Objective:To compare postoperative complications between acellular dermal matrix（ADM）and direct suture for tongue mucosa defect repair during lingual mucosa urethroplasty.Methods:A retrospective analysis was conducted on 106 patients with anterior urethral stricture who underwent lingual mucosal urethroplasty at the Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2022 to July 2024. According to the needs of urethral reconstruction，lingual mucosa was harvested（graft length 0.5 cm longer than the stricture length）. Using an instrumental variable method based on the surgeon’s preference，the tongue wound was repaired either with ADM or direct suture. The ADM group included 56 patients，aged（46.2±18.7）years；diabetes in 8 cases（14.3%），hypertension in 15 cases（26.8%），cardiopulmonary dysfunction in 3 cases（5.3%）；stricture location：penile segment in 44 cases（78.6%），penoscrotal junction in 12 cases（21.4%）；etiology：lichen sclerosus in 8 cases（14.3%），urethritis in 8 cases（14.3%），trauma in 24 cases（42.9%），and re-stricture after hypospadias surgery in 16 cases（28.6%）；maximum urinary flow rate（5.8±2.9）ml/s；graft length（4.02±1.72）cm. The direct suture group included 50 patients，aged（45.8±19.2）years；diabetes in 6 cases（12.0%），hypertension in 12 cases（24.0%），cardiopulmonary dysfunction in 2 cases（4.0%）；etiology：lichen sclerosus in 6 cases（12.0%），urethritis in 8 cases（16.0%），trauma in 25 cases（50.0%），and re-stricture after hypospadias surgery in 11 cases（22%）；stricture location：penile segment in 36 cases（72.0%），penoscrotal junction in 14 cases（28.0%）；maximum urinary flow rate（6.2±3.1）ml/s；graft length（4.18±1.68）cm. There were no statistically significant differences in the above baseline characteristics between the two groups（ P>0.05）.ADM group after electrocautery hemostasis，an ADM patch tailored to the wound size was used to cover the donor site. The edges of the ADM were overlapped with the wound margin and sutured to the submucosal layer using interrupted 4-0 polyglactin sutures. Direct suture group after electrocautery hemostasis，the wound was stretched into a diamond shape and closed in layers by suturing the mucosal layer down to the muscle layer using interrupted 4-0 polyglactin sutures. The primary outcome measures were postoperative tongue complications including hemorrhage，hematoma，and infection（Clavien-Dindo classification）. Secondary outcomes included VAS pain scores，functional recovery（difficulty drinking，difficulty eating，speech impairment，limited mouth opening），and sensory recovery（sensory disturbance，taste disturbance）. Results:The follow-up period ranged from 6 to 24 months，with a mean of 9.2 months. The 6-month follow-up rate was 100%. No Clavien-Dindo grade Ⅲ or higher complications（hemorrhage，hematoma，infection）occurred by the end of follow-up. Regarding secondary outcomes，the VAS pain score on postoperative day 1 was significantly better in the ADM group than in the suture group［0（0，3）vs. 2（0，3），P=0.013］.Functional impact：The incidence of difficulty drinking［24 cases（42.9%）vs. 36 cases（72.0%），16 cases（28.6%）vs. 36 cases（72.0%），8 cases（14.3%）vs. 21 cases（42.0%）］，difficulty eating［20 cases（35.7%）vs. 36 cases（72.0%），16 cases（28.6%）vs. 36 cases（72.0%），8 cases（14.3%）vs. 27 cases（54.0%）］，and speech impairment［20 cases（35.7%）vs. 36 cases（72.0%），16 cases（28.6%）vs. 36 cases（72.0%），8 cases（14.3%）vs. 27 cases（54.0%）］on postoperative day 1，day 7，and within the first month，respectively，was significantly lower in the ADM group（all P<0.05）. On postoperative day 1 and day 7，the incidence of limited mouth opening was higher in the ADM group［0 cases vs. 6 cases（12.0%），0 cases vs. 6 cases（12.0%）］（ P<0.05）.Sensory recovery：The incidence of taste disturbance was higher in the ADM group at 7 days［8 cases（14.3%）vs. 0 cases］，1 month［8 cases（14.3%）vs. 0 cases］，and 3 months［8 cases（14.3%）vs. 0 cases］postoperatively（ P<0.05）. The incidence of sensory disturbance was higher in the ADM group at 1 day［20 cases（35.7%）vs. 6 cases（12.0%）］，7 days［16 cases（28.6%）vs. 6 cases（12.0%）］，and 1 month［16 cases（28.6%）vs. 6 cases（12.0%）］postoperatively（ P<0.05）. Pain scores and complication rates were zero in both groups after 6 months. Conclusions:ADM repair improves early recovery but may increase transient sensory complications. Both methods are safe for clinical application.

Objective:To compare postoperative complications between acellular dermal matrix（ADM）and direct suture for tongue mucosa defect repair during lingual mucosa urethroplasty.Methods:A retrospective analysis was conducted on 106 patients with anterior urethral stricture who underwent lingual mucosal urethroplasty at the Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2022 to July 2024. According to the needs of urethral reconstruction，lingual mucosa was harvested（graft length 0.5 cm longer than the stricture length）. Using an instrumental variable method based on the surgeon’s preference，the tongue wound was repaired either with ADM or direct suture. The ADM group included 56 patients，aged（46.2±18.7）years；diabetes in 8 cases（14.3%），hypertension in 15 cases（26.8%），cardiopulmonary dysfunction in 3 cases（5.3%）；stricture location：penile segment in 44 cases（78.6%），penoscrotal junction in 12 cases（21.4%）；etiology：lichen sclerosus in 8 cases（14.3%），urethritis in 8 cases（14.3%），trauma in 24 cases（42.9%），and re-stricture after hypospadias surgery in 16 cases（28.6%）；maximum urinary flow rate（5.8±2.9）ml/s；graft length（4.02±1.72）cm. The direct suture group included 50 patients，aged（45.8±19.2）years；diabetes in 6 cases（12.0%），hypertension in 12 cases（24.0%），cardiopulmonary dysfunction in 2 cases（4.0%）；etiology：lichen sclerosus in 6 cases（12.0%），urethritis in 8 cases（16.0%），trauma in 25 cases（50.0%），and re-stricture after hypospadias surgery in 11 cases（22%）；stricture location：penile segment in 36 cases（72.0%），penoscrotal junction in 14 cases（28.0%）；maximum urinary flow rate（6.2±3.1）ml/s；graft length（4.18±1.68）cm. There were no statistically significant differences in the above baseline characteristics between the two groups（ P>0.05）.ADM group after electrocautery hemostasis，an ADM patch tailored to the wound size was used to cover the donor site. The edges of the ADM were overlapped with the wound margin and sutured to the submucosal layer using interrupted 4-0 polyglactin sutures. Direct suture group after electrocautery hemostasis，the wound was stretched into a diamond shape and closed in layers by suturing the mucosal layer down to the muscle layer using interrupted 4-0 polyglactin sutures. The primary outcome measures were postoperative tongue complications including hemorrhage，hematoma，and infection（Clavien-Dindo classification）. Secondary outcomes included VAS pain scores，functional recovery（difficulty drinking，difficulty eating，speech impairment，limited mouth opening），and sensory recovery（sensory disturbance，taste disturbance）. Results:The follow-up period ranged from 6 to 24 months，with a mean of 9.2 months. The 6-month follow-up rate was 100%. No Clavien-Dindo grade Ⅲ or higher complications（hemorrhage，hematoma，infection）occurred by the end of follow-up. Regarding secondary outcomes，the VAS pain score on postoperative day 1 was significantly better in the ADM group than in the suture group［0（0，3）vs. 2（0，3），P=0.013］.Functional impact：The incidence of difficulty drinking［24 cases（42.9%）vs. 36 cases（72.0%），16 cases（28.6%）vs. 36 cases（72.0%），8 cases（14.3%）vs. 21 cases（42.0%）］，difficulty eating［20 cases（35.7%）vs. 36 cases（72.0%），16 cases（28.6%）vs. 36 cases（72.0%），8 cases（14.3%）vs. 27 cases（54.0%）］，and speech impairment［20 cases（35.7%）vs. 36 cases（72.0%），16 cases（28.6%）vs. 36 cases（72.0%），8 cases（14.3%）vs. 27 cases（54.0%）］on postoperative day 1，day 7，and within the first month，respectively，was significantly lower in the ADM group（all P<0.05）. On postoperative day 1 and day 7，the incidence of limited mouth opening was higher in the ADM group［0 cases vs. 6 cases（12.0%），0 cases vs. 6 cases（12.0%）］（ P<0.05）.Sensory recovery：The incidence of taste disturbance was higher in the ADM group at 7 days［8 cases（14.3%）vs. 0 cases］，1 month［8 cases（14.3%）vs. 0 cases］，and 3 months［8 cases（14.3%）vs. 0 cases］postoperatively（ P<0.05）. The incidence of sensory disturbance was higher in the ADM group at 1 day［20 cases（35.7%）vs. 6 cases（12.0%）］，7 days［16 cases（28.6%）vs. 6 cases（12.0%）］，and 1 month［16 cases（28.6%）vs. 6 cases（12.0%）］postoperatively（ P<0.05）. Pain scores and complication rates were zero in both groups after 6 months. Conclusions:ADM repair improves early recovery but may increase transient sensory complications. Both methods are safe for clinical application.

Objective:To analyze the clinical symptoms and epidemiological characteristics of patients with tsutsugamushi disease (TD) in Utica County, Shiyan City, providing reference for scientific prevention and control of TD.Methods:The information of 57 TD patients admitted to the Department of Infectious Diseases of the People's Hospital of Utica County in Shiyan City from January to December 2022 was collected, including age, gender, occupation, clinical manifestations (tarsus or chigger, high fever, rash and accompanying syndromes), laboratory and imaging test results, and field work and travel history. Blood samples and body crusts were collected, and enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) were used to detect antibodies against Orientia tsugamushi (Ot-Ab-IgM) and Orientia tsutsugamushi (Ot). The scores of each patient were calculated using the TD Diagnostic Scale. A score of ≥8.5 was considered a clinical diagnosis of TD. According to the number of system functional damages (0, 1, 2, ≥3), 57 patients were divided into 4 groups, A, B, C, and D, TD was analyzed for system functional damages of each system.Results:Among the 57 TD patients, 26 (45.61%) were male and 31 (54.39%) were female, and the proportion of patients aged 40 - 79 years was 92.98% (53/57); farmers accounted for 89.47% (51/57). May was the peak of TD incidence, with 19 cases, which accounted for 33.33% (19/57) of the total number of patients affected that year. Fifty-four patients had a history of fieldwork or field trips before the onset of the disease. The incidence of high fever in 57 TD patients was 100.00%(57/57), the detection rate of body scorch or chiggers was 80.70% (46/57), and the incidence rate of rash was 98.25% (56/57); the incidence rate of tsutsugamushi disease triad (accompanied by scabs, high fever, and rash) was 80.70% (46/57); the incidence of eosinophil decline was 100.00%(57/57), and 77.19% (44/57) of TD patients experienced multiple-system functional damage (MSFD). The TD score diagnostic scale for 57 patients ranged from 8.5 to 10.5 points. After being hospitalized for 1 - 5 days, all TD patients experienced a decrease in body temperature to the normal range, and the damage to various systems functional gradually recovered.Conclusions:TD has become one of the most common natural infectious diseases in Utopia County, Shiyan City, Hubei Province. The patients are mainly middle-aged and elderly people, and the triple syndrome is a typical clinical manifestation. Asymptomatic injuries to the blood system, liver and kidneys are the most common.