Objective:To investigate the clinical outcomes of using autologous mandibular outer cortex "sandwich" grafting to augment mandible for correcting lower facial asymmetry with normal occlusal relationships.Methods:A retrospective analysis was conducted on the clinical data of patients with lower facial asymmetry treated at the Department of Plastic Surgery, the Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, from January 2016 to December 2019. Preoperative cone-beam CT (CBCT) scans of the maxillofacial region were obtained to acquire three-dimensional data of the maxillofacial skeleton. Computer-aided design was used to determine the osteotomy range of the mandibular outer cortex and design osteotomy guide template. The outer cortex of the larger mandibular side (donor site) was harvested according to the osteotomy guide template and sectioned. The segmented mandibular outer cortex was then contoured to match the arc of the recipient side’s mandibular outer cortex and fixed to the inner side of the recipient mandibular outer cortex, thus increasing the width and thickness of the expanded mandible. Follow-up was conducted at 7th day and 6 months postoperatively, CBCT scan was performed to measure the changes in ramus height (Co-Go), mandibular body length (Go-Me), and mandibular outer cortex thickness, and volume, and the patient satisfaction with facial appearance (1 to 5 points, with higher scores indicating higher satisfaction), were assessed to evaluate surgical outcomes. Statistical analysis was performed using SPSS 12.0 software. Paired t-tests were used to compare patient satisfaction scores preoperatively and six months postoperatively. Repeated measurement ANOVA was used to compare Co-Go and Go-Me measurements preoperatively, 7th day, and 6 months postoperatively. If a statistically significant difference is found, further analysis using post-hoc testing(Tukey’s HSD test) will be conducted to examine the data. Results:Sixteen patients with lower facial asymmetry were included, comprising of 5 males and 11 females, aged 18 to 40 years, with an average age of 25.2 years. Surgical method included contralateral mandibular outer cortex "sandwich" grafting to the expanded mandible in 9 cases and simultaneous genioplasty in 7 cases. Follow-up ranged from 6 months to 5 years, with an average follow-up of 18.6 months. All patients experienced numbness of the lower lip postoperatively, which resolved within six months, and no severe complications occurred. The symmetry of lower facial contour improved significantly and remained stable. Patient satisfaction score for facial appearance increased from (1.63±0.62) points preoperatively to (4.19±0.75) points six months postoperatively( P<0.01). The differences in Co-Go on the donor side and Go-Me on the recipient side across the three time points(preoperatively, 7th day and 6 months postoperatively) were not statistically significant(all P>0.05). However, the differences in Go-Me on the donor side and Co-Go on the recipient side across the three time points were statistically significant(all P<0.05). On the donor side, the mandibular outer cortex thickness decreased by a maximum of 6 mm on 7th day postoperatively and increased by a maximum of 2 mm at 6 months postoperatively compared to 7th day. On the recipient side, mandibular outer cortex thickness increased by a maximum of 6 mm on 7th day postoperatively and decreased by a maximum of 2 mm at six months postoperatively compared to 7th day. The volume of the mandibular outer cortex on the recipient side increased by (4 415.94±1 017.21)mm 3 at 7th day postoperatively compared to preoperatively, and decreased by (202.63±300.85)mm 3 at 6 months postoperatively. Conclusion:For lower facial asymmetrical with normal occlusal relationships and no occlusal plane deviation, contralateral mandibular outer cortex "sandwich" bone grafting can effectively increase the width and volume of the mandible on the grafted side, achieving favorable clinical outcomes.

Objective:To investigate the clinical outcomes of using autologous mandibular outer cortex "sandwich" grafting to augment mandible for correcting lower facial asymmetry with normal occlusal relationships.Methods:A retrospective analysis was conducted on the clinical data of patients with lower facial asymmetry treated at the Department of Plastic Surgery, the Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, from January 2016 to December 2019. Preoperative cone-beam CT (CBCT) scans of the maxillofacial region were obtained to acquire three-dimensional data of the maxillofacial skeleton. Computer-aided design was used to determine the osteotomy range of the mandibular outer cortex and design osteotomy guide template. The outer cortex of the larger mandibular side (donor site) was harvested according to the osteotomy guide template and sectioned. The segmented mandibular outer cortex was then contoured to match the arc of the recipient side’s mandibular outer cortex and fixed to the inner side of the recipient mandibular outer cortex, thus increasing the width and thickness of the expanded mandible. Follow-up was conducted at 7th day and 6 months postoperatively, CBCT scan was performed to measure the changes in ramus height (Co-Go), mandibular body length (Go-Me), and mandibular outer cortex thickness, and volume, and the patient satisfaction with facial appearance (1 to 5 points, with higher scores indicating higher satisfaction), were assessed to evaluate surgical outcomes. Statistical analysis was performed using SPSS 12.0 software. Paired t-tests were used to compare patient satisfaction scores preoperatively and six months postoperatively. Repeated measurement ANOVA was used to compare Co-Go and Go-Me measurements preoperatively, 7th day, and 6 months postoperatively. If a statistically significant difference is found, further analysis using post-hoc testing(Tukey’s HSD test) will be conducted to examine the data. Results:Sixteen patients with lower facial asymmetry were included, comprising of 5 males and 11 females, aged 18 to 40 years, with an average age of 25.2 years. Surgical method included contralateral mandibular outer cortex "sandwich" grafting to the expanded mandible in 9 cases and simultaneous genioplasty in 7 cases. Follow-up ranged from 6 months to 5 years, with an average follow-up of 18.6 months. All patients experienced numbness of the lower lip postoperatively, which resolved within six months, and no severe complications occurred. The symmetry of lower facial contour improved significantly and remained stable. Patient satisfaction score for facial appearance increased from (1.63±0.62) points preoperatively to (4.19±0.75) points six months postoperatively( P<0.01). The differences in Co-Go on the donor side and Go-Me on the recipient side across the three time points(preoperatively, 7th day and 6 months postoperatively) were not statistically significant(all P>0.05). However, the differences in Go-Me on the donor side and Co-Go on the recipient side across the three time points were statistically significant(all P<0.05). On the donor side, the mandibular outer cortex thickness decreased by a maximum of 6 mm on 7th day postoperatively and increased by a maximum of 2 mm at 6 months postoperatively compared to 7th day. On the recipient side, mandibular outer cortex thickness increased by a maximum of 6 mm on 7th day postoperatively and decreased by a maximum of 2 mm at six months postoperatively compared to 7th day. The volume of the mandibular outer cortex on the recipient side increased by (4 415.94±1 017.21)mm 3 at 7th day postoperatively compared to preoperatively, and decreased by (202.63±300.85)mm 3 at 6 months postoperatively. Conclusion:For lower facial asymmetrical with normal occlusal relationships and no occlusal plane deviation, contralateral mandibular outer cortex "sandwich" bone grafting can effectively increase the width and volume of the mandible on the grafted side, achieving favorable clinical outcomes.

Objective:To explore the application of biomechanics principle in the repair of double eyelid disappearance after blepharoplasty.Methods:A retrospective analysis was performed on 47 patients (46 females and 1 male) with double eyelid disappearance after blepharoplasty in the Department of Plastic and Cosmetic Surgery, Friendship Plastic Surgical Hospital from July 2018 to December 2022. The patients aged from 19-42 (28±8) years. The repair surgery was performed by increasing the mechanical factors that promoted the double eyelid formation or weakening the mechanical factors that inhibited the double eyelid formation. The overall satisfaction with ocular appearance, and psychological well-being and social function were evaluated with the Face-Q qustionnaires before or after operation.Results:By following-up for 3-24 months, the morphology of upper eyelids in all 47 patients were remarkably improved. 2 patients complained about asymmetry and 1 patient had multiple creases, for whom satisfactory results achieved after re-operation. The remaining patients presented smooth natural double eyelid line, and concave groove deformity when eyes closed were not noticed. The operative effects were satisfactory. After surgery, the scores for ocular satisfaction with facial appearance, psychological well-being and social function were (69.5±10.3), (75.5±13.6) and (68.3±11.3) scores, which were significantly increased than those before operation [(38.7±9.3), (54.8±10.5) and (52.3±8.7) scores], respectively (all P<0.05). Conclusion:More effective and reliable operation results can be obtained in the repair strategies of double eyelid disappearance after blepharoplasty by utilizing the biomechanical mechanism.

Objective To investigate the correlation between interleukin 1β gene-511C/T polymorphism of and essential hypertension in the Yi ethnic group of Yunnan province.Methods-511C/T polymorphism of interleukin 1β gene was detected by PCR-RFLP in 85 Yi patients with essential hypertension(EH group)and 106 Yi healthy people(control group)in Shuanghe Township,Jinning County,Yunnan Province.Genotype and allele frequencies were analyzed by SPSS 27.0 software,and association analysis was performed.Results The frequency distribution of CC,CT and TT genotypes at the mutation site 511 of the IL-1βgene in EH group was 18.82%,44.71%and 36.47%,respectively,and it was 5.66%,26.42%and 67.92%in the control group.The difference in genotype frequency between the two groups was statistically significant(P＜0.05).The allele frequency of C and T in EH group was 41.18%and 58.82%,respectively,and the allele frequency of C and T in control group was 18.87%and 81.13%.The frequency difference of alleles between the two groups was statistically significant(P＜0.05).Both genotype frequency and allele frequency found in males and females had statistical differences(P＜0.05).Conclusions The distribution of IL-1β gene-511C/T polymorphism is related to the incident of essential hyper-tension among the Yi ethnic group Yunnan Province,and is the susceptibility gene of the Yi ethnic group to essen-tial hypertension.

Objective To explore and compare the efficacy and safety of different transurethral enucle-ation procedures for treating benign prostatic hyperplasia.Methods A retrospective analysis was conducted on the clinical data of 215 patients with benign prostatic hyperplasia admitted to our hospital from January 2021 to May 2023.According to the surgical procedures,they were divided into plasma resection group(n=81),treated with transurethral plasma resection of the prostate,laser resection group(n=92),treated with transurethral laser resection of the prostate,and green laser enucleation group(n=42),treated with transurethral green laser enucle-ation of the prostate.The three groups were compared in terms of perioperative indicators(surgical time,intraop-erative bleeding volume,bladder flushing time,indwelling catheter time,postoperative hemoglobin concentration,and hospital stay),urodynamic indicators(RUV,IPSS score,Qmax,and QOL score),and postoperative compli-cations.Results The green laser enucleation group and laser resection group demonstrated a significantly higher total effective rate compared to the plasma electrosurgery group(P<0.05).The three groups showed no statisti-cally significant difference in hospital stay(P>0.05),but the green laser enucleation group showed a signifi-cantly shorter surgical time compared to the other two group(P<0.05).The green laser enucleation group and laser resection group had superiority in intraoperative bleeding,bladder flushing time,and indwelling catheter time compared to the plasma resection group,and a significantly higher postoperative hemoglobin concentration compared to the plasma resection group(P<0.05).Repeated measurement analysis of variance showed that the three groups all exhibited significantly decreases in RUV,IPSS score,and QOL score(P<0.05),and a signifi-cantly increase in Qmax at 1 month and 3 months after surgery(P<0.05).The laser resection group and green laser enucleation group presented with significant decreases in RUV,IPSS score,and QOL score(P<0.05),and a significantly decrease in Qmax compared to the plasma resection group at 1 month and 3 months after surgery(P<0.05).However,the laser resection group and the green laser enucleation group had no statistically signifi-cant difference in RUV,IPSS score,Qmax,and QOL score at 1 month and 3 months after surgery(P>0.05).The green laser enucleation group had the lowest total incidence of postoperative complications,following by the laser resection group and plasma resection group in order(7.14%vs.21.74%vs.35.80%,P<0.05).Conclusion The three surgical procedures all have good therapeutic effects on benign prostatic hyperplasia.Transurethral laser prostatectomy and green laser enucleation have superiority to those of transurethral plasma resection of the prostate in efficacy and safety,and they can promote early recovery of patients.Transurethral green laser enucleation is the best in safety.

Anti-CD19 chimeric antigen receptor (CAR)-T cell therapy has achieved 40%-50% long-term complete response in relapsed or refractory diffuse large B-cell lymphoma (DLBCL) patients. However, the underlying mechanism of alterations in the tumor microenvironments resulting in CAR-T cell therapy failure needs further investigation. A multi-center phase I/II trial of anti-CD19 CD28z CAR-T (FKC876, ChiCTR1800019661) was conducted. Among 22 evaluable DLBCL patients, seven achieved complete remission, 10 experienced partial remissions, while four had stable disease by day 29. Single-cell RNA sequencing results were obtained from core needle biopsy tumor samples collected from long-term complete remission and early-progressed patients, and compared at different stages of treatment. M2-subtype macrophages were significantly involved in both in vivo and in vitro anti-tumor functions of CAR-T cells, leading to CAR-T cell therapy failure and disease progression in DLBCL. Immunosuppressive tumor microenvironments persisted before CAR-T cell therapy, during both cell expansion and disease progression, which could not be altered by infiltrating CAR-T cells. Aberrant metabolism profile of M2-subtype macrophages and those of dysfunctional T cells also contributed to the immunosuppressive tumor microenvironments. Thus, our findings provided a clinical rationale for targeting tumor microenvironments and reprogramming immune cell metabolism as effective therapeutic strategies to prevent lymphoma relapse in future designs of CAR-T cell therapy.

Objective: To investigate the clinical and molecular biological characteristics of patients with accelerated chronic lymphocytic leukemia (aCLL) . Methods: From January 2020 to October 2022, the data of 13 patients diagnosed with aCLL at The First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed to explore the clinical and molecular biological characteristics of aCLL. Results: The median age of the patients was 54 (35-72) years. Prior to aCLL, five patients received no treatment for CLL/small lymphocytic lymphoma (SLL), while the other patients received treatment, predominantly with BTK inhibitors. The patients were diagnosed with aCLL through pathological confirmation upon disease progression. Six patients exhibited bulky disease (lesions with a maximum diameter ≥5 cm). Positron emission tomography (PET) -computed tomography (CT) images revealed metabolic heterogeneity, both between and within lesions, and the median maximum standardized uptake value (SUVmax) of the lesion with the most elevated metabolic activity was 6.96 (2.51-11.90). Patients with unmutated IGHV CLL accounted for 76.9% (10/13), and the most frequent genetic and molecular aberrations included +12 [3/7 (42.9% ) ], ATM mutation [6/12 (50% ) ], and NOTCH1 mutation [6/12 (50% ) ]. Twelve patients received subsequent treatment. The overall response rate was 91.7%, and the complete response rate was 58.3%. Five patients experienced disease progression, among which two patients developed Richter transformation. Patients with aCLL with KRAS mutation had worse progression-free survival (7.0 month vs 26.3 months, P=0.015) . Conclusion: Patients with aCLL exhibited a clinically aggressive course, often accompanied by unfavorable prognostic factors, including unmutated IGHV, +12, ATM mutation, and NOTCH1 mutation. Patients with CLL/SLL with clinical suspicion of disease progression, especially those with bulky disease and PET-CT SUVmax ≥5, should undergo biopsy at the site of highest metabolic uptake to establish a definitive pathological diagnosis.
Humans ; Middle Aged ; Aged ; Leukemia, Lymphocytic, Chronic, B-Cell/genetics* ; Positron Emission Tomography Computed Tomography ; Retrospective Studies ; Biopsy ; Disease Progression

Tracheoesophageal fistulas(TEF)is a kind of pathological fistula between trachea or bronchus and esophagus,including tracheoesophageal fistula and bronchoesophageal fistula.In clinical practice,tracheoesophageal-fistula is more often seen.There are many pathogenesis of TEF,which could cause serious complications.It is a disease which has serious impact on the quality of life,difficult to treat and high mortality.There are many methods to treat TEF,but the therapeutic effect is poor.There is an urgent need for new treatment methods to TEF.The detection of nasogastric tube retention by chest and abdominal X-ray is the gold standard for diagnosis.The main treatment methods include surgical treatment,stent implantation,local biological glue blocking,stem cell therapy and so on.In order to provide reference for relevant clinical diagnosis and treatment of TEF,this article reviews the main research progress in the diagnosis and treatment of TEF in recent years.

Objective:To investigate the clinical effect of W-shaped genioplasty in the correction of broad and short chin deformity.Methods:Thirty-eight patients (5 males, 33 females, aged 20 to 41 years, mean 27.3 years) complained with broad and short chin were admitted to the Affiliated Friendship Plastic Surgery Hospitalof Nanjing Medical University from January 2019 to December 2021. CBCT scan and three-dimensional reconstruction were performed to design osteotomy line and determine the distance of chin lengthening, narrowing and advancing or retrocession preoperatively. Under general anesthesia, the W-shaped osteotomy was performed using an intraoral incision, and the angle between the bilateral free bone fragments, the distance of downward and forward movement were adjusted to change the curvature, width, length and prominence of the lower edge of the chin according to the preoperative designs. The results were evaluated by clinical appearances and image analyses at a follow-up of 3-24 months.Results:The amount of vertical lengthening of the chin in 38 cases were 2 mm to 5 mm, with an average of 3.02 mm. The horizontal narrowing width distances were 3-7 mm, with an average of 5.6 mm. The patients were followed up for 3-24 months, with an average of 10.6 months. There were no complications such as hematoma, wound dehiscence, accidental fracture, surgical area infection and permanent neurosensory disorder. 38 patients had transient sensory loss in the lower lip region of varying degrees, but all recovered spontaneously during routine follow-up period. All patients were satisfied with the improvement of facial contour.Conclusions:W-shaped geinoplasty preserves the central bone of the chin and the attachment of genioglossus muscle, which does not affect the normal anatomy and physiological function of the oral cavity. After osteotomy, the bone is removed and the bilateral bone fragments move flexibly. It can effectively change the radian, width, length and protrusion of the lower edge of the chin in three dimensions, so as to correct the wide and short deformity of the chin.

Objective: To understand the performance of pulmonary function tests in people aged ≥40 years and its changes in China, and provide evidence for the evaluation of the effect of chronic obstructive pulmonary disease (COPD) prevention and control in China. Methods: The subjects of the survey were from COPD surveillance during 2014-2015 and during 2019-2020, which covered 31 provinces (autonomous regions and municipalities) in China. The survey used multi-stage stratified cluster random sampling method, the trained investigators conducted face-to-face interview to know whether subjects had previous pulmonary function testing or not. Complex sampling weighting was used to estimate the rate of pulmonary function testing in people aged ≥40 years, and the pulmonary function testing rates of the two COPD surveillance periods were compared. Results: A total of 148 427 persons were included in the analysis, including 74 591 persons during 2014-2015 and 73 836 persons during 2019-2020. In 2019-2020, the pulmonary function testing rate in Chinese residents aged ≥40 years was 6.7% (95%CI: 5.2%-8.2%), the rate in men (8.1%, 95%CI: 6.7%-9.6%) was higher than that in women (5.4%, 95%CI: 3.7%- 7.0%), and the rate in urban residents (8.3%, 95%CI: 6.1%-10.5%) was higher than that in rural residents (4.4%, 95%CI: 3.8%-5.1%). The rate of pulmonary function testing increased with the increase of education level. During 2019-2020, the residents with history of chronic respiratory diseases had the highest rate of pulmonary function testing (21.2%, 95%CI: 16.8%-25.7%), followed by the residents with respiratory symptoms (15.1%, 95%CI: 11.8%-18.4%) , the pulmonary function testing rate in those who knew the name of chronic respiratory disease was higher than that in those who did not knew the name of respiratory disease, and the pulmonary function testing rate in former smokers was higher than that in current smokers and non-smokers. Those exposed to occupational dust and/or harmful gases had a higher rate of pulmonary function testing compared with those who were not exposed, and those who used polluted fuels indoors had a lower rate of pulmonary function testing than those who did not use polluted fuels indoors (all P<0.05). Compared with 2014-2015, the pulmonary function testing rate in residents aged ≥40 years in China increased by 1.9 percentage points during 2019-2020, and the rate of pulmonary function testing in groups with different characteristics all increased, and the rates of pulmonary function testing increased by 7.4 percentage points and 7.1 percentage points in residents with respiratory symptoms and in those with history of chronic respiratory diseases (all P<0.05). Conclusions: Compared with 2014-2015, the rate of pulmonary function testing increased in China during 2019-2020 and the increase in residents with history of chronic respiratory diseases and respiratory symptoms was relatively obvious, but the overall pulmonary function testing rate was still at a low level. Effective measures should be taken to further increase the rate of pulmonary function testing.
Female ; Humans ; Male ; Asian People ; China ; Dust ; Pulmonary Disease, Chronic Obstructive ; Respiratory Function Tests ; Adult