Objective To investigate the feasibility and clinical experience of kidney transplantation from donors with Marfan syndrome (MFS). Methods Clinical data of 2 recipients undergoing kidney transplantation from the same MFS patient were retrospectively analyzed and literature review of 2 cases was conducted. Characteristics and clinical diagnosis and treatment of kidney transplantation from MFS patients were summarized. Results The Remuzzi scores of the left and right donor kidneys of the MFS patient during time-zero biopsy were 1 and 2. No significant difference was observed in the renal arteriole wall compared with other donors of brain death and cardiac death. Two recipients who received kidney transplantation from the MFS patient suffered from postoperative delayed graft function. After short-term hemodialysis, the graft function of the recipients received the left and right kidney began to gradually recover at postoperative 10 d and 20 d. After discharge, serum creatinine level of the recipient received the left kidney was ranged from 80 to 90 μmol/L, whereas that of the recipient received the right kidney kept declining, and the lowest serum creatinine level was 232 μmol/L before the submission date (at postoperative 43 d). Through literature review, two cases successfully undergoing kidney transplantation from the same MFS donor were reported. Both two recipients experienced delayed graft function, and then renal function was restored to normal. Until the publication date, 1 recipient has survived for 6 years, and the other recipient died of de novo cerebrovascular disease at postoperative 2 years. Conclusions MFS patients may serve as an acceptable source of kidney donors. However, the willingness and general conditions of the recipients should be carefully evaluated before kidney transplantation. Intraoperatively, potential risk of tear of renal arterial media should be properly treated. Extensive attention should be paid to the incidence of postoperative complications.

【Objective】 To investigate the prognostic value of tumor location in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU), and to develop and validate a nomogram model for predicting the overall survival (OS). 【Methods】 UTUC patients undergoing RUN at our hospital during Jan.2010 and Dec.2022 were retrospectively collected, 70% of whom were included in the training group and 30% in the validation group.According to the tumor location, patients were divided into renal pelvis tumor (RPT) group and ureteral tumor (UT) group.The differences in clinicopathological features and prognosis were analyzed.Based on multivariate Cox results, a nomogram model for predicting OS was developed and validated. 【Results】 A total of 366 patients (196 RPT and 170 UT) were included in this study.There were statistically significantly differences in urine cytology (P=0.001), hydronephrosis (P<0.001), history of bladder tumor (P=0.021), pathological T stage (P<0.001) and histological structure (P=0.037) between the two groups.Multivariate Cox results showed that patients with UT had a worse prognosis (HR=2.00, 95%CI: 1.22-3.27, P=0.006).Factors of the nomogram for predicting OS included age, tumor location, lymphovascular invasion and pathological T stage.The model showed good discrimination and calibration, and performed well in internal verification. 【Conclusion】 Compared with RPT, UT has a worse prognosis and the fat around the tumor should be surgically removed more thoroughly to avoid micro-residual.We successfully coustructed a nomogram model that can be used to predict the OS of UTUC patients after RNU surgery.

Objective To evaluate the value of systemic inflammatory markers(SIM)in the prognosis of patients with bladder cancer undergoing radical cystectomy.Methods Clinical data of 233 patients with bladder cancer who underwent radical cystectomy in the Affiliated Hospital of Xuzhou Medical University during Dec.2011 and Nov.2020 were retrospectively collected,the SIM score was calculated and patients were grouped.Progression-free survival(PFS)was assessed with Kaplan-Meier analysis,and differences between groups were compared with log-rank test.Factors affecting PFS were analyzed with Cox proportional risk model.The patients were randomly divided into a training set(n=164)and a verification set(n=69)according to 7:3 ratio,and a nomogram model was established and verified.Results Cox regression analysis showed that SIM score and pathological T staging were independent predictors of PFS(P＜0.05).A predictive model was established based on SIM score and pathological T staging.The area under the receiver operating characteristic(AUC)curve for predicting 1-year,3-year,and 5-year PFS were 0.939,0.943,and 0.943,respectively.After the model was applied to evaluate the validation set,the performance was still stable.Conclusion The prediction model based on SIM score and clinicopathological T staging can accurately predict the survival of patients with bladder cancer after radical cystectomy,and can be used to guide individualized treatment of patients.

Objective To construct a survival prediction model for the patients with extramedullary plasmacytoma (EMP),and to evaluate its application value.Methods The data of the patients diagnosed as EMP from 2000 to 2019 were collected from the National Cancer Institute's Surveillance,Epidemiology,and End Results (SEER) database.Random forest algorithm was used to screen variables,multivariate Cox pro-portional hazards regression model was used to determine the independent risk factors of EMP prognosis,and a nomogram model was constructed based on these factors.The total score of the patients was calculated ac-cording to the nomogram model,and the total samples were divided into the low,medium and high risk groups according to the optimal cutoff value by using X-tile software,and the Kaplan-Meier survival curves of the three groups were analyzed.The predictive performance of the model was evaluated using area under the curve (AUC) of time-dependent receiver operating characteristic (t-ROC) curve,AUC after X years N repeated K-fold cross-validation,calibration curve,and decision curve analysis (DCA).Results A total of 1458 patients with EMP were included,including 796 cases of deletions and 662 cases of death.In the deletion and deaths groups,the majority were aged 60-<75 years old (35.4％,41.2％),male (63.1％,66.3％),white race peo-ple (81.3％,80.4％),and married (68.2％,59.4％).Finally,age (45-<60 years old/60-<75 years old/≥ 75 years old),marital status (single/others),non-primary malignant tumor,and without surgery and radio-therapy were determined to be the independent risk factors for the survival of EPM patients (P<0.05).Based on the above independent risk factors,a survival prediction model was constructed,and a nomogram was drawn.According to the optimal cutoff value,the total sample was divided into the score of 0-96 group (low risk group),score of 98-135 group (medium risk group) and score of 139-191 group (high risk group).The Kaplan-Meier survival analysis revealed that there was statistically significant difference in the survival time a-mong the three groups (P<0.0001).AUC of t-ROC curves for 1,3,5 years and AUC after cross-validation all were>0.7,indicating that the model had a good degree of differentiation.The calibration curves suggested a good consistency between the prediction and practical over survival rate,and DCA indicated that the model could improve the clinical benefits.Conclusion The constructed survival prediction model for EMP patients based on the SEER database could help the clinicians to identify the prognostic risk factors and predict the o-verall survival rate of the patients.

Ureteral stricture, urine leakage and other urinary complications are likely to occur after kidney transplantation, which severely affect the function of renal allograft and even lead to renal allograft loss. Ureteral stent plays a critical role in kidney transplantation, which could promote the urine flow from kidney to bladder after kidney transplantation, lower the pressure within the ureter and reduce the risk of early urinary complications. However, it may also cause urinary tract infection, stent-related complications and BK virus infection, etc. Therefore, clinicians should flexibly grasp the indications for ureteral stent removal. In this article, the application, potential adverse reactions and the timing of removal of ureteral stent in the field of kidney transplantation were reviewed, aiming to provide reference for clinical decision-making related to ureteral stent after kidney transplantation.

Objective To investigate the mechanism of Xiaochengqi decoction(XCQD)in the treatment of acute pancreatitis(AP)based on network pharmacology and molecular docking.Methods Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP)was used to screen the active components of Rhubarb-Trifoliate-Magnolia officinalis and Swiss Target Prediction(STP)to predict the drug targets.The relevant targets of AP were screened in the databases of DrugBank,GeneCards,Online Mendelian Inheritance in Man(OMIM),Therapeutic Target Database(TTD)and Pharmacogenomics Knowledge Base(PharmGKB).The target protein interaction network was constructed by String software,and the network was drawn by Cytoscape and analyzed by topology,respectively.R3.6.2 was used for Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis.Autodock 4.2.6 and Vina were used for molecular docking.Results A total of 124 related therapeutic targets were obtained.Eleven targets,including retinoblastoma 1(RB1),protein kinase B(PKB),cyclin D1(CCMD1),v-myc avian myelocytomatosis viral oncogene homolog(MYC),estrogen receptor1(ESR1),reticuloendotheliosis virus oncogene homolog A(RELA),activator protein-1(AP-1),p53,mitogen-activated protein kinases(MAPK 1,3 and 14),were found to be the core targets by network topology analysis.GO and KEGG enrichment analysis showed that XCQD could play a role in the treatment of AP by regulating the apoptosis,proliferation and differentiation of pancreatic cells,inhibiting oxidative stress,etc,among which,phosphatidylinositol 3 kinase-protein kinase B(PI3K-Akt)signaling pathway is the most important one.In terms of molecular docking,Naringenin-MAPK1,Naringenin-MAPK3,Naringenin-PKB,Nobiletin-p53,Nobiletin-AP-1,Luteolin-CCND1,Luteolin-RELA,Tetramethoxyluteolin-MAPK14,Aloe-emodin-MYC and catechin-ESR1 showed good docking activity due to their low free energy.Conclusion By using network pharmacology and molecular docking,it was confirmed that XCQD had the characteristics of multi-channel and multi-target action and revealed the material basis and mechanism in the treatment of AP,which provided references for the extensive application of classical prescriptions and the theoretical basis for the later basic research.

Objective:To investigate the relationship between thyroid hormone levels during pregnancy and neonatal thyroid function.Methods:Forty pregnant women with abnormal thyroid stimulating hormone (TSH) level during pregnancy and their newborns who received treatment in Yongkang First People's Hospital, China between July 2019 and August 2020 were included in the observation group. An additional 38 healthy pregnant women and their newborns who concurrently received health examination were included in the control group. The clinical data in the two groups were retrospectively analyzed. The levels of thyroid hormones [(triiodothyronine (T 3), tetraiodothyronine (T 4), TSH, free T 3 (FT 3), free T 4 (FT 4)] in pregnant women were compared between the two groups. TSH level in newborns was compared between the two groups. Thyroid dysfunction in newborns was assessed in each group. The correlation between thyroid hormone levels during pregnancy and neonatal thyroid function was analyzed. Results:TSH level during pregnancy in the observation group was significantly higher than that in the control group [(2.89 ± 0.44) mU/L vs. (2.13 ± 0.22) mU/L, t = 9.570, P < 0.001]. T 3, T 4, FT 3 and FT 4 in the observation group were (0.45 ± 0.07) μg/L, (90.87 ± 8.93) μg/L, (1.08 ± 0.19) ng/L and (10.45 ± 1.73) ng/L, respectively, which were significantly lower than those in the control group [(2.13 ± 0.22) μg/L, (1.31 ± 0.21) μg/L, (2.16 ± 0.34) ng/L, (15.31 ± 21) ng/L, t = 24.514, 9.254, 17.432, 10.845, all P < 0.001]. TSH level in newborns in the observation group was significantly higher than that in the control group ( t = 37.041, P < 0.05). The incidence of thyroid dysfunction in the observation group was significantly higher than that in the control group ( χ2 = 4.780, P < 0.05). TSH level in pregnant women was positively correlated with that in newborns ( r = 0.819, P < 0.05). T 3, T 4, FT 3 and FT 4 levels in pregnant women were negatively correlated with TSH level in newborns ( r = -0.773, -0.802, -0.794, -0.824, all P < 0.05). Conclusion:Compared with healthy pregnant women, pregnant women with abnormal thyroid hormone levels have higher TSH levels and lower T 3, T 4, FT 3 and FT 4 levels. The newborns of pregnant women with abnormal thyroid hormone levels have higher TSH levels and a greater risk of thyroid dysfunction than the newborns of healthy pregnant women. The level of thyroid hormone during pregnancy is related to the thyroid function of newborns. This study is scientific and innovative.

Objective:To explore the effect of the interval of radical prostatectomy after prostate puncture on the perioperative period and prognosis of patients.Methods:Patient’s data from September 2016 to September 2018 whom performed laparoscopic radical prostatectomy at the Affiliated Hospital of Xuzhou Medical University were collected and retrospectively analyzed. All prostate biopsy confirmed prostate cancer and 66 patients underwent laparoscopic radical prostatectomy. The average age was (70.11 ± 5.01) years, ranged from 60 to 79 years. The patients were divided into two groups according to the interval time from prostate biopsy to laparoscopic radical prostatectomy: <7 d group ( n=32) and 6-8 weeks group ( n= 34). The operation time, intraoperative blood loss, postoperative hospital stays, positive rate of incisional margin, postoperative urinary incontinence rate and the rate of urinary incontinence 6 months after operation, rate of postoperative erectile dysfunction and bone metastasis were compared and analyzed between the two groups. When the data conformed to the normal distribution, the data were expressed in Mean±standard deviation ( Mean± SD), and the independent sample t-test was used to evaluate the statistical significance between groups. When the data did not conform to the normal distribution, the measurement data was expressed as Median (interquartile range) [ M( P25, P75)], and the Mann-Whitney U test was used for the comparison between groups. Count data comparison between groups using Chi-square test or Fisher exact probability method. Unconditional multivariate Logistic regression was used to analyze the relationship between outcome and exposure. Results:All the 66 patients successfully underwent surgery, the surgery success rate was 100%. The average operation time of <7 d group and group 6-8 weeks group was [185.00(174.50, 193.50)] min and [183.00(175.00, 187.50) min], respectively, the difference was not statistically significant ( P=0.685 8, U=512.0). The average intraoperative blood loss of group <7 d group and 6-8 weeks group was [185.50(177.75, 205.25)]ml, [189.00(180.75, 206.00)] ml, respectively, the difference was not statistically significant ( P=0.685 9, U=512.0). The average postoperative hospital stays of <7 d group and 6-8 weeks group was [14.00(11.75, 16.00)] d, [13.50(12.00, 15.00)] d, respectively, the difference was not statistically significant ( P=0.785 7, U=522.5). The positive rate of incisal margin of<7 d group and 6-8 weeks group was 18.75%, 14.71%, respectively, the difference was not statistically significant ( P=0.659 5, χ2=0.194). The postoperative urinary incontinence rate of <7 d group and 6-8 weeks group was 6.25% and 8.82%, respectively, the difference was not statistically significant ( P=1.000 0). The urinary control after follow-up for six months of <7 d group and 6-8 weeks group was 6.25% and 2.94%, respectively, the difference was not statistically significant ( P=0.607 7). The postoperative erectile dysfunction rate of<7 d group and group 6-8 weeks group was 9.38% and 8.82%, respectively, the difference was not statistically significant ( P=1.000 0). The postoperative bone metastasis rate of group<7 d and 6-8 weeks group was 6.25% and 5.88%, respectively, the difference was not statistically significant ( P=1.000 0). Conclusions:Performing laparoscopic radical prostatectomy within 7 days following prostate biopsy did not adversely affect the postoperative outcomes and prognosis, also not increased postoperative complications, can shorten the patient′s treatment cycle.

Objective To compare the clinical effect of two-person operations of disposable circumcision stitching instrument and one-man operations of disposable circumcision stitching instrument.Methods Clinical data of 340 patients with redundant prepuce or phimosis from March 2015 to August 2017 were randomly divided into control group which patients with two-person operation of disposable circumcision stitching instrument and study group which patients with one-man operation of disposable circumcision stitching instrument were reviewed prospectively.There were 188 patients in the study group,including 22 patients with phimosis and 166 patients with redundant prepuce;Among the 152 patients in the control group,there were 17 cases with phimosis and 135 cases with redundant prepuce.Two groups with operation time,intraoperative blood loss,postoperative skin staple missing,2 hours postoperative pain,postoperative edema,the swelling subsided time,postoperative complications,postoperative patient satisfaction,and so on.Measurement data were represented as (x) ± s,and comparison between groups was analyzed using t test;count data were represented as percentage and comparison between groups was analyzed chi-square.Results All operations were finished successfully for the patients by two-person or one-man of operations of disposable circumcision stitching instrument.In terms of operation,the operation time of the observation group and the control group was (7.76 ±0.45) minutes and (7.86 ±0.91) minutes respectively,and the difference was not statistically significant(P ＞ 0.05).Intraoperative hemorrhage of observation group and control group were (1.77 ± 0.22) ml and (1.72 ± 0.26) ml,and the difference was not statistically significant (P ＞ 0.05).There was no statistically significant difference between the observation group and the control group (P ＞ 0.05) in the postoperative 2 hours pain score and skin staple missing.In the postoperative complications,the deviation rate of the prepuce was 1.11％,significantly lower than the control group 5.92％,and the difference was statistically significant (P ＜ 0.05).There was no statistically significant difference between the observation group and the control group in terms of edema on the third postoperative day,short postoperative anastomosis,patient satisfaction,and postoperative infection.Conclusion The way of one-man operation of disposable circumcision stitching instrumente not only saves labor costs,but also has a good postoperative clinical effect,meanwhile,it has high efficiency and strong operability,and is worthy of promotion for clinical first-line urologists.

Objective To evaluate the effect of global end diastolic volume index (GEDVI) on fluid resuscitation in elderly patients with septic shock. Methods A prospective randomized controlled trial (RCT) was conducted. Septic shock patients over 65 years admitted to intensive care unit (ICU) of Shandong Province, Zibo Central Hospital from January 2013 to December 2015 were enrolled. The patients were randomly divided into control group and observation group, 20 cases in each group. In accordance with the guidelines for the treatment of septic shock, early goal-directed therapy (EGDT), rehydration in the control group was treated with the guide of central venous pressure (CVP); observation group was received pulse indicator continuous cardiac output (PiCCO) monitoring, and rehydration was treated according to the GEDVI and extravascular lung water index (EVLWI), i.e. GEDVI was maintained in 650-800 mL/m2, EVLWI was not obviously increased compared with the basic value and without the emphasis of CVP. Initial acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) score, sequential organ failure score (SOFA), procalcitonin (PCT), mean arterial pressure (MAP), lactic acid (Lac) and oxygenation index (PaO2/FiO2); serial Lac, central venous to arterial carbon dioxide pressure (Pcv-aCO2), fluid balance, the amount of noradrenaline accumulation, PaO2/FiO2 after 6, 24 and 48 hours resuscitation; mechanical ventilation time, incidence of acute heart failure, ICU hospitalization time and 28-day mortality were recorded. Results There was no significant difference in gender,age, APACHE Ⅱ score, SOFA score, primary disease, infection site and basal PCT, MAP, Lac, PaO2/FiO2 between the two groups. Compared with the control group, 6 hours Lac, Pcv-aCO2 recovery, positive fluid balance, noradrenaline accumulation and PaO2/FiO2 of the observation group showed no significant difference; positive fluid balance 24 hours in the recovery was significantly reduced (mL: 2919.80±986.44 vs. 3991.40±933.53), Pcv-aCO2 significantly decreased [mmHg (1 mmHg = 0.133 kPa): 5.55±1.43 vs. 7.10±2.38], PaO2/FiO2 significantly improved (mmHg: 194.80±28.57 vs. 177.65±23.46), and noradrenaline accumulation was increased significantly (mg: 40.99±20.69 vs. 27.31±19.34) with statistically significant difference (all P < 0.05); the blood level of Lac 48 hours in the recovery was significantly decreased (mmol/L: 1.16±0.89 vs. 1.85±1.01), Pcv-aCO2 (mmHg: 5.35±1.18 vs. 6.70±2.34), and PaO2/FiO2 (mmHg: 215.75±33.84 vs. 190.60±32.89) were further improved, the positive fluid balance was significantly reduced (mL: 3141.55±1245.69 vs. 4533.85±1416.67, all P < 0.05). Compared with the control group, mechanical ventilation time (days: 3.65±1.31 vs. 4.50±1.19), ICU hospitalization time (days: 5.80±1.67 vs. 7.15±2.30) was significantly shorter in the observation group (both P < 0.05), acute heart failure rate was decreased significantly (5.0% vs. 30.0%, P < 0.05), but the 28-day mortality showed no statistical significance (25.0% vs. 40.0%, P = 0.311). Conclusions Compared to the conventional EGDT methods, fluid resuscitation under the guidance of GEDVI in elderly patients with septic shock with less liquid loading, can achieve better oxygenation and reduce heart failure, shorten the duration of mechanical ventilation and ICU stay, and play an important significant guidance for elderly patients' fluid resuscitation with septic shock.