Objective To explore relationships between the aesthetical education and the development of students' entire quality in medical school. Methods Taking the Introduction to Medical Aesthetics as the blueprint, we used the multimedia during the whole courses while considering our student's actual needs. Students were given tests and a questionnaire. Results 114 students took the examination, 89.5 % of which achieved the "good" grade, while 10. 5 % of them got the "pass"grade; none of them failed to the test. Conclusion The aesthetical education has taken great impressions on the development of the students' aesthetical quality.

Objective To summarize the clinical experience and efficiency of pernasal intestinal intubation internal intestinal arrangement under radiophotography in treatment of adhesive ileus. Method Three hundred cm-long ileus tube was set to jejunum by nasal cavity under radiophotography observation in 16 cases with recurrent postoperative adhesive ileus,ileus tube was impulsed by enterokinesia to ileum end to relief adhesive ileus and conduct internal intestinal arrangement. Results Sixteen cases recovered smoothly with no complications, which were followed from 8 months to 2 years, 1 case re-occurred adhesive ileus, and the other 15 cases had no intestinal adhesion and obstruction occurred. Conclusion Pernasal intestinal intubation internal intestinal arrangement under radiophotography is a simple,safe and effective management in treating recurrent postoperative adhesive ileus with less complications and reliable outcome.

Objective Developmental validation studies were designed according to the standards of forensic DNA community on DNATyperTM15 kit,which simultaneously amplifies 14 STR loci(D6S1043、D21S11、D7S820、CSF1PO、D2S1338、D3S1358、D13S317、D8S1179、D16S539、Penta E、D5S818、VWA、D18S51、FGA)and amelogenin,a sex-determining locus.Methods Several key factors were tested including:Ⅰ.amount of hot-start Taq polymerase;Ⅱ.annealing temperature;Ⅲ.sensitivity;Ⅳ.reaction volume;Ⅴ.cycle number;Ⅵ.primer concentration.DNATyperTM15 was also compared with two other widely used commercial STR amplification kits,namely IdentifilerTM and PowerPlex.Results No difference in performance was observed with three lots of DNATyperTM15.Performance was not affected even after 20 times of repeated freeze-and-thaw.All three kits performed comparably in the following aspects:Ⅰ.sensitivity;Ⅱ.ability to genotype mixed samples;Ⅲ.amplification of DNA from various sample sources.DNA extraction methods(Chelex-100,magnetic beads,silica beads)did not result in any observable effect on performance with any of the three kits.Conclusion All the results demonstrated that DNATyperTM15 is suitable for both forensic DNA database work and casework.

Objective To report the experience on the modified Abb? flap for correction of mild tightness of the corrected cleft lip deformity. Methods Forty-two patients with a mild or moderately tight lip deformity after primary unilateral cleft lip repair were performed a modified Abb? flap for correcting tight upper lip. The operative technique was that the pocket was creased for the vermilion tubercle by splitting the lip. The skin was incised several millimeters beyond the vermilion-skin border and was moved laterally for a distance equal to the breadth of the vermilion tubercle. The orbicularis oris muscle and the full length of the upper lip vermilion were incised. By releasing the tension, the slight concavity, expressed in profile by the slight pout which a normal upper lip had in cross section, was obtained. The Abb? flap that was taken from the central portion of the lower lip vermilion, was designed to repair the vermilion tubercle and the Cupid's bow. The flap was approximately 8 mm in width. The full length of the lower lip vermilion and the orbicularis oris muscle were incorporated. A ting portion of skin was included, which facilitated closure of the donor site, The flap, based on the labial vessels, was rotated 180?and sutured into the created defect of the upper lip. The pedicle was divided 10 days after operation. Results Forty-two patients all showed an obvious Cupid's bow, Cupid's bow peak, the median tubercle and the height and width of the upper lip. The scarring of the base of the nose was not obvious. Conclusion Use of modified Abb? flap to reconstruct the contour of the upper lip is successful in patients with cleft lip.

Objective To explore the indication,technology and clinical significance of laparoscopic choledocholithotomy and primary suture in treatment of choledocholithiasis.Methods 78 patients with choledocholithiasis were divided into two groups receiving respectively laparoscopic choledocholithotomy and T-tube drainage treatment,and laparoscopic choledocholithotomy and primary suture after common bile duct exploration.The time of operation,postoperative hospital stay and complications were analyzed and compared.Results Bile leakage occurred in 2 cases in the primary suture group and 3 cases in the T-tube drainage group;No residual stones or biliary stricture was found in either groups.The time of operation,postoperative complications were not statistically different (P ＞ 0.05).The difference in postoperative hospital stay and GI function recovery time between the two groups was statistically significant (P ＜ 0.05).Conclusion In well selected cases,the primary suture of common bile duct after laparoscopic choledocholithotomy is feasible and safe.

Objective:To introduce a new style of platysma myocutaneous flap and to evaluate its application value in the restoration of oral-maxiofacial defects.Methods:Platysma myocutaneous flap with apron incision was used for the restoration of oral-maxiofacial defects after oral lesion ablation in 15 cases from January,2014 to September,2015.The platysma muocutaneous flap was harvested with a U shaped apron incision.The skin above the flap pedicle was preserved.The platysma pedicle was widened to ensure the flap survival.All the patients were followed up form 4 to 33 months.Results:Of the 15 platysma myocutaneous flaps,12 survived completely and 3 had partial flap necrosis.The total survival rate of the flaps at the recipient site of buccal mucosa,tongue and alveolar was 8/9,1/3 and 3/3 respectively.Additionally,there were 2 cases of disturbed wound healing in the neck.Except for 1 case of carcinoma of gingiva which had apparent cervical scar and 1 case of tongue carcinoma which had limited tongue mobility,the other cases showed a satisfactory recovery of oral-maxillofacial contour and fucnction.Conclusion:Compared with the traditional platysma myocutaneous flap,the platysma myocutaneous flap with apron incision can provide a larger skin paddle,and is suitable for the restoration of small and medium sized buccal mucosa and alveloar defects,but not for tongue defect.

Objective To evaluate orthotopic splenectomy and pericardial devascularization for the treatment of portal hypertension.Methods The modified anterior approach splenectomy includes dissection of the peri-splenic vessels and ligments before division of short gastric vessels.During pericardial devascularization,the dessection panel was close to the esophagus and the stomach,leaving intact both the anterior and posterior vagus trunks.Results 63 patients underwent this modified operation.The free portal pressure decreased from (38 ±4) cmH2O to(28 ±4)cmH2O.The average blood loss was (530 ± 37)ml.There was no mortality,nor perioperative gastric paralysis and portal venous thrombosis.By 12-36 months follow-up,there was no pancreatic leakage,hepatic coma and recurrence of bleeding.Intrahepatic portal venous thromboses were detected in 4 cases at the sixth postoperative months.Conclusions This modified splenectomy plus selective pericardial devascularization carries less bleeding and is safe and effective for the treatment of portal hypertension.

Objective To explore the effectiveness and safety of temporary immunosuppressant withdrawal for the management of severe infection after liver transplantation.Methods Fifty-one patients with severe infection after liver transplantation were divided into control group (24 cases) and withdrawal group (27 cases ) according to the immunosuppression protocol.In the withdrawal group, the immunosuppressive drugs were temporarily suspended according to ATP values of CD4 + T cell and CD4 + T lymphocyte subsets counting until infection was controlled.The liver function,the incidence of acute rejection and the graft survival rate were monitored during the process.The side effects were observed.Result Severe infection was cured in 39 patients.There were 9 deaths in the control group in which the immunosuppressant was continued during the course of infection and 3 in the withdrawal group,respectively.The median suspension of immunosuppressant in trial group was ( 15.5 ± 4.8 ) d ( 6 ～ 22 d) ; CD4 + T lymphocyte subsets counting rose from (65.60 ± 32.58)/μl to (103.04 ± 12.39)/μl,ATP values of CD4 + T cell rose from (79 ±23) μg/L to ( 112 ± 11 ) μg/L; meanwhile,the temperature dropped from (38.3 ± 1.2) ℃ to (36.4 ± 1.1) ℃,WBC dropped from (15.7 ± 4.4) × 109/L to (6.3 ± 3.8) × 109/L,CRP dropped from ( 153.4 ± 37.1 ) mg/L to ( 16.5 ± 4.8) mg/L.During the course of treatment and follow-up,liver function of patients in the trial group remained normal and no acute rejection occurred.Compared with the control group,the temperature recovery time in the trial group was shorter ( respectively F =5.32,8.37,9.12,all P ＜ 0.05) and the therapeutic outcome was better.Conclusions The cellular immune function test could be evaluated according to the ATP values of CD4 + T cell and CD4 + T lymphocyte subsets counting.For severe infection after liver transplantation, anti-infection treatment and simultaneously withdrawing immunosuppressants help to control the infection.

OBJECTIVETo evaluate the feasibility and outcomes of chimeric deep circumflex iliac artery perforator flap (DCIAPF) applied in the simultaneous reconstruction of the oromandibular defect.

METHODSSix patients underwent simultaneous oromandibular reconstruction using DCIAPF following segmental mandibulectomy in Xiangya Hospital from March 2014 to July 2014. The skin paddle was designed to be centered on the pre-operative perforator mapping. Retrograde dissection was performed through the underlying abdominal wall to raise the skin paddle. The pedicle was isolated from the groin, and the iliac crest was cut. The deep iliac circumflex vessels were dissected until the skin paddle was reached. Finally, the donor site was strictly sutured layer by layer to avoid ventral hernia.

RESULTSThe skin paddles ranged from 3.5 cmx5.0 cm to 7.0 cmx 10.0 cm. The length of the bone components was 5.0 cm to 11.0 cm. All donor sites closed primarily without skin grafting. DCIAPF was harvested successfully in five patients, except for one patient whose perforator originated from the superficial iliac circumflex vessels. An additional pair of anastomoses was performed. All iliac flaps survived. However, slight skin-edge necrosis and exfoliation caused by flap thinning occurred in one patient and healed after pruning and dressing change. The heights of all alveolar ridges were significantly restored, and no serious donorsite complication was observed during the three to six months' follow-up.

CONCLUSIONDCIAPF is a reconstructive option for mandibular defects because of its adequate bone tissue and rich blood supply. Satisfactory alveolar ridge restoration greatly facilitates future denture retention. DCIAPF also has a great degree of mobility between the skin paddle and the bone component when appliedin composite oromandibular defect reconstruction.

Humans ; Iliac Artery ; Ilium ; Mandible ; surgery ; Maxillofacial Abnormalities ; surgery ; Perforator Flap ; Reconstructive Surgical Procedures ; methods ; Skin

Objective To assess the clinical application value of phleboplasties combined with microvascular anastomotic device in venous anastomosis with diameter discrepancy in head and neck defects reconstruction.Methods Sixty-six pairs of veins with significant diameter discrepancy were anastomosed in head and neck reconstructive surgeries with free flaps.Forty of them were anastomosed with microvascular anastomotic device (the coupler group) after phleboplasties including lateral incision, Y-T enlargement and wedge excision while the other 26 pairs of veins were conventionally sutured (the sutured group).Diameter of each vein, anastomosis time, post-operative vascular crisis, flap survival and complications related to the microvascular anastomotic device were recorded.Results The average anastomosis time of the coupler group was (4.78 ± 1.14) min for lateral incision, (5.16 ± 2.07) min for Y-T enlargement and (11.09 ± 3.21) min for wedge excision, and all of them were significantly shorter than that of the sutured group.In the sutured group, all flaps survived except for 2 veins with poor blood flow were cut and re-anastomosed during the operation;1 flap with venous crisis within 72 hours after the operations was explored and replaced with the pectoralis major myocutaneous flap.All veins in the coupler group were successfully anastomosed in a single coupling procedure without anastomotic impatency, blood leak, vessel tearing and ring shedding.No vascular crisis occurred postoperatively.One patient underwent cervical haematoma 5 hours after the operation, and the flap blood supply was unaffected after the haematoma was removed.All flaps in the coupler group survived completely.Patients in both two groups were followed up 6 to 18 months.All flaps healed perfectly and no obvious surgical complications or microvascular anastomotic device rejection happened.Conclusion When anastomoses are carried out using microvascular anastomotic device between veins of different size, phleboplasties including lateral incision., Y-T enlargement and wedge excision can not only reduce the size discrepancy and the anastomosis time, but also ease the difficulty level and guarantee the patency of the venous anastomoses.Wedge excision enjoys the advantage of haemodynamics, and obstruction of venous reflux hardly occurred for size reduction.It should be considered preferentially when external jugular veins are used as the anastomotic vein of the recipient sites in head and neck reconstruction.