Objective: To identify risk factors for febrile urinary tract infection (FUTI) following surgical intervention for urinary stones.
Methods: We systematically searched seven databases (from CNKI to EMBASE) from inception to May 2025 for cohort and case-control studies investigating risk factors for FUTI. Two investigators independently screened studies, extracted data, and assessed quality (Newcastle-Ottawa Scale). Adjusted odds ratio (OR) with 95% confidence interval (CI) were used as effect measures. Meta-analysis was performed using Stata 12.0.
Results: 16 studies (n = 5,366) revealed FUTI incidence of 17% (95%CI:12.6-21.3%). Ten significant risk factors were identified: (1) General factors: Stone size (OR = 1.29, 95%CI:1.09-1.52) and operative duration (OR = 1.05, 95%CI:1.01-1.10). (2) Comorbidity: Diabetes (OR = 2.18, 95%CI:1.65-2.87), Renal insufficiency (OR = 3.19, 95%CI:2.16-4.70). (3) Preoperative: preoperative hydronephrosis (OR = 2.33, 95%CI: 1.14-4.76), elevated preoperative procalcitonin (OR = 1.08, 95%CI: 1.03-1.13), preoperative pyuria (OR = 4.05, 95%CI:1.88-8.74), preoperative bacteriuria (OR = 2.45, 95%CI: 2.07-2.90), perinephric fat stranding (OR = 5.09, 95% CI:1.71-15.14), and tissue margin sign (OR = 2.84, 95%CI:1.91-4.23).
Conclusion: Diabetes mellitus, renal insufficiency, preoperative hydronephrosis, elevated procalcitonin, preoperative pyuria, preoperative bacteriuria, perinephric fat stranding, tissue rim sign, operative duration, and stone size are potential independent predictors of FUTI after urinary stone surgery. These findings enable targeted prevention strategies for high-risk urolithiasis patients.
Objective: Tranexamic acid (TXA) and fluid gelatin (FG) are widely used to reduce perioperative blood loss in total hip arthroplasty (THA). However, the efficacy of single-method hemostatic strategies is increasingly insufficient for meeting clinical demands. The aim of this study was to evaluate the efficacy of TXA in combination with FG for perioperative blood management.
Methods: This retrospective study enrolled 301 patients with unilateral femoral neck fractures who underwent minimally invasive piriformis approach total hip arthroplasty (between 2019 and 2023) and received hemostatics. Patients were divided into TXA (n = 93), FG (n = 102), and TXA + FG (n = 106) groups. A control group (n = 107) with the same inclusion/exclusion criteria was selected. Collected data included demographic characteristics, fracture classification, perioperative clinical parameters, and laboratory findings. The primary and secondary outcome measures included total blood loss (TBL), visible blood loss, hidden blood loss, postoperative hemoglobin and hematocrit levels, blood transfusion, and postoperative complications.
Results: The clinical results of 408 patients indicated that the combination of TXA and FG significantly reduced perioperative blood loss in THA via MIS-TPA (550.68 ± 327.61 mL in the TXA + FG group, 732.50 ± 362.84 mL in the TXA group, 817.19 ± 375.46 mL in the FG group, and 982.99 ± 428.81 mL in the control group; p < 0.001) without an increase in thromboembolic events or wound-related complications.
Conclusion: Combined intravenous TXA and intra-articular FG administration provided superior perioperative blood loss control and did not increase the rate of complications.
Median arcuate ligament syndrome (MALS) is a rare vascular disorder. We report the case of a 72-year-old man with MALS who was found to have an anomalous right inferior phrenic artery originating from the celiac artery (CA), which was not detected on preoperative computed tomography angiography. During laparoscopic decompression, this vessel was encountered unexpectedly. A temporary clamping test was performed, confirming no diaphragmatic or hepatic ischemia, after which the vessel was safely ligated. The CA was then fully decompressed. Postoperatively, the patient's symptoms resolved completely. This case underscores that significant vascular anomalies may only be revealed intraoperatively. The described clamping technique provides a simple and safe method for real-time functional assessment, aiding critical surgical decisions when managing unforeseen anatomical variations.
Objective: End-stage renal disease is an increasing global health problem. Arteriovenous fistula (AVF) thrombosis is a major cause of access failure in maintenance hemodialysis (MHD) patients. An interpretable nomogram, integrated with SHapley Additive exPlanations (SHAP) analysis is developed and validated for predicting thrombotic failure of forearm AVFs in MHD patients.
Methods: A single-center retrospective cohort study enrolled 302 MHD patients with dysfunctional forearm AVFs undergoing percutaneous transluminal angioplasty. Patients were randomly allocated to training (70%) and validation (30%) sets. Univariable and multivariable logistic regression identified independent predictors for AVF thrombosis. A nomogram was constructed and its performance evaluated by the area under the receiver operating characteristic curve, calibration, and decision curve analysis. SHAP analysis was applied to quantify feature importance and directionality in the validation set.
Results: The final model identified hypertension history, frequent intradialytic hypotension, body mass index, total cholesterol, C-reactive protein, and intact parathyroid hormone as independent predictors. The nomogram demonstrated good discrimination, with AUCs of 0.80 (95% CI: 0.73-0.86) in the training set and 0.71 (95% CI: 0.59-0.83) in the validation set, along with satisfactory calibration and clinical utility. SHAP analysis revealed red cell distribution width-standard deviation as the most influential predictor for individual risk, highlighting a distinction between statistical significance and predictive contribution.
Conclusion: This study presents an interpretable nomogram with robust performance for predicting AVF thrombosis. The integration of SHAP analysis enhances model transparency and clinical trust, providing a valuable tool for personalized risk assessment and potential targeting of preventive strategies in MHD patients. Further external validation is warranted.
Objective: To investigate the clinical feasibility and efficacy of using a humeral intramedullary nail for the treatment of subtrochanteric fracture in a patient with ipsilateral poliomyelitis sequelae.
Methods: A case of a 54-year-old female patient with a left subtrochanteric fracture caused by a traffic accident was reported. The patient had a 50-year history of ipsilateral poliomyelitis, leading to developmental deformity and severe stenosis of the femoral medullary canal in the affected limb, which could not accommodate a conventional femoral intramedullary nail. Therefore, we innovatively used a 7 mm diameter humeral interlocking intramedullary nail for internal fixation. Limited open reduction was performed during surgery, supplemented with cerclage wiring to enhance fracture stability. The medullary canal was reamed to 8 mm, after which the nail was successfully inserted.
Results: The surgical procedure was smooth. Intraoperative fluoroscopy and postoperative x-rays showed satisfactory fracture reduction and good positioning of the internal fixation. The patient was followed up for 30 months. Imaging examinations confirmed bony union of the fracture without complications such as failure of internal fixation. Ultimately, the walking and flexion functions of the left lower limb recovered to the pre-injury level.
Conclusion: For special types of subtrochanteric fractures with severe femoral medullary canal stenosis due to conditions like poliomyelitis sequelae, the application of a humeral intramedullary nail is a safe and effective innovative treatment strategy. This approach provides reliable intramedullary fixation. This experience offers a valuable reference for managing similar complex orthopedic problems.
Introduction: Basedow Graves disease (BG) is the most common cause of hyperthyroidism. Lugol's solution (LS) is used preoperatively to inhibit thyroid hormone production, decrease thyroid gland vascularity and ensure a safer surgical field. This study aims to evaluate efficacy of the LS and its association with surgical complications in patients with BG.
Materials and methods: Patients with total thyroidectomy for BG between 2019 and 2024 were retrospectively included. Preoperative calcium (Ca), alkaline phosphatase (ALP), parathyroid hormone (PTH) levels, operative time, resected thyroid specimen weights, postoperative complications were analyzed.
Results: Among 128 patients, 38(29.6%) received LS (Group1), while 90 (70.3%) did not (Group2). No significant difference was found between groups regarding preoperative Ca, ALP, PTH (p = 0.780, p = 1.000, p = 1.000, respectively). Mean operative times were 147.79 ± 64.66 min in Group1, 146.19 ± 35.69 min in Group2 (p = 0.225). Mean thyroid specimen weights were 36.83 ± 26.47 g in Group1, 43.16 ± 30.81 g in Group2 (p = 0.246). The rates of incidental parathyroidectomy were 21.1% (n = 8) in Group1 and 15.6% (n = 14) in Group2 (p = 0.456). Transient hypoparathyroidism rate was slightly higher in Group1 (34.2%, n = 13) than in Group2 (23.3%, n = 21) (p = 0.292). Permanent hypoparathyroidism occurred in 2.63% of Group1 and 8.89% of Group2 patients (p = 0.375). The rates of postoperative vocal cord paralysis, adjusted for the number of nerves at risk, were comparable between the groups (9.21%, 8.89%; p = 1.000).
Conclusion: The primary endpoint of postoperative hypocalcemia/hypoparathyroidism did not differ significantly between groups. Although the incidence of transient hypoparathyroidism was slightly higher in the LS group, no statistically significant difference was observed. Additionally, no significant difference was found regarding intraoperative or long-term outcomes. Present study did not demonstrate a protective effect of preoperative LS on surgical complications in patients with BG.
Pelvic exenteration, once regarded as an 'extreme option for hopeless cases', has evolved into a standard of care for selected patients with advanced or recurrent pelvic malignancy. Parallel to technical and peri-operative advances, there has been a global shift towards structured quality improvement and registry-based outcome measurement. This paper outlines the historical evolution of exenterative surgery, the development of surgical quality registries, and their role in benchmarking performance. It highlights the success of international collaboratives such as PelvEx in standardising definitions and outcomes, and proposes a core dataset of key performance indicators (KPIs) relevant to exenterative surgery. These include oncological, peri-operative, and survivorship outcomes, supported by appropriate risk stratification. Establishing high-quality, prospectively maintained registries enables meaningful comparison between units, facilitates clinical governance, and strengthens advocacy for resources. Ultimately, registry-driven data are essential to refining surgical quality, optimising patient selection, and improving long-term survivorship in this complex patient cohort. This is particularly relevant with the variations in neo-adjuvant therapies.
Background: Talar necrosis and infection present a significant challenge, frequently requiring talectomy, which transforms the tibiotalar joint into a tibiocalcaneal articulation. Key management uncertainties persist regarding the necessity of formal arthrodesis vs. the adequacy of a stable fibrous union, and the optimal method for concomitant limb length restoration. This study evaluates a technique combining minimally invasive midshaft tibial osteotomy with Ilizarov distraction osteogenesis to address tibiocalcaneal reconstruction and limb lengthening, seeking to inform these clinical decisions.
Methods: Twelve patients who underwent TC arthrodesis at the 920th Hospital of the PLA between January 2014 and July 2019 were included. The cohort consisted of 7 cases of talar infection following open fractures and 5 cases of tuberculous talar infection, all with partial or complete necrosis. Outcomes assessed included bone elongation, fusion rates, AOFAS ankle-hindfoot scores, and postoperative complications.
Results: All patients were followed up for 1.5 to 4.5 years. The external fixation frame was maintained for an average of (3.04 ± 0.32) months. Bone transport ranged from 4.3 to 7.0 cm, with a mean of (5.88 ± 1.00) cm. Tibial-calcaneal fusion was achieved in 7 cases, while 5 cases exhibited pseudarthrosis; however, their daily activities were unaffected, and pain levels were mild. The average AOFAS score was (75.92 ± 3.73) postoperatively (p < 0.0001), indicating a marked enhancement in functional outcomes with no recurrent infections or postoperative complications.
Conclusion: This study highlights the role of minimally invasive midshaft tibial osteotomy in optimizing TC arthrodesis outcomes, achieving functional improvements even in cases of pseudarthrosis. Future research should focus on management protocols for pseudarthrosis to further enhance TC arthrodesis effectiveness.
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