Obesity has become one of the important factors affecting the entire management process of liver transplantation. Its impact is not only reflected in the increased risk of liver steatosis and ischemia-reperfusion injury in the donor, but also involves the increased technical difficulty during the perioperative period for the recipient, the increase in postoperative metabolic complications and poorer long-term prognosis. This article, based on recent relevant studies, reviews aspects such as the utilization of obese donors, the characteristics of adult and pediatric recipients, pre-transplant risk assessment and weight loss intervention, and post-transplant weight and metabolic management. Current evidence suggests that simply judging transplantation risks based on body mass index has limitations. Analysis of body composition, assessment of cardiovascular function and identification of sarcopenic obesity are more clinically valuable. For obese liver transplant recipients, in a multidisciplinary collaboration framework, emphasis should be placed on individualized screening, perioperative optimization and long-term follow-up management to improve the outcomes of the graft and the recipient.

Liver transplantation is currently one of the most effective treatment methods for end-stage liver disease， and early postoperative mortality （typically defined as within 30 or 90 days after surgery） remains a key issue affecting the prognosis of patients. This article systematically reviews the research advances in early mortality following liver transplantation， elaborates on the definition， incidence rate， and clinical significance of early mortality， and discusses related risk factors from multiple dimensions， including donor factors， the preoperative status of the recipient， surgical techniques， postoperative complications， and immunosuppressive management. Furthermore， it analyzes the development and application of risk prediction models based on machine learning and big data in recent years and compares the predictive efficacy of different models. Meanwhile， this article summarizes the limitations of existing studies and explores future research directions， so as to provide a theoretical basis for the early identification of high-risk patients and the optimization of intervention strategies to reduce early mortality rates in clinical practice.

For patients with hepatitis B virus (HBV) related hepatocellular carcinoma (HCC) who undergo liver transplantation, tumor recurrence remains the main factor limiting long-term survival. Current evidence suggests that tumor recurrence after transplantation is not merely the continuation of preoperative tumor remnants, but is also related to HBV DNA integration-driven clonal evolution, impaired anti-tumor immunity in the context of immunosuppression and the long-term interaction between the two. This article, based on recent studies, focuses on three aspects: the role of HBV DNA integration and related genomic rearrangements in the formation of recurrent clones, the impact of post-transplant immunosuppression on T cells, myeloid cells and innate immune effects, and the application progress of monitoring minimal residual disease represented by circulating tumor DNA in tumor recurrence warning and risk stratification. Combined with the actual clinical management of liver transplantation, this article discusses the limitations of current evidence and the subsequent research directions that deserve attention, providing a reference for the precise monitoring and stratified intervention of tumor recurrence after HBV-HCC liver transplantation.

OBJECTIVETo compare the differences in pain reaction, hemodynamics and clinical efficacy between extracorporeal shock wave lithotripsy (ESWL) after injection with flurphen mixture (mixture of droperidol and fentanyl citrate) at Shenshu (BL 23) and simple ESWL in the patients.

METHODSSixty-four cases of urinary calculi with ESWL were randomized into an observation group and a control group, 32 cases in each one. In the observation group, 15 to 20 min before ESWL, flurphen mixture (droperidol injection 1.25 mg and fentanyl citrate injection 0.05 mg were diluted to 6 mL with 0.9% sodium chloride solution 4.5 mL) was injected at bilateral Shenshu (BL 23). In the control group, no any adjuvant therapy and medication were used before ESWL. The changes in blood pressure and heart rate, visual analogue scale (VAS) score, lithotripsy frequency till calculi complete removal and the rate of calculi complete removal after the first lithotripsy were observed in the two groups.

RESULTSIn the control group, blood pressure and heart rate were higher during lithotripsy than those before lithotripsy (both P<0.05). In the observation group, the differences in blood pressure and heart rate were not significant statistically as compared with those before lithotripsy (both P>0.05). The blood pressure and heart rate during lithotripsy in the observation group were apparently lower than those in the control group (both P<0.05). VAS scores during lithotripsy in the observation group were lower apparently than those in the control group (both P<0.05). The lithotripsy frequency in the observation group was less than that in the control group. The rate of calculi complete removal in 1 week after the first lithotripsy in the observation group was higher than that in the control group [75.0% (24/32) vs 50.0% (16/32), P<0.05].

CONCLUSIONThe flurphen mixture at Shenshu (BL 23) significantly alleviates pain reaction in patients undergoing ESWL, avoids the fluctuation of hemodynamics and improves the clinical effect of lithotripsy.

Acupuncture Points ; Adolescent ; Adult ; Aged ; Analgesics ; administration & dosage ; Female ; Hemodynamics ; Humans ; Kidney Calculi ; therapy ; Lithotripsy ; adverse effects ; Male ; Middle Aged ; Pain ; drug therapy ; etiology ; Young Adult