Objective To evaluate the efficacy and safety of immunosuppressive strategy of leflunomide (LEF) combined with calcineurin inhibitor and prednisone in Chinese renal transplant recipients.Methods Prospective clinical study was performed in 16 stable renal transplant recipients treated with calcineurin inhibitor, prednisone and either mycophenolate mofetil (MMF) or azathioprine (Aza), and MMF or Aza was replaced by LEF afterward. The loading dose of LEF was 50 mg/day for 3-5 days, and the maintenance dose was 20 mg/day. Prednisone was maintained 10 mg/day. The doses of CsA were adjusted according to its blood concentration.Results One patient dropped due to economic reason 1 mouth later, and continued to take Aza. Another one patient switched back to MMF due to a slight increase of serum creatinine (from 130 ?mol/L to 143 ?mol/L) 6 months after conversion. The remaining 14 patients were still on LEF. The mean observation time under LEF was (8.7?7.2) months (1～18 month). The mean serum creatinine was (103?24) ?mol/L before conversion, (95?26) ?mol/L at 6th month, and (108?27) ?mol/L at one year post-conversion. There was one episode of biopsy proved reversible acute rejection. The observed side effect was tolerable alopecia in 2 cases and rash in 1 case, but there were no significant increases in liver function, decrease of blood WBC count, deterioration of anemia, or any serious infection in any of the patients.Conclusion Immunosuppressive strategy of LEF+calcineurin inhibitor and prednisone is effective and safe in stable Chinese renal transplant recipients.

The report described one case of vascular paralysis syndrome during kidney transplantation to provide references for clinical practice.After intraoperative opening of kidney artery and vein, the recipient developed vascular paralysis syndrome.However, the efficacy is not obvious after dosing of norepinephrine.After an intravenous infusion of methylene blue, the recipient has a successful removal of tracheal intubation and recovered well.

Objective: To investigate the clinical effect of diced cartilage in correcting nasal alar base depression after cleft lip surgery. Methods: A retrospective study was conducted in 15 patients of nasal deformity after lip surgery from January 2018 to January 2019. All the patients were taken from autologous costal cartilage to reconstruct the outline of nasal malformation, and the remaining autologous costal cartilage was cut into 0.5-1.0 mm pieces and filled into the basilar lacunar space of the nasal alar by the 1 ml syringe whose anterior needle nipples was removed. The effects of visual images before and after operation were compared and analyzed by Adobe Photoshop CS6 software. The patients were followed up for 6-15 months (mean 10months). The satisfaction and complications of the patients were investigated. Results: The nasal alar base was significantly elevated and the outline of the nasal deformity was improved in 15 patients after operation. The overall effect was satisfactory and no obvious complications were found. No obvious absorption was found in the follow-up. Conclusions The application of diced cartilage to correct the nasal alar base depression after cleft lip surgery was a feasible method with important clinical value. It advanced in taking good use of the remaining cartilage and reducing the damage to both the donor and recipient area.

Objective: To evaluate the efficacy and safety of DCV-based DAAs therapy for chronic HCV infected Chinese patients. Methods: An open-label, non-randomized, prospective study was designed. Fifty-two patients with chronic HCV infection were enrolled. Among them, there was one patient after liver transplantation, 2 patients after kidney transplantation, 3 patients with hepatocellular carcinoma, and 4 patients with HBV infection. Thirteen cases with chronic hepatitis C (one compensated cirrhosis) who were negative for resistance-related variants [NS5A RAS (-)] of gene 1b and NS5A were treated with daclatasvir (DCV) + asunaprevir (ASV) for 24 weeks. Twenty-five cases of CHC (six compensated cirrhosis) with GT 1b, 2a, 3a, 3b, 6a were treated with DCV + SOF ± RBV for 24 weeks. 8 cases with decompensated cirrhosis of gene 1b and NS5A RAS(-) were given DCV + SOF + RBV regimen for 12 weeks. Six cases with decompensated cirrhosis, of gene 2a, 1b, 2a, 3a, 3b, were given DCV + SOF + RBV regimen for 24 weeks. HCV RNA, blood routine test, liver and kidney function, and upper abdominal ultrasound/MRI were measured at baseline, 4 weeks of treatment, end of treatment, and 12 weeks of follow-up. The incidence of adverse events and laboratory abnormalities during treatment were recorded. A t-test was used to compare the measurement data between two groups, and analysis of variance was used to compare the measurement data between multiple groups. Results: Sixteen patients (100%) achieved SVR12 after treatment, with 0% recurrence rate. Rapid virological response (RVR) of the four treatment regimens were 76.92%, 54.17%, 87.50%, and 83.33%, respectively, and 32 patients achieved 100% virological response after the completion of treatment. The incidence of adverse events of chronic hepatitis C with cirrhosis and decompensated cirrhosis was 62.5% and 64.29%, respectively. The most common adverse event was fatigue in CHC (25.00%), and elevated indirect bilirubin in decompensated cirrhosis (42.86%). No serious adverse drug events, deaths or adverse reactions occurred. Conclusion DCV-based DAAs regimen is promising option for the treatment of HCV genotypes, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and HCV infection after liver/kidney transplantation in china. Above all, it has high SVR12 with good tolerability and safety profile.

AIM:To explore the effects of CD38 on lysosome reformation and cholesterol efflux in macro-phages.METHODS:Bone marrow-derived macrophages from low-density lipoprotein(LDL)receptor knockout(LDLr-/-)mice were cultured as cell model.Live cell imaging system was applied to evaluate the effect of nicotinic acid adenine di-nucleotide phosphate(NAADP)on lysosome number.ELISA was conducted to measure NAADP level in macrophages.After the cells were treated with nicotinic acid(NA),RT-qPCR was conducted to detect CD38 mRNA expression,and Western blot was conducted to observe CD38 protein expression and phosphorylated transcription factor EB(TFEB)level.Laser scanning confocal microscopy was applied to evaluate the influence of CD38/NAADP signaling on lysosome number and cholesterol egression.RESULTS:NAADP remarkably increased lysosome number(P<0.05),and this effect was significantly inhibited by NAADP antagonist NED-19,Ca2+ chelator BAPTA,and calcineurin inhibitor CsA(P<0.05).CD38 markedly enhanced NAADP synthesis in macrophages(P<0.05).NAADP synthetic substrate NA prominently ele-vated the expression of CD38 mRNA and protein(P<0.05).NA significantly decreased the phosphorylated TFEB level;this effect was also attenuated by NED-19,BAPTA and CsA(P<0.05).Disrupting CD38/NAADP signaling pathway markedly inhibited NA-induced enhancement of lysosome number,lysosomal free cholesterol and cytosol cholesterol ester efflux in macrophages(P<0.05).NA-induced enhancement of lysosome number,lysosomal free cholesterol and cytosol cholesterol ester efflux abolished in LDLr/CD38 DKO macrophages(P<0.05),whereas these effects induced by NA were recovered after CD38 gene rescue.CONCLUSION:CD38 triggers lysosome reformation via TFEB and consequently pro-motes the efflux of lysosomal free cholesterol and cytosol cholesterol ester.

Objective:To investigate the application of local free-style perforator flap in repairing gluteal bedsores.Methods:A retrospective study was performed. Date from 35 patients(20 males and 15 females, mean age 46 years old, range from 24-71) with gluteal bedsores between June 2017 and June 2019 were retrieved and reviewed by the Department of Burn and Plastic Surgery, Second Xiangya Hospital of Central South University. Among these cases, 13 were paraplegia after trauma, 6 were paralysis after cerebral hemorrhage, 13 were chronic infection, and 3 were poor wound healing after tumor resection. The average defect size was 5.6 cm×5.0 cm(range from 2.0 cm×3.0 cm to 10.0 cm×5.0 cm). By following the concept of free-style perforator flap, the flap was designed near the wound according to the perforator location detected by Doppler before surgery, and the defects were recovered by the flaps by rotation or other method such as rotation. Or the perforator flap can be modified into dermis-fat flap and flipped 180° to recover the wound. After the surgery, the survival of the flap or the dermis-fat flap, wound healing, as well as the sense and motion function of buttock and lower limbs were observed and recorded.Results:21 cases were repaired by perforator flap and 14 cases were repaired by modified dermis-fat flap. The size of flap range from 3.0 cm×3.0 cm to 10.0 cm×7.0 cm. The follow-up time was 3-22 months(mean, 12 months). All perforator flaps and dermis-fat flaps survived. The appearance of buttock was pleasant and no recurrence of bedsores. The patients without paraplegia had no major sensory loss and pain. The function of gluteus maximus was basically normal, and the motor function of lower limb was also generally satisfactory.Conclusions:The local free-style perforator flap or modified dermis-fat flap has advantages including simple design and operation, reliable blood supply and minimal damage to the donor site. It is a better way to repair gluteal bedsores.

Objective:To investigate the application of local free-style perforator flap in repairing gluteal bedsores.Methods:A retrospective study was performed. Date from 35 patients(20 males and 15 females, mean age 46 years old, range from 24-71) with gluteal bedsores between June 2017 and June 2019 were retrieved and reviewed by the Department of Burn and Plastic Surgery, Second Xiangya Hospital of Central South University. Among these cases, 13 were paraplegia after trauma, 6 were paralysis after cerebral hemorrhage, 13 were chronic infection, and 3 were poor wound healing after tumor resection. The average defect size was 5.6 cm×5.0 cm(range from 2.0 cm×3.0 cm to 10.0 cm×5.0 cm). By following the concept of free-style perforator flap, the flap was designed near the wound according to the perforator location detected by Doppler before surgery, and the defects were recovered by the flaps by rotation or other method such as rotation. Or the perforator flap can be modified into dermis-fat flap and flipped 180° to recover the wound. After the surgery, the survival of the flap or the dermis-fat flap, wound healing, as well as the sense and motion function of buttock and lower limbs were observed and recorded.Results:21 cases were repaired by perforator flap and 14 cases were repaired by modified dermis-fat flap. The size of flap range from 3.0 cm×3.0 cm to 10.0 cm×7.0 cm. The follow-up time was 3-22 months(mean, 12 months). All perforator flaps and dermis-fat flaps survived. The appearance of buttock was pleasant and no recurrence of bedsores. The patients without paraplegia had no major sensory loss and pain. The function of gluteus maximus was basically normal, and the motor function of lower limb was also generally satisfactory.Conclusions:The local free-style perforator flap or modified dermis-fat flap has advantages including simple design and operation, reliable blood supply and minimal damage to the donor site. It is a better way to repair gluteal bedsores.

Objective:To evaluate the effect of preoperative 3D simulation on the evaluation of rhinoplasty.Methods:From December 2017 to March 2019, patients in the Department of Burn and Plastic Surgery of the Second Xiangya Hospital of Central South University were randomly selected as the research subjects. According to whether they had received 3D simulation before surgery, they were divided into the experimental group (after 3D simulation before comprehensive surgery) and the control group (without 3D simulation before comprehensive surgery). Visual analogue scale (VAS) and Rhinoplasty Outcomes Evaluation (ROE ) questionnaires were used to evaluate the satisfaction of all patients preoperative and one month after surgery.Results:At the beginning of this study, a total of 97 cases were included, 97 cases were given questionnaires, and 60 cases were effectively recovered, 30 cases in each group.There was statistical significance in the improvement of the postoperative VAS scores between the experimental group and the control group ( P<0. 05). The mean improvement in the experimental group was (4. 10±0. 88) points, while the mean improvement in the control group was (2. 53±0. 73) points. There was statistical significance in the improvement of the postoperativeROE satisfaction scores between the two groups. The average preoperative satisfaction score of the experimental group was (29. 5±9. 7) points, which increased to (77. 3±13. 7) points after surgery. In the control group, the average satisfaction score was (30. 4±11. 3) points before surgery and increased to (62. 7±23. 4) points after surgery. Conclusions:3D simulation before nasal synthesis can improve the postoperative satisfaction of patients.VAS and ROE questionnaires are good tools for evaluating the effect of comprehensive rhinoplastic surgery.

Objective:To evaluate the effect of preoperative 3D simulation on the evaluation of rhinoplasty.Methods:From December 2017 to March 2019, patients in the Department of Burn and Plastic Surgery of the Second Xiangya Hospital of Central South University were randomly selected as the research subjects. According to whether they had received 3D simulation before surgery, they were divided into the experimental group (after 3D simulation before comprehensive surgery) and the control group (without 3D simulation before comprehensive surgery). Visual analogue scale (VAS) and Rhinoplasty Outcomes Evaluation (ROE) questionnaires were used to evaluate the satisfaction of all patients preoperatively and one month after surgery.Results:At the beginning of this study, a total of 97 cases were included. 97 cases were given questionnaires, and 60 cases were effectively recovered.There were 30 cases in each group. There was statistical significance in the improvement of the postoperative VAS scores between the experimental group and the control group ( P<0.05). The mean improvement in the experimental group was (4.10±0.88) points, while the mean improvement in the control group was (2.53±0.73) points. There was statistical significance in the improvement of the postoperative ROE satisfaction scores between the two groups. The average preoperative satisfaction score of the experimental group was (29.5±9.7) points, which increased to (77.3±13.7) points after surgery.In the control group, the average satisfaction score was (30.4±11.3) points before surgery and increased to (62.7±23.4) points after surgery. Conclusions:3D simulation before nasal synthesis can improve the postoperative satisfaction of patients. VAS and ROE questionnaires are good tools for evaluating the effect of comprehensive rhinoplastic surgery.

Objective:The purpose of this study was to investigate the characteristics of viral pathogen spectrum and the epidemiological characteristics of each viral pathogen in hospitalized cases associated with severe acute respiratory infection (SARI) in Luohe City, Henan Province from 2017 to 2019.Methods:Based the SARI Case Surveillance Platform, SARI cases were collected in Central Hospital of Luohe City, Henan Province from November 2017 to February 2019. In the end, 783 SARI cases were included, whose throat swabs were taken within 24 h of admission, as well as their demographic characteristics, onset time, clinical characteristics and other information recorded. At the same time, viral identification was performed, and the age and time distribution of each virus were analyzed.Results:The age of 783 SARI cases shown as M ( P 25, P 75) was 3 (1, 5) years old, ranging from 1 month to 95 years old. Children under 5 years old were the majority (71.01%). The males (61.81%) were more than females (38.18%). Among the 783 SARI cases, a total of 9 kind of viruses were identified with 64.88% (508/783) of the throat swabs tested positive for at least one virus. The positive rate of influenza virus and human respiratory syncytial virus were both 20.18% (158 cases), which was the highest among all the detected respiratory virus. The co-infection rate was 15.84% (124/783), among which double infection was the most common, accounting for 85.48% (106/124) of the co-infected cases. And human respiratory syncytial virus, human rhinovirus and influenza virus were the most common pathogen in co-infection cases. Moreover, the viral positive rate was 68.71% in children aged 5 years and 63.27% in people aged 60-95 years. Influenza and human respiratory syncytial virus dominated in winter and spring, while human parainfluenza virus was the main infection in summer. Conclusion:Influenza virus and human respiratory syncytial virus were the main viruses in throat swabs of SARI cases from 2017 to 2019 in Luohe City, Henan Province. There were differences in the age and seasonal epidemiological characteristics of each virus.