Objective To explore the clinical effect of auricle reconstruction with expanded auricle posterior flap on mastoidea and auto rib cartilage bracket for repair of congenital microtia.Methods Twenty-one eligible patients with congenital auricle malformation and defect were recruited into this study and three-stage operation was performed.A 50 ml kidney-shaped expander was implanted at mastoid process area to expand skin in stage Ⅰ surgery,followed by a regular affusion to expand skin for 3 to 4 months.The average total waterflood was (80.51 ± 3.87) ml.The volume remained stable for 1 month,once up to the predetermined amount.In stage Ⅱ surgery autogenous costal cartilage was taken and carved into inverted conch shape.Auricle was reconstructed with the expanded flap to cover the auto rib cartilage bracket.The stage Ⅲ surgery was performed for details dressing of the auricle after 3 months.Results All 21 cases underwent operation successfully.Reconstructed ear auricles were similar to uninjured sides in size and shape.Both doctors and patients were contented with the auricles.Conclusions Expanded auricle posterior flap on mastoidea can cover the auto rib cartilage bracket.Autologous costal cartilage can be carved to four layers cartilage bracket that likes an inverted conch,and followed by realistic postoperative auricular shape and strong three-dimensional sense after operation.

Objective To explore the influence of nonylphenol(NP) on the filial generation rats spatial learning and memory capacity which were exposed to the parent rat during its pregnancy. Methods At the first day of the pregnancy, the rats were divided into four groups, which were orally administered with NP at doses of 0,50, 100 and 200 mg/kg,respectively, on gestational days 9～15. Cognitive function was tested by Morris water maze and step-down test. The ultrastructure of hippocampus tissues were observed by electronic microscope.Result The escape latency extended ((61.14±5.92) s) and erroring time increased ((4.57±1.13)times) in Morris water maze, and step down latency extended ((37.5±6.3)s), step through latency shortened((97.8±11.0)s) and erroring time increased ((3.0±1.4) times) in step down test in the N P 200 mg/kg treated groups (P<0 05). The correspond indexes were separately (35.85±4. 29) s, (2.57±0.97) time, (27.1±3.8) s,(172.0±89.2)s and(0.9±0.7)time in control group. Compared to the control group, there were significant differences in the results of the water maze test and step-down test between NP 200 mg/kg and the control group (P <005). The changes of the uhrastructure were found among the hippocampus neurons of NP 200 mg/kg group that characterized with chromatin condensed,clumped in circa-nuclei and mitochondrial tumefaction and vacuolization.Conclusion Exposures to NP during gestation might decreased abilities of spatial learning and memory capacity on F1 rats significantly.

Objective To study the clinical efficacy of autologous cartilage following unilateral cleft lip and palate repair on correction of secondary complex deformity.Methods 17 patients with complex secondary cleft palate were enrolled in this study from December 2004 to December 2014.Correction of nasal and lip deformity and oronasal fistula were achieved at the same time.The therapeutic efficacy was evaluated after follow-up from 3 months to 2 years after operation.Results All 17 patients received satisfactory results,of which 14 patients were satisfied and three cases of general satisfaction.Conclusions Satisfactory results are received by using autologous rib cartilage to repair secondary complex deformity of unilateral cleft lip and palate.

Objective To investigate the application of multiple dilators for excessive expansion of scalp with hair covering and integrated use of expanded flap to repair cicatricial alopecia in a large area.Methods stage Ⅰ surgery was performed as follows:multiple dilators were chosed and embedded below the galea aponeurotica of the scalp with hair covering according to the bald hair shape,size of the alopecia area.Excessive expansion was conducted for 3 to 6 months to get the extra hair scalp.Stage Ⅱ surgery was as follows:Dilators were removed and scar areas were resected,followed by combined use of sliding advancement flap,rotation flap and translocation flap to repair scalp alopecia.Resluts The postoperative effect of all patients was ideal with satisfied appearance.Conclusions Multiple dilator excessive expansion may obtain a large number of additional expansion scalp,combined by reasonable use of skin flap transfer technology,which can be used to repair the large scarring alopecia and get a good clinical effect.

Objective To explore the surgical method of double flag-shaped flap to correct the shortened middle part of upper lip deformity of post burn.Methods From January 2009 to December 2013,9 cases of shortened middle part of upper lip post burn deformity were corrected by double flag-shaped flap,including 4 males and 5 females who aged from 18 to 37 years.They received the surgery from 1 to 3 years after burn.The main clinical manifestations included the upper lip eversion,too short middle part of upper lip,the destruction of the normal anatomy philtrum,philtrum column deformity and poor continuity vermilion border.Results The height of the middle of upper lip of 9 patients enrolled in the experimental treatment was lengthened by 4 to 6 mm after operation,which fundamentally corrected the shortened middle part of upper lip deformity of post burn.The patients were followed up for a period of 3 months to 2 years and received satisfactory results.The operative incisions of 9 cases were primary healing,with no flap blood supply disorders,wound infection,dehiscence and other complications.Conclusions Double flag-shaped flap of the upper lip at the nostrils bottom is a simple and good effective method to correct the shortened middle part of upper lip deformity of post burn.

In this paper, the changes of volatile oil and non-volatile ingredients in Cortex Magnolia Officinalis before and after primary processing were determined by an HPLC and a GC-MS method. The method is based on quantitative determination of three index ingredients, beta-eudesmol, honokiol and magnolol, and on qualitative fingerprinting analysis using HPLC and GC. Big differences were observed between processed and unprocessed samples according to their chromatographic fingerprinting data calculated by statistic software. Compared with unprocessed samples, the contents of honokiol and magnolol in processed samples increased, whereas the contents of beta-eudesmol and magnoloside A in processed samples decreased. Magnoloside A was isolated from this plant for the first time.
Drugs, Chinese Herbal ; chemistry ; Magnolia ; chemistry ; Quality Control ; Technology, Pharmaceutical ; methods

Objective:To discuss the factors related to the prognosis in the alpha fetoprotein(AFP)negative hepatocellular carcinoma(HCC)patients,and to construct the nomogram for predicting the survival time of the patients.Methods:The retrospective analysis on data of 2 064 cases of AFP negative HCC patients extracted from the Surveillance,Epidemiology,and End Results(SEER)Database was conducted,and all the patients were divided into training cohort and internal validation cohort at a ratio of 7∶3,and 101 AFP negative HCC patients from the Integrated Traditional Chinese and Western Medicine Hospital in Hunan Province were regarded as the external validation cohort.The univariate Cox regression analysis results were incorporated into the multivariate analysis,and the independent risk factors for the AFP negative HCC patients were obtained by multivariate Cox analysis to build a cancer specific survival(CSS)prognosis nomogram for the AFP negative HCC patients.The predictive efficacy and clinical utility of the nomogram were evaluated by time-dependent receiver operating characteristic curve(ROC),calibration plots,and decision curve analysis(DCA).The total score obtained from the nomogram was used for the risk stratification to compare the degree of risk discrimination between the nomogram and the American Joint Committee on Cancer(AJCC)staging system.Results:Ten independent risk factors were selected by multivariate Cox regression analysis to construct 3-year,4-year,and 5-year CSS prognostic nomograms for the AFP negative HCC patients,including the patient's age,pathological grade,surgical status,radiotherapy status,chemotherapy status,lung metastasis status,tumor size,tumor T stage,tumor M stage,and marital status.The area under curve(AUC)for the 3-year,4-year,and 5-year time-dependent ROC in the training cohort were 0.807(95%CI:0.786-0.828),0.804(95%CI:0.782-0.826),and 0.813(95%CI:0.790-0.835),respectively.In the internal validation cohort,they were 0.776(95%CI:0.743-0.810),0.772(95%CI:0.737-0.808),and 0.789(95%CI:0.752-0.826),and in the external validation cohort,they were 0.773(95%CI:0.677-0.868),0.746(95%CI:0.620-0.872),and 0.736(95%CI:0.577-0.895).The calibration plots verified that the nomogram fitted well with the perfect line.The DCA curve revealed that the net benefit of the nomogram was significatly higer than that of the AJCC staging system at certain probability thresholds compared with AJCC staging,the nomogram had a better ability to identify high-risk individuals.Conclusion:The serum AFP expression is one of the prognostic markers for the HCC patients.For those patients with AFP negative expression in serum,different considerations should be taken.The nomogram model based on multiple risk factors is a promising clinical tool for assessing the CSS in the AFP negative HCC patients.

Objective To explore the short-term outcome of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) for pancreatic head cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 108 patients with pancreatic head cancer who were admitted to the Affiliated Tongji Hospital of Huazhong University of Science and Technology between July 2014 and July 2015 were collected.Among 108 patients,47 and 61 who respectively underwent LPD and OPD were allocated into LPD and OPD groups.Observation indicators:(1) intraoperative situations;(2) postoperative situations;(3) postoperative pathological situations;(4) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect chemotherapy and postoperative survival situations at 1 and 3 years postoperatively up to June 2018.Measurement data with normal distribution were represented as x±s and comparison between groups was analyzed using the t test.Comparison between groups of count data was analyzed using the chi-square test.Results (1) Intraoperative situations:operation time in the LPD and OPD groups was respectively (288±24)minutes and (265±29)minutes,with no statistically significant difference between groups (t=5.138,P＞0.05).Volume of intraoperative blood loss in the LPD and OPD groups was respectively (136±14)mL and (388±21)mL,with a statistically significant difference between groups (t=-7.297,P＜0.05).Cases with blood transfusion were respectively 3 and 7 iu the LPD and OPD groups,with no statistically significant difference between groups (x2 =0.325,P ＞ 0.05).(2) Postoperative situations:of 47 patients in the LPD group,16 with postoperative complications were improved by conservative treatment,including 7 with pancreatic fistula (5 with biochemical pancreatic fistula and 2 with grading B and C of pancreatic fistula);4 with delayed gastric emptying were cured by gastrointestinal decompression and gastric motility promoting treatment;2 with postoperative bleeding were improved by conservative treatment;2 with intraabdominal infection were improved by enhanced antibiotic therapy and transabdominal percutaneous drainagc;1 with biliary fistula was improved by transabdominal percutaneous drainage;there was no wound infection and perioperative death.Of 61 patients in the OPD group,28 with postoperative complications were improved by conservative treatment,including 12 with pancreatic fistula (9 with biochemical pancreatic fistula and 3 with grading B and C of pancreatic fistula);8 with delayed gastric emptying were cured by gastrointestinal decompression and gastric motility promoting treatment;3 with intra-abdominal infection were improved by enhanced antibiotic therapy and transabdominal percutaneous drainage;2 with postoperative bleeding were improved by conservative treatment;2 with wound infection were c ured by conservative treatment;1 with biliary fistula was improved by transabdominal percutaneous drainage;there was no perioperative death.There was no statistically significant difference in the cases with postoperative complications between groups (x2 =1.546,P＞ 0.05).Duration of hospital stay in the LPD and OPD groups was (13.6±2.1)days and (19.3 ±4.4)days,respectively,with a statistically significant difference (t =-4.354,P＜0.05).(3) Postoperative pathological situations:R0 resection rate was respectively 100.0％ (47/47) and 98.4％ (60/61) in the LPD and OPD groups,with no statistically significant difference (x2 =0,P＞0.05),and there was 1 patient with R1 resection in the OPD group.The total number of lymph node dissected in the LPD and OPD groups was respectively 19±4 and 13±4,with a statistically significant difference (t=-4.126,P＜0.05).The cases with high-and moderate-differentiated tumor and low-differentiated tumor (tumor differentiation),staging T1-T2 and T3-T4 (T stage),staging N0 and N1 (N stage),staging Ⅰ and Ⅱ-Ⅲ (TNM staging) and nerve or vascular invasion were respectively 35,12,28,19,20,27,16,31,21 in the LPD group and 50,11,36,25,36,25,14,47,32 in the OPD group,with no statistically significant difference (x2=0.891,0.003,2.882,1.628,0.643,P＞0.05).(4) Follow-up and survival situations:44 and 55 patients in the LPD and OPD group respectively underwent postoperative adjuvant therapy during the follow-up,with no statistically significant difference (x2=0,P＞0.05).The postoperative 1-year follow-up:47 patients in the LPD group were followed up,37 survived and 10 died;of 61 patients in the OPD group,3 lost to follow-up,and 58 were followed up (43 survived and 15 died);there was no statistically significant difference in survival between groups (x2=0.301,P＞0.05).The postoperative 3-year follow-up:of 47 patients in the LPD group,3 lost to follow-up,and 44 were followed up (21 survived and 23 died);of 61 patients in the OPD group,6 lost to follow-up,and 55 were followed up (23 survived and 32 died);there was no statistically significant difference in survival between groups (x2 =0.346,P＞0.05).Conclusion LPD is safe and feasible for pancreatic head cancer,with advantages of less bleeding,shorter duration of hospital stay and more total number of lymph node dissected,and its survival effect is equivalent to that of OPD.

Objective: To semi-quantify the postoperative complications occurred after laparoscopic pancreaticoduodenectomy(LPD) using Clavien-Dindo score, thereafter exploring its impact factors. Methods: In this retrospective cohort study, the clinical data of 124 patients who had undergone LPD for periampullary tumor from June 2016 to June 2017 at Department of Biliary Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were collected.Malignancy was confirmed based on postoperative pathological reports.Postoperative complications were semi-quantitated using Clavien-Dindo score.Multivariable logistic regression model was applied to explore the factors related to severe complications(Clavien-Dindo Ⅲb-Ⅴ). Results: Of the 124 patients, there were 64 males(51.6%) and 60 females(48.4%), with age of 57 years(range, 23-82 years). In total, postoperative complications occurred in 30 patients(24.2%). Among the 30 patients, 4 patients suffered Clavien-Dindo grade Ⅰ, 18 patients(14.5%) suffered Clavien-Dindo grade Ⅱ, 6 patients(4.8%) suffered Clavien-Dindo grade Ⅲa, 1 patient(0.1%) suffered Clavien-Dindo grade Ⅳb, and 1 patient(0.1%) suffered Clavien-Dindo grade Ⅴ.Intraabdominal hemorrhage occurred in 8 patients, pancreatic fistula was found in 10 patients(7 patients had biochemical leakage and 3 of them had grade B pancreatic fistula), both biliary fistula and gastrointestinal fistula were found in 1 patient.Abdominal infection occurred in 10 patients, both liver failure and renal failure occurred in one patient.Moreover, arrhythmia was found in two patients, and mortality occurred in one patient.Five patients suffered multiple complications.Univariable analysis showed that postoperative complications were associated with body mass index, American Society of Anesthesiologists(ASA) score, intraoperative blood transfusion, and pancreatic texture(P<0.05). In multivariable logistic regression, ASA grade Ⅲ, intraoperative blood transfusion, and pancreatic softness were independently related to postoperative complications after LPD(P<0.05). Conclusions Clavien-Dindo score is feasible to be applied in management of patients with LPD.ASA score, texture of pancreas, and intraoperative blood transfusion were independently associated with postoperative complications.