Objective To evaluate the effect of short-wave ultraviolet combined with millimeter-wave irradiation on pressure ulcers.Methods Fifty-three patients with 87 pressure ulcer wounds were randomly divided into 3 groups.Group A consisted of 17 patients with 28 pressure ulcers,group B had 18 patients with 29 ulcers and group C had 18 patients with 29 pressure ulcers.All the patients in the 3 groups accepted routine care.Group B was treated with short-wave ultraviolet radiation in addition,and group C received millimeter-wave combined with short-wave ultraviolet radiation.Braden's scale was used to evaluate the integrity of the patients' skin before treatment,and the pressure sore status tool (PSST) was used to evaluate exudation and skin recovery before and after treatment.Results Before treatment the patients demographics and pressure sores of the three groups had no significant differences.In group A there was no significant difference in the average PSST-5 score between before and after treatment.Compared with the scores before therapy,the average scores of groups B and C decreased significantly.They were also significantly lower than in group A after treatment.The effect in group C was better than in group B.With regard to improvement rate,the improvement percentages of groups B and C were significantly higher than that of group A,while there was no statistically significant difference between groups B and C.The rate of excellent recovery of group C was better than that of group A or B,but there was no significant difference between groups A and B.Conclusions Combining short-wave ultraviolet irradiation with millimeter-wave irradiation has remarkable effects on exudation from and the recovery of pressure ulcers.

Aim According to various target sites of HLA-E mRNA,to design and synthesize 3 pieces of HLA-E siRNA chain,to compare quantitatively their efficiency of silencing gene in BEL-7402 with HLA-E(+)in order to select the dominant siRNA.Methods The hepatocarcinomal BEL-7402 cells,induced by 5×10~5 IU·L~(-1) IFN-γ,expressed HLA-E(+) and was pured by flow cytometry selecting as target cells for research.3 pieces of specific siRNA(A,B,C group)were designed and chemically synthesized,then the concentration of which(0.1 mmol·L~(-1))was respectively transfected through Lipofectamin 2000 into target cells.After 48 h,the gene silent effect on HLA-E gene in A,B and C groups was quantitatively observed by cytoimmunofluorence,flow cytometery,Western blot and real-time PCR,as well as on NK cytotoxicity to target cells tested by NK killing rate.Results Compared with those of control or non-specific siRNA group,HLA-E antigen,protein product,HLA-E mRNA and HLA-E molecule on cell surface were statistically down-regulated in A,B,and C group(P<0.01),whose were silenced more (above 90%) in B or C group than in A group (P<0.01).The NK killing rate in A,B and C groups was dominantly improved(P<0.01),which in B or C group was higher than in A group (P<0.01).Conclusion The targeted siRNA can specifically and high-efficiently silence HLA-E expression in hepatocarcinomal cells,and may keep them from immunoescape through non-classic HLAⅠ pathway to imply new strategy for hepatocarcinomal gene-immunotherapy.

OBJECTIVETo explore the venous angio-architecture of deep inferior epigastric artery perforator ( DIEP) flap with computed tomography angiography( CTA) and the application of venous angio-architecture in flap thinning of DIEP flap.

METHODSFrom February 2012 to August 2014, preoperative CTA examination of venous system of DIEP flap was performed in 11 patients to study the course, the branch and the anastomosis of the deep inferior epigastric veins, the superficial inferior epigastric veins and the perforator veins. The flap thinning of DIEP flap was based on the finding of the abdominal venous system.

RESULTSThe CTA images were obtained including 22 deep inferior epigastric veins, 22 superficial inferior epigastric veins and 22 perforator veins. The distance between the superficial inferior epigastric vein and abdominal midline was 3.30 cm to 5.77 cm in the zone 3 cm above umbilicus and in the zone 15 cm below umbilicus. The superficial inferior epigastric vein was 0.29 to 0.39 in depth ratio. The superficial inferior epigastric veins were the main drainage vessels of superficial abdominal wall according to the CTA images. They were anastomosed with the deep inferior epigastric veins through perforator veins. The 11 DIEP flaps were thinned based on the structure of the superficial inferior epigastric veins and all flaps had no drainage disturbance.

CONCLUSIONSPreoperative CTA images can display the venous angio-architecture of deep inferior epigastric artery perforator flap. The superficial inferior epigastric vein can be utilized as reference architecture to guide flap thinning of DIEP flap.

Abdomen ; blood supply ; Abdominal Wall ; blood supply ; Angiography ; methods ; Epigastric Arteries ; anatomy & histology ; diagnostic imaging ; Humans ; Perforator Flap ; blood supply ; Phlebography ; methods ; Tomography, X-Ray Computed ; Veins ; anatomy & histology

Objective: To explore flap thinning based on the study of the arterial structure and blood perfusion of the deep inferior epigastric artery perforator (DIEP) flap using computed tomography (CT) angiography. Methods: Clinical imaging study: Preoperative CT angiography was performed in 15 patients with DIEP flap reconstruction to investigate the vascular structure of arterial perforator. Cadaveric imaging study: 10 abdominal specimens harvested from fresh cadavers were cannulated with trocar and injected with contrast medium in the deep inferior epigastric artery perforator. During the perfusion of the contrast medium in the flap, the flap was scanned by three-dimensional CT. The CT data was then sent to CT workstation and the images were processed and reformatted to study the vascular structure of arterial perforators and the blood perfusion. Results: 75 artery perforators in clinical study and 40 artery perforators in cadaveric study were chosen and analyzed. The major deep inferior epigastric artery perforators run directly across the deep layer of adipose tissue without bifurcating beneath the Scarpa′s fascia. Above the Scarpa′s fascia, the artery perforators bifurcate and ultimately terminate in the subdermal vascular plexus. Blood perfusion mode: The subdermal vascular plexus served as the only pathway for blood perfusion between perforasomes. There are two different pathways for blood perfusion in the perforasome: the subdermal plexus and the existing vascular structure of perforator. Conclusions Based on the vascular structure of arterial perforator and blood perfusion of the DIEP flap, thinning of the DIEP flap under the Scarpa′s fascia is safe while thinning above the Scarpa′s fascia should performed according to the blood supply zone of the DIEP flap.

OBJECTIVETo explore the relationship between plasma levels of carbon monoxide and blood-brain permeability in cirrhotic rats.

METHODSWe measured mean arterial pressure (MAP), heart rate, plasma levels of carbon monoxide and amount of Evans blue in the brain tissue taken as the index of blood-brain permeability in cirrhotic rats (n=10) and controls (n=10).

RESULTSCirrhotic rats showed significant increases in plasma carbon monoxide and amount of Evans blue in brain tissue compared with controls [(18.37 +/- 1.79) micromol/L,(18.52 +.- 1.39) ng/mg vs (10.27 +/- 1.21) micromol/L, (15.08 +/- 1.06) ng/mg; P< 0.01]. Carbon monoxide levels in cirrhotic rats correlated positively with blood-brain barrier permeability and inversely with MAP (r=0.72, P< 0.01; r= -0.67, P< 0.05).

CONCLUSIONSCarbon monoxide, involving in the occurrence of hypotension and the increase of blood-brain barrier permeability, may play a role in the development of hepatic encephalopathy.

Alanine Transaminase ; blood ; Animals ; Aspartate Aminotransferases ; blood ; Blood Pressure ; physiology ; Blood-Brain Barrier ; physiology ; Capillary Permeability ; physiology ; Carbon Monoxide ; blood ; Carbon Tetrachloride ; Heart Rate ; physiology ; Liver Cirrhosis, Experimental ; blood ; chemically induced ; physiopathology ; Male ; Rats ; Rats, Sprague-Dawley ; gamma-Glutamyltransferase ; blood

Objective: To explore the establishment and application of three-dimensional model of deep inferior epigastric artery perforator flap based on computed tomography angiography (CTA). Methods: Six patients with breast absence after modified radical mastectomy because of breast cancer, 5 patients with congenital absence of vagina, and 6 patients with Paget′s disease of penis and scrotum were hospitalized in our unit from January 2012 to April 2017. The size of wounds after excision of the lesion or that of flaps needed for reconstruction ranged from 17 cm×5 cm to 25 cm×9 cm. Abdominal CTA was performed before the surgery, and data of CTA were sent to CT workstation to make three-dimensional model of deep inferior epigastric artery perforator flap according to shape and size of wound. The number, course, and location of deep inferior epigastric artery, vein, and their perforators, and the superficial inferior epigastric vein were observed in the above-mentioned three-dimensional model. The rectangular plane coordinate system with the umbilicus as the origin was established to locate and observe course and type of the largest deep inferior epigastric artery perforator in left and right side. Deep inferior epigastric artery perforator flaps were designed and deep inferior epigastric artery perforators etc. were marked according to three-dimensional models of the flaps before the surgery. The condition observed in three-dimensional model of the flap was compared with the clinical condition in the surgery of free transverse bilateral deep inferior epigastric artery perforator flap transplantation for breast reconstruction and longitudinal pedicled thinned unilateral deep inferior epigastric artery perforator flap transplantation for vagina reconstruction and wound repair of Paget′s disease of penis or scrotum. The size of flap ranged from 17 cm×6 cm to 25 cm×10 cm. Results: Seventeen three-dimensional models of deep inferior epigastric artery perforator flaps were established, including 6 bilateral models and 11 unilateral models. Seventy-two reliable deep inferior epigastric artery perforators were observed in the three-dimensional model with 3.2±0.7 in the right and 3.1±0.8 in the left. The locations of the largest deep inferior epigastric artery perforators in the right and left were [(-3.2±1.4) cm, (-1.0±0.7) cm] and [(4.0±1.2) cm, (-1.2±1.1) cm] respectively. Fourteen largest deep inferior epigastric artery perforators coursed directly and nine coursed tortuously in the rectus muscle. Twenty-three superficial inferior epigastric veins were detected in the three-dimensional models of the flaps. The number, location, and course of deep inferior epigastric artery and vein and superficial inferior epigastric vein observed in the three-dimensional model of deep inferior epigastric artery perforator flap were in accordance with the condition observed in the surgery. Seventy reliable deep inferior epigastric artery perforators were detected in the surgery, and the other 2 perforators were unclear due to bleeding. Course of these perforators were in accordance with the condition observed in the three-dimensional model. Deep inferior epigastric artery perforator flaps of all patients survived well with no complication except that 1 patient suffered from delayed healing of wound in perineum. During follow-up of 1 to 12 months, all flaps survived with good shape and texture. Conclusions The three-dimensional model of deep inferior epigastric artery perforator flap based on CTA can be established easily and can provide information of number, location, and course of deep inferior epigastric artery, vein, and their perforators, and superficial inferior epigastric vein to guide preoperative design and intraoperative dissection of the flap effectively.

Objective: To investigate the clinical effect of diced cartilage in correcting nasal alar base depression after cleft lip surgery. Methods: A retrospective study was conducted in 15 patients of nasal deformity after lip surgery from January 2018 to January 2019. All the patients were taken from autologous costal cartilage to reconstruct the outline of nasal malformation, and the remaining autologous costal cartilage was cut into 0.5-1.0 mm pieces and filled into the basilar lacunar space of the nasal alar by the 1 ml syringe whose anterior needle nipples was removed. The effects of visual images before and after operation were compared and analyzed by Adobe Photoshop CS6 software. The patients were followed up for 6-15 months (mean 10months). The satisfaction and complications of the patients were investigated. Results: The nasal alar base was significantly elevated and the outline of the nasal deformity was improved in 15 patients after operation. The overall effect was satisfactory and no obvious complications were found. No obvious absorption was found in the follow-up. Conclusions The application of diced cartilage to correct the nasal alar base depression after cleft lip surgery was a feasible method with important clinical value. It advanced in taking good use of the remaining cartilage and reducing the damage to both the donor and recipient area.

Objective:To introduce a surgical technique applied in autologous costal cartilage rhinoplasty described as the endonasal incision combined with umbrella-like graft.Methods:From February 2018 to May 2019, a total of 52 patients (48 females and 4 males) were enrolled and underwent rhinoplasty operation with bilateral intranasal incision for the construction of umbrellal scaffolds in Department of Burn and Plastic Surgery of the Second Xiangya Hospital. During the operation, bilateral inferior lateral cartilages were fully separated and septal cartilages were exposed. Umbrellal-like scaffolds were built to correct nasal aesthetic defects such as nasal columellar shrinkage and insufficient nasal tip protrusion. During the process of follow-up, all the patients were photographed and were asked to complete the the postoperative satisfaction survey by means of an online link or over the phone.Results:The preoperative nasal aesthetic defection was greatly improved. There is no the temporary complications including infection and bleeding. 30 patients who completed follow-up for 6 months at least and completed postoperative satisfaction survey were included in the case series. The measurements (average): The nasofrontal angle was measured as 141.29°±5.61°preoperation and 137.67°±5.27°postoperation. The nasolabial angle was measured as 89.53°±10.56°preoperation and 94.90°±5.88°postoperation , The nasal tip angle was measured as 86.60°±7.09°preoperation and 80.42°±5.47° postoperation, Columellar-lobular angle was measured as 48.82°±7.32°preoperation and 44.63°±2.51°postoperation , The tip projection-nasal length index was measured as 0.48±0.07 preoperation and 0.54±0.07 postoperation. Columellar-lobular length index was measured as 1.74±0.36 preoperation and 1.22±0.21 postoperation, There were significantly statistical differences between preoperative and postoperative measures. The photograph showed the location and reflection of nasal tip have remained stable, no upward or twist trend occurred. According to questionaire results, postsurgical swelling relieved in all cases within the first 3 to 6 weeks. No prolonged functional sequelae occured, Most of patients were satisfied with the aesthetic and functional results.Conclusions:Endonasal incision combined with umbrella-shape graft facilitates the operation, Bilateral endonasal incision allowed us to evaluate the reestablished nasal tip directly and adjust tip projection with convenience, there’s no columella scar left.

Objective:To introduce a surgical technique applied in autologous costal cartilage rhinoplasty described as the endonasal incision combined with umbrella-like graft.Methods:From February 2018 to May 2019, a total of 52 patients (48 females and 4 males) were enrolled and underwent rhinoplasty operation with bilateral intranasal incision for the construction of umbrellal scaffolds in Department of Burn and Plastic Surgery of the Second Xiangya Hospital. During the operation, bilateral inferior lateral cartilages were fully separated and septal cartilages were exposed. Umbrellal-like scaffolds were built to correct nasal aesthetic defects such as nasal columellar shrinkage and insufficient nasal tip protrusion. During the process of follow-up, all the patients were photographed and were asked to complete the the postoperative satisfaction survey by means of an online link or over the phone.Results:The preoperative nasal aesthetic defection was greatly improved. There is no the temporary complications including infection and bleeding. 30 patients who completed follow-up for 6 months at least and completed postoperative satisfaction survey were included in the case series. The measurements (average): The nasofrontal angle was measured as 141.29°±5.61°preoperation and 137.67°±5.27°postoperation. The nasolabial angle was measured as 89.53°±10.56°preoperation and 94.90°±5.88°postoperation , The nasal tip angle was measured as 86.60°±7.09°preoperation and 80.42°±5.47° postoperation, Columellar-lobular angle was measured as 48.82°±7.32°preoperation and 44.63°±2.51°postoperation , The tip projection-nasal length index was measured as 0.48±0.07 preoperation and 0.54±0.07 postoperation. Columellar-lobular length index was measured as 1.74±0.36 preoperation and 1.22±0.21 postoperation, There were significantly statistical differences between preoperative and postoperative measures. The photograph showed the location and reflection of nasal tip have remained stable, no upward or twist trend occurred. According to questionaire results, postsurgical swelling relieved in all cases within the first 3 to 6 weeks. No prolonged functional sequelae occured, Most of patients were satisfied with the aesthetic and functional results.Conclusions:Endonasal incision combined with umbrella-shape graft facilitates the operation, Bilateral endonasal incision allowed us to evaluate the reestablished nasal tip directly and adjust tip projection with convenience, there’s no columella scar left.

Objective:To investigate the complications and related etiologies after immediate silicone implant and immediate two-stage tissue expander/implant breast reconstruction.Methods:A retrospective study was conducted in 23 patients who underwent implant or tissue expander/implant breast reconstruction surgery from June 2016 to October 2019. The etiology, medical history and clinical symptoms of each patient were analyzed and related treatments were carried out depending on its complication.Results:All patients were followed up for 3-12 months after surgery. Among the 23 patients, a total of 8 patients had different types of postoperative complications. Partial necrosis of the nipple-areola complex occurred in 1 case, postoperative infection in 2 cases, 2 patients experienced deviation of the implant or tissue expander and displacement of the nipple-areola complex in 3 cases. All complications were treated accordingly, and a good therapeutic effect was finally maintained.Conclusions:For patients with complications after immediate silicone implant and two-stage tissue expander/implant breast reconstruction, treatment should be carried out according to the causes of complications in time. In this way, patient can get better prognosis.