Kidney transplantation is the most ideal treatment method for end-stage renal disease, significantly improving the survival rate and quality of life of patients. However, as the postoperative survival period gradually lengthens, chronic diseases have become the main obstacle affecting the long-term outcome of kidney transplantation. These chronic diseases have a high incidence, involve multiple organs and significantly impact prognosis. The core driving factors are mainly related to long-term immunosuppressive therapy. This article systematically discusses the occurrence mechanisms, prevention and treatment strategies, and classification management of common chronic diseases after kidney transplantation (mainly including chronic graft dysfunction, cardiovascular diseases, infections, malignant tumors, bone metabolism disorders, etc.). At the same time, it explores future development directions such as precision medicine, new immune modulators and remote management, emphasizing a comprehensive management model centered on "multidisciplinary collaboration + individualized treatment + continuous monitoring" to achieve long-term, systematic, and dynamic prevention and treatment of chronic diseases for kidney transplant recipients.

Inflammatory bowel disease (IBD) is an autoimmune disorder involving complex immune regulation, where balancing localized and systemic immunosuppression is a key challenge. This study aimed to enhance the therapeutic efficacy by engineering the probiotic Escherichia coli Nissle 1917 (EcN). We removed endogenous plasmids pMUT1 and pMUT2 from wild-type EcN and expressed the mPD-L1 (19‒238 aa)-mFc fusion protein on the bacterial surface using a cytolysin A (ClyA) fragment. This modification stabilized mPD-L1 (19‒238 aa) protein expression and promoted its recruitment to outer membrane vesicles (OMVs). The engineered strain, EcNΔ_pMUT1/2-ClyA-mPD-L1-mFc (EcN-ePD-L1-mFc), features conditional ePD-L1-mFc expression under the araBAD promoter, enhancing gut-targeted release and reducing systemic side effects. This strain improved treatment targeting and efficiency by enabling direct ePD-L1-mFc interaction with immune cells at inflammation sites. OMVs from this strain induced Treg proliferation, inhibited effector T cell proliferation in vitro, and significantly improved intestinal inflammation and colonic epithelial barrier repair in vivo. Additionally, the bacterium restored intestinal microbiota balance, increasing Lactobacillaceae and reducing Bacteroides. This study highlights the engineered bacterium's potential for targeted intestinal immune modulation and offers a novel local IBD treatment approach with promising clinical prospects.

Objective: To investigate the efficacy，safety and feasibility of regional lymph node dissection in laparoscopic radical surgery for bladder cancer under the guidance of indocyanine green fluorescence imaging. Methods: A total of 30 patients with muscle invasive bladder cancer (T2/T3NxM0) who volunteered to enter the clinical trial were randomly divided into the indocyanine green imaging guided laparoscopic regional lymph node dissection group (n=15) and the standard pelvic lymph node dissection group (n=15).The number of positive lymph nodes，operation time，intraoperative bleeding volume，incidence of lymph leakage，and tumor recurrence and metastasis rate 2-year after surgery were collected. Results: The number of positive lymph nodes was (4.20±1.66) and (4.60±1.72) respectively in the indocyanine green and standard groups，with no statistically significant difference (P>0.05).There were no statistically significant difference in the tumor recurrence and metastasis rates 2-year after surgery between the two groups (P>0.05).However，the indocyanine green group had shorter operation time，less intraoperative bleeding volume，and lower incidence of lymphatic leakage than the standard group (P<0.05). Conclusion: Indocyanine green fluorescence imaging guided laparoscopic lymph node dissection has comparable clinical efficacy to standard lymph node dissection，but with fewer complications.

In order to further standardize the vaccination of kidney transplant candidates and recipients in China, the Branch of Organ Transplantation of Chinese Medical Association has organized experts in kidney transplantation and infectious diseases. Based on the "Vaccination of Solid Organ Transplant Candidates and Recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice", and in combination with the clinical reality of infectious diseases and vaccination after organ transplantation in China, as well as referring to relevant recommendations from home and abroad in recent years, these guidelines are formulated from aspects such as epidemiology, types of vaccines, vaccination principles, target population, and specific vaccine administration. The "Guidelines for Vaccination of Kidney Transplant Candidates and Recipients in China" aims to provide theoretical reference for medical workers in the field of kidney transplantation in China, regarding the vaccination of kidney transplant candidates and recipients. It is expected to better guide the vaccination of kidney transplant candidates and recipients, reduce the risk of postoperative infection, and improve survival outcomes.

OBJECTIVE: To investigate the effectiveness of digital three-dimensional (3D) assisted unilateral biportal endoscopy (UBE) in the treatment of highly isolated lumbar disc herniation (LDH) with translaminar approach. METHODS: The clinical data of 59 patients who met the selection criteria and underwent UBE treatment due to highly isolated LDH between January 2022 and December 2023 were retrospectively analyzed. Among them, 25 cases were treated with digital 3D assisted translaminar approach (observation group) and 34 cases were treated with interlaminar approach (control group). There was no significant difference in gender, age, disease duration, surgical segment, and preoperative visual analogue scale (VAS) score and Oswestry disability index (ODI) between the two groups ( P>0.05). The operation time, intraoperative blood loss, and lateral articular surface preservation rate were recorded and compared between the two groups. VAS score and ODI were used to evaluate the improvements of pain and function before operation and at 3 and 6 months after operation. The modified MacNab criteria was used to evaluate the effectiveness at last follow-up. RESULTS: One patient in the control group had dural tear, and the other patients had no nerve injury, infection, dural tear, or other related complications. There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). Patients in both groups were followed up 6-13 months, with an average of 8.3 months. The lateral articular surface preservation rate in the observation group was significantly higher than that in the control group ( P<0.05). Three patients in the observation group and 2 patients in the control group had calf muscle venous thrombosis, which was cured after anticoagulant treatment with rivaroxaban and delayed exercise time. There was no recurrence or second operation during the follow-up period. The VAS score and ODI of the two groups at 3 and 6 months after operation significantly improved when compared with those before operation ( P<0.05). There was no significant difference between the two groups at each time point after operation ( P>0.05). At last follow-up, the effectiveness was evaluated according to the modified MacNab criteria, and there was no significant difference in the evaluation grade and excellent and good rate between the two groups ( P>0.05). CONCLUTION UBE via translaminar approach is safe and effective for the treatment of highly isolated LDH, which is beneficial to protect the facet joint, maintain spinal stability, and reduce soft tissue injury. With the assistance of digital 3D technique, preoperative planning can be performed accurately.
Humans ; Intervertebral Disc Displacement/diagnostic imaging* ; Lumbar Vertebrae/diagnostic imaging* ; Male ; Retrospective Studies ; Female ; Endoscopy/methods* ; Treatment Outcome ; Middle Aged ; Adult ; Imaging, Three-Dimensional ; Operative Time ; Pain Measurement

Transcatheter aortic valve replacement(TAVR)has become an important therapeutic approach for severe aortic stenosis.However,complications associated with TAVR cannot be overlooked,among which contrast agents induced acute kidney injury(AKI)is a common complication.To explore methods to reduce the occurrence of AKI,this article reports two cases of successful treatment of severe aortic stenosis by TAVR under pure echocardiographic guidance,both of whom were elderly women aged 75 and 69,respectively,and both were implanted with a Evolute Pro 26 mm valve.Postoperative echocardiography showed good valve positioning and function.

Objective:To investigate the factors influencing the occurrence of deep vein thrombosis(DVT)in patients with knee osteoarthritis after artificial total knee arthroplasty(TKA)and to construct a nomogram prediction model.Methods:A total of 120 patients with knee osteoarthritis underwent TKA from Dec 2020 to Dec 2022 were selected.The patients were divided into DVT group(n=20)and non-DVT group(n=100)according to whether DVT occurred after surgery.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of each influencing factor to the occurrence of DVT.Multivariable logistic regression was used to analyze the factors affecting the occurrence of DVT.The nomogram prediction model of DVT was constructed by the R software 4.0"rms"package.The calibration and decision curves were used to internally validate and clinically assess the predictive efficacy of the nomogram prediction model.Results:There were significant differences between DVT group and non-DVT group in age,body mass index(BMI),diabetes mellitus,hyperlipidaemia,plasma D-dimer level,operative time,intraoperative haemorrhage,post-operative bedrest,and anaesthesia modality(P＜0.05).ROC curve showed that the AUC for age,BMI,plasma D-dimer,operative time,intraoperative haemorrhage,and postoperative bedrest were 0.663,0.678,0.985,0.856,0.925 and 0.925,respectively.Multivariable logistic regression analysis showed that age≥71 years old,BMI≥25.47 kg/m2,diabetes mellitus,hyperlipidaemia,plasma D-dimer level≥0.69 mg/L,and general anaesthesia were independent risk factors for postoperative DVT(P＜0.05).The calibration curve of the nomogram prediction model was close to the original and ideal curves,with a C-index of 0.813(0.721-0.905),indicating a high degree of fit.The threshold value of the nomogram prediction model was＞0.17,which could provide a net clinical benefit.And its net clinical benefit was higher than age,BMI,diabetes mellitus,hyperlipidemia,plasma D-dimer,and anaesthesia mode.Conclusions:The factors affecting the occurrence of DVT in patients with knee osteoarthritis after TKA are age,BMI,diabetes mellitus,hyperlipidaemia,plasma D-dimer level,operative time,intraoperative haemorrhage,postoperative bedtrest,and anaesthesia mode.The personalized neomorph prediction model constructed by these predictive factors can help to predict and evaluate whether DVT will be occurred in patients with knee osteoarthritis after TKA,so as to intervene early,reduce the incidence and improve the prognosis.

Transcatheter aortic valve replacement(TAVR)has become an important therapeutic approach for severe aortic stenosis.However,complications associated with TAVR cannot be overlooked,among which contrast agents induced acute kidney injury(AKI)is a common complication.To explore methods to reduce the occurrence of AKI,this article reports two cases of successful treatment of severe aortic stenosis by TAVR under pure echocardiographic guidance,both of whom were elderly women aged 75 and 69,respectively,and both were implanted with a Evolute Pro 26 mm valve.Postoperative echocardiography showed good valve positioning and function.

Objective:To investigate the factors influencing the occurrence of deep vein thrombosis(DVT)in patients with knee osteoarthritis after artificial total knee arthroplasty(TKA)and to construct a nomogram prediction model.Methods:A total of 120 patients with knee osteoarthritis underwent TKA from Dec 2020 to Dec 2022 were selected.The patients were divided into DVT group(n=20)and non-DVT group(n=100)according to whether DVT occurred after surgery.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of each influencing factor to the occurrence of DVT.Multivariable logistic regression was used to analyze the factors affecting the occurrence of DVT.The nomogram prediction model of DVT was constructed by the R software 4.0"rms"package.The calibration and decision curves were used to internally validate and clinically assess the predictive efficacy of the nomogram prediction model.Results:There were significant differences between DVT group and non-DVT group in age,body mass index(BMI),diabetes mellitus,hyperlipidaemia,plasma D-dimer level,operative time,intraoperative haemorrhage,post-operative bedrest,and anaesthesia modality(P＜0.05).ROC curve showed that the AUC for age,BMI,plasma D-dimer,operative time,intraoperative haemorrhage,and postoperative bedrest were 0.663,0.678,0.985,0.856,0.925 and 0.925,respectively.Multivariable logistic regression analysis showed that age≥71 years old,BMI≥25.47 kg/m2,diabetes mellitus,hyperlipidaemia,plasma D-dimer level≥0.69 mg/L,and general anaesthesia were independent risk factors for postoperative DVT(P＜0.05).The calibration curve of the nomogram prediction model was close to the original and ideal curves,with a C-index of 0.813(0.721-0.905),indicating a high degree of fit.The threshold value of the nomogram prediction model was＞0.17,which could provide a net clinical benefit.And its net clinical benefit was higher than age,BMI,diabetes mellitus,hyperlipidemia,plasma D-dimer,and anaesthesia mode.Conclusions:The factors affecting the occurrence of DVT in patients with knee osteoarthritis after TKA are age,BMI,diabetes mellitus,hyperlipidaemia,plasma D-dimer level,operative time,intraoperative haemorrhage,postoperative bedtrest,and anaesthesia mode.The personalized neomorph prediction model constructed by these predictive factors can help to predict and evaluate whether DVT will be occurred in patients with knee osteoarthritis after TKA,so as to intervene early,reduce the incidence and improve the prognosis.

Objective:To observe the clinical efficacy of unilateral biportal endoscopy (UBE) assisted bilateral decompression in the treatment of lumbar disc herniation with imaging herniation on one side and clinical symptoms on the contralateral side.Methods:A total of 20 patients with lumbar disc herniation with imaging herniation on one side and clinical symptoms on the contralateral side treated with UBE from January 2022 to January 2024 in the Affiliated Hospital of Binzhou Medical University were retrospectively analyzed. There were 9 males and 11 females, aged 50.4±14.0 years (range, 23-72 years). The intervertebral disc herniation level included L 3-4 in 1 case, L 4-5 in 15 cases, and L 5S 1 in 4 cases. There were 10 cases on the left side and 10 cases on the right side. The duration of symptoms was 24.1±33.7 months (range, 1-120 months). Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate postoperative pain relief and functional recovery. The clinical efficacy was evaluated by modified MacNab criteria at 6 months after operation. Results:All patients successfully completed the operation. The operation time was 90.3±24.6 min (range, 55-134 mins). The VAS scores of patients at 3 days, 1 month, 3 months and 6 months after operation were 3.6±0.9, 2.2±0.7, 1.2±0.5 and 1.0±0.6, respectively, which were lower than those before operation (6.4±0.8), and the differences were statistically significant ( F=668.728, P<0.001). The ODI at 3 days, 1 month, 3 months and 6 months after operation were 34.2%±4.7%, 28.7%±2.8%, 24.3%±2.1% and 20.5%±2.0%, respectively, which were lower than 69.4%±5.2% before operation, and the differences were statistically significant ( F=515.578, P<0.001). The clinical efficacy was evaluated by modified MacNab criteria at 6 months after operation. Among 20 patients, 18 cases were excellent, 1 case was good, and 1 case was fair. All patients were followed up for 9.1±2.1 months (range, 6-14 months). One patient had a dural tear during the operation, but the range was small and there was no defect, and no further treatment was performed. Numbness of the lower limbs occurred 1 day after operation, and the symptoms disappeared after symptomatic treatment. There was no recurrence of lower limb symptoms, lumbar instability, intervertebral space infection or other complications at the last follow-up. Conclusion:Bilateral decompression with UBE is effective in the treatment of lumbar disc herniation with imaging herniation on one side and clinical symptoms on the contralateral side, which can improve the lumbar pain and function of patients.