Objective To detect NRAS gene mutations in patients with acral melanoma, and to analyze their relationship with the prognosis of acral melanoma. Methods Clinical and pathological data were collected from 55 patients with pathologically diagnosed acral melanoma. DNA was extracted from paraffin?embedded specimens from lesions of the 55 patients and 15 patients with nevus. PCR and direct DNA sequencing were performed to detect NRAS gene mutations. Univariate and multivariate analyses were performed using the Cox′s proportional hazards regression model. Results Of the 55 patients, 6(10.9%)carried the Q61R mutation in codon 61 of the NRAS gene. No mutations were found in exon 1 or 2 of the NRAS gene in any of these paraffin?embedded specimens, and none of the pigmented nevus specimens harbored NRAS gene mutations. Of the 6 patients carrying NRAS gene mutations, 4 had lymph node metastasis. Multivariate Cox regression analysis showed that independent factors of poor prognosis included advanced clinical stage(RR = 2.54, 95% CI: 1.062- 6.066, P < 0.05), not receiving surgical resection(RR = 2.98, 95% CI:1.316- 3.525, P < 0.05), and carrying NRAS gene mutations (RR = 2.73, 95% CI: 0.932- 3.257, P < 0.05). Conclusions NRAS gene mutations may be associated with lymph node metastasis in patients with acral melanoma. The prognosis of acral melanoma may be associated with clinical staging, treatment strategies and NRAS gene mutations. Additionally, NRAS gene mutations may serve as a new index for predicting prognosis of acral melanoma.

BACKGROUND: Axial-flow blood pump is a main pump for ventricle assistance. Previous researches demonstrate that poor hemocompatibility of blood pump is an important factor for hemolysis and thrombus.OBJ ECTTVE: To design an axial-flow blood pump based on previous kinds of blood pumps through changing whole appearance and impeller shape of the pump by using Computer-Aided Design CAD) and Computational Fluid Dynamics (CFD), and manufacture it successfully.DESIGN: Rationality of theoretical design was verified by practical tests.SETTTNG: Beijing Anzhen Hospital of Capital University of Medical Sciences Department of Biomedical Engineering,Beijing Institute of Heart, lung and Blood Vessel Diseases; the Faurteenth Institute of China-Aerospace Science and Industry Corporation.MATERIALS: Body of blood pump and impeller were titanium alligation, and shaft bearing was ceramic. Test in vitro was accorded to artificial ventricular assist device which was provided by Department of Biomedical Engineering, Beijing Anzhen Hospital of Capital University of Medical Sciences. Experimental goats were provided by Experimental Animal Center, Beijing Anzhen Hospital of Capital University of Medical Sciences.METHODS: Since the beginning of 2005, a model of axial flow blood pump was designed in the 14th Institute of China-Aerospace Science and Industry Corporation base on decreasing shearing force and circulating dead bands. In the process, CAD and CFD were used to generate the geometrical data document of pump's structure, which included the figures of pump's body, shape and number of impeller's vanes, the structure and position of the guide vanes, and the size of impeller's screw-pitch. And then, NC machine tool was used for shaping. Finally, axial-flow blood pump was fixed on artificial ventricular assist device which was provided by Department of Biomedical Engineering, Beijing Anzhen Hospital of Capital University of Medical Sciences. The pump's hemodynamic output was 5 L/min and the average pressure was 13.3 kPa under the mixture of glycerin and water and fresh anticoagulation goat blood. The samples were collected at every one half hour during pumps being pumping for 4 hours. According to testing pressure output of blood pump, normalized index of hemolysis (NIH) was used to reflect content of free hemoglobin in plasma, observe thrombogenesis in pump and verify pump's hemodynamic output and vascular damaging degree.RESULTS: Shaped axial-flow blood pump included body, impeller, guide vanes, ceramic shaft bearing, export and import. The volume was 63 mL. Experimental results in vitro indicated that when the rotation speed of blood pump was 10 000 r/min, its pressure and flow output were 21.01 kPa and 6.0 L/min. The hemodynamic output might satisfy for left ventricular assistance. Surface temperature did not change obviously during successive rotation. The calculation indicated that most parts in blood pump showed a streaming flow. The mean NIH was (0.047±0.017) g/100 L, which was less than that of previous pumps; while, thrombogenesis was not observed in blood pump.CONCLUSTON: Axial-flow blood pump designed by using CAD and CFD can not only satisfy for the hemodynamics of a left ventricular assistant devices, but also the blood damage is milder than previous pumps. Therefore, axial-flow blood pump improves blood compatibility.

Objective To evaluate the effect of clinical nursing pathway in emergency treatment of for-eign body in respiratory tract of children. Methods Retrospective analysis was carried out in 555 children with foreign body in respiratory tract from February 2005 to December 2007, who were divided into the control group (271 cases) and the experimental group (284 cases). The experimental group was given managed with standardized clinical pathway,the control group received routine management. The preoperative preparation time, average hospital stay, cost of hospitalization, the extent of mastering of health knowledge by patients'par-ents were observed and the data underwent χ2 and t test. Results All patients of the two groups were cured and no nursing complications happened.The mean preoperative preparation time of the experimental group was 10 hours, which was shorter than that of the control group(27 hours). The average length of hospital stay of the experimental group was (4.13 + 0.81)days, which was shorter than that of the control group ,(6.03 + 1.30) days.The average hospitalization cost of the experimental group was (3498.55 + 269.13) yuan, while the control group was(4246.40 + 977.10) yuan. The extent of mastering of health knowledge by patients' parents, including basic knowledge of the disease, preoperative cooperation knowledge,prevention knowledge and diet knowledge, was superior to that of the control group. Conchusions The establishment of clinical pathway of children with foreign body is conducive to the standardized treatment of the disease, it can shorten the preoperative prepara-tion time, improve the capability of emergency treatment, shorten the length of hospital stay, reducing hospital-ization costs, increase the extent of mastering of health knowledge by patients and their families.

As conserved enzymes with important functions, aminoacyl-tRNA synthetase are expressed ubiquitously in cells. These include cytoplasmic aminoacyl-tRNA synthetase, mitochondrial aminoacyl-tRNA synthetase and bifunctional aminoacyl-tRNA synthetase. Mitochondrial aminoacyl-tRNA synthetases catalyze the binding of amino acids with its corresponding tRNA in the mitochondria and participate in the translation of 13 subunits of oxidative phosphorylation enzyme complexes encoded by the mitochondrial genome. Mutations in genes encoding mitochondrial aminoacyl-tRNA synthase may cause a variety of genetic disorders. This review has summarized the clinical characteristics, molecular pathogenesis and treatment of genetic diseases caused by mutations of such genes.
Humans ; RNA, Transfer, Amino Acyl ; Genes, Mitochondrial ; Amino Acyl-tRNA Synthetases/genetics* ; Genome, Mitochondrial ; Mitochondria/genetics*

Objective:To discuss a surgical method that reduces the notch tension and assists in suspending and lifting the skin after reposition so as to relieve scar and to prevent alopecia and maintain long-term lifting effect.Methods:After forehead or temporal open incision rhytidectomy, 2-0 absorbable sutures were used to pass through the intradermal at the hairline and skin junction in front of the incision. After that, the sewing needle passed through the whole skin flap vertically from the two points of the suture inlet and outlet, and then sutured on the deep temporal fascia or galea aponeurotica, in order to reduce tension of the main anchor point of the incision and to assist suspending the elevated flap. Afterwards, the width of the skin excision was determined according to the skin relaxation, the subcutaneous relaxation suture of scalp incision was conducted and the incision closed with nailing device.Results:From June 2016 to October 2018, this method was applied in 33 cases of rhytidectomy. In the early postoperative period, the skin around the hairline had a slight appearance of accumulation due to the traction of sutures, which gradually disappeared with time. During the long-term follow-up, 2 patients had hair loss near the incision, and the hair density decreased. The remaining patients had no obvious scar hyperplasia and alopecia, and no long-term skin accumulation. The facial rejuvenation effect was good, and the satisfactory rate of patients was high.Conclusions:The technique of intradermal tension reduction combined with suspension suture redistributes the tension and significantly reduces the scar hyperplasia and baldness at the incision. Meanwhile, the suture also plays the role of accessory suspension, which helps to increase the stability and durability of facial tissue; the whole procedure is simple, safe, and long lasting.

Sunken upper eyelid is a common eye defect, which seriously affects eye aesthetics and it has become an important issue of periorbital rejuvenation in recent years. This article introduces the mechanism, classification and degree of depression regarding sunken upper eyelid. The correction method of sunken upper eyelid, their indications, postoperative effects as well as the pros and cons of each method were comprehensively summarized and compared, trying to find appropriate corrective method according to the causes and degree of different sunken upper eyelid among patients.

Objective:To explore the method and effect of preventing eyelid ectropion when using expanded skin flap to repair periorbital soft tissue defect.Methods:From April 2015 to December 2019, 176 patients with periorbital soft-tissue defect were treated in the Plastic Surgery Hospital of Chinese Academy of Medical Sciences, including 79 males and 97 females, aged 4-53 years, the defect ranging from 1 cm×1 cm-6 cm×10 cm. According to the location and size of the defect, an appropriate expander was selected before the operation. In the first stage, the expander was embedded, and saline was injected regularly. In the second stage, the expanded flap was transferred to cover the periorbital defect wound, part of the capsule was removed, and the flap was fixed on the periosteum to restore the position and shape of the eyelid and prevent eyelid ectropion. After the operation, elastic headgear was worn for 3-6 months for shaping. The survival and complications of the flaps were followed up.Results:The expander volume was 30-400 ml, and the expansion time was 1-6 months. The size of the expanded flap was 3 cm×3 cm-6 cm×9 cm. All flaps survived after 2 months to 4 years follow-up. Among them, 13 cases had mild lagophthalmus, which was caused by insufficient skin expansion and did not affect the eyelid function, so the patients refused to retreat; 8 cases of lower eyelid ectropion, including 5 cases of scar contracture, 1 case of suture knot falling off, and 2 cases of lower eyelid support tissue relaxation caused by long-term stretching of expander, 5 cases were corrected after skin flap repair, 3 cases were not treated again; the rest were satisfactory. The depression left by the suture fixing flap disappears within 1 to 6 months after surgery.Conclusions:When using an expanded skin flap to repair periorbital soft-tissue defect, preoperative, intraoperative and postoperative interventions were implemented to reduce or disperse the retracting force of expanded skin flap, which could avoid eyelid ectropion and achieve good repair effect.

Objective:To explore the method and effect of preventing eyelid ectropion when using expanded skin flap to repair periorbital soft tissue defect.Methods:From April 2015 to December 2019, 176 patients with periorbital soft-tissue defect were treated in the Plastic Surgery Hospital of Chinese Academy of Medical Sciences, including 79 males and 97 females, aged 4-53 years, the defect ranging from 1 cm×1 cm-6 cm×10 cm. According to the location and size of the defect, an appropriate expander was selected before the operation. In the first stage, the expander was embedded, and saline was injected regularly. In the second stage, the expanded flap was transferred to cover the periorbital defect wound, part of the capsule was removed, and the flap was fixed on the periosteum to restore the position and shape of the eyelid and prevent eyelid ectropion. After the operation, elastic headgear was worn for 3-6 months for shaping. The survival and complications of the flaps were followed up.Results:The expander volume was 30-400 ml, and the expansion time was 1-6 months. The size of the expanded flap was 3 cm×3 cm-6 cm×9 cm. All flaps survived after 2 months to 4 years follow-up. Among them, 13 cases had mild lagophthalmus, which was caused by insufficient skin expansion and did not affect the eyelid function, so the patients refused to retreat; 8 cases of lower eyelid ectropion, including 5 cases of scar contracture, 1 case of suture knot falling off, and 2 cases of lower eyelid support tissue relaxation caused by long-term stretching of expander, 5 cases were corrected after skin flap repair, 3 cases were not treated again; the rest were satisfactory. The depression left by the suture fixing flap disappears within 1 to 6 months after surgery.Conclusions:When using an expanded skin flap to repair periorbital soft-tissue defect, preoperative, intraoperative and postoperative interventions were implemented to reduce or disperse the retracting force of expanded skin flap, which could avoid eyelid ectropion and achieve good repair effect.

Sunken upper eyelid is a common eye defect, which seriously affects eye aesthetics and it has become an important issue of periorbital rejuvenation in recent years. This article introduces the mechanism, classification and degree of depression regarding sunken upper eyelid. The correction method of sunken upper eyelid, their indications, postoperative effects as well as the pros and cons of each method were comprehensively summarized and compared, trying to find appropriate corrective method according to the causes and degree of different sunken upper eyelid among patients.

Objective:To investigate the clinical effect of middle and lower facial rhytidectomy by lifting the prolapsed buccal fat pad using a consecutive suspensions in a dragnet fashion.Methods:from December 2016 to October 2019, 42 female patients aged 46 to 65 with aging faces and prolapsed buccal fat pads were treated with multiple suspension method. The incision was the classic temporal to peri-auricular incions. After the skin flap and superficial musculoaponeurotic system(SMAS) flap was elevated. The suspending stitches were arranged with 5 lines from the lateral edge of orbicularis oris muscle to the level of zygomatic process to lift the sagging buccal fat pad and achieve facial rejuvenation. The short and long term complicationsas well as post-operative satisfaction rate were also investigated.Results:After 9-12 months of follow-up, the facial aging characteristics were significantly improved, especially sagging mandibular bag and loose perioral skin. The volume of middle face was restored with natural contour. Post-operative complications included local facial depression (2 patients), slight asymmetry (1 patient) and mild tactile abnormalities (1 patient). Satisfaction survey showed that 28 patients were very satisfied, 12 were satisfied and 2 were dissatisfied. The subjective satisfaction rate was 95.2% (40/42). There were no serious complications such as facial nerve injury or flap necrosis.Conclusions:This technique has a good outcome combined with conventional rhytidectomy, as it can achieve good effect of rejuvenationin the middle and lower face.