Objective To observe the clinic efficacy of open transforaminal lumbar interbody fusion (TLIF) compared with minimally invasive operation in treating lumbar spinal stenosis and instability among obese and non‐obese patients .Methods A ret‐rospective analysis was performed in these cases of mono‐segmental lumbar spinal stenosis and instability between January 2011 and January 2013 .Perioperative index ,clinical efficacy ,and imaging results were observed and compared between different groups .Re‐sults Thirty‐four obese cases and 105 non‐obese cases were divided into two groups ,including conventional posterior open TLIF and minimally invasive TLIF operation ,to compare the results .Perioperative indexes of obese patients were more than non‐obese patients undergone open TLIF operation way and there was significant difference(P<0 .01);while by minimally invasiveTLIF oper‐ation way ,comparing the results of the surgical blood loss and incision size between obese and non‐obese group ,there was signifi‐cant difference(P<0 .05) .However ,there was not significant difference in the operative time between two groups(P>0 .05) .No cases of slippage or breakage of implants were found among all these patients after 6 months of follow up .Postoperative VAS and ODI among these four groups were better than before(P<0 .01) .Undergoing open postoperative VAS in obese group and in non‐obese group ,there was significant difference(P< 0 .05);undergoing minimally invasive postoperative ODI in obese group and in non‐obese group ,there was significant difference(P< 0 .05) .But ,undergoing open postoperative ODI in obese group and in non‐obese group ,there was not significant difference(P>0 .05);undergoing minimally invasive postoperative VAS in obese group and in non‐obese group ,there was not significant difference(P>0 .05) .Conclusion Therefore ,obese may be risk factor in treating lumbar spinal stenosis and instability .

BACKGROUND:Hyperbaric oxygen (HBO) therapy can aleviate the skin flap congestion by improving the angiogenesis and increasing the oxygen content of blood in skin flaps. Although the HBO therapy ability to increase flap survival has been wel described, the research on the application of HBO pretreatment in skin flap transplantation does not arouse adequate concern.
OBJECTIVE: To investigate the effect of HBO pretreatment on early-stage flap congestion in the rat model of over-length dorsal random skin flaps.
METHODS: Thirty-six SD rats were randomly divided into control group (n=12), HBO pretreatment group (n=12) and HBO treatment group (n=12). Rats in the HBO pretreatment group received 4 days of HBO therapy prior to transplantation, once a day. Rats in the HBO treatment group received 4 days of HBO therapy after transplantation. Rats in the control group were raised in the normal conditions after flap transplantation. At postoperative days 3 and 5, rats were sacrificed and the samples were colected. The inflammation of flap tissues was detected using hematoxylin-eosin staining. The expression of vascular endothelial growth factor and transforming growth factor-β was analyzed by immunohistochemistry staining. The flap survival rate was calculated at postoperative day 5.
RESULTS AND CONCLUSION:The flap survival area of the HBO pretreatment group and HBO treatment group was larger than that of the control group (P < 0.05). At postoperative days 3 and 5, the expression levels of vascular endothelial growth factor and transforming growth factor-β in the flap tissue were higher in the HBO pretreatment group and HBO treatment group than the control group (P < 0.05). However, there was no significant difference in the flap survival area and the expression of vascular endothelial growth factor and transforming growth factor-β between HBO pretreatment and HBO treatment groups (P > 0.05). HBO pretreatment can increase the expression of vascular endothelial growth factor and transforming growth factor-β and promotes angiogenesis in random pattern flaps,thereby improving skin flap survival.

Objective To explore the effect of reconstructing unilateral cleft lip by changing the arc-shaped incision, combined with the 3D reconstruction of upper lip muscles.Methods Twenty unilateral cleft lip patients were treated by using a new surgical operation, the 3D reconstruction of upper lip muscle, to restore normal anatomy and stress of the mucous membrane, muscle and skin.Operation scar was designed for straight line, located on the philtral ridges of the contour line;phitrum and philtral ridges were rebuilt, and postoperative scar reduced.Results A lot of 20 patients had no local infection, hemorrhage, complex crack, and were stage I incision healing.Followed up for 1-8 months postoperatively, the patient's lip bow line continuity was good, with symmetrical shape and good phitrum and philtral ridges;scar was hidden on the philtral ridges of the contour line, and no obvious upper lip scar contracture found through the follow-up period.Conclusions This improved method is simple in the incision design, and less scar hidden on the philtral ridges of the contour line after operation, which can maximize the recovery of the appearance of nose and upper lip with satisfactory effect.It is a feasible improvement method of repairing unilateral cleft lip.

Objective: To study the expression of TNF-α and PCNA in human breast tissue with polyacrylamide hydrogel(PAHG) injection, and to provide the initial theory basis for its prognosis and clinical treatment. Methods: Immunohistochemistry was used to measure the expression of tumor necrosis factor α(TNF-α)and proliferating cell nuclear antigen (PCNA) in 20 normal breast tissues and 40 cases with PAHG injection, analysis was also done by HE staining. Results: ①HE staining showed that there were a large number of homogeneous amorphous gel-like injections under optical microscope. Around PAHG there were different degrees of fibrous tissue hyperplasia with or without fibrous degeneration and lots of inflammatory cells. Local foreign body giant cell reaction and ductal dilatation also can be seen around PAHG. ②The IA levels of TNF-α and PCNA in the experimental group were 3.9± 0.3 and 3.2 ± 0.2, the IA levels of TNF-α and PCNA in the control group were 1.0 ± 0.1 and 1.3 ± 0.3, the IA level in the experimental group was significantly higher than that in the control group (P=0.000). The difference was statistically significant. The positive rates of TNF-α and PCNA in the experimental group were 90% (36/40)and 85% (34/40)respectively; the positive rates of TNF-α and PCNA in the control group were 30% (6/20), 40% (8/20). The positive expression rate in the experimental group was significantly higher than that in the control group (P=0.000). The difference was statistically significant. TNF-α and PCNA has Pearson positive relevance in the changes(r=0.3, P=0.040), the difference was statistically significant. Conclusions TNF-α and PCNA are involved in the immunoreaction of mammalian breast tissue injected with polyacrylamide hydrogel, which may induce the aseptic inflammation, fibrous tissue hyperplasia and related issues through mutual influence.

Objective To investigate the expression of early growth response protein 1 (Egr-1),NGFI-A binding protein 2 (Nab2) and caveolin 1 (Cav-1) in normal skin,flat-cicatrix and hypertrophic scar,and explore its role in the formation of hypertrophic scar.Methods The expression of Egr-1,Nab2 and Cav-1 protein in 9 normal skin tissues,8 flat-cicatrix tissues and 9 hypertrophic scar tissues were examined with immunohistochemistry SP method and were analyzed statistically.Results The expression of Egr-1 in epidermal cells of hypertrophic scar was significantly higher than that in normal skin and flat scar tissue.The expression of Egr-1 increased in the course of scar proliferation.The distribution patterns of Nab2 were different from Egr-1.The expression of Egr-1 was increased,while expression of Nab2 was decreased.The expression of Cav-1 in normal skin and flat-cicatrix was significantly higher than that in hypertrophic scar.Conclusions The expression of Egr-1,Nab2 and Cav-1 is closely related to the formation of hypertrophic scar,and the up-regulated expression of Egr-1 and the deficient expression of Nab2 and Cav-1 may be the indicators of the progress of formation of hypertrophic scar.

Objective To investigate the expression of early growth response protein 1 (Egr-1),NGFI-A binding protein 2 (Nab2) and caveolin 1 (Cav-1) in normal skin,flat-cicatrix and hypertrophic scar,and explore its role in the formation of hypertrophic scar.Methods The expression of Egr-1,Nab2 and Cav-1 protein in 9 normal skin tissues,8 flat-cicatrix tissues and 9 hypertrophic scar tissues were examined with immunohistochemistry SP method and were analyzed statistically.Results The expression of Egr-1 in epidermal cells of hypertrophic scar was significantly higher than that in normal skin and flat scar tissue.The expression of Egr-1 increased in the course of scar proliferation.The distribution patterns of Nab2 were different from Egr-1.The expression of Egr-1 was increased,while expression of Nab2 was decreased.The expression of Cav-1 in normal skin and flat-cicatrix was significantly higher than that in hypertrophic scar.Conclusions The expression of Egr-1,Nab2 and Cav-1 is closely related to the formation of hypertrophic scar,and the up-regulated expression of Egr-1 and the deficient expression of Nab2 and Cav-1 may be the indicators of the progress of formation of hypertrophic scar.

Objective:To investigate the clinical effect of 595 nm pulsed dye laser treatment for superficial hemangiomas on different sites of infants(≤3 years old) .Methods:From January 2018 to January 2020, we retrospectively analyzed the data of infants with superficial hemangioma in our hospital. They were treated with 595 nm pulsed dye laser. The energy and frequency of laser treatment, the effects and adverse reactions were recorded. t-test, SNK- q test and Chi-square test were used to analyze the data. Results:A total of 437 infants were enrolled, including 168 male and 269 female. The ages ranged from 0 to 36 months. They were divided into different lesion sites as head (34 cases) , forehead (37 cases) , cheek (61 cases) , periocular (30 cases) , nose (21 cases) , lip (12 cases) , perioral (10 cases) , ear (16 cases) , neck (26 cases) , chest (36 cases) , abdomen (24 cases) , back (21 cases) , buttocks (12 cases) , perineum (14 cases) , upper arm and forearm (30 cases) , hand (25 cases) , thigh (18 cases) , and foot (10 cases) . The average treatment energy of each sites was 8.0 J/cm 2 , with no significant difference( P>0.05) . The average number of treatments on the head, forehead, cheek, periocular, nasal, lip, perioral and foot was higher than that on other sites, showing a statistical significance ( P<0.05) ; among them, the nasal and perioral parts had most treatments. The total effective rate was 96.57%(422/437). The complications happened in 35 cases(8.01%), including hypopigmentation(22 cases), hyperpigmentation(5 cases), atrophic scar (8 cases). Conclusions:595 nm pulsed dye laser has a good therapeutic effect on infantile superifcial hemangioma with low adverse effect. Hemangioma on different sites requires different times of treatment.

Objective:To investigate the clinical effect of 595 nm pulsed dye laser treatment for superficial hemangiomas on different sites of infants(≤3 years old) .Methods:From January 2018 to January 2020, we retrospectively analyzed the data of infants with superficial hemangioma in our hospital. They were treated with 595 nm pulsed dye laser. The energy and frequency of laser treatment, the effects and adverse reactions were recorded. t-test, SNK- q test and Chi-square test were used to analyze the data. Results:A total of 437 infants were enrolled, including 168 male and 269 female. The ages ranged from 0 to 36 months. They were divided into different lesion sites as head (34 cases) , forehead (37 cases) , cheek (61 cases) , periocular (30 cases) , nose (21 cases) , lip (12 cases) , perioral (10 cases) , ear (16 cases) , neck (26 cases) , chest (36 cases) , abdomen (24 cases) , back (21 cases) , buttocks (12 cases) , perineum (14 cases) , upper arm and forearm (30 cases) , hand (25 cases) , thigh (18 cases) , and foot (10 cases) . The average treatment energy of each sites was 8.0 J/cm 2 , with no significant difference( P>0.05) . The average number of treatments on the head, forehead, cheek, periocular, nasal, lip, perioral and foot was higher than that on other sites, showing a statistical significance ( P<0.05) ; among them, the nasal and perioral parts had most treatments. The total effective rate was 96.57%(422/437). The complications happened in 35 cases(8.01%), including hypopigmentation(22 cases), hyperpigmentation(5 cases), atrophic scar (8 cases). Conclusions:595 nm pulsed dye laser has a good therapeutic effect on infantile superifcial hemangioma with low adverse effect. Hemangioma on different sites requires different times of treatment.

Objective: To explore the effect of hyperbaric oxygen preconditioning with different frequency on the survival rate of flap and ischemia-reperfusion injury in rats after transplantation, and to explore the best preconditioning conditions to improve the survival rate of rat flaps after transplantation. Methods: Thirty-six Sprague Dawley rats were randomly divided into four groups according to the random number table method, 9 groups in each group.Four groups of rats were pretreated with hyperbaric oxygen pretreatment for 0, 2, 4, and 6 days before the operation, control group, pretreatment 2 d group, pretreatment 4 d group, and pretreatment 6 d group. Taking the midline of the back of the rat as the axis, an ultra-long random flap with a pedicle at the tail end and about 1 cm from the superior iliac spine was designed and cut to a size of 10.0 cm×2.5 cm. The survival of the flaps in each group was observed and the final survival area and survival rate of the flaps were measured on the 7th day after surgery. On the 7th day after operation, the tissue was taken at a distance of 5 cm from the pedicle, and the histopathology was observed; The content of superoxide dismutase (SOD) and malondialdehyde (MDA) in flap tissue was detected by immunohistochemistry, and the expression rate of positive cells in each group was calculated. Immunofluorescence was used to detect the expression of interleukin-6 (IL-6) in the flap tissue. Results: On the 7th day after the operation, the survival area and survival rate of the transplanted flaps in the hyperbaric oxygen pretreatment group were significantly higher than those in the control group (P<0.05), and the pretreatment 4 d and 6 d groups were significantly higher than the pretreated 2 d group (P<0.05), but there was no significant difference between the pretreated 4 d group and the 6 d group (P=0.095). Pathological observation on the 7th day after operation showed that there was some necrosis in the control group, the vascular cells in the pretreated 2 d group had more vascular structures, and more neovascularization was observed in the pretreated 4 d group. The inflammatory cells were the least in the 6 d pretreatment group, and the neovascularization was the same as the pretreatment 4 d group. The absorbance A value of SOD in the control group was 0.009 7±0.000 3, and the positive expression rate was 20%, which was significantly lower than that in the hyperbaric oxygen pretreatment group. The difference was statistically significant (P<0.05). However, the absorbance A value of MDA in the control group was 0.055 1±0.003 0, and the positive expression rate was 55%, which was significantly higher than that in the hyperbaric oxygen pretreatment group. The difference was statistically significant (P<0.05). Among them, the SOD absorbance A value of the pretreated 2 d group was 0.023 8±0.003 0, and the positive expression rate was 30%, which was lower than the pretreatment 4 d group (absorbance A value 0.046 9±0.003 0, positive expression rate 35%) and 6 d group (absorbance A value 0.047 2±0.003 6, positive expression rate 40%), The MDA absorbance A value of the pretreated 2 d group was 0.037 2±0.003 2, and the positive expression rate was 30%, which was higher than the pretreatment 4 d group (absorbance A value 0.014 7±0.002 4, positive expression rate 5%) and 6 d group (absorbance A value 0.017 0±0.001 8, positive expression rate 10%), the difference was statistically significant (P<0.05). However, there was no significant difference in the expression of SOD and MDA between the pretreated 4 d group and the pretreated 6 d group (P>0.05). The expression of IL-6 in the hyperbaric oxygen pretreatment group was significantly lower than that in the control group (absorbance A value 44.937 0±0.594 0), the difference was statistically significant (P<0.05). The absorbance A value in the pretreated 2 d group was 41.698 0±0.724 0, which was significantly higher than the pretreatment 4 d group (absorbance A value 34.049 0±0.323 0) and 6 d group (absorbance A value 33.524 0±0.639 0). The difference was statistically significant (P<0.05). There was no significant difference in the expression of the pretreated 4 d group compared with the 6 d group (P=0.068). Conclusions Hyperbaric oxygen preconditioning can significantly promote the survival of rat flaps after transplantation. Preoperative hyperbaric oxygen preconditioning once daily for 4 consecutive days, can enhance the tolerance of flap tissue to ischemia and anoxia and reduce tissue ischemia-reperfusion injury.