Objective:To analyze the causes and influencing factors of conversion from laparoscopic surgery to laparotomy.Methods:To analyze and summarize the clinical data of 84 patients who converted to laparotomy in 16 203 cases of laparoscopic surgery from August 2017 to August 2020 in the Department of Gynecology of the Affiliated Hospital of Qingdao University, each patient converted to surgery was matched with 2 patients who underwent simple laparoscopic surgery. The patients were divided into conversion to laparotomy group (84 cases) and control group (168) cases, and analyze the influencing factors of laparoscopic conversion to laparotomy. χ 2 test or corrected χ 2 test or Fisher exact probability method were used for the comparison of counting data between groups, and conditional regression analysis was used for the multivariate analysis of case control design. Results:The conversion rate of gynecologic laparoscopic surgery to laparotomy was 0.52%(84/16 203). The reasons for 84 cases of conversion from laparoscopic surgery to open surgery were as follows: pelvic adhesion 50.0%(42/84), unexpected malignant tumor 19.0%(16/84), tumor oversize or special shape and location 14.3%(12/84), hemostasis difficulty 7.1%(6/84), multiple uterine fibroids 3.5%(3/84), simultaneous surgery 3.5%(3/84), bladder injury 1.2%(1/84), and subcutaneous emphysema 1.2%(1/84) during the operation. There were no significant differences in body mass index and comorbidities (diabetes, hypertension, coronary heart disease, thyroid disease) between the two groups (all P>0.05). And the history of endometriosis was 36.9% (31/84) and the history of pelvic surgery in the transperitoneal group was 60.7% (51/84) higher than that in the conversion to laparotomy group of 20.8% (35/84), 30.6% (51/84) (χ 2=7.482, 21.42, P=0.006). The results of conditional regression analysis showed that that surgical history( OR=3.979, 95% CI 2.010-7.874, P<0.001 and thyroid history ( OR=15.333, 95% CI 1.087-216.346, P=0.005) increased the risk of conversion to laparotomy; Hypertension history ( OR=0.203, 95% CI 0.067-0.622, P=0.005) reduced the risk of conversion to laparotomy. Further analysis of which operation type affected the conversion to laparotomy showed that cesarean section ( OR=2.105, 95% CI 1.109-4.351, P=0.044), myomectomy ( OR=11.605, 95% CI 3.306-40.735, P<0.001), and ovarian cyst removal ( OR=7.914, 95% CI 2.157-21.037, P=0.002) affected the conversion to laparotomy. Conclusion:The main reason for conversion from gynecologic laparoscopic surgery to laparotomy is pelvic adhesion. The history of surgery and thyroid disease are the risk factors for conversion to laparotomy. Among them, myomectomy and ovarian cyst removal are important factors for conversion to laparotomy. Before operation, appropriate clinical operation methods should be selected according to the patient's medical history and condition to ensure the patient's safety.

Objective:To analyze the correlation between clinical features and prognosis or prognostic risk factors in patients with KMT2A::AFF1 gene positive B-ALL.Methods:Retrospective cohort study was conducted. 167 cases of B-ALL admitted to the Shanghai General Hospital and the Naval Medical University Affiliated First Hospital from April 1, 2011 to July 31, 2022 were divided into groups according to gene types. 22 cases with KMT2A::AFF1 positive B-ALL were enrolled as the experimental group, 54 cases with BCR::ABL gene positive B-ALL as control group 1 and 91 cases with KMT2A::AFF1 and BCR::ABL gene negative B-All as control group 2. The median age of first diagnosis in the experimental group, control group 1 and control group 2 were 43.5(30.5, 56), 43.5(34, 55) and 32(24, 46) respectively. The median white blood cell counts of the three groups were 142.4(25.7, 247.2)×10 9/L, 37.6(15.7, 102.2)×10 9/L and 13.4(4.3, 33.0)×10 9/L, respectively. Allo-HSCT rates in three groups were 45.5%, 72.2% and 72.5% respectively. Using SPSS 26.0 software, the statistical methods of nonparametric rank sum test, chi-square test, Kaplan-Meier and Cox regression were used to analyze and compare the differences in clinical characteristics, chemotherapy and prognosis between the experimental group and the control groups, and to analyze the risk factors and the differences in prognosis of allo-HSCT in the experimental group. Results:The age difference between the experimental group and the control group 2 was significant ( Z=-2.151, P=0.031). The white blood cell count in experimental group was significantly higher than that in control group 1 ( Z=-2.363, P=0.018) and control group 2 ( Z=-4.886, P<0.001). The rate of allo-HSCT in experimental group was lower than that in control group 1(45.5% vs 72.2%, χ 2=4.890, P=0.027) and control group 2 (45.5% vs 72.5%, χ 2=5.897, P=0.015). The remission rates of the patients in three groups after receiving one course of chemotherapy were 60%(12/20), 83.3%(45/54) and 76.6%(69/90); the remission rates after two courses of chemotherapy were 25%(5/20), 7.4%(4/54) and 12.2% (11/90), and the non-remission rates of more than two courses of treatment were 15%(3/20), 9.3%(5/54) and 11.1%(10/90), respectively. The effect of chemotherapy in experimental group was worse than that in control group 1 ( Z=-1.979, P=0.048). There was no significant difference between the three groups in sex, whether the chromosome is a standard-risk karyotype, hemoglobin at the time of initial onset, platelet count and percentage of bone marrow blast cells. The overall survival rate (OS) of experimental group was significantly lower than that of control group 1 and control group 2(23.9% vs 36.7%, χ 2=7.608, P=0.006 and 23.9% vs. 44.8%, χ 2=6.442, P=0.011), and the 3-year recurrence-free survival (RFS) was also lower than that of the other two groups (14.0% vs 57.6%, χ 2=17.823, P<0.001 and 14.0% vs 48.2%, χ 2=16.432, P<0.001). There was a significant difference in the total OS rate between the experimental group and the group without allo-HSCT (45.0% vs 9.2%, χ 2=15.254, P<0.001). Univariate analysis showed that age was the risk factor of RFS in the experimental group, and allo-HSCT therapy was the protective factor of OS. Multivariate analysis showed that allo-HSCT was an independent protective factor for OS in the experimental group. Conclusions:Patients with KMT2A::AFF1 positive B-ALL had higher white blood cells, less sensitivity to chemotherapy and poor prognosis. Age was a risk factor of RFS in KMT2A::AFF1 positive B-ALL, and allo-HSCT could improve the prognosis.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.