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.

OBJECTIVES: Exposure to rare earth elements (REEs) has been linked to various systemic diseases, but their impact on the offspring blood-brain barrier (BBB) via the gut-brain axis remains unclear. This study aims to investigate the effects of maternal exposure to neodymium oxide (Nd₂O₃) on the BBB integrity of offspring rats, and to evaluate the potential protective role of bifidobacterium tetrad viable tablets (BTVT) against Nd₂O₃-induced intestinal and BBB damage. METHODS: Healthy adult SD rats were mated at a 1:1 male-to-female ratio, with the day of vaginal plug detection marked as gestational day 0. A total of 60 pregnant rats were randomly assigned to the following groups: Control, 50 mg/(kg·d) Nd₂O₃, 100 mg/(kg·d) Nd₂O₃, 200 mg/(kg·d) Nd₂O₃, and 200 mg/(kg·d) Nd₂O₃ + BTVT group. Treatments were administered by daily oral gavage throughout pregnancy and lactation. On postnatal day 21 (weaning), offspring feces, brain, and colon tissues were collected. Hematoxylin and eosin (HE) staining was used to assess structural changes in brain and intestinal tissues. Short-chain fatty acids (SCFAs) in feces were quantified by gas chromatography-mass spectrometry (GC-MS). Evans Blue (EB) dye extravasation assessed BBB permeability. Gene and protein expression levels of tight junction proteins occludin and zonula occludens-1 (ZO-1) were measured by reverse transcription PCR (RT-PCR) and Western blotting (WB), respectively. Neodymium levels in brain tissue were determined via inductively coupled plasma mass spectrometry (ICP-MS). RESULTS: HE staining revealed that maternal Nd₂O₃ exposure caused mucosal edema, increased submucosal spacing, and lymphocyte infiltration in offspring colon, as well as neuronal degeneration and vacuolization in brain tissue. BTVT intervention alleviated these changes. GC-MS analysis showed that levels of acetic acid, propionic acid, butyric acid, and isobutyric acid significantly decreased, while valeric acid and isovaleric acid increased in offspring of Nd₂O₃-exposed mothers (P<0.05). BTVT significantly restored levels of acetic, propionic, and isobutyric acids and reduced valeric acid content (P<0.05). EB permeability was significantly elevated in Nd₂O₃-exposed offspring brains (P<0.05), but reduced with BTVT treatment (P<0.05). RT-PCR and WB showed downregulation of occludin and ZO-1 expression following Nd₂O₃ exposure (P<0.05), which was reversed by BTVT (P<0.05). ICP-MS results indicated significantly increased brain neodymium levels in offspring from all Nd₂O₃-exposed groups (P<0.05), while BTVT significantly reduced neodymium accumulation compared to the 200 mg/(kg·d) Nd₂O₃ group (P<0.05). CONCLUSIONS Maternal exposure to Nd₂O₃ during pregnancy and lactation disrupts intestinal health and BBB integrity in offspring, elevates brain neodymium accumulation, and induces neuronal degeneration. BTVT effectively mitigates Nd₂O₃-induced intestinal and BBB damage in offspring, potentially through modulation of the gut-brain axis.
Animals ; Female ; Blood-Brain Barrier/pathology* ; Pregnancy ; Rats, Sprague-Dawley ; Rats ; Male ; Neodymium/toxicity* ; Prenatal Exposure Delayed Effects/prevention & control* ; Lactation ; Maternal Exposure/adverse effects* ; Brain

Objective To investigate the distribution of pathogens and changes in serum humanβ-defendin-3(HBD3)and FMS like tyrosine kinase 3 ligand(Flt3L)levels in patients with pulmonary infection after esophageal cancer radical surgery.Methods Prospectively,patients who underwent radical resection of esophageal cancer and developed pulmonary infection from January 2022 to January 2024 were selected as the infection group(75 cases),and patients who underwent radical resection of esophageal cancer and did not develop pulmonary infection were selected as the non-infection group(93 cases).Patients in the infection group were divided into the mild group(25 cases),the moderate group(39 cases),and the severe group(11 cases)based on the CURB-65 score.The distribution of pathogenic bacteria in patients of the infection group was analyzed by the fully automatic microbial identification instrument.The expression levels of HBD3 and Flt3L in serum were detected by enzyme-linked immunosorbent assay(ELISA).Multivariate Logistic regression was applied to analyze the risk factors for postoperative pulmonary infection in esophageal cancer patients.ROC curve was applied to analyze the diagnostic value of HBD3 and Flt3L levels for postoperative pulmonary infection in esophageal cancer patients.Results Among 75 infected patients,90 strains of pathogens were detected,including 49 strains(54.44％)of Gram negative bacteria,29 strains(32.22％)of Gram positive bacteria,and 12 strains(13.33％)of fungi.The serum HBD3 and Flt3L levels in the infection group were greatly higher than those in the non infection group(P＜0.05).The serum HBD3 and Flt3L levels in the severe group were higher than those in the moderate group and mild group(P＜0.05),while the serum HBD3 and Flt3L levels in the moderate group were higher than those in the mild group(P＜0.05).Multivariate Logistic regression analysis showed that HBD3,Flt3 L,tumor location in the upper/middle segment,intraoperative bleeding ≥ 500 ml,diabetes,and smoking history were all factors influencing the pulmonary infection after radical resection of esophageal cancer(P＜0.05).According to the ROC curve,the AUC value for diagnosing postoperative pulmonary infection in esophageal cancer patients with serum HBD3 level alone was 0.789.The AUC value for diagnosing postoperative pulmonary infection in esophageal cancer patients with serum Flt3L level alone was 0.863,the AUC value of the combined diagnosis of the two was 0.934,which was greatly higher than that of the individual diagnosis(Zcombination vs HBD3=3.723,Zcombination vs Flt3L=2.098,P＜0.05).Conclusion The serum HBD3 and Flt3L levels in patients with pulmonary infection after esophageal cancer radical surgery are highly expressed,and the serum HBD3 and Flt3L levels are correlated with the severity of pulmonary infection.The two are risk factors for postoperative pulmonary infection in esophageal cancer patients after radical surgery,and their combination can effectively diagnose postoperative pulmonary infection in esophageal cancer patients.

Objective To investigate the distribution of pathogens and changes in serum humanβ-defendin-3(HBD3)and FMS like tyrosine kinase 3 ligand(Flt3L)levels in patients with pulmonary infection after esophageal cancer radical surgery.Methods Prospectively,patients who underwent radical resection of esophageal cancer and developed pulmonary infection from January 2022 to January 2024 were selected as the infection group(75 cases),and patients who underwent radical resection of esophageal cancer and did not develop pulmonary infection were selected as the non-infection group(93 cases).Patients in the infection group were divided into the mild group(25 cases),the moderate group(39 cases),and the severe group(11 cases)based on the CURB-65 score.The distribution of pathogenic bacteria in patients of the infection group was analyzed by the fully automatic microbial identification instrument.The expression levels of HBD3 and Flt3L in serum were detected by enzyme-linked immunosorbent assay(ELISA).Multivariate Logistic regression was applied to analyze the risk factors for postoperative pulmonary infection in esophageal cancer patients.ROC curve was applied to analyze the diagnostic value of HBD3 and Flt3L levels for postoperative pulmonary infection in esophageal cancer patients.Results Among 75 infected patients,90 strains of pathogens were detected,including 49 strains(54.44％)of Gram negative bacteria,29 strains(32.22％)of Gram positive bacteria,and 12 strains(13.33％)of fungi.The serum HBD3 and Flt3L levels in the infection group were greatly higher than those in the non infection group(P＜0.05).The serum HBD3 and Flt3L levels in the severe group were higher than those in the moderate group and mild group(P＜0.05),while the serum HBD3 and Flt3L levels in the moderate group were higher than those in the mild group(P＜0.05).Multivariate Logistic regression analysis showed that HBD3,Flt3 L,tumor location in the upper/middle segment,intraoperative bleeding ≥ 500 ml,diabetes,and smoking history were all factors influencing the pulmonary infection after radical resection of esophageal cancer(P＜0.05).According to the ROC curve,the AUC value for diagnosing postoperative pulmonary infection in esophageal cancer patients with serum HBD3 level alone was 0.789.The AUC value for diagnosing postoperative pulmonary infection in esophageal cancer patients with serum Flt3L level alone was 0.863,the AUC value of the combined diagnosis of the two was 0.934,which was greatly higher than that of the individual diagnosis(Zcombination vs HBD3=3.723,Zcombination vs Flt3L=2.098,P＜0.05).Conclusion The serum HBD3 and Flt3L levels in patients with pulmonary infection after esophageal cancer radical surgery are highly expressed,and the serum HBD3 and Flt3L levels are correlated with the severity of pulmonary infection.The two are risk factors for postoperative pulmonary infection in esophageal cancer patients after radical surgery,and their combination can effectively diagnose postoperative pulmonary infection in esophageal cancer patients.

Objective:This study aimed to evaluate the efficacy and safety of lenalidomide combined with bortezomib and dexamethasone (VRD) in the treatment of newly diagnosed multiple myeloma (MM) .Methods:A total of 150 newly diagnosed patients with MM diagnosed in The First Affiliated Hospital of Soochow University from November 2018 to February 2021 and received VRD as the induction regimen were included to evaluate the safety and efficacy of VRD induction therapy for newly diagnosed MM.Results:The median follow-up was 22 months, two patients (1.3%) died early after treatment, and 148 patients (98.7%) completed induction therapy. 116 patients (77.3%) were mobilized to collect autologous hematopoietic stem cells, 101 cases (87.1%) were qualified in the collection, of which 48 cases (41.4%) were excellent in the collection. The 3-year progression-free survival (PFS) rate was 59%, and the 3-year overall survival (OS) rate was 83%. After induction, complete remission (CR) /stringent CR rate was 54.4%, ≥ very good partial remission rate was 77.3%, overall response rate was 86.0%, and minimal residual disease negative rate was 46.0%. There was no statistically significant difference in the efficacy of cytogenetic high-risk patients compared with standard risk patients ( P=0.456) . The median PFS time of cytogenetic high-risk patients was shorter than that of standard risk patients (not reached vs 33 months, P=0.014) . There was no statistically significant difference in the median OS time (not reached vs not reached, P=0.072) . The highest incidence of hematological adverse events was thrombocytopenia (72%) , followed by neutropenia (42%) and anemia (20%) . The highest incidence of non-hematological adverse events was peripheral neuritis (56.7%) . The main digestive tract symptoms include constipation (30.0%) and diarrhea (17.3%) . Upper respiratory tract infection (23.3%) and lung infection (7.3%) are the main infections. The incidence of adverse thrombocytopenia (90.0% vs 63.7%, P=0.001) , neutropenia (54.2% vs 36.3%, P=0.038) , anemia (33.3% vs 13.7%, P=0.005) , diarrhea (27.1% vs 12.7%, P=0.030) , limb edema (20.8% vs 3.9%, P=0.030) , fever (20.8% vs 4.9%, P=0.006) , thrombosis (8.3% vs 0, P=0.016) , and renal function deterioration (20.8% vs 3.9%, P=0.030) in patients with renal insufficiency was higher than that in patients with normal renal function. Conclusion:The VRD regimen has a significant effect on newly diagnosed MM, does not affect the hematopoietic stem cell collection, and has controllable adverse events; however, the incidence of adverse events was higher in patients with renal insufficiency.

Objective To observe the incidence and clinical feature of sleep-related breathing disorder in patients with idiopathic pulmonary fibrosis (IPF). Methods Thirty-four IPF patients who were measured by polysomnography (PSG) were collected in the Department of Respiration of Tianjin Medical University General Hospital. According to the results of apnea hypoventilation index (AHI), patients were divided into pure IPF group (AHI<5 events/h, n=7) and IPF combined with obstructive sleep apnea hypopnea syndrome (IPF+OSAHS) group (AHI≥5 events/h, n=27). The PSG reports of two groups were analyzed, and the correlation between AHI and pulmonary function and oxygen saturation in sleep and at wake were analyzed. Results (1)Thirty-four IPF patients were all demonstrated sleep disorders, low sleep efficiency, increased proportion of stageⅠand stageⅡand decreased proportion of stageⅢand rapid eye movement (REM). The arousal index and the proportion of stageⅠand stageⅡwere higher in IPF+OSAHS group than those of pure IPF group (P<0.01), while the proportion of stageⅢwas lower in IPF+OSAHS group than that of pure IPF group (P<0.01). There was no significant difference in stage REM between two groups. (2)Twenty-seven patients (79%) combined with OSAHS, among which five subjects (15%) were mild OSAHS with 5 events/h≤AHI<15 events/h, and 22 subjects (65%) were moderate-severe with AHI≥15 events/h. The main type of sleep-disorder breathing was hypoventilation, which mainly happened in stage REM. (3) Thirty-four IPF patients showed sleep hypoxemia, and the oxygen desaturation index (ODI) was higher in IPF-OSAHS group than those of pure IPF group (P<0.05). (4)The AHI was positively correlated with body mass index (r=0.791, P<0.05), and was negatively correlated with forced vital capacity (FVC%pred) (r=-0.574, P<0.05) and forced expiratory volume in 1 second (FEV1%pred) in IPF patients (r=-0.664, P<0.05). The lowest oxygen saturation (LSO2) and mean oxygen saturation (MSO2) in sleep were positively related with oxygen saturation at wake (r=0.421 and r=0.464, P<0.05 respectively). Conclusion The IPF patients show severe sleep disorder and hypoxemia, which can be worsen by OSAHS and produce negative effect on daily life. We should initiate active treatment in patients with sleep-related breathing disorders.