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.

The clinical diagnosis and treatment of urinary tract infection has long faced the challenges of insufficient standardization of diagnosis and treatment pathways,irrational use of antimicrobial drugs and high recurrence rate.How to optimize the hierarchical diagnosis and treatment pathway of urinary tract infection,standardize the use of antimicrobial drugs,and reduce the recurrence rate have always been the focus of clinical attention.There is significant heterogeneity in the existing diagnostic criteria for urinary tract infection,which seriously affects the comparability and evidence integration of clinical and research studies.In order to solve the above problems,a consensus on global multidisciplinary diagnostic criteria for urinary tract infection has been formed by international multidisciplinary experts after three rounds of Delphi method.Breaking through the traditional classification framework,the consensus innovatively established a four-dimensional quantitative scoring system including local symptoms and signs,systemic inflammatory response,quantitative analysis of pyuria and urine culture results,and established a hierarchical standard for stepwise urinary tract diagnosis according to the scoring threshold.Based on the key citations related to the consensus,this paper interprets in detail the basis for the selection of core indicators and the establishment of thresholds for the diagnosis of urinary tract infection in the consensus,and focuses on the key issues and implementation paths of the consensus in localization practice.This consensus provides a unified standard for standardizing the clinical diagnosis and treatment of urinary tract infection,improving the homogeneity of clinical research through standardized diagnostic processes,and promoting the standardization of UTI drug research and development and the rational use of antibiotics and precision.

The clinical diagnosis and treatment of urinary tract infection has long faced the challenges of insufficient standardization of diagnosis and treatment pathways,irrational use of antimicrobial drugs and high recurrence rate.How to optimize the hierarchical diagnosis and treatment pathway of urinary tract infection,standardize the use of antimicrobial drugs,and reduce the recurrence rate have always been the focus of clinical attention.There is significant heterogeneity in the existing diagnostic criteria for urinary tract infection,which seriously affects the comparability and evidence integration of clinical and research studies.In order to solve the above problems,a consensus on global multidisciplinary diagnostic criteria for urinary tract infection has been formed by international multidisciplinary experts after three rounds of Delphi method.Breaking through the traditional classification framework,the consensus innovatively established a four-dimensional quantitative scoring system including local symptoms and signs,systemic inflammatory response,quantitative analysis of pyuria and urine culture results,and established a hierarchical standard for stepwise urinary tract diagnosis according to the scoring threshold.Based on the key citations related to the consensus,this paper interprets in detail the basis for the selection of core indicators and the establishment of thresholds for the diagnosis of urinary tract infection in the consensus,and focuses on the key issues and implementation paths of the consensus in localization practice.This consensus provides a unified standard for standardizing the clinical diagnosis and treatment of urinary tract infection,improving the homogeneity of clinical research through standardized diagnostic processes,and promoting the standardization of UTI drug research and development and the rational use of antibiotics and precision.

Objective To investigate the clinical significance of serum B cell activating factor(BAFF)and complement lytic factor Bb in patients with idiopathic membranous nephropathy(IMN),as well as their correlation with the urinary albumin-to-creatinine ratio(UACR).Methods A total of 204 IMN patients were enrolled as the study group,and 100 healthy individuals undergoing physical examinations during the same period served as the control group.Serum levels of BAFF,Bb,and UACR were measured and compared between the two groups.Pearson correlation analysis was performed to assess the associations among serum BAFF,Bb,and UACR.The patients in the study group were followed up for 12 months and stratified into a favorable prognosis group and a poor prognosis group(defined as no remission)based on disease remission status.Demographic and clinical characteristics,as well as serum BAFF and Bb levels,were compared between the two outcome groups.Multivariate logistic regression analysis was conducted to identify independent predictors of poor prognosis in IMN patients.Receiver operating char-acteristic(ROC)curve analysis was employed to evaluate the predictive value of these indicators for poor prognosis.Results The levels of BAFF,Bb,and UACR in the research group were significantly higher than those in the con-trol group(P<0.05).Pearson correlation analysis revealed that both BAFF and Bb were positively correlated with UACR(r=0.716 and 0.543,respectively;P<0.05).After one year of follow-up,a total of 200 patients completed the study,among whom 46 experienced poor prognosis.Based on the follow-up outcomes,patients were categorized into a poor prognosis group(n=46)and a good prognosis group(n=154).The poor prognosis group exhibited significantly higher levels of serum creatinine,24-hour urinary protein,BAFF,and Bb,as well as lower eGFR values,compared to the good prognosis group(P<0.05).Multivariate regression analysis identified 24-hour urinary protein,BAFF,and Bb as independent risk factors for poor prognosis in patients with IMN,whereas eGFR was identified as a protective factor(P<0.05).ROC curve analysis demonstrated that the combined assessment of 24-hour urinary protein,eGFR,BAFF,and Bb yielded a higher AUC value for predicting poor prognosis in IMN patients than any single indicator alone(Z=4.145,3.908,4.308,3.864;P<0.05).Conclusions The serum levels of BAFF and Bb in patients with IMN are significantly elevated and positively correlated with the UACR.The combi-nation of 24-hour urinary protein excretion and eGFR demonstrates high predictive value for poor prognosis in these patients.These findings suggest that BAFF and Bb may serve as potential biomarkers for prognostic assessment in IMN,and the integrated measurement of multiple parameters could provide a more comprehensive clinical basis for disease management.

ObjectiveTo observe the effects of the Fuyuan Tongluo prescription （composed of Astragali Radix， Carthami Flos， Spatholobi Caulis， Liquidambaris Fructus， Lycopodii Herba， Centellae Herba， etc.） in the treatment of restenosis with collateral obstruction syndrome after interventional operation of lower limb arteriosclerosis obliterans， and its impact on the primary patency rate. MethodsA total of 88 patients with collateral obstruction syndrome after interventional surgery for lower limb arteriosclerosis obliterans were randomly divided into two groups. The control group （n₁=44） received dual antiplatelet therapy with aspirin and clopidogrel. The observation group （n₂=44） was treated with Fuyuan Tongluo prescription non-decocted granules in addition to aspirin and clopidogrel. Both groups received treatment for 24 weeks and were followed up for 36 weeks. The changes in primary patency rate， symptom scores， ankle-brachial index （ABI）， coagulation function， and inflammatory markers before and after treatment were compared between the two groups. ResultsFor primary patency rate， after 36 weeks of treatment， the observation group had a significantly better primary patency rate than the control group （χ²=4.14，P<0.05）. After 24 weeks of treatment， there was no significant difference in primary patency rate between the two groups. Clinical efficacy comparison： Based on symptom quantification scores， and using the Nimodipine method as a reference， the overall efficacy of the observation group was superior to that of the control group after 24 weeks of treatment （χ²=2.24，P<0.05）. ABI levels： The observation group had a higher ABI than the control group after 24 and 36 weeks of treatment （P<0.05）. Coagulation function indicators： After 24 and 36 weeks of treatment， D-dimer and fibrinogen levels in both groups were lower than before treatment （P<0.05）. Inflammatory markers： After 24 and 36 weeks of treatment， CRP levels in the observation group were lower than those in the control group （P<0.05）. There were no significant differences in white blood cell （WBC） and erythrocyte sedimentation rate （ESR） levels before and after treatment between the two groups. ConclusionAdding Fuyuan Tongluo prescription non-decocted granules to dual antiplatelet therapy can improve the primary patency rate of the affected vessels in patients with lower limb arteriosclerosis obliterans after interventional surgery. Longer use of Fuyuan Tongluo prescription can significantly improve clinical symptoms， demonstrating clinical application value.

ObjectiveTo observe the effects of the Fuyuan Tongluo prescription （composed of Astragali Radix， Carthami Flos， Spatholobi Caulis， Liquidambaris Fructus， Lycopodii Herba， Centellae Herba， etc.） in the treatment of restenosis with collateral obstruction syndrome after interventional operation of lower limb arteriosclerosis obliterans， and its impact on the primary patency rate. MethodsA total of 88 patients with collateral obstruction syndrome after interventional surgery for lower limb arteriosclerosis obliterans were randomly divided into two groups. The control group （n₁=44） received dual antiplatelet therapy with aspirin and clopidogrel. The observation group （n₂=44） was treated with Fuyuan Tongluo prescription non-decocted granules in addition to aspirin and clopidogrel. Both groups received treatment for 24 weeks and were followed up for 36 weeks. The changes in primary patency rate， symptom scores， ankle-brachial index （ABI）， coagulation function， and inflammatory markers before and after treatment were compared between the two groups. ResultsFor primary patency rate， after 36 weeks of treatment， the observation group had a significantly better primary patency rate than the control group （χ²=4.14，P<0.05）. After 24 weeks of treatment， there was no significant difference in primary patency rate between the two groups. Clinical efficacy comparison： Based on symptom quantification scores， and using the Nimodipine method as a reference， the overall efficacy of the observation group was superior to that of the control group after 24 weeks of treatment （χ²=2.24，P<0.05）. ABI levels： The observation group had a higher ABI than the control group after 24 and 36 weeks of treatment （P<0.05）. Coagulation function indicators： After 24 and 36 weeks of treatment， D-dimer and fibrinogen levels in both groups were lower than before treatment （P<0.05）. Inflammatory markers： After 24 and 36 weeks of treatment， CRP levels in the observation group were lower than those in the control group （P<0.05）. There were no significant differences in white blood cell （WBC） and erythrocyte sedimentation rate （ESR） levels before and after treatment between the two groups. ConclusionAdding Fuyuan Tongluo prescription non-decocted granules to dual antiplatelet therapy can improve the primary patency rate of the affected vessels in patients with lower limb arteriosclerosis obliterans after interventional surgery. Longer use of Fuyuan Tongluo prescription can significantly improve clinical symptoms， demonstrating clinical application value.

Objective To investigate the clinical significance of serum B cell activating factor(BAFF)and complement lytic factor Bb in patients with idiopathic membranous nephropathy(IMN),as well as their correlation with the urinary albumin-to-creatinine ratio(UACR).Methods A total of 204 IMN patients were enrolled as the study group,and 100 healthy individuals undergoing physical examinations during the same period served as the control group.Serum levels of BAFF,Bb,and UACR were measured and compared between the two groups.Pearson correlation analysis was performed to assess the associations among serum BAFF,Bb,and UACR.The patients in the study group were followed up for 12 months and stratified into a favorable prognosis group and a poor prognosis group(defined as no remission)based on disease remission status.Demographic and clinical characteristics,as well as serum BAFF and Bb levels,were compared between the two outcome groups.Multivariate logistic regression analysis was conducted to identify independent predictors of poor prognosis in IMN patients.Receiver operating char-acteristic(ROC)curve analysis was employed to evaluate the predictive value of these indicators for poor prognosis.Results The levels of BAFF,Bb,and UACR in the research group were significantly higher than those in the con-trol group(P<0.05).Pearson correlation analysis revealed that both BAFF and Bb were positively correlated with UACR(r=0.716 and 0.543,respectively;P<0.05).After one year of follow-up,a total of 200 patients completed the study,among whom 46 experienced poor prognosis.Based on the follow-up outcomes,patients were categorized into a poor prognosis group(n=46)and a good prognosis group(n=154).The poor prognosis group exhibited significantly higher levels of serum creatinine,24-hour urinary protein,BAFF,and Bb,as well as lower eGFR values,compared to the good prognosis group(P<0.05).Multivariate regression analysis identified 24-hour urinary protein,BAFF,and Bb as independent risk factors for poor prognosis in patients with IMN,whereas eGFR was identified as a protective factor(P<0.05).ROC curve analysis demonstrated that the combined assessment of 24-hour urinary protein,eGFR,BAFF,and Bb yielded a higher AUC value for predicting poor prognosis in IMN patients than any single indicator alone(Z=4.145,3.908,4.308,3.864;P<0.05).Conclusions The serum levels of BAFF and Bb in patients with IMN are significantly elevated and positively correlated with the UACR.The combi-nation of 24-hour urinary protein excretion and eGFR demonstrates high predictive value for poor prognosis in these patients.These findings suggest that BAFF and Bb may serve as potential biomarkers for prognostic assessment in IMN,and the integrated measurement of multiple parameters could provide a more comprehensive clinical basis for disease management.

Objective To evaluate the effects of bladder neck preservation on postoperative stress urinary inconti-nence and retrograde ejaculation in patients undergoing transurethral thulium laser enucleation of the prostate(ThuLEP).Methods The clinical data of 203 patients who underwent ThuLEP in our hospital from September 2021 to December 2023 were retrospectively analyzed.According to the operation method,the patients were divided into bladder neck preservation group(n=95)and non-bladder neck preservation group(n=108).The occurrence of postoperative stress urinary inconti-nence and retrograde ejaculation of the two groups were compared.Results The differences between the patients of two groups in operative time(110[80,130]min vs 110[90,140]min),hospital stay(8[8,8]d vs 8[8,8]d),in-dwelling catheter time(7[7,7]h vs 7[7,7]h),and hemoglobin decline(9[6,14]g/L vs 8[4,13]g/L)were not statistically significant(P＞0.05).There were no statistically significant differences between the two groups at 3 months postoperatively in maximum flow rate(20[18,21]mL/s vs 19[18,20]mL/s),scores of International Prostate Symp-tom Scale(5[4,6]vs 5[4,5]),post-void residual urine volume(0[0,8]mL vs 0[0,7.5]mL)and quality of life(2[1,3]vs 2[1,3])(P＞0.05).The differences in the rates of postoperative stress urinary incontinence(2.1％vs 9.3％)and retrograde ejaculation(49.4％vs 74.5％)between the two groups were statistically significant(P＜0.05).Conclusion Bladder neck preservation during ThuLEP reduces the incidence of postoperative stress urinary incontinence and retrograde ejaculation.

Objective:This article introduces a novel technique for totally laparoscopic, right thoracic approach, esophagojejunostomy for digestive tract reconstruction.Methods:A retrospective analysis was conducted on the clinical data of patients with adenocarcinoma of the esophagogastric junction who successfully underwent totally laparoscopic esophagojejunostomy via the right thoracic approach at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, between February 2022 and March 2022.The surgical procedure was performed as follows:(1)Following total laparoscopic resection of the gastric tumor and lymph node dissection, the specimen was transected distal to the tumor margin. The specimen was then placed into a retrieval bag and extracted through the umbilical observation port.(2)Dissection was continued through the esophageal hiatus to mobilize the esophagus. The tumor-bearing tissue, along with the esophagus, was delivered into the thoracic cavity via the esophageal hiatus.(3)The jejunum was transected 20 cm distal to the ligament of Treitz. The distal Jejunum was mobilized for 15-20 cm and subsequently delivered into the thoracic cavity through the esophageal hiatus.(4)A Roux-en-Y jejunojejunostomy was constructed 45-50 cm distal to the cut end of the distal jejunal limb; the mesenteric defect was closed, and the duodenal stump was reinforced.(5)The patient was repositioned into the left lateral decubitus position. Port placement was established as follows: the observation port at the 7th intercostal space (ICS) in the right midaxillary line, the main operating port at the 4th ICS in the anterior axillary line, and the assistant operating port at the 9th ICS in the scapular line.(6)The main operating port incision was enlarged. Using a purse-string instrument, the esophagus was clamped and transected at least 5 cm proximal to the upper tumor margin, and the specimen was removed. (7)The distal jejunum was delivered into the thoracic cavity via the esophageal hiatus. Under total laparoscopic visualization, esophagojejunostomy was completed.Results:Both patients who underwent totally laparoscopic esophagojejunostomy via the right thoracic cavity successfully completed the procedure without conversion to laparotomy, unplanned reoperation, or any intraoperative/postoperative complications. The patients recovered well postoperatively, with no evidence of abdominal or thoracic hemorrhage. Postoperative computed tomography (CT) scans of the chest and abdomen confirmed the absence of anastomotic leakage or other related complications.Conclusions:The esophagojejunostomy was performed totally laparoscopically via the right thoracic cavity. This approach overcomes the drawback of significant trauma associated with open surgery while ensuring safe esophageal resection margins and thorough lymph node dissection. This technique offers advantages including minimal invasiveness, accelerated postoperative recovery, and a reduced incidence of reflux esophagitis. To our knowledge, no similar method of digestive tract reconstruction has been reported in the literature. Its novelty and clinical potential may offer new therapeutic options for patients with Siewert type II adenocarcinoma of the esophagogastric junction (AEG).

Purpose To investigate the relationship between FN1 expression and clinical and pathologic features of laryngeal squamous cell carcinoma(LSCC)and the expression of tumor-associated macrophages(TAMs).Methods LSCC datasets GSE33232 and GSE84957 were analyzed and screened the differentially expressed gene FN1,and draw the receiver operating characteristic(ROC)curve.Bioinformatics analysis of FN1 expression,and prognosis in LSCC was performed.To investigate the effect of down-regulating FN1 expression in TU177 cells on the malignant bio-logical behavior of LSCC,we performed a scratch wound healing assay and a Transwell chamber assay to assess the effect of FN1 on cell proliferation,migration,and invasion in vitro.Immunohistochemical(IHC)staining was per-formed to detect the expression of FN1 and CD 163 in LSCC tissues.Results Analysis of the GSE33232 and GSE84957 datasets and online databases showed that FN1 was significantly overexpressed in LSCC tissues(P＜0.05),and patients with high FN1 expression had a significantly lower recurrence-free survival rate(HR=1.6,P=0.017).After transfection with si-FN1,the expression of FN1 in TU177 cells was significantly reduced(0.34±0.02 vs 1.00±0.03,P＜0.01).Compared with the control group,the down-regulation of FN1 expression inhibited the in vitro migra-tion(56.1±3.1 vs 19.23±1.0)and invasion(480±23 vs 288±20)ability of TU177 cells(both P＜0.01).Im-munohistochemistry findings showed that FN1 was highly expressed in both the tumor parenchyma(nest)and stromal cells of LSCC tissue,with a statistically significant difference[52.1％(24/46)vs 71.7％(33/46),P＜0.001].It was found that high expression of N-FN1 was associated with patients' pathological grade and lymph node metastasis(P＜0.05),while high expression of S-FN1 was associated with patients' age,lymph node metastasis,and TNM stage(P＜0.05).In addition,the co-expression of FN1 and CD163 was correlated with patients' pathological grad-ing,lymph node metastasis,and TNM stage(all P＜0.05).Conclusion FN1 and CD163 exhibit high expression levels in LSCC patients,which are closely associated with malignant progression,including invasion and metastasis.Notably,during LSCC progression,there may be a potential synergistic interaction between FN1 and CD 163-positive macrophages in the tumor microenvironment.