Objective:To investigate the correlations of KCNJ5 gene mutations and pathological subtypes based on 11β-hydroxylase (CYP11B1)/aldosterone synthase (CYP11B2) immunohistochemistry with clinical characteristics and postoperative outcomes in patients with unilateral primary aldosteronism undergoing adrenalectomy.Methods:This retrospective study enrolled 155 patients with primary aldosteronism who underwent unilateral adrenalectomy at the Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, between May 2023 and May 2024. KCNJ5 mutations were detected by Sanger sequencing, and patients were stratified into KCNJ5-mutant and wild-type groups based on genetic results. The KCNJ5-mutant cohort was further subclassified into complete remission and partial remission groups according to surgical outcomes. For KCNJ5-mutant cases, postoperative tissues underwent immunohistochemical subtyping for CYP11B1/CYP11B2 expression, and were divided into the CYP11B2 mono-positive group (CYP11B1 -/CYP11B2 +) and the CYP11B1/CYP11B2 co-expression group (CYP11B1 +/CYP11B2 +). Correlations of KCNJ5 mutations and pathological subtypes with baseline characteristics, biochemical profiles, and postoperative outcomes in unilateral primary aldosteronism patients were analyzed. Results:A total of 100 patients were included in the final analysis, aged (51.1±11.0) years, including 35 females (35%). The somatic KCNJ5 mutation rate was 69% (69/100), with 69 KCNJ5-mutant and 31 wild-type cases. Compared to wild-type patients, KCNJ5-mutant patients were younger ((48.4±10.8) years vs. (56.9±9.3) years, P=0.000 2), had a higher female proportion (45% vs. 13%, P=0.004 0), exhibited lower preoperative renin levels (3.4 (1.1, 39.5) ng/L vs. 9.7 (2.7, 19.6) ng/L, P=0.009 1) and had a higher rate of complete clinical remission (55% vs. 16%, P=0.000 3). Among KCNJ5-mutant patients, 38 achieved complete remission and 31 achieved partial remission. The complete remission group demonstrated younger age ((45.6±10.2) years vs. (52.0±10.5) years, P=0.012 6), shorter hypertension duration ((6.2±6.1) years vs. (10.7±10.1) years, P=0.020 4), higher preoperative plasma (951.5 (652.2, 1 690.8) pmol/L vs. 749.8 (518.5, 955.4) pmol/L, P=0.027 7) and urinary ((86 271.4±51 873.8) pmol/24 h vs. (61 860.2±24 411.2) pmol/24 h, P=0.019 2) aldosterone levels, greater lateralization index (22.6 (10.1, 42.5) vs. 11.1 (5.1, 19.8), P=0.022 7), fewer baseline antihypertensive defined daily dose (2.6±1.3 vs. 4.0±1.3, P<0.000 1), and larger tumor diameter (1.5 (1.2, 1.8) cm vs. 1.1 (1.0, 1.5) cm, P=0.000 7). Immunohistochemical subtyping revealed CYP11B2 mono-positivity in 24 mutant cases and CYP11B1/CYP11B2 co-expression in 45. The CYP11B2 mono-positive group showed more pronounced postoperative reduction in antihypertensive defined daily dose (2.9±1.3 vs. 2.2±1.2, P=0.018 3), though no significant difference in complete remission rates (46% vs. 60%, P=0.259 8) was observed. Conclusion:In patients with unilateral primary aldosteronism, those carrying KCNJ5 somatic mutations exhibit characteristics such as younger age and a higher proportion of females compared to wild-type patients, along with significantly better surgical outcomes. Moreover, among patients with KCNJ5 mutations, those whose pathological subtype shows pure CYP11B2 expression demonstrate a more pronounced reduction in postoperative antihypertensive defined daily dose than those with co-expression of CYP11B1/CYP11B2.

Objective:To investigate the correlations of KCNJ5 gene mutations and pathological subtypes based on 11β-hydroxylase (CYP11B1)/aldosterone synthase (CYP11B2) immunohistochemistry with clinical characteristics and postoperative outcomes in patients with unilateral primary aldosteronism undergoing adrenalectomy.Methods:This retrospective study enrolled 155 patients with primary aldosteronism who underwent unilateral adrenalectomy at the Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, between May 2023 and May 2024. KCNJ5 mutations were detected by Sanger sequencing, and patients were stratified into KCNJ5-mutant and wild-type groups based on genetic results. The KCNJ5-mutant cohort was further subclassified into complete remission and partial remission groups according to surgical outcomes. For KCNJ5-mutant cases, postoperative tissues underwent immunohistochemical subtyping for CYP11B1/CYP11B2 expression, and were divided into the CYP11B2 mono-positive group (CYP11B1 -/CYP11B2 +) and the CYP11B1/CYP11B2 co-expression group (CYP11B1 +/CYP11B2 +). Correlations of KCNJ5 mutations and pathological subtypes with baseline characteristics, biochemical profiles, and postoperative outcomes in unilateral primary aldosteronism patients were analyzed. Results:A total of 100 patients were included in the final analysis, aged (51.1±11.0) years, including 35 females (35%). The somatic KCNJ5 mutation rate was 69% (69/100), with 69 KCNJ5-mutant and 31 wild-type cases. Compared to wild-type patients, KCNJ5-mutant patients were younger ((48.4±10.8) years vs. (56.9±9.3) years, P=0.000 2), had a higher female proportion (45% vs. 13%, P=0.004 0), exhibited lower preoperative renin levels (3.4 (1.1, 39.5) ng/L vs. 9.7 (2.7, 19.6) ng/L, P=0.009 1) and had a higher rate of complete clinical remission (55% vs. 16%, P=0.000 3). Among KCNJ5-mutant patients, 38 achieved complete remission and 31 achieved partial remission. The complete remission group demonstrated younger age ((45.6±10.2) years vs. (52.0±10.5) years, P=0.012 6), shorter hypertension duration ((6.2±6.1) years vs. (10.7±10.1) years, P=0.020 4), higher preoperative plasma (951.5 (652.2, 1 690.8) pmol/L vs. 749.8 (518.5, 955.4) pmol/L, P=0.027 7) and urinary ((86 271.4±51 873.8) pmol/24 h vs. (61 860.2±24 411.2) pmol/24 h, P=0.019 2) aldosterone levels, greater lateralization index (22.6 (10.1, 42.5) vs. 11.1 (5.1, 19.8), P=0.022 7), fewer baseline antihypertensive defined daily dose (2.6±1.3 vs. 4.0±1.3, P<0.000 1), and larger tumor diameter (1.5 (1.2, 1.8) cm vs. 1.1 (1.0, 1.5) cm, P=0.000 7). Immunohistochemical subtyping revealed CYP11B2 mono-positivity in 24 mutant cases and CYP11B1/CYP11B2 co-expression in 45. The CYP11B2 mono-positive group showed more pronounced postoperative reduction in antihypertensive defined daily dose (2.9±1.3 vs. 2.2±1.2, P=0.018 3), though no significant difference in complete remission rates (46% vs. 60%, P=0.259 8) was observed. Conclusion:In patients with unilateral primary aldosteronism, those carrying KCNJ5 somatic mutations exhibit characteristics such as younger age and a higher proportion of females compared to wild-type patients, along with significantly better surgical outcomes. Moreover, among patients with KCNJ5 mutations, those whose pathological subtype shows pure CYP11B2 expression demonstrate a more pronounced reduction in postoperative antihypertensive defined daily dose than those with co-expression of CYP11B1/CYP11B2.

Objective:To explore the safety and efficacy of ultrasound-assisted facial filler injection, based on the anatomy of facial vessels to prevent intravascular embolization.Methods:From Jan. 2019 to Sep. 2020, 142 patients were treated with facial soft-tissue filler injection (mean age, 39.7 years; 131 female and 11 male). According to the patients＇ own will, autologous fat or hyaluronic acid was applied respectively. When injecting, the assistant could press over the periorbital artery to temporarily occlude the artery, confirmed with Doppler ultrasound, thus reduced the risk of intravascular embolization, and carefully injected with minimal pressure and tiny amount.Results:A total of 142 patients were enrolled in the study, and 54 patients were treated with autologous fat grafting, while 88 patients were injected with hyaluronic acid. The injection sites included forehead, temple, glabella, nasal root, tear trough, nasolabial fold, cheek, chin, and lips. Facial rejuvenation improvement was satisfied with a smooth contour and proper augmentation. No vascular embolization occurred. 9 patients received a second or third round fat grafting to achieve better outcome. Follow-up duration ranged from 1 month to 6 months.Conclusions:With ultrasound assistant, digital pressure over the orbital artery could temporarily occlude the artery and may reduce the risk of intravascular embolization. The simple technique may add a significant benefit with no additional cost or risk to the patients.

Objective: To investigate the clinical efficacy and safety profile of hyaluronic acid dermal filler(Restylane®) in treating nasolabial folds in Chinese population. Methods: 103 subjects in this study were recruited from five Chinese clinical trial centers between July 2014 and December 2015. Subjects were treated with hyaluronic acid dermal filler in correcting nasolabial folds and an optional re-treatment was performed after 12 months according to the subjects′wishes. The improved of nasolabial folds was evaluated by the change of severity (wrinkle severity rating scale, WSRS) and aesthetic improvement (global aesthetic improvement scale, GAIS). Satisfaction of subjects on treatment was evaluated using subject satisfaction questionnaires (SSQ). Safety indicators such as pain, skin and soft tissue presentation at the injection site were continuously evaluated throughout the whole treatment process. Results: Significant improvement in scores of WSRS and GAIS of all subjects was observed after treatment. Nine months after treatment, the scores of WSRS in 80 subjects (77.7%) and GAIS in 96 subjects (93.2%) were still improved. The 68 subjects (95.8%) received re-treatment after 12 months gained further improvement in nasolabial folds. Most adverse events were mild or moderate (transient/reversible local manifestations) and all resolved before study end, no severe adverse event related to products observed. Conclusions Hyaluronic acid dermal filler is effective and safe in treatment of nasolabial folds in Chinese population and the effect can last up to 12 months.

Objective: To investigate the clinical efficacy of circumferential thigh liposuction with three incisions in thigh. Methods: From April 2017 to October 2018, 31 patients received circumferential thigh liposuction with three incisions. All patients were females at 17-42 years old, with the mean age of 25.6± 0.8 years. An incision was designed in the pubic area, two in right and left inferior gluteal folds respectively. After injecting tumescent liquid into operation area, blunt and bent cannulas with 2.5-3.5 mm in diameter and 20-45 cm in length were used to extract deep subcutaneous fat, but 0.5 cm thick subcutaneous superficial fat was preserved. Elastic pants were dressed for 3 months after surgery. The thigh contour improvement was evaluated by the patients and 2 doctors. Results: All the patients recovered uneventfully, without complications of fat embolism or infection. Satisfaction ratios of overall thigh and inner thigh contour increased from 81.7% to 80.6%, evaluated by patients. Ten patients completed postoperative outpatient revisit after 2 months. Satisfaction ratios of overall thigh and inner thigh contour increased from 80% to 75%, evaluated by doctors. Conclusion Three-incision circumferential thigh liposuction is an effective method in thigh contouring with concealed incision scar.

Objective: To investigate the effect of perioperative fluid therapy on early postoperative pulmonary complication (PPC) after orthotopic liver transplantation (OLT). Methods: The clinical data of 132 patients who underwent OLT in the First Affiliated Hospital of Xi′an Jiaotong University from April 2016 to December 2017 were analyzed retrospectively. These patients included 96 males and 36 females, aged (47.3±9.6) years (range: 24-69 years). Based on the clinical manifestations, laboratory and imaging findings of patients in ICU and PPC occurrence within 7 days after OLT surgery, the patients were divided into 2 groups: non-PPC group and PPC group. Univariate and multivariate logistic regression analyses were used to evaluate the association between perioperative variables and PPC. The Kaplan-Meier method was used to estimate cumulative survival of recipients with or without PPC within 2-years. Results: During the follow-up, 11 patients (8.3%) died and 72 patients (54.5%) developed PPC after operation. There were 34 cases, 6 cases, 3 cases, 4 cases, 15 cases, 6 cases and 4 cases of only pleural effusion, only pulmonary edema, only pneumonia, pleural effusion with pneumonia, pleural effusion with pulmonary edema, pleural effusion with atelectasis, and pleural effusion with pneumonia and pneumonia in PPC, respectively. Univariate analysis showed that the preoperative factors (model for end-stage liver disease score), the intra-operative factors (duration of surgery, total infusion volume, total blood products) and the postoperative cumulative fluid balance within the first 24 h, 48 h, and 72 h were the prognosis factors of PPC (P<0.05). At least two out of the first three postoperative days with a fluid balance of ≤-500 ml was a protective factor. Using multivariate analysis by Logistic regression, only the red blood units >10 U (OR=3.55, 95% CI: 1.35-9.26, P=0.010) and the cumulative fluid intake >12 L (OR=2.98, 95% CI: 1.14-7.80, P=0.026) within the first 72 h after operation were independent prognosis factors of PPC after OLT. Kaplan-Meier analysis showed that the cumulative survival rate was lower in PPC group than that in non-PPC group (χ²=6.590, P=0.01). Conclusion Massive red blood cell transfusion and the cumulative fluid volume >12 L during perioperative 72 hours are independent prognosis factors of PPC after OLT.

Objective: To observe the safety and efficiency of face-lift combined with fat grafting in facial rejuvenation. Methods: We performed a retrospective study, which included 23 patients. SMAS suspension and multi-site suspension were combined to correct the nasolabial fold, mid-cheek aging and malar mounds. Structural fat grafting was performed to treat the volume loss in mid-face. Results: All patients demonstrated a significant improvement in midfacial appearance. No infection or nerve injury were found in this study. Only three patients did not get primary healing in temple region, which led to temporal hair loss from secondary healing. Conclusions This study demonstrates that fat grafting and multiple layers face-lift are efficient method for facial rejuvenation. These approaches appear to be very promising for facial anti-aging techniques.

Objective: This paper discusses a surgical method to improve the middle part of face and the temporal surface by using the patented technology of embedding guidance technology. Methods: On the basis of not removing the skin, the application of embedding guidance technology was applied to achieve the effect of facial lifting by placing a 2-0 polyester knitting line under the scalp with a minimally invasive incision(3-5 mm) , paving up to the skull periosteum and down to the hairline edge for compound fixation. Results: Among the 200 patients, 197 were female and 3 were male. Aging from 23-62 years old, all of the patients suffered from mild to moderate problem of saggy skin.Post-operation follow-up was kept from 3 months to 5 years after the treatment, which demonstrated that all of the patients showed different degrees of facial lifting after edema subsided at 3 months, including improvedfacial skin condition, shallower nasolabial groove, lifting of the lateral canthus and tightening of facial skin. The patients were satisfied with the effect. Conclusions The surgical method is an effective method to solve the problem of facial aging with advantages, such as simple execution, minimized wound, fast recovery, no post-operation bandage requirement and showing great result towards patients suffering from mild and moderate saggy facial skin problem.

Objective: To explore the clinical effect of cervico-acromial fasciocutaneous flap based on the supraclavicular artery as a method for face and neck reconstruction. Methods: From Oct 1990 to June 2014, 17 patients, with the age range of 7 to 51 years, suffering from cicatricle contractures of neck or facial defect, were treated with cervico-acromial fascicutaneous flaps. 29 flaps were used in 12 patients bilaterally or multiply. The donor sites of 2 patients were closed by skin graft; while in the rest 15 patients, the donor sites were closed by expanded flaps. Results: All the 29 flaps were survived, with satisfactory color and texture. Hematoma occurred in 1 case after tissue expander implantation, but the flap was successfully expanded after evacuation of hematoma. The size of flaps ranged from 15 cm×7 cm to 35 cm×15 cm. 10 patients completed 6 months follow-up, and presented with satisfactory appearance and better functional results. Conclusions Cervico-acromial fascicutaneous flap based on the supraclavicular artery is an good choice for reconstruction of neck and facial defects.

Objective: Hepatitis B surface antigen (HBsAg) loss is seldom achieved with nucleos(t)ide analog (NA) therapy in chronic hepatitis B patients but may be enhanced by switching to finite pegylated-interferon (Peg-IFN) alfa-2a. We assessed HBsAg loss with 48- and 96-week Peg-IFN alfa-2a in chronic hepatitis B patients with partial response to a previous NA. Methods: Hepatitis B e antigen (HBeAg)-positive patients who achieved HBeAg loss and hepatitis B virus DNA < 200 IU/mL with previous adefovir, lamivudine or entecavir treatment were randomized 1:1 to receive Peg-IFN alfa-2a for 48 (n = 153) or 96 weeks (n = 150). The primary endpoint of this study was HBsAg loss at end of treatment. The ClinicalTrials.gov identifier is NCT01464281. Results: At the end of 48 and 96 weeks' treatment, 14.4% (22/153) and 20.7% (31/150) of patients, respectively, who switched from NA to Peg-IFN alfa-2a cleared HBsAg. Rates were similar irrespective of prior NA or baseline HBeAg seroconversion. Among those who cleared HBsAg by the end of 48 and 96 weeks' treatment, 77.8% (14/18) and 71.4% (20/28), respectively, sustained HBsAg loss for a further 48 weeks. Baseline HBsAg < 1 500 IU/mL and week 24 HBsAg < 200 IU/mL were associated with the highest rates of HBsAg loss at the end of both 48- and 96-week treatment (51.4% and 58.7%, respectively). Importantly, extending treatment from 48 to 96 weeks enabled 48.3% (14/29) more patients to achieve HBsAg loss. Conclusion Patients on long-term NA who are unlikely to meet therapeutic goals can achieve high rates of HBsAg loss by switching to Peg-IFN alfa-2a. HBsAg loss rates may be improved for some patients by extending treatment from 48 to 96 weeks, although the differences in our study cohort were not statistically significant. Baseline and on-treatment HBsAg may predict HBsAg loss with Peg-IFN alfa-2a.