ObjectiveTo discuss the potential relationship of plaque burden (PB) and coronary remodeling in acute coronary syndrome (ACS) patients.MethodsNinety-one patients with ACS in Qingdao Municipal Hospital during January 2011 to June 2014 underwent the conventional coronary angiography and intravascular ultrasonography (IVUS). The remodeling of 60 cases were positive (remodeling index [RI]>1) and those of 31 cases were negative (RI<1). All 91 patients were included in this study, including 9 cases (PB<60%), 19 cases (60%≤PB<70%), 48 cases (70%≤PB<80%) and 15 cases (PB>80%). The difference of plaque cross-sectional area (P-CSA), lumen cross-sectional area (L-CSA), external elastic membrane cross-sectional area (EEM-CSA), average EEM-CSA, PB between positive remodeling andnegative remodeling were compared by independent-samplest test. ANOVA was used to compare P-CSA, L-CSA, EEM-CSA and RI among patients with different PB. The relevance of PB, P-CSA, EEM-CSA, L-CSA and RI were analyzed by Pearson correlation analysis.ResultsThere were no signifi cant differences in P-CSA, L-CSA, EEM-CSA and PB between patients with positive remodeling and negative remodeling. Average EEM-CSA of patients with negative remodeling were signifi cantly greater than that of patients with positive remodeling ([13.24±1.98] mm2vs [17.30±3.16] mm2,t=2.46,P<0.05). P-CSA, EEM-CSA and L-CSA had signifi cant differences (F=24.56, 28.97 and 7.14,P<0.001) while RI had not statistical signifi cant difference among patients with different PB. With the increase of PB, P-CSA and EEM-CSA increased (P-CSA: [6.01±1.68], [9.12±2.00], [11.42±2.05] and [14.05±4.00] mm2, EEM-CSA: [11.43±1.90], [13.64±2.93], [15.14±2.64] and [16.64±4.08] mm2), L-CSA reduced ([5.44±0.89], [4.52±0.99], [3.72±0.74] and [2.60±0.63] mm2). PB was positively correlated with P-CSA and EEM CSA (r=0.76, 0.50,P<0.001), but was negatively correlated with L-CSA (r=-0.74, P<0.001). RI had no relationship with PB, P-CSA, L-CSA and EEM-CSA.ConclusionsCoronary artery remodeling is a very complicated dynamic process. Except the PB, other factors probably affect the direction of remodeling. RI is not suitable as the index for the assessment of vascular remodeling.

Objective To explore the methods of Y-V vascular pedicle lengthening technique for cover-age of the defect of great toe after wrap-around flap transfer, and decrease the morbidity of donor site in great toes. Methods Fifteen patients received three kinds of flap for immediate resurfacing of donor defect of the great toes during wrap-around flap transfer, all flaps were harvested with Y-V vascular pedicle lengthening technique. Among them, 9 cases received the free lateral tarsal flaps transplantation for coverage of defect in donor great toes, 5 cases was repaired by medial tarsal flaps, and only one was treated by the medial plantar flap. Results All the flaps survived postoperatively. The medial plantar flap encountered the venous crisis in postoperative 3 days, and regained the normal blood supply after continuous bleeding for 2 days. All patients were satisfied with cosmetic and functional outcome in average 10- month follow-up. The appearance and sensory function of donor toe repaired by medial tarsal flaps was best among three ones. Conclusion Depending on the Y-V vascular pedicle lengthening technique, the local pedical flaps of foots are enlarged scope for coverage of great toe after wrap-around flap harvest, which can decrease the complication of donor site at the most.

The purpose of the experiment was to study the efficacy of edaravone in enhancing flap viability after ischemia/reperfusion (IR) and its mechanism.Forty-eight adult male SD rats were randomly divided into 3 groups:control group (n=16),IR group (n=16),and edaravone-treated IR group (n=16).An island flap at left lower abdomen (6.0 cm×3.0 cm in size),fed by the superficial epigastric artery and vein,was created in each rat of all the three groups.The arterial blood flow of flaps in IR group and edaravone-treated IR group was blocked for 10 h,and then the blood perfusion was restored.From 15 min before reperfusion,rats in the edaravone-treated IR group were intraperitoneally injected with edaravone (10 mg/kg),once every 12 h,for 3 days.Rats in the IR group and control group were intraperitoneally injected with saline,with the same method and frequency as the rats in the edaravone-treated IR group.In IR group and edaravone-treated IR group,samples of flaps were harvested after reperfusion of the flaps for 24 h.In the control group,samples of flaps were harvested 34 h after creation of the flaps.The content of malondialdehyde (MDA) and activity of superoxide dismutase (SOD) were determined,and changes in organizational structure and infiltration of inflammatory cells were observed by hematoxylin-eosin (HE) staining,apoptotic cells of vascular wall were marked by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay,and the apoptotic rate of cells in vascular wall was calculated.The ultrastructural changes of vascular endothelial cells were observed by transmission electron microscopy (TEM).Seven days after the operation,we calculated the flap viability of each group,and marked vessels of flaps by immunohistochemical staining for calculating the average number of subcutaneous vessels.The results showed that the content of MDA,the number ofmulticore inflammatory cells and apoptotic rate of cells in vascular wall in the edaravone-treated IR group were significantly lower than those in the IR group.The activity of SOD,flap viability and average number of subcutaneous vessels in the edaravone-treated IR group were significantly higher than those in the IR group.All the differences were statistically significant.The ultrastructure injury of vascular endothelial cells in the edaravone-treated IR group was slighter than that in IR group.It was concluded that edaravone can significantly enhance IR flap viability and protect flap vessels,which is related to scavenging oxygen free radicals,reducing the consumption of SOD,reducing the extent of lipid peroxidation and inflammation,and protecting functional structure of vessels in the early stages of reperfusion.

OBJECTIVETo introduce a method to reconstruct hemifacial atrophy (Romberg's disease).

METHODSThrough a temporal incision, the compound grafts of pedicled superficial temporal fascial flap and free dermis-fat were inserted into the cheek to correct soft tissue depression on the face. The dermis-fat was harvested from gluteal crease site.

RESULTS6 cases were treated with this technique. 3 to 10 months' follow-up showed satisfactory results and few resorption of the compound grafts.

CONCLUSIONSThe mentioned technique is simple and reliable in reconstructing bulk defects of the face.

Adipose Tissue ; transplantation ; Adolescent ; Adult ; Age of Onset ; Child ; Dermis ; transplantation ; Facial Hemiatrophy ; epidemiology ; surgery ; Humans ; Reconstructive Surgical Procedures ; methods ; Subcutaneous Tissue ; transplantation ; Surgical Flaps ; Young Adult

OBJECTIVETo investigate the method for creation of auriculocephalic sulcus.

METHODSThe reconstruction was performed 4-12 months after the first surgery. Skin incision was made 5mm posterior to the outer margin of the auricle. The ear framework was elevated with a thick fascia at the deep surface. The costal cartilage banked at the first operation was shaved and transplanted to the deep surface of the concha with sutures. The position and angle of the ear framework was adjusted to be familiar to the healthy ear. The auriculocephalic angle was slightly larger than that in the contralateral ear. Two flaps were designed at the upper and lower area of reconstructed ear and rotated to cover the cartilage. The wound at the donor site was closed with skin graft.

RESULTSA total of 72 patients were treated. All the flaps survived completely. 51 patients were followed up for 3-24 months with satisfactory results. The auriculocephalic sulcus maintained at about 20-30 degree.

CONCLUSIONSIt is a simple, safe and reliable method to create a auriculocephalic sulcus with two random skin flaps from mastoid area combined with skin graft.

Adolescent ; Cartilage ; transplantation ; Dermatologic Surgical Procedures ; methods ; Ear ; Ear Auricle ; surgery ; Ear Deformities, Acquired ; surgery ; Fascia ; Humans ; Mastoid ; Ribs ; Skin Transplantation ; methods ; Surgical Flaps ; transplantation

BACKGROUNDThe optimal age at which to initiate for auricular reconstruction is controversial. Rib cartilage growth is closely related to age and determines the feasibility and outcomes of auricular reconstruction. We developed a method to guide the timing of auricular reconstruction in children with microtia ranging in age from 5 to 10 years.

METHODSRib cartilage and the healthy ear were assessed using low-dose multi-slice computed tomography. The lengths of the eighth rib cartilage and the helix of the healthy ear (from the helical crus to the joint of the helix and the earlobe) were measured. Surgery was performed when the two lengths were approximately equal.

RESULTSThe preoperative eighth rib measurements significantly correlated with the intraoperative measurements (P < 0.05). From 5 to 10 years of age, eighth rib growth was not linear. In 76 (62.8%) of 121 patients, the eighth rib length was approximately equal to the helix length in the healthy ear; satisfactory outcomes were achieved in these patients. In 18 (14.9%) patients, the eighth rib was slightly shorter than the helix, helix fabrication was accomplished by adjusting the length of the helical crus of stent, and satisfactory outcomes were also achieved. Acceptable outcomes were achieved in 17 (14.0%) patients in whom helix fabrication was accomplished by cartilage splicing. In 9 (7.4%) patients with insufficient rib cartilage length, the operation was delayed. In one (0.8%) patient with insufficient rib cartilage length, which left no cartilage for helix splicing, the result was unsatisfactory.

CONCLUSIONSEighth rib cartilage growth is variable. Rib cartilage assessment relative to the healthy ear can guide auricular reconstruction and personalize treatment in young patients with microtia.

Age Factors ; Autografts ; Cartilage ; diagnostic imaging ; growth & development ; transplantation ; Child ; Child, Preschool ; Congenital Microtia ; surgery ; Ear, External ; diagnostic imaging ; growth & development ; Female ; Humans ; Male ; Reconstructive Surgical Procedures ; Ribs ; diagnostic imaging ; growth & development ; Tomography, X-Ray Computed

OBJECTIVETo evaluate a method to repair the defects after the secondary tumor excision and radiation ulcer in the chest, back and axilla.

METHODSEight patients, with the defects after the secondary tumor excision and the radiation ulcer in the chest, back and axilla, were undergoing the treatment. A "T" shape incision or up-side-down "T" shape incision was designed above the breast or along the inframammary fold below breast, just close to the defect. A split-breast flap was raised above the pectoralis major or deep fascia. The defect was then repaired with a rotating and advancing way.

RESULTSEight patients were repaired in one stage. Blood circulation of the flaps was abundant except one with distal edge necrosis. The ptosis breast was corrected and the fullness of the chest wall was also achieved. But, the Nipple of the opposite health breast was lost the original position to the lateral or medial.

CONCLUSIONSThe above-mentioned technique may be an efficient method to repair the defects after the secondary tumor excision and radiation ulcer in the chest, back and axilla. It is adapt to the old patients whose health is worse, but it is not good for the young patients resulted from the injury breast.

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Axilla ; surgery ; Back ; surgery ; Breast ; surgery ; Dermatologic Surgical Procedures ; Female ; Humans ; Middle Aged ; Surgical Flaps ; Surgical Procedures, Operative ; methods ; Thorax ; Treatment Outcome

Clinical evidence of hematopoietic restoration with umbilical cord blood (UCB) grafts indicates the UCB can be a useful source of hematopoietic stem cells for routine bone marrow reconstitution. Considering (10 +/- 5) x 10(8) nucleared cells per cord blood unit, there is a potential limitation for the use of cord blood in adults, which, however, can be overcome by ex vivo expansion of cells. A prerequisite for expansion is the significantly higher recovery of MNC, CD34+ cells and colony-forming cells (CFC) by thawing cryopreserved MNC. Cooling rate always acts as a critical factor that can affect the recovery of cells. Although the rate of - 1 degrees C/min is adopted in most of the cryopreservations, no data has been reported about the detailed effects of different cooling rates. The aim of the study was to reveal the different effects of cooling rates on cryopreservation of hematopoietic stem cells from cord blood. UCB samples were collected, and cryopreserved as mononuclear cells (MNC) with different cooling rates of - 0.5 degrees C/min, - 1 degrees C/min, - 5 degrees C/min, and the recovery and viability of MNC and CD34+ cells, the clonogenic capacity and the ex vivo expansion potential of UCB progenitor cells were evaluated after thawing. With - 1 degrees C/min cooling rate, the recovery of MNC reached 93.3% +/- 1.8% , viability 95.0% +/- 3.9% , recovery of CD34+ cells 80.0% +/- 17.9% , and clonogenic recovery were 87.1% +/- 5.5%, 88.5% +/- 8.9%, 86.2% +/- 7.4% for BFU-E CFU-GM CFU-MK, respectively. After 14 days of liquid culture, no significant difference was detected in CFC expansion between fresh and cryopreserved MNC cells with - 1 degrees C/min cooling rate, but this was not the case with - 0.5 degreesC/min and - 5 degrees C/min. In conclusion, it was demonstrated that controlling the rate at - 1 degrees C/min is more suitable for cryopreservation of hematopoietic stem cells than - 0.5 degrees C/min and - 5 degrees C/min.
Cell Survival ; physiology ; Cells, Cultured ; Cryopreservation ; methods ; Erythroid Precursor Cells ; cytology ; Fetal Blood ; cytology ; Flow Cytometry ; Granulocyte-Macrophage Progenitor Cells ; cytology ; Hematopoietic Stem Cells ; cytology ; Humans

The liver has a unique dual blood supply through the portal vein and the hepatic artery. There are several communications between these two vessels under various conditions such as in hepatic tumors, trauma and liver cirrhosis, vascular compromise, among others. When vascular compromise occurs, this dual blood supply system can cause changes in the volume of blood flow in individual vessels or even in the direction of blood flow. With rapid image acquisition and increased resolution available in multislice CT and MR imaging, hepatic perfusion disorders are now more frequently encountered than in the past. Familiarity with imaging findings of these perfusion disorders will be helpful in characterizing focal hepatic lesions and will also help to avoid false positive diagnoses.
Diagnosis ; Hepatic Artery ; Liver ; Liver Cirrhosis ; Magnetic Resonance Imaging* ; Perfusion* ; Portal Vein ; Recognition (Psychology)

PURPOSE: Acute mesenteric ischemia (AMI) is one of the most dramatic abdominal emergencies. The most common cause of AMI is a thrombo-embolism of the mesenteric artery or vein. The aim of this study was to evaluate the feasibility of CT angiography for evaluating mesenteric vascular steno-occlusive lesion in AMI. MATERIALS AND METHODS: Fifteen patients with clinically and angiographically proven AMI underwent a two-phase CT. The CT angiographic images were reconstructed using a 3D rendering algorithm, such as the maximum intensity projection and volume-rendering. All the CT angiographic images were reviewed with respect to stenosis or occlusion of mesenteric vessel by the consensus of two radiologists, and were correlated with the findings of digital subtraction angiography. RESULTS:Digital subtraction angiography (DSA) visualized 60 mesenteric vessels including the superior mesenteric artery (n=15) and vein (n=15), and the inferior mesenteric artery (n=15) and vein (n=15). DSA showed steno-occlusive lesions in 16 mesenteric vessels (13 superior mesenteric arteries, two superior mesenteric veins, and one inferior mesenteric artery). CT angiography detected steno-occlusive lesions in 16 mesenteric vessels (12 superior mesenteric arteries, one superior mesenteric vein, and three inferior mesenteric arteries). The sensitivity, specificity, and accuracy of CT angiography for evaluating mesenteric vascular steno-occlusive lesion were 87.5%, 95.4%, and 93.3%, respectively. CONCLUSION: CT angiography is an useful adjunct to abdominal CT in an AMI setting on account of its ability to detect the causes of AMI such as a steno-occlusive lesion of the mesenteric vessel.
Angiography* ; Angiography, Digital Subtraction* ; Consensus ; Constriction, Pathologic ; Emergencies ; Humans ; Ischemia* ; Mesenteric Arteries ; Mesenteric Artery, Inferior ; Mesenteric Artery, Superior ; Mesenteric Veins ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Veins