The use of flaps for plastic and reconstructive surgery is very popular today.More and more surgeons have realized that the blood supply plays an important role in the design and survival of flaps.After Ian McGregor and Ian Jackson first introduced the axial flaps into clinics,Mathes divided the flaps into two types in 1981,the fasciocutaneous perforator flaps and musculocutaneous perforator flaps.In 1989,the concept of perforator flap was first brought into clinical practice.With the development of microsurgery and anatomy,the epidermis of human skin is divided into areas based on the vascular anatomy.A new century of musculocutaneous perforator flaps has been established.The terminology,classification,characteristics and application of musculocutaneous perforator flaps are described in this paper.

Objective To study the mechanics situation of proximal femoral locking plate internal fixation after dynamic hip fixation in-tertrochanteric fracture. Methods Totally 10 couple of elderly proximal femur specimens were collected and intertrochanteric fracture model were prepared. Fixation material was removed after dynamic hip screw fixation. The left sides were collected as control group and given anti-rotation intramedullary nail internal fixation, while the right side were collected as observation group and given proximal femoral locking plate internal fixation. Then vertical displacement, axial stiffness and rotational stiffness under different loads were compared. Results Under dif-ferent loads, femoral bone vertical displacement and femur tuberosity vertical displacement in the observation group were both significantly shorter than those in the control group (P<0. 05), and femoral bone and femur tuberosity axial stiffness and rotational stiffness in the observation group were significantly higher than those of the control group (P<0. 05). Conclusion Proximal femoral locking plate internal fixation can improve stress load and enhance axial stiffness and rotational stiffness, and it's an ideal material for refracture fixation model after dynamic hip fixation intertrochanteric fracture.

AlM:To study the treatment effect of traditional Chinese medicine in the treatment of high myopia macular hemorrhage, using Chinese medicine etiology and pathogenesis, syndrome differentiation treatment, and provide the basis for the clinical treatment. METHODS: Eighty patients ( 135 eyes ) with high myopia macular hemorrhage were selected in the hospital from January 2012 to september 2014 as treatment group, and applied traditional Chinese medicine treatment. Forty-five patients (64 eyes) with the same period, as the control group, received routine western medicine treatment. After 1mo treatement, the treatment effect and vision improvement situation of two groups were observed, and after 6mo follow-up, the relapse was observed.RESULTS: The total effective rate of treatment group was 85. 19% (115/135), higher than the control group 78. 13% (50/64) (P<0. 05). The average corrected visual acuity of treatment group was 0. 48±0. 11, higher than the control group 0. 36 ± 0. 09, the difference was statistically significant (P<0. 05). The average diopter and macular bleeding scope of the treatment group were -9. 81±0. 85D and 0. 51 ± 0. 27PD, lower than the control group -10. 76 ± 0. 91D and 0. 78 ± 0. 23PD, the differences were statistically significant ( P < 0. 05 ). The eye ground hemorrhage absorption time of treatment group was 25. 34±2. 28d, less than the control group 29. 72 ± 2. 13d, the difference was statistically significant (P<0. 05). The bleeding again of the control group 7. 81% ( 5/64 ), higher than the treatment group was 5. 19% (7/135), the difference was statistically significant (P<0. 05).CONCLUSlON: Evidence-based treatment of traditional Chinese medicine for high myopia macular hemorrhage has good clinical effect, can shorten the treatment time, and is beneficial to the recovery of postoperative vision, worthy of clinical popularization and application.

OBJECTIVETo study the mechanism and applicability of Bite-bumper combined with fixed appliance in treatment of lingual tipping deep bite.

METHODS14 children aged 12-16 years old with lingual tipping deep bite participated in the experiment. Bite-bumper combined with fixed appliance was used to correct the deep bite. Clinic effect was observed. Lateral cephalograms were taken before treatment and after bite opening. The related hard tissues were estimated through the cephalograms.

RESULTS1) The average duration for bite-opening with Bite-bumper and fixed appliance of 14 patients was 28 days. 2) After bite-opening, the changes in length direction of jaw (SNA, SNB, ANB) had no statistical variances. Anterior and posterior facial height (S-Go, ANS-Me) were increased. No significant changes were observed in the ratio of posterior facial height to anterior facial height (S-Go/N-Me), angle of mandibular plane (SN-MP) and Y axis. Labial incline in upper and lower incisors (U1-SN, L1-MP) and interincisa angle (U1-L1) were decreased. The posterior teeth (U6-PP, L6-MP) were extruded and the upper incisors (U1-PP) were intruded. The overbite was decreased.

CONCLUSIONBite-bumper combined with fixed appliance can be used effectively for deep bite correction and improve the short face of patients with lingual tripping deep overbite.

Cephalometry ; Child ; Dental Occlusion ; Humans ; Incisor ; Malocclusion, Angle Class II ; Mandible ; Overbite ; Tooth ; Tooth Movement Techniques

OBJECTIVETo discuss the treatment characteristics of secretory otitis media (SOM) in cleft palate children.

METHODSA total of 319 patients (524 ears) with SOM and cleft palate (3-14 years old) who accepted treatment were divided into experiment group A, group B, and group C according to effusion characteristics in the middle ear and tympanic pressure. Group A included 112 patients with serous effusion (198 ears). Group B included 162 patients with mucinous effusion (248 ears). Group C included 45 patients (78 ears) with negative pressure in the middle ear without effusion and an acoustic immittance. A total of 208 patients (246 ears) with SOM and tonsil and adenoid hypertrophy were divided into control group Al, group B1, and group Cl matched with the same effusion characteristics in the middle ear and tympanic pressure. Group A and Al accepted puncture in the tympanic cavity, group B and B1 accepted tympanostomy tubes, and group C and Cl accepted puncture in the tympanic cavity after palatoplasty, adenoidectomy, and tonsillectomy. All groups were treated with antibiotics and ear drops. Cure rate and recurrence rate between the experiment group and the control group were compared.

RESULTSThe control group had a better cure rate [93.09% (229/246)] than the experiment group [77.29% (405/524)] 12 months after treatment. The experiment group had a higher recurrence rate [14.57% (59/405)] than the control group [3.93% (9/229)]. Statistical differences were observed between the two groups (P<0.05). SOM with cleft palate initially had a low cure rate, and thus it was treated repeatedly for many times.

CONCLUSIONSOM with cleft palate is different from normal otitis media in terms of clinical manifestation, treatment, outcome, and prognosis. This case should be considered a special otitis media to be treated with special examination and therapy to obtain better results. Repeated puncture in the tympanic cavity and tympanostomy tubes for six months according to effusion characteristics are better treatment options for patients with SOM and cleft palate.

Child ; Cleft Palate ; Humans ; Middle Ear Ventilation ; Otitis Media with Effusion ; therapy ; Prognosis ; Recurrence

Total aerobic plate counts for bacterial colonies in the Bullacta exarata ranged from 7. 3?10 5 to 2. 8?10 6 cells per gram. 217 strains of bacteria were isolated from the Bullacta exarata and 88. 5% of them were Gram-negative rod . The predominant genera were composed of Enterobacteriaceae (61 strains), Aeromonas (58), Vibrio (27), Pseudomonas (21). The results indicate that total bacteria numbers exceeds state standard by 1～2 quantity level in every samples. The coliform bacteria numbers exceeds health standard in sample of seven and nine month. It should be brought to attention. The microflora were composed of ten genus , predominant Bacillus of rearing shoal were few in the Bullacta exarata that may play a special role for regulating and controlling the microbial community .

Objective To investigate the potential clinical factors associated with the prognosis and relapse of adult onset Still's disease(AOSD).Methods The factors possibly influencing the prognosis and relapse of AOSD were analyzed by logistic regression and COX regression in the cohort study.Ninety-six con- secutive inpatients of AOSD diagnosed based on Yamaguchi criteria in the hospital from March 1996 to September 2004 were included in the study.Results Nine cases(9.4%)were lost during the follow-up. Eleven patients(12.6%)were diagnosed as other diseases(5 with other rheumatic diseases,4 with tumor and 2 with infections)in the 87 follow-up cases.In 76 cases,3 patients(3.9%)died and 33 patients(43.4%) got remission over one year after treatment.Splenomegaly(OR=3.14,95%CI=1.01～9.74)and treated with methotrexate(OR=0.22,95%CI=0.07～0.67)were associated with the prognosis from the logistic regression analysis of the 76 cases.The serum ferritin(RR=I.05,95%CI=1.01～1.08)and treated with methotrexate (RR=0.13,95%CI=0.02～0.76)were associated with relapse from the COX regression analysis of the 61 remis- sion cases.Conclusion We need to be very cautious in the follow-up of AOSD patients because some of them may change to other diseases.Methotrexate may be an importent therapy of AOSD not only in improve- ment the prognosis but also in reduction of relapse.

Objective To evaluate the effect of air temperature on non-accidental mortality (A00-R99) and years of life lost in Wuxi city. Methods Data on daily non-accidental mortality and meteorology index were collected from 2012 to 2017. Distributed lag non-linear model (DLNM) was used to assess the effect of temperature on non-accidental death and YLL and the cumulative effects between cold and hot temperature on non-accidental mortality and years of life lost with different lag days. Results A V-shaped relationship was noticed between temperature and mortality. Cold effects were delayed by 3 days and persisted for 14 days. Hot effects appeared acute and reached the peak at the same day. Low temperature had stronger gross effect than high temperature had. There were differences of temperature effects between different age and gender groups. Conclusions Low and high temperature were associated with elevated mortality risk. Cold effect had lagged effect and persisted for long time, however, hot effects appeared acute and the impact of low temperature was greater.

AIM:To observe the application efficiency of 5g/L indocyanine green ( ICG ) staining technique for continuous circular capsulorhexis ( CCC ) during phacoemulsification in white cataract.
METHODS:Ninety-eight patients (98 eyes) with white cataract were randomly divided into staining group ( 50 cases, 50 eyes) and control group (48 cases, 48 eyes). The control group didn't do anterior capsule staining. The staining group was injected to fill the anterior chamber, 5g/L ICG 0.1mL was applied on the central surface of the anterior capsule, using a 27G blunt needle through the side-port after 30s, and the redundant ICG was replaced by BSS, and continuous curvilinear capsulorhexis was accomplished using capsulorhexis forceps.
RESULTS: In staining group: after ICG staining, the capsule, which presented uniform light green and visualization of the anterior capsule was significantly improved. There are 48 eyes capsulorhexis success. The rate of success was 96%. Meanwhile, in control group, there was 29 eyes capsulorhexis success. The rate of success was 60%. The difference was statistically significant (P<0. 05). During follow-up, no dye particle and the complications of iritis or high intraocular pressure were found in the eyes of staining group. Anterior chamber inflammation, corneal opacity compared with control group, the difference was not statistically significant.
CONCLUSION:Indocyanine green staining increases the visibility of anterior capsule in over mature cataract, and it should be an effective and helpful method which can increase the success rate of capsulorehxis. At the same time, it can reduce the incidence of intraoperative complications. This will help beginners quickly grasp continuous curvilinear capsulorhexis, and shorten the learning curve.

Background Prevention and treatment of posterior capsular opacification (PCO) is a hot issue.To establish a PCO animal model is the basis of relevant studies.The most common methods of creating a PCO model are phacoemulsification surgery with or without intraocular lens (IOL) implantation.But the suitability of different methods is unclear.Objective This experiment was to compare the outcome between the two methods of establishing a PCO model in rabbit eyes.Methods Twenty New Zealand white rabbits were collected and randomized into 2 groups.Phacoemulsification of cataract with IOL or without IOL implantation was performed on the right eyes of rabbits in these two groups.The operative eyes were examined under the slit lamp from day 1 through 3 months after surgery.The inflammatory response was evaluated and compared between the two groups,and the extent of PCO was graded based on Odrich's criteria.The use of the animals complied with the Regulations for the Administration of Affairs Concerning Experimental Animals by State Science and Technology Commission.Results The inflammatory response,including conjunctival congestion,corneal edema and aqueous flare were less severe in the model eyes with IOL implantation than the eyes without IOL implantation 1-3 days after operation.Inflammatory response gradually disappeared and showed the same degree in the PCO grade from 2 weeks through 3 months in both groups.The numbers of eyes with 1-3 grade of PCO were 8 and 9,and those with 0 grade of PCO were 2 and 1 in the with IOL implantation group and without IOL implantation group,respectively,showing a significant difference (P=0.39).PCO appeared at 1 month,extended at 2 months and formed dense fibrosis following operation.Conclusions The model outcome of phacoemulsification combined with IOL implantation is better than without IOL implantation one.It is the ideal animal model for the study of after cataract.