Viral infection has always been a significant challenge to human health. Transplant recipients, including those who have undergone solid organ transplantation and allogeneic hematopoietic stem cell transplantation, are at high risk of viral infection due to their weak immune function under immunosuppressive therapy. Unlike the general population, transplant recipients are prone to pneumonia and even severe pneumonia after respiratory viral infection, which requires close attention from clinicians. Therefore, this article reviews the clinical characteristics and special management of viral infection in this population, focusing on the epidemiological features of common respiratory viral infection in transplant recipients, early diagnosis and intervention after infection, severe warning signs and drug treatment strategies, for the reference of clinical colleagues.

Objective To observe the clinical effects of Yiweining Capsules combined with rebamipide tablet in the treatment of spleen-stomach qi deficiency syndrome in chronic atrophic gastritis(CAG).Methods Totally 80 patients with CAG were divided into the study group and the control group by using the random number table method,with 40 cases in each group.Both groups were given rebamipide tablet,0.1 g/time,3 times a day,orally;on this basis,the study group added Yiweining Capsules 2 g/time,3 times a day,orally.Both groups were treated continuously for 12 weeks.The TCM efficacy,the efficacy of gastroscopy and the efficacy of histopathology in the two groups were observed.The TCM symptom score before and after treatment in two groups were observed.The adverse reactions were recorded.Results No cases fell off in both groups.The total effective rate was 92.5%(37/40)in the study group and 70.0%(28/40)in the control group,and the clinical efficacy of the study group was better than that of the control group(P<0.01).Compared with before treatment,the total TCM symptom scores in the two groups after treatment decreased(P<0.01);Compared with after treatment,the total scores of TCM symptom in the study group were lower than those in the control group(P<0.05,P<0.01).The total effective rate of gastroscopy in the study group(82.5%)was better than that in the control group(67.5%),with statistical significance(P<0.05).The overall efficacy rate of histopathdogy in the study group(87.5%)was better than that of the control group(70.0%),with statistical significance(P<0.01).There were no adverse reactions in both groups.Conclusion Yiweining Capsules combined with rebamipide tablet can effectively improve the clinical symptoms,gastroscopic manifestations and the degree of mucosal lesions in patients with CAG,with remarkable efficacy.

OBJECTIVE: To investigate short-term effectiveness of arthroscopic repair via modified subacromial viewing portal (hereinafter referred to as modified viewing portal) in treatment of LafosseⅠsubscapularis tendon tears. METHODS: A clinical data of 52 patients with LafosseⅠsubscapularis tendon tears, who underwent the arthroscopic repair via modified viewing portal between October 2020 and November 2022 and met the selective criteria, was retrospectively analyzed. There were 15 males and 37 females with an average age of 63.4 years (range, 41-76 years). Twelve patients had trauma history and the other 40 patients had no obvious inducement. The main clinical symptom was shoulder pain and the hug resistance tests were positive in all patients. The interval between symptom onset and admission ranged from 3 to 26 months (mean, 7.2 months). The shoulder pain and function were evaluated by visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and University of California Los Angeles (UCLA) score before operation and at 12 months after operation. The shoulder range of motion (ROM) of forward flexion, abduction, and external rotation and the internal rotation strength were measured before operation and at 3 and 12 months after operation. MRI was performed at 3-6 months after operation to assess the tendon healing and the structural integrity and tension of reattached tendon. Patient's satisfactions were calculated at last follow-up. RESULTS: All incisions healed by first intention, no complication such as incision infection or nerve injury occurred. All patients were followed up 12-37 months (mean, 18.5 months). The VAS, UCLA, and ASES scores at 12 months after operation significantly improved when compared with those before operation ( P<0.05). The ROMs of abduction and forward flexion and the internal rotation strength at 3 and 12 months significantly improved when compared with those before operation ( P<0.05); and the ROMs at 12 months significantly improved compared to that at 3 months ( P<0.05). However, there was no significant difference ( P>0.05) in the ROM of external rotation at 3 months compared to that before operation; but the ROM at 12 months significantly improved compared to that before operation and at 3 months after operation ( P<0.05). Thirty-one patients underwent MRI at 3-6 months, of which 28 patients possessed intact structural integrity, good tendon tension and tendon healing; 3 patients underwent tendon re-tear. At last follow-up, 41 patients (78.8%) were very satisfied with the effectiveness, 7 were satisfied (13.5%), and 4 were dissatisfied (7.7%). CONCLUSION Arthroscopic repair via modified viewing portal for Lafosse Ⅰsubscapularis tendon tears, which can achieve the satisfactory visualization and working space, can obtain good short-term effectiveness with low overall re-tear risk.
Male ; Female ; Humans ; Middle Aged ; Rotator Cuff/surgery* ; Rotator Cuff Injuries/surgery* ; Shoulder Pain ; Retrospective Studies ; Treatment Outcome ; Arthroscopy ; Shoulder Joint/surgery* ; Tendons/surgery* ; Range of Motion, Articular

Objective:To analyze the operational efficiency of the oncology department in multi-campus hospital, providing reference for rational resource allocation and efficiency enhancement.Methods:A certaion tertiary grade A Hospital is a multi-campus public hospital with integrated management. This study focused on its oncology department, with 9 wards located in different campus as decision-making units. Data from 2020 to 2022 were extracted from the hospital′s medical records management system, disease diagnosis-related groups management system, and hospital information system. The super-efficiency DEA model and Malmquist index model were used to evaluate efficiency variations of the oncology department in different time slots and decision-making units. Identifying input redundancies and output deficiencies in wards not achieving constant returns to scale through projection value analysis. Selecting the total number of medical staff and the actual total number of bed-days occupied as input indicators, while bed utilization rate, discharge rate, and case mix index as output indicators.Results:From 2020 to 2022, the wards with a DEA super-efficiency value greater than 1 were 0, 2, and 4, respectively, showing a gradual increase in overall efficiency. In 2022, wards S3, S4, S7, and S9 achieved constant returns to scale with super-efficiency values of 1.001, 1.005, 1.113, and 1.112, respectively. The other five wards had zero input redundancy, but some suffered from insufficient outputs. For example, wards S5 and S8 should increase their bed utilization rates by 5% and 4%, respectively. Wards S1 and S8 needed to increase their annual discharge numbers by 24% and 1%, respectively, while wards S2 and S6 should increase their annual case mix index by 21% and 20%, respectively. From 2020 to 2021, the Malmquist index of the oncology department was 0.959, while from 2021 to 2022 it rose to 1.030, and the Malmquist index of each ward was greater than 1.Conclusions:By implementing integrated management across multiple campus, the operational efficiency of the oncology department has been comprehensively improved. The use of the super efficient DEA-Malmquist index model to evaluate the operational efficiency of departments has practical significance.

Objective:To explore the therapeutic characteristics of population with gout achieving treat-to-target (T2T) indicators through real-world research and evaluate their safety.Methods:A total of 3 287 patients diagnosed with gout by rheumatologists in 21 first-class tertiary hospitals in 10 provinces, municipalities, and autonomous regions in China from January 2015 to December 2021 were included in this polycentric cross-sectional study. The database included patients′ general information, disease characteristics, and clinical application of traditional Chinese and Western medicine treatment measures. SPSS and Excel software were used for data analysis. Frequency analysis, cluster analysis, and factor analysis were used to summarize the characteristics and rules of treatment measures for patients with gout who achieved the target after treatment. The occurrence of adverse events (AE) was recorded during treatment.Results:After treatment, 691 visits (7%) achieved the serum urate (SUA) target, and the most frequent use of urate-lowering therapy (ULT) was febuxostat, followed by benzbromarone. The most common treatment options were following: GroupⅠ: traditional Chinese medicine (TCM) decoction-TCM external treatment-physical exercise-proprietary Chinese medicine; GroupⅡ: ferulic acid-nonsteroidal anti-inflammatory drugs (NSAIDs); Group Ⅲ: allopurinol-sodium bicarbonate-benzbromarone; Group Ⅳ: glucocorticoid-colchicine; Group Ⅴ: febuxostat. A total of 5 898 visits (60%) chieved manifestations of joint pain VAS scores target, and the most frequently used drug to control joint symptoms was NSAIDs. The frequency of use of drugs to control joint symptoms were 2 118 times (usage rate reached 35.9%), while the frequency of ULT were 2 504 times (usage rate reached 42.5%), which was higher than the joint symptom control drug. The most common treatment options were following: Group Ⅰ: proprietary Chinese medicine-TCM decoction-TCM external treatment-physical exercise; Group Ⅱ: NSAIDs-colchicine hormones; Group Ⅲ: allopurinol, Group Ⅳ: benzbromarone; Group Ⅴ: febuxostat. A total of 59 adverse events occurred during treatment.Conclusion:The proportions of gout patients who reach target serum urate level & good control of joint symptoms are both very low, and ULT and anti-inflammatory prescription patterns are very different from international guidelines, so it is necessary to strengthen the standardized management of gout patients. At the same time, life intervention measures account for a certain proportion of the treatment plans for the T2T population, and further exploration is needed.

Progressive multifocal leukoencephalopathy (PML) is a rare and yet serious central nervous system disorder due to JC viral infection.PML occurs predominantly in immunocompromised individuals, including solid organ transplant (SOT) recipients.Clinically, SOT-related PML commonly presents as cognitive and behavioral impairments. Pathologically, PML is characterized by multifocal demyelinating lesions, with neuroimaging technique typically revealing white matter damage in the temporoparietal regions. Clinical diagnosis usually involves integrating clinical manifestations, cranial magnetic resonance imaging, and detection of JC virus in cerebrospinal fluid. Currently, specific medications for PML are lacking, and the treatment mainly relies on supportive care and immunomodulatory strategies. The prognosis of PML remains unfavorable, early diagnosis and enhanced adaptive immune responses are crucial for PML management in SOT recipients.

Currently COVID-19 variant virology and its prevalence both domestically and internationally have become a new norm.With the emergence of Omicron variant, the protective effect of original preventive measures against reinfection with variant strains has declined.Current prevalence of COVID-19 variant strains, the mechanisms of reinfection and the risks of reinfection in solid organ transplant recipients(SOTR)were discussed.Immunocompromised individuals, especially SOTR, face an elevated risk of multiple infections, such as seasonal influenza and respiratory syncytial virus, during high transmission seasons for respiratory viruses and require special care and protection.With the introduction of several small molecule drugs, there are now more options available for antiviral regimens.This review offered a brief overview of the characteristics of COVID-19 variant strains in the current scenario, disease incidence among SOTR in China, unique features of novel antiviral agents and optimizing the selection of diagnostic and therapeutic plans.

Objective:To explore the clinical effect of a modified single-trunk arterialised venous flap in reconstruction of soft tissue defect in hand and foot.Methods:From January 2019 to June 2022, 25 patients with soft tissue defect in hand and foot were treated in the Department of Hand and Foot Plastic Surgery of Lecong Hospital of Shunde in Foshan. The soft tissue defects were reconstructed with a venous flap, of which a single trunk of vein was ligated and then a blood flux of the flap was re-established via a modified single vein trunk. One patient had soft tissue defect in dorsal foot and toes, 3 patients had defects in dorsal hand, 3 patients had defects in 2 digits and 18 patients had defects in single-digit. The sizes of defects were 2.0 cm×1.0 cm-10.0 cm×4.5 cm. The sizes of flaps were 2.0 cm×1.0 cm-12.0 cm×5.5 cm. Donor sites of the 19 cases were directly sutured and 6 were covered by skin grafts. The postoperative follow-ups were conducted at outpatient clinics and via telephone reviews to observe the survival of flaps. Functional recovery of 23 cases whose soft tissue defects in hand were evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association. The sensory recovery of flaps was evaluated according to the comprehensive flap scale.Results:All 25 single-trunk venous flaps survived successfully. There were small number of blisters on 5 flaps, due to tissue oedema. One patient lost in follow-up. The other 24 patients had 2-18 months of follow-up. The appearance of flaps was soft and thin, with wear-resistant. According to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, the function recovery were excellent in 12 cases, good in 9 cases and poor in 2 cases. Sensations of the flaps were 90-99 point with an average of 97 point according to the comprehensive flap scale, of which 22 flaps were in excellent and 2 in good.Conclusion:The method of ligation of single vein-trunk to make a arterialised venous flap is a simple surgical procedure. There are many selections of donor site with minimum damage. It is an effective method and with satisfactory outcomes.

Objective To analyze the changes of postoperative pulmonary function in lung transplant recipients. Methods Clinical data of 81 recipients undergoing bilateral lung transplantation and combined heart-lung transplantation were collected, and postoperative status of the recipients was analyzed. Pulmonary ventilation and diffusion function indexes at 1 month, 3 months, every 3 months (3-18 months after lung transplantation) and every 6 months (18-36 months after lung transplantation) were analyzed in the recipients. The characteristics of the optimal pulmonary function in the recipients were assessed. Results Postoperative mechanical ventilation time was 4 (2, 9) d, and the length of postoperative ICU stay was 10 (7, 20) d. Among 81 recipients, 27 recipients developed primary graft dysfunction (PGD) after lung transplantation, with an incidence rate of 33%. Postoperative forced vital capacity (FVC) to predicted value ratio (FVC%pred), forced expiratory volume in one second (FEV₁) to predicted value ratio (FEV₁%pred), FEV₁/FVC to predicted value ratio (FEV₁/FVC%pred) and corrected diffusion lung capacity for CO to predicted value ratio (D_LCOc%pred) were changed over time (all P<0.001). FVC%pred and FEV₁%pred were gradually increased within postoperative 9 months, and D_LCOc%pred was gradually elevated within postoperative 3 months (all P<0.05). Thirty-six recipients had FVC%pred≥80%, FEV₁%pred≥80% in 41 cases, FEV₁/FVC%pred≥92% in 76 cases, FVC%pred≤40% in 1 case and FEV₁%pred≤40% in 1 case, respectively. Sixteen recipients had D_LCOc%pred≥80%, corrected diffusion lung capacity for CO/alveolar volume to predicted value ratio (D_LCOc/V_A%pred) ≥80% in 63 cases, D_LCOc%pred≤40% in 4 cases and D_LCOc/V_A%pred≤40% in 1 case, respectively. Postoperative FVC%pred, FEV₁/FVC%pred and D_LCOc%pred in recipients with a primary disease of obstructive pulmonary disease were significantly higher than those in their counterparts with restrictive pulmonary disease (all P<0.05). Postoperative D_LCOc%pred in recipients with PGD was significantly lower than that in those without PGD (P<0.05). Conclusions Pulmonary ventilation function in lung transplant recipients reaches the optimal state and maintains a steady state at postoperative 9 months, and pulmonary diffusion function reaches a steady state at postoperative 3 months. Primary diseases and the incidence of PGD may affect postoperative pulmonary function.

This article summarizes the new progress in the diagnosis and treatment strategies on drug-resistant cytomegalovirus(CMV)infections in organ transplant recipients, including the prevention and treatment medications for CMV infection, the diagnosis and treatment strategies, and the immunological treatment regimen for drug-resistant CMV infection.The article is aimed to provide references for the prevention and treatment of drug-resistant CMV infection in organ transplant recipients.