Objective To analyze the main causes and risk factors of unplanned reoperation after liver transplantation. Methods The clinical data of 242 liver transplant recipients in the First Affiliated Hospital of Anhui Medical University from January 2015 to December 2024 were retrospectively analyzed. According to whether unplanned reoperation was performed during the same hospitalization after surgery, the recipients were divided into the reoperation group (n=36) and the non-reoperation group (n=206). The preoperative, intraoperative and postoperative data of the two groups, as well as donor and graft-related data, were compared to analyze the risk factors of unplanned reoperation after liver transplantation and the survival status of the two groups. Results Among the 242 liver transplant recipients, 36 underwent unplanned reoperations, with a total of 54 procedures including various laparotomies, endoscopic and interventional surgeries, among which there were 20 laparotomies, 18 endoscopic surgeries and 16 interventional surgeries. The most common cause of unplanned reoperation was biliary complications (20 times), followed by vascular complications (17 times). Compared with the non-reoperation group, the reoperation group had longer graft cold ischemia time, higher postoperative fatality rate of recipients, longer length of stay in the intensive care unit and postoperative hospital stay, and higher total hospitalization costs (all P<0.05). The incidence of unplanned reoperation was higher in recipients who underwent split liver transplantation (P<0.05). Multivariate analysis showed that intraoperative blood loss ≥1 000 mL, positive culture of graft perfusate and split liver transplantation were independent risk factors for unplanned reoperation (all P<0.05). The postoperative 7-day, 1-month, 3-month and 6-month survival rates of recipients in the reoperation group and the non-reoperation group were 100% vs. 98.1%, 88.9% vs. 94.2%, 69.4% vs. 90.8% and 66.7% vs. 90.8%, respectively, and the postoperative survival rate of recipients in the reoperation group was lower than that in the non-reoperation group (P<0.05). Conclusions The main causes of unplanned reoperation after liver transplantation are biliary complications, vascular complications, abdominal incision infection and intra-abdominal hemorrhage. Intraoperative massive blood loss, positive culture of graft perfusate and split liver transplantation are the risk factors associated with unplanned reoperation after liver transplantation.

To analyze the clinical and genetic features of oculopharyngodistal myopathy (OPDM) patients and compare the phenotypic differences among various causative genes.

Colorectal cancer is one of the most prevalent malignant tumors in the digestive system globally,with both its incidence and mortality showing an upward trend.In recent years,immunother-apy has become a research focus in the prognosis of CRC.Different states of tumor-infiltrating lym-phocytes(TILs)in patients have distinct impacts on tumor progression.The diversity of TILs and their interactions among cells reflect the complex relationship between tumors and the immune system.Patients with mismatch repair-deficient and microsatellite instability-high(dMMR/MSI-H)molecular phenotypes exhibit higher levels of TILs.Moreover,immune checkpoint inhibitors(ICIs),which are relevant targeted drugs for immune checkpoint blockade,also demonstrate a higher response rate in colorectal cancer patients with dMMR/MSI-H molecular phenotypes.This article reviewed the basic characteristics and prognostic value of TILs,as well as the relationship between dMMR/MSI-H and the immunological characteristics of colorectal cancer patients.

High mobility group box 1 (HMGB1), when released extracellularly, plays a pivotal role in the development of spinal cord synapses and exacerbates autoimmune diseases within the central nervous system. In experimental autoimmune encephalomyelitis (EAE), a condition that models multiple sclerosis, the levels of extracellular HMGB1 and interleukin-33 (IL-33) have been found to be inversely correlated. However, the mechanism by which IL-33 deficiency enhances HMGB1 release during EAE remains elusive. Our study elucidates a potential signaling pathway whereby the absence of IL-33 leads to increased binding of P300/CBP-associated factor with HMGB1 in the nuclei of astrocytes, upregulating HMGB1 acetylation and promoting its release from astrocyte nuclei in the spinal cord of EAE mice. Conversely, the addition of IL-33 counteracts the TNF-α-induced increase in HMGB1 and acetylated HMGB1 levels in primary astrocytes. These findings underscore the potential of IL-33-associated signaling pathways as a therapeutic target for EAE treatment.
Animals ; Encephalomyelitis, Autoimmune, Experimental/metabolism* ; Astrocytes/metabolism* ; Interleukin-33/metabolism* ; HMGB1 Protein/metabolism* ; Acetylation ; Mice, Knockout ; Mice, Inbred C57BL ; p300-CBP Transcription Factors/metabolism* ; Mice ; Spinal Cord/metabolism* ; Cells, Cultured ; Female ; Signal Transduction

Objective To investigate the status of hearing impaired children's hearing device independence skills,and to explore the ways to improve their self-use of hearing equipment.Methods This study surveyed 64 re-habilitation teachers and 411 parents of children with hearing impairment aged 0-12 years.Through face-to-face or remote telephone interview,3 good habits(A asking parents for advice before removing the HA,B putting the de-vice into a moisture-proof box after removing it,C bringing batteries to school and knowing where are them)and 3 key abilities[D wearing the device independently,E replacing the battery independently,and F independently handle foreign bodies in the ear mold(Fa)and water vapor(Fb)]was investigated.The age when mastering skills or de-veloping habits difference of hearing impaired children in different groups were compared.Results ① The ratio of ability D in the bilateral CI group and the bilateral HA group of preschool children was 30.97％and 18.57％respec-tively.Among elementary school children,85.29％and 90.70％had this ability respectively.② The ratio of ability E in the bilateral CI group,the bilateral HA group and the bimodel group were 11.50％,15.71％and 16.49％,re-spectively.Among elementary school children,64.71％,53.49％and 68.52％had this ability,respectively.③Among preschool children,there was no statistical difference in age when different equipment groups developed the three good habits and acquired ability D and E(P＞0.05).④ Among primary school children,there was a statisti-cal difference in the age when different equipment groups formed habit A(P＜0.05),and the age when double CI group had this ability was slightly earlier than the double HA group.There was no significant difference in other abilities among age groups(P＞0.05).Conclusion The age at which hearing impaired children develop the three good habits precedes the age at which they master the key skills,which accords with the law of skill acquisition and development of ordinary children.Corresponding teaching process should be based on the age and ability of hearing-impaired children without considering the type of equipment.

BACKGROUND:Ankle inversion injuries frequently occur during landing,injuring the anterior talofibular and calcaneofibular ligaments.Previous studies usually used indirect indicators,such as inversion angle,as an injury risk indicator,but epidemiological support is lacking.OBJECTIVE:To calculate anterior talofibular and calcaneofibular ligament strains using a three-dimensional multi-body foot model during a drop-landing and to investigate whether increasing the foot toe-out angle for landing would reduce the risk of inversion sprains.METHODS:Thirty-five participants with high sports demands[15 males and 20 females,age:(21.0±0.9)years,height:(176.2±8.8)cm,body mass:(71.6±12.8)kg]were recruited to perform a drop-landing test using a trapdoor device to simulate ankle inversion sprains.Two landing conditions were tested,i.e.,natural landing and toe-out landing.Kinematic data were collected using a 12-camera motion analysis system,the strains of the anterior talofibular and calcaneofibular ligaments were calculated using a three-dimensional rigid-body foot model.RESULTS AND CONCLUSION:From natural landing to toe-out landing conditions,the anterior talofibular ligament strain decreased[natural landing=(3.57±1.92)％,toe-out landing=(0.36±1.18)％,P＜0.001,Cohen's d=2.01),as was the calcaneofibular ligament strain[natural landing=(1.38±1.80)％,toe-out landing=(0.28±2.29)％,P=0.003,Cohen's d=0.81).It could be concluded that increasing foot toe-out angle reduces anterior talofibular and calcaneofibular ligament strains during drop-landing with ankle inversion,thereby reducing the potential of ankle inversion sprains.

OBJECTIVE: To evaluate the analgesic efficacy of ultrasound-guided high fascia iliaca compartment block (HFICB) in managing tourniquet-related pain following total knee arthroplasty (TKA). METHODS: A prospective randomized controlled trial was conducted involving 84 patients with severe knee osteoarthritis or rheumatoid arthritis who underwent unilateral TKA between March 2024 and December 2024. Patients were randomly assigned to two groups ( n=42) using a random number table. In the trial group, ultrasound-guided HFICB was performed preoperatively, with 0.2% ropivacaine injected into the fascia iliaca compartment. No intervention was administered in the control group. Baseline characteristics, including gender, age, surgical side, body mass index, and preoperative visual analogue scale (VAS) scores at rest and during movement, showed no significant difference between the two groups ( P>0.05). In both groups, a tourniquet was applied after osteotomy and before pulsed lavage, and removed after the closure of the first layer of the joint capsule. Postoperative assessments were conducted at 6, 12, 24, and 48 hours, including VAS scores at the tourniquet site (at rest and during movement), Bromage motor block scores, Ramsay sedation scores, and Bruggrmann comfort scale (BCS) scores to evaluate patient comfort. Additionally, the average tramadol consumption and incidence of nausea and vomiting within 48 hours postoperatively were recorded and compared. RESULTS: In the trial group and control group, VAS scores during movement at the tourniquet site significantly improved at all postoperative time points compared to preoperative levels ( P<0.05). VAS scores at rest increased transiently at 6 hours after operation in both groups, and then gradually decreased to the preoperative level. Except that there was no significant difference at 48 hours after operation in the trial group ( P>0.05), there were significant differences at other time points of two groups compared to preoperative score ( P<0.05). Except for VAS score at rest at 6 hours, VAS score during movement at 48 hours, and BCS comfort score at 48 hours ( P>0.05), the trial group showed significantly better outcomes than the control group in terms of VAS score at rest, VAS score during movement, Ramsay sedation scores, and BCS comfort scores at all other time points ( P<0.05). No significant difference was found in Bromage motor block scores between the groups ( P>0.05). Tramadol was used in 3 patients in the trial group and 7 patients in the control group within 48 hours after operation, the dosage was (133.30±14.19) mg and (172.40±22.29) mg, showing significant difference ( P<0.05). Nausea and vomiting occurred in 4 patients (9.5%) in the trial group and 3 patients (7.1%) in the control group, with no significant difference in incidence between groups ( P>0.05). CONCLUSION Ultrasound-guided HFICB provides effective analgesia for tourniquet-related pain following TKA, facilitates early postoperative functional recovery of the knee joint, and may serve as a valuable clinical option for postoperative pain management in TKA patients.
Humans ; Arthroplasty, Replacement, Knee/adverse effects* ; Nerve Block/methods* ; Male ; Female ; Pain, Postoperative/etiology* ; Tourniquets/adverse effects* ; Prospective Studies ; Middle Aged ; Ropivacaine/administration & dosage* ; Aged ; Ultrasonography, Interventional ; Anesthetics, Local/administration & dosage* ; Pain Measurement ; Fascia ; Osteoarthritis, Knee/surgery* ; Treatment Outcome ; Arthritis, Rheumatoid/surgery*

Objective To investigate the clinical and radiological features of osteofibrous dysplasia(OFD),and to improve the diagnostic accuracy of OFD and reduce the misdiagnosis rate.Methods A retrospective analysis was conducted on the clinical and radiological data of 21 patients with OFD confirmed by surgical pathology.Results Among the 21 patients,the imaging manifestations showed that the lesions were mainly located within the anterior cortex of the tibia,presenting as cystic expansile bone destruction with corti-cal expansion and thinning,protruding into the medullary cavity.Within the lesions,unequal thickness linear bony septations were visible,resembling soap-bubble changes,along with patchy ground-glass density shadow.A sclerotic rim was observed surrounding the lesions,with a clear boundary from normal tissue.No obvious soft tissue mass or periosteal reaction was noted in all cases.On MRI,the majority of the lesions exhibited prolonged T,and T2 signals,with linear hypointense separations observed within the lesions.No significant edema was noted in the surrounding bone and soft tissues,although a minor degree of bone marrow edema was present.All patients underwent surgical treatment.Fifteen patients were followed up for review,ranging from 3 to 38 months postoperatively.Among them,9 patients had no recurrence,while 6 patients experienced recurrence,manifesting as new lytic bone destruction in the surgical area.Conclusion The radiological manifestations of OFD are characteristic,and an accurate diagnosis can be made for typical cases in combination with the patient's age,location of the lesion and clinical presentation.Due to the high recurrence rate after OFD sur-gery,regular follow-up is recommended.

Objective To explore the impact of the number of negative lymph node resections on the overall survival and recurrence rate of patients with ovarian cancer.Methods A retrospective selection was made of 150 ovarian cancer patients admitted to our hospital from October 2021 to October 2023 as the research subjects.According to the standard of the number of negative lymph nodes removed,they were divided into three groups:T1 group(≤17),T2 group(18～27),and T3 group(≥28).Clinical characteristics and surgical indicators were collected,and the recurrence and survival situations were analyzed.Results The clinical characteristic analysis results showed that there were no statistically significant differences among the three groups in terms of age,meno-pausal status,BMI,CCI,family history of tumors,etc.(P>0.05).There were no significant differences in surgi-cal methods,residual lesion size,postoperative complications among the three groups(P>0.05).In terms of operation time,T1 group0.05),but with the increase in the number of lymph node resections(from T1 group to T3 group),the recurrence rate showed a statistically significant downward trend(P<0.05).Cox regression analysis showed that the univariate analysis indicated that for each additional negative lymph node,the risk of death decreased by 4.7%(HR=0.953,P<0.05);the multivariate analysis(after adjusting for confounding factors)showed that the risk decreased by 5.8%(HR=0.942,P<0.05).Restricted cubic spline(RCS)analysis confirmed a significant linear association between the two(P<0.05).With 5 lymph nodes as the reference,the risk ratios for 10,20,and 30 resections were 1.003,0.760,and 0.317,respectively,and the trend showed that the risk of death contin-ued to decrease as the number of lymph nodes increased.Multivariate Cox analysis showed that the risk of death in T3 group was 68%lower than that in T1 group(P<0.05),the risk in FIGO stage Ⅲ was 3.11 times higher(P<0.05),and the risk in high-grade tumors was 2.80 times higher(P<0.05).Conclusions The number of nega-tive lymph nodes removed in patients with ovarian cancer is linearly correlated with prognosis.The more lymph nodes removed,the lower the risk of death for the patients.Adequate lymph node removal should be an important part of the surgical treatment for ovarian cancer.

Objective: To investigate the expression of triple motif protein 21 (TRIM21) at different time points in Cisplatin induced acute kidney injury (Cis-AKI) mouse model and its correlation with pathological score . Methods: Acute kidney injury (AKI) model was induced by intraperitoneal injection of cisplatin (20 mg/kg) . Peripheral blood serum was collected at 12 , 24 , 48 and 72 h , respectively . Body weight and kidney mass were also recorded . The dynamic changes of serum creatinine ( SCr) and urea nitrogen ( BUN) were detected . The expressions of TRIM21 protein and endoplasmic reticulum stress (ERS) proteins GRP78 , GRP94 , P-elf2αand CHOP were de- tected by Western blot. HE staining was used to observe the pathology of renal tissue and analyze the correlation between the expression of TRIM21 protein at different time points . Results: Compared with the control group , the renal body ratio of Cis-AKI mice significantly increased at 48 h and 72 h (P < 0. 01) . SCr and BUN of Cis-AKI mice significantly increased at 48 h and 72 h compared with control group ( P < 0. 01) . HE staining showed that compared with the control group , the renal pathological scores of Cis-AKI mice increased at 12 and 24 h ( P < 0. 000 1) . At the same time , the expression of TRIM21 protein significantly increased at 24 h (P < 0. 01) . Com- pared with the control group , the renal pathological score of Cis-AKI mice significantly increased at 48 h ( P < 0. 000 1) , and the protein expression of TRIM21 , CHOP and GRP78 was significantly up-regulated at 48 h (P < 0. 05) . Compared with the control group , the renal pathological score of Cis-AKI mice significantly increased at 72 h (P < 0. 000 1) , and the expression of TRIM21 , GRP94 and P-elf2αproteins was significantly up-regulated at 72 h (P < 0. 05) . The results of correlation analysis showed that the expression of TRIM21 protein at different time points was positively correlated with the HE pathological scores at different time points (P < 0. 000 1) . Conclusion At different time points , TRIM21 may participate in the pathological progression of Cis-AKI by affecting ERS ,and it is positively correlated with renal pathological scores , which is expected to become a potential early diagnos- tic marker and intervention target.