OBJECTIVETo improve the paramedian forehead flap for nasal reconstruction.

METHODSBased on the findings of the Cutaneous branch of supratrochlear artery, the forehead musculo-cutaneous flap was divided into the musculo-flap and the skin-flap in 3 patients. The musculo-flap were used to reconstruct the septi-bone structure, and envelop silicon nasal-frame, while the skin-flap were used to reconstruct the nose. In 6 patients, the forehead flap was used as a skin-flap just with the muscle pedicle to reconstruct a nose with good appearance of nasal subunits, without the secondary operation.

RESULTSIn all of 9 cases, the cutaneous-branch of supratrochlear artery was found 1.7-2.0 cm above the orbital-rim. Eight patients got good results, only 1 patient had to do the secondary operation to coverage the exposed nasal frame.

CONCLUSIONSThe cutaneous-branch of supratrochlear artery could be an anatomical finding to form the forehead skin-flap and it is a good choice to be used to reconstruct a nose, even in complicated cases.

Adolescent ; Adult ; Female ; Forehead ; Humans ; Male ; Muscles ; transplantation ; Nose ; surgery ; Patient Satisfaction ; Reconstructive Surgical Procedures ; methods ; standards ; Skin Transplantation ; methods ; Surgical Flaps ; Treatment Outcome

Objective:To investigate the attention deployment emotion regulation disorder and its neural mechanisms in major depressive disorder(MDD).Methods:Twenty-six MDD patients(MDD group) and twenty-nine healthy control individuals(control group) were enrolled in this study.The accuracy and reaction time were recorded in the attention deployment behavioral paradigm.Neuroscan 64 Brain Evoked Potentiometer was used to detect the N1 and P3 components of the above two groups of subjects.SPSS 16.0 software were used to analyze the data.Results:(1)In the accuracy of attention deployment paradigm, the group main effect was significant ( F=11.626, P=0.001), indicating that the MDD group (0.82±0.01) was significantly lower than the control group(0.89±0.01)( P=0.001). In the reaction time of attention deployment paradigm, the group main effect was significant( F=16.55, P<0.01), indicating that the MDD group (1 460.82±41.86)ms)was significantly higher than the control group(1 226.31±39.63)ms)( P<0.01). (2)In the event-related potential of attention deployment paradigm, the group main effect of N1 was not significant ( F=2.949, P=0.092), and the interaction between task and group was significant ( F=4.756, P=0.034), indicating that the N1 amplitude induced by the MDD group in the calculation task(-3.699±0.441)μV) was significantly smaller than that of the control group (-5.055±0.418)μV)( P=0.030). The group main effect of P3 was not significant ( F=1.165, P=0.285), and the interaction between task and image attributes was significant ( F=11.602, P=0.001), indicating that the P3 amplitude induced by negative images(2.757±0.438)μV) was significantly higher than that of neutral images (1.963±0.460)μV)( P=0.002). Conclusion:Patients with MDD have difficulty transferring attention in emotional strategies, and it occurs in the early stages.

OBJECTIVETo evaluate the clinical value of laparoscopy-assisted modified Soave procedure for Hirschsprung disease in adults.

METHODSTwenty-eight patients with a preoperative diagnosis of Hirschsprung disease underwent laparoscopy-assisted modified Soave procedure between March 2005 and December 2009. Clinical data were retrospectively analyzed.

RESULTSThere were no conversions to open surgery. The mean operative time was (165±12) minutes (range: 135-185 minutes). Estimated blood loss ranged from 50 to 250 ml, and no patients required intraoperative blood transfusion. Postoperative pathologic examination showed Hirschsprung diseases in 19 patients and Hirschsprung allied diseases in 9. Only two patients developed rectal cuff infection and three mild seepage. Other patients had no postoperative complications. The mean hospital stay was (17.5±1.0) days. No fecal incontinence or recurrent constipation occurred during follow-up.

CONCLUSIONLaparoscopy- assisted modified Soave procedure is safe and effective for Hirschsprung disease.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Hirschsprung Disease ; surgery ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVESTo analyze the pathogenic bacterial's distribution and the drug resistance in the upper urinary tract stones, and to provide the information for choosing suitable antibiotics.

METHODSStone samples were taken for culture and for drug sensitivity test in 146 patients undergoing percutaneous nephrolithotomy between April 2007 and October 2008, and the results were analyzed.

RESULTSPathogens presented in 72 (49.3%) patients. There were 70 (86.4%) Gram-negative bacteria strains. Escherichia coli, Pseudomonas aeruginosa and Enterobacter cloacae were the predominant bacteria, accounted for 30.9%(25 strains), 23.5% (19 strains) and 12.3% (10 strains), respectively. There were 10 (12.3%) Gram-positive bacteria strains, the predominant bacteria was Staphylococcus epidermidis (6 strains), accounting for 7.4%. And there was 1 fungi strain (1.2%). Resistance to ampicillin/sulbactam (88.7%), ceftriaxone (81.3%) and ciprofloxacin (67.5%) was most commonly found in pathogen, and the rate of resistance to amikacin, imipenem and piperacillin/tazobactam were 8.6%, 10.0%, 10.0%, respectively. Erythromycylamine, teicoplanin, SMZ-TMP, nitrofurantoin were sensitive to Gram-positive bacteria.

CONCLUSIONSBacterial's distribution of upper urinary tract stones are multiple, and the majority pathogen is Gram-negative bacteria. A big variant resistance is found among different bacterium. The suitable antibiotics should be chosen according to the different bacterium in the patients who underwent percutaneous nephrolithotomy.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bacteria ; drug effects ; isolation & purification ; Child ; Child, Preschool ; Drug Resistance, Bacterial ; Female ; Humans ; Kidney Calculi ; microbiology ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Retrospective Studies ; Ureteral Calculi ; microbiology ; Young Adult

OBJECTIVETo improve the safety of the abdominoplasty by the study of the complication of abdominal compartment syndrome after abdominoplasty.

METHODSThree cases were analyzed and discussed respectively in aspects of clinic symptoms, pathological reason, treatments and follow-up results. The treatment was the incision of musculoaponeurotic system, which usually cause defect of abdominal wall after pressure releasing. The defect of musculoaponeurotic system was reconstructed by Mesh, and the defect of skin was repaired by skin graft.

RESULTSThe pathologic change of the complications was the shrinking of the belly cavity's volume and the increasing internal pressure of the abdomen caused the internal pressure of the thoracic cavity increase. The clinical manifestations included compressive feelings of chest and abdomen, high urinary frequency and psychiatric symptom. 2 patients accepted the operation. The abdominal compartment syndrome disappeared after the operation, and the results of the two years follow-up were satisfied.

CONCLUSIONSFull abdominoplasty has the risk of causing abdominal compartment syndrome. This complication can be cured by decompression of abdominal wall. The effect is stable after long time's follow-up. Special preventive methods should be used in high-risk patients to avoid this complication.

Abdominal Cavity ; Abdominal Wall ; surgery ; Adult ; Aged ; Compartment Syndromes ; etiology ; Female ; Humans ; Male ; Postoperative Complications ; Surgery, Plastic ; adverse effects

OBJECTIVETo evaluate the significance and effect of nasal aesthetic sub-unit principle.

METHODSBased on nasal aesthetic sub-unit, 27 patients were divided into 5 groups according to their nasal defects. They were nasal dorsum, tip, alar lobule, soft triangle and two or two above nasal subunit defects groups. Local restore were applied in defects which were less than 50 percent of one nasal subunit. Total nasal subunit reconstruction were applied, if areas of defects were larger than 50 percent of one nasal subunit 10 cases were received free tissue transplantation (including free skin transplantation, composite auricle transplantation, etc), 4 cases were received local flap, and 13 cases were received forehead flap. Following up for 5 to 37 months, evaluation item were contour and color.

RESULTSSkin transplantation and local flap were all survived. Auricle composite flap were all survived except for 2 cases whose epidermis looked red and purple. These two case's epidermis regained normal 6 months after operation. Forehead flap for nasal reconstruction were all survived, but one of them had to perform secondary surgery for coverage of the exposed nasal frame. 27 cases were followed up in all. Patients and their family members were satisfied with the nasal's contour and color.

CONCLUSIONSGood aesthetic effects comes from nasal aesthetic sub-unit principle in nasal reconstruction and repairing of nasal defects.

Adolescent ; Adult ; Esthetics ; Female ; Follow-Up Studies ; Humans ; Male ; Nose ; pathology ; Nose Deformities, Acquired ; surgery ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; Surgical Flaps ; Young Adult

OBJECTIVETo introduce a new prefabricated flap with matched colour, texture, thin enough thickness, large enough dimension and reliability for reconstruction of massive defect of face and neck.

METHODSThe patients with massive scar of face and neck were selected for treatment with prefabricated flap. Flap prefabrication involved two stages. The "sandwich" structure including the descending branch of the lateral femoral circumflex vessels and surrounding muscle fascia was harvested from the thigh and anastomosed to superior thyroid artery or facial vessels. Flap prefabrication was performed by inserting the fascia flap between the cervicothoracic skin and the tissue expander placed beneath the skin. After a period of expansion, the flap was transferred to the recipient site based on the implanted vessels. The results including complications were examined during follow-up.

RESULTSNine patients received this treatment. The average dimensions of fascia flap harvested was 6.3 cm x 11.2 cm. After mean interval of 16.7 weeks, the expanders were filled to a mean volume of 1670cc. The size of prefabricated flap ranged from 12 cm x 15 cm to 15 cm x 32 cm. In all cases, the flap efficiently covered the entire defect of the face and neck, and the donor site of the flap is closed primarily. All of the flaps developed venous congestion in some degree after the second operation. Partial flap necrosis occurred in two cases. Three flap was thinned to contour the bulky pedicle. During follow-up, the transferred flap was matched well to the adjacent skin. The reconstructed face restored nature contour and expression. Muscle weakness or paraesthesia was not found in the donor thigh.

CONCLUSIONSCervicothoracic Prefabricated Flap, is reliable and versatile in the reconstruction of massive soft tissue deficits with restoration nature surface and expression of the face and neck.

Adolescent ; Adult ; Child ; Face ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neck ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps ; Thorax ; Tissue Expansion ; Young Adult

Objective To evaluate the impact of different rating instruments used by raters with different seniority in OSCEs. Methods Surgical interns were randomly divided into two groups to undertake a nine－station surgical OSCEs. Raters with different seniority were also divided into two groups with four senior raters and four junior raters in one group. OSCE results were compared. Results There was no statistical significance when comparing results from different raters using checklist rating instrument. Results from different raters using global rating scale instrument were significantly different. Correlations between raters using checklist and global rating scale instruments showed statistical significance in 81.3% of stations. Conclusion Checklist rating instrument showed high capability of repeating the results. Therefore, it is recommended to apply checklist as many as possible in OSCE exams with mixed rater seniorities. Research on design of rating instruments are to be investigated to insure the effectiveness as well as the credibility of the rating system.

BACKGROUNDComparing with two dimensional (2D) imaging, both in diagnosis and treatment, three dimensional (3D) imaging has many advantages in clinical medicine. 3D reconstruction makes the target easier to identify and reveals the volume and shape of the organ much better than 2D imaging. A 3D digitized visible model of the liver was built to provide anatomical structure for planing of hepatic operation and for realizing accurate simulation of the liver on the computer.

METHODSTransverse sections of abdomen were chosen from the Chinese Visible Human dataset. And Amira software was selected to segment and reconstruct the structures of the liver. The liver was reconstructed in three-dimensions with both surface and volume rendering reconstruction.

RESULTSAccurately segmented images of the main structures of the liver were completed. The reconstructed structures can be displayed singly, in small groups or as a whole and can be continuously rotated in 3D space at different velocities.

CONCLUSIONSThe reconstructed liver is realistic, which demonstrates the natural shape and exact position of liver structures. It provides an accurate model for the automated segmentation algorithmic study and a digitized anatomical mode of viewing the liver.

Asian Continental Ancestry Group ; Female ; Humans ; Image Interpretation, Computer-Assisted ; methods ; Imaging, Three-Dimensional ; Liver ; anatomy & histology ; Male ; Software ; Visible Human Projects

BACKGROUNDLeft main coronary artery (LMCA) stenosis has been recognized as a risk factor for early death among patients undergoing coronary artery bypass grafting (CABG). This study aimed to assess if LMCA lesions pose an additional risk of early or mid-term mortality and/or a major adverse cardiac and cerebrovascular event (MACCE) after off-pump coronary artery bypass grafting (OPCABG), compared with non-left main coronary artery stenosis (non-mainstem disease).

METHODSFrom January 1, 2009 to December 31, 2010, 4869 patients had a primary isolated OPCABG procedure at Beijing Anzhen Hospital. According to the pathology of LMCA lesions, they were retrospectively classified as a non-mainstem disease group (n = 3933) or a LMCA group (n = 936). Propensity scores were used to match the two groups, patients from the non-mainstem disease group (n = 831) were also randomly selected to match patients from the LMCA group (n = 831). Freedom from MACCE in the two groups was calculated using the Kaplan-Meier method.

RESULTSThe difference in the mortality and the rate of MACCE during the first 30 days between the non-mainstem disease group and the LMCA group did not reach statistical significance (P = 0.429, P = 0.127 respectively). With a mean follow-up of (12.8 ± 7.5) months and a cumulative follow-up of 1769.6 patient-years, the difference in the freedom from MACCEs between the two groups, calculated through Kaplan-Meier method, did not reach statistical significance (P = 0.831).

CONCLUSIONAnalysis of a high volume of OPCABG procedures proved that LMCA lesions do not pose additional early and mid-term risk to OPCABG. Therefore, a LMCA lesion is as safe as non-mainstem disease lesion during the OPCABG procedure.

Adult ; Aged ; Coronary Artery Bypass, Off-Pump ; adverse effects ; mortality ; statistics & numerical data ; Coronary Artery Disease ; surgery ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Retrospective Studies