Objective To investigate the clinical characteristics,treatment methods,and prognosis of a-cute leukemia patients with extramedullary infiltration.Methods The clinical characteristics and treatment methods of 47 acute leukemia patients with extramedullary infiltration admitted to the Affiliated Hospital of Guizhou Medical University from April 2014 to April 2023 were retrospectively analyzed.Subgroup analysis was performed according to whether there was extramedullary infiltration before transplantation,and whether there was isolated extramedullary recurrence after transplantation.Based on this analysis,the patients were di-vided into the pre-transplantation radiotherapy group and pre-transplantation non-radiotherapy group,the post-transplantation radiotherapy group and post-transplantation non-radiotherapy group.According to the treatment methods of central nervous system leukemia(CNSL),the patients were divided into the intrathecal injection group(n=12)and combination of intrathecal injection and radiotherapy group(n=13).The local remission situation,survival duration,and toxic and side effects of radiotherapy and chemotherapy were com-pared.Results For acute leukemia patients with extramedullary infiltration,the overall survival time(OS)in the radiotherapy group was better than that in the non-radiotherapy group(median OS:706 d vs.151 d,P=0.015).Subgroup analysis showed that the OS of the pre-transplantation radiotherapy group was better than that of the pre-transplantation non-radiotherapy group(median OS:592 d vs.386 d,P=0.035).For CNSL,the combination of intrathecal injection and radiotherapy group had a better OS than the intrathecal injection group(median OS:547 d vs.388 d,P=0.045).The event-free survival time(EFS)of the radiotherapy group was better than that of the non-radiotherapy group(median EFS:175 d vs.50 d,P=0.005).The COX pro-portional-hazards model showed that treatment with or without radiotherapy had a significant impact on the OS of acute leukemia patients with extramedullary infiltration.The risk of death in the pre-transplantation non-radiotherapy group was 2.231 times higher than that in the pre-transplantation radiotherapy group(HR=3.231,95％CI:1.021-10.227,P=0.046).Compared with the non-radiotherapy group,the radiother-apy group had a higher local remission and a lower risk of haematological toxicity,infection,and haemorrhage.Conclusion Radiotherapy can rapidly alleviate the local symptoms of acute leukemia complicated with extr-amedullary infiltration,prolong the survival time of these patients,and reduce the risk of hematologic toxicity,infection,and haemorrhage.

Objective:To investigate the abdominal function and aesthetics outcomes of patients with abdominally based breast reconstruction.Methods:In this research, we retrospectively analyzed the cases of breast reconstruction in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from July 2013 to June 2018. In accordance with the inclusion and exclusion criteria, patients undergoing breast reconstruction by deep inferior epigastric perforator flap (DIEP) or muscle-sparing transverse rectus abdominis myocutaneous flap (TRAM) were included in the study. A questionnaire was designed to evaluate the patient’s abdominal strength, and the BREAST-Q breast reconstruction abdominal health module was used to assess the patient’s satisfaction degree with the abdomen. SPSS 21.0 statistical software was used to analyze the data. The independent-samples t test is used for comparison between the two groups; the matched-samples t test is used for the preoperative and postoperative comparison of a single group. P<0.05 indicates that the difference is statistically significant. Results:A total of 32 patients were enrolled, including 17 cases of DIEP breast reconstruction, aged 43.6±9.2 years old, and 15 cases of TRAM breast reconstruction, aged 41.0±10.1 years old. The postoperative follow-up period ranged from 12 to 73 months, with an average of 41.5 months. Preoperative abdominal wall strength scores in the DIEP group and the TRAM group were 4.71±0.47 and 4.60±0.50 , respectively, and there were on significant difference between two groups. Three months after operation, the abdominal wall strength of the DIEP group scored 2.65±0.86, which was higher than the score in the TRAM group(1.93±0.70) ( P<0.05). The scores of the two groups were significantly different from those before operation ( P<0.01). One year after the operation, the abdominal wall strength of DIEP group scored 4.65±0.49, which was significantly higher than the score in TRAM group (4.07±0.88)( P<0.05). There was no significant difference between the scores of DIEP group and those before operation ( P>0.05), however, the scores of TRAM group were significantly different from those before surgery ( P<0.05). One year after operation, the appearance of the abdomen was not significantly different between the preoperative and postoperative score in both two groups ( P>0.05). Preoperative abdominal satisfaction scores of the DIEP group and the TRAM group were 86.53±5.68 and 85.87±7.31, respectively, and there was no significant difference between two groups ( P>0.05). Three months after the operation, the abdominal satisfaction score of the DIEP group was 76.41±7.74, which was higher than the score in the TRAM group(68.00±9.08) ( P<0.01). The scores of the two groups were compared with those before surgery, and the differences were statistically significant ( P<0.01). One year after the operation, the abdominal satisfaction score was 85.00±5.32 in the DIEP group and 82.93±6.12 in the TRAM group, showing no statistical significance between two groups ( P>0.05). There was no significant difference between the scores of DIEP group and those before operation ( P>0.05), however, the scores of TRAM group were significantly different from those before surgery ( P<0.05). Conclusions:The study demonstrates that both two kinds of abdominal flaps can obtain a better abdominal appearance. The long-term abdominal function and abdominal satisfaction of patients undergoing breast reconstruction with DIEP flaps can return to the baseline levels, however, that of TRAM flaps can not return to the baseline levels. Further research is needed for the longer term results.

Objective:To investigate the influences of different amounts of negative pressure on postoperative drainage volume for patients undergoing axillary endoscopic augmentation mammoplasty.Methods:According to the random number table, patients who were admitted to the Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology for augmentation mammoplasty between January 1st, 2018 and May 31st, 2019 were randomly grouped into high negative pressure group and low negative pressure group respectively. In the high negative pressure group, -90 kPa negative pressure was applied through a 600 ml negative pressure drainage bottle. In the low negative pressure group, -10 to -16 kPa negative pressure was applied through a 200 ml negative pressure drainage ball. Total drainage volume, drainage volume per day, drainage placement time, incidence and types of complications were recorded. Independent sample t-test or the rank-sum test for two independent samples was applied for comparison between groups. Results:A total of 56 patients who met the inclusion criteria were divided into high negative pressure group(age 28.2±4.1 years) and low negative pressure group(age 27.0±3.3 years). Patients’ BMI was (19.2±1.4) kg/m 2 in the high negative pressure group and (19.1±1.2) kg/m 2 in the low negative pressure group. Implant volume was (249.2±24.9) ml in the high negative pressure group and (257.5±23.8) ml in the low negative pressure group. There was no significant difference in baseline data between 2 groups ( P>0.05). There were significant differences in the daily drainage volume per breast (except for the third day), total drainage volume per breast and the duration of drainage placement between the two groups. The duration of drainage placement was 5.9±0.9 days in the high negative pressure group and 4.8±1.1 days in the low negative pressure group. Total drainage volume per breast was (336.4±86.7) ml in the high negative pressure group and (233.5±43.8) ml in the low negative pressure group. Patients were followed up for 12 months. No hematoma, seroma, inflammation or capsular contracture occurred in either group. One patient(3.6%) suffered breast implant displacement in the high negative pressure group and had revisional surgery. Conclusions:Lower negative pressure (-10 to -16 kPa) was associated with less drainage volume and shorter drainage placement time compared to higher negative pressure (-90 kPa) in patients undergoing axillary endoscopic augmentation mammoplasty.

Objective:To investigate the abdominal function and aesthetics outcomes of patients with abdominally based breast reconstruction.Methods:In this research, we retrospectively analyzed the cases of breast reconstruction in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from July 2013 to June 2018. In accordance with the inclusion and exclusion criteria, patients undergoing breast reconstruction by deep inferior epigastric perforator flap (DIEP) or muscle-sparing transverse rectus abdominis myocutaneous flap (TRAM) were included in the study. A questionnaire was designed to evaluate the patient’s abdominal strength, and the BREAST-Q breast reconstruction abdominal health module was used to assess the patient’s satisfaction degree with the abdomen. SPSS 21.0 statistical software was used to analyze the data. The independent-samples t test is used for comparison between the two groups; the matched-samples t test is used for the preoperative and postoperative comparison of a single group. P<0.05 indicates that the difference is statistically significant. Results:A total of 32 patients were enrolled, including 17 cases of DIEP breast reconstruction, aged 43.6±9.2 years old, and 15 cases of TRAM breast reconstruction, aged 41.0±10.1 years old. The postoperative follow-up period ranged from 12 to 73 months, with an average of 41.5 months. Preoperative abdominal wall strength scores in the DIEP group and the TRAM group were 4.71±0.47 and 4.60±0.50 , respectively, and there were on significant difference between two groups. Three months after operation, the abdominal wall strength of the DIEP group scored 2.65±0.86, which was higher than the score in the TRAM group(1.93±0.70) ( P<0.05). The scores of the two groups were significantly different from those before operation ( P<0.01). One year after the operation, the abdominal wall strength of DIEP group scored 4.65±0.49, which was significantly higher than the score in TRAM group (4.07±0.88)( P<0.05). There was no significant difference between the scores of DIEP group and those before operation ( P>0.05), however, the scores of TRAM group were significantly different from those before surgery ( P<0.05). One year after operation, the appearance of the abdomen was not significantly different between the preoperative and postoperative score in both two groups ( P>0.05). Preoperative abdominal satisfaction scores of the DIEP group and the TRAM group were 86.53±5.68 and 85.87±7.31, respectively, and there was no significant difference between two groups ( P>0.05). Three months after the operation, the abdominal satisfaction score of the DIEP group was 76.41±7.74, which was higher than the score in the TRAM group(68.00±9.08) ( P<0.01). The scores of the two groups were compared with those before surgery, and the differences were statistically significant ( P<0.01). One year after the operation, the abdominal satisfaction score was 85.00±5.32 in the DIEP group and 82.93±6.12 in the TRAM group, showing no statistical significance between two groups ( P>0.05). There was no significant difference between the scores of DIEP group and those before operation ( P>0.05), however, the scores of TRAM group were significantly different from those before surgery ( P<0.05). Conclusions:The study demonstrates that both two kinds of abdominal flaps can obtain a better abdominal appearance. The long-term abdominal function and abdominal satisfaction of patients undergoing breast reconstruction with DIEP flaps can return to the baseline levels, however, that of TRAM flaps can not return to the baseline levels. Further research is needed for the longer term results.

Objective:To investigate the influences of different amounts of negative pressure on postoperative drainage volume for patients undergoing axillary endoscopic augmentation mammoplasty.Methods:According to the random number table, patients who were admitted to the Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology for augmentation mammoplasty between January 1st, 2018 and May 31st, 2019 were randomly grouped into high negative pressure group and low negative pressure group respectively. In the high negative pressure group, -90 kPa negative pressure was applied through a 600 ml negative pressure drainage bottle. In the low negative pressure group, -10 to -16 kPa negative pressure was applied through a 200 ml negative pressure drainage ball. Total drainage volume, drainage volume per day, drainage placement time, incidence and types of complications were recorded. Independent sample t-test or the rank-sum test for two independent samples was applied for comparison between groups. Results:A total of 56 patients who met the inclusion criteria were divided into high negative pressure group(age 28.2±4.1 years) and low negative pressure group(age 27.0±3.3 years). Patients’ BMI was (19.2±1.4) kg/m 2 in the high negative pressure group and (19.1±1.2) kg/m 2 in the low negative pressure group. Implant volume was (249.2±24.9) ml in the high negative pressure group and (257.5±23.8) ml in the low negative pressure group. There was no significant difference in baseline data between 2 groups ( P>0.05). There were significant differences in the daily drainage volume per breast (except for the third day), total drainage volume per breast and the duration of drainage placement between the two groups. The duration of drainage placement was 5.9±0.9 days in the high negative pressure group and 4.8±1.1 days in the low negative pressure group. Total drainage volume per breast was (336.4±86.7) ml in the high negative pressure group and (233.5±43.8) ml in the low negative pressure group. Patients were followed up for 12 months. No hematoma, seroma, inflammation or capsular contracture occurred in either group. One patient(3.6%) suffered breast implant displacement in the high negative pressure group and had revisional surgery. Conclusions:Lower negative pressure (-10 to -16 kPa) was associated with less drainage volume and shorter drainage placement time compared to higher negative pressure (-90 kPa) in patients undergoing axillary endoscopic augmentation mammoplasty.

Objective:To report the effect of the abdominal plastic technique for reconstruction of lower abdomen defect.Methods:22 patients with defect in lower abdomen were treated with radical resection and abdominal plastic technique from 2017. 3. to 2019.3. There were 10 males and 12 females, age 45-62years, skin lesions ranged from 7 cm ×10 cm to 25 cm× 29 cm. In cases with lower wound tension, the defect was directly closed with abdominal plastic technique . In cases with high wound tension and absolute insufficient abdominal skin, pedicled anterolateral thigh (ALT)flap and abdominal plastic technique were performed. In cases with high wound tension and relatively insufficient abdominal skin, pedicled deep inferior epigastric artery perforator (DIEP) flap and abdominal plastic technique were performed. Follow-up was performed every 3 months postoperatively to observe local recurrent and lymphatic metastasis.Results:4 cases were treated with abdominal plastic technique, 10 cases received ALT flap transfer and abdominal plastic technique, 8 cases received DIEP flap transfer and abdominal plastic technique. Follow-up was carried out 1-12 months, no total failure of flap was observed. No donor-site complication was observed. The contour and function of reconstructed abdomen was satisfactory.Conclusions:The abdominal plastic technique for reconstruction of skin defect in lower abdomen is reliable. It features low donor-site morbidity, high reconstructive efficiency and reliable perfusion.

Objective:To report the effect of the abdominal plastic technique for reconstruction of lower abdomen defect.Methods:22 patients with defect in lower abdomen were treated with radical resection and abdominal plastic technique from 2017. 3. to 2019.3. There were 10 males and 12 females, age 45-62years, skin lesions ranged from 7 cm ×10 cm to 25 cm× 29 cm. In cases with lower wound tension, the defect was directly closed with abdominal plastic technique . In cases with high wound tension and absolute insufficient abdominal skin, pedicled anterolateral thigh (ALT)flap and abdominal plastic technique were performed. In cases with high wound tension and relatively insufficient abdominal skin, pedicled deep inferior epigastric artery perforator (DIEP) flap and abdominal plastic technique were performed. Follow-up was performed every 3 months postoperatively to observe local recurrent and lymphatic metastasis.Results:4 cases were treated with abdominal plastic technique, 10 cases received ALT flap transfer and abdominal plastic technique, 8 cases received DIEP flap transfer and abdominal plastic technique. Follow-up was carried out 1-12 months, no total failure of flap was observed. No donor-site complication was observed. The contour and function of reconstructed abdomen was satisfactory.Conclusions:The abdominal plastic technique for reconstruction of skin defect in lower abdomen is reliable. It features low donor-site morbidity, high reconstructive efficiency and reliable perfusion.

Objective: To report the effect of the free anterolateral thigh flap with KISS technique in reconstruction of scalp defect. Methods: 11 patients with scalp tumor were treated with radical resection and free transfer of the anterolateral thigh flap with KISS technique from March 2016 to June 2017. The flap was designed carrying two skin pedals according to preoperative detection of perforators, then the flap was dissected to carry one main pedicle or two different pedicles, after that two skin pedals were assembled with the KISS technique to cover the wound. Results: No total failure of flap was observed. No donor-site complication was observed. The contour of reconstructed scalp was satisfactory. Conclusions The free anterolateral thigh flap with KISS technique is reliable in reconstruction of scalp defect. It features low donor site morbidity, high reconstructive efficiency and reliable perfusion.

Objective To observe the influence of Peiyuan Tongluo Fang(Qi-tonifying Collateral-dred-ging Decoction,PTF)on clinical efficacy and micro-inflammation state in patients with phase IV diabetic kidney disease(DKD),and investigate the mechanism of PTF in treatment of DKD.Methods Phase IV DKD patients(n=106)were randomly divided into treatment group and control group(each n=53).There were actually 98 patients had complete treatment in 2 groups(each n=49).Besides of basic therapy,the treatment group was treated with PTF,and control group was treated with Niaoduqing Gran-ule for 8 weeks.The changes of TCM patterns and levels of serum creatinine(SCr),estimated glomeru-lar filtration rate(eGFR),24 h urinary protein excretion(24 h U-pro), urinary microalbumin protein (U-Alb),high sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α)and interleu-kin-6(IL-6)were observed and analyzed statistically in two groups.Results After treatment,all TCM patterns were significantly relieved(P<0.05 or P<0.01)in treatment group compared with before, which were superior to those in control group(P<0.05 or P<0.01).After treatment,levels of SCr,24 h U-pro and U-Alb decreased significantly(P<0.01)and eGFR level increased(P<0.05)in treat-ment group compared with before treatment,which were superior to those in control group(P<0.05 or P<0.01).After treatment, levels of hs-CRP, TNF-αand IL-6 decreased significantly(P <0.01)in treatment group compared with before treatment, which were superior to those in control group(P <0.05).The total effective rate was 73.47%(36/49)in treatment group,and 44.90%(22/49)in con-trol group(P<0.05).No adverse reactions were observed in 2 groups.Conclusion PTF combined with basic therapy of Western medicine can effectively reduce urine protein,protect kidney and alleviate micro-inflammation state in patients with phase IV DKD.

Objective: To report the pedicled anterolateral thigh flap with kiss technique for reconstruction of vulva. Methods: From Mar.2015 to Mar.2017, 17 patients with vulvar tumor were treated with radical resection and transfer of the pedicled anterolateral thigh flap with kiss technique. Results: All the flaps survived completely with no complication. The contour and function of reconstructed vulva was satisfactory. Conclusions The pedicled anterolateral thigh flap with kiss technique for reconstruction of vulva has the advantages of reliable blood supply, low morbidity at donor sites, and good therapeutic effect.