Objective:To investigate the clinical effect of four-layer reposition of skin flap, musculocutaneous flap, orbital septum flap, and orbitum septum fat flap via lower eyelid margin approach, combined with periorbital fixed-point suspension of the midfacial soft tissue, to reconstruct the aesthetic structure of lower eyelid subunits.Methods:The clinical data of patients admitted to the Department of Beauty and Plastic Surgery of Zhejiang Rongjun Hospital for midface rejuvenation via lower eyelid margin approach surgery from June 2019 to August 2021 were retrospectively analyzed. The layer above the orbital septal, maxillary space, and zygomatic space were dissected to form a musculocutaneous flap. The septal fat flap was released and fixed, then the orbital septum flap was dissected and to make a net-like fixation in horizontal and vertical arrangement around the orbit. The mid and lateral suspension points and suspension tissues were determined and marked by pushing up the facial soft tissues in the sitting position, followed by fixation. Then, the abondant part of the musculocutaneous flap and the lower eyelid margin skin were trimmed to form a flap. Post-operative follow-up was performed by patient self-assessment (very satisfied, satisfied, dissatisfied, very dissatisfied). One attending plastic surgeon who was not involved in the surgery evaluated the results of the reconstruction of the aesthetic structures of the lower lid subunits, including laughing hill, lower eyelid fold, inferior sulcus of the lower tarsal plate, and eyelid-cheek junction based on global aesthetic improvement scale (IGAIS) (-1 to 3, the higher the score the more significant the improvement).Results:A total of 96 patients were included, including 7 males and 89 females, aged 38-83 years, with an average age of 53 years. In all patients, the swelling subsided 1 week after surgery, with no complication such as hematoma, lower eyelid retraction, blepharon separation, lower eyelid ectropion, etc. There was no malar lateral soft tissue accumulation and suspension point sunken deformity. 6-12 months postoperative follow-up showed that all patients had expected benefit outcomes in the reconstruction of laughing hill, lower eyelid fold, and inferior sulcus of lower tarsal plate. Yet, fat bulgings at the eyelid-cheek junction were moderately visible in 2 cases, and it is slightly visible in 3 cases. The rest of the patients had good curvilinear continuity in the eyelid-cheek junction area. Patient self-assessment showed that 76 were very satisfied, 16 were satisfied, and 4 were dissatisfied. IGAIS score showed 96 patients scored 2.43±0.35, with 76 scored 3, 16 scored 2 and 4 scored 1.Conclusion:Four-layer reposition of skin flap, musculocutaneous flap, orbital septum flap, and orbital septum fat flap via lower eyelid margin approach, combined with periorbital fixed-point suspension of the midfacial soft tissue can effectively reconstruct the aesthetic structure of the lower eyelid subunits, including the laughing hill, lower eyelid fold, inferior sulcus of inferior tarsal plate and eyelid-cheek junction.

Enterotoxigenic Escherichia coli（ETEC）infection can induce watery diarrhea，leading to dehydration，electrolyte disturbance，and even death in severe cases. Recombinant B subunit/inactivated whole-cell cholera（rBS/WC）vaccine is effective in preventing ETEC infectious diarrhea. On the basis of the latest evidence on etiology and epidemiology of ETEC，as well as the effectiveness，safety，and health economics of rBS/WC vaccine，National Clinical Research Center for Child Health（The Children’s Hospital，Zhejiang University School of Medicine）and Zhejiang Provincial Center for Disease Control and Prevention invited experts to develop expert consensus on rBS/WC vaccine in prevention of ETEC infectious diarrhea. It aims to provide the clinicians and vaccination professionals with guidelines on using rBS/WC vaccine to reduce the incidence of ETEC infectious diarrhea.

Objective:To investigate the clinical effect of four-layer reposition of skin flap, musculocutaneous flap, orbital septum flap, and orbitum septum fat flap via lower eyelid margin approach, combined with periorbital fixed-point suspension of the midfacial soft tissue, to reconstruct the aesthetic structure of lower eyelid subunits.Methods:The clinical data of patients admitted to the Department of Beauty and Plastic Surgery of Zhejiang Rongjun Hospital for midface rejuvenation via lower eyelid margin approach surgery from June 2019 to August 2021 were retrospectively analyzed. The layer above the orbital septal, maxillary space, and zygomatic space were dissected to form a musculocutaneous flap. The septal fat flap was released and fixed, then the orbital septum flap was dissected and to make a net-like fixation in horizontal and vertical arrangement around the orbit. The mid and lateral suspension points and suspension tissues were determined and marked by pushing up the facial soft tissues in the sitting position, followed by fixation. Then, the abondant part of the musculocutaneous flap and the lower eyelid margin skin were trimmed to form a flap. Post-operative follow-up was performed by patient self-assessment (very satisfied, satisfied, dissatisfied, very dissatisfied). One attending plastic surgeon who was not involved in the surgery evaluated the results of the reconstruction of the aesthetic structures of the lower lid subunits, including laughing hill, lower eyelid fold, inferior sulcus of the lower tarsal plate, and eyelid-cheek junction based on global aesthetic improvement scale (IGAIS) (-1 to 3, the higher the score the more significant the improvement).Results:A total of 96 patients were included, including 7 males and 89 females, aged 38-83 years, with an average age of 53 years. In all patients, the swelling subsided 1 week after surgery, with no complication such as hematoma, lower eyelid retraction, blepharon separation, lower eyelid ectropion, etc. There was no malar lateral soft tissue accumulation and suspension point sunken deformity. 6-12 months postoperative follow-up showed that all patients had expected benefit outcomes in the reconstruction of laughing hill, lower eyelid fold, and inferior sulcus of lower tarsal plate. Yet, fat bulgings at the eyelid-cheek junction were moderately visible in 2 cases, and it is slightly visible in 3 cases. The rest of the patients had good curvilinear continuity in the eyelid-cheek junction area. Patient self-assessment showed that 76 were very satisfied, 16 were satisfied, and 4 were dissatisfied. IGAIS score showed 96 patients scored 2.43±0.35, with 76 scored 3, 16 scored 2 and 4 scored 1.Conclusion:Four-layer reposition of skin flap, musculocutaneous flap, orbital septum flap, and orbital septum fat flap via lower eyelid margin approach, combined with periorbital fixed-point suspension of the midfacial soft tissue can effectively reconstruct the aesthetic structure of the lower eyelid subunits, including the laughing hill, lower eyelid fold, inferior sulcus of inferior tarsal plate and eyelid-cheek junction.

Objective:To explore the clinical features, etiologies and outcomes of unknown origin fever after simultaneous pancreas-kidney transplantation(SPK).Methods:From March 2015 to January 2020, clinical data were retrospectively reviewed for 120 SPK recipients.According to the definite evidence of fever, such as microbial culture, imaging findings or rejection, they were divided into three groups of free-fever(FF, n=41)and defined-fever(DF, n=47)and fever of unknown origin(FUO, n=32). The differences in general clinical features, surgical complications, laboratory tests and prognoses were compared.Logistic regression was employed for analyzing the risk factors of FUO and Kapla-Meier for survival analysis.And P<0.05 was deemed as statistically significant. Results:Multivariate analysis revealed that preoperative diabetic gastroenteropathy was an independent risk factor for unexplained fever.Significant differences existed between FUO and DF groups in leucocyte count[6.50(5.13, 7.36)vs.10.36(6.11, 12.97)×10 9/L], C-reactive protein(CRP)[11.75(6.25, 16.85)vs.35.00(16.30, 75.00)μg/ml], procalcitonin[0.13(0.06, 0.18)vs.0.19(0.11, 1.05)ng/ml]( P<0.001, P<0.001, P=0.025). As compared with DF group, 19 recipients in FUO group only received 1-2 antibiotics and there was a shorter course of treatment[13(40.6%)vs.32(68.1%), P=0.016]. For 6(18.7%)recipients after a diagnosis of FUO, clinical outcome was achieved with only NSAIDs.Length of stay was(48.72±19.51)days in FUO group versus(57.36±27.46)days in DF group and the difference was statistically significant( P<0.001). Hospitalization expenses of two groups were 253 463.25 and 334 605.96 yuan respectively and the difference was also statistically significant( P=0.002). Conclusions:Diabetic gastroenteropathy is an independent risk factor for early FUO after SPK transplantation.Inflammatory markers of leukocytes, CRP and procalcitonin in FUO patients are significantly lower than DF group.And these clinical features can help diagnose FUO in an early stage.

Anti-CD19 chimeric antigen receptor (CAR) T cell therapy has shown impressive efficacy in treating B-cell malignancies. A single-center phase I dose-escalation study was conducted to evaluate the safety and efficacy of T cells transduced with CBM.CD19 CAR, a second-generation anti-CD19 CAR bearing 4-1BB costimulatory molecule, for the treatment of patients with refractory diffuse large B-cell lymphoma (DLBCL). Ten heavily treated patients with refractory DLBCL were given CBM.CD19 CAR-T cell (C-CAR011) treatment. The overall response rate was 20% and 50% at 4 and 12 weeks after the infusion of C-CAR011, respectively, and the disease control rate was 60% at 12 weeks after infusion. Treatment-emergent adverse events occurred in all patients. The incidence of cytokine release syndrome in all grades and grade ⩾ 3 was 90% and 0, respectively, which is consistent with the safety profile of axicabtagene ciloleucel and tisagenlecleucel. Neurotoxicity or other dose-limiting toxicities was not observed in any dose cohort of C-CAR011 therapy. Antitumor efficacy was apparent across dose cohorts. Therefore, C-CAR011 is a safe and effective therapeutic option for Chinese patients with refractory DLBCL, and further large-scale clinical trials are warranted.
Antigens, CD19/adverse effects* ; China ; Humans ; Lymphoma, Large B-Cell, Diffuse/therapy* ; Receptors, Chimeric Antigen ; T-Lymphocytes

Humans ; Computed Tomography Angiography ; Deep Learning ; Coronary Angiography ; Coronary Artery Disease ; Tomography, X-Ray Computed ; Coronary Stenosis/diagnosis* ; Retrospective Studies ; Fractional Flow Reserve, Myocardial ; Predictive Value of Tests

Objective:This study aims to explore the clinical characteristics of T-cell large granular lymphocyte leukemia (T-LGLL) patients with STAT3 mutation status and provide a reference for clinical management of such patients.Methods:The clinical data of T-LGLL patients between 2009 and 2019 in Jiangsu Province Hospital were retrospectively analyzed. Differences in baseline clinical data, treatment responses, and survival outcomes in patients with STAT3 mutations or with no mutations were compared.Results:A total of 80 patients were included, including 66 patients without STAT3 mutation and 14 patients (17.5%) with STAT3 mutation. The frequency of Y640F mutation was the highest (42.9%) . Compared with non STAT3 mutation group, STAT3 mutation group had lower HGB (67.5 g/L vs 82.5 g/L, P=0.018) , lower neutrophil count (0.665×10 9/L vs 1.465×10 9/L, P<0.001) , higher LDH (229 U/L vs 198 U/L, P=0.041) , higher ferritin (402.5 g/L vs 236.0 g/L, P=0.029) , higher expression rate of TCR Vβ subfamily (89.2% vs 65.4%, P=0.014) and higher proportion of patients with treatment indications (100% vs 74%, P=0.033) . The complete remission rates of STAT3 mutation group and non mutation group were 38.5% and 32.7%, respectively, with no significant difference ( P=0.748) . The overall response rate of first-line immunosuppressive therapy in STAT3 mutation group and non mutation group were 69.2% and 69.4%, respectively, with no significant difference ( P=1.000) . The median follow-up time was 63 (2-121) months. There was no significant difference in the overall survival time between the two groups ( P=0.170) . Conclusions:T-LGLL patients with STAT3 mutations seems to be correlated with an increased tumor burden and high treatment demand, and had a good response to first-line immunotherapies. The prognostic significance of STAT3 mutation in T-LGLL patients requires further validation.

Objective:To compare the prognostic value of four prognostic models in predicting time to first treatment (TTFT) in patients with Binet A Chinese chronic lymphocytic leukemia (CLL) .Methods:This retrospective analysis included one hundred and ten patients with Binet A CLL, initially diagnosed in the First Affiliated Hospital of Nanjing Medical University (Pukou CLL center) from June 2009 to January 2020. Risk stratification was conducted according to IPS-E, CLL-IPI, CLL1-PM, and Barcelona-Brno prognostic models.Results:Among 110 patients with Binet A CLL patients, the median age was 58 (25-84) years. The median follow-up time was 35 (4-189) months, and 57 (51.8%) patients met the indication for treatment due to symptomatic disease progression during follow-up. Log-rank analysis of nine variables was conducted involving age, Rai stage, absolute lymphocyte count (ALC) , lymph node size, lymphocyte doubling time (LDT) , β 2-Microglobulin, IGHV status, TP53, and Del (11q) . Additionally, Rai Ⅰ-Ⅲ, ALC>15×10 9/L, palpable lymph node size ≥1cm, β 2-Microglobulin>3.5 mg/L, unmutated IGHV, TP53 mutation or deletion, and 11q deletion were independent risk factors of TTFT. Predictive value of each model was assessed by Harrel C-index and Akaike information criterion (AIC) with CLL1-PM (C-index=0.736, AIC=777) , followed by CLL-IPI (C-index=0.722, AIC=933) , IPS-E (C-index=0.683, AIC=1004) , and Barcelona-Brno prognostic model (C-index=0.663, AIC=986) . Conclusion:All four prognostic models effectively predicted TTFT. IPS-E might be an ideal model to guide clinical surveillance because of its easy accessibility and low expenses in routine clinical practice. Therefore, for patients receiving fluorescence in situ hybridization (FISH) and next-generation sequencing (NGS) examination at diagnosis, CLL-IPI or CLL1-PM could be applied to evaluate their prognosis more comprehensively.

Objective:This study aims to investigate the expression of E3 ubiquitin-ligase (WWP1) in chronic lymphocytic leukemia (CLL) patients and analyze its correlation with clinical prognostic indicators (TP53, CD38, IGHV mutation) and its prognostic value.Methods:A total of 48 CLL patients and 9 age-matched normal subjects were enrolled in the study. The WWP1 expression was detected by SYBR Green-based real-time PCR, and the clinical relationship was analyzed by GraphPad Prism software.Results:The WWP1 median expression was 0.007 (95% CI 0.005-0.010) in the normal control group and 0.031 (95% CI 0.019-0.044) in the CLL group ( P<0.001) . A sub-groups analysis implicated a statistically significant result ( P=0.022) , showing that the median time from a relatively high and low transcription level of WWP1 to the first treatment was 24 months and 35 months, respectively. Positive CD38 and ZAP-70 expressions were associated with a higher WWP1 expression ( P=0.012 and 0.029, respectively) . Conclusion:An abnormal WWP1 mRNA expression was found in CLL patients with significant correlation with ZAP-70 and CD38 expressions, and WWP1 may become a new supplement of CLL prognostic markers.

Objective: To evaluate the prognostic value of lymphocyte to monocyte ratio (LMR) and PET scan performed after first two cycles of chemotherapy (PET-2) in Hodgkin’s lymphoma (HL) . Methods: The clinical data of 133 patients with HL diagnosed from January 2007 to March 2016 at the First Affiliated Hospital of Nanjing Medical University, were retrospectively analyzed. The X-tile software was used to calculate the optimal cut-off value of LMR. Kaplan-Meier method and Cox regression were used for survival analysis. Results: The median age of 133 HL patients was 33 (18–84) years, and the male to female ratio was 1.9∶1. The optimal cut-off value of LMR was 2.5, and progression free survival (PFS) (P<0.001) and overall survival (OS) (P<0.001) were significantly lower in the LMR<2.5 group than that of LMR≥2.5. Multivariate survival analysis showed that LMR<2.5 was an independent predictor of PFS (P=0.002, HR=2.35, 95%CI 1.36–4.07) and OS (P=0.002, HR=10.36, 95%CI 2.35–45.66) in HL patients. The analysis of PET-2 from 56 HL patients showed that PET-2 positive patients had significantly poorer PFS (P=0.022) . After grouping LMR combined with PET-2, significant differences were found in PFS and OS between the three groups (P values were 0.009 and 0.012) . Conclusion LMR<2.5 is an independent prognostic factor for patients with HL. PET-2 combined with LMR may have better prognostic value.