In 2025， the European Liver and Intestine Transplant Association released the guidelines on the utilization and evaluation of deceased donor livers. The guidelines focus on the definition of high-risk donor livers and the strategies and criteria for dynamic liver assessment， aiming to provide standardized guidance for clinicians. This article gives an excerpt of the key recommendations in the guidelines.

Objective To explore the nutritional risk investigation and influencing factors of elderly patients with community-acquired pneumonia (CAP). Methods The clinical data of 239 elderly patients with CAP in Western Theater General Hospital were retrospectively analyzed from January 2022 to January 2024. Nutritional risk screening scale (NRS2002) was used to investigate the nutritional risk of patients. According to the nutritional risk investigation results, 239 elderly patients with CAP were divided into higher risk group (NRS2002≥3 points) and lower risk group (NRS2002<3 points). Univariate analysis was used to compare the gender, age, education level, body mass index (BMI), family monthly income, living condition, severity of pneumonia, smoking history, presence or absence of chronic diseases, cognitive dysfunction and self-care ability. The independent risk factors of nutritional risk in elderly patients with CAP were analyzed by binary logistic regression analysis. Results According to NRS2002 score, there were 87 cases (36.4%) in higher risk group and 152 cases (63.6%) in lower risk group. The NRS2002 scores in higher risk group were significantly higher than those in lower risk group (P<0.05). There were no obvious differences in gender, BMI, family monthly income and presence or absence of smoking history between groups (P>0.05). The higher risk group had significantly higher rates of age>70 years old, education level (high school and below), living condition (living alone), severity of pneumonia (high-risk pneumonia), chronic disease, cognitive dysfunction and poor self-care ability than the lower risk group (P<0.05). Binary logistics regression analysis showed that age>70 years old , education level of high school and below, living condition (living alone), severity of pneumonia (high-risk pneumonia), chronic diseases, cognitive dysfunction and self-care ability (poor) were independent risk factors for nutritional risk in elderly CAP patients (P<0.05). Conclusion Elderly patients with CAP have high nutritional risk, which may be affected by many factors such as age, education level, living condition, severity of pneumonia, presence or absence of chronic diseases, cognitive dysfunction and self-care ability. It is necessary to formulate targeted intervention measures according to the above factors to improve the nutritional risk of patients.

Objective:To summarize and analyze the current application status of oral mucosal graft (OMG) technique in the repair of ureteral strictures in China, and clarify the feasibility, safety and effectiveness of this technique.Methods:The 175 patients who underwent repair of ureteral stricture using oral mucosal patches from June 2015 to February 2022 were etrospectively analyzed in 14 medical centers in China, including 49 cases in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 32 cases in Affiliated Seventh Medical Center of PLA General Hospital, 3 cases in The Second Hospital of Anhui Medical University, 6 cases in The First Affiliated Hospital of Zhengzhou University, 56 cases in Peking University First Hospital, 3 cases in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 cases in Shanghai Sixth People' s Hospital, 4 cases in General Hospital of Estern Theater Command, 4 cases in Lanzhou University Second Hospital, 2 cases in Guizhou Province People 's Hospital, 2 cases in Peking University People' s Hospital, 5 cases in Jinzhou First People's Hospital, 5 cases in The First Affiliated Hospital of Wannan Medical College, 1 case in Shandong Provincial Hospital. In this study, 127 patients (72.6%) used lingual mucosal patches, 32(18.3%) labial mucosa, and 16(9.1%) buccal mucosa. The surgical approach for OMG ureteral reconstruction was mainly minimally invasive, with robot-assisted laparoscopy in 84 patients (48.0%), traditional laparoscopic surgery in 87 patients (49.7%), and open surgery in only 4 patients (2.3%). There were 133 males and 42 females with an average age of (35.0±17.2) years. The mean body mass index (BMI) and stenosis length were (23.1±4.1) kg/m 2 and (4.7±1.8) cm, respectively. The stricture was located in the left ureter in 116 patients, right ureter in 58 case and bilateral ureter in 1 case. The most common causes of ureteral stricture were endoscopic surgery in 88(50.3%)patients, congenital stricture in 55(31.4%)patients, failed ureteroplasty in 29(16.6%)patients, history of extracorporeal shock wave lithotripsy in 13(7.4%)patients, radiotherapy history in 3(1.7%)patients and other causes in 6(3.4%)patients. Strictures were mainly located in the upper ureter, accounting for 61.7% (108/175 cases), followed by 36.0% (63/175) at the ureteropelvic junction and 2.3%(4/175)in the middle ureter. According to the surgical methods, the patients were divided into robot-assisted laparoscopic surgery group ( n=84), traditional laparoscopic surgery group ( n=87)and open surgery group ( n=4). Subgroup analysis of patients in robot-assisted laparoscopic and traditional laparoscopic surgery groups was performed. There were no significant difference in preoperative data between the two groups except for age (32.0±18.3) years vs.(37.0±15.9)years, P=0.040], BMI[(22.5±4.3)kg/m 2 vs. (23.7±3.6)kg/m 2, P=0.028], and etiology of stenosis [endoscopic injury, 34(40.5%) vs. 53(60.9%), P=0.012]. Preoperative hydronephrosis and stricture length were assessed by CTU and ureterography. Ureterography 7-9 weeks after surgery showed patency of the reconstructed segment, or no recurrence of hydronephrosis was judged as success. Evaluate the operation method, operation time, success rate, length of OMG in repairing ureteral stricture between laparoscopic and robot-assisted groups. Results:The overall success rate of oral mucosal graft repair surgery reached 97.7%(171/175). The success rate of ureteral reconstruction in the two groups were 96.4%(81/84)and 98.9%(86/87), respectively ( P=0.351), and the difference was not statistically significant. There was no significant difference for operation time, intraoperative blood loss, and mean oral mucosal length between the robotic and laparoscopic groups[(244.7±85.8) min and (222.7±83.5)min ( P=0.116), (58.9±38.6) ml and (68.4±45.5) ml ( P=0.217), (5.0±2.0) cm and (4.6±1.5) cm ( P=0.350)], respectively.Postoperative complications were reported in 23 (13.1%) patients, such as fever, urinary leakage, lymphatic leakage, infection, but only 2 (1.4%) cases patients had complications of Clavien-Dindo score ≥ Ⅲ. The two patients developed urinary stricture after surgery with failed conservative treatment, and no urinary stricture occurred following endoscopic treatment.The short-term (three months after surgery)incidence of complications in the site where the oral mucosa was taken, such as difficulty in opening mouth, pain, and swelling, was 12.0% (21/175), and there was no significant difference for oral complications between patients harvesting different length of mucosal graft. Conclusions:Ureteroplasty with oral mucosal graft is a safe, feasible and reliable technique for ureteral reconstruction. At present, minimally invasive technology is the main surgical approach for ureteroplasty, and there is no significant difference in operation time and success rate between robotic surgery and laparoscopic surgery.

Objective:The surgical method and clinical efficacy was studied on the anterior lateral malleolar venous network grafting in repair of the defects of superficial palmar arch.Methods:From February 2015 to July 2021, 8 cases (6 males and 2 females; aged 32-44 years old, mean age at 39 years old) were treated in the Department of Hand Surgery of Yantaishan Hospital. Anterior lateral malleolar venous network was grafted to repair the defects of superficial palmar arch of the patients. The patients had different degrees of tendon damage, and injuries of nerve, deep palmar arch, common palmar digital artery or proper palmar digital artery. The length of the vessel defect was 6.0-10.0 cm. Blood supply insufficiency occurred in 1st-5th digits in 1 case, 2nd-4th fingers in 5 cases, and 2nd-5th fingers in 2 cases. The anterior lateral malleolar venous network was transferred to repair 3 broken ends of vessels in 5 cases, 4 broken ends in 1 case and 5 broken ends in 2 cases. The wound of hand was sutured directly in 2 cases. The emergency surgical repair of the wound of hand by transfer of ALTPF was performed in 2 patients, and elective ALTPF transfer in 3 cases. Forearm dorsi-ulnar flap transfer was performed in 1 case. The follow-up reviews were carried out via the outpatient clinic visit, telephone, WeChat interviews or home visits. The blood supply of the distal digit, skin sensation, TPD, the range of motion of the phalangeal joints were observed.Results:The results showed that all the digits and the grafted flaps survived. The follow-up was carried out for 10-53 months, with an average of 17.9 months. The functions of digit extension and flexion, finger opposition and thumb opposition were restored in 5 cases, and the patients returned back to former jobs. The finger flexion and thumb opposition were limited in 3 cases, and these cases participated in light physical work. The proprioception of the digits were recovered, and the TPD was 5-7 mm. Functional recovery was evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association and rated as excellent in 5 cases and good in 3 cases. The donor sites of the foot showed a linear scar. There was no effect on the function and the shape of the donor site.Conclusion:The anterior lateral malleolar venous network grafting is an ideal method in repair of the defects of superficial palmar arch.

Objective:To explore the clinical application of the posterior tibial artery perforator flap with the great saphenous vein (GSV) in the treatment of severe degloving injury of the forearm.Methods:From June 2015 to October 2020, 5 patinets (4 males and 1 female, aged 20-46 years old, mean age 37 years old) were treated in the Department of Hand Surgery of Yantaishan Hospital in Yantai. Aposterior tibial artery perforator flap with GSV was used to repair the partial wound of the injured forearm, together with the establishment of venous circulation of dorsal hand for all 5 patients. All the patients suffered from severe forearm degloving injury. Of which, 3 accompanied with ulna radius fracture, 2 with ulnar and radial artery injury and 2 with blood supply insufficiency in the injured fingers. The sizes of soft-tissue defect were 26 cm×18 cm-32 cm×25 cm. The sizes of the posterior tibial artery perforator flap with GSV ranged from 12 cm×5 cm to 33 cm×6 cm. The anastomoses were performed on the perforating artery and the radial artery. The GSV was anastomosed with cephalic vein with bridging anastomosis to re-establish the venous circulation of dorsal hand. Combined anterolateral thigh flaps (ALTF) were used to repair the rest wound of injured limbs in 4 patients, and the combined pedicled abdominal flap was used in 1 patient. The donor site of calf flap was sutured directly, and the skin of upper limb was thinned into medium thick to cover the thigh flap donor site, which was packed with pressure dressing. Regular follow-up reviews were carried out by outpatient clinic, telephone, WeChat APP or home-visit after the operation to observe the survival of flaps, the swelling of the distal end of injured limb, functional recovery and healing at the donor site. Functional recovery was evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Results:All the grafted flaps in 5 patients survived. Necrosis at epidermal edge occurred in 1 calf flap, and achieved secondary healing after dress changing for 4 weeks. There was neither arterial nor venous crisis in all flaps. The oedema of the hand disappeared within 4-8 weeks, with clear dermatoglyph. There was no obvious enlarged circumference of thumb and fingers. The follow-up was carried out for 8-20 months, with 11 months in average. The flaps were elastic in good colour, and full texture without pigmentation. The donor site of the calf flap showed a linear scar. No swollen was seen in the hands of the injured forearm and the feet of donor lower legs. The range of motion of phalangeal joints was good. Recovery of finger sensation achieved at S 4. The recovery of the sensation of posterior tibial artery perforator flap reached S 3 in 2 patients and S 2 in 3 patients. Assessment of the Upper Limb Function using the Standard Issued by the Hand Surgery Society of Chinese Medical Association rated excellent in 3 patients and good in 2 patients. Conclusion:The posterior tibial artery perforator flap with GSV has a reliable blood supply with a small damage to the donor site. This flap is ideal for repair of severe degloving injury of forearm and meanwhile to achieve the re-establishment of venous circulation in dorsal hand.

Objective To explore the clinical application effect of multiple end-to-side anastomosis in free anterolateral thigh perforator flap transplantation.Methods From January,2013 to October,2017,29 cases were applied the technology of multiple end-to-side anastomosis to the same recipient vessel in anterolateral thigh perforator flap transplantation for wound repair.Fifteen cases treated with multiple end-to-side anastomosis on flap arteries,and 2-3 arteries were anastomosed,with the average of 2.13.Nine cases were treated with venous multiple end-to-side anastomosis,and 2-4 veins were anastomosed,with the average of 3.11.Five cases treated with arterial and venous multiple end-to-side anastomosis,and 4-6 vessels were anastomosed,with the average of 5.20.Distribution of wounds:10 cases with hands and wrists wounded,15 cases with forearms and elbow joints wounded,and 4 cases with lower legs and feet wounded.The soft tissue defect size was 5 cm×13 cm-11 cm×27 cm,and the flap area was 6 cm× 15 cm-12 cm×29 cm.Postoperative followed-up was performed every 3-6 months to review flap survival.Results All flaps of 29 cases survived.Venous congestion occurred in 2 flaps within 48 h after the operation,among which,1 was overcomed after released the dressing and sutures,and the other underwent surgical exploration.The venous end-to-side anastomotic stomas were unobstructed,and hematoma was formed.After the hematoma compression was removed,circulation was recovered and the flap survived.With followed-up for 6 months to 2.5 years,both donor site and recipient site of the flaps healed well and the injured distal limbs had no hemodynamic disorder.Conclusion The application of multiple end-to-side anastomosis to the same recipient vessel for free transplantation of anterolateral thigh perforator flaps is safe and reliable.

Purpose To investigate the expression of transcriptional suppressor CtBP1,Zeb1,Zeb2 and their target gene E-cadherin,and their significance in cholangiocarcinoma.Methods The expression of CtBP1,Zeb1,Zeb2 and E-cadherin proteins in cholangiocarcinoma and the paired non-neoplastic tissue array were detected by the immunohistohemical staining.Results The positive rates of CtBP1 expression in cholangiocarcinoma and the paired non-neoplastic tissue were 44.44％ and 17.86％,these of Zeb2 were 34.92％ and 10.71％,and these of E-cadherin were 50.79％ and 100％,respectively.The differences between the groups were statistically significant (all P ＜ 0.05).There was only one case with expression of Zeb1 in cholangiocarcinoma,but no expression in the paired non-neoplastic tissue.CtBP1 was correlated with the degree of differentiation of cholangiocarcinoma (P ＜ 0.05).Ecadherin was related to the differentiation degree,and distant metastasis of cholangiocarcinoma (all P ＜ 0.05).The E-cadherin expression was negatively correlated with CtBP1 and Zeb2 (r =-0.034,-0.029,all P ＜ 0.05).The Zeb2 expression was positively correlated with CtBP1 (r =0.228,P =0.005).Conclusion CtBP1,Zeb2 and E-cadherin express abnormally in cholangiocarcinoma.CtBP1,Zeb2 may be involved in the regulation of E-cadherin expression.Joint detection of CtBP1 and Ecadherin is expected to be a reference index to evaluate the malignant biological behavior of cholangiocarcinoma.

Objective To discuss ureaplasma urealyticum (Uu) and Mycoplasma hominis (Mh)susceptibility and resistance change trend in Lanzhou recent years .Methods Detected and statistical analyzed the mycoplasma drug sensitivity level of urinary tract infection patients in urinary clinic with Mycoplasma culture sensitivity reagents from 2010 to 2014 .Results Mycoplasma to Josamycin ,Doxycycline and Clarithromycin were more sensitive .In the 12 kinds of antibacterial drugs ,we found the declining trend of Ofloxacin and Spectinomycin drug sensitivity rates ,and upward trend of Minocycline and Josamycin drug sensitivity rates .Con‐clusion Mycoplasma overall drug sensitivity rate has a gradually downward trend ,which indicating a poor drug resistance control . It′s important to strengthen the antibiotic drug surveillance and security management .

Objective To evaluate the diagnostic value of multi-slice spiral CT (MSCT)for traumatic spleen and liver rupture.Methods We made a retrospective analysis of 140 cases of liver and spleen injury with clinical manifestations confirmed by operation.MSCT examination results and clinical data were compared.Results Of the 140 cases,male patients outnumbered female ones,and the peak age was 10 - 30 years old.The injuries were most commonly attributed to traffic accident and falling.There were 69 (49%)cases of spleen injury,5 1 (36%) cases of liver injury,and 20 (14%)cases of both.Liver and spleen injuries showed on MSCT examination were liver and spleen laceration, hematoma within the liver and spleen as well as hematoma beneath the envelop. Conclusion MSCT has an important diagnostic value for traumatic liver and spleen rupture and thus can guide clinical treatment choice.