Objective Based on the concept of organ medicine and the application of normothermic machine perfusion technology，a new in vitro and in vivo multi-organ laparoscopic system was created. Methods Smagister consists of a normothermic machine perfusion platform，porcine abdominal organs（liver，gallbladder，pancreas， stomach，intestine，kidney，uterus，bladder，etc.），a laparoscopic light source，a laparoscopic lens，an ultrasonic scalpel，laparoscopic surgical instruments，a high-definition monitor，and a software system. The logbook recordedthe results of blood gas analysis per hour and the number of intestinal peristalsis per hour. Organ population viability was subjectively assessed hourly by means of questionnaires. Three types of Laparoscopic surgery are performed on the Smagister，including laparoscopic cholecystectomy（LC），laparoscopic enterotomy closure（LEC）， laparoscopic liver resection（LLR），to demonstrate the specific procedures of each procedure. Experts in related fields were invited to compare the feasibility of completing the operation and the demonstration of complications with the actual operation. Results The mean arterial pressure of the perfusion machine was maintained at60 mmHg（1 mmHg ＝ 0.133 kPa），blood flow at approximately 1 000 ml/min，and organ temperature between 36.5 ～ 37.4℃ throughout the procedure. The intestinal peristalsis could be clearly seen during the whole perfusion process，with an average peristalsis frequency of 2.2 times /min，which was maintained until the end of the experiment. During the laparoscopic operation，clear bile secretion could be seen when the porta hepatis were separated and the bile duct was ligated. In addition，when the blood vessel was injured during liver resection，the blood vessel rupture and blood outflow can be seen. Experts evaluated that the organ activity was good during the whole laparoscopic operation，the anatomical structure of the organ could be clearly displayed，and the tactile feedback of the operation was very real. Conclusion Smagister combines a live animal model with an ex vivo simulation，pooling the advantages of both modalities and expanding the training field to provide high-quality laparoscopic training for both novice and veteran surgeons. 

Objective To investigate the current status of kinesiophobia in liver transplant recipients and to explore its influencing factors. Methods Liver transplant recipients who were hospitalized or followed up at theOrgan Transplantation Center of Jiangsu Province Hospital from January to September 2025 were selected by conveniencesampling. The 13-item Tampa Scale for Kinesiophobia （TSK-13）， Patient Health Questionnaire-9（PHQ-9）， FatigueSeverity Scale （FSS）， Sarcopenia-Five （SARC-F） questionnaire， and Health Literacy Scale for Chronic Patients were used for assessment. Univariate analysis， Pearson correlation analysis， and multiple linear regression analysis were performed to identify factors associated with kinesiophobia. Results The mean score of kinesiophobia among liver transplant recipients was （31.61±6.13）， and 37.6% of them had moderate-to-severe kinesiophobia. Univariate analysis showed that gender and living alone were significantly associated with kinesiophobia levels （P ＜ 0.05）. Pearson correlation analysis revealed that kinesiophobia scores were positively correlated with fatigue， sarcopenia， and depression scores （all P＜0.05）. Multiple linear regression analysis indicated that living alone， fatigue， and depression were independent influencing factorsof kinesiophobia （all P ＜ 0.05）. Conclusion Kinesiophobia is prevalent in postoperative liver transplant recipients，with nearly 40% experiencing moderate-to-severe levels. Living alone， fatigue， and depression are the main independent risk factors. Clinical medical staff should routinely screen for kinesiophobia and related risk factors， and implement comprehensive interventions for high-risk patients to effectively reduce kinesiophobia and improve long-term quality of life. 

Objective To understand the psychological feelings of parents of children with congenital biliaryatresia，and to provide the basis for the treatment and rehabilitation of such diseases. Methods Convenience sampling method selected 50 parents of children with congenital biliary atresia who were hospitalized in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine as the research objects，and the Chinese version of the parent experience of child illness（PECI）was used to investigate and analyze the results of the survey. Results The scores of parents' perception frequency of children with congenital biliary atresia from high to low were guilt and worry〔（30.8±7.4）scores〕，unknown sadness and anger〔（19.3±6.4）scores〕，emotions（support，comfort） 〔（12.7±3.7）scores〕，long-term uncertainty〔（10.6±4.3）scores〕. The parents of children with biliary atresia with a monthly income of 3 000 yuan and below felt more guilty and worried than those with an income of more than 3 000 yuan. The difference was statistically significant（P ＜ 0.05）. The parents of children with biliary atresia who lived in the north of the Qinling Mountains-Huaihe line had a statistically significant difference in theirfeelings of emotion（support，comfort）than the parents who lived in the south of the Qinling Mountains-Huaihe line （P ＜ 0.05）. Conclusion In clinical work，medical staff should pay attention to the guilt and worry needs of the parents of children，and at the same time pay attention to the differences in the needs between different groups， especially the characteristics of monthly income and living area，so as to enhance the confidence of parents in caring for children and the ability to promote the rehabilitation of children with disease. 

Objective To evaluate the effect and safty of islet transplantation after kidney transplantation for patients with type 2 diabetes mellitus（T2DM）and end-stage renal disease. Methods One case of islet transplantation was performed on a patient with T2DM complicated with chronic renal failure who had received kidney transplantation 3 months ago. The recipient was given exgenous insulin therapy with a dose of 1.26 U/（kg·d） before islet transplantation. The islets were transplanted into the liver through interna jugular vein transhepatic portal catheterization， as TIPS approach， the portal channel was established within the main portal vein， and the islets were slowly injected into the recipient's liver at a constant speed. Anti-CD25 monoclonal antibody was used as induction and a combination ofetanercept， mycophenolate mofetil and tacrolimus were used as maintenance immunosuppression therapy. Insulin dose， the level of blood glucose， C-peptide and the value of HbA1c were observed.Results Blood glucose was normal soon afteroperation， and the exogenous insulin was suspended. The fasting blood glucose was 4.8 ~ 8.5 mmol/L and the postprandial blood glucose was 6.9 ~ 15.1 mmol/L within the first week after operation. The total amount of exogenous insulin decreased by 50.14% compared with that before operation. The value of HbA1c was 6.3% within the first week after operation（the level of HbA1c was 6.6% before operation）. The fasting and postprandial C-peptide and insulin levels increased after operation. On the 7th day after operation， insulin and C-peptide release tests were performed. The results showed that the function of transplanted islets was partially restored, and insulin secretion was rhythmic. Conclusion Islet transplantation is an effective treatment for T2DM patients with ESRD after kidney transplantation.

Objective To optimize triple immunosuppressive dose in renal transplantation. Methods According to the dose of triple combined immunosuppressive regimen，200 patients were divided into conventional dose group（n＝145）and low-dose group（n＝128）. The dose of immunosuppressive regimen at two，four weeks， two，three and six months post-transplantation，the incidences of acute rejection，pulmonary infection and patient/graft survival rate were compared respectively between the two groups. Results The dose of triple immunosuppressive agents in the low-dose group was significantly lower than that in conventional dose group at six months post-transplantation. During the first six months post-transplantation，acute rejection including biopsy-proven and clinical presumed acute rejection occurred in 24 of 145 patients（16.5%）in the conventional dose group，and in 24 of 128 patients（18.7%）in the low-dose group（P＞0.05）. At six months post-transplantation，pulmonary infection， especially severe pulmonary infection，had a significantly higher occurrence in the conventional dose than in the low-dose group（30.4% vs 10.2% and 22.1% vs 4.7% respectively，both P＜0.01）. At 12 months，patient survival rate was 89.7% and 98.4%（P＜0.01），while the graft survival rate was 86.9% and 96.9%（P＜0.01）in the conventional dose group and low-dose group respectively. Excluding the death caused by infection with normal renal function，no significant difference was noted between the two groups（P＞0.05）. Conclusion The low-dose combination of triple immunosuppressive agents post-transplantation can significantly reduce the pulmonary infection and mortality without increasing the incidence and severity of acute rejection and subclinical rejection.

Objective To evaluate efficacy and safety of long-acting or intermediate-acting insulin combined with oral hypoglycemic drug in treatment of patients with high blood sugar early after kidney transplantation. Methods 45 cases at 1 month after kidney transplantation with high blood glucose were divided into three groups according to insulin used，insulin detemir group（A），insulin glargine group（B）and Novolin N group（C），and 15 patients in each group. The original oral acarbose dose was maintained，and each group of patients received 1 dose a day injections of insulin for 4 weeks. Blood glucose and incidence of hypoglycemia were monitored. Results Fasting blood glucose and post prandial blood sugar after treatment of three groups were significantly decreased，with most

significantly decreased in the A group ；and A，B groups decreased more than C group〔fasting blood glucose （mmol/L）：3.08±0.51，2.86±0.58 vs. 0.92±0.34 ；post prandial blood sugar（mmol/L）：4.38±1.19，4.18±1.22 vs. 2.34±0.77〕，the difference was statistically significant（all P＜0.05）；A，B groups of hypoglycemia events were obviously less than group C（6%，13% vs. 26%）. Conclusions In patients early after kidney transplantation with high blood glucose and cannot be controlled well by acarbose，treatment with addition of long-acting or intermediate- acting insulin can decrease the level of blood glucose obviously. Insulin detemir is effective and gentle for control forblood glucose with less incidence of hypoglycemia，which is a more ideal physiological simulated insulin secretion.

Objective To investigate the effect of wuzhi capsule combined with CYP3A5*3 genetic polymorphism on the tacrolimus blood trough concentration （C0） of renal transplant recipients in the early post transplant stage. Methods CYP3A5*3 genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism （PCR-RFLP）. Tacrolimus C0 was tested using chemiluminescence immunoassay （CMIA）. The effect of both the daily dose （D） of wuzhi capsule and CYP3A5*3 genotype on the tacrolimusdose-adjusted trough concentration （C0/D） was evaluated in the early post transplant stage. Results Among all of the different wuzhi capsule groups （0，22.5 and 45 mg）， tacrolimus C0/D of CYP3A5 expressers （*1/*1+*1/*3） wassignificantly lower than that of non-expressers （*3/*3） on day 3，7 and 14 after renal transplantation （P ＜ 0.05）. InCYP3A5 expressers on day 3，7 and 14， there were significant differences of tacrolimus C0/D among different wuzhi capluse groups （0，22.5 and 45 mg）. However， on day 14， tacrolimus C0/D with 67.5 mg wuzhi capsule group was significantly lower than those of both 22.5 mg and 45 mg groups （P ＞ 0.05）， and tacrolimus C0/D with 45 mg groupwas significantly lower than that of 22.5 mg group （P ＞ 0.05）. Conclusion For renal transplant recipients with CYP3A5 express， wuzhi capsule could be used to increase the blood concentration of tacrolimus and reduce its costs in the early stage after transplantation. 

Objective To investigate the value of serum AFP，PIVKA- Ⅱ and miR-21 in hepatocellular carcinoma（HCC）. Methods A total of 90 patients with compensatory cirrhosis who hospitalized in the Department of Hepatology，Tianjin Second People's Hospital from December 2017 to June 2018 wereenrolledAll patients underwent liver（gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid，Gd - EOB - DTPA ）enhanced MRI. The patients were divided into three groups ：HCC group，high-grade dysplastic nodules（HGDN）group and regenerative nodule（RN）group，and each group had 30 patients. Their serum samples were collected and the serum levels of PIVKA- Ⅱ，AFP and miR-21 were measured. Kruskal-wallis H test was used to compare thedifferences between groups. Significance levels were corrected by Bonferroni method and pairwise comparisons were made .The index of AFP，PIVKA- Ⅱ and miR-21 was analyzed by binary logistic regression，and the diagnostic value of the above indexes for HCC was evaluated by the areas under the receiver operating characteristic curve （AUC）. Results There were no difference in AFP and PIVKA- Ⅱ level between RN and HGDN group. However， AFP and PIVKA- Ⅱ levels in HCC group were higher than those in the other two groups，and the difference was statistically significant（adjusted P ＜ 0.05）. The level of miR-21 increased gradually from the RN group，HGDN group to HCC group. There were significant differences in the serum levels of miR-21 among the three groups （adjusted P ＜ 0.05）. When measured alone，the specificity and sensitivity of AFP were 91.7% and 53.3% in the diagnosis of HCC. The specificity and sensitivity of PIVKA- Ⅱ were 93.3% and 66.7% and the sensitivity and specificity of miR-21 were 97.1% and 85.0%，respectively. The sensitivity and specificity of the combined model of APR were 93.3% and 91.7%. The AUC of AFP，PIVKA- Ⅱ，miR-21 and APR were 0.756、0.873、0.953 and 0.963，respectively. Among them，APR had the highest AUROCs. Conclusion Serum AFP，PIVKA- Ⅱ and miR-21 have a high clinical value in the diagnosis of HCC，but each has its own limitation when measured alone. The combination of the three makers is beneficial to the diagnosis and screening of HCC. 

Objective To explore the association between immune therapy and the risk of rejection after liver transplantation in patients with hepatocellular carcinoma （HCC）. Methods A retrospective analysis was conducted on 11 HCC patients who received immune therapy before transplantation at Beijing Friendship Hospital from 2019 to 2025， and 70 cases reported in the literature were included. The incidence of rejection and influencing factors were analyzed. Results The rejection rate in our center's cohort was 9.1% （1/11）， which was lower than that in theneoadjuvant therapy cohort （25.0%）and the post-transplantation cohort （30.8%）in the literature. The rejection rate was significantly reduced when the interval between the last dose of immune therapy and transplantation was more than two halflives. The expression of programmed death ligand 1（PD-L1）in the graft may be related to the risk of rejection and could serve as a potential biomarker for predicting rejection. Conclusion It is recommended to wait at least 8 weeks （two halflives）after immune therapy before liver transplantation. The expression levels of programmed death receptor 1（PD-1）/PDL1 in the graft tissue can be used as potential biomarkers， but further research is needed to explore the mechanism and safe time intervas. 

Objective To investigate the methods and techniques for organ procurement from Chinesefirst category infant donation after cardiac death，and to evaluate post-transplant outcomes. Methods In this retrospective study, clinical data of 6 cases of Chinese first category infant donation after cardiac death organprocurements were analyzed Modified epigastric multivisceral organ harvesting were performed in all of thecases. Results The average warm ischemia time was 2 minutes（1.0 ～ 3.6 minutes）with the average procurementtime of 46 minutes（36 ～ 58 minutes）. Six livers and 12 kidneys were procured followed by 6 cases of livertransplantation，6 cases of en-bloc kidney transplantation. All of the recipients were healthy for 3 ~ 16 months follow-up without primary non-function and other complications except one who underwent transplant nephrectomy due to renal vein thrombosis on post operation day 7. Conclusion Modified epigastric multivisceral organ harvesting is a safe method for organ procurement from Chinese first category infant donation after cardiac deathguaranteeing procurement of high quality of organs.