Objective:To investigate the risk factors and construct a nomogram model for predicting the occurrence of cirrhotic portal vein thrombosis in patients combined with esophagogastric variceal bleeding (EVB).Methods:Clinical data on 416 cirrhotic PVT cases was collected from the First Hospital of Lanzhou University between January 2016 and January 2022. A total of 385 cases were included after excluding 31 cases for retrospective analysis. They were divided into an esophagogastric variceal bleeding group and a non-esophagogastric variceal bleeding group based on the clinical diagnosis. The esophagogastric variceal group was then further divided into an EVB group and a non-bleeding group. All patients underwent gastroscopy, serology, and imaging examinations. The risk factors of PVT combined with EVB were identified by univariate analysis using SPSS 26. The prediction model of cirrhotic PVT in patients combined with EVB was constructed by R 4.0.4. The prediction efficiency and clinical benefits of the model were evaluated by the C-index, area under the receiver operating characteristic curve, calibration plots, and decision curve. The measurement data were examined by a t-test or Mann-Whitney U test. The counting data were tested using the χ2 test or the Fisher exact probability method. Results:There were statistically significant differences in the etiology, Child-Pugh grade,erythrocyte count, hematocrit, globulin, and serum lipids between the esophageal and non-esophageal varices groups ( P < 0.05). There were statistically significant differences in etiology, erythrocyte count, hemoglobin, hematocrit, neutrophil percentage, total protein, globulin, albumin/globulin, urea, high-density lipoprotein cholesterol, calcium, and neutrophil lymphocyte ratio (NLR) between the EVB and non-bleeding groups ( P < 0.05). Multivariate logistic regression analysis showed that etiology ( OR = 3.287, 95% CI: 1.497 ~ 7.214), hematocrit ( OR = 0.897, 95% CI: 0.853 ~ 0.943), and high-density lipoprotein cholesterol ( OR = 0.229, 95% CI: 0.071 ~ 0.737) were independent risk factors for cirrhotic PVT patients combined with EVB. The constructed normogram model predicted the probability of bleeding in patients. The nomogram model had shown good consistency and differentiation (AUC = 0.820, 95% CI: 0.707 ~ 0.843), as verified by 10-fold cross-validation (C-index = 0.799) and the Hosmer-Lemeshow goodness of fit test ( P = 0.915). The calibration plot and the decision curve suggested that the prediction model had good stability and clinical practicability. Conclusion:The risk factors for EVB occurrence include etiology, erythrocyte, hemoglobin, hematocrit, percentage of neutrophils, total protein, globulin, albumin/globulin, urea, high-density lipoprotein cholesterol, calcium, and NLR in patients with cirrhotic liver. The constructed prediction model has good predictive value, and it can provide a reference for medical personnel to screen patients with high bleeding risk for targeted treatment.

ObjectiveTo understand the pathogenic spectrum and epidemiological characteristics of severe acute respiratory infection （SARI） in adult inpatients in Yangpu District， Shanghai， China， in order to explore strategies for the prevention and treatment of respiratory infectious diseases. MethodsIndividual cases were from adult inpatients with SARI in Yangpu District， Shanghai， China from January 2019 to July 2021. Their respiratory samples were collected for etiological pathogen testing. ResultsA total of 681 SARI cases were enrolled for sampling and lab testing. Among them， 79.00% were aged 60 years and older， and 75.48% had confirmed chronic disease history. A total of 163 infection inpatients （23.94%） were positive for at least one pathogen. The pathogens identified most frequently were influenza A virus （6.75%）， followed by rhinovirus/enterovirus （3.23%）， parainfluenza virus （PIV） （2.79%）， Mycoplasma pneumoniae （2.35%）， coronavirus （CoV） （2.06%）. The positive rates of adenovirus （AdV）， human metapneumovirus （hMPV）， respiratory syncytial virus and bocavirus were all less than 2%. Bacterial strains were identified in eleven SARI cases， including Staphylococcus aureus and Pseudomonas aeruginosa （4 strains）， Klebsiella pneumoniae （3 strains）. Legionella pneumophila was detected in 9 cases （1.32%） and Bordetella pertussis in 5 cases （0.73%）. Two pathogens were co-detected from 11 cases， accounting for 1.62% of 163 positive cases. The most common co-detected pathogens were influenza A virus and other pathogens， accounting for 54.55% of the mixed infection. The positive rates of pathogens were not significantly different between less than 60 years old and over 60 years old groups except for Bordetella pertussis， adenovirus and Mycoplasma pneumonia（P<0.05）. Influenza virus had epidemic peak in winter and spring， but not in summer from 2019 to 2021. ConclusionVarious respiratory pathogens are detected from adult SARI cases. It is mainly influenza virus， with co-detected pathogens and rare pathogens. This study provides helpful information for targeted prevention and control measures including vaccination.

Objective:To investigate the clinical effect of open reduction and internal fixation for the treatment of double-column acetabular fractures by lateral rectus abdominis approach.Methods:A retrospective case series study was conducted to analyze the data of 44 patients with double-column acetabular fractures admitted to Shandong Provincial Hospital Affiliated to Shandong First Medical University from June 2015 to June 2019. There were 29 males and 15 females, with the age of 21-72 years [(41.3±8.4)years]. All patients were treated by open reduction and internal fixation through a single lateral rectus abdominis approach. Operation time, intraoperative blood loss and fracture healing time were recorded. The quality of fracture reduction was assessed according to the Matta reduction criteria, and hip function by the modified Merle D'Aubigne and Postel score at last follow-up. Postoperative complications were observed.Results:A total of 40 patients were followed up and 4 patients were lost to follow-up. The follow-up time was 12-46 months [(30.5±6.4)months]. The operation time ranged from 45 to 150 minutes[(111.2±20.6)minutes], and the intraoperative blood loss was 200-1 200 ml [(398.5±78.5)ml]. The fractures were healed, with the healing time of 10 to 16 weeks [(11.8±3.3)weeks]. At last follow-up, according to the Matta criteria, the results were excellent in 29 patients, good in 7, fair in 3, poor in 1, with the excellent and good rate of 90%. At last follow-up, according to the Merle D'Aubigne and Postel score, the results were excellent in 27 patients, good in 6, fair in 6, poor in 1, with the excellent and good rate of 83%. One patient had heterotopic ossification with no impact on hip function, and no special treatment was given. One patient with the reaction of foreign body was finally controlled by anti-infection treatment, and the internal fixation was removed again one year after operation. Three patients with mild osteoarthritis were relieved by oral anti-inflammatory and analgesic drugs. Two patients with deep venous thrombosis of lower extremities were cured by anti-coagulation therapy such as low molecular weight heparin.Conclusions:The single rectus abdominis approach for open reduction and internal fixation of double-column acetabular fractures can take into account the anterior column, quadrilateral body and posterior column. Meanwhile, this approach has advantages of satisfactory acetabular reduction and functional recovery, and less postoperative complications, suggesting an alternative procedure for treatment of double-column acetabular fractures.

Objective To explore the feasibility and safety of kidney transplantation for pre-sensitized infants using deceased donors and summarize the relevant literature reports .Methods A second kidney transplantation was successfully performed for an 8-month-old pre-sensitized girl in July 2017 .She had a low level of donor specific antibody (DSA ) against human leucocyte antigen (HLA ) B62 due to severe acute rejection (AR) after her first kidney transplantation .For desensitization , plasmapheresis and intravenous immunoglobulin plus anti-CD20 antibodies were offered on operative day .Clinical data and outcomes were retrospectively analyzed .Results Renal graft regained immediate function after transplantation .Preformed DSA could be detected at 1 week .However ,there was no de novo DSA .At 1 year post-transplantation ,preformed DSA turned negative .During a follow-up period of 2 years ,renal graft showed an excellent function with a serum creatinine of 31 μmol/l and eGFR of 110 ml/min/1 .73m2 .No AR episode or proteinuria occurred .DSA stayed negative .Simultaneously physical development also caught up .Her height of 93 cm tall and weight of 13 .5 kg at month 24 & 8 months corresponded to normal grow th curve of her age .Conclusions Pre-sensitized infant could tolerate desensitization therapy well and achieve satisfactory outcomes .With surgical precisions and optimized managements ,kidney transplantation provides excellent renal functions and survivals for infants with organs from deceased donors .

Objective To evaluate the efficacy of tigecycline plus prolonged high-dose meropenem infusion in the prevention and treatment of early carbapenem-resistant Klebsiella pneumoniae (CRKP) infection after renal transplantation .Methods From January 2016 to December 2018 ,clinical data were retrospectively analyzed for 13 renal transplant recipients with graft-carried CRKP .The relevant clinical data included treatments and outcomes of grafts and recipients .KPC-2 gene was the only resistance gene detectable in all isolates of CRKP . Among 13 CRKP positive recipients ,there were positive cultures of graft preservation solution ,recipient blood & urine (n=1) , positive cultures of graft preservation solution & urine (n=1) ,positive cultures of graft preservation solutions & peri-graft drainage (n=3) ,continuous positive cultures of peri-graft drainage more than twice (n= 3) and positive culture of graft preservation solution (n= 5).All patients received tigecycline plus prolonged high-dose meropenem infusion-based antibiotics .Results Five patients with CRKP positive in preservation solution were successfully prevented from infection after a treatment period of (12 .4 ± 2 .1)days .Among another 8 cases ,additional topical medications (n= 3) and surgical debridement (n= 1) were used .It took a median time of 16 (7～60) days until a negative culture and the total antibiotic treatment course was 20 (10～93) days .The average hospitalization duration was (50 ± 35) days .During a median follow-up period of 25 (6～28) months ,there was no onset of renal arterial rupture ,graft nephrectomy or death .The survival rate was 100％ for recipients and 92 .3％ for grafts .Conclusions For post-transplant infections due to graft-carried KPC-2 producing CRKP ,rapid diagnostics and tigecycline plus prolonged high-dose meropenem infusion may optimize clinical outcomes by decreasing the rate of graft nephrectomy and the recipient mortality .

Objective To analyze the safety of renal transplant from donors with primary central nervous system (CNS) tumors.Methods We retrospectively analyzed the clinical data of 33 donors with primary CNS tumors and the 63 corresponding renal recipients between January 2013 and December 2016 in Tongji Hospital.Results The mean period from diagnosis as primary CNS tumor to donation was about (21.8± 46.4) months (range:0.5 to 192.0 months).The pathological classification of these tumors included gliomas,meningioma,medulloblastoma,etc.Besides,there were 10 donors with high-grade CNS malignancies.Eleven donors have ever been through at least one of the four treatments (craniotomy,V-P/V-A shunt,radiotherapy and chemotherapy),14 donors have undergone none,and the clinical data of rest were unavailable.All the 63 recipients got well renal function after transplant.During an average follow-up of (15.9 ± 8.2) months (range:2.7 to 35.5 months),one recipient got donor-derived rhabdoid tumor 4 months posttransplant,underwent comprehensive treatments,including allograft nephrectomy,radiotherapy,chemotherpy and returned to hemodialysis,while the 62 cases got no donor-derived tumors.Conclusion Tumor transmission of renal allograft from donors with primary CNS tumors is inevitable but with low risk,which means this kind of donors can be used with careful assessment,full informed consent and good balance between wait-list death and tumor transmission.

Objective To investigate the feasibility and safety of the single kidney transplantation from pediatric donors to adult recipients.Methods From May 2013 to January 2017,a total of 50 single kidney transplants from pediatric donation after citizen death (DCD) donors of age between 3 to 12 years to adult recipients were performed and the data were summarized.Results The average age of donors was 6.4 ± 2.5 years with an average donor weight of 19.1 ± 5.9 kg,and the average kidney length was 6.3 ± 0.6 cm.For the 50 adult recipients,the average age was 38.5 ± 12.1 years,the average body weight was 56.1 ± 13.1 kg,and the number of female patients was 26 (52％).All except 3 of these patients were transplanted for the first time.Delayed graft function (DGF) was observed in 15 patients (30％).The average value of eGFR among all the patients was rapidly increased in the first 3 months after transplantation and then steadily increased to (82.3 ± 13.4) mL· min-1·1.73 m-2 at 1 st year,followed by (83.8 ± 22.5) mL· min-1·1.73 m-2 at 2nd year.Four renal grafts developed acute rejection (8％),and 3 of them were successfully reversed by the treatment.Pulmonary infection occurred in 4 recipients,and 2 died.During a follow-up period of 19 months,uncensored grafts survival was 94％,and patients survival was 96％.Conclusion Excellent intermediate-term transplant outcome can be achieved by using single kidneys from pediatric donors elder than 3 years,which may shorten the waiting time in adult recipients and alleviate the contradictions in the absence of suitable pediatric recipients.

Objective To observe the effect of different methods such as combined treatment of traditional Chinese and western medi-cine, the simple excision and expanded resection for the treatment of granulomatous lobular mastitis. Methods 60 cases of patients treated in our hospital from Jan. 2010 to Jan. 2013 were enrolled in this study, and they were confirmed the diagnosis of granulomatous lobular mas-titis by pathology examination. According to randomly number table, they were divided into three groups and they were given the treatment of combined treatment of traditional Chinese medicine and Western medicine, the simple excision, and expanded resection respectively. Where-after, the therapeutic effect of the three groups were observed. Results There were 9 cases (45. 0%) were of cure and 11 cases (55. 0%) of recurrence in the combined treatment group. There were 16 cases (80. 0%) of cure and 4 cases (20. 0%) of recurrence in the simple ex-cision group. There were 8 cases (90. 0%) of cure and 2 cases (10. 0%) of recurrence in the combined treatment group. It shows that the recurrence rate of combined treatment group was higher than the other two groups (P<0. 05). The satisfactory rate of breast appearance after treatment were 17 (85%), 15 (75%) and 16 (80%) respctively, and there is no significant difference (P>0. 05). Conclusion The effect of extended resectionin for the treatment of granulomatous is better and it has important clinical value.

Objective To investigate the clinical pattern,therapeutic principle and influencing factors of interstitial pneumonia in renal allograft recipients.Method The general information,clinical manifestation,treatment and outcomes of 30 recipients with interstitial pneumonia after renal transplantation from Nov.2006 to Dec.2013 were analyzed retrospectively.Result Twenty-nine of 30 patients developed interstitial pneumonia between 2 to 6 months post-transplant.The total course of the pneumonia lasted for 34.9 ± 7.5 days on average.Chest CT scans were used to monitor severity of interstitial pneumonia each week.The mean duration between the onset to the fastigium of pneumonitis was approximately 14.8 ± 1.9 days.The mean duration of the fastigium lasted for 7.3 ±3.6 days,after that the patients usually started to recover.Deteriorated chest CT scan findings and long terms of the fastigium usually indicated poor outcomes.The mean duration of the recovery period was 13.1 ± 3.7 days.After adjusted administration of methylprednisolone,antibiotics,antifungal agents,nutritional support as well as immunosuppressive drugs,23 patients with mild and moderate pneumonia by the chest CT scans were cured and discharged.However,4 of the 7 patients with severe pneumonia by the chest CT scans died.Conclusion The progression of interstitial pneumonia after renal transplantation is characterized by a more consistent regularity.After adjusted administration of methylprednisolone,antibiotics,antifungal agents,nutritional support as well as immunosuppressive drugs,renal allograft recipients with interstitial pneumonia could obtain a good therapeutic effect without over-treatment.

Objective To investigate the safety and efficacy of pegylated interferon (PEG-IFN) and ribavirin for chronic hepatitis C following renal transplantation.Method Nine adult renal transplant recipients of ＞ 12-month duration,infected with hepatitis C virus (HCV),and with stable renal graft function were recruited.All patients were administered with PEG-IFN-α 2b 50 μg/week,plus ribovirin 400-600 mg/day.HCV viral load was reexamined monthly.Consolidation therapy lasted for 3-9 months after initial remission of HCV-RNA.Viral response,adverse effects and changes in hemogram,alanine aminotransferase and andserum creatinine were also monitored.Result The duration of treatment for 9 patients was 4-20 months.Sustained virologic response (SVR) occurred in 6 patients with no relapse during 6-month follow up period after the ceasation of the treatment.Two patients,with rapid virologic response,had a virologic relapse after completing their 3-month consolidation therapy.One patient maintained no obvious virologic response during 8 months of treatment.Renal function was kept in normal range in all patients and no one experienced a rejection episode during or after PEG-IFN-α 2b therapy.The major adverse reactions included influenza-like syndrome (fever,muscle soreness,anorexia),transient bone marrow suppression and anemia.All of the adverse reactions were transient and tolerable,and no discontinuation of PEG-IFN-a 2b therapy was required in all these patients.Conclusion For renal transplant recipients with stable renal graft function,treatment with PEG-IFN-α 2b and ribavirin has high efficacy in the treatment of HCV and is not associated with high risk of acute rejection of renal allografts.