Immediate breast reconstruction with pedicle great omentum metasasis is safe,easy to perform, and has extensive clinical indications, less postoperative complications. The shape of reconstructed breast is plump and symmetrical, which is the optimal choice for reconstruction surgery with small and medium-sized breast at present. The surgical methods and effects of breast reconstruction with pedicle great omentum metastasis in 5 patients are reported in this article. Combined with the previous literature, the feasibility and safety of surgery is discussed, which provide a reference to clinicians.

Objective To study the application of pectoralis majoris fascia combined with serratus anterior fatty fascia flap in immediate breast reconstruction (IBR).Methods 40 patients with early breast cancer were divided into three groups according to indications and their own requirements.11 cases got implants combined with the pectoralis majoris fascia and the serratus anterior fatty fascia flap as a biological membrance,5 patients got latissimus dorsi myocutaneous flap reconstruction,and 24 cases underwent simple mastectomy.The three groups underwent routine sentinel lymph node biopsy.The operation time,subcutaneous drainage volume,drainage time,discharge time,postoperative pain score,infection of incision and patients' satisfaction were compared between the three groups.Results The reconstruction that used implants with pectoralis majoris fascia and serratus anterior fatty fascia flap as a biological membrance had the shortest recovery time,and the least subcutaneous fluid,and the differences were statistically significant(P＜0.05).The difference of incision infection had no statistical significance (P＞0.05).The difference of postoperative pain score and satisfaction had no statistical significance between fascia group and altissimo doris group (P＞0.05).Conclusion The technique of the prosthetic reconstruction of the pectoralis majoris fascia combined with the serratus anterior fatty fascia flap as a biological membrance is simple and safe,with small trauma,quick recovery and high patients' satisfaction,and can be widely used in clinical practice.

Objective:To assess the diagnostic and prognostic value of lymphocyte subtyping for invasive candidiasis infection (ICI) in critically ill patients with non-neutropenic sepsis.Methods:A prospective observational cohort study was performed at Peking Union Medical College Hospital (PUMCH), 377 patients with non-neutropenic sepsis admitted to Department of Critical Care Medicine from January 2017 to November 2019 were enrolled. There were 9.0% (34/377) patients diagnosed as ICI. Vital signs, supportive care therapy and microbiological specimens were collected. Peripheral blood lymphocyte subtypes, serum globulin, complements, inflammatory factors such as interleukin(IL)-6, IL-8, IL-10 and tumor necrosis factor were detected within 24 hours after sepsis was diagnosed. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value and prognostic significance of immunological indicators for ICI. Multiple logistic regression was used to analyze the independent risk factors for ICI. Kaplan-Meier analysis was used to analyze survival.Results:The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was 17.0 (13.0, 21.0) in all 377 patients. The sequential organ failure score (SOFA) was 11.0 (8.0, 13.0), and the 28-day mortality rate was 27.6% (104/377). Peripheral blood CD8 +absolute T lymphocyte count≤177 cells/μl, CD28 +CD8 +T-cell count≤81 cells/μl and 1, 3-β-D-glucan (BDG) ≥88.20 ng/L were closely correlated with the diagnosis of ICI (AUC=0.793,95 %CI 0.749-0.833, P<0.000 1;AUC=0.892,95 %CI 0.856-0.921, P<0.000 1;AUC=0.761, 95 %CI 0.715-0.803, P<0.000 1, respectively), with sensitivity of diagnosis 94.12%, 100.00%, and 88.24%; the specificity of diagnosis 81.34%, 62.39%, 63.56% respectively. Multivariate logistic regression analysis identified CD8 +T-cell count≤139 cells/μl ( OR=7.463, 95 %CI 1.300-42.831, P=0.024) and CD28 +CD8 +T-cell counts≤52 cells/μl ( OR=57.494, 95 %CI 3.986-829.359, P=0.003) as independent risk factors for higher mortality. Kaplan-Meier survival analysis suggested that CD8 +T-cell count ≤139 cells/μl ( P=0.0159) and CD28 +CD8 +T-cell count≤52 cells/μl ( P=0.000 1) were associated with higher mortality within 28 days (68.8%, 91.7%). Conclusions:Low CD28 +CD8 +T cell count in peripheral blood is closely related to the development and clinical outcome of ICI in sepsis patients, which could be used as an effective indicator for the diagnosis and prognosis prediction of ICI.

Objective To systematically analyze the World Health Organization Rehabilitation Competency Framework (RCF) theoretical framework, methodology and its application in the field of rehabilitation.Methods We systematically analyzed RCF conceptual framework and key characteristics, and discussed how to apply the RCF in the fields of human resource planning, education program and curriculum system, and vocational competency standards and certification criteria for rehabilitation human resources.Results The RCF encompasses five domains, naming practice, professionalism, learning and development, management and leadership, and research. Rehabilitation professionals' performance is the result of the interaction of their core values and beliefs, competencies, activities, knowledge, and skills. The RCF can be used to plan rehabilitation human resources, establish competency-based rehabilitation education programs and curriculum systems, and develop competency certification standards and licensure accreditation standards.Conclusion This study analyzed background, content and implementation framework of RCF, and systematically discussed the theories and methods related to how to use the RCF to construct national rehabilitation human resources development plans, develop rehabilitation education programs and curriculum systems based on the RCF, and establish certification and assessment standards for rehabilitation human resources.