Objective To investigate the expression of monocyte subsets and their chemokine,i.e.,monocyte chemoattractant protein (MCP-1) and fractalkine (FKN),in patients with acute coronary svndrome (ACS),and to analyze their correlation.Methods Patients with the syndrome of pectoralgia and to be inspected with coronary angiography (CAG) in our hospital from Sep.to Dec.,2016 were included.Patients' venous blood was collected on the operation day before operation,the level and proportion of monocyte (Mon) subsets,which was namely CD14 + CD16-Mon (Mon1),CD14+CD16 + Mon (Mon2) and CD14-CD16 + Mon (Mon3) according to the expression of cluster differentiation-14 (CD14) and CD16,were detected by flow cytometry (FCM).Patients' venous blood was collected on the operation day before operation and one day after operation,the concentrations of MCP-1 and FKN in plasma were measured by ELISA.We compared the expression levels of MCP-1-Mon1 and FKN-Mon3,and analyzed their relationship between each other respectively in different groups.Results Diagnosed according to the clinical symptoms,myocardial markers,electrocardiogram and CAG results,70 individuals were analyzed,including 30 patients with acute myocardial infarction (AMI group),25 patients with unstable angina pectoris (UAP group) and 15 patients with the chest pain symptoms and normal CAG results (control group).The percentage of Mon1 in the AMI group was higher than that in the other groups (P＜0.05);no difference was observed for Mon3 among the groups (P＞0.05).The Mon3/Mon1 ratio in the AMI group was lower than that in the control group (P＜0.05).Moreover,the levels of FKN and MCP-1 in the ACS group were greater than those in the control group.The level of red blood cell distribution width (RDW) was significantly increased in the AMI and UAP group than that in the control group (P＜0.05).There was a significant correlation between FKN and Mon3 (P＜0.05,R=0.650 2).Conclusions The monocyte subset of Mon1 and Mon3 increased in the early stage of ACS,with their chemokine (FKN and MCP-1) increasing at the same time.There is a significant correlation between FKN and Mon3,which indicates MCP-1-Mon1 and FKN-Mon3 may participate in the pathophysiological process of early ACS in patients.

Objective To evaluate clinical features,therapeutic effects and outcomes of patients with non-human immunodeficiency virus(HIV)-infected cryptococcal meningitis treated with fluconazole or fluconazole and flucytosine.Methods Twenty-four cases of non-HIV-infected cryptococcal meningitis(fluconazole with or without flucytosine as initial therapy)in Huashan Hospital,Fudan University from 1997 to 2007 were retrospectively reviewed.Clinical manifestations,therapeutic effects and outcomes of the patients were collected.Results Fluconazole was administered with median dosage of 400 mg/d,for a median duration of 20.5 days.After fluconazole initial therapy for 2 weeks,16.7% showed partial response,83.3% showed no response,and the overall response rate was 16.7%.After 10 weeks,33.3% showed partial response,29.2% showed complete response,16.7% showed no response,and the overall response rate was 62.5%.Mortality at week 10 was 20.8%.Twenty-two patients who failed to respond to initial therapy were switched to other antifungal drugs(amphotericin B,amphotericin B colloidal dispersion,itraconazole)or other fluconazole containing combined therapy.Eleven out of the 24 patients died during one-year follow-up,8 of whom died of eryptococcal meningitis,and 3 died of other diseases.Conclusions The initial therapy of fluconazole with or without flucytosine is inefficient,and most of the patients need other antifungal drugs because of initial therapy failure.Therefore,fluconazole might not be appropriate for initial therapy in non-HIV-infected cryptococcal meningitis.

Objective:To investigate the differences between Tanner-Whitehouse (TW)3-Carpal and TW3-RUS(radius, ulna and short bone)-based artificial intelligence (AI)-assisted bone age assessment system using real world data.Methods:The image data of 262 children who received X-ray examination of left wrist in the Affiliated Children′s Hospital, Capital Institute of Pediatrics from July to September 2021 were retrospectively collected. The AI bone age assistant methods based on TW3-RUS and TW3-Carpal criteria were used to obtain the bone age results, respectively. Two senior pediatric radiologists evaluated the bone age on the basis of TW3-RUS and TW3-Carpal criteria, and the averaged values of two reviewers was calculated and taken as the gold standard reference. The cases were stratified into six age groups at 3-year intervals according to the gold standard reference, including 1-3 ( n=10), 4-6 ( n=35), 7-9 ( n=70), 10-12 ( n=118), 13-15 ( n=27) and 16-18 ( n=2) years old groups. Intraclass correlation coefficient (ICC) was used to evaluate the consistency between AI results and the gold standard bone age results. Pearson correlation method was used to measure the reliability between AI results and the gold standard results. The difference of bone age results between using TW3-RUS and TW3-Carpal criteria in different age groups was compared using paired t-test. Results:As for the whole sample, the results based on TW3-RUS criteria were 8.9±3.1 years old for AI assessment and 8.7±2.9 years old for the golden standard reference, with the ICC of 0.983; and the results based on TW3-Carpal criteria were 8.7±3.0 years old for AI and 8.8±2.8 years old for the golden standard reference, with the ICC of 0.976. Positive correlation were found in both TW3-RUS ( r=0.985, P<0.001) and TW3-Carpal criteria groups ( r=0.978, P<0.001). There were significant differences between TW3-RUS and TW3-Carpal at age groups of 7-9( t=-3.36, P=0.001), 10-12( t=-1.77, P=0.046), and 13-15 years old ( t=1.84, P=0.040). The bone age assessment using TW3-RUS and TW3-Carpal criteria were both in good agreement with the gold standard reference in age group of 4-6 years old (ICC=0.929 and 0.940), as well as in age group of 7-9 years old (ICC=0.882 and 0.927, respectively), with the results using TW3-Carpal criteria were slightly higher. As for the age groups of 10-12 and 13-15 years old, the method using TW3-RUS criteria showed excellent agreement with the gold standard reference (ICC=0.962 and 0.963, respectively), which were better than the performance of method using TW3-Carpal criteria (ICC=0.744 and 0.605, respectively). Conclusions:AI-assisted bone age system based TW3-Carpal and TW3-RUS criteria both show good reliability and accuracy in the bone age measurements. The AI method based TW3-Carpal criteria shows better performance in age group of 4-9 years old, while the method based on TW3-RUS criteria may be better for children of age 10-15 years old.

Minimal access breast surgery with the assistance of an endoscopy or robot has been an important advancement in surgical treatment in recent years. Compared to conventional open surgery, minimal access breast surgery only requires small incisions in concealed areas such as axillary fossa, avoiding visible scars on the surface of the breast, significantly improving the postoperative aesthetic appearance and patient satisfaction. With the rapid development of minimal access breast surgery, several institutions have established their own distinctive techniques. The concept of membrane anatomy in the breast, for example, has led to more natural-looking breast reconstruction following endoscopic procedures. The adoption of the reverse space dissection technique has greatly optimized the workflow of endoscopic breast cancer resection. Intraoperative navigation system for endoscopic breast-conserving surgery could allow precise localization of excision margins. Furthermore, the widespread use of the cold dissection technique for flap separation has reduced surgical duration and minimized flap damage. The emergence of unique techniques in the field of minimal access breast surgery promises to further advance and promote the adoption of minimal access breast surgery in China.

Objective:To examine the postoperative prosthesis-related complications, short-term surgical outcomes and patient satisfaction with breast reconstruction between patients who underwent endoscopic assisted versus conventional nipple sparing mastectomy and immediate prothesis breast reconstruction.Methods:This study was a retrospective cohort study. A retrospective analysis was performed on clinical data of 104 women with breast cancer who received nipple sparing mastectomy and immediate prothesis breast reconstruction from August 2021 to August 2022 at the Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University. They were divided into two groups according to the surgical approach. A total of 53 patients, aged (43.3±9.9) years (range: 25 to 66 years), underwent endoscopic nipple sparing mastectomy (E-NSM group) and immediate prothesis breast reconstruction. The other 51 patients aged (39.9±7.8) years (range: 25 to 54 years) underwent conventional open surgery (C-NSM group). Short-term surgical outcomes including operation time, postoperative hospital stay, postoperative blood loss, and postoperative drainage volume in 2 days were recorded. Patient satisfaction with breast reconstruction was compared using the Wilcoxon rank sum test. Postoperative prothesis-related complications were investigated to determine the experience to deal with them.Results:No postoperative prosthesis-related infection, prosthesis loss, or necrosis of the nipple-areola complex occurred in the E-NSM group, while 1 patient suffered from hematoma, whose wound was skinned with resuture after disinfection. Five patients in the C-NSM group had prosthesis-related infection, 2 of them received prosthesis removal surgery combined with sufficient antimicrobial agent, another one underwent surgery for subcutaneous placement of the drain, as well as antimicrobial agent therapy, and the rest of them healed up only with antimicrobial agent therapy. All recovered well after treatment. One patient recovered from necrosis of the nipple-areola complex through periodic iodophor disinfection and dressing which ended in improvement of necrotic areas, another patient who had hematoma accepted the same treatment mentioned above and also healed. All the patients mentioned above are now in stable conditions. Patients in the E-NSM group had higher satisfaction with the cosmetic results of the breast prosthesis implant than those in the C-NSM group ( Z=-4.511, P<0.01). Conclusions:Both surgical approaches were proven to be safe and effective with a low rate of postoperative prosthesis-related complications. Patients in the E-NSM group were more satisfied with the cosmetic results of breast reconstruction than those in the C-NSM group.

Minimal access breast surgery with the assistance of an endoscopy or robot has been an important advancement in surgical treatment in recent years. Compared to conventional open surgery, minimal access breast surgery only requires small incisions in concealed areas such as axillary fossa, avoiding visible scars on the surface of the breast, significantly improving the postoperative aesthetic appearance and patient satisfaction. With the rapid development of minimal access breast surgery, several institutions have established their own distinctive techniques. The concept of membrane anatomy in the breast, for example, has led to more natural-looking breast reconstruction following endoscopic procedures. The adoption of the reverse space dissection technique has greatly optimized the workflow of endoscopic breast cancer resection. Intraoperative navigation system for endoscopic breast-conserving surgery could allow precise localization of excision margins. Furthermore, the widespread use of the cold dissection technique for flap separation has reduced surgical duration and minimized flap damage. The emergence of unique techniques in the field of minimal access breast surgery promises to further advance and promote the adoption of minimal access breast surgery in China.

Objective:To examine the postoperative prosthesis-related complications, short-term surgical outcomes and patient satisfaction with breast reconstruction between patients who underwent endoscopic assisted versus conventional nipple sparing mastectomy and immediate prothesis breast reconstruction.Methods:This study was a retrospective cohort study. A retrospective analysis was performed on clinical data of 104 women with breast cancer who received nipple sparing mastectomy and immediate prothesis breast reconstruction from August 2021 to August 2022 at the Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University. They were divided into two groups according to the surgical approach. A total of 53 patients, aged (43.3±9.9) years (range: 25 to 66 years), underwent endoscopic nipple sparing mastectomy (E-NSM group) and immediate prothesis breast reconstruction. The other 51 patients aged (39.9±7.8) years (range: 25 to 54 years) underwent conventional open surgery (C-NSM group). Short-term surgical outcomes including operation time, postoperative hospital stay, postoperative blood loss, and postoperative drainage volume in 2 days were recorded. Patient satisfaction with breast reconstruction was compared using the Wilcoxon rank sum test. Postoperative prothesis-related complications were investigated to determine the experience to deal with them.Results:No postoperative prosthesis-related infection, prosthesis loss, or necrosis of the nipple-areola complex occurred in the E-NSM group, while 1 patient suffered from hematoma, whose wound was skinned with resuture after disinfection. Five patients in the C-NSM group had prosthesis-related infection, 2 of them received prosthesis removal surgery combined with sufficient antimicrobial agent, another one underwent surgery for subcutaneous placement of the drain, as well as antimicrobial agent therapy, and the rest of them healed up only with antimicrobial agent therapy. All recovered well after treatment. One patient recovered from necrosis of the nipple-areola complex through periodic iodophor disinfection and dressing which ended in improvement of necrotic areas, another patient who had hematoma accepted the same treatment mentioned above and also healed. All the patients mentioned above are now in stable conditions. Patients in the E-NSM group had higher satisfaction with the cosmetic results of the breast prosthesis implant than those in the C-NSM group ( Z=-4.511, P<0.01). Conclusions:Both surgical approaches were proven to be safe and effective with a low rate of postoperative prosthesis-related complications. Patients in the E-NSM group were more satisfied with the cosmetic results of breast reconstruction than those in the C-NSM group.

Objective:To compare the short-term clinical efficacy and patient satisfaction of single-port assisted endoscopic breast-conserving surgery versus open approach in the treatment of female breast cancer patients.Methods:This study retrospectively analyzed the clinical data of 129 female breast cancer patients admitted to Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University from March 2022 to June 2023. In this study, 56 patients underwent breast-conserving surgery assisted by single-port endoscopy (endoscopic group) and 73 patients underwent conventional open breast-conserving surgery (conventional group).Results:Compared to the conventional group (73 cases), the endoscopic group (56 cases) had slightly longer operation time [(200.0±43.2) min vs. (185.3±56.5) min] and intraoperative blood loss [(34.0±25.4) ml vs. (27.2±21.8) ml, P>0.05]. The endoscopic group had a significantly shorter surgical incision length than the conventional group [(4.7±0.7) cm vs. (8.0±1.1) cm, P<0.05], the difference in postoperative tumor margin was not significant (endoscopic group: 3.5% vs. conventional group: 5.7%, P>0.05). In terms of postoperative complications, the endoscopic group had a significantly lower incidence of radiation-related skin reactions than the conventional group ( P<0.05). The endoscopic group had a higher satisfaction rate in terms of postoperative aesthetics (73.2% vs. 56.2%, P<0.05). Conclusions:The short-term clinical efficacy of breast-conserving surgery for female breast cancer by single-port assisted endoscopy is not inferior to that of conventional open breast-conserving surgery, with added better cosmetic results.

Objective:To investigate the clinical effect of free fibula flap transplantation in repairing the defect of mandibular osteoradionecrosis (ORN).Methods:A total of 151 mandibular ORN patients undergoing free fibular flap transplantation were selected from August 2005 to September 2020 in the Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. Among them, 109 patients were males and 42 patients were females, aged (54.1±10.1) (ranged 31-85) years old. The clinical data of the patients was collected and the survival rate of the flaps and postoperative function were calculated to evaluate the surgical efficacy. The χ 2 test was used for difference analysis. Results:Among the 151 patients, mandibular ORN caused by radiotherapy for nasopharyngeal carcinoma accounted for 79.5% (120/151). The average time for mandibular ORN appeared was 5(6) years after radiotherapy. Facial artery [57.2%(87/152)] and superior thyroid artery [32.9%(50/152)] were the main anastomotic arteries in the recipient area. There was no significant difference in the necrosis rates of the two flaps [10.3%(9/87) and 12.5% (5/50), respectively, P=0.949]. The main anastomotic veins in the recipient area were the external jugular vein [48.4%(135/279)] and the common facial vein [26.5%(74/279)]. Twenty-five cases (16.6%) had one vein anastomosed, and 126 cases (83.44%) had two veins anastomosed. There was no significant difference in the flap necrosis rate between the two conditions [20.0%(5/25) and 7.1%(9/126), respectively, P=0.100]. Ninety-seven cases (64.2%) used the peroneal musculocutaneous-fascia composite flap to repair the maxillofacial soft and hard tissue defects. Thirteen cases (8.6%) underwent the restorations with digital virtual surgery design, of which 5 cases were repaired with dental implants at the same time. After the operations, lower respiratory tract infection occurred in 17 patients (11.3%), and upper respiratory tract obstruction occurred in 3 cases (2.0%). The survival rate of the flap after operation was 90.7% (136/151), and 21 patients (13.9%) had flap vascular crisis. Delayed healing of maxillofacial wounds occurred in 33 cases (21.9%). After 3 to 24 months of follow-ups, 110 patients (76.9%) had no fistula inside/outside the oral cavity, 118 patients (82.5%) had an improvement in opening mouth of increasing (≥0.5 cm) after surgery, 135 patients (94.4%) had pain relief, 97 cases (67.8%) could eat normal diet, semi-liquid or soft food, and 137 cases (95.8%) were satisfied or basically satisfied with the treatment effects. Conclusions:The free fibular flap transplantation is an effective method to repair mandibular ORN defects. Preoperative vascular assessment is helpful for the selection of recipient vessels. Facial artery, superior thyroid artery, external jugular vein and common facial vein can be used as the main recipient vessels. The repair of the peroneal musculocutaneous-fascia composite flap facilitates the closure of internal and external fistulas. Digital technology can help to restore the maxillofacial shape more accurately, improve the patient′s occlusal and chewing function and enhance the quality of life of mandibular ORN patients.

Objective:To explore the application of bilateral autogenous auricular concha cartilage graft in the construction of nasal tip cartilage complex in comprehensive rhinoplasty.Methods:From January 2016 to June 2019, a total of 521 rhinoplasty patients in the Second Xiangya Hospital and in the Health Medical Cosmetic Hospital received the operation, including 310 patients with primary rhinoplasty and 211 patients with secondary rhinoplasty. There were 12 males and 509 females, aged 18-53 years. Contracted nose patients with severe tissue destruction were excluded. The operation method: the bilateral auricular concha cartilage was cut and combined, including the nasal columella support graft, the anti derotation graft and the cap graft, and the combination of the nasal tip framework complex was constructed to shape the nasal tip framework. At the same time, the expanded polytetrafluoroethylene or silicone prosthesis was carved into willow leaf shape to elevate the bridge of the nose. Patients were followed up after operation. Physicians, patients and a third party were asked to evaluate the preoperative and postoperative photos of more than 6 months to evaluate the surgical effect. The results suggested that the three parties were regarded as significantly effective, two parties satisfied as effective, one party satisfied as average, all dissatisfied as poor; postoperative complications such as infection and prosthesis exposure were judged as invalid. At the same time, the changes of nose tip height and nose length were measured.Results:521 patients in this group got satisfactory appearance effect immediately after operation. After 6-24 months follow-up, the shape of the nose tip remained good, the color of blood circulation was normal, the appearance of the nose tip was natural and beautiful, three-dimensional and straight. Among the 521 cases, 471 cases were significantly improved, 30 cases were improved, 15 cases were acceptable and other 5 cases were poor. The satisfaction rate was 96% (501/521). The average height of nasal tip was(3.5±0.3) mm higher than that before operation. The average length of nose was(4.9±0.4) mm longer than that before operation.Conclusions:The combination of auricular concha cartilage framework and silica gel prosthesis or expanded polytetrafluoroethylene can be used as a routine method for primary rhinoplasty and secondary rhinoplasty.