OBJECTIVETo investigate the feasibility and advantages of total auricular reconstruction with single big expander at dual plane through incision at remnant ear.

METHODS52 patients with microtia were treated. Through incision at remnant ear, one big expander (150 ml) was implanted in the post-auricular area beneath the superficial facial in the hairless area, and above the superficial fascia in the area with hair. In the second stage, total auricular was reconstructed with autologous cartilage framework and expanded skin. Skin graft was not necessary. Another 32 paitents with single big expander above the superficial fascia were used as control. The downward shift distance of expanders, the appearance of auriculocephalic sulcus and complication were recorded in order to assess the effect of these two methods.

RESULTSThe downward shift distance of expanders in the dual plane group (0.7 ± 0.3) cm were lower than that in the control group (1.3 ± 0.4) cm, showing significant difference (P < 0.05). After a follow-up period of 6-12 months, shallow auriculocephalic sulcus was presented in 5 patients of the dual plane group and 12 patient of the control group. The shallow auriculocephalic sulcus was cut to make it deeper and covered with full skin graft.

CONCLUSIONSDual plane skin expansion could reduce the downward shift distance of expander. Adequate skin on the upper part of expander could make satisfactory auriculocephalic sulcus.

Cartilage ; transplantation ; Congenital Microtia ; surgery ; Feasibility Studies ; Hair ; Humans ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Subcutaneous Tissue ; Surgical Flaps ; trends ; Tissue Expansion ; methods ; Tissue Expansion Devices

OBJECTIVETo investigate the application of intense pulsed light (IPL) depilation in the auricular reconstruction with totally expanded skin and its suitable parameter.

METHODSFrom February 2009 to September 2013, one tissue expander(100 or 150 milliliters) were implanted under the skin of mastoid in 126 patients who suffered from microtia. During the skin expanding, the hair on the expanded skin was depilated by JPL technique. The parameter, operation, interval, the depilation result and the complication were recorded. The autologous rib cartilage frameworks were implanted in the second phase of auricular reconstruction.

RESULTSThe energy of IPL was 20 - 35 J/cm2 (mean 25. 3 J/cm2), the width of pulse was 26 - 30 ms ( mean 27. 9 ms), the interval between two operations was 4 weeks. Ninety-six patients were cured(76. 2%, 96/126). The total depilation efficient is 96. 8% (122/126). A fine banding blisters was found in one patient whose depilation areas was marked by black pen. Skin erythema was found in five patients and skin pigmentation was found in 7 patients. There were no skin necrosis and expander exposure in all patients. During 6 - 12 months of follow-up period, ninety-two patients were cured (73.0%, 92/126) and the total depilation efficient is 92. 9% (117/126).

CONCLUSIONSIPL depilation during the skin expanding is feasible and safe with careful procedure. The hairless expanded skin is enough to cover the framework, as well as the post-auricular area. The appearance of reconstructed ear is better without hair.

Congenital Microtia ; surgery ; Costal Cartilage ; transplantation ; Ear, External ; Erythema ; etiology ; Hair Removal ; methods ; Humans ; Mastoid ; Phototherapy ; adverse effects ; methods ; Reconstructive Surgical Procedures ; Skin Pigmentation ; Surgical Flaps ; Tissue Expansion ; Tissue Expansion Devices

Objective To study the clinical features bone marrow biopsy of secondary myelofibrosis(SMF).Methods 69 patients with secondary myelofibrosis were analyzed retrospectively,and the relationship between myelofibrosis degree and megakaryocyte count was analyzed. Results Analysis of 69 cases of patients with SMF, the original incidence included 20 cases (29.0 ％)of chronic myeloid leukemia (CML),14 (20.3 ％) cases of lymphoma,10 (14.5 ％) cases of acute myeloid leukemia (AML),10 (14.5 ％) cases of myelodysplastic syndrome (MDS),6 cases(8.7 ％)of acute lymphoblastic leukemia (ALL),4 cases of multiple myeloma (MM),3 cases of myeloproliferative neoplasms (MPN),2 cases of chronic lymphocytic leukemia (CLL).There was no significant difference of the mygakaryocytes’ count and association of myelofibrosis with it was found (r=0.024,P=0.848). Conclusion Various clinical diseases of blood system may associated with secondary myelofibrosis. Bone marrow biopsy can be used to initial diagnostics of malignant disease of hematological system patients.When cellular examination of bone marrow is dry tap or dilution, which means higher incidence of SMF. Bone marrow biopsy plays an important role in diagnosis of SMF.

Objective To investigate left ventricular(LV) systolic dyssynchrony in heart failure of different etiology which caused respectively by ischemic heart disease and dilated cardiomyopathy and analyse the correlation between the systolic dyssynchrony index(SDI) and the LV ejection fraction(LVEF). Methods Forty-three subjects were divided into two groups. Group A consisted of 17 heart failure patients which caused by ischemic heart disease and group B included 26 heart failure patients which caused by dilated cardiomyopathy. Three-dimensional datum of left ventricle were obtained using real-time three-dimensional echocardiography (RT-3DE) in full volume mode. Post-processing software Qlab was used for advanced analysis. The end-diastolic volume (EDV), end-systolic volume (ESV), LVEF and bull eye graph of seventeen segments were obtained. Standard deviation of time-to-minimal-systolic-volume of 16-LV segments corrected by R-R interval was calculated as SDI of LV. Results There was no statistical difference in age, heart rate, LVEF and EDV between the two groups (P >0.05). SDI of group A was lower than that of group B,but there was no statistical difference between them (P>0.05). Bull eye graph of seventeen segments revealed that the distribution of delayed systolic segments were different between the two groups. SDI of two groups appeared negative correlation with LVEF(r = -0.83, r = -0.71, P-< 0.01). Conclusions LV systolic dyssynchrony existed in heart failure which caused by ischemic heart disease and dilated cardiomyopathy,but the distribution of delayed systolic segments were different between them. SDI increased with worsening LV systolic function.

BACKGROUND:Alveolar bone remodeling and sustained absorption due to tooth extraction seriously affect the implanting conditions and morphology of hard and soft tissue in implant zone. OBJECTIVE:To evaluate the effect of nano-hydroxyapatite/polycaprolactone electrospinning scaffolds to improve the osteogenic effect of bone defects around immediate implants. METHODS:Tissue-engineered bone was prepared by combining canine bone marrow mesenchymal stem cels with nano-hydroxyapatite/polycaprolactone electrospinning scaffold. Bilateral mandibular second premolars from six dogs were extracted mandibular second premolar, and an immediate implant was placed in the mesial fossa of the mandibular second premolar. Three-wal bone defects was made buccaly using titanium nails, then tissue-engineered bone and Bio-Oss bone powders were implanted bilateraly covered by colagen membranes (Bio-Gide). Imageology examination was performed to measure bone gray levels immediately, 4, 8, 12 weeks after surgery. After 12 weeks, the mandible was removed completely, toluidine blue staining was used for observation of microstructure, new bone formation, bone morphology and implant osseointegration. RESULTS AND CONCLUSION: Between the two groups, there was no difference in bone mineral density at each time point after surgery, indicating that the effects of the two materials to promote bone regeneration process are basicaly the same. After implantation, the dense lamelar bone formed in the bone defect region of tissue-engineered bone group, mature bone cels, Haversian canal, and implant osseointegration were visible. While, in the Bio-Oss group, the lamelar bone was dense, a smal amount of Bio-Oss particles distributed within new bone tissues, fewer bone cels were found, a part of Haversian canal was shown to have blood capilaries, and new bone was in close conjunction with the implant. These findings indicate that the nano-hydroxyapatite/polycaprolactone electrospinning scaffold combined with bone marrow mesenchymal stem cels and Bio-Gide colagen membrane can promote the regeneration of alveolar bone around the implant.

Objective To evaluate the role of heparanase in endotoxemia-induced destruction of vascular endothelial glycocalyx in rats.Methods Forty-eight pathogen-free male Sprague-Dawley rats, aged 8-10 weeks, weighing 200-250 g, were randomly divided into 3 groups (n=16 each) using a random number table: control group (group C), lipopolysaccharide (LPS) group (group L) and LPS+ heparin group (group LH).Endotoxemia was induced by intravenous LPS 15 mg/kg in L and LH groups, and heparin sodium 100 U · kg-1 · h-1 was infused simultaneously in group LH.At 3 and 6 h after LPS injection, blood samples were collected from the femoral vein for determination of the serum concentrations of serum heparin sulfate (HS), syndecan-1, E-selectin and intercellular adhesion molecule-1 (ICAM-1) concentrations.The rats were then sacrificed, and lungs were removed for microscopic examination and for determination of wet/dry lung weight ratio (W/D ratio).Results Compared with group C, the serum HS, syndecan-1, E-selectin and ICAM-1 concentrations and W/D ratio were significantly increased in group L, and the serum HS and ICAM-1 concentrations were increased in group LH (P＜0.05).Compared with group L, the serum HS, syndecan-1, E-selectin and ICAM-1 concentrations and W/D ratio were significantly decreased in group LH (P＜0.05).The pathological changes of lungs were obvious in group L, and were significantly mitigated in group LH.Conclusion Heparanase is involved in endotoxemiainduced destruction of vascular endothelial glycocalyx in rats.

Objective To study the curative effect and prognosis of malignant pleural effusion treated by staphylotoxoid injection and its effect on immune system.Methods A total of 65 patients with malignant pleural effusion from August 2012 to 2014 November in Lishui City Central Hospital were selected,and divided into observation group(n=33) and control group (n=32) in terms of different treating methods,two groups were implemented with thoracic closed drainage to drain pleural effusion up.The observation group was completely drained after 2 500 U intrapleural injection of staphylotoxoid injection,the control group to the traditonal method of bleomycin 1 mg/kg injection.The efficacy,prognosis and immune system were compared.Results The effective of rate of the observation group was significantly higher(72.7%) than the control group(43.8%);the adverse reaction rate of observation group was lower and its median survival time was longer;white blood cells counts of observation group was significantly more than control group ( P<0.05).Conclusion Compared with the traditional method of bleomycin intrapleural injection treatment of malignant pleural effusion, staphylotoxoid injection can be more effective control of the disease , reduce adverse reactions, and can improve their immunity and improve the body tolerance .

ObjectiveTo investigate the role of platelet in mouse pulmonary microvascular endothelial cell (PMVEC) injury caused by lipopolysaccharide( LPS)-activated neutrophil.MethodsPMVECs were obtained from pathogen-free C3H/HeN mice of both sexes aged 6-8 weeks weighing 18-25 g according to the method described by Lim YC et al.Platelets and neutrophils were isolated from mouse blood by twice centrifugation and denaity gradient centrifugation respectively.PMVECs were seeded into twelve- or six-well plates ( 1 or 2 ml/well) after 2-5 passages and were randomly divided into 4 groups (n =31 each): group LPS; group platelets (group P);group neutrophils (group N) and group platelets + neutrophils (group PN).Each well contained about 5 × 107/ml platelets and/or 5 × 105/ml neutrophils respectively.PMVECs were incubated with LPS1 μg/ml at 37 ℃ in a 5％ CO2 humidified atmosphere for 1,6,12,18 and 24 h respectively in all 4 groups.The cells were examined with phase contrast microscope for morphological changes and survival condition.Viability rate,apoptotic rate and activation rate of PMVECs were detected by flow cytometry at each time points.ResultsThere was no significant difference in morphology and number of endothelial cells (ECs) among the 4 groups,while the number of activated ECs was significantly increased but the number of living cells decreased in group PN compared with group LPS.The activation rate of ECs was significantly higher after being incubated with LPS for 6-12 h in groups P and N than in group LPS.The viability rate was significantly lower,while the apoptotic rate and activation rate were significantly higher after ECs were incubated with LPS in group PN than in groups LPS,P and N.ConclusionPlatelets play a decisive role in mouse PMVEC injury induced by LPS activated neutrophils.

Objective To assess the effects of QRS duration on left ventricular systolic synchronicity in patients with heart failure by real-time three-dimensional echocardiography(RT-3DE).Methods Thirty-four patients with heart failure(LVEF≤35%)were selected and divided into two groups.Group A consisted of 20 patients with normal QRS duration,and group B included 14 patients with long ORS duration.All the patients underwent two-dimensional echocardiography(2DE)and RT-3DE respectively.Parameters including left ventricular inlernal diameter(LVIDd),left ventricular ejection fraction(LVEF)of 2DE,and left ventricular endsystolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),LVEF,the time to minimal systolic volume of 16-segmental standard deviation as a ratio of R-R interval(Tmsv16-sd/RR)of RT-3DE were obtained and analyzed between the two groups.Results There were no significant differences of LVIDd,LVEF acquired by 2DE between the two groups(P＞0.05);LVESV,LVEDV,Tmsv16-sd/RR of RT-3DE were slightly higher in group B than those in group A,but didn't reach the significant difference between the two groups(P＞0.05).The mechanical dyssynchrony maybe related to the severity of heart failure.Conclusions RT-3DE can quantify global left ventricular systolic synchronicity.QRS duration has no significant effect on left ventricular systolic synchronicity in patients with heart failure.

Objective To discuss the diagnosis and treatment of systemic lupus erythematosus(SLE)patients associated with pancreatic pleural effusion and pancreatic:panniculitis.Methods Retrospectively analyzed the clinical data,therapy and experiences.Results A 40-year-old female SLE patient associated with pancreatitis,huge pancreatic pseudocysts,pancreatic pleural effusion,pancreatic panniculitis.Abdominal computed tomography(CT)showed an edematous swelling of the pancreas and several pseudocysts,the biggest one measuring 230 mm×95 am.Markedly elevated amylase (11 327 U/L)was contained in the massive pleural effusion.Erythema nodosum tissue pathology revealed the pancreatic panniculitis.The pscudocyst did not completely resolve with high-dose steroid.Growth hormone release inhibiting hormone (GIH),ulinastatin,nasojejunal feeding,and it was later complicated by infection and rupture.After a surgical percutaneous drainage for the complicated pseudocyst,the clinical symptoms and signs were markedly improved.Conclusion This case shows the importance of performing eady drainage rather than conservative treatment for pancreatic pseudocyst in patients with lupus-associated pancreatitis.