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At present, nasal abnormalities is often classified from different perspectives, such as the alar-columella relationship, nasal base width, and the condition of alar hyperplasia. However, due to the impact of race and region, different people may be applied to different classification methods, resulting in different clinical diagnosis and treatments. So far, there is no unified standard for alar deformity classification to guide clinical treatment. In alar-columella relationship, the retracted ala and the hanging columella, hanging ala and retracted columella are easily confused. According to the classification of nasal base width, it is easy to confuse the alar flare with wide alar base. Therefore, the accurate preoperative evaluation of the nasal ala and the selection of appropriate clinical treatments for different abnormalities are beneficial for surgeons to achieve perfect rhinoplasty results.
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Humans , Cleft Lip , Hyperplasia , Nasal Septum/surgery , Nose , Preoperative Care , Rhinoplasty/methodsABSTRACT
Objective@#To investigate the clinical effect of diced cartilage in correcting nasal alar base depression after cleft lip surgery.@*Methods@#A retrospective study was conducted in 15 patients of nasal deformity after lip surgery from January 2018 to January 2019. All the patients were taken from autologous costal cartilage to reconstruct the outline of nasal malformation, and the remaining autologous costal cartilage was cut into 0.5-1.0 mm pieces and filled into the basilar lacunar space of the nasal alar by the 1 ml syringe whose anterior needle nipples was removed. The effects of visual images before and after operation were compared and analyzed by Adobe Photoshop CS6 software. The patients were followed up for 6-15 months (mean 10months). The satisfaction and complications of the patients were investigated.@*Results@#The nasal alar base was significantly elevated and the outline of the nasal deformity was improved in 15 patients after operation. The overall effect was satisfactory and no obvious complications were found. No obvious absorption was found in the follow-up.@*Conclusions@#The application of diced cartilage to correct the nasal alar base depression after cleft lip surgery was a feasible method with important clinical value. It advanced in taking good use of the remaining cartilage and reducing the damage to both the donor and recipient area.
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Objective@#To study the tissue size, calcification characteristics and the correlation between calcification and age and lateral side of 6, 7 and 8 costal cartilage in women, so as to provide reference for clinical application.@*Methods@#From the radiology storage center of Second Xiangya Hospital, 70 cases of female costal cartilage were treated with dual-source CT three-dimensional reconstruction. The reconstructed images were treated with maximum intensity projection (MIP) and volume reconstruction (VR). The length, width and thickness of bilateral 6, 7 and 8 costal cartilage were measured by VR images, and the correlation between calcification rate, calcification degree, calcification type, calcification location, calcification with age and side was observed and analyzed on VR and MIP images. The data were analyzed by SPSS 20.0 and compared by corresponding statistical method, including independent sample t test, chi-square test, logistic regression analysis and variance analysis.@*Results@#(1) The length of costal cartilage on the left was (98.7 ±12.7) mm, (132.8 ±13.8) mm, (81.5 ±11.6) mm, width (12.6 ±1.5) mm, (11.0 ±1.4) mm, (7.4 ±1.1) mm, thickness (8.1 ±0.5) mm, (7.7 ±0.6) mm, (6.6 ±0.6) mm. On the right side, the length of costal cartilage was (95.8 ±11.3) mm, (133.1 ±12.0) mm, (81.7 ±12.3) mm, width (12.2 ±1.4) mm, (11.11 ±1.5) mm, (7.4 ±1.1) mm, thickness (8.2 ±0.6) mm, (7.7 ±0.5) mm, (6.5 ±0.6) mm. There was no significant difference in the length, width and thickness of the left and right sides of the costal cartilage in the same sequence (P>0.05). There were significant differences in length, width and thickness between unilateral costal cartilage with different ordinal numbers (P<0.01). (2) The total calcification rates of left and right costal cartilage were 61.9% (130/210) and 60.0% (126/210), respectively, and there was no significant difference between the two groups (The chi-square was equal to 0.160. The P value was equal to 0.689), but there was no significant difference in left and right total calcification types, total calcification location and total calcification count (P>0.05). There was no significant difference in the total calcification type between left and right, the total calcification location and the total calcification degree count (P>0.05). There was also no significant difference between the two groups (P>0.05). There was no significant difference in the calcification rate between the left and right sides of the 6th, 7th and 8th costal cartilage, but there was significant difference in the total calcification types of the 6th, 7th and 8th costal cartilage (The chi-square was equal to 61.541, P value was less than 0.001). (3)The relationship between calcification rate and age was analyzed by univariate analysis and logistic regression equation. The higher the age, the higher the calcification rate. The relationship between the calcification degree and age of the 6th, 7th and 8th costal cartilage was tested by variance test, and the regression equation showed that the calcification degree of the 6th, 7th and 8th costal cartilage was higher with the age.@*Conclusions@#Preoperative three-dimensional reconstruction and image post-processing of costal cartilage with dual-source CT can accurately measure the amount of cartilage tissue and define the characteristics of calcification, so as to guide the clinical selection of costal cartilage that meets the requirements of operative method. In female patients of different ages undergoing rhinoplasty and external ear reconstruction, the calcification rate of costal cartilage increased with age, but there was no positive correlation. With the increase of calcification with age, artificial materials can be used for cases with severe calcification to avoid the blindness of surgery.
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The atmospheric particulate matter(PM) is widely regarded as one of major environmentally and unfriendly ambient air pollution, and therein PM2.5 (diameter≤2.5 μm) is most closely related to human health.Because of its smaller diameter with longer suspension duration, PM can absorb many pathogenic microorganisms, and easily enter into the deep of airway and then deposit on the bronchus and alveoli, and it brings damage to the lung tissues and the surfactant proteins.PM can give rise to oxidative stress, inflammation response, cells and DNA damage.Now, this review focuses on the characterization and composition of PM, as well as the impact of PM2.5 on the lung, surfactant proteins and human health, which helps to call for more people to pay attention to this environmental issue in order to better mitigate and prevent the damage caused by PM.
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In May 2019, the International Diabetic Foot Working Group (IWGDF) updated and issued guidelines for the prevention and management of diabetic foot disease. This guide puts forward some suggestions for the diagnosis, treatment and effective prevention of diabetic foot: the prevention of diabetic foot should start with high-risk foot, early screening and treatment of diabetic foot infection, foot ulcer and peripheral vascular disease and early comprehensive treatment. Effective prevention and early treatment can reduce the incidence of cardiovascular and cerebrovascular events in patients with diabetes, reduce the amputation rate and mortality, and improve the prognosis and quality of life of patients.
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In May 2019,the International Diabetic Foot Working Group (IWGDF) updated and issued guidelines for the prevention and management of diabetic foot disease.This guide puts forward some suggestions for the diagnosis,treatment and effective prevention of diabetic foot:the prevention of diabetic foot should start with high-risk foot,early screening and treatment of diabetic foot infection,foot ulcer and peripheral vascular disease and early comprehensive treatment.Effective prevention and early treatment can reduce the incidence of cardiovascular and cerebrovascular events in patients with diabetes,reduce the amputation rate and mortality,and improve the prognosis and quality of life of patients.
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The atmospheric particulate matter(PM) is widely regarded as one of major environmentally and unfriendly ambient air pollution,and therein PM2.5 (diameter≤2.5 μm) is most closely related to human health.Because of its smaller diameter with longer suspension duration,PM can absorb many pathogenic microorganisms,and easily enter into the deep of airway and then deposit on the bronchus and alveoli,and it brings damage to the lung tissues and the surfactant proteins.PM can give rise to oxidative stress,inflammation response,cells and DNA damage.Now,this review focuses on the characterization and composition of PM,as well as the impact of PM2.5 on the lung,surfactant proteins and human health,which helps to call for more people to pay attention to this environmental issue in order to better mitigate and prevent the damage caused by PM.
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Because of the versatility of autologous cartilage and proven advantages, it has been widely used in all kinds of rhinoplasty. Autologous cartilage have good biocompatibility with less complications such as infection, extrusion of graft, compared to biological synthetic materials, so it is generally considered the primary graft for nasal surgery especially septal, conchal and costal cartilage. With the popular clinical application of autologous cartilage, problem also arised and considered.The purpose of this paper is to review the application of autologous cartilage and complications in rhinoplasty.
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Objective@#To investigate the treatment and clinical effect of thin anterolateral thigh perforator flap with sensory nerve in the repair of soft tissue defect of dorsal foot.@*Methods@#During January 2012 to February 2017, 14 cases of soft tissue defect of dorsalis pedis were treated. The flap was designed according to the three-dimensional structure of the defect in the recipient area, and the lateral femoral cutaneous nerve was carried. Free transplantation was performed for repair of soft tissue defect of dorsal foot after fine thinning under microscope. The selected size of the flap ranged from 6 cm×4 cm to 15 cm×9 cm, 10 cases of donor site width is less than or equal to 8 cm with direct suture, 4 cases of donor site wound greater than 8 cm, Free skin graft on the wound surface.@*Results@#After operation, all flaps survived. Meanwhile, superficial necrosis occurred in the distal part of the flap in 1 case due to local infection, and healed after dressing change. All patients were followed up for 6-24 months, the appearance of the flap was pleasant, the texture, color and elasticity of the flap were satisfactory. In addition, Partial skin flap two-point discrimination was 6-10 mm with S2, S3 sensory recovery. During the follow-up, patients were able to walk with normal shoes, no ulcer occurred in the flap, and healed well in donor site.@*Conclusions@#The application of thin anterolateral thigh perforator flap with sensory nerve is safe and reliable in the repair of soft tissue defect of dorsal foot. After the repair, the skin flap has a good appearance and can restore part of the sensation.
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Objective@#To explore the establishment and application of three-dimensional model of deep inferior epigastric artery perforator flap based on computed tomography angiography (CTA).@*Methods@#Six patients with breast absence after modified radical mastectomy because of breast cancer, 5 patients with congenital absence of vagina, and 6 patients with Paget′s disease of penis and scrotum were hospitalized in our unit from January 2012 to April 2017. The size of wounds after excision of the lesion or that of flaps needed for reconstruction ranged from 17 cm×5 cm to 25 cm×9 cm. Abdominal CTA was performed before the surgery, and data of CTA were sent to CT workstation to make three-dimensional model of deep inferior epigastric artery perforator flap according to shape and size of wound. The number, course, and location of deep inferior epigastric artery, vein, and their perforators, and the superficial inferior epigastric vein were observed in the above-mentioned three-dimensional model. The rectangular plane coordinate system with the umbilicus as the origin was established to locate and observe course and type of the largest deep inferior epigastric artery perforator in left and right side. Deep inferior epigastric artery perforator flaps were designed and deep inferior epigastric artery perforators etc. were marked according to three-dimensional models of the flaps before the surgery. The condition observed in three-dimensional model of the flap was compared with the clinical condition in the surgery of free transverse bilateral deep inferior epigastric artery perforator flap transplantation for breast reconstruction and longitudinal pedicled thinned unilateral deep inferior epigastric artery perforator flap transplantation for vagina reconstruction and wound repair of Paget′s disease of penis or scrotum. The size of flap ranged from 17 cm×6 cm to 25 cm×10 cm.@*Results@#Seventeen three-dimensional models of deep inferior epigastric artery perforator flaps were established, including 6 bilateral models and 11 unilateral models. Seventy-two reliable deep inferior epigastric artery perforators were observed in the three-dimensional model with 3.2±0.7 in the right and 3.1±0.8 in the left. The locations of the largest deep inferior epigastric artery perforators in the right and left were [(-3.2±1.4) cm, (-1.0±0.7) cm] and [(4.0±1.2) cm, (-1.2±1.1) cm] respectively. Fourteen largest deep inferior epigastric artery perforators coursed directly and nine coursed tortuously in the rectus muscle. Twenty-three superficial inferior epigastric veins were detected in the three-dimensional models of the flaps. The number, location, and course of deep inferior epigastric artery and vein and superficial inferior epigastric vein observed in the three-dimensional model of deep inferior epigastric artery perforator flap were in accordance with the condition observed in the surgery. Seventy reliable deep inferior epigastric artery perforators were detected in the surgery, and the other 2 perforators were unclear due to bleeding. Course of these perforators were in accordance with the condition observed in the three-dimensional model. Deep inferior epigastric artery perforator flaps of all patients survived well with no complication except that 1 patient suffered from delayed healing of wound in perineum. During follow-up of 1 to 12 months, all flaps survived with good shape and texture.@*Conclusions@#The three-dimensional model of deep inferior epigastric artery perforator flap based on CTA can be established easily and can provide information of number, location, and course of deep inferior epigastric artery, vein, and their perforators, and superficial inferior epigastric vein to guide preoperative design and intraoperative dissection of the flap effectively.
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Objective To introduce the experience of using costal cartilage in oriental secondary rhinoplasty.Methods From January 2012 to December 2016,we used costal cartilage grafts to obtain a functional and aesthetic reconstruction,in which silicone was used in 34 previous cases and e-PTFE was used in 5 cases.Results The mean duration of follow-up was 1.5 years,43 (86％) patients showed high satisfaction with the shape of nose.1 case of infection and 2 cases of costal cartilage warping occurred.1 case was somewhat dissatisfactied with outcome.There was no case of chest wall deformity and pneumothorax,but scar on the chest wall at the donor site was observed in 2 cases.Conclusions We have obtained good aesthetic results using costal cartilage grafts which could display sufficient and stable support for the scaffold of nose.We can conclude that costal cartilage is a good material in secondary rhinoplasty,and can be used to reconstruct an aesthetic nose.
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Objective To discuss the prevention and treatment of the complications of rib rhinoplasty in Chinese.Methods A total of 209 patients received rib rhinoplasty in which postoperative complications happened in 14 cases from Jan.2010 to Aug.2017,and the clinical data were analyzed retrospectively.Results 195 patients showed satisfactory results and no complications.Postoperative complications occurred in 14 cases.There were 12 cases of rib cartilage warping (incidence rate was 5.7％).4 cases were thought that warping was within acceptable range,and 8 cases had satisfactory results after the secondary repair surgery.There were 3 cases of resorption of rib cartilage (incidence rate was 1.4％),of which 2 cases were complicated with cartilage warping and 1 case complicated with infection.None of them underwent repair surgery.The infection complicated with cartilage resorption was 1 case (0.5％).The infection was improved by conservative treatment and the cartilage was not removed.There was 1 case of hypertropic scar on chest wall (incidence rate was 0.5％).Conclusions The warping of cartilage can be significantly reduced by selecting straight section of costal cartilage,preserving the central costal cartilage grafts,symmetrically carving and crosscutting.Meanwhile,sterility and accurate operation can decrease the incidence of infection,aerothorax and scars.
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Objective@#To explore the measurement of Hunan Han young female nasal shape and its application for short nose rhinoplasty.@*Methods@#From June to December 2015, 162 Han young females in Hunan Xiangtan were chosen. Their photographs were used by the photogrammetry for measuremnet of nasal length, nasal height, nasal breadth, nasal depth, nasolabial angle, nasofrontal angel, nasorostral angel, columellar-facial angle, nose width-nose height index, nasal depth-nose width index, nasion to tip-defining point. The measurementresult were collected to create nasal shape database. During the period of January to June 2016, the database was applied to thirty-nine cases with short nose, to serve as guidelines for preoperative design and postoperative evaluation. Independent sample t-test was used to evaluate theresult of the operations by comparing the postoperative data with the nasal shape database of Hunan female nose assessment system.@*Results@#The measurementresult of Hunan Han young female nasal shape were as follow: nasal length (4.4±0.2) cm, nasal height(4.8±0.2) cm, nasal width (3.3±0.2) cm, nasal depth (1.8±0.2) cm, nasolabial angle (88.6±7.0)°, nasofrontal angle (136.0±5.5)°, columellar-facial angle (33.3±3.0)°, nasal tip angle (82.4±5.4)°, nose width-nose height index 70.4±4.8, nasal depth-nose width index 55.1±5.7, nasion to tip-defining point (47.4±11.4)%.The short noses deformity was corrected greatly. The measurement data of nasolabial angle, nasofrontal angel, nasorostral angel, columellar-facial angle, nose width-nose height index, nasal depth-nose width index and nasion to tip-defining point had no statistical significance between postoperative patient and Hunan female, but nasal length, nasal height, nasal width and nasal depth difference have statistical significance.@*Conclusions@#The Hunan Han young female nasal shape database could provide quantitative reference for preoperative design, performance and post-operative aesthetics evaluation.
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Objective@#To explore flap thinning based on the study of the arterial structure and blood perfusion of the deep inferior epigastric artery perforator (DIEP) flap using computed tomography (CT) angiography.@*Methods@#Clinical imaging study: Preoperative CT angiography was performed in 15 patients with DIEP flap reconstruction to investigate the vascular structure of arterial perforator. Cadaveric imaging study: 10 abdominal specimens harvested from fresh cadavers were cannulated with trocar and injected with contrast medium in the deep inferior epigastric artery perforator. During the perfusion of the contrast medium in the flap, the flap was scanned by three-dimensional CT. The CT data was then sent to CT workstation and the images were processed and reformatted to study the vascular structure of arterial perforators and the blood perfusion.@*Results@#75 artery perforators in clinical study and 40 artery perforators in cadaveric study were chosen and analyzed. The major deep inferior epigastric artery perforators run directly across the deep layer of adipose tissue without bifurcating beneath the Scarpa′s fascia. Above the Scarpa′s fascia, the artery perforators bifurcate and ultimately terminate in the subdermal vascular plexus. Blood perfusion mode: The subdermal vascular plexus served as the only pathway for blood perfusion between perforasomes. There are two different pathways for blood perfusion in the perforasome: the subdermal plexus and the existing vascular structure of perforator.@*Conclusions@#Based on the vascular structure of arterial perforator and blood perfusion of the DIEP flap, thinning of the DIEP flap under the Scarpa′s fascia is safe while thinning above the Scarpa′s fascia should performed according to the blood supply zone of the DIEP flap.
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The Chinese clinical medical national licensing examination is the profession ad-mittance exam, which is undertake the responsibility of selecting qualified physicians. It also promotes the medical education in China. The standard for examination, the examination content, methods for measuring the Chinese clinical medical national licensing examination as well as the reform and de-velopment, has a certaln guiding role to China's medical education and medical education reform. While reviewing the medical students' performance in the examination, we can discover the weakness in medical education, which is then conducive to the promotion of teaching reform and innovation. The competence based medical licensing examination reform in China, advocating the cultivation of clinical comprehensive ability as the core content to tralning and evaluating, is conducive to continuously im-proving the quality of medical education in China, and to tralning more qualified physicians in the country.
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OBJECTIVE@#To investigate the association between angiopoietin-like 4 (ANGPTL4) and aldolase A (ALDOA) in human melanoma cell. @*METHODS@#Overexpression or knockdown of ANGPTL4 was performed in WM-115 or WM-266-4 cells, respectively. The expression of ANGPTL4 and ALDOA was measured by RT-PCR and Western blot, respectively. The promoter activity of ALDOA gene was determined by luciferase assay. @*RESULTS@#The promoter activity of ALDOA gene and the expression of ALDOA (mRNA and protein) were increased or decreased in the melanoma cells with overexpression or knockdown of ANGPTL4, which was blocked by selective protein kinase C (PKC) inhibitor or restored by PKC agonist, respectively. @*CONCLUSION@#ANGPTL4 promotes ALDOA expression in human melanoma cell in a PKC dependent manner.
Subject(s)
Humans , Angiopoietin-Like Protein 4 , Angiopoietins , Genetics , Metabolism , Blotting, Western , Cell Line, Tumor , Fructose-Bisphosphate Aldolase , Metabolism , Gene Knockdown Techniques , Melanoma , Genetics , Metabolism , RNA, Messenger , Genetics , MetabolismABSTRACT
OBJECTIVE@#To evaluate the effectiveness of the anterolateral thigh flap in reconstruction for the tissue defects of hypopharyngeal and cervical esophageal tumor resection.@*METHOD@#Retrospective review of two clinical cases who underwent pharyngoesophageal reconstruction with the anterolateral thigh flap after tumor ablation.@*RESULT@#No flap failure, fistula and stricture occurred in two patients. Two patients tolerated a regular diet. An esophageal voice was progressively acquired with the help of speech therapy. With followup for 16 and 41 months two patients were alive without tumor evolution.@*CONCLUSION@#The higher success rate,lower complication, quick recovery, made the anterolateral thigh flap interposition is the ideal choice for pharyngoesophageal reconstruction.
Subject(s)
Adult , Humans , Male , Middle Aged , Esophageal Neoplasms , General Surgery , Hypopharyngeal Neoplasms , General Surgery , Plastic Surgery Procedures , Methods , Retrospective Studies , Skin Transplantation , Surgical Flaps , Thigh , General SurgeryABSTRACT
Objective:To evaluate the effectiveness of the anterolateral thigh flap in reconstruction for the tissue defects of hypopharyngeal and cervical esophageal tumor resection.Method:Retrospective review of two clinical cases who underwent pharyngoesophageal reconstruction with the anterolateral thigh flap after tumor ablation.Result:No flap failure, fistula and stricture occurred in two patients.Two patients tolerated a regular diet.An esophageal voice was progressively acquired with the help of speech therapy.With followup for 16 and 41 months two patients were alive without tumor evolution.Conclusion:The higher success rate,lower complication,quick recovery,made the anterolateral thigh flap interposition is the ideal choice for pharyngoesophageal reconstruction.
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Objective To analyse clinical application of reversed anterolateral thigh adipefascial flap in repair of defects around the knee. Methods Reversed anterolateral thigh adipofascial flap was employed to repair defects of knee and upper shank in five patients from July 2006 to April 2007. The perforator arteries were detected and labelled with a hand held Doppler flowmeter before operation. The size of flaps containing perforator artery ranged from 6 cmx 8 cm to 12 cm×13 cm. After the descending branch was severed at the bifurcation of the lateral circumflex femoral artery, the flaps were elevated distal-ly to cover the defects of the knee and upper part of the shank. A split thickness graft was harvested to cover the flap. Results All the reversed anterolateral thigh adipofascial flaps survived well, with no complications occurred in donor site. Partial graft necrosis occurred in one patient and healed after conser-vative wound dressing change. Conclusion The reversed anterolateral thigh adipofascial flap is a good choice for repair of defects around the knee, for it can provide long thin vascular pedicle and maintain contour of the donor cite.
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Objective To evaluate the method of vulvar reconstruction after extended vulvectomy. Methods Retrospectively, fourteen cases of vulva carcinoma were treated by radical wide local excision, and the defects were repaired with anterolateral thigh flap and inferior pedicle rectus abdominal myocutaneous flap. After the flap was harvested, it was put on the defect through the tunnel between the donor and the recipient site and the vulvae was reconstructed. Results All the flaps were survived except 1 anterolateral thigh flap with partial necrosis. One patient was infected at the groin incision but the flap and the grafted skin were survived. The patients were treated with change of the dressing and recovered after skin grafting. All other incisions were healed with first intention. The partial necrosis area was about 4 cm?6 cm, it healed at 36 postoperative days after free skin grafting. The reconstructed vulvae were plump and elastic. It appeared like the normal vulvae and there was no contraction of the vagina. Conclusions Vulvar reconstruction with the anterolateral thigh flap and rectus abdominal flaps after the radical vulvectomy could make the patients recover easily. It produces almost normal appearance and function of the vulvae, reduces the time of would healing. The patient could have the next therapy more quickly and the quality of life improves. It has wide application value in clinics.