Objective To develop a special ambulance for airfield rescue of pilots in danger or offering medical care for pilots in flight.Of course the ambulance can also be used to rescue the wounded daily or in the war.Methods The ambulance owned a cross-country motorcar chassis and bearing carriage.A luffing extension-jib was installed on top of the carriage with a telescopic nacelle.The medical carriage owned a generator,air-conditioner,launder & antisepsis facilities,telescopic medical table,Air Force medical facilities for first aid and so on.It could simultaneously treat 2 injured pilots in lying position.Oxygen outputs were equipped to sustain Persons in carriage.Result The maximal speed of the ambulance was 95 km/h.The time of simulated rescue was about 3 minutes in the maxium height.Conclusion Without new staff established,the ambulance can adapt to any road and is suitable to war field.It can arrive at the location of flight accident quickly and rescue the pilot rapidly.It meets the needs of medical support in flight,war-time medical care in airport and mobile accompanying support.

Objective To formulate a five-level pediatric emergency triage standard and evaluate the efficacy and reliability of it in determining severity of emergency pediatric patients.Methods According to the assessment methods in Pediatric Advanced Life Support recommended by American Heart Association and American Academy of Pediatrics,we formulated a five-level pediatric emergency triage standard based on the situation of our hospital and analyzed the data one year before and after the application of it.Results Before and after the application of the triage standard,the average satisfaction rate of emergency patients were (81.28 ± 3.97) ％ and (94.13 ± 4.62) ％,and there was significant difference (P ＜ 0.01) ; the proportion of whom became worse during waiting time were 1.83％ (628/34275) and 0.04％ (16/36 187),and there was significant difference (P ＜0.01) ;the average waiting time of emergency admission patients were (12.71 ± 2.32) min and (3.34 ± 1.95) min,and there was significant difference (P ＜0.01) ;the misjudgment rate of severity were 3.78％ (1 296/34 275) and 0.57％ (205/36 187),and there was significant difference (P ＜ 0.05).Conclusion The five-level triage standard is objective,easy to master,and suitable for pediatric triage.It can quickly sort out critical cases from emergency pediatric patients,which can improve the effectiveness of emergency service,make use of medical resources rationally and somewhat solve the problem of overcrowding.

Objective To evaluate the clinical effect of popliteal artery perforator-based sural neurovascular flap for repairing soft tissue defects in middle and distal upper leg.Methods Between December,2011 to September,2015,18 cases with skin soft tissue defects on the middle and distal upper leg were treated with popliteal artery perforator-based sural neurovascular flap,in which 12 cases were males,and 6 cases were females.The age was from 24 to 55 years,with the average age of 35.9 years.The size of tissue defects ranged from 3.0 cm × 3.0 cm to 7.0 cm × 9.0 cm.Results All flaps survived completely in 18 cases,1 case of marginal infection heated after dressing,and the rest cases in Ⅰ healing.The outline and function of survived flap were satisfactory during 3-16 months follow-up,with two-point discrimination of 4.0-10.0 mm.Conclusion The anterograde sural neurovascular flap based on the popliteal artery perforator provides a practical option for covering tissue defects in middle and distal upper leg.This flap is characteristiced by reliable blood supply without sacrificing main vesses,good contour and texture,in addition,the operation is easy of handling.

Objective We aimed to recent experience at our hospital in the diagnosis and treatment of pericardial effusion after cardiac surgery and to identify risk factors for its development.Methods We searched our hospital for patient who had cardiac surgery with cardiopulmonary bypass from January 2002 through December 2010.For patient with pericardial effusion,medical records were reviewed to evaluate its manifestations and management.To identify risk factors for effusion,patients with effusions were compared with patients without effusions.All patients had routine postoperative echocardiographic examination.Results Of 22462 patients identified,509 (2.3％) had pericardial effusion.Compared with patients without pericardial effusion,ages,sex,cardiac function and so on were no significant( P ＞ 0.05 ).Body,valve cardiac diseases,and cardiopulmonary bypass time and so on were significant ( P ＜ 0.05 ).Among 509 patients with pericardial effusion,262 patients (51.4％) of whom had specific symptoms.Clinical features of tamponade were documented in 51 patients( 10.1％ ).Pericardial effusions were evacuated by echocardilgraphy-guided pericardiocentesis ( n =27,10.3％ ) or surgical drainage ( n =15,5.7％ ).Pericardial effusion resolved after left thoracocentesis for pleural effusion in 5 patients ( 1.9％ ) ; The Other patients with pericardial effusion were treated conservatively.Indeperdent risk factors for pericardial effusion were large body,valve cardiac operations,and prolonged cardiopulmonsry bypass.Conclusion In our study,pericardial effusion occurred in 2.3％ of patients,and symptoms were nonspecific.Several factors,mainly related to preoperative characteristics and type of operation,predispose patients to effusion,echocardiography-guided pericardiocentesis is effective and safe in these patients with pericardial effusion.

Objective:To investigate the possible mechanism of DiI labeled bone marrow mesenchymal stem cells (BMSCs) in contact co-cultured with neonatal rat cardiomyocytes (CMs) on polycaprolactone (PCL) film to make myocardial patch.Methods:BMSCs from Sprague Dawley rats (aged 5-6 weeks) were isolated, cultured, and characterized for surface marker expression using flow cytometry. CMs from 15 neonatal rats were isolated and cultured. After cultured for 3 generations, BMSCs were labeled with DiI dye. On PCL film, DiI labeled BMSCs were co-cultured with CMs as the experimental group, and CMs were replaced with the same amount of unlabeled BMSCs in the control group. After 24 h of co-culture, the cell growth was observed under fluorescence microscope and the co-culture was observed under scanning electron microscope. Immunofluorescence staining was performed after 7 days to detect myocardial markers, including cardiac troponin T (cTnT) and α-actinin. BMSC differentiation on the PCL film was observed under a fluorescence microscope. The differentiation efficiency of BMSCs into cardiomyoid cells was analyzed by flow cytometry on days 1 and 7 of co-culture. Intercellular dye transfer was observed by staining CMs with calcein and co-culturing them with DiI-labeled BMSCs on PCL film. The cells were stained with immunofluorescence to detect the expression of connexin 43 (Cx43) and observe the relationship between gap junction and contact co-culture.Results:Flow cytometry showed strong positivity for CD90 and CD44 and negativity for CD11b/c and CD45 on BMSCs. After 24 h of co-culture, DiI labeled BMSCs glowed red on the PCL film, while unlabeled CMs did not; the number of cells on PCL film was large and cell morphology appeared normal under scanning electron microscope. On the 7th day of co-culture, some DiI labeled BMSCs expressed cTnT and α-actinin. Flow cytometry showed a higher differentiation rate of stem cells in the experimental group on day 7 compared to the control group ((20.12±0.15)% vs. (3.49±0.20)%, P<0.05). From the second day of co-culture, some BMSCs exhibited green dot fluorescence in Cx43 immunofluorescence staining; and by the third day, dye transfer test showed green fluorescence emission from some BMSCs. Conclusion:Contact co-culture of DiI labeled BMSCs and CMs on PCL film can make myocardial patch. The mechanism of contact co-culture promoting the differentiation and formation of myocardial patch may be associated with gap junctions and intercellular signal pathways mediated by gap junctions.

Objective:To investigate the validity of a simple technique of drilling nasal spine in costal cartilage based rhinoplasty.Methods:From August 2018 to October 2020, the clinical data of patients whom received costal cartilage rhinoplasty in Plastic Surgery Hospital of Chinese Academy of Medical Sciences were retrospectively analyzed. During the operation, the towel clamp was slid into the space of the nasal spine, with minor adjustments of its position, slowly and steadily, the towel clamps were tightened until the bilateral tips were met, and the perforation procedure was successful. Then, based on this aperture, the columellar strut was firmly fixed to the nasal spine, and the cartilage framework was established. Postoperative follow-up was conducted to investigate the satisfaction of the patients, as well as a third-party plastic surgeon was introduced to evaluate the pre-and post-operative photos of the patients by the observer’s overall cosmetic improvement score (IGAIS).Results:A total of 35 female patients with the age of (27.7±2.3) years (22-37 years old) were included. All patients presented low tip and dorsum, with flat, flaring alae. There were no significant short-term complications such as infection, mucosal perforation and graft exposure. The patients were followed up for 6 to 24 months. Two cases presented cartilage warping, and was corrected after revision surgery. The appearance of the nose was significantly improved, and the subjective satisfaction was 97.1% (34/35). The third-party physician evaluation results were: in 35 cases, 33 cases achieved significant improvement, 2 cases achieved moderate improvement, 100% (35/35) of the patients reached the improvement, and the improvement score was 1.08±0.28.Conclusions:The drilling technique of utilizing a towel forcep is simple and practical which facilitates stable fixation of nasal columellar support graft, and renders a good outcome in the clinical application of autologous costal cartilage rhinoplasty.

Objective:To introduce a new method of lateral nasal osteotomy. The key of this method is to fully dissect the tissue around the piriform foramen to achieve nasal osteotomy under direct vision. The osteotomy line in the whole process can be seen, which provides a more reliable control for the degree of osteotomy during the operation, and also makes the postoperative outcome more predictable.Methods:Patients whom were treated with open external osteotomy combined with autologous costal cartilage implantation for augmentation rhinoplasty (with 24 cases of hump nose correction) from October 2018 to October 2020. During the surgery, the whole nasal dorsum was exposed, the superior lateral cartilage was separated from the nasal septum, and the whole process was carried out through the mucosa from the intranasal approach under direct view. The osteotomy line was evaluated at the same time.Results:A total of 33 female patients were retrospectively analyzed. All the operations were successful, and the local swelling occurred after operation. The follow-up time was 3-18 months. After 3 months, the nasal contour and dorsal curves were smooth. Severe infections, major injuries like nasolacrimal duct, lacrimal sac, medial canthus ligament, nerve branches were not noticed in all patients. During the long-term follow-up, two patients exhibited slightly widened nasal bone, but did not require surgical intervention. The shape of nose was greatly improved. Patients were satisfied with the result . The subjective evaluation had "very satisfactory" in 24 cases (72.7%) and "satisfactory" in 9 cases (27.3%). The IGAIS evaluation were also positive: the average score of 33 patients was 1.26±0.34, including 30 cases (90.9%) scoring 1 point and 3 cases (9.1%) scoring 2 points.Conclusions:The open osteotomy technique has better control than that of conventional blind operation. It is more reliable, safer for the surgeons who are new to rhinoplasty and the experienced ones.

Objective:To investigate subalar change after rhinoplasty with costal cartilage.Methods:A retrospective study was performed on patients who received cartilaginous rhinoplasty at the Rhinoplasty Center of Plastic Surgery Hospital, Chinese Academy of Medical Sciences from May 2019 to August 2020. The facial three-dimensional(3D) and CT scanning data of young female cases was analyzed. Pre-operative and more than 6 months follow-up data was matched. The 3D facial coordinate system was established. Preoperative and postoperative location of the subnasale and the lateral point of nasal-facial junction, the angle between endocanthion-alare and coronal plane and the nasolabial angle were analyzed with paired samples t-test. The volume of subalar area was analyzed with one-sample t-test. Results:Eighteen female cases aged (27.30±4.41) years were enrolled in the study with (10.61±3.53) months follow-up. One case (5.6%) suffered from nostril asymmetry one month after the surgery. The subnasale moved forward from (74.30±1.97) mm to (77.67±2.37) mm [average difference (3.36±0.96) mm]. The lateral point of nasal-facial junction moved forward from (65.51±2.45) mm to (68.05±2.52) mm [average difference (2.53±1.50) mm]. Nasolabial angle was (88.79±11.21) degree preoperatively and (101.37±5.53) degree postoperatively [average difference (12.57±7.57) degree]. Angle between endocanthion-alare and coronal plane increased from (9.01±3.24) degree to (12.73±3.27) degree [average difference (3.72±2.22) degree]. The differences between pre- and post-operative data were statistically significant ( P<0.01). The volume of subalar area increased by (282.59±103.22) mm 3. The difference was statistically significant ( P<0.01). Conclusions:Rhinoplasty with costal cartilage could make subalar area move forward.

Objective:To investigate the clinical application of a cartilage graft fixation method in the context of rib-based rhinoplasty.Methods:The clinical data of patients who underwent costal cartilage based rhinoplasty in the Center of Rhinoplasty and Nasal Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2020 to January 2022 were retrospectively analyzed. A 20 ml syringe needle was used to drill several micropores about 1 mm in diameter on the surface of the cartilage grafts prior to its placement. "septal extension grafts with micropores" were prepared, and the preparation of the remaining grafts was conventional.Results:A total of 30 female patients aged 21-45 years, with an average age of 36 years underwent primary or repaired autogenous costal cartilage rhinoplasty without severe damage to the nasal septum cartilage (at least retention of L-shaped scaffolds larger than 10 mm) were enrolled. All operations were successful, the cartilage scaffold was stable and durable. There were no serious complications such as infection, septal hematoma and cartilage exposure. Postoperative patients were followed up for a duration of 6-24 months. Two out of 30 patients were not satisfied with the postoperative appearance. During the revision surgery, the septal perichondrium was separated, mucosal tissue had grown into the bilateral holes which further verified of the feasibility of drilling. The other patients were satisfactied with the results.Conclusion:Nasal septum extension graft based on drilling technique is beneficial to maintain the long-term stability of cartilage scaffold after comprehensive costal cartilage nasal surgery, which justifies its application in comprehensive nasal plastic surgery.

Objective:To investigate the clinical effect of jujube core-shaped tissue resection technique in the treatment of alar reduction.Methods:A retrospective analysis was performed for the clinical data of patients who underwent alar reduction from February 2019 to June 2022. A spindle-shaped incision line was designed along the outer edge of the base of the nasal lobule, with a width of 4-5 mm and a length of 8-12 mm. The incision line was 1-2 mm away from the alar groove, and the inner side of the design line was extended to the inside of the nasal vestibule. After the incision was made, the subcutaneous tissue was undermining dissected with curved sharp scissors, and the shape of the extended excision tissue was similar to that of jujube core. After reduction, the incision was closed with vertical mattress suture. The surgical effect and complications were followed up after surgery, and an independent attending plastic surgeon evaluated the outcome and scarring based on photos before and at the last postoperative follow-up using the global aesthetic improvement scale (GAIS) and the Vancouver scar scale (VSS). GAIS is graded as 1, 2, 3, 4, and 5 points, and the lower the score, the better the improvement(≤3 points as effective improvement). VSS includes four parameters: color (0-3 points), thickness (0-4 points), vascular distribution (0-3 points), and softness (0-5 points). The higher the score, the more significant the scar is.Results:A total of 20 patients were enrolled, including 6 males and 14 females, aged 20 to 33 years, with an average age of 24.9 years. Before the operation, there were different degrees of alar flare and alar hypertrophy. After surgery, 13 patients had mild swelling, ecchymosis, which resolved after 3 days. There were no major complications as infection, incision dehiscence, and delayed healing. After 3 to 16 months of postoperative follow-up, 2 patients gradually developed cartilage deformation and affected the appearance of the nostrils 6 to 9 months after surgery due to the combination of rib-based rhinoplasty, and the satisfactory results were obtained after revision surgery. The symmetry of the nostrils was significantly improved. The GAIS score of 20 patients was (1.20±0.41) points, of which, 16 patients were rated as 1 point and 4 patients were rated as 2 points, all of which met the improvement criteria, and the VSS score was (1.45±0.60) points, in which the average score for color, thickness, vasculature and compliance are 0.60, 0.05, 0.55 and 0.30 points respectively.Conclusion:The application of jujube core-shaped tissue resection technique for alar reduction can increase the amount of tissue removal with the same incision width, which can not only fully narrow the alar effectively but also correct the hypertrophy of the alar tissue.