To investigate the effectiveness of the digital technology in repairing hand soft tissue defect with the lateral arm perforator flap. Methods From January, 2015 to February, 2018, 15 cases of hand soft tissue defect were treated with free lateral arm perforator flaps transferring. Injury site: 7 cases on the back of the hand, 4 cases on the palm, and 4 cases on the mouth of the tiger. All of them had tendon exposure. The size of defect was 2.0 cm×1.5 cm to 14.0 cm×5.0 cm. CT angiography was conducted and analyzed before operation, and the donor sites and preferred perforators were selected.Then the CTA data was imported into the Mimics 17.0 software to recon-struct the three dimensional structure of the perforators, bone, and skin. The flap was obtained on the basis of preop-erative design during operation.The size of flaps varied from 3.0 cm×2.0 cm to 15.0 cm×6.0 cm.The survival status of the flap, the appearance and function of the hand were followed-up and analyzed after operation. Results All the flaps survived. The wounds and incisions at donor sites healed primarily. The patients were followed-up for 6-12 (mean, 8) months. The hand function recovered satisfactorily, and the sensation was S2-S3 at 6 months after operation. According to the functional assessment criteria of upper limb formulated by the Hand Surgery Branch of Chinese Medical Association, the results were excellent in 4 cases, good in 9 cases, and fair in 2 cases. The linear scars were observed at the donor sites. Conclusion The lateral arm perforator flap has a stable vessel pedicle, good texture and sensation. So it is a good method to repair soft tissue defects of hand. The preoperative individualized design of the lateral arm perforator flap can realize through CTA digital technology and Mimics 17.0 software. It can reduce the operation risk.

Objective:To investigate the efficacy and safety of humanized CD19-specific chimeric antigen receptor T cells (hCART19s) in treating children and young adults with relapsed/refractory acute lymphoblastic leukemia (R/R ALL) and to analyze relevant factors affecting its curative effect and prognosis.Methods:We conducted a single-center clinical trial involving 31 children and young adult patients with R/R B-ALL who were treated with humanized CD19-specific CAR-T cells (hCART19s) from May 2016 to September 2021.Results:Results showed that 27 (87.1%) patients achieved complete remission (CR) or CR with incomplete count recovery (CRi) one month after CAR-T cell infusion. During treatment, 20 (64.5%) patients developed grade 1-2 cytokine release syndrome (CRS) , and 4 (12.9%) developed grade 3 CRS. Additionally, two patients had grade 1 neurological events. During the follow-up with a median time of 19.3 months, the median event-free survival (EFS) was 15.7 months (95% CI 8.7-22.5) , and the median overall survival (OS) was 32.2 months (95% CI 10.6-53.9) . EFS and OS rates were higher in patients who have undergone hemopoietic stem cell transplantation (HSCT) than in those without [EFS: (75.0 ± 12.5) % vs (21.1 ± 9.4) %, P=0.012; OS: (75.0 ± 12.5) % vs (24.6 ± 10.2) %, P=0.035]. The EFS and OS rates were significantly lower in patients with >3 treatment lines than in those with <3 treatment lines [EFS: 0 vs (49.5±10.4) %, P<0.001; OS: 0 vs (52.0±10.8) %, P<0.001]. To the cutoff date, 12 patients presented with CD19 + relapse, and 1 had CD19 - relapse. Conclusion:hCART19s are effective in treating pediatric and young adult R/R ALL patients, with a low incidence of severe adverse events and reversible symptoms. Following HSCT, the number of treatment lines can affect the long-term efficacy and prognosis of pediatric and young adult R/R ALL patients.

【Objective:】 To explore the influencing factors of ethical cognition of intensive care unit (ICU) nursing staff. 【Methods:】 The convenient sampling method was used to select 530 ICU clinical nursing staff from 4 grade A tertiary hospitals in a city from May 2019 to May 2021 as the subjects. Univariate analysis and multivariate analysis were used to determine the influencing factors of ethical cognition of ICU nursing staff. 【Results:】 The results of univariate analysis showed that there were statistically significant differences in ethics committee knowledge scores and research ethics knowledge scores of nursing staff with different education levels, professional titles, attitudes, and training experiences (P<0.05). Among them, nursing staff with a bachelor’s degree or above had a higher total score of ethical cognition than those with a specialized degree or below (P<0.05), the total score of ethical cognition among professor of nursing was higher than that of nurses, nurse practitioners, and nurses-in-charges (P<0.05), the total score of ethical cognition among nursing staff with positive attitudes was higher than that of general positive nursing staff (P<0.05), and the total score of ethical cognition of nurses with training experience was higher than that of those without training experience (P<0.05). The results of multivariate analysis showed that education level, professional title, attitude, and training experience were all influencing factors of the ethical cognition among ICU nursing staff (P<0.05). 【Conclusion:】 Education level, professional title, attitude, and training experience are all influencing factors affecting the ethical cognition of ICU nursing staff, and the above factors should be combined to improve the cognitive ability of ICU nursing staff through multiple ways.