Objective: To explore the clinical application effects of portable visual retractor in superficial temporal fascia flap harvesting. Methods: From January 2010 to June 2019, 27 patients meeting the inclusion criteria and planning to perform operation of superficial temporal fascia flap harvesting were admitted to the Department of Plastic and Reconstructive Surgery of the First Clinical Medical Center of the People′s Liberation Army General Hospital. The patients were divided into traditional surgical method group [6 males and 3 females, aged (34±14) years], cold light source retractor group [6 males and 4 females, aged (35±16) years], and portable visual retractor group [7 males and 1 female, aged (30±14) years] according to way of superficial temporal fascia flap harvesting. The superficial temporal fascia flaps of patients in traditional surgical method group were resected by traditional way of resection, and the superficial temporal fascia flaps of patients in cold light source retractor group and portable visual retractor group were resected at assistance of cold light source retractor and portable visual retractor, respectively. Length of incision, operation time, intraoperative blood loss volume, postoperative drainage volume, and postoperative complication of patients in 3 groups were observed and recorded. Data were processed with Fisher′s exact probability test, one-way analysis of variance, least significant difference test, Kruskal-Wallis H test, and Bonferroni correction. Results: The length of incision of patients in visual retractor group was (3.6±0.8) cm, significantly shorter than (12.6±1.6) cm in traditional surgical method group and (5.8±0.9) cm in cold light source retractor group (P<0.05). The incision length of patients in traditional surgical method group was significantly longer than that in cold light source retractor group (P<0.05). The operation time of patients in visual retractor group was 24.0 (23.3, 25.8) min, significantly shorter than 35.0 (30.5, 36.5) min in traditional surgical method group and 28.5 (26.8, 30.5) min in cold light source retractor group (H=16.5, 9.8, P<0.05). The operation time of patients in traditional surgical method group was significantly longer than that in cold light source retractor group (H=6.6, P<0.05). The intraoperative blood loss volume was (26±3) mL of patients in visual retractor group, significantly less than (34±4) mL in traditional surgical method group and (30±6) mL in cold light source retractor group (P<0.05). The intraoperative blood loss volume of patients in traditional surgical method group was significantly more than that in cold light source retractor group (P<0.05). The postoperative drainage volumes of patients in visual retractor group, cold light source retractor group, and traditional surgical method group were (33±4), (34±6), and (31±7) mL, respectively, and there were no significantly statistical differences in postoperative drainage volumes among patients in the three groups (F=0.3, P>0.05). There were no severe complications such as ischemia and necrosis of superficial temporal fascia flaps in patients of the three groups. One patient in cold light source retractor group had subcutaneous hematoma after operation, which was improved by removing stitches and hematoma. Conclusions Superficial temporal fascia flap harvesting at the assistance of portable visual retractor has the advantages of clear visual field, simple operation, short operation time, small incision, and less intraoperative blood loss.

Objective To compare the efficacy of tibial tuberosity osteotomy (TTO) combined with medial patellofemoral ligament reconstruction (MPFLR) with simple TTO in treatment of recurrent patella dislocation associated with patella alta.Methods From July 2010 to December 2015,50 patients with recurrent patella dislocation and patella alta were included in this study.There were 15 males and 35 females with an average age of 20.6 years.These patients received surgical treatment and their clinical data were collected and retrospectively analyzed by case-control study.According to surgical methods,patients were divided into TTO group (32 cases) and MPFLR + TTO group (18 cases).The differences between preoperative status and postoperative status were evaluated by knee function scores including Tegner,international knee documentation committee (IKDC),Kujala scores,knee injury and osteoarthritis outcome score (KOOS).Patellar stability was checked at the last follow-up visit.Results The TTO group and MPFLR + TTO group were followed up for (50.9 ± 17.8) months and (22.3± 10.1)months,respectively.Two patients occurred recurrent dislocation in TTO group,who showed positive in both extrapolation test and extrapolation apprehension test at 0°flexions of knee.All patients in MPFLR + TTO group did not occur recurrent dislocation,who showed negative in both extrapolation test and extrapolation apprehension test at 0° flexions of knee.There was no significant difference between preoperative and postoperative results in TTO group in Tegner score (P ＞ 0.05),KOOS scores in pain and daily life activities subdomains (P ＞ 0.05),while differences in the rest of scores were statistically significant (P ＜ 0.05).Compared with TFO group,the differences of all scores were statistically significant (P ＜ 0.05) and KOOS scores in the pain and daily life activities subdomains were significantly improved postoperatively in MPFLR + TTO group P ＜0.05).Conclusions For patients with recurrent patellar dislocation associated with patella alta,both surgical methods are found to be effective.Postoperative improvements in pain and daily life activities are less obvious in TTO.While postoperative improvements in pain and daily life activities in MPFLR + TTO are superior to those of TTO.

Objective To establish a HPLC method for determining the concentration of voriconazole (VRC) in human plasma.Methods The analysis was conducted using a ZORBAX Eclipse Plus C18 column and the column temperature was 40 ℃.The mobile phase consisted of methanol and water (55∶45).The flow rate was 1 mL · min-1 and the detection was performed at 254 nm.And the internal standard substance was p-Chloroacetanilide.The specificity,lower limit of quantitation (LLOQ),standard curve,precision,accuracy,recovery and stability were investigated.Results Endogenous impurities did not interfere with the determination of the samples in plasma.The standard curve was linear in the range of 0.1-10.0 μg · mL-1 (r =0.999 2),LLOQ was 0.1 μg · mL-1.The RSDs of inter-day and intra-day were all less than 10％ in the plasma and the extraction recovery was 89％-92％.Conclusion This method was simple,sensitive,accurate,efficient and suitable for routine determination of the concentration of VRC in human plasma.

The distal femoral fracture, tibial plateau fracture and patellar fracture may all develop into traumatic knee arthritis, which is probably associated with knee dysfunction problems. Total knee arthroplasty (TKA) is an effective treatment for end-stage knee arthritis. The distal femoral valgus cut angle (VCA) is an important reference for distal femoral resection in TKA and significantly affects postoperative prosthesis position and lower extremity alignment after TKA. For VCA, the specific methods for definition, measurement methods, clinical application and influencing factors are currently controversial. Hence, the authors review the research progress in the role of VCA in TKA from the above-mentioned four aspects, hoping to provide a reference for accurate preoperative planning and intraoperative performance of TKA.

Objective:To investigate the value of ultrasonic measurement of the ratio of optic nerve sheath diameter (ONSD) to eyeball transverse diameter(ETD) in the diagnosis and prognosis of intracranial hypertension in patients with craniocerebral trauma.Methods:A total of 120 patients with craniocerebral trauma treated in the Xingtai General Hospital of North China Medical and Health Group from December 2021 to January 2023 were perspectively selected, and they were divided into normal intracranial pressure group (73 cases) and intracranial hypertension group (47 cases) according to the results of intracranial pressure measurements, and the intracranial hypertension group was divided into good prognosis group (20 cases) and poor prognosis group (27 cases) according to the follow-up prognosis. The efficacy of ONSD, ETD and ONSD/ETD in intracranial hypertension diagnosis and prognosis assessment were analyzed by receiver operating characteristic (ROC) curve. Kaplan-Meier method was used to evaluate the 6-month risk of adverse prognosis of patients, and the comparison was made by Log-rank test.Results:The levels of intracranial pressure, ONSD, ONSD/ETD in the normal intracranial pressure group were lower than those in the intracranial hypertension group: (130.73 ± 23.63) mmH 2O (1 mmH 2O = 0.009 8 kPa) vs. (270.11 ± 35.78) mmH 2O, (5.47 ± 0.29) mm vs. (5.78 ± 0.44) mm, 0.246 ± 0.018 vs. 0.263 ± 0.018, there were statistical differences ( P<0.05). The scores of Glasgow Coma Scale (GCS), intracranial pressure, ONSD, ONSD/ETD in the good prognosis group were lower than those in the poor prognosis group: (5.50 ± 1.24) scores vs. (6.41 ± 1.34) scores, (256.15 ± 30.23) mmH 2O vs. (280.44 ± 36.56) mmH 2O, (5.62 ± 0.40) mm vs. (5.90 ± 0.44) mm, 0.254 ± 0.014 vs. 0.270 ± 0.017, there were statistical differences ( P<0.05). ROC curve analysis results showed that the area under the curve (AUC) of ONSD and ONSD/ETD for diagnosing intracranial hypertension in patients with craniocerebral trauma were 0.718 and 0.765, respectively, and the critical values were 5.87 mm and 0.263, respectively. The AUC of ONSD and ONSD/ETD predicting prognosis of intracranial hypertension patients was 0.677 and 0.763, respectively, and the critical values were 5.90 mm and 0.267, respectively. Grouped by the threshold of ONSD/ETD for the prognosis of intracranial hypertension (0.267), the incidence of adverse prognosis in ONSD/ETD > 0.267 group was higher than that in the ONSD/ETD≤0.267 group, there was statistical difference ( P<0.05). Conclusions:ONSD/ETD can be used as an index for diagnosis and prognosis of intracranial hypertension.

Objective:To investigate the clinical effect of water-jet excision combined with skin graft in the treatment of giant congenital melanotic nevus.Methods:The patients with giant nevus who were admitted to the Department of Plastic Surgery, Chinese PLA General Hospital from January 2015 to May 2019 were retrospectively analyzed. All patients were treated by layer-by-layer cutting of giant nevus with water-jet, preserving the subcutaneous fascial layer and part of the dermis as much as possible, then following by skin graft transplantation. The patients visited the hospital 1-2 years after operation. The postoperative scar of skin graft area was scored by Patient and Observer Scar Assessment Scale (POSAS), and the satisfaction of skin graft area was evaluated by digital scoring method (1-10 points). The recurrence of nevus pigmentosus and implantation metastasis were observed. Descriptive method were used for statistical analysis.Results:A total of 7 children were included, 2 males and 5 females, aged 4 to 14 years. There were 3 cases on the trunk and 4 cases on the extremities. Giant nevi accounted for (7.4 ± 3.1)% of the body surface area. Then skin graft survived well after surgery in all 7 children. During the 1-year follow-up after operation, the POSAS score of skin graft scar showed that the sum of 1-3 points in the scores of scar pain, itching, hardness and thickness by the patients or their families was 6, 4, 4 and 5 cases, respectively, and the sum of 4-10 points in the pigmentation and irregularity was 5 and 5 cases, respectively. None of the 7 patients had functional limitation in the skin graft area; the physicians’, scores for vascularity, pigmentation, thickness, and flexibility of the scars in the skin graft area were low, with a sum of 6, 3, 4, and 4 for the number of cases with 1-3 points and 2 and 4 for the number of cases with 1-3 points and 4-6 points in the flatness score, respectively. The satisfaction of both doctors and patients (sum of 7-10 points) was 4 and 5 cases, respectively. 7 cases were reexamined 1 year after operation, with recurrence of 2 punctate nevus pigmentosus(less than 1 mm in diameter) in only one case. No implantation metastasis in the skin graft area of nevus pigmentosus happened.Conclusions:Water-jet excision combined with skin graft in the treatment of giant nevus is simple and only one procedure required. The donor site only needs to cut a split-thickness skin graft. The postoperative scar is not obvious and the skin elasticity is better. Patients were relatively satisfied with the postoperative effect. It is suitable for the resection of nevus pigmentosus in the trunk especially the nevus pigmentosus with good texture and lighter color but not for the lesion at articular area of limbs.

Objective:To investigate the clinical effect of water-jet excision combined with skin graft in the treatment of giant congenital melanotic nevus.Methods:The patients with giant nevus who were admitted to the Department of Plastic Surgery, Chinese PLA General Hospital from January 2015 to May 2019 were retrospectively analyzed. All patients were treated by layer-by-layer cutting of giant nevus with water-jet, preserving the subcutaneous fascial layer and part of the dermis as much as possible, then following by skin graft transplantation. The patients visited the hospital 1-2 years after operation. The postoperative scar of skin graft area was scored by Patient and Observer Scar Assessment Scale (POSAS), and the satisfaction of skin graft area was evaluated by digital scoring method (1-10 points). The recurrence of nevus pigmentosus and implantation metastasis were observed. Descriptive method were used for statistical analysis.Results:A total of 7 children were included, 2 males and 5 females, aged 4 to 14 years. There were 3 cases on the trunk and 4 cases on the extremities. Giant nevi accounted for (7.4 ± 3.1)% of the body surface area. Then skin graft survived well after surgery in all 7 children. During the 1-year follow-up after operation, the POSAS score of skin graft scar showed that the sum of 1-3 points in the scores of scar pain, itching, hardness and thickness by the patients or their families was 6, 4, 4 and 5 cases, respectively, and the sum of 4-10 points in the pigmentation and irregularity was 5 and 5 cases, respectively. None of the 7 patients had functional limitation in the skin graft area; the physicians’, scores for vascularity, pigmentation, thickness, and flexibility of the scars in the skin graft area were low, with a sum of 6, 3, 4, and 4 for the number of cases with 1-3 points and 2 and 4 for the number of cases with 1-3 points and 4-6 points in the flatness score, respectively. The satisfaction of both doctors and patients (sum of 7-10 points) was 4 and 5 cases, respectively. 7 cases were reexamined 1 year after operation, with recurrence of 2 punctate nevus pigmentosus(less than 1 mm in diameter) in only one case. No implantation metastasis in the skin graft area of nevus pigmentosus happened.Conclusions:Water-jet excision combined with skin graft in the treatment of giant nevus is simple and only one procedure required. The donor site only needs to cut a split-thickness skin graft. The postoperative scar is not obvious and the skin elasticity is better. Patients were relatively satisfied with the postoperative effect. It is suitable for the resection of nevus pigmentosus in the trunk especially the nevus pigmentosus with good texture and lighter color but not for the lesion at articular area of limbs.

Objective To investigate the effects of down-regulated miR-9 expression on ultraviolet rays (UV)-induced reactive oxygen species (ROS) damage in nasopharyngeal carcinoma (NPC) cells.Methods The NPC cells were transfected with inhibitors of miR-9 by lipofectamine to decrease the expression of miR-9,and the cells transfected with inhibitor control as the control.ROS levels following UV exposure were examined with DCF-DA method and the concentration of glutathione was analyzed via the benzoic acid method; DNA damage and apoptosis also were evaluated.Results There was significant difference in ROS levels between miR-9 expression-inhibited cells and control cells (26 895 ± 218 vs 15 765-±927,t =39.754,P ＜0.001),and also there were significant differences in DNA damage rates (28.0％ ± 10.0％ vs 23.6％ ±9.2％) and in apoptosis rates (8.0％ ±0.9％ vs 4.5％ ±0.8％) following UV exposure between two groups of cells.The miR-9 expression-inhibited cells showed lower level (1.87 ± 0.15) μmoL/L of glutathione compared with the control cells (9.85 ± 0.15) μmol/L (t =-48.832,P＜0.001).Conclusion Inhibition of miR-9 expression promoted UV-induced ROS damage in nasopharyngeal carcinoma cells.

This paper retrieved an updated version of the kidney disease improving global outcomes (KDIGO) guideline and Chinese Medical Association guideline.By combining Micromedex given Thomson grade,we draw a evidence-based evaluation of off-label drug use in pediatric kidney disease.We concluded updated pediatric nephritic disease guidelines.Doctors and pharmacists should cause the attention,and regard off-label uses of drugs normatively and rationally.

Objective:To explore the methods of repairing large soft tissue defect with latissimus dorsi myocutaneous flap and the management of secondary wound in donor site.Methods:From June 2015 to June 2019, 30 patients with soft tissue defect caused by various reasons or hyperplastic scar were hospitalized in the First Medical Center of Chinese PLA General Hospital, including 10 males and 20 females, aged 25-64 years, with 18 cases of head soft tissue defects caused by the growth and rupture of tumor, 7 cases of hypertrophic scar in trunk and limbs, and 5 cases of facial and neck soft tissue defects caused by trauma. The area of primary wound after debridement or enlarged lesion resection was 14 cm×10 cm-18 cm×16 cm. Preoperative evaluation of 20 patients showed that the wound was relatively large, and the donor site could not be directly closed by suturing after resection of conventional single-lobe latissimus dorsi myocutaneous flap, so the bilobed latissimus dorsi myocutaneous flap with area of 14 cm×5 cm-18 cm×8 cm was cut to repair the wound, and the donor site was directly closed by suturing. Preoperative evaluation of 10 patients showed that the donor site could be directly closed by suturing after resection of conventional single-lobe latissimus dorsi myocutaneous flap, so that conventional single-lobe latissimus dorsi myocutaneous flap with area of 11 cm×9 cm-13 cm×10 cm was resected to repair the primary wound, resulting in big tension in donor site and secondary wound with area of 6 cm×4 cm-8 cm×6 cm that couldn′t be directly sutured, which was repaired with donor site local flap with area of 7 cm×4 cm-9 cm×6 cm, and the second donor site was directly closed by suturing. Intraoperative end-to-end anastomosis was performed between the thoracodorsal arteries and veins of the latissimus dorsi myocutaneous flap and the arteries and veins of the primary recipient wound. The survival of latissimus dorsi myocutaneous flaps and local flaps were observed after surgery, and the appearance and function of the donor and recipient areas were observed during follow-up.Results:All the latissimus dorsi myocutaneous flaps and local flaps survived in the patients after surgery. Follow-up of 6-12 months showed that the latissimus dorsi myocutaneous flap was similar in color to the surrounding normal skin, with soft texture and good elasticity. The donor site of 20 patients repaired with bilobed latissimus dorsi myocutaneous flaps were only left with linear scars, among which 2 patients had hypertrophic scars and none had functional impairment. The donor site of 10 patients repaired with single-lobe latissimus dorsi myocutaneous flaps and donor site local flaps had good appearance, left with linear scar, irregular shape, but no local traction or dysfunction.Conclusions:When repairing a large soft tissue defect, the bilobed latissimus dorsi myocutaneous flap or the single-lobe latissimus dorsi myocutaneous flap combined with the local flap transfer in the donor site can be used after preoperative evaluation so that the donor site wound can be closed at one time while repairing the primary wound. The donor site has less scar, and both the recipient and donor sites have good appearance and function after surgery.