Post living donor liver transplantation (LDLT) biliary complications can be troublesome over the post-operative course of patients, especially those with recurrent cholangitis or choledocholithiasis. Thus, in this study, we aimed to evaluate the risks and benefits of Roux-en-Y hepaticojejunostomy (RYHJ) performed after LDLT as a last option to deal with post-LDLT biliary complications. Retrospectively, of the 594 adult LDLTs performed in a single medical center in Changhua, Taiwan from July 2005 to September 2021, 22 patients underwent post-LDLT RYHJ. Indications for RYHJ included choledocholithiasis formation with bile duct stricture, previous intervention failure, and other factors. Restenosis was defined if further intervention was needed to treat biliary complications after RYHJ was performed. Thereafter, patients were categorized into success group (n = 15) and restenosis group (n = 4). The overall success rate of RYHJ in the management of post-LDLT biliary complications was 78.9% (15/19). Mean follow-up time was 33.4 months. As per our findings, four patients experienced recurrence after RYHJ (21.2%), and mean recurrence time was 12.5 months. Three cases were recorded as hospital mortality (13.6%). Outcome and risk analysis presented no significant differences between the two groups. A higher risk of recurrence tended to be related to patients with ABO incompatible (ABOi). RYHJ served well as either a rescue but definite procedure for recurrent biliary complications or a safe and effective solution to biliary complications after LDLT. A higher risk of recurrence tended to be related to patients with ABOi; however, further research would be needed.

Introduction: This study compares the intraoperative process of hepatic artery anastomosis using conventional microscope and novel 3D digital microscope and discusses our technique and operative set-up. Method: A retrospective comparative cohort study with 46 hepatic artery reconstructions in living donor liver transplant patients. Either an operational microscope (control group) or a 3D digital microscope Mitaka Kestrel View II (study group) was used for hepatic artery anastomosis. We then discuss and share our institution’s experience of improving surgical training. Results: Both operation instruments provide effective and comparable results. There was no statistical difference regarding operational objective results between conventional microscope and exoscope. Both instruments have no hepatic artery size limit, and both resulted in complete vessel patency rate. Conclusions: There was no statistical differences regarding hepatic artery anastomosis between microscope and exoscope cohorts. Microsurgeons should perform hepatic artery anastomosis efficiently with the instruments they are most proficient with. Yet, exoscope provided better ergonomics in the operation room and lessened musculoskeletal strain, allowing surgeons to work in a more neutral and comfortable posture while allowing the first assistant to learn and assist more effectively. Using exoscope with micro-forceps and modified tie technique make artery reconstruction easier.

Objectives This study explored the association between work stress and professional commitment among clinical nurses, focusing on the serial multiple mediating effects of resilience and coping. Clinical nurses experience high levels of work stress that may negatively impact their professional commitment. However, the mechanisms underlying this relationship, particularly the mediating roles of resilience and coping, remain unclear. Materials and Methods This cross-sectional study was conducted at a single medical center and involved 345 clinical nurses recruited from internal medical and surgical wards, obstetric and pediatric wards, and emergency and critical care units. The valid response rate was 97.2%. All participants were recruited from inpatient units within the same medical center, ensuring a consistent clinical setting across all departments. Descriptive, univariate, and Pearson correlation analyses were performed, and mediation effects were tested using PROCESS Model 6. Results Nurse stress was significantly negatively associated with professional commitment (total association: c = −0.0808, p < 0.001). With resilience and coping as mediators, the direct effect remained significant (c′ = −0.0382, p = 0.0011). Conclusion Higher nurse stress was significantly associated with lower professional commitment. Resilience and coping were significantly associated with this relationship as serial mediating factors. Given the cross-sectional design, these findings should be interpreted as associations rather than causal effects. Strengthening resilience and adaptive coping may help support nurses’ professional commitment.

Objectives This study explored the association between work stress and professional commitment among clinical nurses, focusing on the serial multiple mediating effects of resilience and coping. Clinical nurses experience high levels of work stress that may negatively impact their professional commitment. However, the mechanisms underlying this relationship, particularly the mediating roles of resilience and coping, remain unclear. Materials and Methods This cross-sectional study was conducted at a single medical center and involved 345 clinical nurses recruited from internal medical and surgical wards, obstetric and pediatric wards, and emergency and critical care units. The valid response rate was 97.2%. All participants were recruited from inpatient units within the same medical center, ensuring a consistent clinical setting across all departments. Descriptive, univariate, and Pearson correlation analyses were performed, and mediation effects were tested using PROCESS Model 6. Results Nurse stress was significantly negatively associated with professional commitment (total association: c = −0.0808, p < 0.001). With resilience and coping as mediators, the direct effect remained significant (c′ = −0.0382, p = 0.0011). Conclusion Higher nurse stress was significantly associated with lower professional commitment. Resilience and coping were significantly associated with this relationship as serial mediating factors. Given the cross-sectional design, these findings should be interpreted as associations rather than causal effects. Strengthening resilience and adaptive coping may help support nurses’ professional commitment.

Objectives This study explored the association between work stress and professional commitment among clinical nurses, focusing on the serial multiple mediating effects of resilience and coping. Clinical nurses experience high levels of work stress that may negatively impact their professional commitment. However, the mechanisms underlying this relationship, particularly the mediating roles of resilience and coping, remain unclear. Materials and Methods This cross-sectional study was conducted at a single medical center and involved 345 clinical nurses recruited from internal medical and surgical wards, obstetric and pediatric wards, and emergency and critical care units. The valid response rate was 97.2%. All participants were recruited from inpatient units within the same medical center, ensuring a consistent clinical setting across all departments. Descriptive, univariate, and Pearson correlation analyses were performed, and mediation effects were tested using PROCESS Model 6. Results Nurse stress was significantly negatively associated with professional commitment (total association: c = −0.0808, p < 0.001). With resilience and coping as mediators, the direct effect remained significant (c′ = −0.0382, p = 0.0011). Conclusion Higher nurse stress was significantly associated with lower professional commitment. Resilience and coping were significantly associated with this relationship as serial mediating factors. Given the cross-sectional design, these findings should be interpreted as associations rather than causal effects. Strengthening resilience and adaptive coping may help support nurses’ professional commitment.

Objectives This study explored the association between work stress and professional commitment among clinical nurses, focusing on the serial multiple mediating effects of resilience and coping. Clinical nurses experience high levels of work stress that may negatively impact their professional commitment. However, the mechanisms underlying this relationship, particularly the mediating roles of resilience and coping, remain unclear. Materials and Methods This cross-sectional study was conducted at a single medical center and involved 345 clinical nurses recruited from internal medical and surgical wards, obstetric and pediatric wards, and emergency and critical care units. The valid response rate was 97.2%. All participants were recruited from inpatient units within the same medical center, ensuring a consistent clinical setting across all departments. Descriptive, univariate, and Pearson correlation analyses were performed, and mediation effects were tested using PROCESS Model 6. Results Nurse stress was significantly negatively associated with professional commitment (total association: c = −0.0808, p < 0.001). With resilience and coping as mediators, the direct effect remained significant (c′ = −0.0382, p = 0.0011). Conclusion Higher nurse stress was significantly associated with lower professional commitment. Resilience and coping were significantly associated with this relationship as serial mediating factors. Given the cross-sectional design, these findings should be interpreted as associations rather than causal effects. Strengthening resilience and adaptive coping may help support nurses’ professional commitment.