Objective The purpose of this study is to summarize the situation of non-standard donor hearttransplantations（HTx）in Fuwai Hospital，and to compare the HTx outcomes between non-standard donors group and conventional donors group. Methods A retrospective analysis of HTx cases in Fuwai Hospital from January 2015 to December 2021 was conducted to summarize the use of non-standard donors; compare the clinical data of thetwo groups of recipients; analyze the postoperative survival of the two groups of recipients; explore the association between indicators of non-standard donors and postoperative 1-year mortality. Results A total of 616 HTx patients were analyzed，of which 456 were male（70.0%）and 160 were female（30.0%）. The average age was（46.0 ± 14.1）years. In these patients，330 patients were included in non-standard donor group，and 289 were included in conventional standard

donor group. Compared with the standard donor group，the non-standard donor group have longer cardiopulmonary bypass time，higher proportion of postoperative cardiac dysfunction，postoperative ECMO and IABP insertion and postoperative infection. Longer postoperative mechanical ventilation duration and ICU hospitalization duration，and higher serum creatinine before discharge（P ＜ 0.05）were also seen in the non-standard donor group. In terms of prognosis，the in-hospital mortality of the non-standard donor group was higher. Kaplan-Meier survival analysis showed that the one-year survival rate of the non-standard donor group was lower than that of the standard donor group（P ＜ 0.01），but there was no significant difference in the long-term survival rate of the patients who survived for one year after operation between thetwo groups（P ＝ 0.12）. After adjusting for recipient-related factors，multivariate analysis showed that donor coronaryartery abnormalities and donor high-dose positive inotropic drug support were independent risk factors for one-year mortality. Conclusion The application of non-standard donor heart can alleviate the shortage of donor heart resources，but it may increase post-transplant early mortality. Donor high-dose vasoactive drugs support and abnormal coronary artery of donor heart are risk factors of one-year mortality，so we should pay more attention to the management and assessment of donors before donation.

Objective To explore the effect of surgical method selection on prognosis of lung re-transplantation. Methods A retrospective cohort study was conducted on patients（n ＝15）who chose re-transplantation due to chronic lung allograft dysfunction（CLAD）at Wuxi Lung Transplant Center from January 1，2015 to December 31，2021.We analyzed the indications for re-transplantation，intraoperative conditions，perioperative and longterm survival rates，and compared them within groups based on the choice of surgical methods. Results In the 15 CLADpatients，the survival rate of patients who chose right single lung and double lung re-transplantation was better than that of left single lung re-transplantation，while double lung re-transplantation was not better than right single lung transplantation. Conclusion The choice of surgical method for the recipient of secondary lung transplantation affects the prognosis of patients . Further exploration is needed to select reasonable surgical methods according to different indications of patients. 

Objective IABP is currently considered as a mean of bridging patients with end-stage heart failure to HTx，moreover，it is able to effectively improve the hemodynamic status of patients beforetransplantation. In the study，we summarize the preoperative status and prognostic impact of bridging patients with end-stage heart failure to HTx in our center. Methods We firstly carried out a retrospective analysis of bridging patients with end-stage heart failure to HTx by adopting IABP independently in our center from January 2011 to December 2020. Then，we further compared the improvement before IABP and after transplantation ；the 1 ：1 PSM was realized in accordance with baseline information，donor age and cold ischemia time wasused to further compare the differences of clinical profile and postoperative survival between bridging patientswith independent IABP and those who had no instrument aid. Results The final analysis was performed in 70 patients with IABP bridging alone before HTx and 669 patients without device assistance during the same period. before IABP assistance，the IABP group had higher mean pulmonary artery pressure〔（346±11.79）mmHg vs.（27.6± 10.31）mmHg〕，pulmonary artery wedge pressure 〔28（17，34）mmHg vs. 18（11，24）mmHg〕，creatinine 〔111.8（93.82，130.27）μmol/L vs. 90.51（76.13，110.1）μmol/L〕，and total bilirubin〔26.2（18.3，41.08）μmol/L vs.22.76（16.09，34.7）〕μmol/L（P ＜0.05）；After IABP placement，mean pulmonary arterypressure〔（34.56± 11.79）mmHg vs.（24.71±9.68）mmHg〕and pulmonary artery wedge pressure〔28（17，34）vs. 16（12，28）decreased inthe IABP group（P＜ 0.01）；Creatinine〔111.80（93.82，130.27）vs. 101.44（80.22，128.46）〕，total bilirubin〔26.2（18.3，41.08）vs. 8.465（6.40，11.05）〕，lactic acid〔1.00（0.90，1.53）mmol/L vs. 0.85（0.30，1.50）mmol/L〕and NT-proBNP 〔7469.5（3819.25，13411.75）ng/ml vs. 2797（1256.55，5639）ng/ml〕were significantly improved（P ＜0.05）；UNOS scores were higher in the IABP group〔5.17±1.88 vs. 2.85±1.51，P ＜ 0.05〕，and afterIABPassistance，there wasno difference in UNOS scores in this group compared to the no-device group 3.84±1.30 vs.2.85±1.51（P＞0.05）；After1 ：1 PSM，there was no significant difference in in-hospital mortality（5.71 % vs. 5.71%，P＞0.05）and long-term posttransplant survival（including 1，3 and 5 years）betweenthe IABP groupand patients without device assistance（94.3%vs. 92.8% ，94.3% vs. 91.3%，94.3%vs. 91.3%，P ＞ 0.05）. Conclusion IABP treatment iseffective in improving the preoperative status of HTx recipients，resulting in short-term and long-term survival rates comparable to those of devicefree assisted recipients with betterpreoperative status.

Objective Explore the feasibility and experience of using long-term implantable ventricularassist devices to treat intractable cardiogenic shock caused by acute myocardial infarction. Methods In November 2019，the Shenzhen Hospital of Fuwai Hospital treated a case of acute myocardial infarction，cardiogenic shock，and cardiac tamponade with oval foramen repair surgery. The patient underwent coronary artery bypass grafting，and implantation of the CH-VAD ventricular assist device. Early postoperative observations included hemodynamic and organperfusion monitoring indicators. Long-term follow-up after discharge included transthoracic echocardiography，NYHAcardiac function classification，6-minute walk distance，and cardiopulmonary exercise testing to assess the recovery process of cardiac function and exercise tolerance. Results During the surgery，150 ml of dark，red，bloody pericardial effusionwas found after opening the pericardium. The apex of the left ventricle was significantly thinned，and the surrounding tissue was edematous. An old thrombus had formed at the 3 o'clock position. The cardiopulmonary bypass time was 120 min，the aortic cross-clamp time was 55 min，and the time for clamping the aortic sidewall was 10 min. Early postoperative CH-VAD pump speed was adjusted to between 2 500 and 2 900 rpm，with a flow rate of between 3.5 and 4.5 L/min. The invasive mean arterial pressure was maintained between 65 and 75 mmHg，and blood lactate，cTnI，and cTnT levels returned to normal on the day of surgery and on the 7th day postoperatively. The endotracheal tube was removed 26 h after surgery，and episodes of short bursts of ventricular tachycardia and ventricular fibrillation occurred between the 7th and 15th days postoperatively.During this period，asynchronous defibrillation was repeatedly performed at 100 ～ 200 J，and the endotracheal tube wasreinserted on the 8th day after the surgery. The patient was smoothly discharged with the CH-VAD pump on the 90th day after the operation，with a pump speed of 2 800 rpm and a flow of 3.9 L/min. Twelve months after the surgery，the patient's ultrasound indicated an LVEDD of 60 mm，an LVEF of 29%，restoration of the aortic valve and cardiac cycle opening ratio to 1 ∶ 1，NYHA Class Ⅰ，and a 6-minute walk distance of 490 m. The dressing on the driveline cable woundwas changed once a day，with no abnormalities such as wound redness，effusion，or purulent secretions. The dressing onthe driveline cable wound was changed onceaday，withnoabnormalities such aswoundredness，effusion，orpurulent secretions. ConclusionLong-termimplantableVADis aneffectivetreatmentstrategy forpatients with acute myocardialinfarction combined with intractable cardiogenicshockand should beconsidered as earlyas possible. 

Objective To summarize the application and management of ECMO in 9 patients with lungtransplantation during perioperative period. Methods The data of ECMO assisted lungtransplantation patients who have been hospitalized in the thoracic surgery Department of Thoracic Surgery of the First Affiliated Hospital of Xi'an Jiaotong University since October 2022 were collected，and theirclinical characteristics and managementexperience were retrospectively analyzed.Results Of the9 patients，6 received VA-ECMO，2receivedVV-ECMO，and1 receivedVAV-ECMO. The VA intubation method is the axillary artery femoral vein method，the VV intubation method is the femoral vein internal jugular vein method，and the VAV intubation method is the femoral vein internal jugular vein ascending aorta intubation method. The main complications were hemorrhage and renal injury，and most of them were successfully removedfrom the machine. Conclusion ECMO technology is a safe and effective support tool during the perioperative period of lung transplantation，and its circulation and intubation methods，removal timing，complications management，and other issues need to be carefully managed. 

Objective To retrospectively analyze the safety，efficacy of target dose candesartan in the treatment of chronic heart failure（CHF）and the factors affecting the target dose. Methods From March 2018 toDecember 2020，CHF patients with clinically stable NYHA Ⅱ - Ⅲ receiving candesartan in the outpatient departmentwere enrolled. Demographic data，drug combination therapy，echocardiographic parameters（UCG），NT-proBNP，serum creatinine and potassium were collected. According to the dose of candesartan，these patients were divided into candesartan target group（32 mg）and less than 32 mg group. Pair t-test was used to compare the difference of efficacy between groups before and after treatment. Logistic regression analysis was used to analyze the factors affecting candesartan to reach thetarget dose. Results A total of 79 patients were included in this study. The median follow-up time was 11 months. A total number of 40 patients（50.6%）reached the target dose of candesartan. The average candesartan dose of the other39 patients（49.4%）was 18.8±7.6 mg. A total of 60 patients with left ventricular ejection fraction（LVEF）less than 50% were included in this study（35 cases in the standard group and 25 cases in the substandard group）. After the candesartan treatment，the level of LVEF increase 30.7% significantly（P ＜ 0.001），and a significantly decrease of left ventricular end-diastolic diameter〔LVEDD，（67.7±9.3）mm vs（62.2±10.3）mm，P ＜ 0.01〕and left atrial diameter〔LAD，（46.2±7.3）mm vs（43.0±5.4）mm，P ＜ 0.05〕was observed in the target group. In the substandard group，LVEF increased by 15.1% comparing with the baseline（P ＜ 0.01），while the diameters of LVEDD and LAD were not significantly improved （P ＞ 0.05）. A total of 19 CHF patients with LVEF ≥ 50%（HFpEF）were included in this study. The diameters of LVEDD，LVEF，LAD，and the level of NT-proBNP improved after treatment but failed to reach the statistical significance（P ＞ 0.05）. Multivariate analysis showed that the etiology of dilated cardiomyopathy，LVEF ＜ 40% and high LAD diameter were the favorable factors for reaching the target dose of candisartan. The high level of NT-proBNP and the combined application of spironolactone negatively affected the dose reaching the standard. The diastolic blood pressure decreased significantly after treatment both in the standard group〔（83.4±12.4）mmHgvs（77.4±13.5）mmHg，P ＜ 0.05）〕and thenon-standard group〔（79.4±12.9）mmHg vs（74.2±13.1）mmHg，P ＜ 0.05）〕，while the systolic blood pressure did not decrease significantly（P ＞ 0.05）.1 patient was newly diagnosed of renal insufficiency in the standard group with creatinine of 115 μmol/L（normal value ＜ 104 μmol/L）and 4 in the substandard group（creatinine 143 μmol/L）. In the substandard group，the systolic blood pressure decreased below 90 mmHg in 1 patient. There was no hyperkalemia in both groups. Conclusion Thetarget dose of candesartan is more effective in the treatment of CHF，And the safety is satisfactory. A high level of NT-proBNPrather thana lowlevelof LVEF isthe limiting factor for candesartan toreach the targetdose

Objective To analyze the effect of different perioperative fluid rehydration protocols on nurses' workload and nursing ability after kidney transplantation from multiple dimensions. Methods Using a retrospective study, 100 nurses organ transplantation from three hospitals in Shanghai from June 2020 to December 2020 were divided into experimental group（n ＝ 50）and control group（n ＝ 50）. The control group received the traditional fluid rehydration protocol，and the experimental group received the compound fructose electrolyte solution. All nurses received three questionnaires ：the simplified coping style questionnaire（SCSQ），the utrecht workengagementscale（UWES），and the healthcare professional humanization scale for nursing（HUMAS）.Results The positive copingdimension of the experimental group was（25.32 ±4.30）points，while the control group was（23.10 ± 4.63）points. The score of the experimental group was higher than that of the control group，and there was a statistical difference（P ＝ 0.003）. There was no statistically significant difference in the scores of negative coping dimensions between the two groups（P ＞ 0.05）. The scores of work engagement and humanistic nursing ability in the experimental group were higher than those in the control group and had statistical significance（P ＜ 0.05）. Conclusion The single variety continuous rehydration protocol could effectively help to decrease the pressure and workload of nurses，improve the work enthusiasm，motivate their work engagement，and developtheir nursing abilities.