Objective:To investigate the clinical features and prognostic factors of pediatric patients with acute hyperleukocytic leukemia (AHL).Methods:A retrospective case series study was conducted. The clinical data of 99 pediatric patients diagnosed with AHL who admitted to the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University between May 2015 and November 2020 were retrospectively analyzed. The enrolled children were grouped based on the following factors including gender, age, initial white blood cell count (WBC), initial lactate dehydrogenase (LDH), whether tumor lysis syndrome (TLS) occurred, immunophenotype, fusion gene, whether complete remission (CR) was achieved on the 19th day (D19) after transplantation, and whether CR was achieved on the 46th day (D46) after transplantation. All the patients were treated with the chemotherapy regimen of Shanghai Children's Medical Center - Acute Lymphoblastic Leukemia - 2015 (SCMC-ALL-2015). Flow cytometry was used to monitor the minimal residual disease (MRD); fluorescence in situ hybridization (FISH) was used to screen out the mutant genes. The median follow-up time was 47 months. The Kaplan-Meier method was used for survival analysis, and the log-rank test was used for intergroup comparisons. Multivariate Cox proportional hazard regression model was used to screen out the the prognostic factors.Results:Among 99 AHL patients, there were 65 males and 35 females; the median age was 7.71 (3.32, 11.20) years. At the initial diagnosis, 48 cases had WBC≤100×10 9/L, and 51 cases had WBC>100×10 9/L; 36 cases had LDH ≤ 2 000 U/L, and 63 cases had LDH > 2 000 U/L; 3 cases had TLS, 5 cases had MLL::AF4 positive, 7 cases had BCR::ABL positive, 7 cases had E2APBX1 positive, and 10 cases had TEL::AML1 positive; 28 cases were acute T-cell lymphoblastic leukemia (T-ALL), and 71 cases were acute B-cell lymphoblastic leukemia (B-ALL). At D19, 74 cases achieved bone marrow CR; at D46, 82 cases achieved bone marrow CR; 3-year and 5-year OS rates were 74.5% and 71.3%, respectively. During the follow-up, 14 cases relapsed and 15 died, including 12 dying of relapse, 2 dying of infection and 1 case dying of pulmonary graft-versus-host disease (GVHD). There were statistically significant differences in the 3-year OS rate in patients with different age, initial WBC, initial LDH, immunophenotyping, whether bone marrow CR at D19 was achieved, whether MRD at D19 occurred, whether bone marrow CR at D46 was achieved, whether MRD at D46 occurred, the presence of TLS, MLL::AF4 positive and TEL::AML1 positive (all P < 0.05). Furthermore, multivariate Cox regression analysis showed that LDH(>2 000 U/L), MLL::AF4 positive, T immunophenotyping, relapse, not achieving bone marrow CR at D19, not achieving bone marrow CR at D46, and MRD positive at D46 were independent risk factors influencing 3-year OS rate (all P < 0.05). Conclusions:Pediatric patients with AHL have high tumor burden at early stage, and TLS may cause death. Patients treated with the SCMC-ALL-2015 protocol can achieve favorable therapeutic effects and prognosis. LDH, MLL::AF4, immunophenotyping and relapse are prognostic factors.

Objective:To evaluate the efficacy of different surgical approaches in treating various types of small-volume benign prostatic hyperplasia (BPH).Methods:The data of 62 patients with small-volume BPH (≤30 ml) who were treated at Affiliated Jinhua Hospital, Zhejiang University School of Medicine from March 2018 to March 2023 were retrospective analyzed.The average age of the patients was (63.21 ± 5.38) years old.Among them, 9 patients had bladder calculi and 12 presented with urinary retention. Patients were stratified into two groups based on preoperative cystoscopy findings: 38 patients with hyperplasia of the middle or bilateral lobes underwent anterior lobe-sparing holmium laser enucleation of the prostate (HoLEP)(group A); 24 patients with bladder neck elevation and no significant hyperplasia received transurethral holmium laser incision of the prostate (group B). Preoperative baseline characteristics: international prostate symptom score(IPSS) were (23.68±4.89) and (22.59±3.62) respectively, quality of life (QOL) were (4.82±0.43) and (4.59±0.31) respectively, maximum flow rate (Q max)(7.89±1.83) ml/s and (7.26±1.72)ml/s respectively. The operative parameters (including procedure duration and catheterization time), postoperative complications (infection, urinary incontinence, and bladder neck contracture) were evaluated. Results:All 62 procedures were successfully completed. The mean operative time of group A was (32.36±6.17) minutes, postoperative catheterization duration was 1-3 days, and no cases of urinary incontinence or infection at 1-month follow-up. During the 12-month follow-up period, no cases of bladder neck contracture were observed in group A. The mean operative time of group B was (19.58 ± 3.87) minutes, and postoperative catheterization duration was 5-7 days. One case of fever with epididymitis was observed after operation, and there was no urinary incontinence at 1-month follow-up. During the 12-month follow-up period, no case of bladder neck contracture was observed in group B. Postoperative outcomes of group A and B at 1 month were as follows: IPSS (7.20±1.72) and (7.80±1.52) respectively, QOL (2.12±0.33) and (2.36±0.25) respectively, Q max(19.32±3.55)ml/s and (18.29±2.83)ml/s respectively.All postoperative parameters showed significant improvement compared with preoperative values ( P<0.05). Conclusions:For small-volume BPH, patients with middle or bilateral lobe hyperplasia can benefit from anterior lobe-sparing HoLEP, patients with bladder neck elevation and minimal hyperplasia can achieve optimal outcomes with transurethral holmium laser incision. Both approaches demonstrate significant symptom improvement with low rates of postoperative urinary incontinence and bladder neck contracture.

Objective:To investigate the clinical value of right-sided overlap and single-flap valvuloplasty (ROSF) in Da Vinci robotic proximal gastrectomy.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 12 patients who underwent ROSF in Da Vinci robotic proximal gastrectomy at The Affiliated Hospital of Xuzhou Medical University from September 2023 to May 2024 were collected. There were 7 males and 5 females, aged 62(range, 35?75)years. Observation indicators: (1) surgical conditions; (2) postoperative pathological results; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and mea-surement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers. Results:(1) Surgical conditions. All patients successfully completed the surgery, without conversion to laparotomy. The operation time of 12 patients was (236±24)minutes. The time of single-layer fabrication and anastomosis was (105±28)minutes. The volume of intra-operative blood loss was (36±19)mL. Time to postoperative first fluid food intake was (3.5±1.1)days. The amylase levels in the abdominal drainage fluid on postoperative days 1, 2, and 3 were (321±121)U/L, (225±97)U/L, and (85±22)U/L, respectively. Time to postoperative drainage tube removal was (5.3±1.5)days. Duration of postoperative hospital stay was (7.6±1.1)days. All 12 patients had no anasto-motic related complications such as anastomotic leakage, anastomotic bleeding, anastomotic stenosis, and had no functional complications such as gastric emptying disorders or gastroesophageal reflux after surgery. (2) Postoperative pathological results. The distance of the proximal tumor margin of the 12 patients was (1.8±1.1)cm. The distance of distal margin was (5.7±2.1)cm. Number of lymph node dissected was 31.0(range, 22.0?45.0). Number of positive lymph node dissected was 3.4±2.4. Number of lymph node dissected from the pancreatic superior margin was 14.7±4.3. Results of postoperative pathological examination in the 12 patients showed 8 cases of Ⅰ stage, 3 cases of Ⅱ stage, 1 case of Ⅲ stage of the TNM staging. (3) Follow-up. All 12 patients were followed up for 6 (range, 3?24)months. During the follow-up period, all 12 patients had no local tumor recurrence or distant metastasis. All 12 patients had no complications such as anastomotic leakage, anastomotic bleeding, or anastomotic stenosis, and did not experience symptoms of gastroesophageal reflux such as heartburn or vomiting.Conclusion:The ROSF in Da Vinic robotic proximal gastrectomy is safe and feasible.

Objective:To investigate the clinical value of right-sided overlap and single-flap valvuloplasty (ROSF) in Da Vinci robotic proximal gastrectomy.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 12 patients who underwent ROSF in Da Vinci robotic proximal gastrectomy at The Affiliated Hospital of Xuzhou Medical University from September 2023 to May 2024 were collected. There were 7 males and 5 females, aged 62(range, 35?75)years. Observation indicators: (1) surgical conditions; (2) postoperative pathological results; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and mea-surement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers. Results:(1) Surgical conditions. All patients successfully completed the surgery, without conversion to laparotomy. The operation time of 12 patients was (236±24)minutes. The time of single-layer fabrication and anastomosis was (105±28)minutes. The volume of intra-operative blood loss was (36±19)mL. Time to postoperative first fluid food intake was (3.5±1.1)days. The amylase levels in the abdominal drainage fluid on postoperative days 1, 2, and 3 were (321±121)U/L, (225±97)U/L, and (85±22)U/L, respectively. Time to postoperative drainage tube removal was (5.3±1.5)days. Duration of postoperative hospital stay was (7.6±1.1)days. All 12 patients had no anasto-motic related complications such as anastomotic leakage, anastomotic bleeding, anastomotic stenosis, and had no functional complications such as gastric emptying disorders or gastroesophageal reflux after surgery. (2) Postoperative pathological results. The distance of the proximal tumor margin of the 12 patients was (1.8±1.1)cm. The distance of distal margin was (5.7±2.1)cm. Number of lymph node dissected was 31.0(range, 22.0?45.0). Number of positive lymph node dissected was 3.4±2.4. Number of lymph node dissected from the pancreatic superior margin was 14.7±4.3. Results of postoperative pathological examination in the 12 patients showed 8 cases of Ⅰ stage, 3 cases of Ⅱ stage, 1 case of Ⅲ stage of the TNM staging. (3) Follow-up. All 12 patients were followed up for 6 (range, 3?24)months. During the follow-up period, all 12 patients had no local tumor recurrence or distant metastasis. All 12 patients had no complications such as anastomotic leakage, anastomotic bleeding, or anastomotic stenosis, and did not experience symptoms of gastroesophageal reflux such as heartburn or vomiting.Conclusion:The ROSF in Da Vinic robotic proximal gastrectomy is safe and feasible.

Objective:To evaluate the efficacy of different surgical approaches in treating various types of small-volume benign prostatic hyperplasia (BPH).Methods:The data of 62 patients with small-volume BPH (≤30 ml) who were treated at Affiliated Jinhua Hospital, Zhejiang University School of Medicine from March 2018 to March 2023 were retrospective analyzed.The average age of the patients was (63.21 ± 5.38) years old.Among them, 9 patients had bladder calculi and 12 presented with urinary retention. Patients were stratified into two groups based on preoperative cystoscopy findings: 38 patients with hyperplasia of the middle or bilateral lobes underwent anterior lobe-sparing holmium laser enucleation of the prostate (HoLEP)(group A); 24 patients with bladder neck elevation and no significant hyperplasia received transurethral holmium laser incision of the prostate (group B). Preoperative baseline characteristics: international prostate symptom score(IPSS) were (23.68±4.89) and (22.59±3.62) respectively, quality of life (QOL) were (4.82±0.43) and (4.59±0.31) respectively, maximum flow rate (Q max)(7.89±1.83) ml/s and (7.26±1.72)ml/s respectively. The operative parameters (including procedure duration and catheterization time), postoperative complications (infection, urinary incontinence, and bladder neck contracture) were evaluated. Results:All 62 procedures were successfully completed. The mean operative time of group A was (32.36±6.17) minutes, postoperative catheterization duration was 1-3 days, and no cases of urinary incontinence or infection at 1-month follow-up. During the 12-month follow-up period, no cases of bladder neck contracture were observed in group A. The mean operative time of group B was (19.58 ± 3.87) minutes, and postoperative catheterization duration was 5-7 days. One case of fever with epididymitis was observed after operation, and there was no urinary incontinence at 1-month follow-up. During the 12-month follow-up period, no case of bladder neck contracture was observed in group B. Postoperative outcomes of group A and B at 1 month were as follows: IPSS (7.20±1.72) and (7.80±1.52) respectively, QOL (2.12±0.33) and (2.36±0.25) respectively, Q max(19.32±3.55)ml/s and (18.29±2.83)ml/s respectively.All postoperative parameters showed significant improvement compared with preoperative values ( P<0.05). Conclusions:For small-volume BPH, patients with middle or bilateral lobe hyperplasia can benefit from anterior lobe-sparing HoLEP, patients with bladder neck elevation and minimal hyperplasia can achieve optimal outcomes with transurethral holmium laser incision. Both approaches demonstrate significant symptom improvement with low rates of postoperative urinary incontinence and bladder neck contracture.

[Objective]To investigate primary and secondary transfer of exfoliated cells from human hands on non-porous substrates such as plastic steering wheel or computer mouse.[Methods]DNA detection sensitivity and detection limit for mixed DNA profiling were examined to understand our laboratory's ability to test for trace DNA.Forensic swabs were used to collect samples from volunteers'one-hour-long unwashed hands,substrates touched by volunteers'immediately or 30 min following shaking hands,and individual A's daily-use substrates touched by individual B and then by individual A again.Simulations were conducted to assess the potential for introduction of another person's exfoliated cells from hands into routine casework samples.[Results]Our laboratory can obtain a full DNA profile from as little as 0.020 ng of DNA and detect minor components in a 1:9 mixed DNA sample.85%of samples from unwashed hands yielded a full DNA profile.Primary transfer of a full DNA profile was found in 77%of substrates touched by volunteers'dominant hand 30 min after hand washing,allowing differentiation between good and poor shedders,with no significant difference in genders and substrate types.75%of substrates touched 30 min after hand washing and then immediately following handshaking yielded the other individual's DNA profile(secondary transfer),with the number of short tandem repeat(STR)loci detected ranging from 0 to 23;the percentage and number decreased substantially when the substrates were touched 30 minutes later.No foreign DNA was detected in routine casework samples with introduced exfoliated cells from hands.When two individuals took turns touching items with their hands,the major contributor to the DNA profile was not always the individual who made the last contact.[Conclusions]Primary and secondary DNA transfer can be detected on non-porous substrates,and based on the deposit of hand exfoliated cells,individuals can be categorized as good or poor shedders,which is an important factor affecting detection of DNA transfer.Besides considering the laboratory's DNA detection sensitivity,if DNA is detected on substrates by hand contact,we need to take into account the potential for secondary transfer at different levels of activity when interpreting the results.

Objective:To evaluate the clinical efficacy and advantage of urinary continence after holmium laser enucleation of the prostate (HoLEP)with reservation of different structures for benign prostatic hyperplasia (BPH).Methods:The data of 242 patients with BPH who underwent HoLEP in Affiliated Jinhua Hospital Zhejiang University School of Medicine from June 2020 to June 2023 were analyzed retrospectively.Of the 242 patients, 89 received anterior lobe-sparing HoLEP(Group A), 81 received HoLEP with partial urethral mucosa reservation(group B), and 72 received conventional HoLEP(group C). There were no significant differences among the three groups( P > 0.05)in terms of the age[(73.72±6.35)years old vs.(72.58±6.14)years old vs.(73.18±6.73)years old], prostate volume[(82.31±43.58)ml vs.(81.54±42.83)ml vs.(82.12±44.27)ml], the proportion of diabetes mellitus[11 cases(12.4%)vs. 9 cases(11.1%)vs. 7 cases(9.7%)], the proportion of calculus of bladder[9 cases(10.1%) vs. 6 cases(7.4%)vs. 6 cases(8.3%)], the proportion of urinary retention[20 cases(22.5%)vs.17 cases(21.0%)vs. 14 cases(19.4%)], international prostate symptom score(IPSS)[(22.47±3.56) vs.(21.83±4.18)vs.(21.54±3.37)], quality of life score (QOL)[(4.87±0.92) vs.(4.65±0.86) vs.(4.74±0.73)]and quantity of maximum flow rate(Q max)[(8.32±3.09)ml/s vs.(8.41±2.75)ml/s vs.(7.96±2.82)ml/s].The perioperative related indexes of the three groups were compared. IPSS, QOL, Q max, and the incidence of urinary incontinence at 1 week, 1 month and 3 months after surgery were compared in the three groups. Results:All procedures were performed successfully without conversion.Among groups A, B, and C, the differences of surgical enucleation time [(35.17±12.38)min vs. (34.19±10.26)min vs. (33.75±11.34)min], prostate enucleation mass [(57.43±37.58)g vs. (59.72±38.35)g vs. (60.37±39.52)g], retention of urinary catheter time [(3.18±1.55)d vs. (3.62±1.78)d vs. (3.49±1.69)d], the proportion of perforation of the peritoneum [1 case(1.1%) vs. 1 case(1.2%) vs. 2 cases (2.8%)], and the proportion of postoperative infections [1 case (1.1%) vs. 1 case (1.2%) vs. 2 cases (2.8%)]were not statistically significant ( P>0.05). At 1st week and 1st month after surgery in group A, IPSS[(9.41±2.21), (8.34±1.67) points], QOL[(2.17±0.58), (1.89±0.41)points], Q max[(20.53±5.18), (22.41±6.17)ml/s]were significantly improved as compared with those before surgery( P<0.05).At 1st week and 1st month after surgery in group B, IPSS[(10.19±2.47), (8.73±1.81) points], QOL[(2.63±0.62), (2.14±0.57)points], Q max[(19.64±4.59), (21.43±5.39)ml/s]were significantly improved as compared with those before surgery( P<0.05).At 1st week and 1st month after surgery in group C, IPSS[(10.35±1.98), (9.21±1.78)points], QOL[(2.79±0.76), (2.28±0.68)points], Q max[(20.21±5.83), (23.15±5.49)ml/s]were significantly improved as compared with those before surgery( P<0.05).There were no significant differences in the IPSS, QOL and Q max at the same time among the three groups( P>0.05).The incidence of postoperative urinary incontinence after one week in group A and group B were significantly lower than that in group C[2.2%(2/89) vs. 12.3%(10/81) vs. 34.7%(25/72), P<0.05], and the incidence of postoperative urinary incontinence after one week in group A was significantly lower than that in group B ( P<0.05). The incidence of postoperative urinary incontinence after one month in group A and group B were significantly lower than that in group C[0(0/89) vs. 6.2%(5/81) vs. 22.2%(16/72), P<0.05], and the incidence of postoperative urinary incontinence after one month in group A was significantly lower than that in group B( P< 0.05). Conclusions:Holmium laser enucleation of the prostate with anterior lobe-sparing can significantly reduce the incidence of urinary incontinence after operation, which is worthy of clinical application.

Objective:To evaluate the clinical efficacy and advantage of urinary continence after holmium laser enucleation of the prostate (HoLEP)with reservation of different structures for benign prostatic hyperplasia (BPH).Methods:The data of 242 patients with BPH who underwent HoLEP in Affiliated Jinhua Hospital Zhejiang University School of Medicine from June 2020 to June 2023 were analyzed retrospectively.Of the 242 patients, 89 received anterior lobe-sparing HoLEP(Group A), 81 received HoLEP with partial urethral mucosa reservation(group B), and 72 received conventional HoLEP(group C). There were no significant differences among the three groups( P > 0.05)in terms of the age[(73.72±6.35)years old vs.(72.58±6.14)years old vs.(73.18±6.73)years old], prostate volume[(82.31±43.58)ml vs.(81.54±42.83)ml vs.(82.12±44.27)ml], the proportion of diabetes mellitus[11 cases(12.4%)vs. 9 cases(11.1%)vs. 7 cases(9.7%)], the proportion of calculus of bladder[9 cases(10.1%) vs. 6 cases(7.4%)vs. 6 cases(8.3%)], the proportion of urinary retention[20 cases(22.5%)vs.17 cases(21.0%)vs. 14 cases(19.4%)], international prostate symptom score(IPSS)[(22.47±3.56) vs.(21.83±4.18)vs.(21.54±3.37)], quality of life score (QOL)[(4.87±0.92) vs.(4.65±0.86) vs.(4.74±0.73)]and quantity of maximum flow rate(Q max)[(8.32±3.09)ml/s vs.(8.41±2.75)ml/s vs.(7.96±2.82)ml/s].The perioperative related indexes of the three groups were compared. IPSS, QOL, Q max, and the incidence of urinary incontinence at 1 week, 1 month and 3 months after surgery were compared in the three groups. Results:All procedures were performed successfully without conversion.Among groups A, B, and C, the differences of surgical enucleation time [(35.17±12.38)min vs. (34.19±10.26)min vs. (33.75±11.34)min], prostate enucleation mass [(57.43±37.58)g vs. (59.72±38.35)g vs. (60.37±39.52)g], retention of urinary catheter time [(3.18±1.55)d vs. (3.62±1.78)d vs. (3.49±1.69)d], the proportion of perforation of the peritoneum [1 case(1.1%) vs. 1 case(1.2%) vs. 2 cases (2.8%)], and the proportion of postoperative infections [1 case (1.1%) vs. 1 case (1.2%) vs. 2 cases (2.8%)]were not statistically significant ( P>0.05). At 1st week and 1st month after surgery in group A, IPSS[(9.41±2.21), (8.34±1.67) points], QOL[(2.17±0.58), (1.89±0.41)points], Q max[(20.53±5.18), (22.41±6.17)ml/s]were significantly improved as compared with those before surgery( P<0.05).At 1st week and 1st month after surgery in group B, IPSS[(10.19±2.47), (8.73±1.81) points], QOL[(2.63±0.62), (2.14±0.57)points], Q max[(19.64±4.59), (21.43±5.39)ml/s]were significantly improved as compared with those before surgery( P<0.05).At 1st week and 1st month after surgery in group C, IPSS[(10.35±1.98), (9.21±1.78)points], QOL[(2.79±0.76), (2.28±0.68)points], Q max[(20.21±5.83), (23.15±5.49)ml/s]were significantly improved as compared with those before surgery( P<0.05).There were no significant differences in the IPSS, QOL and Q max at the same time among the three groups( P>0.05).The incidence of postoperative urinary incontinence after one week in group A and group B were significantly lower than that in group C[2.2%(2/89) vs. 12.3%(10/81) vs. 34.7%(25/72), P<0.05], and the incidence of postoperative urinary incontinence after one week in group A was significantly lower than that in group B ( P<0.05). The incidence of postoperative urinary incontinence after one month in group A and group B were significantly lower than that in group C[0(0/89) vs. 6.2%(5/81) vs. 22.2%(16/72), P<0.05], and the incidence of postoperative urinary incontinence after one month in group A was significantly lower than that in group B( P< 0.05). Conclusions:Holmium laser enucleation of the prostate with anterior lobe-sparing can significantly reduce the incidence of urinary incontinence after operation, which is worthy of clinical application.

There are many validated surgical techniques for the repair and reconstruction of facial defects, such as skin grafting, free flap grafting and local flap grafting, all of which have achieved good results within their scope of application. As a local flap, the keystone design perforator island flap (KDPIF) has the advantages of easy harvest and design, abundant blood supply, and a wide range of applicability. However, this flap has not been frequently applied in facial defect reconstruction. In reviewing the literatures, the authors believe that the KDPIF is a worthy method for facial defect repair. The principles, types, surgical techniques and applications, and considerations are also summarized.

There are many validated surgical techniques for the repair and reconstruction of facial defects, such as skin grafting, free flap grafting and local flap grafting, all of which have achieved good results within their scope of application. As a local flap, the keystone design perforator island flap (KDPIF) has the advantages of easy harvest and design, abundant blood supply, and a wide range of applicability. However, this flap has not been frequently applied in facial defect reconstruction. In reviewing the literatures, the authors believe that the KDPIF is a worthy method for facial defect repair. The principles, types, surgical techniques and applications, and considerations are also summarized.