ObjectiveTo analyze the factors influencing meropenem-related liver injury （MRLI） and to explore their clinical predictive value. MethodsA retrospective case-control study was conducted， and the Chinese Hospital Pharmacovigilance System （CHPS） was used to establish a retrieval scheme. A total of 1 625 hospitalized cases using meropenem from January 2018 to December 2022 were collected. Patients were divided into case group （n=62） and control group （n=1 563） based on the presence or absence of liver injury. Clinical data and laboratory indicators from both groups were collected and analyzed. The t-test was used for comparison of normally distributed continuous data between the two groups， while the Mann-Whitney U test was used for comparison of continuous data not conforming to a normal distribution. The chi-square test was used for comparison of categorical data between the two groups. A multivariate Logistic regression analysis was performed to identify the influencing factors for MRLI. A Logistic regression equation was established， and the predictive value of these factors was assessed using the receiver operating characteristic （ROC） curve. ResultsThe results of univariate analysis indicated that the rates of male patients， hypoproteinemia， shock， intensive care unit （ICU） admissions， sepsis， and liver， gallbladder， and cardiovascular diseases， the levels of alanine aminotransferase （ALT）， alkaline phosphatase （ALP）， gamma-glutamyl transpeptidase （GGT）， aspartate aminotransferase （AST）， creatinine （CREA）， and procalcitonin （PCT）， and the number of hospitalization days were significantly higher in the case group than in the control group （P<0.05）， and that the platelet levels in the case group were significantly lower than those in the control group （P<0.05）. The multivariate Logistic regression analysis showed that male sex （odds ratio ［OR］=2.080， 95% confidence interval ［CI］： 1.050 — 4.123， P=0.036）， admission to the ICU （OR=8.207， 95%CI： 4.094‍ ‍—‍ ‍16.453， P<0.001）， comorbidity with gallbladder disease （OR=8.240， 95%CI： 3.605‍ ‍—‍ ‍18.832， P<0.001）， ALP （OR=1.012， 95%CI： 1.004‍ ‍—‍ ‍1.019， P=0.004）， GGT （OR=1.010， 95%CI： 1.005‍ ‍—‍ ‍1.015， P<0.001）， and PLT （OR=0.997， 95%CI： 0.994‍ ‍—‍ ‍0.999， P=0.020） were the influential factors for MRLI. The areas under the ROC curve of ALP， GGT， and PLT were 0.589， 0.637， and 0.595， respectively， and the AUC of them combined was 0.837. ConclusionMale sex， ICU admission， comorbidity with gallbladder disease， increased ALP， increased GGT， and decreased PLT were influencing factors for MRLI， and a combination of factors has a better predictive value for the occurrence of MRLI.

Objective:To explore the genetic background for a patient with refractory myelodysplastic/myeloproliferative neoplasm (MDS/MPN) with co-morbid neutrophilia patient.Methods:A MDS/MPN patient who was admitted to the First Affiliated Hospital of Nanjing Medical University in May 2021 was selected as the study subject. RNA sequencing was carried out to identify fusion genes in his peripheral blood mononuclear cells. Fusion gene sequence was searched through transcriptome-wide analysis with a STAR-fusion procedure. The novel fusion genes were verified by quantitative real-time PCR and Sanger sequencing.Results:The patient, a 67-year-old male, had progressive thrombocytopenia. Based on the morphological and molecular examinations, he was diagnosed as MDS/MPN with co-morbid neutropenia, and was treated with demethylating agents and Bcl-2 inhibitors. Seventeen months after the diagnosis, he had progressed to AML. A novel fusion gene NCOR1: : GLYR1 was identified by RNA-sequencing in his peripheral blood sample, which was verified by quantitative real-time PCR and Sanger sequencing. The patient had attained morphological remission after a DCAG regimen (a combinatory chemotherapy of decitabine, cytarabine, aclarubicin and granulocyte colony-stimulating factors) plus Chidamide treatment. A significant decrease in the NCOR1: : GLYR1 expression was revealed by quantitative real-time PCR at post-chemotherapy evaluation. Conclusion:NCOR1: : GLYR1 gene is considered as the pathogenic factor for the MDS/MPN patient with neutropenia.

Objective:To analyze the sensitivity of cytoplasmic light-chain immunofluorescence with fluorescence in situ hybridization in bone marrow smears (new FISH) for detecting cytogenetic abnormalities in multiple myeloma (MM) .Methods:42 MM patients admitted to the First Affiliated Hospital of Nanjing Medical University from April 2022 to October 2023 were enrolled. The patients with MM were detected by new FISH and CD138 immunomagnetic bead sorting technology combined with FISH (MACS-FISH) or cytoplasmic immunoglobulin FISH (cIg-FISH) to analyze cytogenetic detection results using combination probes which included 1q21/1p32, p53, IgH, IgH/FGFR3 [t (4;14) ], and IgH/MAF [t (14;16) ].Results:In 23 patients with MM, the abnormality detection rates of cIg-FISH and new FISH were 95.7% and 100.0%, respectively ( P>0.05). The detection rates of 1q21+, 1p32-, p53 deletion, and IgH abnormalities by cIg-FISH and new FISH were consistent, which were 52.2%, 8.7%, 17.4%, and 65.2%, respectively. The results of the two methods further performed with t (4;14) and t (14;16) in patients with IgH abnormalities were identical. The positive rate of t (4;14) was 26.7%, whereas t (14;16) was not detected. In 19 patients with MM, the abnormality detection rates of MACS-FISH and new FISH were 73.7% and 63.2%, respectively ( P>0.05). The positivity rate of 1q21+, 1p32- and IgH abnormalities detected by MACS-FISH were slightly higher than those detected by new FISH; however, the differences were not statistically significant (all P values >0.05) . Conclusion:The new FISH method has a higher detection rate of cytogenetic abnormalities in patients with MM and has good consistency with MACS-FISH and cIg-FISH.

Objective:To explore the effects of Compound Huangbai Liquid coating combined with Xiaochuang Mixture on wound healing, clinical symptoms and inflammatory response in patients with perianal abscess surgery; To evaluate the clinical efficacy.Methods:Randomized controlled trial. 120 patients after perianal abscess surgery in the hospital from August 2021 to August 2022 were selected as the observation subjects, and they were divided into three groups by the random number table method, with 40 cases in each group. On the basis of routine anti-infection therapy, external TCM application group was given Compound Huangbai Liquid coating, oral TCM administration group was given oral Xiaochuang Mixture, and combined treatment group was treated with Compound Huangbai Liquid coating + Xiaochuang Mixture. The three groups were continuously treated for 15 days. TCM symptoms scores and VAS score were performed on the 2nd day, 7th day and 15th day after surgery, and the levels of IL-6 and TNF-α were detected by ELISA. The wound healing time and carrion shedding time of patients were observed and recorded, and the clinical efficacy was evaluated.Results:The scores of perianal secretions, granulation morphology and surrounding tissue edema and score of VAS decreased in the three groups at 7 days and 15 days after surgery compared with those at 2 days after surgery ( P<0.01), and with the extension of time, the scores of perianal secretions, granulation morphology and surrounding tissue edema and VAS score from the aspects of time-point effect ( F=21.69, 134.65, 19.27, 73.15) and between-group effect ( F=7.99, 98.79, 8.68, 10.71) were declined ( P<0.01), and there was an interaction effect between the decline degree and the treatment method ( F=9.78, 59.52, 11.29, 22.48, P<0.01). The carrion shedding time [(4.63±1.31) d vs. (6.22±2.14) d, (6.17±2.09) d, F=9.16] and healing time [(27.76±3.46) d vs. (30.27±4.11) d, (31.48±4.23) d, F=9.24] were earlier in combined treatment group than those in the external TCM application group and oral TCM administration group ( P<0.01). Serum levels of IL-6 and TNF-α in the three groups at 7 and 15 days after surgery were reduced compared with those at 2 days after surgery ( P<0.01), and with the extension of time, the levels of serum IL-6 and TNF-α in the three groups decreased from the aspects of time-point effect ( F=69.36, 38.76) and between-group effect ( F=21.81, 13.50) ( P<0.01), and there was an interaction effect between the decrease degree and treatment method ( F=28.46, 23.34, P<0.01). The total effective rate was 100.0% (40/40) in combined treatment group, 80.0% (32/40) in external TCM application group and 87.2% (34/39) in oral TCM administration group ( H=8.44, P=0.015). Conclusion:The combination of Compound Huangbai Liquid coating and Xiaochuang Mixture can reduce perianal secretions, improve granulation morphology, alleviate surrounding tissue edema and wound pain, promote wound healing, and reduce inflammatory response of patients with perianal abscess surgery.

Objective:To explore the influencing factors of acute rejection (AR) within one year after pediatric kidney transplantation (KT) and the effect of AR onset time on prognosis.Methods:From January 2011 to October 2021, a total of 112 patients aged under 18 years at the time of transplantation were selected.After excluding 6 of them with early renal non-function caused by non-rejection, 106 cases were examined.There were 63 males and 43 females with the age of 15(12, 16) years.The donors were living related (n=26) and deceased (n=80).According to the presence/absence and onset time of AR, they were assigned into three groups of AR within one year, AR after one year and non-AR.The relevant clinical data of donor/recipient, influencing factors of AR and therapeutic outcomes of AR were retrospectively compared.One-way ANOVA or Kruskal-Wallis test was utilized for comparing 1-year renal function after the occurrence of AR among three groups.With graft-function loss as an end-point event of follow-up, the effects of AR within one year and AR after one year on survival rate and function of graft-kidney were analyzed by Kaplan-Meier survival curve.Results:The median follow-up period of 106 pediatric KT recipients was 35 months.During follow-ups, 19 episodes of AR occurred in 17(16.0%) patients and 89 recipients exhibited no AR episode by the end of follow-up (non-AR group).As for initial AR, 9 episodes of AR occurred within one year (AR within one year group) and 8 episodes of AR after one year (AR after one year group).After anti-rejection treatment, 8 patients (47.1%) achieved full recovery and 6 patients (35.3%) failed to completely normalize and 3 patients (17.6%) developed graft failure.Univariate analysis indicated that, as compared with non-AR group, female recipients, donors aged under 8 years and early postoperative infection with parvovirus B19 were risk factors of AR within one year ( P=0.032, P=0.039, P=0.047).Kaplan-Meier survival analysis revealed that the incidence rates of AR within one year in patients with donors aged under 8 years and early postoperative parvoviral infection were 14.5%(8/55) and 30.0%(3/10) respectively.They were significantly higher than 2.0%(1/51) and 6.3%(6/96) of patients with donors aged above 8 years and those without parvoviral infection ( P=0.012, P=0.004).With graft-function loss as an end-point event of follow-up, Kaplan-Meier survival analysis showed that 10-year kidney graft survival rate in AR within one year and AR after one year groups were 88.9% and 65.6%.Both were significantly lower than that in non-AR group (98.9%).And the inter-group differences were statistically significant ( χ2=4.286, P=0.038; χ2=7.787, P=0.005).However, no significant difference existed in survival rate between AR within one year and AR after one year groups ( P=0.689).One-way ANOVA and Kruskal-Wallis test indicated that estimated glomerular filtration rates at 3/6/12 months after an onset of AR in AR within one year group were (76.8±51.6), (80.6±56.6) and (85.6±40.2) ml·min -1·1.73 m -2.The values of 3/6 months were lower than (125.3±39.2) and (124.7±38.2) ml·min -1·1.73 m -2 in AR after one year group.And the inter-group differences were statistically significant ( P=0.021, P=0.039).The values of 3/6/12 months were lower than (112.2±34.2), (115.3±33.2) and (117.4±30.2) ml·min -1·1.73 m -2 in non-AR group.And the inter-group differences were also statistically significant ( P=0.019, P=0.020, P=0.020). Conclusions:Female recipients, donors aged under 8 years and early postoperative infection with parvovirus B19 may elevate the risks of AR in children within one year of KT.AR within one year affects the survival rate of graft-kidney and renal function.

Objective:To explore the therapeutic characteristics of population with gout achieving treat-to-target (T2T) indicators through real-world research and evaluate their safety.Methods:A total of 3 287 patients diagnosed with gout by rheumatologists in 21 first-class tertiary hospitals in 10 provinces, municipalities, and autonomous regions in China from January 2015 to December 2021 were included in this polycentric cross-sectional study. The database included patients′ general information, disease characteristics, and clinical application of traditional Chinese and Western medicine treatment measures. SPSS and Excel software were used for data analysis. Frequency analysis, cluster analysis, and factor analysis were used to summarize the characteristics and rules of treatment measures for patients with gout who achieved the target after treatment. The occurrence of adverse events (AE) was recorded during treatment.Results:After treatment, 691 visits (7%) achieved the serum urate (SUA) target, and the most frequent use of urate-lowering therapy (ULT) was febuxostat, followed by benzbromarone. The most common treatment options were following: GroupⅠ: traditional Chinese medicine (TCM) decoction-TCM external treatment-physical exercise-proprietary Chinese medicine; GroupⅡ: ferulic acid-nonsteroidal anti-inflammatory drugs (NSAIDs); Group Ⅲ: allopurinol-sodium bicarbonate-benzbromarone; Group Ⅳ: glucocorticoid-colchicine; Group Ⅴ: febuxostat. A total of 5 898 visits (60%) chieved manifestations of joint pain VAS scores target, and the most frequently used drug to control joint symptoms was NSAIDs. The frequency of use of drugs to control joint symptoms were 2 118 times (usage rate reached 35.9%), while the frequency of ULT were 2 504 times (usage rate reached 42.5%), which was higher than the joint symptom control drug. The most common treatment options were following: Group Ⅰ: proprietary Chinese medicine-TCM decoction-TCM external treatment-physical exercise; Group Ⅱ: NSAIDs-colchicine hormones; Group Ⅲ: allopurinol, Group Ⅳ: benzbromarone; Group Ⅴ: febuxostat. A total of 59 adverse events occurred during treatment.Conclusion:The proportions of gout patients who reach target serum urate level & good control of joint symptoms are both very low, and ULT and anti-inflammatory prescription patterns are very different from international guidelines, so it is necessary to strengthen the standardized management of gout patients. At the same time, life intervention measures account for a certain proportion of the treatment plans for the T2T population, and further exploration is needed.

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 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 assess the efficacy of induction chemotherapy followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of FLT3-ITD + acute myeloid leukemia (AML) with normal karyotype. Methods:The clinical data of FLT3-ITD + AML patients with normal karyotype in the First Affiliated Hospital of Nanjing Medical University from Jan 2018 to March 2021 were retrospectively analyzed. Results:The study included 49 patients with FLT3-ITD +AML, 31 males, and 18 females, with a median age of 46 (16-59) years old. All patients received induction chemotherapy, and 24 patients received sequential allo-HSCT (transplantation group) . The median follow-up time was 465 days, the one-year overall survival (OS) from diagnosis was (70.0 ± 7.4) %, and one-year disease-free survival (DFS) was (70.3±7.4) %. The one-year OS was significantly different between the transplantation group and the non-transplantation group [ (85.2 ± 7.9) % vs (52.6 ± 12.3) %, P=0.049]. but one-year DFS [ (84.7 ± 8.1) % vs (55.2 ± 11.9) %, P=0.061] was not. No significance was found in one-year OS between patients with low-frequency and high-frequency FLT3-ITD + ( P>0.05) . There were 12 patients with high-frequency FLT3-ITD + in the transplantation and the non-transplantation groups, respectively. The one-year OS [ (68.8 ± 15.7) % in the transplantation group vs (26.2 ± 15.3) % in the non-transplantation group, P=0.027] and one-year DFS [ (45.5 ± 21.3) % in the transplantation group vs (27.8±15.8) % in the non-transplantation group, P=0.032] were significantly different between the two groups. Conclusion:Induction chemotherapy followed by allo-HSCT can enhance the prognosis of FLT3-ITD + patients, particularly those with FLT3-ITD high-frequency mutation.