Objective:To evaluate the effectiveness and safety of rituximab (RTX) and cyclophosphamide/azathioprine (CYC/AZA) in the treatment of anti-neutrophil cytoplasmic antibody (ANCA)-related vasculitis (AAV).Methods:After setting up the search strategy, the inclusion and screening criteria of the literature were determined, the Pubmed, Cochrane Library, Embase, China Biomedical Literature Database, CNKI, Wanfang Database, Weipu Database were searched for RTX and CYC/AZA treatment for AAV. For randomized controlled studies, in which the experimental group was RTX for AAV, and the control group was CYC/AZA for AAV were included. The retrieval time span was from January 2000 to June 2021, and the data obtained were analyzed using Revman 5.3 software.Results:A total of 9 articles and 4 studies were included, with a total of 384 patients, including 203 cases in the experimental group and 181 cases in the control group. In the treatment of AAV, the difference in the remission rate of RTX and CYC/AZA treatment of AAV was statistically significant, and the remission rate of the RTX group was higher [ OR(95% CI)=1.58(1.03, 2.40), P=0.03]. For the remission rates of different types of AAV, RTX and CYC/AZA were benefit for the treatment of granulomatous vasculitis, microscopic polyangiitis, eosinophilic granulomatous vasculitis, there was no statistically significant difference in the remission rate of patients with protease 3-related vasculitis and myeloperoxidase-related vasculitis. The incidence of granulocytopenia in the RTX group was significantly lower than that in the CYC/AZA group, and RTX treatment could reduce the incidence of other serious adverse reactions. Conclusion:For the remission induction therapy, RTX is not inferior to CYC for all subtypes of AAV. In the maintenance treatment phase, RTX has a higher remission rate and a lower recurrence rate. During the entire treatment process, patients who were treated with RTX had a higher long-term remission rate than patients who were not treated with RTX. RTX can effectively reduce the occurrence of adverse reactions such as neutropenia.

Objective To evaluate the diagnostic value of quantitative detection of cytomegalovirus (CMV) DNA from different sources [plasma, sputum and bronchoalveolar lavage fluid(BALF)] for CMV pneumonia after allogeneic hematopoietic stem cell transplantation. Methods Clinical data of 405 recipients undergoing allogeneic hematopoietic stem cell transplantation were retrospectively analyzed. Among them, 19 recipients diagnosed with CMV pneumonia were assigned into the CMV pneumonia group, and 229 recipients with CMV viremia alone, 11 recipients without CMV pneumonia who received fiberoptic bronchoscopy and 16 recipients diagnosed with bacterial or fungal pneumonia based on pathogenic evidence receiving sputum culture were assigned into the control A, B and C groups, respectively. The incidence of CMV pneumonia was summarized. The CMV DNA load of specimens from different sources (plasma, sputum and BALF) of recipients with CMV pneumonia was analyzed. The clinical prognosis of recipients with CMV pneumonia was evaluated. Results Among 405 recipients undergoing allogeneic hematopoietic stem cell transplantation, 19 cases developed CMV pneumonia, and the overall incidence of CMV pneumonia was 4.7%(19/405). The CMV DNA load in the plasma, sputum and BALF of recipients with CMV pneumonia was higher than those in the control A, B and C groups (all P < 0.05). In the 19 recipients, 12 cases were cured after antiviral treatment and 7 died from treatment failure(3 cases abandoned treatment). The fatality was 37%(7/19). Conclusions Quantitative detection of CMV DNA in the plasma, sputum and BALF may increase the diagnostic rate of CMV pneumonia, thereby improving clinical prognosis of recipients undergoing allogeneic hematopoietic stem cell transplantation.

Objective To investigate the clinical efficacy of pretreatment regimen containing idarubicin (IDA) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) for high-risk refractory leukemia. Methods A total of 116 patients with high-risk refractory leukemia who received allo-HSCT treated with 7 types of IDA-containing pretreatment regimes were enrolled in this study. The implantation rate of 116 recipients was summed up. The 2-year overall survival (OS), 2-year disease free survival (DFS), cumulative recurrence rate, recurrent mortality, transplantation related mortality (TRM), cumulative incidence of acute graft-versus-host disease (aGVHD) and chronic graft-versus-host disease (cGVHD) were statistically analyzed by Kaplan-Meier survival curve. Results All 116 recipients successfully implanted. The median follow-up time was 28 (7-70) months. Among them, 64 recipients survived, the 2-year OS was 55.2%, 2-year DFS was 51.7%, 2-year recurrent mortality was 23.3% and 2-year TRM was 18.1%. Among 116 recipients, 72 cases suffered from aGVHD. The 2-year cumulative incidence rate of aGVHD was 62.1% including 20 cases of grade Ⅲ-Ⅳ aGVHD, the 2-year cumulative incidence rate was 17.2%. Among 116 recipients, 59 cases presented with cGVHD. The 2-year cumulative incidence rate was 55.4%, of which the 2-year cumulative incidence rate of extensive cGVHD was 14.7%. Among 116 recipients, 30 cases recurred with a 2-year cumulative recurrence rate of 25.9%. Conclusions IDA-containingpretreatment regime has high safety and effectiveness, and can be used as an effective pretreatment regime for transplantation preprocessing in patients with high-risk refractory leukemia.

Objective: To investigate the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of leukemia patients also suffering from central nervous system leukemia (CNSL) . Methods: A total of 48 leukemia patients with central nervous system leukemia admitted to our hospital from May 2012 to December 2017 were retrospectively analyzed. Results: ① Including 22 cases of acute lymphocytic leukemia (ALL) , 21 cases of acute myeloid leukemia (AML) , and 5 cases of chronic myelogenous leukemia (CML) . Before transplantation, 19 patients achieved complete remission (CR) , and the rest 29 ones without remission. ②The conditioning regimen used TBI as the main protocol, and 6 patients were combined with whole brain and total spinal cord radiotherapy, 2 with Cyber knife treatment, and children with modified IDA combined with BUCY. ③All 48 patients were successfully transplanted, the median time for leukocyte engraftment was 14 (10-23) days, the median time for platelet transplant 16 (6-78) days. ④Bone marrow was evaluated 28 days after transplantation, all 48 patients reached CR, and DNA testing confirmed that they were all full donor chimerism. ⑤The median follow-up was 14 (2-69) months. Of them, 28 cases survived, 10 relapsed and the rest 3 had recurrence of CNSL after transplantation. One year after allo-HSCT, the overall survival (OS) of CR and non-CR groups were (77.3±10.0) % and (57.6±9.3) % (P=0.409) , respectively, the disease-free survival rates (DFS) were (71.2±11.0) % and (53.9±9.5) % (P=0.386) , respectively. The 1-year OS rates of ALL and AML groups after transplantation were (54.2±10.7) %, (80.1±8.9) %, respectively (P=0.200) , and DFS rates were (49.2±10.8) %, (75.0±9.7) % (P=0.190) , respectively. Conclusion Allo-HSCT was safe and effective for leukemia patients with CNSL.

Objective:There is currently no consensus on the ideal plane for implant placement in breast reconstruction. This meta-analysis provides a comparison of prepectoral breast reconstruction (PBR) vs. subpectoral breast reconstruction (SBR), with primary outcomes of surgical efficacy and patient safety, to find out the best surgical approach.Methods:PubMed, Cochrane, Web of Science, and Embase databases were searched from January 1st, 2019, to April 1st, 2022, to retrieve studies that compared PBR with SBR after mastectomies. The main outcomes were surgical complications and satisfaction with breasts domain. The literature was screened according to the inclusion and exclusion criteria, the data was extracted and the methodological quality of the included studies was assessed by 2 reviewers independently. Meta-analysis was performed using RevMan 5.3.Results:A total of 14 comparative studies with 2 355 patients were included. The meta-analysis showed no statistical differences in seroma, implant removal, flap necrosis, capsular contracture, and wound dehiscence between PBR and SBR groups. PBR patients demonstrated lower hematoma, animation deformity rates, and higher BREAST-Q scores compared to SBR groups.Conclusions:Surgical efficacy and patient safety are similar between PBR and SBR groups. PBR patients have lower hematoma, animation deformity rates and are more satisfied with breasts domain. Further well-designed multi-center prospective studies are required to increase the robustness of the findings.

Objective:There is currently no consensus on the ideal plane for implant placement in breast reconstruction. This meta-analysis provides a comparison of prepectoral breast reconstruction (PBR) vs. subpectoral breast reconstruction (SBR), with primary outcomes of surgical efficacy and patient safety, to find out the best surgical approach.Methods:PubMed, Cochrane, Web of Science, and Embase databases were searched from January 1st, 2019, to April 1st, 2022, to retrieve studies that compared PBR with SBR after mastectomies. The main outcomes were surgical complications and satisfaction with breasts domain. The literature was screened according to the inclusion and exclusion criteria, the data was extracted and the methodological quality of the included studies was assessed by 2 reviewers independently. Meta-analysis was performed using RevMan 5.3.Results:A total of 14 comparative studies with 2 355 patients were included. The meta-analysis showed no statistical differences in seroma, implant removal, flap necrosis, capsular contracture, and wound dehiscence between PBR and SBR groups. PBR patients demonstrated lower hematoma, animation deformity rates, and higher BREAST-Q scores compared to SBR groups.Conclusions:Surgical efficacy and patient safety are similar between PBR and SBR groups. PBR patients have lower hematoma, animation deformity rates and are more satisfied with breasts domain. Further well-designed multi-center prospective studies are required to increase the robustness of the findings.

Forensic examination materials are often plagued by trace amounts,mixes,and other factors.Single-cell isolation technology can solve these forensic problems to some extent by studying each cell individually to obtain comprehensive and reliable information.There are many single cell isolation techniques available in research reports,such as flow cytometry,laser capture microdissection,etc.This review will summarize the most common single cell isolation techniques used by researchers today,and summarize the application of various techniques in forensic science,summarize the selection strategies for single-cell isolation techniques in different scenarios based on cost,degree of automation,yield,cell damage rate,and the availability of relevant forensic platforms,and finally explore the forensic application prospects of single-cell isolation techniques.In general,single cell isolation can be applied to multiple fields such as mixed stain examination,post-mortem time inference,pre-and post-mortem injury determination,forensic toxicology analysis,forensic microbiology and forensic anthropology.The development of single cell isolation technology is of great value to the application of forensic medicine,and will provide a new way of deciphering difficult examination materials.

The analysis of cerebrospinal fluid (CSF) facilitates the diagnosis and therapy of central nervous system (CNS) diseases. Compared to traditional methods, single-cell sequencing is conducive to analyze the cells composition and heterogeneity and discover scarce cells in CSF. Recent studies of single-cell sequencing in CSF has mainly focused on the neuroinfectious diseases, neurodegenerative and neuroinflammatory diseases, and leptomeningeal metastases (LM), reflecting the superiority and clinical value of single-cell sequencing in CNS diseases and providing new directions for the diagnosis and treatment of CNS diseases.

The development of information technology in the medical industry is accelerating the construction of 3-level rehabilitation networks centering on community-based rehabilitation, which is based on the Internet and in combination with the Internet of things(IOT). A municipal rehabilitation hospital cooperated with the health centers of sub-district communities in the city to build a remote rehabilitation network based on IOT technology, for rehabilitation training of community stroke patients. The two sides worked out a cooperation scheme on project management, designed and built a remote community rehabilitation management model. Under the remote monitoring and equipment data IOT, the medical team of the municipal rehabilitation hospital could formulate the therapeutic plan according to the immediately obtained relevant functional evaluation data, and the medical team of the community health service center was responsible for the implementation of the plan. Fifty-three patients in the experimental group received the training of remote lower limb intelligent feedback system based on IOT together with routine rehabilitation training. After 8 weeks of treatment, the functional evaluation data of the two groups were improved in varying degrees( P< 0.05), but the improvement of the experimental group was significantly better than that of the control group( P < 0.05). Remote rehabilitation under the construction path of remote rehabilitation network based on IOT technology could significantly promote the improvement of post-functional rehabilitation of community stroke patients. This study can provide reference for the construction of three-level remote rehabilitation networks based on IOT and the implementation of home-based remote rehabilitation therapy in the future.

Objective To investigate perioperative nursing of new generation optical coherence tomography (OCT) in the diagnosis of percutaneous coronary intervention (PCI).Methods Nursing methods and clinical data of 42 patients who received OCT during PCI were retrospectively summarized.Results After OCT,the incidence rate of blood vessel complications such as coronary artery spasm,slow coronary blood flow were 7.1％.All the complications were relieved after intracoronary nitroglycerin injection,and no chest pain and ECG changes were observed.No complications such as acute heart failure,malignant arrhythmia,and coronary artery dissection were seen,and no contrast nephropathy after surgery was observed after reasonable hydration and nursing cooperation.Conclusion The new generation OCT can accurately determinate the characteristics of coronary artery lesions without blocking coronary flow,and the skilled coordination and strict observation of perioperative nursing are important factors for OCT examination.