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.

BACKGROUND:The cortical bone reinforcement area of bone cement in the vertebral body during percutaneous vertebroplasty for osteoporotic vertebralcompression fractures has an important influence on spinal biomechanics and clinical efficacy,but previous studies were mostly limited to the two-dimensional level. OBJECTIVE:To investigate the effect of the difference in cortical bone reinforcement of bone cement in the three-dimensional plane of the vertebral bodyon the biomechanical distribution of the vertebral body,adjacent intervertebral disc and endplate in osteoporotic vertebral compression fractures by finite element analysis during percutaneous vertebroplasty,so as to evaluate its effect.METHODS:The finite element model of percutaneous vertebroplasty for osteoporotic vertebral compression fractures of T12 vertebrae was established. The presence or absence of cortical reinforcement of bone cement was analyzed in groups from the transverse,sagittal and coronal planes. The effects of cortical reinforcement on the biomechanics of T12 vertebral cancellous bone,cortical bone,T11/T12 intervertebral disc,T12/L1 intervertebral disc,T11 lower endplate,and L1 upper endplate under different body position changes were studied.RESULTS AND CONCLUSION:(1) Under the effect of vertical compression force,percutaneous vertebroplasty cortical reinforcement with or without bone cement had no significant changes in structural stress except for the injured vertebral cortical bone. (2) The Von Mises stress value of the injured cortical bone was significantly different in human forward flexion,left/right bend,and left/right axial rotation. The maximum Von Mises stress value in the best group of cortical reinforcement was significantly smaller than that in the non-cortical reinforcement group. The Von Mises stress value showed a downward trend with extensive cortical reinforcement in the same plane. (3) It is indicated that when percutaneous vertebroplasty is performed,bone cement should be distributed as broadly and symmetrically horizontally along the cortical edge of the vertebral body as far as possible in cross section. Bone cement in sagittal plane should be widely distributed longitudinally near the upper and lower endplates and the anterior and posterior walls. Bone cement in coronal plane should be widely distributed on both sides of the midline while symmetrically touching the upper and lower endplates and lateral walls. It can effectively avoid the risk of refracture of the injured vertebra and does not increase the risk of adjacent vertebral fracture and residual discogenic pain.

Autoimmune uveitis is a blinding intraocular inflammation primarily caused by immune dysregulation mediated by CD4+ T cells. CD4+ T cells differentiate into various functional subsets, including Th1, Th2, Th17, and Treg cells. These subsets participate in immune responses and mediate the initiation and resolution of inflammation by secreting different cytokines. This article primarily focuses on the functional characteristics and interplay network of Th1/Th2 and Th17/Treg cells, along with the specific effects of their key secreted cytokines(e.g., IFN-γ, TNF-α, IL-17, IL-10, TGF-β)in driving or suppressing ocular inflammation. The goal is to clarify the fundamental pathogenesis of this disease from the perspective of immune balance. Furthermore, this work explores potential therapeutic targets based on restoring the balance between Th1/Th2 and Th17/Treg, such as modulating the differentiation of specific subsets, blocking key pro-inflammatory cytokines, or enhancing anti-inflammatory functions. This investigation aims to provide a scientific rationale and guidance for optimizing existing diagnostic and therapeutic strategies, as well as developing new immunotherapies(e.g., biological agents, cell therapies).

Objective:To establish a prognostic prediction model for hepatocellular carcinoma (HCC) using bioinformatics approaches to guide personalized therapy.Methods:Based on bioinformatics, the differential analysis was carried out on the GSE19665 data set of The Cancer Genome Atlas-Liver Hepatocellular Carcinoma (TCGA-LIHC) and Gene Expression Omnibus (GEO), and the same differentially expressed genes were obtained by means of Wayne diagram. Functional enrichment analyses using Gene Ontology, Kyoto Encyclopedia of Genes and Genome, and Gene Set Enrichment Analysis were conducted on co-expressed genes. Based on clinicopathological and transcriptomic profiles, TCGA-LIHC patients were stratified into training ( n=246) and internal validation ( n=116) cohorts, with external validation using Japanese liver cancer data ( n=231) from the International Cancer Genome Consortium. A LASSO-Cox regression-derived risk scoring model was established and visualized as a nomogram. The clinical utility of the risk score was evaluated through multiple analytical approaches.A nomogram incorporating the risk score was developed, and its predictive performance was validated using the concordance index (C-index) and calibration curves. The measurement data of normal distribution were expressed as mean±standard deviation( ± s), and the t-test was used for comparison between groups. The measurement data with non-normal distribution were expressed as M( Q1, Q3), and the Wilcoxon test was used for comparison between groups. The Kruskal-Wallis test was applied to evaluate the significance of the differences among multiple groups. The prognostic value of the risk score was estimated using Kaplan-Meier analysis and ROC curve. Multivariate Cox regression clarified the independent prognostic value of the risk score. Results:Differential analysis identified 457 commonly expressed differentially expressed genes (DEGs). Enrichment analysis revealed that these common DEGs were significantly enriched in pathways related to the cell cycle of tumor cells.The LASSO-Cox regression model selected eight candidate genes ( CENPA, NDC80, ANXA10, NEIL3, G6 PD, MCM10, SOCS2, MMP1). The predictive risk score generated using these eight genes demonstrated a strong association with the overall survival of HCC patients.The nomogram combining the predictive risk score with clinicopathological features exhibited high predictive performance in both the training and validation cohorts. Furthermore, the prognostic value of this risk score was successfully validated in the external validation cohort. Conclusion:This study successfully developed a new predictive model that accurately predicts the 1-year, 3-year and 5-year survival rates of patients with liver cancer. This can serve as a potential tool to help guide patients in personalized treatment.

Solitary hepatocellular carcinoma (HCC), defined as a single lesion without distant metastasis, is a subtype of primary liver cancer with high surgical resectability. Hepatectomy is considered the most effective curative treatment; however, the optimal surgical approach and resection margin width remain controversial. This review systematically examines the impact of anatomical resection (AR) versus non-anatomical resection (NAR) on prognosis in various clinical contexts. It highlights the advantages of AR in patients at high risk of recurrence, while also acknowledging the value of NAR in preserving liver function. Furthermore, the article discusses the role of wide versus narrow resection margins in postoperative recurrence control, indicating that wide margins may help eliminate potential micrometastases, though postoperative risks must be balanced in patients with limited hepatic reserve. The review proposes that a combined strategy involving both surgical approach and margin width may exert a synergistic effect in improving outcomes. Looking ahead, the integration of imaging techniques, preoperative predictive models, and individual biological characteristics will facilitate personalized and precise surgical planning, thereby optimizing the prognosis of patients with solitary HCC.

Objective:To evaluate the clinical equivalence between a domestic calcipotriol/betamethasone dipropionate ointment and the originator product in the treatment of stable plaque psoriasis.Methods:A multicenter, randomized, double-blind, three-arm, parallel-group, active- and placebo-controlled study was conducted, and 449 patients aged 18 - 65 years with stable plaque psoriasis were enrolled from 25 hospitals (such as the First Affiliated Hospital of China Medical University). Eligible patients had a baseline physician's global assessment (PGA) score of ≥ 3 points, baseline body surface area (BSA) involvement of 5% - 30%, and a target lesion psoriasis area and severity index (TL-PASI) for plaque elevation of ≥ 3 points. Participants were randomly assigned in a 2:2:1 ratio to the test group ( n = 179), reference group ( n = 180), and placebo group ( n = 90), and applied the domestic calcipotriol/betamethasone dipropionate ointment, originator product, and ointment base respectively, once daily in the evening for 4 weeks. Efficacy and safety were assessed at weeks 1, 2, and 4. The primary efficacy endpoints were the treatment success rates and clinical success rates in each group at week 4. The per-protocol set (PPS) was used for the primary efficacy analysis, and the intention-to-treat (ITT) set for supplementary efficacy analysis. Equivalence between the test and reference preparations was tested using the Cochran-Mantel-Haenszel method adjusted for randomization strata. Superiority of the test and reference preparations over the placebo was also tested. Measurement data were compared among the 3 groups using analysis of variance or non-parametric tests, while treatment success rates, clinical success rates, and incidence rates of adverse reactions were compared using the chi-square test. Results:The ITT, PPS, and safety sets included 447, 420, and 448 patients, respectively. In the ITT set, patients were aged 43.6 ± 12.8 years, including 320 (71.6%) males and 127 (28.4%) females, and the disease duration was 11.21 ± 9.05 years; 316 (70.7%) had a PGA score of 3 points and 131 (29.3%) had a PGA score of 4 - 5 points. No significant differences in the baseline characteristics (including age, sex, disease duration and disease severity) were observed among the 3 groups (all P > 0.05). Based on the PPS analysis, the treatment success rates were 57.9% (99/171) in the test group, 50.3% (86/171) in the reference group, and 7.7% (6/78) in the placebo group, and the clinical success rates were 57.9% (99/171), 50.3% (86/171), and 10.3% (8/78), respectively; both the test and reference groups were superior to the placebo group in both treatment and clinical success rates (all P < 0.001) ; the rate differences for treatment success (90% confidence interval [ CI]: -1.3% - 16.4%) and clinical success (90% CI: -1.3% - 16.3%) between the test and reference groups were entirely within the pre-defined equivalence margin (-20% - 20%). Subgroup analyses by baseline PGA scores: for patients with a baseline PGA score of 3 points, the treatment success rates in the test, reference, and placebo groups were 60.8% (73/120), 52.1% (62/119), and 11.1% (6/54), respectively, and the corresponding clinical success rates were 61.7% (74/120), 53.8% (64/119), and 13% (7/54), respectively; the test and reference groups did not differ significantly in treatment or clinical success rates (both P > 0.05), but both showed higher success rates than the placebo group (all P < 0.001) ; the results of statistical comparisons among the 3 groups in patients with a baseline PGA score of 4 - 5 points were consistent with those observed in patients with a baseline PGA score of 3 points. The percentage reductions in PGA and TL-PASI scores from baseline to weeks 1, 2, and 4 showed significant differences among the 3 groups, which were significantly higher in the test and reference groups than in the placebo group (all P < 0.001), but did not differ between the test and reference groups (all P > 0.05). The primary adverse reactions were local skin reactions, such as pruritus, pain, and erythema. The incidence rates of adverse reactions were 8.9% (16/179) in the test group, 7.3% (13/179) in the reference group, and 7.8% (7/90) in the placebo group, with no significant difference among the 3 groups ( P > 0.05) . Conclusions:The domestic calcipotriol/betamethasone dipropionate ointment demonstrated clinical equivalence to the originator product in the treatment of stable plaque psoriasis, and the two agents exhibited comparable efficacy for patients with varying degrees of disease severity, and were comparable in the speed and degree of clinical improvement, with similar favorable safety profiles.

Objective:To explore the predictive factors for ureteral stone impaction preoperatively and to construct a nomogram prediction model for impacted ureteral stones.Methods:A retrospective analysis was conducted on the clinical data of 209 patients with ureteral stones treated at The Second Affiliated Hospital of Zhengzhou University from July 2023 to June 2024. There were 164 males（78.5%）and 45 females（21.5%）. The age was 49（47，57）years，and the body mass index（BMI）was 25.10（23.55，27.24）kg/m2. Of the patients，85（40.7%）had comorbid hypertension and 85（40.7%）had comorbid diabetes. Stones were located on the left side in 124 patients（59.3%）and on the right side in 85 patients（40.7%）. Hydronephrosis was present in 169 patients（80.9%），and urine culture was positive in 29 patients（13.9%）. Patients were divided into impacted and non-impacted groups based on the presence or absence of ureteral stone impaction. Univariate and multivariate logistic regression analyses were performed to determine independent predictive factors for impacted ureteral stones. A nomogram model was constructed based on these results. The performance of the predictive model was evaluated using receiver operating characteristic（ROC）curves，calibration plots，and decision curve analysis（DCA）.Results:Among the 209 patients in this study，85（40.7%）experienced ureteral stone impaction. The impacted group had a significantly higher neutrophil-to-lymphocyte ratio（NLR）than the non-impacted group（3.91 ± 2.05 vs. 3.25 ± 2.10， P = 0.024），a higher rate of hydronephrosis［81.2%（69/85）vs. 80.6%（100/124）， P = 0.002］，larger stone surface area［（64.96 ± 39.96）mm2 vs.（51.86 ± 39.80）mm2， P = 0.021］，greater ureteral wall thickness（UWT）［（3.96 ± 1.37）mm vs.（3.06 ± 1.33）mm， P < 0.001］，and a higher ratio of the upper ureter diameter（D1）to the lower ureter diameter（D2）（DDR）（2.87 ± 1.58 vs. 2.00 ± 0.99， P < 0.001）. Univariate analysis showed that NLR，hydronephrosis，stone length，stone surface area，UWT，D1，D2，and DDR were statistically significant（ P < 0.05）. After multivariate logistic regression analysis，the following items were identified as independent predictors of impacted ureteral stones：NLR（ OR = 1.205，95% CI 1.026 - 1.415， P = 0.023），hydronephrosis（ OR = 1.840，95% CI 1.236 - 2.740， P = 0.003），stone length（ OR = 1.587，95% CI 1.142 - 2.206， P = 0.006），ureteral wall thickness（UWT）（ OR = 1.643，95% CI 1.263 - 2.136， P < 0.001），and DDR（ OR = 2.907，95% CI 1.040 - 8.130， P = 0.042）.Based on these independent predictive factors，a nomogram prediction model for impacted ureteral stones was constructed. The area under the ROC curve was 0.797（95% CI 0.737 - 0.858），and the calibration curve showed good consistency. The decision curve suggested that the model had good clinical net benefit. Conclusions:NLR，hydronephrosis，stone length，UWT，and DDR are all independent predictors for impacted ureteral stones. The nomogram model constructed based on these factors has good predictive performance.

Objective:To evaluate the effects of nasal endoscopy in curettage of large mandibular cyst.Methods:20 cases of large mandibular cyst admitted to Xianyang Hosptial of Yan'an University from January 2022 to December 2023 were included.The curet-tage of mandibular cyst was performed under general anesthesia through intraoral incision by nasal endoscopy-assisted illumination and enlargement of the lesion area during the operation.The application effects were evaluated from the aspects of surgical incision length,nerve injury and cyst recurrence.Results:During operation,the surgical filed of view was clear and the operation was suc-ceeded in all cases.There was no complication in and after the nasal endoscopy-assisted curettage,no cyst recurrence was observed during 1-year follow-up.Conclusion:Nasal endoscopy-assisted curettage of large mandibular cyst is effective and safe.

The implementation of the Good Pharmacovigilance Practice(GVP)in 2021 has laid a solid foundation for improving China's pharmacovigilance system,a matter of paramount importance currently emphasized by Marketing Authorization Holders(MAHs).Given the unique organizational structures of corporate groups,establishing a centralized pharmacovigilance system can optimize resource utilization.This paper analyzes the challenges faced by corporate groups in developing such central-ized systems and proposes an organizational framework with defined operational divisions.The findings aim to provide actionable insights for vaccine manufacturers in establishing and refining life cycle pharmacovigilance systems.

Objective:To evaluate the clinical equivalence between a domestic calcipotriol/betamethasone dipropionate ointment and the originator product in the treatment of stable plaque psoriasis.Methods:A multicenter, randomized, double-blind, three-arm, parallel-group, active- and placebo-controlled study was conducted, and 449 patients aged 18 - 65 years with stable plaque psoriasis were enrolled from 25 hospitals (such as the First Affiliated Hospital of China Medical University). Eligible patients had a baseline physician's global assessment (PGA) score of ≥ 3 points, baseline body surface area (BSA) involvement of 5% - 30%, and a target lesion psoriasis area and severity index (TL-PASI) for plaque elevation of ≥ 3 points. Participants were randomly assigned in a 2:2:1 ratio to the test group ( n = 179), reference group ( n = 180), and placebo group ( n = 90), and applied the domestic calcipotriol/betamethasone dipropionate ointment, originator product, and ointment base respectively, once daily in the evening for 4 weeks. Efficacy and safety were assessed at weeks 1, 2, and 4. The primary efficacy endpoints were the treatment success rates and clinical success rates in each group at week 4. The per-protocol set (PPS) was used for the primary efficacy analysis, and the intention-to-treat (ITT) set for supplementary efficacy analysis. Equivalence between the test and reference preparations was tested using the Cochran-Mantel-Haenszel method adjusted for randomization strata. Superiority of the test and reference preparations over the placebo was also tested. Measurement data were compared among the 3 groups using analysis of variance or non-parametric tests, while treatment success rates, clinical success rates, and incidence rates of adverse reactions were compared using the chi-square test. Results:The ITT, PPS, and safety sets included 447, 420, and 448 patients, respectively. In the ITT set, patients were aged 43.6 ± 12.8 years, including 320 (71.6%) males and 127 (28.4%) females, and the disease duration was 11.21 ± 9.05 years; 316 (70.7%) had a PGA score of 3 points and 131 (29.3%) had a PGA score of 4 - 5 points. No significant differences in the baseline characteristics (including age, sex, disease duration and disease severity) were observed among the 3 groups (all P > 0.05). Based on the PPS analysis, the treatment success rates were 57.9% (99/171) in the test group, 50.3% (86/171) in the reference group, and 7.7% (6/78) in the placebo group, and the clinical success rates were 57.9% (99/171), 50.3% (86/171), and 10.3% (8/78), respectively; both the test and reference groups were superior to the placebo group in both treatment and clinical success rates (all P < 0.001) ; the rate differences for treatment success (90% confidence interval [ CI]: -1.3% - 16.4%) and clinical success (90% CI: -1.3% - 16.3%) between the test and reference groups were entirely within the pre-defined equivalence margin (-20% - 20%). Subgroup analyses by baseline PGA scores: for patients with a baseline PGA score of 3 points, the treatment success rates in the test, reference, and placebo groups were 60.8% (73/120), 52.1% (62/119), and 11.1% (6/54), respectively, and the corresponding clinical success rates were 61.7% (74/120), 53.8% (64/119), and 13% (7/54), respectively; the test and reference groups did not differ significantly in treatment or clinical success rates (both P > 0.05), but both showed higher success rates than the placebo group (all P < 0.001) ; the results of statistical comparisons among the 3 groups in patients with a baseline PGA score of 4 - 5 points were consistent with those observed in patients with a baseline PGA score of 3 points. The percentage reductions in PGA and TL-PASI scores from baseline to weeks 1, 2, and 4 showed significant differences among the 3 groups, which were significantly higher in the test and reference groups than in the placebo group (all P < 0.001), but did not differ between the test and reference groups (all P > 0.05). The primary adverse reactions were local skin reactions, such as pruritus, pain, and erythema. The incidence rates of adverse reactions were 8.9% (16/179) in the test group, 7.3% (13/179) in the reference group, and 7.8% (7/90) in the placebo group, with no significant difference among the 3 groups ( P > 0.05) . Conclusions:The domestic calcipotriol/betamethasone dipropionate ointment demonstrated clinical equivalence to the originator product in the treatment of stable plaque psoriasis, and the two agents exhibited comparable efficacy for patients with varying degrees of disease severity, and were comparable in the speed and degree of clinical improvement, with similar favorable safety profiles.