Misophonia is a psychophysiological and behavioral disorder characterized by an individual's low tolerance to specific sounds， leading to intense negative emotional experiences and physiological responses. Currently， there is no standardized and universally effective treatment for misophonia in clinical practice worldwide. This article reports the case of an 18-year-old male patient with misophonia who showed poor response to sertraline combined with exposure and response prevention therapy. Subsequently， the patient received 8 weeks of Morita therapy （once a week， 50 minutes per session）， with symptomatic improvement. By presenting this case， we explore the potential efficacy of Morita therapy in treating misophonia， aiming to provide a reference for its clinical management. ［Funded by Scientific Research Development Fund Project of Shandong Second Medical University （number， 2024FYM034）］

Objective:To explore the efficacy and safety of ibrutinib for the treatment of newly treated and relapsed refractory (R/R) lymphoplasmacytic lymphoma (LPL) /Waldenstr?m macroglobulinemia (WM) .Methods:Retrospectively collected clinical data of 98 cases of newly treated and R/R LPL/WM patients who received ibrutinib treatment at the Hematology & Blood Diseases Hospital of the Chinese Academy of Medical Sciences from March 2016 to June 2023, and analyzed their efficacy and safety.Results:A total of 98 LPL/WM patients were included, which consisted of 45 newly treated patients and 53 R/R patients. Of these, 74 were males (75.5%) and the cohort had a median age of 64 (42-87) years. Eighty-eight patients were eligible for efficacy evaluation with a median treatment time of 20.8 (2.1-55.0) months, a major remission rate (MRR) of 78.4%, and an overall response rate (ORR) of 85.2%. The MRR and ORR of the newly treated patients were 78.4% and 86.5%, respectively, whereas the MRR and ORR of the R/R patients were 78.4% and 84.3%, respectively. There were no statistically significant differences in MRR and ORR between the initial treatment and R/R patients (all P values >0.05) . The median follow-up period was 29.1 (2.9-50.3) months and the median overall survival time for newly treated and R/R patients was not reached. The median progression-free survival time was 23.5 (95% CI 10.5-36.5) months and 45.0 (95% CI 34.0-56.0) months, respectively, with no statistically significant differences (all P values >0.05) . There were 25 deceased patients and no deaths were related to ibrutinib treatment. The main adverse reactions of ibrutinib were thrombocytopenia (5.1%) , pneumonia (8.1%) , and hyperuricemia (21.4%) . The incidence of atrial fibrillation was 2.0%. Conclusion:Ibrutinib exhibits good efficacy and safety for newly treated and R/R LPL/WM patients.

Objective:To investigate the postoperative effect of paranasal concavity augment by block united with diced autologous costal cartilage.Methods:The data of 76 patients who were underwent costal cartilage rhinoplasty together with paranasal augmentation from January 2016 to December 2019 were analyzed retrospectively. The surgical technique was described in detail. Medical charts and operative records were reviewed to summary the complications. Patients′subjective satisfaction of the postoperative nasal appearance was self-evaluated with grading (1 worse, 2 no change, 3 improved, and 4 much improved). Cosmetic effects were evaluated by the measurements of the nasolabial angle and the distance between ACJ and intertragic notch preoperatively and postoperatively.Results:The postoperative follow-up duration was 6 to 34 months. Overall, functional and aesthetic outcome was satisfactory in most patients, and the mean score by the patients′self-evaluation was 3.4±0.5. Graft exposure, mobility, or significant resorption, pneumothorax or significant donor-site pain were not observed. The average nasolabial angle was changed from (78.2±13.2)° preoperatively to (89.8±10.2)° 6 months postoperative at the last follow-up ( t=152.00, P<0.01). And the distance from the alar-cheek junction to the left tragus was increased by 3.8±2.1 (2.2-6.1) mm. Conclusions:Costal cartilage rhinoplasty combined with augmentation of parasal area can improve parasal depression, with stable postoperative effect and fewer postoperative complications, and has a good effect for patients with normal occlusal relationship or mild abnormality.

Objective:This retrospective, single-center study aimed to evaluate the efficacy and safety of programmed death-1 (PD-1) inhibitors, either as monotherapy or in combination with chemotherapy, in the management of relapse/refractory classical Hodgkin's lymphoma (R/R cHL) .Methods:A total of 35 patients with R/R cHL who received treatment at the Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College from September 2016 to December 2020 were enrolled in this study. Among them, 17 patients received PD-1 inhibitor monotherapy (PD-1 inhibitor group), while 18 patients received a combination of PD-1 inhibitor and chemotherapy (PD-1 inhibitor + chemotherapy group). Clinical data and follow-up information were retrospectively analyzed, and survival analysis was conducted using the Kaplan-Meier method and Cox proportional hazards model.Results:The median age of the 35 patients with R/R cHL was 29 years (range: 11-61 years), with 54.3% being male. According to the Ann Arbor staging system, 62.9% of patients presented with advanced (stage Ⅲ/Ⅳ) disease, and 48.6% had extranodal involvement. Before PD-1 inhibitor therapy, the median number of prior lines of therapy was 2 (range: 1-3). Objective responses were observed in 28 patients, including 22 complete response (CR) cases, resulting in an overall response rate (ORR) of 80.0% and a CR rate of 62.9%. Specifically, the ORR and CR rates were 64.7% and 58.8%, respectively, in the PD-1 inhibitor group and 94.4% and 66.7%, respectively, in the PD-1 inhibitor + chemotherapy group. Among the 18 patients who underwent sequential autologous hematopoietic stem cell transplantation (auto-HSCT) [13 CR and five partial response (PR) cases], eight patients received PD-1 inhibitor therapy after auto-HSCT as consolidation therapy. All patients maintained a CR status after transplantation, and they exhibited significantly improved progression-free survival (PFS) rates compared with those who did not undergo sequential auto-HSCT (4-year PFS rates: 100% vs 53.5% ; P=0.041). The incidence of immune-related adverse events was 29%, with only one patient experiencing grade≥3 adverse reactions, which indicated a favorable safety profile for the treatment approach. Conclusions:PD-1 inhibitor monotherapy demonstrates notable efficacy and sustained response in patients with R/R cHL. PD-1 inhibitors combined with chemotherapy significantly improve response rates. Additionally, for salvage therapy-sensitive patients, consolidation treatment with PD-1 inhibitors after auto-HSCT exhibits the potential for prolonging PFS.

Objective:To explore the effect of two different treatment methods of dorsum implants using autologous costal cartilage, accordion technique (AT) and multilayer oppositional suture technique (MOST), in preventing complications such as distortion and warping of the grafts.Methods:From January 2016 to December 2019, 119 patients underwent rhinoplasty with autologous costal cartilage as the dorsum implant. The dorsum implants were processed by two different techniuqes. Medical charts and operative records were reviewed to summary the complications, especially warping. Patients′ subjective satisfaction and doctors′ objective measurement of the postoperative nasal appearance were evaluated with a grading system.Results:The postoperative follow-up duration was 6 to 28 months. Graft exposure, mobility, or significant resorption, pneumothorax or significant donor-site pain were not observed. The warping rate was higher in the AT (7.8%, 6/77) than in the MOST (2.4%, 1/42) group, although not significantly. Overall, there were no differences in overall patient functional and aesthetic satisfaction between the two groups.Conclusions:Multilayered oppositional suture technique for the autologous costal cartilage grafting may minimize the complication of graft warping and might be an effective alternative for nasal dorsal augmentation, particularly in Asian patients.

Objective:To investigate the clinical features, diagnosis, and treatment of the central nervous system (CNS) toxicity caused by bortezomib.Methods:This study reports five new cases of CNS toxicity caused by bortezomib to elucidate its characteristics along with a review of the literature.Results:CNS toxicity caused by bortezomib presents in three clinical forms: syndrome of inappropriate antidiuresis (SIAD) , posterior reversible encephalopathy syndrome (PRES) , and central fever, which is the most common clinical manifestation. Four of our five patients developed central fever after the administration of bortezomib, manifested as persistent high fever, anhidrosis, and absence of infective foci; the symptom could be improved by discontinuance of bortezomib. Of these patients, three concurrently presented with refractory hyponatremia and one was clearly diagnosed with SIAD. The bortezomib could have caused damages to the hypothalamus and induced both central fever and SIAD. In addition, one patient was diagnosed with PRES due to disturbance of consciousness and epilepsy after taking bortezomib. After discontinuation of bortezomib, the symptoms disappeared and did not recur. We also found that thrombocytopenia may be related to the severity of the CNS toxicity of bortezomib.Conclusion:Cases of CNS toxicity of bortezomib are extremely rare and present as SIAD, PRES and central fever. Early detection and treatment of bortezomib are very important to prevent irreversible neurological complications.

Objective:To investigate the efficacy of fludarabine and cyclophosphamide combined with rituximab (FCR) in previously untreated patients with chronic lymphocytic leukemia (CLL) .Methods:The clinical data of 43 enrolled patients from May 2004 to December 2017 were analyzed the efficacy and survival results.Results:A total of 43 patients with 31 males and 12 females, and the median age was 58 years old (range 36 to72) before treatment. There were 8 patients with symptom B. The median number of peripheral blood lymphocyte was 26 (3-550) ×10 9/L. IGHV unmutated was detected in 62.1% (18/29) patients, P53 deletion in 14% (6/43) patients, RB1 deletion in 18.6% (8/43) patients, Trisomy 12 in 25.6% (11/33) patients, ATM deletion in 16.7% (7/42) patients, respectively. The median number of treatment courses administered was 4 (range 2-6) . Twenty patients obtained CR (46.5%) , 18 patients obtained PR, 4 patients were SD, 1 patient was PD. The overall response rate (ORR) was 88.37%. Seven patients obtained MRD negative. After the median follow-up time of 51 (6-167) months, median PFS was 67 (29-105) months, median OS was not reach, 5-year PFS was (62.1±8.6) %, 10-year PFS was (31±14.3) %, 5-year OS was (70.5±8.3) %, and 10-year OS was (51.3±13.8) %. Less than 4 courses predicted adverse OS ( P<0.05) . P53 deletion and less than 4 courses were associated with poor PFS ( P<0.001) , and the prognostic value still remained after multivariate analysis[ HR=7.65 (95% CI 1.74-33.60) , P=0.007; HR=3.75 (95% CI 1.19-11.80) , P=0.025]. Eighteen patients (41.9%) appeared grade 2-3 infection after chemotherapy, and 19 patients (44.2%) appeared grade 3-4 hematological adverse reactions. One patient (2.3%) was developed tumor lysis syndrome. All adverse reactions were controlled or recovered spontaneously. Conclusion:Previously untreated CLL patients treated with FCR had a high response rate and good survival rate, which is an important treatment choice for fit patients.

Objective To present our experience and techniques with the use of autologous costal cartilage grafts in Asian rhinoplasty,and to report the surgical results and complications in 86 consecutive rhinoplasty cases.Methods All operations were performed by the first author (Liu AT) with open approach,costal cartilages and perichondrium were used to reconstruct the nasal tip projection according to the tripod theory in rhinoplasty,after removing the previous injection material,L-shaped implant or hypertrophic scar tissue in the tip.Medical charts and operative records were reviewed retrospectively to summary the complications.Nasal dorsum augmentation was done by costal cartilage or I-shaped allograft,sometimes with anterior sheath of rectus abdominis.Patients' subjective satisfaction of the postoperative nasal appearance was self-evaluated with grading (1 worse,2 no change,3 improved,and 4 much improved).Results From September 2015 to March 2017,86 patients underwent rhinoplasty at our hospital.The postoperative follow-up duration was 6 to 20 months.Overall,functional and aesthetic outcome was satisfactory in most patients,and the mean score by the patients' self-evaluation was 3.3 ± 0.6.Graft exposure,mobility,or significant resorption,pneumothorax or significant donor-site pain were not observed.Conclusions Even with minimal complications and morbidities,autologous costal cartilage grafts in Asian rhinoplasty is a versatile and reliable graft material for nasal tip surgery in severe short or saddle nose,contracted nose due to previous L-shaped augmentation and revision rhinoplasty in which the septal cartilage has already been harvested.

Objective To clarify the applied anatomy of Chinese female breasts,to improve the breast reduction mammoplasty,and to compare the quality of life in women with symptomatic macromastia before and after reduction mammoplasty with the modified round block technique.Methods The blood supply and innervation of the nipple-areolar complex were dissected in 6 Chinese adult females (12 breast specimens).Special attention was paid to the Würinger horizontal septum and the medial and lateral ligaments.The specific beneficial effects of reduction mammoplasty were evaluated with the modified round block technique,and a general questionnaire the Short Form-36 Health Survey Questionnaire (SF-36) was used in this study,which has good reliability and validity.The scores of the patients before and after the surgery were collected respectively.Results In 12 breast specimens,there existed Würinger horizontal septum and the medial and lateral ligaments.The blood supply and nerve innervation of nipple-areolar complex went along Würinger horizontal septum.In all the patients enrolled,SF-36 showed significant higher quality of life after the operation with regard to 7 of 8 investigated domains.Role of emotion increased most significantly.Increased self-esteem and increased personal and public self-consciousness after surgery were observed.Conclusions The incidence of postoperative complications is reduced after using the modified round block technique.Patients have a higher degree of satisfaction overall.These data are further evidence that breast hypertrophy is not solely an esthetic problem.The reduction mammoplasty with the modified round block technique is an ideal technique.

Objective To investigate the feasibility of urethral prefabrication with vaginal mucosa in female-to-male transsexuals and to compare the urologic complications after penile reconstruction in female-to-male transsexuals between prefabrication group and forearm group.Methods Prefabrication of the neourethra with tubed vaginal mucosal graft was performed for 22 female-to-male transsexual patients from 2007 to 2016,while radial forearm flap,known as the traditional tube-within-tube method,was used to construct the neourethra for other 31 cases.Results All of the reconstructed penises survived completely and allowed the patients to urinate while standing in the prefabrication group.Phalloplasty by using the vaginal mucosal graft for urethroplasty significantly decreased the donor scar,the duration of the second operation and the incidence rates of urologic strictures,comparing with the forearm group (P＜0.05).Conclusions It is reliable to use the prefabrication of the neourethra with tubed vaginal mucosal graft in phalloplasty female-to-male transsexual patients.