Objective:To explore the application of biomechanics principle in the repair of double eyelid disappearance after blepharoplasty.Methods:A retrospective analysis was performed on 47 patients (46 females and 1 male) with double eyelid disappearance after blepharoplasty in the Department of Plastic and Cosmetic Surgery, Friendship Plastic Surgical Hospital from July 2018 to December 2022. The patients aged from 19-42 (28±8) years. The repair surgery was performed by increasing the mechanical factors that promoted the double eyelid formation or weakening the mechanical factors that inhibited the double eyelid formation. The overall satisfaction with ocular appearance, and psychological well-being and social function were evaluated with the Face-Q qustionnaires before or after operation.Results:By following-up for 3-24 months, the morphology of upper eyelids in all 47 patients were remarkably improved. 2 patients complained about asymmetry and 1 patient had multiple creases, for whom satisfactory results achieved after re-operation. The remaining patients presented smooth natural double eyelid line, and concave groove deformity when eyes closed were not noticed. The operative effects were satisfactory. After surgery, the scores for ocular satisfaction with facial appearance, psychological well-being and social function were (69.5±10.3), (75.5±13.6) and (68.3±11.3) scores, which were significantly increased than those before operation [(38.7±9.3), (54.8±10.5) and (52.3±8.7) scores], respectively (all P<0.05). Conclusion:More effective and reliable operation results can be obtained in the repair strategies of double eyelid disappearance after blepharoplasty by utilizing the biomechanical mechanism.

Objective:To study the improvement of normal tissue region of interest (ROI) segmentation based on clustering-based multi-Atlas segmentation method, thereby achieving better delineation of organs at risk.Methods:CT images of 100 patients with cervical cancer who had completed treatment in Zhejiang Cancer Hospital during 2019-2020 were selected as the Atlas database. According to the volume characteristic parameters of the organs at risk (bladder, rectum and outer contour), the Atlas database was divided into several subsets by k-means clustering algorithm. The image to be segmented was matched to the corresponding Atlas library for multi-Atlas segmentation. The dice similarity coefficient (DSC) was used to evaluate the segmentation results.Results:Using 30 patients as the test set, the sub-Atlas generated by different clustering methods were compared for the improvement of image segmentation results. Compared with general multi-Atlas segmentation methods, clustering-based multi-Atlas segmentation method significantly improve the segmentation accuracy for the bladder (DSC=0.83±0.09 vs. 0.69±0.15, P<0.001) and the rectum (0.7±0.07 vs. 0.56±0.16, P<0.001), but no statistical significance was observed for left and right femoral head (0.92±0.04, 0.91±0.02) and bone marrow (0.91±0.06). The average segmentation time of clustering-based multi-Atlas segmentation method was shorter than that of the general multi-Atlas segmentation method (2.7 min vs. 6.3 min). Conclusion:The clustering-based multi-Atlas segmentation method can not only reduce the number of Atlas images registered with the image to be segmented, but also can be expected to improve the segmentation effect and obtain higher accuracy.

Polyetheretherketone (PEEK) as a new type of thermoplastic engineering plastic, has good biological activity, elastic modulus close to human cortical bone and radiation permeability, and has been widely used in medical field. This study aims to explore the safety and clinical efficacy of using 3D printing personalized PEEK materials to repaire scapular bone defects after bone tumor resection. A total of 6 patients who underwent the implantation of 3D printed PEEK scapular prosthesis from January 2020 to December 2021 in Yunnan Cancer Hospital were retrospectively analyzed. There were 3 males and 3 females, with age ranged from 14 to 52 years. There were 1 case of synovial sarcoma, 1 of Ewing's sarcoma, and 4 of chondrosarcoma. PEEK prosthesis was designed and fabricated based on CT data before surgery. Tumor resection and prosthesis replacement were performed under the premise of ensuring safe surgical boundaries, including 2 cases of total scapular prosthesis replacement and 4 cases of partial scapular prosthesis replacement. The operation time was 90-170 min, and the intraoperative blood loss was 100-400 ml. All 6 patients received satisfactory follow-up, with a tumor progression free survival time of 16-28 months. No tumor recurrence or metastasis was observed, and all patients survived tumor free. At last follow-up, the Constant-Murley shoulder joint score was a minimum of 62 points and a maximum of 68 points. The Japanese Orthopaedic Association's shoulder joint score was 63 points minimum and 78 points maximum. Computer-aided design 3D printing PEEK material prosthesis has certain advantages in the treatment of scapular tumor limb salvage. It has light weight, well adapted, relatively simple installation, good histocompatibility, and can obtain a better appearance and function of the shoulder joint after operation. It can become one of the options for limb salvage treatment of scapular tumor.

ObjectiveTo perform the analysis of influenza surveillance in Dehong from 2016 to 2020 and determine the epidemic situation of influenza and prevalent virus strains， so as to provide evidence for local influenza prevention and control. MethodsThe influenza surveillance data in Dehong Prefecture was collected from January 2016 to December 2020. Statistical analysis was conducted by descriptive epidemiological methods. ResultsA total of 4 146 samples from influenza-like illness cases were examined. The 502 specimens tested positive for influenza virus， including 311 cases with influenza A virus and 136 cases with influenza B virus， resulting in a positive rate of 12.11%. The positive rate was the highest in 2017， followed by 2019， and the lowest in 2020 （P < 0.05）. It peaked in winter and fall. Furthermore， it was the lowest among children aged 0‒4 years and the highest among adults aged 25‒59 （P < 0.001）. In addition， positive rate did not differ significantly by gender（P>0.05） ConclusionThe positive rate of influenza has decreased in Dehong since January 2020. The influenza epidemic is seasonal， mainly in fall and winter， except 2020. Influenza A virus is predominant， compared to alternating influenza B virus.

Lateral epicondylitis is a common clinical disease with characteristics of lateral elbow pain, insidious onset and easy recurrence, which can cause forearm pain and decreased wrist strength, seriously affecting patients′ daily life and work. Although there are various treatment methods for lateral epicondylitis with different effects, standard treatments are still lacking nowadays. Platelet-rich plasma (PRP) has good effects on bone and tendon repair, and is now widely used in the treatment of lateral epicondylitis. However, there is a lack of a unified understanding of the technology and specifications of PRP in the treatment of lateral epicondylitis. Therefore, the Sports Medicine Branch of the Chinese Medical Association and Physical Medicine and Rehabilitation Branch of the Chinese Medical Association organized experts in the fields of sports medicine and rehabilitation medicine in China to formulate the "clinical expert consensus on platelet-rich plasma treatment for lateral epicondylitis (2022 version)", and proposed suggestions based on evidence-based medicine mainly from the concept, epidemiology and pathophysiology of lateral epicondylitis, symptoms, signs and imaging manifestations of lateral epicondylitis, PRP concept and application component requirements, quality control of PRP preparation technology, indications and contraindications of PRP in the treatment of lateral epicondylitis, PRP injection in the treatment of lateral epicondylitis, application of PRP in the operation of lateral epicondylitis, related problems after PRP treatment of lateral epicondylitis, evaluation of the results after PRP treatment of lateral epicondylitis, and health and economic evaluation of PRP treatment of lateral epicondylitis, so as to provide guidance for clinical diagnosis and treatment.

Objective: To investigate the clinical characteristics and prognosis of children B-cell acute lymphoblastic leukemia (B-ALL) with TEL-AML1 fusion gene positive. Methods: Clinical characteristics, therapeutic effects and prognostic factors of 55 children B-ALL patients with TEL-AML1 fusion gene positive in Children's Hospital of Shanxi from January 2013 to June 2018 were retrospectively analyzed. Kaplan-Meier method was used to evaluate 3-year event-free survival (EFS) rate and overall survival (OS) rate. Influencing factors of EFS and OS were evaluated by using Cox regression analysis. Results: TEL-AML1 fusion gene was positive in all 55 children, and no other fusion gene positive was merged. There were 4 patients (7.3%) ≥10 years old. At initial diagnosis, 33 patients (60.0%) had hepatomegaly, 28 patients (50.9%) had splenomegaly, and 27 patients (49.1%) had superficial lymphadenectasis. There were 5 patients (9.1%) with white blood cell count ≥50×10⁹/L, and 19 patients (34.6%) had abnormalities of chromosome. All the 55 children were divided into the low risk group [36 cases (65.5%)], the intermediate risk group [18 cases(32.7%)], high risk group [1 case (1.8%)] according to Morphology, Immunology, Cytogenetics and Molecular Biology (MICM) and adjusted risk. After regular treatments, 50 patients achieved complete remission (CR) on the 15th day. The CR rate after one-course of induction therapy was 100.0%. On the 33rd day, 43 patients (78.2%) had minimal residual disease (MRD) <10^-4, 12 patients (21.8%) had MRD≥10^-4 and MRD<10^-2, 1 patient (1.8%) had MRD≥10^-3 at the 12th week. During three to six months, the negative rate of fusion gene was 61.8% (34/55). There were 3 deaths (5.5%), and one (1.8%) of them died of recurrence, and the recurrence time was 27 months from the initial diagnosis; the other 2 cases (3.6%) died of infection during chemotherapy. In 55 patients, the 3-year EFS rate and OS rate was 90.3% and 93.2%, respectively. The 3-year EFS rate and OS rate in the low risk group was 100.0% both; the 3-year EFS rate and OS rate in the intermediate risk group was 78.7% and 86.6%, respectively; the 3-year EFS rate and OS rate in the high risk group was 0 both and one died. EFS rate and OS rate in low risk group were higher than those in the intermediate risk group, and the differences were statistically significant (P < 0.05). The EFS rate was 92.0% and 0 at the 12th week MRD<10^-3 group and MRD≥10^-3 group, and OS rate was 95.0% and 0 at the 12th week MRD<10^-3 group and MRD≥10^-3 group (P < 0.05). Cox multivariate analysis showed that MRD at the 12th week was an independent risk factor influencing EFS and OS (OR= 2.971, 95% CI 1.330-6.633, P= 0.008; OR= 2.884, 95% CI 1.295-6.419, P= 0.009). Conclusions Children B-ALL patients with TEL-AML1 fusion gene positive have a low recurrence rate, high survival rate and good prognosis. Risk stratification and the 12th week MRD are the influencing factors of the prognosis.

[Objective]To compare and contrast the dosimetry between Tomo planning and BrainLab planning for lung metasta-ses in stereotactic body radiation therapy(SBRT).[Methods]Four Patients with one,two,three and four metastases were selected. The PTV is 2.89 ± 1.15 cm3. Two plannings with total dose of 50 Gy to cover 95% of PTV ,5 Gy/Fraction and 10 fractions were designed using Tomo planning system and BrainLab planning system respectively. The DVH curves of spinal cord ,both lungs and normal tissue were compared. The conformity index andhomogeneityindex were analyzed as well.[Results]The homogeneity index (HI)and conformity index(CI)of the targets in Tomo planning system were 1.0314 ± 0.0700 and 0.687 ± 0.075,respectively. In BrainLab planning system the HI and CI of the targets were 1.0764 ± 0.1241 and 0.571 ± 0.042,respectively. To HI the P value in T test was less than 0.01 and the HI was better in Tomo than BrainLab and so was CI. The dose to spinal cord was higher in BrainLab planning system than that in Tomo. The dose to nomal tissue and both lungs were not different in the two planning systems and V20 of lung is as small as 10%.[Conclusions]For small volume lung metastases which longest diameter were less than 4 cm,the tomotherapy should be better choice.

Objective To analyze the effect of the rhinoplasty on body image in the patients receiving cosmetic surgery,to investigate the change of postoperative body image disturbance(BDD)and to analyze the influencing factors of preoperative BDD in order to provide a basis for the psychological health management and reference for the diagnosis and treatment of plastic surgery.Methods A prospective study was performed on 84 patients with rhinoplasty admitted to the Affiliated Friendship Aesthetic Plastic Surgery Hospital of Nanjing Medical University from January 2015 to March 2016.The general data were investigated.The Plastic Psychological State Self-rating Scale was adopted to evaluate the patient′s body image situation,which was reexamined at postoperative 1-3 months.Results The preoperative non-BDD accounted for 60.71％,the occurrence rate of BDD was 19.05％,the other mental disorders,mental diseases or nervous system disease which had no relation with the BDD accounted for 20.24％;the occurrence rate of postoperative BDD was significantly lower than that of preoperative BDD(P＜0.05),moreover the patients with non-BDD had no postoperative BDD occurrence.The scores of question 1-10 before operation in the BDD group were higher than those in the non-BDD group,the scores of question 1-4 after operation in the non-BDD group were decreased,the scores of question 1-4,6-10 in the BDD group were decreased,while the scores of question 1,7,9-10 in the BDD group were higher than those in the non-BDD group(P＜0.05).The proportion of preoperative rhinoplasty and plastic surgery in the BDD group was higher than that in the non-BDD group,the difference was statistically significant(P＜0.05).Conclusion The occurrence rate of BDD in the patients with rhinoplasty is higher,operation is conducive to lessen the BDD,moreover operation itself will not result in new BDD.

Objective To explore the clinical effect of endoscopic-assisted intraoral reduction mandibuloplasty.Methods From January 2010 to December 2014,a total of 186 patients with prominent mandibular angles underwent one stage long-curved ostectomy combined with splitting corticectomy through an intraoral approach with endoscopic assistence according to preoperative design for reduction mandible three-dimensionally,and achieved reduced width of the lower face with smooth curve of mandibular edge.The distance between both gonions was measured and the complications recorded to evaluate the clinical effect of the surgery during follow-up.Results All the 186 patients had no complications of bleeding and infection.The mean distance between both gonions measurement was (117.3±2.5) mm before surgery and (102.6±2.3) mm after operation;it was reduced (14.1 ±2.4)mm.After 1 month to 2 years of follow up,the width of the lower face was reduced in the frontal view and the mandibular angle appeared natural and inconspicuous in the lateral view.The patients were satisfied with both their frontal and lateral appearances.Conclusions Intraoral approach mandibular ostectomy with endoscopic-assisted allows surgeons to perform accurate,safe and reproducible ostectomies and to recontour mandible symmetrically and reduce the complications.

Objective To observe the effect of hyperbaric oxygen therapy (HBOT) on mineral density and biomechanics of new-formed bone in distraction gap.Methods The mandibles were subjected to osteotomy and distractors were placed bilaterly in 30 rabbits,which were divided randomly into 2 groups.After 5 days for latency,the mandibles were distracted at a rate of 0.8 mm/day for 10 days,and then for consolidation.After surgery,group A received HBOT with daily distraction,whereas group B only distracted without HBOT served as control group.The animals in groups A and B were sacrificed 1 wk,2 wk,4 wk of consolidation,respectively.The mandibles were harvested and subjected to examination for new bone formation,and bone mineral density (BMD) and biomechanics of newly formed bone in the distraction gap.Results At one week of consolidation,no significant differences were observed between the BMD of newly formed bone in the two groups (P＞0.05);however,at the other time points,BMD of newly formed bone in group A was significantly higher than that in group B (P＜0.05).Moreover,at 4 weeks of consolidation,the strength,maximum fragile energy and modulus of elasticity of newly formed bone in group A were significantly higher than those in group B (P＜0.05).Conclusions The results suggest that HBOT improves mineral density and strength of new formed bone in distraction gap.