Objective:To analyze the diagnostic and prognostic value of routine bone marrow examination in patients with extranodal NK/T-cell lymphoma (ENKTCL) based on PET-CT staging.Methods:Clinical data of 186 patients who received bone marrow biopsy and bone marrow aspiration in Fujian Medical University Union Hospital from 2013 to 2021 were retrospectively analyzed. All patients were divided into bone marrow biopsy + bone marrow aspiration group ( n=186) and PET-CT + bone marrow biopsy group ( n=139). The sensitivity, specificity, positive and negative predictive values were compared between two groups. The data were analyzed and plotted. Survival analysis was performed using Kaplan-Meier method and log-rank test. Results:In the whole cohort, 45 patients were positive for bone marrow biopsy, and 30 of them were positive for bone marrow aspiration. A total of 141 patients who were negative for bone marrow biopsy also achieved negative results for bone marrow aspiration. A total of 139 patients completed PET-CT staging and bone marrow biopsy. And 30 patients were diagnosed with positive bone marrow by PET-CT, in which 22 of them were confirmed positive by bone marrow biopsy. Among 109 patients diagnosed with negative bone marrow by PET-CT, 5 of them were confirmed positive by bone marrow biopsy. All these cases were classified as stage Ⅳ due to distant metastases. PET-CT had a diagnostic sensitivity of 81.5%, a specificity of 92.9%, a positive predictive value of 73.3%, and a negative predictive value of 95.4%. Among early stage (Ⅰ-Ⅱ stage) patients diagnosed with PET-CT, all of them were negative for bone marrow biopsy (the negative predictive value was 100%). In stage Ⅳ patients ( n=55), the 1-year overall survival of patients with bone marrow involvement by bone marrow biopsy or PET-CT ( n=35) compared with their counterparts with the involvement of other organs ( n=20) was 28.7% vs.42.0% ( P=0.13), and 1-year progression free survival rates was 23.2% vs. 23.3% in ( P=0.94). Conclusions:Routine bone marrow biopsy does not change the original staging of patients with early stage ENKTCL based on PET-CT staging. Advanced stage patients with positive bone marrow biopsy tend to obtain worse prognosis, indicating that bone marrow biopsy still has certain value.

Objective: To investigate the prevalence of soil-borne nematode infections among rural residents in Tiantai County, Zhejiang Province, so as to provide insights into improving the control strategy. Methods: According to the Zhejiang Provincial Surveillance Programme on Soil-borne Nematodiasis and Clonorchiasis, 5 administrative villages were randomly selected in Tiantai County according to geographical locations on April, 2021, and all permanent residents at ages of 3 years and older were sampled from each village using a cluster sampling method. Subjects' gender, age, occupation, education level and deworming were collected. Subjects' stool samples were collected, and soil-borne nematode eggs were detected using the modified Kato-Katz technique, and larval culture was performed using a filter-paper culture method among hookworm egg positives for identification of hookworm species. In addition, the intensity of infection was evaluated using hookworm eggs per gram stool sample. Results: A total of 1 013 residents participated in the survey, including 495 men (48.86%) and 518 women (51.14%), and there were 502 participants at ages of 51 to 70 years (49.56%), 874 farmers (86.28%) and 436 subjects with an education level of primary school (43.04%). However, no subjects received deworming. The prevalence of hookworm infections was 3.85% among the study subjects, and only Necator americanus was identified. There were 31 cases with mild infections (79.49%), 5 cases with moderate infections (12.82%) and 3 cases with severe infections (7.69%), and all infections occurred in farmers. The prevalence of hookworm infections was 3.84% among men and 3.86% among women. No hookworm infection was detected among residents at ages of <41 years, and the prevalence of hookworm infections appeared a tendency towards a rise with age among residents at ages of 51 years and older (χ2trend=24.091, P<0.001), while the prevalence of hookworm infections appeared a tendency towards a decline with educational levels among residents (χ2trend=19.534, P<0.001). The greatest prevalence of hookworm infections was found in Qianyang Village (10.95%). Conclusions Hookworm disease is the predominant type of soil-borne nematodiasis in Tiantai County, and the middle-aged and elderly farmers with a low education level are high-risk populations for soil-borne nematodiasis control.

Objective To investigate the role of the Janus tyrosine kinase (JAK)- signal transducer and activators of transcription (STAT) signaling pathway in thrombosis formation after splenectomy in cirrhotic patients with portal hypertension. Methods A total of 198 liver cirrhosis patients with portal hypertension who underwent splenectomy and devascularization were recruited from March 2018 to April 2020 and then divided into thrombosis ( n =41) and non-thrombosis groups ( n =157) according to whether portal vein thrombosis occurred 3 months after surgery. mRNA levels of JAK2 and STAT3 in peripheral blood mononuclear cells (PBMCs) were assessed. Comparison of continuous data between groups was performed using t test, while comparison of categorial data between group was performed using chi square test. Clinicopathological data from patients were collected and analyzed for the potential risk factors of portal vein thrombosis by using univariate and multivariate Logistic regression analyses. The prediction values of JAK2 and STAT3 mRNA for portal vein thrombosis were evaluated by area under the receiver operating curve ( AUC ). Results The diameter of portal vein, the diameter of portal vein, the velocity difference of portal vein and the volume of spleen in the thrombus group were significantly higher than those in the non-thrombus group ( t =4.718, 3.945, 8.671, and 2.006 respectively; P < 0.05).The relative mRNA levels of JAK2 and STAT3 in PBMCs of the two groups were significantly increased after surgery ( t =12.933, 15.442, 14.386, 10.896; P < 0.05), and their levels were also much higher in the thrombosis group than in the non-thrombosis group of patients ( P < 0.05). Multivariate Logistic regression analytic data showed that the portal vein diameter, the velocity difference of portal vein and mRNA level of JAK2 and STAT3 were all predictors for thrombosis in these patients ( P < 0.05). The AUC of JAK2 and STAT3 mRNAs was 0.850 and 0.787, respectively in diagnosis of thrombosis in these patients. Conclusion The JAK / STAT signaling was activated in the process of thrombosis after splenectomy in cirrhotic patients with portal hypertension, which may be one of the important mechanisms of postoperative portal vein thrombosis, and may become a potential target for the prevention and treatment of postoperative portal vein thrombosis.

Objective To investigate the clinical application of the modified keystone perforator island flap for reconstruction of skin defects at head and face.Methods From January 2013 to September 2014,13 cases with skin defects at head and face were repaired by modified keystone perforator island flap.The skin defects ranged from 0.8 cm× 1.0 cm to 20.0 cm × 10.0 cm.And the flap size ranged from 1.5 cm × 1.0 cm to 22.0 cm × 12.0 cm.The flap was designed along the edge of the defect,the vascular supply was supported by muscular perforators.In order to relieve suture tension and have a good cosmetic effect,auxiliary incisions should be as less as possible.Flap should be designed to hide parts of facial incision or surgical margins within the natural borders of each facial unit,or along the direction of striae.Incision within the hairline should be taken to minimize damage to the hair follicles.The direction of hair growth shouldn't be changed after the flap transfer.Results All cases had 1-12 months' follow-up period.12 flaps survived completely,with one partial flap necrosis.The flaps had good appearance with high aesthetic satisfactory.Conclusions The modified keystone perforator island flap produces excellent aesthetic results.It can be a very useful flap for tbe individual reconstruction of skin defects at head and face.

Objective To investigate the clinical application of the modified keystone perforator island flap for reconstruction of skin defects at head and face.Methods From January 2013 to September 2014,13 cases with skin defects at head and face were repaired by modified keystone perforator island flap.The skin defects ranged from 0.8 cm× 1.0 cm to 20.0 cm × 10.0 cm.And the flap size ranged from 1.5 cm × 1.0 cm to 22.0 cm × 12.0 cm.The flap was designed along the edge of the defect,the vascular supply was supported by muscular perforators.In order to relieve suture tension and have a good cosmetic effect,auxiliary incisions should be as less as possible.Flap should be designed to hide parts of facial incision or surgical margins within the natural borders of each facial unit,or along the direction of striae.Incision within the hairline should be taken to minimize damage to the hair follicles.The direction of hair growth shouldn't be changed after the flap transfer.Results All cases had 1-12 months' follow-up period.12 flaps survived completely,with one partial flap necrosis.The flaps had good appearance with high aesthetic satisfactory.Conclusions The modified keystone perforator island flap produces excellent aesthetic results.It can be a very useful flap for tbe individual reconstruction of skin defects at head and face.

ObjectiveTo introduce the application of slender narrow subcutaneous fascia pedicle flap in repairing the cavity of conchs wound in microtia plasty,and to investigate its survival mechanism.MethodsThe all 6 congenital microtia cases were repaired with the concha compound flap up rotation.The all microtia concha wounds were repaired with the slender narrow pedicle.The lateral maxillocevicai fasciotaneous flap with its slender subcutaneous fascia pedlcle located in front of auricle.The size of the flaps ranged from 3.0 cm × 3.0 cm to 4.0 cm × 4.5 cm,The width and length of the pedicle ranged 1.0-1.5 cm and 3.5-4.5 cm.Results6 cases of the slender narrow subcutaneous fascia pedlcle flaps all survived,with primary wound healing and ideal appearance.ConclusionsThis slender narrow subcutaneous fascia pedlcle flap does not contain any major blood vessel,which is dissected easily in the operation.Due to its slender narrow pedicle,the flap rotation is also easy and its coverage area is large,without cat ears.The postoperative appearance (color,lexture,cosmetic aspect)is satisfactory.The slender narrow flap is an extraordinary new design and is ideal for the cavity of concha wound repair in the microtia plasty.

Objective To characterize contemporary electrographic neonatal seizures by video electroencephalogram (VEEG) and to assess the value and the limitations of two-channel (C3-C4/T3-T4) amplitude-integrated electroencephalogram (aEEG) plus original EEG signals used to diagnose neonatal seizure with video EEG as a golden standard.Methods Sixty-six neonates admitted to Children's Hospital of Fudan University from January 2011 to July 2011 with clinical or suspected clinical seizure were investigated and bedside VEEG were recorded for more than 3 hours.VEEG signals were transformed into three kinds of aEEG signals by Galileo NT PMS software:one-channel aEEG (C3-C4),one-channel aEEG (C3-C4) plus original EEG,two-channel aEEG (C3-C4/T3-T4) plus original EEG.Electrical seizure activity on VEEG was signed out with respect to its occurrence,duration and localization of seizure onset; while aEEG seizure was recorded only with its occurrence.The relationship between aEEG and VEEG was analyzed by Spearman analysis.The value and the limitations of aEEG to diagnose neonatal seizure were evaluated by sensitivity,specificity,positive predictive value and negative predictive value.Results A total of 62 traces were suitable for analysis.(1) VEEG showed 39 seizure activities,among which 8 status epilepticus; and the rest 31 neonates had 352 non-status epilepticus electrical seizures,79.3％ (279/352) of which occurred over the centrotemporal region.(2) Eight cases with status epilepticus on VEEG were all diagnosed as status epilepticus on aEEG.For non-status epilepticus electrical seizures,the sensitivity of aEEG for detection of electrical seizures was as followed:49.1％ (173/352) for one-channel aEEG,54.5 ％ (192/352) for one-channel aEEG plus original EEG,81.2％ (286/353) for two-channel aEEG plus original EEG.Results from one-channel aEEG,one-channel aEEG plus original EEG and two-channel aEEG plus original EEG were all related to VEEG (ρ =0.790,0.907 and 0.953,respectively,P＜ 0.01).(3) Sensitivity of seizure detection was 66.7％ (26/39,95％ CI:0.62-0.81) for one-channel aEEG,74.4％(29/39,95％ CI:0.78-0.96) for one-channel aEEG(C3-C4) plus original EEG and 89.7％ (35/39,95％ CI:0.89-1.00) for two-channel aEEG(C3-C4/T3-T4) plus original EEG.Conclusions VEEG might help aEEG in diagnosis of neonatal seizure.two-channel aEEG (C3-C4/T3-T4) plus original EEG could significantly increase the sensitivity of neonatal seizures indentification.

Objective To measure the set-up errors of patients with head and neck (H&N) cancer during the image guided intensity-modulated radiotherapy (IMRT) treatment and analyze the impact of setup errors on dose distribution ; then to further investigate the necessity of adjustment online for H&N cancer during IMRT treatment.Methods Cone-beam CT (CBCT) scanning of thirty patients with H&N cancer were acquired by once weekly with a total of 6 times during IMRT treatment.The CBCT images and the original planning CT images were matched by the bony structure and worked out the translational errors of the x,y,z axis,as well as rotational errors.The dose distributions were recalculated based on the data of each setup error.The dose of planning target volume (PTV) and organs at risk were calculated in the replanning,and than compared with the original plan by paired t-test.Results The mean value of x,y,z axis translational set-up errors were ( 1.06 ± 0.95 ) mm,( 0.95 ± 0.77 ) mm and ( 1.31 ± 1.07 ) mm,respectively.The rotational error of x,y,z axis were ( 1.04 ±0.791 ),( 1.06 ±0.89) and (0.81 ±0.61 ),respectively.PTV 95％ volume dose ( D95 ) and PTV minimal dose of replanning for 6 times set-up were lower than original plan (6526.6 cGy:6630.3 cGy,t =3.98,P =0.000 and 5632.6 cGy:5792.5 cGy,t =- 2.89,P =0.007).Brain stem received 45 Gydose volume ( V45 ) and 1％ brain stem volume dose ( D01 )were higher than original plan ( 3.54％:2.75％,t =3.84,P =0.001 and 5129.7 cGy:4919.3 cGy,t =4.36,P =0.000).Conclusions The set-up errors led to the dose of PTV D95 obviously insufficient and significantly increased V45,D01 of the brainstem.So,adjustment online is necessary for H&N cancer during IMRT treatment.

Objective To introduce a new and practical method of treating blepharoptosis with direct suspension of the frontal muscle-fascia improvement. Methods 22 cases of blepharoptosis were corrected by direct suspension of the frontal muscle-fascia in which the dynamia still came from frontal muscle.Through double-fold eyelid incision, the frontal muscle-fascia was dissected from the subcutaneous tissue and a 1.5 cm length incision of the frontal muscle-fascia was cut under the supraorbital margin. And through the incision, the frontal muscle-fascia on the superficies of periosteum was dissected 1.5 cm to the upper margin of orbital, and then the frontal muscle-fascia was pulled down and fixed to the levator muscle aponeurosis directly by mattress sutures, with the tension being adjusted to a moderate degree. Results 22 cases of blepharoptosis were cured by primary healing with this method. The patients were followed up for 3 to 6 months with satisfactory results and no recurrence. Conclusion Compared with the traditional methods,this one may decrease the damage to the upper lid and frontalis area, leaving no risk of damaging the vessels or nerves. The technique is simple and the curative effect is affirmed. It can be used to treat any blepharoptosis patient with normal frontal muscle function.