Objective To evaluate the influence of fatty donor liver on the recurrence of liver cancer andsurvival of patients after liver transplantation. Methods A retrospective analysis was performed from the data of 248 patients who underwent liver transplantation for hepatocellular carcinoma from January 1，2015 to December 31，2018，at Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine. Two hundred and seventeen cases were non-fatty donor livers and 31 cases were fatty donor livers. Statistical analysis was performed on overall survival rate and recurrence-free survival rate by collecting patients’data and tumor characteristics，the influence of fatty donor liver on the tumor recurrence and survival of patients after liver transplantation was alsoevaluated. Results Among the 248 liver cancer patients who underwent liver transplantation，31 received fattydonor livers. There were no significant differences in age，gender，hepatitis B infection，liver cirrhosis，number of tumors，tumor maximum diameter，pathological grade. There were no significant differences in overall survival rateand recurrence-free survival rate bewteen patients with fatty livers and non-fatty donor livers. Further subgroup classification was done according to whether the patients met the UCSF criteria before the operation，the overall survival rate and recurrence-free survival rate of the two groups of patients who met the UCSF criteria were not significantly different. There was no significant difference in the overall survival rate in patients who did not meet the UCSF criteria，but there was a significant difference in the recurrence-free survival rate，and the 1-year and 3-year recurrence-free survival rates in which the fatty liver group were lower. Conclusion There was no significant difference between the 1- and 3-year overall survival rate，recurrence-free survival rate and postoperative liver function recovery of fatty liver recipients compared with the control group. Therefore，fatty donor liver is safe andfeasible for liver cancer liver transplantation. At the same time，we have observed that in patients beyond UCSF criteria，fatty donor liver seems to have an impact on the prognosis of the patient. More detailed stratification of fat degree of fatty donor liver in combination with tumor stage and patient’s risk factors are needed，this can be an evidence of the expansion of donor source so as to benefit more hepatocellular carcinoma patients. 

Objective The impact of hepatic steatosis on the diagnostic capability of liver stiffness measurement（LSM）has not been completely investigated. Therefore，we aimed at exploring the associationbetween the existence of non-alcoholic fatty liver disease（NAFLD）and the diagnostic performance of LSM among patients with chronic hepatitis B virus（CHB）in a single center. Methods A total number of 752 patients with CHB from outpatients and inpatients who underwent FibroTouch examination in Tianjin ThirdCentral Hospital from March 2014 to December 2017 were included in this study. A total number of 506 patientswith CHB alone were included in thenon-NAFLD group，and 246 patients with CHB combined with NAFLD were included in the NALFD group. Results There were significant differences in BMI，CAP and LSMbetween the NAFLD group and non-NAFLD group. BMI were higher in NAFLD group than in non-NAFLD group （P ＜ 0.001）. CAP were higher in NAFLD group than in non-NAFLD group（P ＜ 0.001）. LSM were higher in NAFLD group than in non-NAFLD group（P ＜ 0.001）. Besides，the patients in NAFLD group had remarkably higher serum Hb，PLT，ALB，ALT，γ-GT，AST，Glu，TC，TG，TB，BUN，Cr，SPT levels than those without NAFLD. More male subjects were in NAFLD group than non-NAFLD group（P ＜ 0.001）.Multivariate linear regression analysis showed that gender（male）（B ＝ 0.004，P ＜ 0.120）、 CAP （B ＝ 0.098， P ＜ 0.001），ALB （B ＝ -0.265， P ＜ 0.001），γ-GT （B ＝ 0.128， P ＜ 0.001）， ALP （B ＝ 0.090，P ＝ 0.001），ALT （B ＝ 0.124，P ＝ 0.004）were positively correlated with LSM. Stratified analysis by gender showed higher BMI，CAP and LSM in NAFLD group than in non-NAFLD group in both genders（P ＜ 0.001）. Conclusion LSM is higherin CHB patients with NAFLD，which could lead to an overestimation of fibrosis in those patients. 

Objective To evaluate the effect of preoperative B-ultrasound-leaded transversus abdominisplane block（TAPB）or erector spinae plane block（ESPB）combining with patient controlled intravenous analgesia （PCIA）on postoperative analgesia in patients undergoing orthotopic liver transplantation. Methods Forty-five patients with modified piggy-back orthotopic livertransplantation were selected. The aged was 18 ～ 64 years old. The body mass index was 18 ～ 24 kg/m2，and the ASA grade was Ⅲ～Ⅴ . They were divided into 3 groups（n ＝ 15）：preoperative TAPB group，preoperative ESPB group and regular PCIA group（C group）. In the TAPB group，after the induction of general anesthesia，ultrasound-guided two-step TAPB was performed under the bilateral costal approach. Each point was injected with a mixture drug 15 ml（0.33% ropivacaine 30 ml + dexamethasone 5 mg）. In the ESPB group，after the induction of general anesthesia，ultrasound-guided bilateral TAPB was performed in T7. Each point was injected with a mixture drug 30 ml（0.33% ropivacaine 30 ml + dexamethasone 5 mg）. Group C was a conventional general anesthesia group，no nerve block was performed. Sufentanil 2 μg/kg PCIA was used in every groups，and the visual analog scale score（VAS）was maintained ≤ 3 within 48 h after operation. Sufentanil 5 μg was intravenously injected as rescue analgesic. The intraoperative consumption of remifentanil and the requirement for sufentanil as rescue analgesic were recorded. The extubation time after operation and development of nausea，vomiting，itching and respiratory depression were recorded within 48 h after surgery. Results Compared with group C，the consumption of remifentanil and the requirement of sufentanil as rescue analgesic within 48 h after operation were both decreased in TAPB and ESPB groups. Also the time of extubation was shortened，and the adverse reactions were decrecing within two days after operation（P ＜ 0.05）. Compared with group TAPB，the consumption of remifentanil and the requirement of sufentanil as rescue analgesic within 48 h after operation were decreased in ESPB group. But there were no significant difference of the time of extubation and the adverse reactions between the two groups within 48 h after operation（P ＞ 0.05）. Conclusion Preoperative ultrasound-guided TAPB or ESPB combining with PCIA can both provide better efficacy of postoperative analgesia with fewer adverse reactions in patients undergoing orthotopic liver transplantation. Compared with TAPB，the consumption of postoperative intravenous analgesic is decelerated in ESPB. 

Objective The occurrence of early acute kidney injury（AKI）after liver transplantation（LT） is one of the common problems affecting the longterm prognosis of patients. This study tried to create a nomogram to accurately predict the occurrence of AKI after LT. Methods We retrospectively analyzed 369 patients who were treated in our hospital between July 1，2017 and December 31，2020，and 349 patients were included in this study. We used univariate and binary logistic regression analysis to identify the significantly related predictors for occurrence，and used these predictors to create a nomogram risk prediction model and evaluated the effectiveness of the nomogramby using the internally verified consistency index（C-index）. Results The occurrence rate of AKI after LT was 53%（185/349）within 7 days after LT. Multiple logistic regression analysis found age（OR ＝ 2.049 ；95% CI ＝1.252 ～ 3.352），BMI（OR ＝ 2.041 ；95%CI ＝ 1.251 ～ 3.329），preoperative γ-glutamyl transpeptidase（GGT）（OR ＝ 2.261；95%CI ＝ 1.288 ～ 3.970），postoperative lactic acid peak（OR ＝ 2.917；95%CI ＝ 1.798 ～ 4.733），ascites（OR ＝ 1.874；95%CI ＝ 1.104 ～ 3.180）and preoperative albumin（OR ＝ 0.475；95% CI ＝ 0.271 ～ 0.832）were independent risk factors for AKI after LT. The nomogram for predicting early AKI after LT verified C-index was 0.755，the slope of the calibration curve was close to 1 which was well calibrated. Conclusion The nomogram obtained in this study has good clinical application value in predicting early AKI after LT. 

Objective The“transition”program was evaluated about its effect on improving the self-management and quality of life（QOL）among the patients of pediatric liver transplantation. Methods The intervention of the "transition" program was implemented for the research subjects，and the questionnaires were used to conduct pre- and post-intervention investigations. The contents of the questionnaires included basic information，follow-up compliance，self-management ability and quality of life. Results A total of 40 children were included in this study，including 16 males（40%）and 24 females（60%）. The average age of the children was（10.4±2.6）years，the years after transplantation were（8.7±2.0）years，the height was（142.1±15.2）cm，and the weight was（32.9±11.3）kg. The follow-up compliance before the intervention was（3.35±0.72）points （total score was 4 points），among which males were（3.42±0.90）points and females were（3.29±0.59）points.The follow-up compliance after the intervention was（3.52±0.78）points（total score 4 points），of which males were（3.50±0.90）points and females were（3.53±0.72）. There was no significant difference in follow-up compliance between males，females and all population before and after the intervention（P ＞ 0.05）. The self- management score before the intervention was（75.3±11.2）points（total score was 100 points），males were（74.3± 10.9）points and females were（76.0±11.6）points ；after the intervention，the self-management score was（77.7± 12.1）points（total score was 100 points），among which males were（75.5±10.7）and females were（79.3±13.3）. There was no significant difference in self-management scores between males，females and all population before and after the intervention（P ＞ 0.05）. The total score of quality of life before intervention was（71.8±11.7）points，andthe total score of quality of life after intervention was（73.0±10.2）points，and the difference was not statistically significant（P ＞ 0.05）. Conclusion The long-term effect of“transition”program in improving the adherence，self-management and quality of life among the population of pediatric liver transplantation patients should be discussed in the future. 

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 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.