Long term follow-up evaluation of combined surgery for congenital tibial pseudarthrosis in children / 中华外科杂志

Objective: To explore the long-term effect of combined surgery for the treatment of congenital tibial pseudarthrosis in children. Methods: The clinical data of 44 children with congenital tibial pseudarthrosis who underwent combined surgery (tibial pseudarthrosis tissue resection, intramedullary rod fixation, Ilizarov external fixator fixation, wrapped autologous iliac bone graft) from August 2007 to October 2011 at the Department of Pediatric Orthopedics, Hunan Children's Hospital were collected retrospectively. There were 33 males and 11 females. The age at the time of surgery was (3.7±2.2)years (range:0.6 to 12.4 years), including 25 cases under 3 years old and 19 cases above 3 years old.Among them, 37 cases were complicated with neurofibromatosis type 1.The operation status, postoperative complications and follow-up results were recorded. Results: The follow-up time after surgery was (10.9±0.7)years (range:10 to 11 years).Thirty-nine out of 44 patients (88.6%) achieved initial healing of tibial pseudarthrosis, with an average healing time of (4.3±1.1)months (range:3 to 10months).In the last follow-up, 36 cases (81.8%) had unequal tibial length, 20 cases (45.4%) had refractures, 18 cases (40.9%) had ankle valgus, 9 cases (20.4%) had proximal tibial valgus, and 11 cases (25.0%) had high arched feet.Nine cases (20.4%) developed distal tibial epiphyseal plate bridging.17 cases (38.6%) had abnormal tibial mechanical axis.Seven cases (15.9%) developed needle infection, and one case (2.3%) developed tibial osteomyelitis. 21 patients (47.7%) had excessive growth of the affected femur.Five patients (11.3%) had ankle stiffness, and 34 patients (77.2%) had intramedullary rod displacement that was not in the center of the tibial medullary cavity.Among them, 8 cases (18.1%) protruded the tibial bone cortex and underwent intramedullary rod removal.18 children have reached skeletal maturity, while 26 children have not been followed up until skeletal maturity. Conclusion: Combined surgery for the treatment of congenital pseudarthrosis of the tibia in children has a high initial healing rate, but complications such as unequal tibia length, refracture, and ankle valgus occur during long-term follow-up, requiring multiple surgical treatments.

Risk factors analysis for tibial fracture in patients with congenital anterolateral bowing of the tibia / 中华骨科杂志

Objective:To explore the risk factors associated with tibia fractures in children with congenital anterolateral bowing of the tibia (ALBT).Methods:A retrospective analysis was conducted on data from 87 children diagnosed with ALBT at the Children's Hospital of Hunan Province from January 2012 to January 2020. The collected data included age at initial diagnosis, affected limb side, whether there was a concomitant type I neurofibromatosis, whether there was a concomitant fibular pseudoarthrosis, whether there was concomitant ankle joint deformity, whether there was bone cystic change in the region of tibial bowing deformity, location of the apex of the bowing deformity, diameter of the tibial bowing deformity on the affected side, diameter on the healthy side in the same plane as the tibial bowing deformity, angle of lateral bending deformity of the tibia, angle of anterior bending deformity of the tibia, occurrence of tibia fracture, history of trauma before fracture, location of fracture, and age at the time of fracture. The follow-up endpoint was January 2023. Receiver operating characteristic (ROC) curves were used to determine the optimal cutoff values for the angles of lateral and anterior bending deformity of the tibia and the ratio of cross-sectional areas. The correlation between the above factors and tibial fractures in children was analyzed by single factor survival analysis, and the indicators with statistical significance were included in multivariate Cox proportional risk regression analysis to determine the risk factors for tibial fractures in children with ALBT.Results:Of the 87 children diagnosed with ALBT, the median age at initial diagnosis was 14.0 months (range, 1-93 months), with 42 males and 45 females, 44 left-sided and 43 right-sided cases. The median follow-up time for non-fracture cases was 42.0 months (range, 1-124 months). At the last follow-up, 43 children had experienced fractures, while 44 had not. The average time to fracture-free survival was 70.3 months, the median fracture-free survival time was 55.0 months, and the median survival time without fractures was 42.0 months. The ROC curve results indicated a cutoff value of 25.55° for the lateral bending angle of the tibia and 32.63° for the anterior bending angle of the tibia, with no statistically significant significance for the cross-sectional area ratio [AUC=0.54, 95% CI (0.42, 0.66), P=0.530]. Single-factor analysis of fracture-free survival suggested that there were statistically significant differences in the intergroup fracture-free survival rates of four factors: lateral bending angle of the tibia (χ 2=7.06, P=0.008), anterior bending angle of the tibia (χ 2=8.96, P=0.003), history of trauma (χ 2=18.26, P<0.001), and tibial bone cystic change (χ 2=4.30, P=0.038). The results of the multivariate Cox proportional hazards regression analysis showed that a lateral bending angle of the tibia≥25.55° ( HR=2.73, P=0.007), tibial bone cystic change ( HR=2.35, P=0.018), and history of trauma ( HR=2.65, P=0.004) were all positively correlated with fractures. Conclusion:The main risk factors for tibia fractures in children with ALBT include trauma, tibial bowing deformity with concomitant bone cystic change, and lateral bending angle of the tibia≥25.55°.

Proteomics investigation on periosteum of children with tibia congenital pseudarthrosis / 中华骨科杂志

Objective:To identify and analyze different proteins expression in the periosteum of congenital pseudarthrosis of the tibia (CPT) using tandem mass tags (TMT) proteomics.Methods:The samples were divided into three groups, namely CPT with neurofibromatosis type 1 (NF1) group (NF1-CPT group), CPT without NF1 group (nonNF1-CPT group) and control group (patients with open tibial fracture). A fold change ≥1.5 or ≤0.66 and P-value <0.05 was regarded as the threshold to screen differentially expressed proteins (DEPs). Subsequently, bioinformatics resources such as online tools DAVID and STRING were used to conduct GO annotation, KEGG pathways enrichment and protein-protein interaction (PPI) network with DEPs. Results:A total of 347 proteins differentially expressed in NF1-CPT group, 212 of which were up-regulated and 135 down-regulated. We identified 467 DEPs in nonNF1-CPT group, including 281 up-regulated and 186 down-regulated. Among of them, NF1-CPT group and nonNF1-CPT group shared 231 DEPs, except for HLA-DRB1 which increased in NF1-CPT group but decreased in nonNF1-CPT group. The remaining 230 DEPs showed the same expression trend in the two positive groups, including 117 up-regulated and 113 down-regulated. In particular, a total of 116 proteins were altered only in NF1-CPT group, including 94 up-regulated and 22 down-regulated. However, there were 236 proteins altered only in nonNF1-CPT group, including 164 up-regulated and 72 down-regulated. The results indicated that the pathogenesis of NF1-CPT was similar as nonNF1-CPT largely with a few differences. Finally, compared with nonNF1-CPT, there were 47 proteins changed 1.5-fold and P-value <0.05 in NF1-CPT group. Conclusion:The proteins expression in the periosteum of CPT is different from that of normal tibia. The expression of periosteal protein is also different between NF1-CPT and nonNF1-CPT. The present study will deepen our understanding of the pathogenesis of CPT in the protein level.

Chronic myeloid leukemia with a significant increase of monocytes and rare karyotype: A case report and literature review / 中南大学学报(医学版)

Chronic myeloid leukemia with a significant increase of monocytes is rare and difficult to identify from chronic myelo-monocytic leukemia in clinic. A 31-year-old male patient with systemic pain was initially diagnosed as chronic myelo-monocytic leukemia, who was finally diagnosed as chronic myeloid leukemia by fusion gene and chromosome examination. In addition to the typical Ph chromosome, a rare chromosome translocation t(2; 7)(p13; p22) was observed. The detection of monocyte subsets by multi-parameter flow cytometry is a diagnostic marker to distinguish the above 2 diseases. The relationship between fusion genes and mononucleosis is not clear. Tyrosine kinase inhibitors or allogeneic hematopoietic stem cell transplantation can be used in the treatment for this disease.

Curative effect of autologous platelet rich plasma on facial acne scars / 中华医学美学美容杂志

Objective To compare the efficacy and safety of two administration modes of autologous platelet-rich plasma (PRP),intradermal injection (ID) and microneedle technique in the treatment of facial post acne scars.Methods From March 2017 to March 2018,32 patients (8 male,14female) with facial acne scars were included.They were randomly divided into two groups (group A and group B) and both underwent splitface therapy.Each group was randomly divided into two subgroups.Group A was administered by microneedle + PRP (A1) on one side and by microneedle + saline (A2) on the other.In group B,one cheek was treated with ID PRP (B1) and the other received ID saline (B2).Each patient received overall 3 treatments per session with 28 days intervals.Patients were followed-up six months after their last treatment and clinical evaluation was assessed by 2 independent plastic surgeons and patients themself.Results The results were obvious difference between each group.The score of evaluation by physicians and patients in A1 group (2.565 ± 0.504) point showed significantly better results compared with other groups.B1 group (1.820±0.592) point was significantly higher than B2 group (1.345±0.483) point (P＜0.05).There were no statistical difference regarding scores of improvement between A2 group (1.405±0.499) point and B2 group (1.345±0.483) point (P＞0.05).The total effective rate in A1 group was 100％,which was higher than B1 group (43.75％),A2 group (81.25％) and B2 group (25％),with statistical significance (P＜0.05).Conclusions The current study introduces the combination of autologous PRP and microneedle technique as an effective and safe modality in the treatment of facial post acne scars with short recovery time and easy operation.Any concerns of immunogenic reactions or disease transfer are eliminated because PRP is prepared from autologous blood.Therefore,the method is suitable to be widely used in clinic.

Early diagnosis of pulmonary embolism in patients with skin and soft tissue defects after trauma / 中华烧伤杂志

Objective@#To investigate the early diagnosis method of pulmonary embolism in patients with skin and soft tissue defects after trauma.@*Methods@#From January 2011 to July 2014, 5 patients with skin and soft tissue defects and pulmonary embolism after trauma were admitted to Department of Plastic Surgery and Burns of the Affiliated Drum Tower Hospital of Nanjing University Medical School, including 4 males and 1 female, aged 26-68 years. The medical records of the 5 patients were retrospectively analyzed. Hierarchical screening of patients with suspected pulmonary embolism was performed after admission for 4-45 days. Computed tomography pulmonary angiography (CTPA) was performed immediately in 2 patients who had hemodynamic disorder and were able to tolerate CTPA, and pulmonary embolism was confirmed. Clinical risk assessment was conducted for the other 3 patients who had no obvious hemodynamic disorder and only had clinical manifestations of pulmonary embolism such as chest tightness and dyspnea. Among the 3 patients, two of them were assessed as high risk possibility by clinical risk assessment and diagnosed with pulmonary embolism by CTPA immediately. The other one patient′s clinical risk assessment was moderate risk possibility, but D-dimer was positive, and the patient was diagnosed with pulmonary embolism by CTPA immediately. Wound exudation of all patients was collected within 1 week after admission for microbial culture, and wound debridement and skin grafting were performed according to the wound condition. The color Doppler ultrasonography of blood vessel on lower extremity was performed to determine deep venous thrombosis of lower extremity after appearance of symptoms of pulmonary embolism. The patient was immediately given urokinase or recombinant tissue plasminogen activator by intravenous infusion for thrombolysis after definite diagnosis of pulmonary embolism. The activated partial thromboplastin time (APTT) was monitored after treatment, and standardized anticoagulation began when APTT was equal to or lower than 70 seconds. The treatment results of patients, D-dimer measurement value, bed time before definite diagnosis of pulmonary embolism, number of patients underwent wound debridement during hospitalization, definite diagnosis time of pulmonary embolism after wound debridement, and number of patients with deep venous thrombosis of lower extremity and wound infection were recorded.@*Results@#Wounds with skin and soft tissue defects of all patients were completely healed, all skin grafts survived well, pulmonary embolism recovered well after timely treatment, and the trunk and branches of involved pulmonary artery recovered blood supply. The course of disease ranged from 1 month to 3 months. The measurement value of D-dimer was 2.4-31.7 mg/L, and the measurement values of D-dimer of 4 patients were equal to or higher than 5.0 mg/L. The bed time before definite diagnosis of pulmonary embolism was 4-46 days, with an average of 23.2 days. Four patients underwent wound debridement during hospitalization. The definite diagnosis time of pulmonary embolism after the wound debridement was 14-40 days, with an average of 20.5 days. Four patients were diagnosed with deep venous thrombosis of lower extremity. All patients had wound infection, and the bacteria causing wound infection included Pseudomonas aeruginosa of 2 cases, Staphylococcus aureus of 2 cases, and Enterococcus faecalis of 1 case.@*Conclusions@#In the diagnosis process of pulmonary embolism in patients with skin and soft tissue defects after trauma, D-dimer positive, long-term bed rest, experiencing operation during hospitalization, and with deep vein thrombosis and wound infection can be regarded as the key points for diagnosis. When a patient has clinical symptoms of pulmonary embolism and the above conditions, the clinician should promptly perform hierarchical screening, select the corresponding examination to confirm pulmonary embolism, and immediately perform thrombolysis for the patient with pulmonary embolism according to the patient′s tolerance, thereby improving patient survival rate.

Efficacy of different doses of botulinum toxin A injections on bromhidrosis in adolescents / 中华医学美学美容杂志

Objective To explore the therapeutic effect of different doses of botulinum toxin A injections on bromhidrosis.Methods A total of 200 cases were divided into mild-to-moderate group (N=100) and severe group (N=100) based on the grade of bromhidrosis,and each group was further divided into two groups:low dose group (50 cases) were treated by botulinum toxin A injections (100 U) and high dose group (50 cases) were treated with 200 U for bilateral axillary.The total effective rate and recurrence rate in both groups were compared.Results In the mild to moderate group,after treatment for 3 months,the total effective rate of both groups had no statistical difference (P＞ 0.05),and the same with recurrence rate in 6 months follow-up (P＞0.05).In the severe group,after treatment for 3 months,the total effective rate of the high dose group (82％) was significantly higher than that of the low dose group (64％),with statistical significance (x2 =4.110,P＜0.05).After 6 months follow-up,recurrence rate in the high dose group (22％) was significantly lower than that of the low dose group (46％),with statistical significance (x2 =6.417,P ＜ 0.05).Conclusions A suitable dose of botulinum toxin A can be selected based on the severity of bromhidrosis,which is a individualized therapy for cost savings and might have potential benefits for patients with osmidrosis.

Challenges for rescue and treatment of mass burns: the experience of rescue and treatment for casualties in August 2nd Kunshan factory aluminum dust explosion accident / 中华烧伤杂志

The Kunshan factory aluminum dust explosion accident in August 2nd, 2014 caused the largest number of serious burn casualties in China in the recent 30 years. With the support of the whole country and the multidisciplinary cooperation, 185 severely burned patients were rescued and treated at 20 hospitals in Jiangsu province and Shanghai with satisfactory results. The rescue and treatment of mass burn is a complicated and systematic project on account of its suddenness, uncertainty, and non-repeatability. The treatment of this explosion accident was reviewed in this paper to explore the treatment model and experience of multidisciplinary cooperation. It is worthy to ponder and explore how to face challenges and strive to improve the treatment level of mass burns.

Experience of wound treatment on extremely severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident / 中华烧伤杂志

Objective@#To explore experience of wound treatment of extremely severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident.@*Methods@#On August 2nd, 2014, 98 extremely severe burn mass patients involved in August 2nd Kunshan factory aluminum dust explosion accident were admitted to 20 hospitals in China. The patients with complete medical record were enrolled in the study and divided into microskin graft group with 56 patients and Meek skin graft group with 42 patients. Split-thickness skin in area of residual skin were resected to repair wounds of patients in microskin graft group and Meek skin graft group by microskin grafting and Meek miniature skin grafting, respectively. The residual wound size on 28 days post injury and wound infection after skin grafting of patients in the two groups, and position of donor site of all patients were retrospectively analyzed. Data were processed with t test and chi-square test.@*Results@#The size of residual wound of patients in Meek skin graft group on 28 days post injury was (59±13)% total body surface area (TBSA), which was obviously smaller than that in microskin graft group [(70±14)%TBSA, t=4.379, P<0.05]. Twenty-nine patients in microskin graft group and 11 patients in Meek skin graft group suffered from obvious wound infection after skin grafting. Wounds of patients in two groups were repaired with residual skin around wound in head, trunk, groin, armpit, and uncommon donor sites of scrotum (4 patients), vola (10 patients), and toe or finger web (8 patients).@*Conclusions@#Meek skin graft is the first choice for wound repair of extremely severe burn mass patients, with faster wound healing, less wound infection. Uncommon donor sites of scrotum, vola, and toe or finger web can also be used for wound repair in case of lack of skin.

Law of dominant eye's transformation after cataract phacoemulsification and intraocular lens implantation surgery / 中南大学学报(医学版)

To study the change of the dominant eye in the age-related cataract patients before and after surgery, to analyze the correlation between the orientation of the dominant eye and the visual quality, and to observe whether the patients with the change in dominant eye were converted to dizziness.
 Methods: A total of 44 patients, with age-related cataract between 60 and 80 years old were enrolled. Group A: the non-dominant (secondary) eye served as the surgical eye (n=35); Group B: the dominant eye served as the surgical eye (n=9); Group C: the operation was performed on the contralateral eye after a month (n=28). Measurement of the dominant eye was performed before operation, 1 week after operation and 1 month after the operation. The changes in the uncorrected distance visual acuity (UCDVA), contrast sensitivity (CS), best corrected visual acuity (BCVA) and spherical equivalent (SE) between the dominant and non-dominant eye were compared.
 Results: The UCDVA, CS, BCVA and SE were significantly improved at 1 day after the operation. There was significant difference between the 2 groups (P0.05); in group B, the UCDVA, CS, BCVA in the dominant eye were better than the non-dominant eye's, but the difference was not statistically significant (P>0.05). After operation: the UCDVA, CS and BCVA in the dominant eye in group A and group B were higher than those of the non-dominant eye with statistical difference (P0.05). The dominant eye's transformation occurred in group A when the non-dominant eye's postoperative visual quality improved over the leading eye. The transformation rate was 60% in 1 week, and the conversion rate was 80% in 1 month. In group C, the dominant eye reduction rate was 100%, and the visual quality was not significant difference between the two eyes (P>0.05). After the operation, the patients with the dominant eye's transformation felt discomfort, which could be relieved within 1 week.
 Conclusion: The location of the dominant eye was correlated with uncorrected visual acuity, contrast sensitivity, and the best corrected visual acuity. The dominant eye's transformation occurred when the non-dominant eye's postoperative visual quality improved over the leading eye after the surgery. If the contralateral eye's surgery was performed in a short term, the dominant eye can be returned to the initial state.

Surgical treatment for persistent pupillary membranes / 中南大学学报(医学版)

Objective:To explore surgical treatment for persistent pupillary membrane (PPM) and its effect.Methods:The medical records and postoperative follow-up data for 12 consecutive patients (16 eyes),who were submitted to PPM resection in Xiangya Hospital,Central South University from March 2011 to August 2016,were retrospectively reviewed.Results:Among 12 consecutive patients (16 eyes),8 patients (12 eyes) with PPM and clear lens were submitted to simply PPM resection,and 4 patients (4 eyes) with PPM and cataract were submitted to PPM resection combined with cataract surgery.In the patients who received the combined operation,phacoaspiration with or without intraocular lens implantation was performed in 3 eyes or in 1 eye.In the early stage after surgery,1 eye was complicated with a transient high intraocular pressure.In the patients who were submitted to PPM resection,the final follow-up visual acuity in 7 patients (11 eyes) were improved except 1 patient (1 eye).After the PPM resection combined with cataract surgery,the follow-up visual acuity was improved in 2 patients (2 eyes) but not in the other 2 patients (2 eyes).Conclusion:The surgical treatment is effect on congenital pupil residual membrane.Serious membrane pupil residual membrane should be surgically treated at early stage,and amblyopia treatment after the surgery is important.

Effects of moxibustion on Treg/Th17 cell and its signal pathway in mice with rheumatoid arthritis / 中国针灸

<p><b>OBJECTIVE</b>To observe the effects of moxibustion on Treg/Th17 imbalance and related signal pathway in mice with rheumatoid arthritis (RA), so as to explore the action mechanism of moxibustion on RA.</p><p><b>METHODS</b>Twenty-four DBA/1J male mice were randomly divided into a normal group, a model group, a sham moxibustion group and a moxibustion group, 6 mice in each one. RA model was induced by subcutaneous injection of typeⅡcollagen and adjuvant at tail in mice other than the normal group. The mice in the moxibustion group were treated with moxibustion at"Zusanli" (ST 36) and "Shenshu" (BL 23), 1 mg per cone, 6 cones per acupoint. The consecutive 6-day treatment was taken as one course, and totally 2 courses were given with an interval of 2 d between courses. The mice in the sham moxibustion group were treated with immobilization as the moxibustion group. The effects of moxibustion on joint swelling was evaluated by RA scale of collagen induced arthritis (CIA); the pathological changes of joint inflammation were observed by HE staining; the cell count of Th17 and Treg in spleen was analyzed by flow cytometry; the content of cytokine IL-1β, IL-6, IL-10, IL-17, IL-23, TGF-β and Galectin-9 were analyzed by ELISA; the mRNA and protein expression of Foxp3, Galectin-9, RORγt, CARMA1, NF-κB were analyzed by Real-time PCR and Western Blotting method.</p><p><b>RESULTS</b>Ten to 12 d after the secondary immune, red and swelling of ankle joint, feet and toe joint were observed, indicating successful establishment of RA model. 15 d into moxibustion treatment, the joint swelling was improved in the moxibustion group and the sham moxibustion group, which was superior in the moxibustion group (<0.05). As for pathological changes, compare with the normal group, the articular surface was rougher and synovial layer thinner in the model group, which was recovered to a certain extent in the sham moxibustion group; the articular surface was smooth and synovial layer was thicker in the moxibustion group, which was similar to the normal group. The results of flow cytometry test indicated the cell count of Treg in the model group was reduced but that of Th17 was increased than the normal group (both<0.01); the moxibustion could increase significantly the cell count of Treg (<0.05), but no effect was observed on Th17 (>0.05). The results of ELISA test indicated the differences of increasing of IL-1β, IL-6, IL-17, IL-23, TGF-βas well as the reducing of IL-10 were not significant between the sham moxibustion group and the moxibustion group (all>0.05); moxibustion treatment could increase the content of Galectin-9 which was reduced in RA mice (<0.05). The results of RT-PCR and Western blotting test indicated the mRNA and protein expression of Foxp3, Galectin-9 were reduced in the model group (all<0.01), which could be up-regulated by moxibustion treatment (<0.05,<0.01); the mRNA and protein expression of RORγt, CARMA1, NF-κB was increased (all<0.01), which could be down-regulated by moxibustion treatment (<0.05,<0.01).</p><p><b>CONCLUSION</b>Moxibustion could improve the swelling of joint and inflammatory reaction of joint synovial in RA mice; the mechanism may be related to the regulation of Treg cells number in spleen and the expression of Foxp3, Galectin-9, RORγt, CARMA1, NF-κB, mRNA and protein expression.</p>

Effects of femtosecond laser-assisted anterior capsulotomy versus manual continuous curvilinear capsulorhexis on intraocular lens centration / 眼科新进展

Objective To assess the effects of femtosecond laser-assisted anterior capsulotomy versus manual continuous curvilinear capsulorhexis on intraocular lens (IOL) centration by measuring and comparing shape,size and positional parameters.Methods Eighty cases (80 eyes) with age-related cataract from March 2015 to July 2016 in our hospital were collected.Forty patients (40 eyes) in the femtosecond group underwent femtosecond laser anterior capsulotomy and 40 patients (40 eyes) in the annular group were treated with annular continuous capsulorhexis.At postoperative 1 week,1 month,1 year,the slit lamp digital photography and Pentacam anterior segment analyzer were used to collect the anterior segment images,and the parameters include horizontal and vertical diameter,roundness,package and partial centre of IOL were analyzed by image analysis software image-pro-plus 6.0.Using repeated measurement of variance analysis,Fisher exact probability,and Generalized estimation equations (GEE),the differences between parameters of the groups and IOL decentration predictor were analyzed.Results The vertical diameter,roundness,maximum distance,minimum distance,package and horizontal deviation were statistically significant between the femtosecond group and the annular group at 1 week and 1 month after operation (all P ＜ 0.05),and there was no significant difference in horizontal diameter and vertical deviation between two groups (all P ＞ 0.05).At 1 year after operation,the maximum distance,minimum distance,package and horizontal deviation between two groups were statistically significant (all P ＜ 0.05).There was no significant difference in vertical and horizontal diameter,roundness,and vertical deviation between two groups (all P ＞ 0.05).There was no patient with horizontal shift ＞ 0.4 mm in the femtosecond group at 1 week,1 month and 1 year;The ratio of cases with horizontal shift ＞0.4 mm and ＜0.4 mm in the annular group at 1 week,1 month and 1 year were 2/38,4/36,8/32,respectively.There was significant difference in the horizontal shift ＞ 0.4 nun between the two groups after 1 year(P ＜ 0.05).In the univariate generalized estimating equation model,the capsulorhexis type was a significant predictor of horizontal shift.Of all the capsulorhexis parameters,the difference of inclusion degree was statistically significant (P =0.001).There was negative correlation between the horizontal shift and package at different time points in the femtosecond group at 1 week,1 month and 1 year (r =-0.89,P ＜ 0.05;r =-0.72,P ＜ 0.05;r =-0.58,P ＜ 0.05);There was negative correlation between the horizontal shift and package at different time points in the annular group at 1 week(r =-0.68,P ＜ 0.05),but no correlation at 1 month and 1 year (r=-0.41,P＞0.05;r=-0.33,P＞0.05).Conclusion The anterior capsule made by femtosecond laser anterior capsulotomy is more round,centered and accurate,pocket IOL position is more stabled and neutral.

Exploration of flipped classroom model in the medical laboratory English class / 中华检验医学杂志

Specialty English of Medical Laboratory is a comprehensive and overlapping discipline and plays a major role in multiple medical courses, including Life Science, Clinical Medicine and Laboratory Medicine.However, its teaching practices are limited due to the extensive contents, scattered basic knowledge points, complexities of language learning processes and high demanding of sophisticated teaching skills.Since internet technology′s breakout and the web-based education expanding in the past decade, personalized flipped classroom has drawn considerable attention in the education field and became a hop-spot in teaching practice system.In the present study, the concepts of flipped classroom and basic characteristics of Specialty English of Medical Laboratory were elaborated, as well as the reconstructing teaching processes, exploring the concrete plan for teachers and students in undergraduate program.

Aesthetic repair of medial upper lip defects / 中华医学美学美容杂志

Objective To explore the aesthetic results of medial upper Iip repair for skin and soft tissue defects using local flap.Methods According to the location and the size of upper lip defect,the modified rhomboid flap of 60 ° above the defect was designed to repair the wound in philtrum;the O-L flap along philtral column to vermilion border was designed to cover the wound close to the peak and lateral to philtral column.Results Twenty-one postoperative patients that underwent pigmented nevus removal (12 female,9 male;ages 16-33 years) had defects in philtrum for 10 cases and close to the peak and philtral column for 11 cases.The diameter of the defect ranged from 0.5 cm to 1.0 cm.All flaps survived primarily without any complications and follow-up was for 1 to 18 months with excellent outcomes in all cases.All patients were satisfied with contour and functions.No pigmented nevus recurrence occurred.Conclusions The flap designed according to the aesthetic principle could be used to repair medial upper lip defect of medium-sized,which not only obtains functional reconstruction,but also satisfies aesthetic results,with aesthetic subunits saved and scar concealed.

Plastic an d cosmetic surgeon:the angel of perfect combi-nation of medical, aesthetics and art / 医学研究生学报

Plastic and cosmetic surgery is an emerging disci-pline which can create beauty with medical intervention.It can be say that plastic and cosmetic surgery can combine medicine with aesthetics and art.Plastic surgeon is the angel of this perfect combination.In this paper, the author discusses how to be a qualified plastic surgeon to real-ize the combination of medical, aesthetics and art through more than 30 years clinical experience and teaching practice in plastic and cosmetic surgery.

Genetic abnormality in 101 cases of plasma cell dyscrasias by FISH technology and cytogenetic examination / 中南大学学报(医学版)

OBJECTIVE@#To investigate several abnormal genes by the fluorescence in situ hybridization (FISH) in multiple myeloma (MM), monoclonal gammopathy of undetermined significance (MGUS) and reactive plasmacytosis (RP), and to increase the diagnosis and differential diagnosis levels for these common plasma diseases. 
@*METHODS@#The clinical manifestations, image and laboratory tests and the FISH detection were retrospectively analyzed in 61 cases of newly diagnosed MM, 20 cases of MGUS and 20 cases of RP from August, 2012 to February, 2015 in the Xiangya Hospital of Central South University. 
@*RESULTS@#Fifty cases among 61 MM patients showed genetic abnormality by FISH technology. The total positive rate was 81.9%. Among them, 19 cases (31.1%) had 1q21 amplification, 18 cases (29.5%) lacked D13S319, 10 cases (16.4%) missed RB1, 10 cases (16.4%) had IGH translocation and 7 cases (11.4%) lacked p53 gene. The positive rate for two or more genes abnormal was 19.8% in 12 cases. However, in 20 cases of MGUS patients, the positive detection rate was 25%, including 4 cases (20%) of 1q21 augmentation and 2 cases (10%) of IGH translocation. There were not two or more abnormal genes in one case. While in RP cases, only 1 case of patients had D13S319 abnormal gene, and the positive rate was only 5%. There was significant difference (P<0.05) among the 3 groups. 
@*CONCLUSION@#The positive detection rate is 81.9% in MM patients by FISH, which is significantly higher than that in patients with MGUS or RP. FISH technology can detect a variety of abnormal genes in MM. It is useful for the differential diagnosis and prognosis for MM, MGUS and RP.

Research progress of Autologous Fat Grafting for Scar Treatment / 医学研究生学报

The scar tissue, resulting from aberrant process of wound healing , can bring about cosmetic deformeties and func-tional limitation, even the displacement of tissues and organs .The widely use of autologous fat graft in regenerative medicine offers a relatively new option for scar treatment .Lipofilling has improved symptoms and appearance of scars in several studies .The application , therapeutic effect and mechanism research of autologous fat graft for scar treatment are summarized in this paper .

Repair of skin and soft tissue defects around the knee joints / 中华烧伤杂志

Skin and soft tissue defects around the knee joints are often accompanied by popliteal artery injury, patellar ligament injury, patellar fracture, and other deep tissue damage or exposure, making them challenging to repair. The principle is to repair the wound, reconstruct anatomical structure of the knee joint, and recover the knee joint function. At present the reconstruction with skin flap or myocutaneous flap is our priority. Local flap or myocutaneous flap can be used for repairing minor defects around the knee joints. Repairing with perforator flap, fascia flap, and free flap are main alternatives for covering larger and complex defects around the knee joints. During the treatment, a joint effort is mandatory, not only to repair the wound, but also to reconstruct vasculature, fix fracture, repair ligament, and finally recover the knee joint function. Therefore, the importance of multidisciplinary cooperation must be emphasized. Moreover, along with the development of new technologies, new methods, and new materials, perforator flap plays an important role in repairing skin and soft tissue defects around the knee joints.

Clinical analysis of malignant glaucoma after glaucoma surgery / 中南大学学报(医学版)

OBJECTIVE@#To explore the risk factors, the ciliary body anatomy structures, the therapeutic methods and the prognosis for malignant glaucoma through retrospectively collecting the clinical data from primary angle-closure glaucoma (PACG) patients.@*METHODS@#Clinical data in 1183 patients (1456 eyes) with PACG were collected between July, 2010 and May, 2014 from Xiangya Hospital, Central South University. Thirty patients (38 eyes) were diagnosed as malignant glaucoma. According to symptom, these patients were divided into a PACG group (1418 eyes) and a malignant glaucoma group (38 eyes); according to age, they were divided into a 3-40 years old group (171 eyes), a 41-70 years old group (1016 eyes) and a ≥71 years old group (269 eyes); according to therapeutic methods, they were divided into a drug therapy group (5 eyes), a lens extraction group (6 eyes) and a vitrectomy surgery group (27 eyes); according to the different method of surgery, they were divided into a vitrectomy group (27 eyes), a nonvitrectomy group (11 eyes). The age, sex, anterior chamber depth (ACD), axial length (AL), lens thickness (LT), visual acuity, intraocular pressure, therapeutic methods and surgery history were recorded. Meanwhile, the ciliary body thickness (CBT), trabecular ciliary process angle (TCA) and lens diameter were measured by ultrsound biomicroscopy (UBM).@*RESULTS@#Male and female ratio was 1:2 in the malignant glaucoma group. The average age [(51.87±12.92) years] in the malignant glaucoma group was less than that in the PACG group [(57.87±8.78) years](P<0.05). Malignant glaucoma was more likely to occur in the first 3 months after PACG trabeculectomy with a rate of 85.7%. The LT [(4.33±0.67) mm], AL[(21.44±1.18) mm] and ACD [(2.12±0.41) mm] in the malignant glaucoma group were less than those in the PACG group [(4.81±0.50), (22.17±0.97) and (2.49±0.48) mm, respectively](all P<0.05). The CBT0, CBT1, CBTmax, TCA and lens diameter in the malignant glaucoma group were less than those in the PACG group (all P<0.05).@*CONCLUSION@#Female PACG patients, with short axial length, shallow anterior chamber, thin lens, thin ciliary body, small trabecular ciliary process angle and short lens diameter, are more likely to suffer from malignant glaucoma. Vitrectomy can significantly reduce intraocular pressure.