Background and aims:Despite growing evidence linking pretransplant exposure to immune checkpoint inhibitors(ICIs)to increased allograft rejection risk after liver transplantation(LT),a lack of comparative studies to definitively establish the correlation between ICI exposure and adverse short-term outcomes after LT exists.This study aimed to analyze the impact of preoperative ICI exposure on short-term post-LT prognosis and allograft rejection risk.Methods:This retrospective cohort study included 121 recipients who underwent LT for hepatocellular carcinoma(HCC)between June 2019 and March 2023.The recipients were categorized into ICI(n=35)and non-ICI(n=86)exposure groups based on pretransplant ICI exposure.Demographics,clinical characteristics,and short-term outcomes were compared between the cohorts.Kaplan-Meier analysis evaluated the impact of ICI exposure on graft survival.Univariate and multivariate logistic regression models assessed the impact of patient characteristics on allograft rejection.Results:Recipients with or without ICI exposure exhibited comparable demographic baseline charac-teristics.The incidences of early allograft dysfunction and biliary and vascular complications were similar between both groups.Post-transplant infection incidence was 37.1％and 20.9％in the ICI and non-ICI groups,respectively(P=0.064).Allograft rejection rates were significantly higher in the ICI group than in the non-ICI group(22.9％vs.5.8％,P=0.015).The ICI group exhibited a higher 90-day post-transplant mortality rate than that of the non-ICI group(14.3％vs.2.3％,P=0.034).Logistic regression analyses demonstrated that allograft rejection independently correlated with 90-day post-transplant mortality,with ICI exposure being an independent risk factor for allograft rejection.In recipients with ICI exposure,a shorter interval between ICIs and LT(washout period)was significantly associated with a higher allograft rejection risk,with the optimal washout period identified as 21 days for predicting 90-day rejection-free survival(P=0.0001).Moreover,in recipients with allograft rejection,the peripheral CD4+/CD8+T cell ratio was much lower in the ICI group than in the non-ICI group.Conclusions:Pretransplant ICI exposure was an independent risk factor for allograft rejection and was significantly associated with 90-day post-transplant mortality after LT for HCC.A ≤21-day washout period was significantly associated with allograft rejection.Future multicenter studies with larger cohorts and prospective designs are essential to validate these findings,confirm causality,and establish standardized clinical guidelines for ICI use before transplantation.Trail registration:ClinicalTrials.gov NCT05913583.

Objective:To explore the feasibility of active surveillance for multifocal papillary thyroid microcarcinoma(PTMC).Methods:It was a cross-sectional study. The thyroid ultrasonography data from 124 580 health check-up participants in the Health Management Center at the Affiliated Zhongshan Hospital of Dalian University between March 2017 and December 2023 were retrospectively analyzed. The patients were divided into unifocal or multifocal group according to the number of PTMC. The rates of growth, lymph node metastasis and progression in the unifocal and multifocal PTMC group during active surveillance were compared by using the Kaplan-Meier method and the log-rank test. The patients were divided into the group of progression or no-progression according to the outcome of active surveillance, and the basic clinical characteristics between the groups were compared. The Cox proportional hazards regression analysis was used to identify the risk factors for the progression of PTMC.Results:A total of 304 patients were enrolled in this study, among them, there were 239 cases of unifocal PTMC and 65 cases of multifocal PTMC. There was no significant differences in the rates of growth, lymph node metastasis and progression in the PTMC between the two groups during active surveillance (all P>0.05). During the active surveillance period, a total of 47 cases of PTMC progressed, while 257 cases did not. The progression rate was 15.5%. There was statistically significant difference in the initial age of PTMC diagnosis between the progression and non-progression group ( P<0.05). Multivariate regression analysis showed that age of initial diagnosis was the only risk factor for the progression of PTMC, the risk of progression decreased by 0.079 for every one-year increase in the initial diagnosis age [ HR=0.921, (95% CI: 0.888-0.955), P<0.001], multifocality was not a risk factor[ HR=1.973, 95% CI(0.972-4.462), P=0.103]. Conclusion:Active surveillance can be performed for multifocal PTMC in patients of appropriate age.

Objective:To explore the feasibility of active surveillance for multifocal papillary thyroid microcarcinoma(PTMC).Methods:It was a cross-sectional study. The thyroid ultrasonography data from 124 580 health check-up participants in the Health Management Center at the Affiliated Zhongshan Hospital of Dalian University between March 2017 and December 2023 were retrospectively analyzed. The patients were divided into unifocal or multifocal group according to the number of PTMC. The rates of growth, lymph node metastasis and progression in the unifocal and multifocal PTMC group during active surveillance were compared by using the Kaplan-Meier method and the log-rank test. The patients were divided into the group of progression or no-progression according to the outcome of active surveillance, and the basic clinical characteristics between the groups were compared. The Cox proportional hazards regression analysis was used to identify the risk factors for the progression of PTMC.Results:A total of 304 patients were enrolled in this study, among them, there were 239 cases of unifocal PTMC and 65 cases of multifocal PTMC. There was no significant differences in the rates of growth, lymph node metastasis and progression in the PTMC between the two groups during active surveillance (all P>0.05). During the active surveillance period, a total of 47 cases of PTMC progressed, while 257 cases did not. The progression rate was 15.5%. There was statistically significant difference in the initial age of PTMC diagnosis between the progression and non-progression group ( P<0.05). Multivariate regression analysis showed that age of initial diagnosis was the only risk factor for the progression of PTMC, the risk of progression decreased by 0.079 for every one-year increase in the initial diagnosis age [ HR=0.921, (95% CI: 0.888-0.955), P<0.001], multifocality was not a risk factor[ HR=1.973, 95% CI(0.972-4.462), P=0.103]. Conclusion:Active surveillance can be performed for multifocal PTMC in patients of appropriate age.

Objective:To investigate the factors related to the tumor growth in subjects with low-risk papillary thyroid microcarcinoma (PTMC) based on ultrasonography.Methods:This was a cross-sectional study. A total of 136 subjects who received health check-up in Health Management Center, the Affiliated Zhongshan Hospital of Dalian University from October 2017 to December 2023 were enrolled in the study. Low-risk PTMC were detected by ultrasonogrphy in those subjects and ultrashonography was followed up to observe the changes of maximum diameter and volume of the tumor, and metastasis of cervical lymph nodes. The clinical characteristics and ultrasonic image features were compared between the subjects with the tumor growth and without tumor growth, and the influencing factors of tumor growth were analyzed.Results:Among 136 subjects with low-risk PTMC, there were 23 cases (16.9%) with tumor growth (growth group) and 113 cases (83.1%) without tumor growth (non-growth group). Cervical lymph node metastasis occurred in 8 cases (5.9%: 7 (30.4%) in the growth group and 1 (0.9%) in non-growth group), no distant metastasis were detected. There were significantly differences in patients age of initial diagnoisi, maximum diameter and volume of tumors between the growth group and non-growth group (all P<0.05). Logistic regression analysis showed that age of initial diagnoisi ≤40 years ( OR=4.299, 95% CI:1.662-12.175, P=0.003) was an independent risk factor for tumor growth and the maximum diameter of the initial examination was independent protective factor for tumor growth (increasing 1 mm of initial diameter: OR=0.554, 95% CI:0.317-0.969, P=0.038). Conclusion:The size of most low-risk PTMC detected by ultrasonography during the health check-up does not grow and the risk of cervical lymph node metastasis is low; however, for those with age of initial diagnoisi ≤40 years and smaller size tumor, the risk of PTMC growth would be increased.

Objective:To explore the effectiveness and safety of percutaneous radiofrequency ablation for renal tumors, guided by both ultrasound and CT, under local anesthesia.Methods:A retrospective analysis was conducted on the clinical data of 40 patients with renal tumors admitted to Nanjing Drum Tower Hospital between January 2018 and December 2022. This treatment involved ultrasound/CT dual-guided radiofrequency ablation under local anesthesia. The cohort included 33 males and 7 females, with an average age of (61.5±11.9) years old and a body mass index (BMI) of (24.79±3.37) kg/m 2. The tumors were located in the left kidney in 20 cases and the right kidney in 16 cases, with 4 cases involving bilateral renal tumors. There were 44 tumors in 40 patients, with the maximum tumor diameter ranging from 1.0 to 4.0 cm [mean (2.3 ± 0.7) cm]. Distribution by kidney pole was as follows: 15 cases at the upper pole, 21 at the middle pole, and 8 at the lower pole. Of the tumors, 23 were exophytic, 5 were endophytic, and 16 exhibited mixed features. There were 2 patients with multiple metastases before surgery(including 1 patient with bilateral renal tumor). Preoperative serum creatinine level was 68.0(56.5, 87.5)μmol/L, and the estimated glomerular filtration rate (eGFR) was 114.2 (79.6, 132.4) ml/(min·1.73 m 2). All patients underwent renal biopsy before or during radiofrequency ablation. Percutaneous radiofrequency ablation surgery was performed using ultrasound and CT dual guidance on all patients, ensuring complete tumor destruction during the procedure as confirmed by dual positioning. Patients with bilateral tumors underwent two separate surgeries, spaced one month apart. Postoperatively, closely monitor the patient's vital signs and conduct long-term follow-ups to record any recurrence and metastasis. Results:In this series, all 40 procedures (involving 44 renal units) were successfully completed under local anesthesia without any need for blood transfusion, conversion to open surgery, or perioperative deaths. The average radiofrequency ablation time was (9.5 ± 3.6) min. Tumor characteristics included predominantly exophytic growths (23 cases, 52.3%), with 31 cases (70.5%) located more than 7 mm from the collecting system and 28 cases (63.6%) positioned posteriorly. Thirteen cases (29.5%) were entirely outside the polar line. The average R. E.N.A.L. nephrometry score was 6.1±0.2. Pathological examination revealed 34 cases of clear cell carcinoma, 2 of papillary renal cell carcinoma, 4 of unclassified renal cell carcinoma, and 4 benign renal tumors. In this cohort, two patients with bilateral renal tumors exhibited benign tumors on one side, while two other patients had malignant tumors in both kidneys. All 40 malignant tumors identified in 38 cases were classified at stage cT 1a.Postoperative serum creatinine level was 71.5 (59.0, 94.3) μmol/L, showing no statistically significant change from preoperative levels ( P > 0.05). Similarly, the eGFR post-operation was 107.4 (79.7, 132.2) ml/(min·1.73 m 2), which also did not differ significantly from preoperative values ( P > 0.05). There were no postoperative complications of Clavien-Dindo grade ≥Ⅱ, except for one case of severe pain (score 7-10). The follow-up period ranged from 15 to 70 months. Among the 38 cases, 36 patients did not have distant metastasis before surgery. There were 2 patients (5.5%) with local recurrence within 60 months after surgery. Among them, one case relapsed 6 months after radiofrequency ablation and was treated with partial nephrectomy. The patient was followed up for 60 months after the second treatment, and no local recurrence occurred. Another patient relapsed 41 months after surgery and was treated with radiofrequency ablation again. The patient was followed up for 12 months after the second treatment, and no local recurrence occurred. Two patients with distant metastasis before surgery were treated with targeted therapy plus immunotherapy for 12 months after surgery. One case had local recurrence 8 months after surgery and was treated with partial nephrectomy. The patient was followed up for 60 months after partial nephrectomy and no local recurrence occurred. Another patient with bilateral renal tumors developed left kidney recurrence 34 months after radiofrequency ablation, and underwent left partial nephrectomy. The right kidney recurred 42 months after radiofrequency ablation and underwent radiofrequency ablation again. After the second right renal radiofrequency ablation, no local recurrence occurred during 12 months of follow-up. Conclusions:Ultrasound/CT dual-guided percutaneous radiofrequency ablation, performed under local anesthesia for treating renal tumors, has minimal impact on the patient's renal function. The procedure boasts a low complication rate, with no postoperative severe complications. Additionally, the postoperative tumor control is effective, making it a safe and minimally invasive surgical option.

Objective:To observe the size changes under ultrasound of 4C type thyroid micronodules classified by 2020 Chinese Thyroid Imaging Reporting and Data System (C-TIRADS)during follow-up.Methods:In this cross-sectional study, the data of thyroid ultrasonography in physical examination center in the Affiliated Zhongshan Hospital of Dalian University between December 2017 and December 2021 were retrospectively included, thyroid nodules were classified according to C-TIRADS, to observe the changes by ultrasound of maximum diameter and volume of 4C type thyroid micronodules during follow-up.Results:A total of 102 subjects receiving physical examinations with 103 thyroid micronodules were enrolled in this study. The maximum diameter and volume of thyroid micronodules at initial examination was 5.0 (4.0, 7.0) mm and 52.5 (25.2, 113.4) mm 3 respectively, and it was 6.0 (4.0,7.0) mm、65.6 (25.2,147.0) mm 3 at the last examination, respectively. Of the thyroid micronodules, 79 (76.7%) remained stable, 14 (13.6%) magnified and 10 (9.7%) shrunk during the follow-up. The cervical lymph nodes in all physical examiners were normal. There were significant changes in the maximum diameter and volume in the thyroid micronodules between the initial and last examination in subjects whose micronodules shrunk or magnified during the follow-up (all P<0.05). Conclusion:Size of most C-TIRADS 4C thyroid micronodules remains stable or even decreases during ultrasound follow-up observation, for such thyroid nodules, follow-up observation appears to be a safe and feasible way to postpone surgery.

Objective To investigate the safety and efficacy of fiber choledochoscope in the treatment of patients with biliary cast syndrome (BCS) after liver transplantation (LT).Methods Clinical data of 10 patients with BCS after LT treated with fiber choledochoscope in the Affiliated Hospital of Qingdao University between March 2014 and June 2016 were analyzed retrospectively. There were 8 males and 2 females, aged 46-66 years old and the median age was 50 years old. The primary diseases of the patients were primary liver cancer (n=6), biliary cirrhosis (n=1), hepatic cirrhosis after hepatitis B (n=2), and hepatic cirrhosis after hepatitis C (n=1). The informed consents of all patients were obtained and the local ethical committee approval was received. For patients with BCS in the early stage after LT, T tube was replaced. For patients in late stage after LT, T tube fistula dilatation was performed, then biliary cast (BC) was removed and the supporting drainage tube was placed.Results 2 cases received T tube replacement when in early stage after LT, 8 received T tube fistula dilatation when in late stage after LT. All 10 cases had BC removed successfully with fiber choledochoscope. Liver function of 8 cases returned to normal after surgery, and the biliary drainage tube was removed. 2 cases had BC again and recurrent biliary infection, and then received PTCD drainage. Conclusion Fiber choledochoscope is safe, effective and feasible for the treatment of BCS after LT.

Objective To explore the early diagnosis and proper treatment for pancreas injuries. Methods 31 patients with pancreatic injury were treated from Oct. 1997 to Nov. 2008 in the Third Hospital of Yanzhou Mining Group. The early clinical signs and characters, treatment and causes of death of the 31 cases of pancreas injuries were studied retrospectively. Results All 31 cases with blunt pancreatic injury underwent operation. 28 patients were cured, 2 died from the pancreatic fistula and 1 multiple organ dysfunction syndrome.Pancreatic fistula and pancreatic pseudocysts were the main complications. Conclusions The preoperative diagnosis is difficult. Surgical exploration is the main method to guarantee accurate diagnosis of pancreatic injuries.Selecting proper surgical operation according to the situation of pancreatic injuries during the exploration can elevate successful rate.

Objective To carry out a taxonomic identification of a strain of claviform bacteria iso-lated from prostatic fluid of a patient who suffered from chronic prostatitis, and to approach its phylogenic and biologic position. Methods We undertaked an initial identification by phenotypic characters such as morphologecal, physiological and biochemical characteristics to ascertain its phylogeny by chemical composi-tion analysis of cell wall and 16S rRNA gene sequencing and alignment. Results A club-shaped gram posi-tive rod bacillus was isolated in pure culture state. Its biochemical reactions were not active. The diamino-acid of cell wall was meso-diaminopimelic acid (meso-DAP) and it had wall chemotype Ⅳ ( contained arabi-nose, galactose and maltose ). Sequence searches of the GenBank database revealed that this strain had a highest level of 16S rDNA sequence similarity (99.4%) to C. tuberculostearicurn strain ATCC35692 with only 8 nucleotides difference. Conclusion On the basis of phenotypic and phylngenetie analysis, it is rea-sonable to assign this strain to the species C. tuberculostearicum, and this is the first isolation of C. tubercu-lostearicum from prostatic fluid home and abroad.

Objective To evallhte factors affecting blood loss during mini-percutaneous nephrolithotomy using ureteroscope and pneumatic intracorporeal lithotripsy(MPCNL). Methods 1156MPCNL procedures in 885 patients from July 2002 to October 2006 were reviewed. Various patientrelated and intraoperative factors were assessed for association with total blood loss using multivariate regression analysis. ResuIts The average hemoglobin drop was(14.2+8.3)g/L.The overall blood transfusion rate was 1.5%. Approximately 0.6%of patients required angiography embolization to control intractable bleeding. Multivariate regression analysis showed that the occurrence ot operative complications(6=0.496,P＜0.001),size of the tract(b=0.405,P＜0.001),mature nephrostomy tract(6=0.377,P＜0.001),multiple tracts(6=0.326,P=0.005),size of stone(b=0.210,P=0.015),operative time(6=0.139,P=0.027),renal parenehymal thickness(b=0.128,P=0.035),prior stone intervention(b=-0.121,P=0.038),diabetes(b=0.110,P=0.051),and bacteriuria(b=-0.095,P=0.058)were significant predictors of blood loss.Factors such as age,sex,side,obesity,hypertension,renal function,operating surgeon,anaesthesia,calix of puncture,number of attempts to successful puncture,urine from puncture needle may not affect the blood loss. Concluslons Maneuvers that may reduce blood loss include reducing the operative time,decreasing the occurrence of intraoperative complications, reducing the tract size and tract number, and staging the procedure.Staging the procedure of MPCNL is a judicious decision in case of a large stone burden,intraoperative complications,multiple-tract,lager tract or diabetes.