 55 cases of birth defect (1.08%). Among the 350 clinical pregnancies achieved by ICSI, there were 30 cases of spontaneous abortion (8.6%) and 229 live births, with 3 cases of birth defect (1.31%). The birth defect rate of ART with cryopreserved donor sperm was significantly lower than that published by the Chinese Ministry of Health (0.86% vs 1.53%,P<0.01)., Conclusions: The safety of the offspring conceived by ART with cryopreserved donor sperm is controllable.