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Objective:To explore the potential genetic causes of unexplained neonatal encephalopathy.Methods:This retrospective study enrolled 113 infants diagnosed with unexplained neonatal encephalopathy and underwent genetic testing in the Children's Hospital of Hunan Province from January 2019 to May 2021. Perinatal data, clinical manifestations, electroencephalograph, brain MRI findings, genetic information, and prognosis of those patients were analyzed. T-test or Chi-square test were used for data analysis. Results:Of the 113 infants enrolled, 74 (65.5%) were males. The gestational age at birth was (38.6±1.5) weeks, and the birth weight was (2 957±561) g. The most common clinical manifestation was the disturbance of consciousness (83/113, 73.5%), followed by seizures (39/113, 34.5%). There were 38.2% (34/89) of the patients with abnormal brain MRI, and 80.4% (74/92) presented abnormal electroencephalography. Among the 113 infants, 60 (53.1%) had genetic abnormalities, including 48 with single nucleotide variations, eight with copy number variations, and four with chromosome abnormalities. Single nucleotide variations in the 48 patients were classified into syndromic ( n=18, 37.5%), metabolic ( n=16, 33.3%), epileptic ( n=11, 22.9%) and mitochondrial-related genes ( n=3, 6.3%), of which 14 were not included in any database. Among the 103 cases which were successfully followed up until December 31, 2021, 75 (72.8%) had a poor prognosis, including 52 (50.5%) death cases and 23 (22.3%) cases of development retardation. Birth weight and the incidence of seizures in the poor prognosis group were both lower than those in the non-poor prognosis group [(2 876±536) vs (3 254±554) g, t=3.15; 29.3% (22/75) vs 53.6% (15/28), χ2=5.20; both P<0.05], while the incidence of disturbance of consciousness was higher [80.0% (60/75) vs 53.6% (15/28), χ2=7.19, P<0.05]. The proportion of infants with genetic abnormalities in the poor prognosis group was higher than that in the non-poor prognosis group, but the difference was not statistically significant [53.3% (40/75) vs 46.4% (13/28), χ2=0.39, P=0.533]. Conclusions:Genetic abnormality is one of the leading causes of unexplained neonatal encephalopathy. Nucleotide variation is the most common genetic type. Syndromic, metabolic, and epileptic variants are frequently detected in these patients.
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Objective:To study the risk factors of metabolic bone disease (MBD) associated fracture in very low birth weight premature infants.Methods:From January 2012 to December 2019, premature infants (gestational age <32 weeks, birth weight <1 500 g) were admitted to our hospital and followed-up regularly for 1.5 years (once every month within first 6 months, then once every 3 months). The infants were assigned into two groups according to X-ray diagnosis: the fracture group and the non-fracture group. The clinical data of the two groups were compared and the risk factors of fracture were analyzed.Results:A total of 62 preterm infants with MBD were included in this study, including 11 in the fracture group and 51 in the non-fracture group. The risk factors of MBD associated fracture included intrauterine growth restriction (IUGR), birth weight <1 000 g, gestational age, respiratory support duration and total parenteral nutrition (TPN) duration ( P<0.05). Logistic regression analysis showed that IUGR ( P<0.05, OR=2.159, 95% CI 1.536~2.759) and TPN duration ( P<0.05, OR=1.143, 95% CI 1.042~1.270) were independent risk factors for fracture. Serum alkaline phosphatase (ALP) in the fracture group was significantly higher than the non-fracture group and 25(OH)VitD was significantly lower than the non-fracture group ( P<0.05). Conclusions:IUGR and TPN duration are risk factors for MBD associated fracture in preterm infants. As biochemical markers of bone metabolism, ALP and 25(OH)VitD levels have clinical value predicting MBD associated fracture.
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Background and Objectives@#Adipose-derived stem cell (ADSC) transplantation improves stem cell paracrine function and can enhance wound healing. However, in diabetic patients, glucose-associated effects on this function and cell survival lead to impaired wound closure, thereby limiting ADSC transplantation efficiency. The hypoxia-inducible factor HIF-1α has an important protective function during wound healing. Here, we aim to clarify the regulatory mechanism of ADSCs. @*Methods@#and Results: ADSCs were isolated from BALB/C mice adipose samples. We then used high-throughput se-quencing to assess abnormal expression of circular RNAs (circRNAs). We also used an in vivo full-thickness skin defect mouse model to assess the effects of transplanted ADSC on diabetic wound closure. Hypoxic pretreatment of ADSCs accelerated diabetic wound closure, which enhanced angiogenic growth factor expression in our mouse model. High-throughput sequencing and RT-qPCR indicated that circ-Gcap14 was upregulated in hypoxic pretreated ADSCs. Similarly, circ-Gcap14 downregulation also decreased the therapeutic effects of ADSCs; however, circ-Gcap14 overexpression increased the effects of ADSC by promoting angiopoiesis. We also used a luciferase reporter assay to confirm that miR-18a-5p and HIF-1α were downstream targets of circ-Gcap14. HIF-1α expression plays an important role in increased VEGF level. @*Conclusions@#Based on our data, we suggest that circ-Gcap14 plays an important role in accelerating hypoxic ADSC-mediated diabetic wound closure, by enhancing mouse angiogenic growth factor expression and regulating downstream miR-18a-5p/HIF-1α expression.
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OBJECTIVE：To reference for the rational use of sodium va lproate in clinic. METHODS ：By retrospective analysis，blood concentration monitoring results of sodium valproate and medical record data in 856 patients were collected from the Affiliated Tianyou Hospital of Wuhan University of Science and Technology during Jan. 2016-Dec. 2018. The dosage form of sodium valproate ，monitoring times of therapeutic drugs ，monitoring results of steady-state blood concentration of sodium valproate up to the standard ，dosage adjustment and the combination with carbamazepin ，fluconazol and carbapenem drugs were analyzed. Fisher exact test was used to analyze the factors influencing the steady-state blood concentration of sodium valproate up to the standard. RESULTS ：A total of 1 270 cases of sodium valproate were monitored in 856 patients，involving 407 males and 449 females，with age of （38.2±13.8）years and body mass of （52.3±10.0）kg. Among 1 270 cases of monitoring ，steady-state blood concentration of sodium valproate in 554 cases were in the range of 50-100 µg/mL，and 43.6％ of which reached the standard. The rate of reaching the standard in patients with multiple monitoring was higher than patients with single monitoring ；the dosage of patients with last monitoring reaching the standard was higher than that of patients with the first monitoring reaching the standard. The rate of reaching the standard in Sodium valproate sustained-release tablet group was higher than general Sodium valproate tablet group；the carbamazepin/fluconazol free group was higher than the carbamazepin combination group and fluconazol combination group；the carbapenem free group was higher than the carbapenem combination group （all P＜0.05）. CONCLUSIONS ：Clinical pharmacists should pay attention to the monitoring of sodium valproate treatment drugs ， strengthen the publicity and 3551851542@qq.com education of patients and their families ，and try to use Sodium valproate sustained-release tablets. When patients additionally receive carbapenem drugs like carbamazepin or fluconazol ， the standard level of sodium valproate will be reduced ，then the dosage of sodium valproate should be adjusted.
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Objective To realize the clinical characteristics of fungemia in premature infants.Methods Clinical characteristics of fungemia in premature infants in the intensive care unit of a children''s hospital between January 2011 and December 2015 were analyzed retrospectively, general condition of premature infants, laboratory-related indicators, and antimicrobial susceptibility testing results were compared.Results From January 2011 to December 2015, 42 premature infants with confirmed fungemia were treated in this hospital, 22 (52.38％) of whom were with fungemia caused by Candida albicans(C.albicans), 13 (30.95％) by Candida parapsilosis (C.parapsilosis), 3 by Candida krusei (C.krusei), and 4 by other fungi.Patients were grouped according to the main pathogens causing infection: C.parapsilosis group and C.albicans group.Maternal genitourinary tract infection rate and incidence of fungal meningitis in C.albicans group were both higher than C.parapsilosis group(27.27％ vs 7.69％, 27.27％ vs 0.00％ respectively), peripherally inserted central catheter (PICC) rate in C.albicans group was lower than that in C.parapsilosis group(22.73％ vs 69.23％), platelet count in C.parapsilosis group was lower than C.albicans group, differences were all statistically significant (all P<0.05).Conclusion The major fungi causing fungemia in premature infants were C.parapsilosis and C.albicans, maternal reproductive system infection during pregnancy can easily lead to candidemia, premature infants with candidemia are more vulnerable to developing fungal meningitis;PICC is more likely to lead to C.parapsilosis fungemia, and platelet decline is more obvious.
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Objective To discuss the effects of citral on adhesion and aggregation of platelets induced by AA(arachidonic acid)for clinical treatment and prevention of thrombotic diseases. Methods Evaluation of citral on adhesion and aggregation of platelets induced by AA were processed by multimode reader. Results There was significant difference in inhibiting aggregation of platelets between the control group and the drug group in a concen-tration of 111 μg/mL of citral.A series of concentration of citral also contributed the same effect in concentration of 25,30,35 mmol/L of AA. Conclusions The most effective concentration of citral is 111 μg/mL in inhibiting aggregation of platelets.The citral has an effect in inhibiting aggregation of platelets.
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Objective To investigate the effects of Delta-opioid receptor activator DADLE on the expression of the p38 MAPK and the neuronal apoptosis after global cerebral ischemia-reperfusion and explore the neuroprotective mechanisms of DADLE.Methods Global cerebral ischmemia-reperfusion models in rats were induced by bilateral common carotid artery occlusion combined with hypotension.Rats were randomly divided into sham group (n=10),ischemia-reperfusion group(n=10) and three treatment groups with different doses of DADLE (2 mg group,3 mg group,5 mg group,n=10).TUNEL method and Western blot analysis were used to measure apoptotic neurons and expression levels of p38 MAPK phosphorylation,repectively.Results DADLE treatment significantly reduced neuron apoptosis (P＜0.05).The expression levels of p38 MAPK were increased in ischemia-reperfusion group than in sham group (P＜ 0.05).In DADLE treated groups,the expression levels of p38 MAPK were dose-dependently decreased compared with the ischemia-reperfusion group.Conclusion Delta-opioid receptor activator DADLE can be neuroprotective against global I/R injury.Attenuation of apoptosis and p38 MAPK signal pathway might be involved in the neuroprotective mechanism of DADLE.
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Objective To investigate the effects of Delta-opioid receptor activator DADLE on the expression of the p38 MAPK and the neuronal apoptosis after global cerebral ischemia-reperfusion and explore the neuroprotective mechanisms of DADLE.Methods Global cerebral ischmemia-reperfusion models in rats were induced by bilateral common carotid artery occlusion combined with hypotension.Rats were randomly divided into sham group (n=10),ischemia-reperfusion group(n=10) and three treatment groups with different doses of DADLE (2 mg group,3 mg group,5 mg group,n=10).TUNEL method and Western blot analysis were used to measure apoptotic neurons and expression levels of p38 MAPK phosphorylation,repectively.Results DADLE treatment significantly reduced neuron apoptosis (P＜0.05).The expression levels of p38 MAPK were increased in ischemia-reperfusion group than in sham group (P＜ 0.05).In DADLE treated groups,the expression levels of p38 MAPK were dose-dependently decreased compared with the ischemia-reperfusion group.Conclusion Delta-opioid receptor activator DADLE can be neuroprotective against global I/R injury.Attenuation of apoptosis and p38 MAPK signal pathway might be involved in the neuroprotective mechanism of DADLE.
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Objective To study the clinical features and follow-up of newborns with severe hypoxic-ischemic encephalopathy ( HIE) , and to provide the basis for rational diagnosis, treatment and follow-up.Methods Clinical data of cases of HIE from the Neonatal Department of our Hospital from January 2011 to October 2014 were studied retrospectively. The data of general information, laboratory examination, treatment, outcome, follow-up and prognosis of the patients were collected. Multivariate logistic regression analysis was used to study the influential factors of the prognosis of HIE.Results A total of 123 infants with sever HIE were enrolled in our study. In addition to general therapy, 6 cases were treated with mild hypothermia, and 21 cases were treated with high pressure oxygen. 60 cases improved our treatment, 55 cases had withdrawal treatment with parental consent, and 8 cases died. Single factor analysis showed that 5 minutes Apgar score, convulsions, coma, pH, BE, organ injury, and mild hypothermia treatment were the risk factors that affect the prognosis of severe HIE. Multiple factors analysis showed that 5 min Apgar score <3 points ( OR=4. 071 ,95℅CI 1. 309-15. 613 ) and BE≤-10 mmol/L ( OR=36. 810, 95℅CI 5. 913-41. 119) were independent risk factors of prognosis of severe HIE ( P<0. 05). Hospitalization within the first 72 hours of life ( OR=0. 096, 95℅CI 0. 096-0. 353) was a protective factor of severe HIE. Multiorgan injury ( mainly the injury of brain, lung and heart) and electrolyte imbalance ( mainly hypocalcemia and hyponatremia ) were common complications of serve HIE. In the follow-up of these patients, 33 cases were loss in follow up, and 49 cases died (8 cases died during hospitalization, 41 cases died after withdrawal of treatment). The top five causes of death were abandonment of treatment due to financial reasons and the fear of adverse outcome (n=20), multiple organ dysfunction ( n =16 ) , and pneumothorax ( n =4 ) , diffuse intravascular coagulation (n=6), and shock (n=3). 41 cases survived were followed up for 9~54 months. The critical clinical conditions observed among these infants included cerebral palsy ( n = 5 ) , epilepsy ( n = 3 ) and developmental retardation(n=26).Conclusions There are many complications of severe HIE.The mortality of severe HIE is high, and the incidence of poor outcome of survivors is also high. Timely detection of risk factors is the key to the prevention of severe HIE. Long-term prognosis of severe HIE requires proper organization of neonatal follow up.
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Objective To evaluate the clinical efficacy of nerve-related acupoints electrical stimulation in preventing urinary retention after hemorrhoid surgery. Method Ninety-seven patients were randomized into two groups: the treatment group received nerve-related acupoints electrical stimulation 1 h after Milligan-Morgan hemorrhoidectomy for mixed hemorrhoids, while the control group was taken as a blank control. The incidence of postoperative urinary retention, residual urine volume after the first urination, general urinary condition score, and satisfaction evaluation were compared between the two groups. Result The incidence of postoperative urinary retention and residual urine volume after the first urinary were lower, and the general urination condition and satisfaction evaluation were higher in the treatment group compared to those in the control group. Conclusion Nerve-related acupoints electrical stimulation can prevent and reduce the adverse reactions such as urinary retention after hemorrhoidectomy, and it can effectively protect the bladder function and improve the prognosis.
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Objective To determine the significance of MDR -1 and MRP mRNA expression in periph-eral blood lymphocytes in lung cancer patients with chemotherapy treatment .Methods Peripheral blood samples were taken from each lung cancer patient before chemotherapy and three weeks after the first chemotherapy cycle . The expressions of MDR-1 and MRP were tested for 39 lung cancer cases using RT -PCR technique comparing to 20 normal control cases .Results There was no significant difference for MDR -1 mRNA and MRP mRNA ex-isting in lung cancer cases and control group (P>0.05).MDR-1 and MRP mRNA expressions were increased after treatment of chemotherapy courses in almost all pathological types of lung cancer .Furthermore,the expres-sion level in small cell lung cancer after chemotherapy was significantly higher than that before .Conclusion Chemotherapy may induce the incidence rate of MDR -1mRNA and MRP mRNA expression in lung cancer .Ade-nocarcinoma and squamous cell carcinoma are mainly intrinsic MDR while small cell lung cancer is mainly ac -quired MDR to chemotherapy .Based on the positive expression rate of MDR -1 mRNA and MRP mRNA in pe-ripheral blood ,we may evaluate the results of chemotherapy in lung cancer patients easily and conveniently .
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Purpose To investigate the expression of OTUB1 in colon cancer and the relationship between its expression and some clinicopathologic parameters. Methods Quantitative real-time PCR and immunohistochemical SP method were carried out in selected colon cancer and normal mucosa tissues. Results OTUB1 mRNA in colon cancer was 3. 5-fold higher than the normal mucosa. The expression of OTUB1 protein in the colon cancer was significantly higher than normal mucosa (P<0. 05). Moreover, its expression in normal tissues, adenoma and colon cancer showed a gradually increasing trend (P<0. 05). The higher expression of OTUB1 in colon cancer was related with tumor size, differentiation and lymph node metastasis. Conclusions OTUB1 may play an important role in co-lon cancer development.
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ischemia reperfusion model .DADLE might have a protective effect on lung tissues of ALI in rats .
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Objective To investigate the effects of cell proliferation and apoptasis on the develop-ment of gastric mucosal lesion in patients with primary pathological duodena-gastric reflux (DGR). Methods Gastroscopy, histologie examination of gastric mucosal biopsy and 24-hour intra-gastric bilirubin monitoring with Bilitec 2000 were performed in 58 patients with primary pathological DGR. Immunohisto-chemical staining was used to detect the expressions of Ki-67 and Bcl-2 proteins. Cell apoptosis in gastric mucesa was determined by TUNEL technique. Results The proliferating index (PI) and apoptosis index (AI) in patients with primary pathological DGR were significantly higher than those in control group (P< 0.05). The differences of PI and AI between high reflux group and low reflux group were significant (P< 0.05). The incidence difference of chronic superficial gastritis (CSG) and chronic atrophic gastritis (CAG) in gastric antrum between the two groups was significant (P<0.05). With lesion progressing from normal gastric mucosa, CSG, CAG to intestinal metaplasia (IM), PI and AI increased gradually and consistently. PI was still on the rise after dysplasia (Dys), but AI decreased. The positive expression rate of Ki-67 in Dys were significantly higher than that of other groups (P<0.05), so was that of Bcl-2 (P<0.05). Conclusion Cell proliferation and apoptesis may be one aspect of the main pathogenesis of gastric mucesa lesion and cell dysplasia in patients with primary pathological DGR. Over-expreasion of Ki-67 and Bcl-2 proteins in CAG, IM and Dys may play a key role in the development of gastric cancer.
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Objective To monitor the resistance of Streptococcus pneumoniae following the 2004 in Qingdao area, and to provide a reasonable basis for clinical application of antimicrobial agents. Methods Collecting respiratory tract, blood, cerebrospinal fluid and other specimens from out-patient and in-patients of some hospital in Qingdao from January 2005 to December 2008. According to the recommendation of NCCLS, antibiotic resistance analysis of 11 kinds of antibiotic to the isolated 231 Streptococcus pneumoniae by micro-agar dilution method, and analysis resistance trends and age differences. Results The results showed that the rate of Streptococcus pneumoniae not sensitive to penicillin is 23. 38% (PRSP: 9.52% , PISP: 13. 85% ) , resistant to cefotaxime is 9. 96% (23/231), resistant to amoxicillin is 12. 55% , resistant to erythromycin is 90. 48% (209/231). PRSP rate of patients younger than 14 years of age 27. 91% (12/43), significantly higher than that of the PRSP rate of adults 5. 38% (10/186). Conclusion The rate of resistant to penicillin Streptococcus pneumoniae increased significantly from 2004, and an increasing trend year by year, the resistance of Streptococcus pneumoniae is also a rising trend year by year. For patients infected low penicillin-resistant Streptococcus pneumoniae in this region, cefotaxime, amoxicillin are preferred drugs.
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Objective To explore the therapeutic effects and the possible defense mechanisms of Shenmai injection on acute lung injury.Methods SD rats were randomly divided into three groups:the control group(NS),the oleic acid group(OA)and the Shenmai injection group(SM).The modal of acute lung injury in rat(OA group and SM group)were induced by receiveing 0.1ml/kg oleic acid injection into tail vein,and NS group were injected 0.9% sodium chloride 0.1ml/kg.After in jecting loeic acid SM group were injected with Shenmai injection by 2ml each one.The expression of ICAM-1 was examined meanwhile examining breath frequency,wet/dry weight ratio,artery blood oxygen each group of rats,the histopathologieal change of lung tissue was observed.Results The W/D ratio,polymorphonuclear(PMN)infiltration,the lung interstitial edema,the extent of pulmonary alvedus wall destroys and the ICAM-1 expression in lung tissue of OA group increasingly increased compared with NS group,and SM group significantly decreased compared with OA group.Also along with time extending,the ICAM-1 expression of OA group devates gradually,while SM group does not change significantly.The arterial partial pressure of oxygen in group OA significantly decreased compared with NS group,while SM group increased compared with OA group.The microscope demonstrated that the extent of lung injury of OA group was more serious than that of NS group,while OA group was milder than OA group.Conclusion Shenmai injection can lighten oleic acid induced acute lung iniury,and cut down the expression of ICAM-1 in lung tissue.So it has a certain function to the early the acute lung injury.
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Objective To study the association among gastric mucosal lesions caused by primary pathological duodenogastric reflux(DGR),H.pylori infection,and bile reflux.Methods Twenty-four hour intragastric bilirubin monitoring were performed on 58 patients with primary pathological DGR.The patients were divided into high reflux group(n=29)and lOW reflux group(n=29)based on the severity of bile reflux(＜23.60%).The association among gastric mucosal lesions,H.pylori infection,and bile reflux were analyzed.Results The positive rate of H.pylori infection was 20.7% (6/29)in high reflux group and 48.3%(14/29)in low reflux group(P＜0.05).The frequency of intestinal metaplasia in gastric antrum and angularis in high reflux group was higher than that in low reflux group(P＜0.05).The pathological scores of gastric antrum and angularis in H.pylori positive group and high reflux group were higher than those in H.pylori negative group and low reflux group (P＜0.05).The time percentage of bilirubin absorbance≥0.25 in H.pylori positive group was lower than that in negative group(P＜0.05),while the difference in short reflux frequency,long reflux frequency,longest reflux time,maximum,mean and median value of absorbance between H.pylori positive and negative groups showed no significant difference(P＞0.05).The time percentage of bilirubin absorbance≥0.25 was positively correlated with pathological scores of gastric antrum and angularis in both H.pylori positive and negative groups(P＜0.05),but was not correlated with that of gastric body(P＞0.05).Conclusions In patients with primary pathological DGR,excessive bile reflux is related to chronic lesion of gastric mucosa.regardless of H.pylori infection.Bile reflux may inhibit H.pylori to locate in gastric mucosa.H.pylori infection and bile reflux may co-contribute to gastric mucosal lesions.
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Objective To investigate the functional changes of anastomosed vascular or neurovascular mini-muscle transfer and to provide experimental data to clinical application. Methods 32 New Zealand rabbits were operated on by anastomosed neurovascular mini-muscle transfer. In group A, 16 rabbits accepted the anastomosed vascular mini-muscle transfer. In group B, 16 rabbits accepted the anastomosed neurovascular mini-muscle transfer. The electromyography was measured 2 months and 3 months after operation. Results The amplitude of electrical muscle graph (EMG) data in the group A was (2.02±0.41)mV 2 months after operation, and (1.73±0.18) mV 3 months after operation. The EMG data in the group B was (3.90±0.52) mV 2 months after operation and (3.35±0.86) mV 3months after opera-tion. The difference between the two groups was significant (P<0.01). The EMG of anastomosed neu-rovasular mini-muscle transfer was significantly greater than that of anastomosed vasular transfer only.There was no significant difference in latent period of EMG between the two groups (P>0.05). Conclu-sions The muscle functional recovery of anastomosed neurovascular mini-muscle transfer is significant with less demage and no secondary deformity. The results suggest that this technique is worthy to apply for treating facial paralysis.
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OBJECTIVE To study and evaluate the value of the antibiotic-neutralized culture bottle applied by manual operations.METHODS A total of 711 blood samples were collected from clinical high fever patients in Qingdao Central Hospital from 2002 to 2005.To compare the bacteria detected rates,cultural time and bacteria types in 399 samples cultured in manual blood-culture bottles with those in 312 samples cultured in antibiotic-neutralized culture bottles applied by manual operations.RESULTS The bacteria detected rates were 10.28% in manual blood-culture bottles and 20.83% in antibiotic-neutralized culture bottles applied by manual operations.There was significant difference between both of them(P72h were no statistical difference between manual blood-culture bottles and antibiotic-neutralized culture bottles.Twenty species of bacteria were detected in manual blood-culture bottles and 29 species of bacteria in antibiotic-neutralized culture bottles applied by manual operations.CONCLUSIONS The bacteria detected rate and species of bacteria were more obviously raised in antibiotic-neutralized culture bottles applied by manual operations than in manual blood-culture bottles.
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<p><b>OBJECTIVE</b>The purpose of this study was to provide the guidelines with respect to the location of the facial vessels, observe the potential reversed flow of the facial artery, and reemphasize the value of color Doppler ultrasound studies in flap planning.</p><p><b>METHODS</b>A study was carried out to investigate the location and dynamics of the facial artery and vein using color Doppler ultrasonography in 12 adults.</p><p><b>RESULTS</b>The facial artery and the vein were located together at the lower border of the mandible. Around the oral commissure and under the nasal ala, they run apart from each other at variable distances. The reverse flow was observed in the 12 patients after the blood flow of the facial artery was blocked by applying pressure manually at the lower border of the mandible.</p><p><b>CONCLUSIONS</b>The divergence of the facial vein from the artery is important information in planning of axial pattern flaps. Observation of the reversed flow confirms the possibility of safe elevation of a retrograde flow-arterialized flap based on the distal portion of the facial artery.</p>