Objective:To explore the effect of free transplantation of composite tissue flap from the anterior lateral aspect of the femur in repairing head skin defects with artificial dural exposure infection.Methods:A retrospective study was conducted on 13 patients admitted to the First Affiliated Hospital of Air Force Military Medical University from April 2018 to August 2020 with craniotomy complications, including craniotomy skin and soft tissue defects combined with artificial dural exposure and infection. After preoperative anti infection treatment, the neurosurgery department participated in debridement and removed the artificial dura mater as much as possible during the operation. A composite tissue flap carrying the fascia lata was designed for the anterior lateral aspect of the thigh, and the flap artery and vein were anastomosed with the superficial temporal artery and superficial temporal vein/middle temporal vein respectively. The defect of the dura mater was repaired with the fascia lata with blood supply. The flap was used to seal the wound, and the donor site was directly sutured or transplanted with autologous medium thick skin graft. The postoperative blood supply and survival of the flap, the presence of cerebrospinal fluid leakage, and the healing of the donor site were observed; The observation of dural integrity and postoperative effects of skull reconstruction using cranial magnetic resonance imaging was followed up.Results:Among the 13 patients in this group, 11 patients had their artificial dura mater completely removed, while 2 patients were not completely removed due to severe adhesion. Among them, 1 patient had a residual area of 0.8 cm×1 cm, and the other had 3 residual areas, with a maximum area of 0.5 cm×0.7 cm; All transplanted skin flaps survived, with 12 cases achieving primary healing and 1 case of partial wound rupture after suture removal, which healed after conservative dressing change; All patients had no cerebrospinal fluid leakage; There was one case of partial necrosis of the graft in the donor site, which healed after supplementing the graft; Thirteen patients underwent cranial magnetic resonance imaging at 3-6 months postoperatively, all of which showed intact dura mater; Among them, 8 patients have completed skull reconstruction surgery, and all of them have healed well after reconstruction, with a good appearance of the surgical area.Conclusions:For wounds with head skin defects and exposed artificial dura mater infection, free transplantation of the anterior lateral composite tissue flap carrying the fascia lata can effectively cover the wound and repair the dura mater defect, achieve good function and appearance, and create favorable conditions for later skull reconstruction.

Objective:To explore the effect of previous different spontaneous abortion times on pregnancy outcomes of patients with the first in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET). Methods:A retrospective cohort study was performed on the clinical data of patients with the first IVF/ICSI-ET in the Reproductive Center of Henan Provincial People's Hospital from January 1, 2010 to December 31, 2018. A total of 12 912 patients were included. According to the number of previous spontaneous abortions, the patients were divided into four groups: zero time group ( n=10 948), 1 time group ( n=1 506), 2 times group ( n=345) and ≥3 times group ( n=113). The basic data of patients and pregnancy outcomes after assisted pregnancy were compared among the four groups, and the influence of the number of previous spontaneous abortions on pregnancy outcomes of IVF/ICSI-ET patients was investigated by univariate and categorical multivariate logistic regression analysis. Results:Univariate logistic regression analysis showed that age, infertility duration, previous spontaneous abortion times, endometrial thickness, the numbers of embryos transferred and high-quality embryos transferred were all influencing factors of implantation rate, pregnancy rate, early spontaneous abortion rate and live birth rate (all P<0.001, except for the influence of endometrial thickness on early spontaneous abortion rate P=0.002). The types of embryo transferred, follicle-stimulating hormone (FSH) level, luteinizing hormone (LH) level, LH/FSH, and anti-Müllerian hormone (AMH) level all had effects on the implantation rate, the pregnancy rate, and the live birth rate (all P<0.001, except for the effect of AMH on the live birth rate P=0.002). Body mass index (BMI) was the influencing factor of early spontaneous abortion rate and live birth rate ( P=0.006, P=0.002). After adjusting for confounding factors, multiple regression analysis showed that with zero time group as the reference group, the implantation rate of ≥3 times group ( OR=0.63, 95% CI: 0.42-0.94, P=0.025) was significantly decreased; the early spontaneous abortion rate was significantly increased in 1 time group ( OR=1.56, 95% CI: 1.27-1.93, P<0.001), 2 times group ( OR=2.28, 95% CI: 1.61-3.23, P<0.001), and ≥3 times group ( OR=3.32, 95% CI: 1.89-5.82, P<0.001); the live birth rate was significantly reduced in 1 time group ( OR=0.80, 95% CI: 0.71-0.91, P<0.001), 2 times group ( OR=0.66, 95% CI: 0.52-0.84, P<0.001) and ≥3 times group ( OR=0.45, 95% CI: 0.29-0.67, P<0.001). Conclusion:The number of previous early spontaneous abortions is an independent factor affecting the implantation rate, the early spontaneous abortion rate and the live birth rate for patients undergoing IVF/ICSI-ET. With the increase of the number of previous early spontaneous abortions, the implantation rate and the live birth rate after IVF/ICSI were gradually decreased, and the risk of early spontaneous abortion gradually increased.

Objective:To study the relationship between endometrial thickness (EMT) at the time of human chorionic gonadotropin (hCG) trigger day or endometrial transformation day and spontaneous abortion in in vitro fertilization (IVF) cycle and analyze the threshold effect. Methods:A retrospective cohort study was performed to analyze the clinical data of infertile patients who underwent the first IVF cycle in the Reproductive Center of Henan Provincial People's Hospital from January 2010 to December 2018. The patients were divided into four groups according to EMT, group A: EMT<8 mm, group B: 8 mm≤EMT<10 mm, group C: 10 mm≤EMT<12 mm, and group D: EMT≥12 mm. The effect of EMT on spontaneous abortion rate during IVF cycle was investigated by univariate analysis, multivariate logistic regression analysis, smooth curve fitting and the threshold effect analysis.Results:In all 12 912 IVF cycles, 8 674 cycles got clinical pregnancy, 1 102 cycles resulted in early spontaneous miscarriage and the spontaneous abortion rate was 12.70%. Univariate regression analysis showed that age, body mass index, duration of infertility, type of infertility, male factors in infertility factors, No. of spontaneous abortions, EMT and No. of embryos transferred had influences on the spontaneous abortion rate (all P<0.05). Multivariate logistic regression analysis adjusted for confounding factors and group A was used as control group. The results showed that the spontaneous abortion rate of groups B, C and D was significantly lower than that of group A during embryo transfer at cleavage stage ( P=0.008 , P<0.001, P<0.001); there was no significant difference in spontaneous abortion rate with the increase of EMT during blastocyst stage ( P>0.05). The threshold effect analysis showed that when the EMT was <10.3 mm, the spontaneous abortion rate decreased significantly with the increasing of EMT for cleavage embryo, and the spontaneous abortion rate decreased 14.7% with each 1 mm increment in EMT ( OR=0.853, 95% CI: 0.792-0.918, P<0.001); there was no significant difference in spontaneous abortion rate when EMT was ≥10.3 mm ( OR=1.006, 95% CI: 0.959-1.056, P=0.798). The spontaneous abortion rate changed steadily with the increase of EMT, and the difference was not statistically significant for blastocyst embryo ( P>0.05). Conclusion:In IVF cycle, the relationship between EMT and spontaneous abortion was curvilinear for cleavage embryo. Before the EMT reached the threshold of 10.3 mm, the spontaneous abortion rate decreased significantly with the increase of EMT.

Objective:To explore the effect of previous different spontaneous abortion times on pregnancy outcomes of patients with the first in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET). Methods:A retrospective cohort study was performed on the clinical data of patients with the first IVF/ICSI-ET in the Reproductive Center of Henan Provincial People's Hospital from January 1, 2010 to December 31, 2018. A total of 12 912 patients were included. According to the number of previous spontaneous abortions, the patients were divided into four groups: zero time group ( n=10 948), 1 time group ( n=1 506), 2 times group ( n=345) and ≥3 times group ( n=113). The basic data of patients and pregnancy outcomes after assisted pregnancy were compared among the four groups, and the influence of the number of previous spontaneous abortions on pregnancy outcomes of IVF/ICSI-ET patients was investigated by univariate and categorical multivariate logistic regression analysis. Results:Univariate logistic regression analysis showed that age, infertility duration, previous spontaneous abortion times, endometrial thickness, the numbers of embryos transferred and high-quality embryos transferred were all influencing factors of implantation rate, pregnancy rate, early spontaneous abortion rate and live birth rate (all P<0.001, except for the influence of endometrial thickness on early spontaneous abortion rate P=0.002). The types of embryo transferred, follicle-stimulating hormone (FSH) level, luteinizing hormone (LH) level, LH/FSH, and anti-Müllerian hormone (AMH) level all had effects on the implantation rate, the pregnancy rate, and the live birth rate (all P<0.001, except for the effect of AMH on the live birth rate P=0.002). Body mass index (BMI) was the influencing factor of early spontaneous abortion rate and live birth rate ( P=0.006, P=0.002). After adjusting for confounding factors, multiple regression analysis showed that with zero time group as the reference group, the implantation rate of ≥3 times group ( OR=0.63, 95% CI: 0.42-0.94, P=0.025) was significantly decreased; the early spontaneous abortion rate was significantly increased in 1 time group ( OR=1.56, 95% CI: 1.27-1.93, P<0.001), 2 times group ( OR=2.28, 95% CI: 1.61-3.23, P<0.001), and ≥3 times group ( OR=3.32, 95% CI: 1.89-5.82, P<0.001); the live birth rate was significantly reduced in 1 time group ( OR=0.80, 95% CI: 0.71-0.91, P<0.001), 2 times group ( OR=0.66, 95% CI: 0.52-0.84, P<0.001) and ≥3 times group ( OR=0.45, 95% CI: 0.29-0.67, P<0.001). Conclusion:The number of previous early spontaneous abortions is an independent factor affecting the implantation rate, the early spontaneous abortion rate and the live birth rate for patients undergoing IVF/ICSI-ET. With the increase of the number of previous early spontaneous abortions, the implantation rate and the live birth rate after IVF/ICSI were gradually decreased, and the risk of early spontaneous abortion gradually increased.

Objective:To study the relationship between endometrial thickness (EMT) at the time of human chorionic gonadotropin (hCG) trigger day or endometrial transformation day and spontaneous abortion in in vitro fertilization (IVF) cycle and analyze the threshold effect. Methods:A retrospective cohort study was performed to analyze the clinical data of infertile patients who underwent the first IVF cycle in the Reproductive Center of Henan Provincial People's Hospital from January 2010 to December 2018. The patients were divided into four groups according to EMT, group A: EMT<8 mm, group B: 8 mm≤EMT<10 mm, group C: 10 mm≤EMT<12 mm, and group D: EMT≥12 mm. The effect of EMT on spontaneous abortion rate during IVF cycle was investigated by univariate analysis, multivariate logistic regression analysis, smooth curve fitting and the threshold effect analysis.Results:In all 12 912 IVF cycles, 8 674 cycles got clinical pregnancy, 1 102 cycles resulted in early spontaneous miscarriage and the spontaneous abortion rate was 12.70%. Univariate regression analysis showed that age, body mass index, duration of infertility, type of infertility, male factors in infertility factors, No. of spontaneous abortions, EMT and No. of embryos transferred had influences on the spontaneous abortion rate (all P<0.05). Multivariate logistic regression analysis adjusted for confounding factors and group A was used as control group. The results showed that the spontaneous abortion rate of groups B, C and D was significantly lower than that of group A during embryo transfer at cleavage stage ( P=0.008 , P<0.001, P<0.001); there was no significant difference in spontaneous abortion rate with the increase of EMT during blastocyst stage ( P>0.05). The threshold effect analysis showed that when the EMT was <10.3 mm, the spontaneous abortion rate decreased significantly with the increasing of EMT for cleavage embryo, and the spontaneous abortion rate decreased 14.7% with each 1 mm increment in EMT ( OR=0.853, 95% CI: 0.792-0.918, P<0.001); there was no significant difference in spontaneous abortion rate when EMT was ≥10.3 mm ( OR=1.006, 95% CI: 0.959-1.056, P=0.798). The spontaneous abortion rate changed steadily with the increase of EMT, and the difference was not statistically significant for blastocyst embryo ( P>0.05). Conclusion:In IVF cycle, the relationship between EMT and spontaneous abortion was curvilinear for cleavage embryo. Before the EMT reached the threshold of 10.3 mm, the spontaneous abortion rate decreased significantly with the increase of EMT.

Objective To investigate the effect of letrozole in decreasing the early-stage ovarian hyperstimulation syndrome (OHSS) occurrence during the luteal phase for patients of OHSS high-risk after oocyte retrieval.Methods A total of 176 high-risk OHSS patients were randomly divided into two groups after oocyte retrieval.Patients in experiment group (n=86) received 5 mg letrozole per day from the retrieval day and last for 5 days.Others in control group (n=90) received placebo.The serum concentration of FSH,LH,estradiol (E2),progesterone (P) and vascular endothelial growth factor (VEGF) from the day of hCG injection to days after injection (5 days,8 days,10 days) were measured.And the incidence of moderate and severe OHSS was observed.Results The concentration of E2 on the indicated days (5 days,8 days,10 days after hCG injection) in experiment group and control group were (5 727±2 089) versus (11 826±4 281) pmol/L,(1 613±879) versus (7 925±3 507) pmol/L,(193±90) versus (1 628±888) pmol/L; the concentration of VEGF on the indicated days in the two groups were (80± 14) versus (108± 19) ng/L,(66± 11) versus (126± 14) ng/L,(48±7) versus (148± 14) ng/L; the concentration of E2 and VEGF were lower than those in control group (all P＜0.01).The FSH concentration in experiment group were (2.1 ± 1.1) and (3.5± 1.3) U/L on the day of fifth and eighth day after hCG injection,which were significantly higher than (0.7±0.3) and (0.7±0.4) U/L in control group (P＜0.05); the LH concentration in experiment group were (0.26±0.19) and (0.72±0.60) U/L on the day of fifth and eighth day after hCG injection,which were significantly higher than (0.11 ±0.03) and (0.14±0.08) U/L in control group (P＜0.05).The incidence of moderate and severe OHSS was signicantly decreased after letrozole treatment compared with control group [2％ (2/86) versus 12％ (1 1/90),P＜0.05].Conclusion Administration of 5 mg/d letrozole for 5 days during the luteal phase can reduce the E2 and VEGF levels for the high-risk OHSS patients who needed cryopreserve all embryos,and also reduce the occurrence of early OHSS.

Objective To investigate the change of CD_4~+CD_(25)~(high)CD_(127)~(low)> regulatory T cells (Trcg cells) sub-group level in peripheral blood of non-Hodgkin lymphama (NHL) patients, and to explore its clinical significance. Methods Treg cells levels in peripheral blood of lymphoma patients and normal were detected by flow cytometry, followed by statistical analysis. Results In the 65 cases of NHL patients, Treg cells in peripheral blood were (6.72±1.38) %, higher than that in the normal control group (5.65±0.68) % (P <0.05). Percentage of Treg cells are significantly different between clinical stages and normal: [P <0.05, normal control group (5.65±0.88) %, Ⅰ -Ⅱ period (6.08±1.18) %, Ⅲ-Ⅳ period (6.95±0.85) %]. The percentage of Treg cells are also different among pathological types of patients and normal [P <0.05, normal control group (5.65± 0.68) %. The percentage of Treg diffuse large B-cell lymphoma (5.83±0.95) % and other subtypes of lymphoma (7.83±1.76) %]were observed. It is not sure that Treg cells percentage among patients with different levels of lactate dehydrogenase and normal are significantly different. [P >0.05, normal control group (5.65±0.68) %, patients with normal LDH group (6.97±1.20) %, patients with lactate dehydrogenase (6.54±1.02) %]. Conclusion Treg cells induced by tumor and could inhibit the immune cells, Treg cells percentage in peripheral blood of tumor patients is higher than that the normal control group, and increased with the clinical staging, so the percentage of Treg cells may serve as a clinical indicator to evaluate tumor load.

Objective To test different expression protein markers of the serum from B-cell non-Hodgkin lymphoma(B-cell NHL) between diffuse large B-cell lymphoma(DLBCL) and follicular lymphoma(FL)patients using sudace enhanced laser desorption/ionization-time of flight-mass spectrometry(SELDI-TOF-MS)protein chip technology. Further, to test different expression of the protein markers of B-eell NHL patients after chemical therapy in order to discuss clinical significance. Methods Different expression of protein markers were analysed in serum between 54 B-cell NHL patients and 27 healthy volunteers by using SELDI-TOF-MS WCX-2 pertein chip. Meanwhile different expression of protein markers relative to pathology classification between 23 DLBCL patients and 12 FL patients were screened; and protein markers which affected prognosis of 23 DLBCL patients were screened. Results There were five specific marker proteins in 54 B-cell NHL patients and 27 healthy volunteers. Their relative molecular weights were 7974, 15 938, 3398,8564, and 8692. The protein markers of 7974 and 15 938 were at high level in patients and the protein markers of 3398, 8564 and 8692 were at low level in patients. There were two protein markers which affected the prognosis, with better outcome when the expression of 4795 and 4998 were increased. Conclusion SELDI-TOF-MS protein chip technology is a quick, easy and convenient method, with high-throughput analyzer which can screen several relatively specific protein markers from the serum of patients to diagnose B-cell NHL The relatively specific protein markers can be used to make pathology classification and to judge the prognosis of B-cell NHL, and have better clinical value.

Objective To evaluate percutaneous intratumoral injection of chemotherapeutic agents lipiodol emulsion (CALE) for the treatment of primary liver cancer. Methods This study included 57 patients of hepatocellular carcinoma (n=49) and intrahepatic cholangiocarcinoma (n=8).53 were male and 4 were female,with a mean age of 48.02 years(range,19～70 years).In all,ninety CALE injections were assigned to 90 target areas within the lesions.Before the procedures,transcathetcr arterial chemoembolization (n=55) or infusion (n=2) was carried out in these patients.By arteriography,low blood supply of target areas was showed or it was concluded that superselective catheterization of supply arteries of lesions could not accomplished.Percutaneous intratumoral CALE injection was carried out under fluoroscopy or CT guidance.Therapeutic effect,side effect and complications were assessed based on clinical manifestation,laboratory examination and fluoroscopy or CT one week after procedure.Follow-up was carried out after 1,3,6 months and 1 year,and once every six months thereafter.Local recurrences were treated according to patients'will.Results 90 sessions of percutaneous injection were successfully performed on 57 patients,with 100% technique success rate.The volume of CALE iniected per session ranged 3.0-7.0 ml(mean,6.0 ml) in target size less than 3 cm,12.0-20 ml(mean,15 ml)in target size of 3-5 cm and 24-40 ml in target larger than 5 cm.Serum AFP was positive in 43 patients and decreased to normal in 14 patients(28%).54 lesions(60%)were with well distribution of the lipiodol-chemotherapy mixture on CT 1 month after procedure.Follow-up ranged from 2 months to six years(mean,16 months).The median survival time was 400 d.The cumulative survival rates at 200 d,600d was 85%and 30%,respectively.Complications included fever (n=22,24.4%),nausea and vomit(n=11,12.2%),and pain at the puncture site (n=17,18.9%).Conclusions Percutaneous intratumor CALE injection is safe and effective for the treatment of primary liver cancer.

Objective To research correlation of serum protein spectrometry and lymphoma markers for diffuse large B cell lymphoma (DLBCL) patients. Whether there is relative between the protein and prognosis will be further researched. Methods Serum protein spectrometry of 62 DLBCL patients was detected by the SELDI-TOF-MS technique and Weak cation exchange 2 (WCX2) chip. Lactate dehydrogenase (LDH) was detected by biochemistry method. Beta-2-microglobulin (β2-MG) and cancer antigen125(CA125)were detected by enzyme-linked immunosorbent assay (ELISA). The level of LDH, β2-MG and CA125 for DLBCL patients between 11×103～12×103 protein expressed positively and negatively was analyzed. Meanwhile,correlation analysis and survival analysis were done. Results LDH, β2-MG and CA125 in 11×103～12×103protein expressed positive group were (523.30±435.96)U/L, (3.23±1.24)mg/L, (81.07±61.39)U/L respectively,and they were higher than that in negative group (P＜0.05). 11×103～12×103 protein was positive correlated to LDH, β2-MG and CA125 (P＜0.01). The survival time in 11×103～12×103 protein expressed in positive group,in which median survival time was 11 months, was shorter than that in negative group(P ＜0.01). The survival time in LDH normal group was longer than that in increased group(P ＜0.01). The survival time of β2-MG and CA125 had no significant difference between increased group and normal group. Conclusion LDH and 11×103～12×103 protein are expected to be prognosis indicators for DLBCL patients.