Application of PiCCO-guided goal-directed volume management in off-pump coronary artery bypass surgery during perioperative period / 中国医师进修杂志

Objective:To evaluate the influence of goal-directed volume management based on cardiac output index (CI), intrathoracic blood volume index (ITBVI) and extravascular lung water index (EVLWI) in patients undergoing off-pump coronary artery bypass surgery.Methods:Forty patients (ASA 2 to 3 grade) undergoing off-pump coronary artery bypass surgery in Lanzhou University Second Hospital from January 2017 to December 2018 were selected. The patients were divided into 2 groups by random digits table method with 20 cases in each group: study group (goal-directed fluid therapy treatment with CI, ITBVI and EVLWI) and control group (conventional fluid therapy). The control group was given central venous pressure (CVP) monitoring rehydration, and the study group was given PiCCO hemodynamic monitoring indicators. The CVP, CI, ITBVI and EVLWI for fluid management were measured. Accurate assessment of volume status of patients was done. The study group received goal-directed fluid therapy based on CVP, CI, ITBVI and EVLWI, with the goal of CI in the 3.0 to 5.0 L/(min·m 2) range, ITBVI in the 800 to 1 000 ml/m 2 range and EVLWI in the 3.0 to 7.0 ml/kg range. The heart rate, mean arterial pressure (MAP), urine volume, central venous oxygen saturation (ScvO 2), lactic acid and renal function were monitored. The ventilator withdrawal time, hospitalization in ICU, length of stay, incidence of acute pulmonary edema, incidence of acute renal failure, mortality of 30 d after surgery were recorded and compared between the two groups. Results:Tissue perfusion and urine volume of the study group was significantly improved compared with that of control group ( P<0.05). ScvO 2 of the study group was higher than that of the routine group ( P<0.05). The concentration of lactic acid of the study group was lower than that of the routine group ( P<0.05). The incidences of acute pulmonary edema, acute renal insufficiency and mortality of the study group were lower than those of the routine group (5.0% vs. 15.0%, 5.0% vs. 10.0% and 5.0% vs. 15.0%), and there were statistical differences ( P<0.05). The length of stay and hospitalization in ICU were both lower than those in the control group ( P<0.01). Conclusions:Goal-directed fluid therapy based on CI, ITBVI and EVLWI can effectively optimize the cardiac preload of patients undergoing off-pump coronary artery bypass surgery, improve cardiac output, ensure microcirculation perfusion, maintain the balance of oxygen supply and demand, and reduce the incidence of complications and mortality.

"Comparison of mandibular angle morphometry between the ""beautiful face"" and ordinary face of young Han women" / 中华医学美学美容杂志

Objective To analyze the difference of soft and hard tissues between beautiful face and ordinary face in young Han women for providing data basis for modification of lower facial contour.Methods 38 cases of young Han women were selected with craniofacial spiral CT scanning,three-dimensional reconstruction and histomorphometry of the mandibular angle region (12 cases of beautiful face and 26 cases of ordinary face).Results The difference of bony bigonial breadth,lower face width,angle of mandibular angle,mandibular branch width and height,the distance between the mandibular angle point and pogonion in mandibular angle region had statistical significance (P ＜ 0.05);the difference of mandibular angle thickness had no statistical significance (P＞0.05);the difference of masseter muscle length,width and thickness had statistical significance (P ＜ 0.05).Conclusions In clinical lower facial contour modification practice,we can refer to the data of soft and hard tissue of mandibular angle region of beautiful face,combining with the specific circumstances of the pursuit of beautiful people and select the appropriate surgical approach for lower facial contour modification.

Use the technique of three layers suspension to lift the mid-low face / 中华医学美学美容杂志

Objective To explore an ideal surgical method for mid-low face lifting.Methods In this procedure,the first surgical step was subcutaneous undermining that was performed through the incision along temporal hairline,anteriorear,and mastoideae.It extended distally beyond the furthest skin fold and along the mandibular border or the midline of the neck if nacessary.Then three layers suspension were performed,which included three procedures:first,SMAS was purse string sutured in certain direction;secondly,the malar fat pad was suspended to tow directions backward and upward and anchored in the periosteum of zygoma and SMAS too;lastly,through traction suture of reducing tension step-by-step,lots of the tension was relieved from the incision;at the same time,new retaining ligaments between flap and SMAS were reestablished.And redundant skin was removed in incision at the end of the procedure.Results A total of 22 cases received this operation.16 cases were followed up from 3 months to 24 months after operation.The results of operation were divided into three degrees:excellent,acceptable and poor;and those were evaluated by patients themselves.14 cases obtained excellent result (87.5 ％),2 cases regarded that their results were acceptable (12.5 ％).The total satisfactory rate was 100 ％.None serious complication occurred in those eases except some slight complications,such as local edema,skin numbness and small hematoma which relieved in 3 to 6 months after operation.Scar was inconspicuous.Conclusions This technique can correct the posies of lower tow-third face better,especially for mitigating the nasolabial fold and enhancing the elastic of face skin.Simultaneously,it is an effective,safe and simple technique.

Mesenchymal stem cells in the treatment of myocardial infarction: how long is the way from bench to bedside? / 中国组织工程研究

BACKGROUND: Mesenchymal stem cells, a kind of popular seed cells for cell transplantation after myocardial injury, have become a hot research topic in the treatment of ischemic heart diseases. OBJECTIVE: To review the new progress of mesenchymal stem cell transplantation in the treatment of ischemic heart diseases. METHODS: We searched Medline, Ovid Embase, PubMed Central, Cochrane Library, Chinese Periodical Full-Text Database, Chinese Biomedical Literature Database, VIP database, Wanfang Database for relevant articles in Chinese and English languages, and the retrieval time was from 1985 to 2015. Articles related to randomized controlled trials or clinical research on mesechymal stem cell transplantation for treatment of ischemic heart diseases were included, and relevant review were also included. Observational studies, casereports, study protocols with no standard or rational design, reviews with no normative and rigorous inclusion criteria, cross-test studies, cluster randomized trials, and studies that have nothing to do with the topic were excluded.RESULTS AND CONCLUSION: Through literature screening, we summarize the research progress in the mesenchymal stem cell transplantation, including cell source, safety, efficacy, action of mechanism and injection mode, and analyze the merits and demerits of mesenchymal stem cell transplantation. Bone marrowmesenchymal stem cell transplantation provides a new insight into the clinical treatment of myocardial infarction,but there are still many problems to be solved, such as cell quality, cell dose, transplantation mode, transplantation timing and patient selection, which so limit the clinical application of mesenchymal stem cell transplantation.

rTFPI reduces ischemic necrosis in random pattern skin flap avulsion injuries rat model / 中华显微外科杂志

Objective To determine whether rTFPI could inhibit vascular thrombosis and salvage random pattern skin flaps following AIRC in rat models.Methods From April,2013 to June,2015,30 adult male Sprague-Dawley rats were randomized into 3 groups;a control group,an avulsion injury with roll compaction (AIRC) group,and an AIRC plus rTFPI therapy group.An 8.0 cm× 2.5 cm random flap was raised on the dorsum of each rat.The AIRC and AIRC plus rTFPI flaps were then altered with a device designed to simulate avulsion injury with roll compaction.After flap closure primarily,treatment was initiated immediately and continued for 3 days.Phosphate buffered saline was used in the control group and the AIRC group,while the AIRC plus rTFPI group received the recombinant Tissue Factor Pathway Inhibitor.Laser Doppler flowmetry and infra-red thermalgraphy were used on postoperative day three to assess nicrocirculatory blood flow and viability of the avulsed flaps.At postoperative day seven,final flap survival was determined.Using SPSS19.0 statistical analysis.Results The flap survival in AIRC group was only (32.7 ± 5.2)％ versus (62.5 ± 6.5)％ in control group,but the flap survival significantly increased (51.6 ± 8.2)％ after topical injecting rTFPI in experimental group.Statistically significant differences exist (P ＜ 0.05) between every two groups.The detection results of Laser-Doppler flowmetry and infra-red thermography showed that perfusion arrived the centre of the flaps in experimental group,while perfusion only arrived the proximal part of the flaps in the AIRC control group.Conclusion rTFPI therapy is effective in reducing ischemic necrosis of random pattern flaps following avulsion injury in the rat model.It suggests that rTFPI therapy may play an important role in clinical salvage of the failing avulsion injuries with roll compaction.

Clinical application of transplantation of autologous fat with stromal vascular fraction for breast augmentation / 中华医学美学美容杂志

Objective To explore the clinical effect of transplantation of autologous fat with stromal vascular fraction for breast augmentation.Methods From September 2012 to March 2014,15 people accepted breast augmentation by transplanting autologous fat with SVF under local anaesthesia.Three-dimensional computer tomography reconstruction (3D-CT reconstruction) was applied preoperatively and postoperatively,the data of the thickness of breast's subcutaneous tissue was compared to observe the breast contour improvement.Results Autologous fat was injected 2 times in 3 cases,and the rest were 1 time.6 months after operation,13 cases were satisfied with the results,and 2 cases were quite satisfied.3D-CT reconstruction was performed before operation and 6 months after operation;statistics showed that before operation the thickness of breast subcutaneous tissue of the right side was (11±4) mm,the left side was (11±6) mm;6 months after operation the right side was (14±3) mm,the left side was (16±3) mm (P＞0.05).The breast was soft,no major complication such as nodules,cysts or calcification were seen.Conclusions The transplantation of SVF with autologous fat is a safe,effective procedure for breast augmentation.3D-CT reconstruction can show more details of breast structures,which is a more effective method to guide and evaluate the lipotrans plantation.

Application of three-dimensional CT reconstruction in correction of mandibular angle hypertrophy with milling technique through intraoral incision / 中华医学美学美容杂志

Objective To observe the surgical results of milling technique in treating mandibular angle hypertrophy through an intraoral approach and the effect of three-dimensional computer tomography (3D-CT) reconstruction.Methods Milling-technique was used to treat mandibular angle hypertrophy of 43 patients through intraoral approach under local anaesthesia.3D-CT was applied preoperatively and postoperatively,the data of mandibular angle and masseter muscle thickness were compared preoperatively and postoperatively.The facial contour improvement was also observed.Results Of 43 cases,33 cases were followed-up for 4 to 24 months after operation.The majority of patients were satisfied with the aesthetic results,changes of anterior and lateral view of basifacial part were obvious,the curve of the mandibular angle was smooth and the shape was natural; no major complications such as facial nerve injury or malfracture were seen.Conclusions Milling-technique is a safe,effective and simple method for mandibular angle reduction,and 3D-CT reconstruction has a positive effect preoperatively and postoperatively.

A novel 5' splice site mutation in ACTC1 gene may play an important role in congenital ventricular septal defect / 中国组织工程研究

BACKGROUND: As a candidate gene of congenital heart disease, ACTC1 gene is related to congenital atrial septal defect inhumans.OBJECTIVE: To perform a mutation screen of ACTC1 gene in 110 nuclear families of congenital heart disease.METHODS: A case-control study was conducted based on 110 nuclear families of congenital heart disease and 300 normalhuman beings with no reported cardiac malformation. Six fragments in the coding region of ACTC1 gene was amplified by PCR invitro using five primers pairs. PCR products were screened for gene mutations.RESULTS AND CONCLUSION: A novel G-to-A variant was found at the third nucleotide of the intron downstream from exon 5.This mutation existed in a 5-year-old female with an isolated ventricular septal defect and her 30-year-old father, who had noreported cardiac anomalies. This mutation was not detected in 300 normal controls. These findings indicate that the mutation maybe related with congenital ventricular septal defects in humans.

Repair of cervical scar contracture with expanded island flaps based on cervical cutaneous branch of transverse cervical artery / 中华医学美学美容杂志

Objective To explore an ideal surgical treatment for cervical sear eontraeture. Methods From January, 2005 to December, 2008, 11 eases of cervical sear contraeture (Ⅱ-Ⅲ) were treated with the expanded flaps based on the cervical cutaneous branch of transverse cervical artery. At the first step, one or two soft tissue expanders were implanted beneath the skin at the clavicular-pectoral region. At the second step, after fully expanding, an expanded clavicular-pectoral flap that based on the cervical cutaneous branch of transverse cervical artery was designed and raised completely according to cervical cutaneous defect. And then, the flap was transferred to reconstruct the defect in cervix. The donor area was closed directly or covered with graft. Results The 11 cases were performed with unilateral flaps based on the cervical cutaneous branch of transverse cervical artery. No necrosis occurred. And the cervical contour and function have been mended. All of them had been followed up for 6-18 months with satisfactory results. Conclusions This procedure can be very useful for the plastic and reconstruction surgeons who are confronted with a difficult case of cervical scar contracture. By this means, a lot of materials of reparation with similar color, and texture can be obtained. And this method is simple, safe, and effective.

Application of Medpor in restoration of craniofacial contour deformities / 中华医学美学美容杂志

Objective To explore the effects of Medpor in surgical treatment of craniofacial de-pressed deformities. Methods Combining with other surgical methods, 37 patients with craniofacial de-pressed deformities were treated with Medpor. Of them, 29 cases of craniofacial depression and defects subjected to trauma, 6 cases were progressive facial hemiatrophy and 2 case were angle of mandible de-formity. All were followed up from three months to four year. Results Facial configurations and func-tions of all the 37 cases were greatly improved after the treatment, without any complication of infection or rejection;patients were all very satisfactory or relatively satisfied with the results. Conclusion Med-por is an ideal implant material to correct the deformity of earaniofacial, and combining with others methods, the treatment of earaniofacial deformity can obtain good results.

Effective treatment for lactation complications after augmentation mammoplasty with polyacrylamide hydrogel / 中华医学美学美容杂志

Objective To explore an effective treatment for lactation complications after augmenta-tion mammoplasty with polyacrylamide hydrogel (PAHG). Methods 13 cases with lactation complica-tions after augmentation mammoplasty with polyacrylamide hydrogel (PAHG) were treated with taking out PAHG and the pathological tissue through the periareolar incision, using continual drainage and medi-cation that can choke back hypergalactia. Results All cases were cured and followed up for 3 months to 4 years with satisfactory results. Conclusion This method for the treatment of lactation complications after augmentation mammoplasty with PAHG is effective, safe and simple.

Histopathological changes of skin in freckle patients after phenol chemical peel / 中华医学美学美容杂志

Objective To study the histopathological changes of skin after phenol chemical peeling.Methods Immunohistochemical staining (ABC method) and transmission electron microscopy were used to investigate the skin of changes 15 cases of freckle.Results After phenol chemical peeling,the melansomes in basal layer cells decreased dramatically, the elastic and collagenous fibers in dermis enlarged ,and the skin thickened .Conclusions After phenol chemical peeling,the melansomes in cuticular layer cells decrease remarkably and the freckle disappears.The proliferative activitities of fibroblasts in dermis have been improved,resulting in thickness of elastic and collagenous fibers in dermis. It may be the reason why the skin delays to be aged.