Objective To explore the clinical value of color Doppler ultrasoundcardiogram in the screening of congenital heart disease(CHD) in neonates. Methods 29568 neonates were examined by color Doppler ultrasoundcardiogram. Results 369 CHD patients were identified, the overall incidence of CHD was 12.48‰. The incidence in 2009 or 2010 were significantly higher than those in 2005 or 2004 ( all P ＜ 0. 05 ), the mean incidence of four years from 2007 to 2010 was significantly higher than that from 2003 to 2006( 13.78‰ vs 10.17‰,P ＜0. 01 ). Of 369 CHD cases,most of them were ventricular septal defect( occupied 48.24% ) ,next was atrial septal defect( occupied 44.17% ). Conclusion The incidence of CHD ascended rapidly from 2003 to 2010,and color Doppler ultrasoundcardiogram was an important method to diagnose CHD in newborns.

Objective:To investigate the expression of miRNA‐146a in the inflammatory response model of rat Schwann cells (SCs) cultured in vitro .Methods:Lipopolysaccharide(LPS) was applied to induce inflammatory response model of rat SCs .The cyclooxygenase‐2(COX‐2) inhibitor (NS398) was added six hours after LPS had been used .In normal group ,the same amount of culture medium was replaced while the LPS was applied in LPS group .The expression of miRNA‐146a and the proliferative capacity of SCs were detected by real‐time PCR and CCK‐8 method .Results:Compared with that in the normal group ,the ex‐pression levels of miRNA‐146a in all LPS groups increased significantly (P<0 .05) ,and the expression level of miRNA‐146a was up‐regulated in accordance with the increase of the concentration of LPS .If NS398 was added six hours after the applica‐tion of 1 .0 μg/mL LPS ,The expression of miRNA‐146a was down‐regulated .Six hours after the application of 10 μg/mL LPS ,the proliferative capacity of SCs declined .However ,if NS398 was added six hours after the application of LPS ,then the proliferative capacity of SCs improved .Conclusions:The miRNA‐146a is involved in the regulation of inflammatory response in Schwann cells cultured in vitro ,and its expression level may reflect the severity of inflammatory response to a certain extent .

Objective: To investigate application effect of collaborative care model on self?cre ablilioy in patients with craniocere?bral trauma in recovery period. Methods: A total of 96 patients with craniocerebral trauma in recovery period were randomly divided into experimental group and control group ( n=48) . Control group received the routine nursing methods. The experimental group re?ceived collaborative care model on the basis of routine nursing methods. Self care ability scale ( ESCA) was used to evaluate self?care ability in two groups before and after the intervention. Results: There was no statistical significance in self?care ability before inter?vention in two groups ( P>0?05) . Self?care skills, personal responsibility, self concept and health knowledge levels in the experi?mental group after intervention were significantly higher than those in the control group ( P<0?01) . Conclusion: Collaborative care model used in patients with craniocerebral trauma in recovery period can solve a variety of health problems, improve the training effect, and improve the level of self?care ability.

Objective:To evaluate the functional and anatomical outcomes of autologous single retinal pigment epithelium (RPE) transplantation for severe obsolete submacular hemorrhage (SMH) in late age-related macular degeneration (AMD).Methods:A retrospective clinical study. From January 2012 to December 2015, 11 patients with AMD (11 eyes) with obsolete SMH who were diagnosed and treated by pars plana vitrectomy (PPV) combined with autologous RPE transplantation at the Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were included. Among them, there were 9 eyes in 9 males and 2 eyes in 2 females. All the eyes underwent the examinations of best corrected visual acuity (BCVA) and optical coherence tomography; 4 eyes underwent macular fixation function (MAIA) at the same time. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. All eyes were treated with PPV combined with autologous single-layer RPE transplantation or autologous RPE-choroidal full-thickness transplantation, and were divided into S group and C group, with 5 and 6 eyes respectively. The differences of age ( t=-0.363), gender composition ratio ( χ2=0.549), course and thickness of SMH ( t=0.118, 0.231), average times of anti-vascular endothelial growth factor drug treatments ( t=0.129), times of PPV ( t=-0.452) between the two groups were not statistically significant ( P>0.05). The follow-up period was 6-40 months after the operation, and the BCVA, MAIA, graft status and complications of the eyes after the operation were observed. The comparison of continuous variables between groups was performed by independent-sample t test; the comparison of categorical variables was performed by χ2 test. Results:At the last follow-up, the average logMAR BCVA of the eyes in group S and C were 1.62±0.34 and 1.03±0.20, respectively; group C was better than group S, however, the difference was not statistically significant ( t=1.532, P=0.160). There were 4 eyes (80%, 4/5) and 6 eyes (100%, 6/6) in S group and C group with BCVA better than preoperative, the difference was no statistical significance ( χ2=0.677, P=0.895). There were 2 (40%, 2/5) and 3 (50%, 3/6) eyes with logMAR BCVA better than 1.0 in S group and C group, and the difference was not statistically significant ( χ2=0.572, P=0.423). After the operation, 6 eyes of grafts were in good condition and 5 eyes were in poor condition; the BCVA of grafts in good condition was significantly higher than that of poor condition, the difference was statistically significant ( t=4.894, P=0.001). Among the 4 eyes that underwent MAIA examination, 2 eyes were unstable and diffusely fixed on the graft; the fixation point was located at the normal retina adjacent to the graft area in 2 eyes. Secondary subretinal hemorrhage occurred in 3 eyes after the operation; the intraocular pressure was high in 1 eye after the operation. During the follow-up period, no intraocular infection, secondary retinal detachment, recurrent choroidal neovascularization or low intraocular pressure occurred in all eyes. Conclusions:Both autologous single-layer RPE transplantation and autologous RPE-choroidal full-thickness transplantation can help stabilize or even improve the visual function of eyes with severe SMH secondary to advanced AMD. The visual acuity after surgery is closely related to the state of the graft.

Objective:This study aimed to explore the clinical application value of the indication selection criteria for bi-pedicled deep inferior epigastric arterial perforator flap(DIEP) versus pedicled transverse rectus abdominis myocutaneous flap(TRAM) combined with DIEP for breast reconstruction.Methods:The clinical data of patients who underwent delayed bi-pedicled abdominal flap breast reconstruction after breast cancer surgery in the Department of Oncoplastic and Reconstructive Breast Surgery and Department of Mammoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2008 to April 2022 were retrospectively analyzed. According to the indications for each procedure, corresponding blood supply source was selected. Subsequently, patients were divided into two groups: bi-pedicled DIEP group and pedicled TRAM+ DIEP combined flap group according to the type of blood supply source. The indication selection criteria for pedicled TRAM+ DIEP combined flap was as follows: lack of two groups of recipient vessels; no dominant perforator in the abdominal donor site; previous abdominal liposuction or abdominal surgery with large dissection range and severe scar; patients were unable to tolerate prolonged surgery or had high risk factors for microsurgery. A comparison of breast reconstruction surgery characteristics was conducted between the two groups. Independent-samples t-test, rank sum test, Chi-square test and Fisher’s exact probability method were used to analyze various data including age, body mass index (BMI), time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy, history of chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length, preoperative and postoperative conditions, as well as postoperative complications. Statistical significance was defined at P<0.05. Results:A total of 54 patients who underwent unilateral breast reconstruction were included in this study with a mean age of 42.2 years (range, 30-59 years). The pedicled TRAM+ DIEP combined flap group consisted of 21 patients with a mean age of 42.7 years (range, 33-56 years) while the bi-pedicled DIEP group comprised 33 patients with a mean age of 41.8 years (30-59 years). Out of the 54 patients, a total of 38 were eventually followed up, comprising 14 in the pedicled TRAM+ DIEP combined flap group and 24 in the bi-pedicled DIEP group. The average follow-up duration for the pedicled TRAM+ DIEP combined flap group was 42 months (range, 6-69 months). Abdominal bulge occurred in one patient, while another patient experienced abdominal hernia. The average follow-up duration for the bi-pedicled DIEP group was 47 months (6-179 months), with no reported cases of abdominal bulge or abdominal hernia. There were no statistically significant differences observed between the two groups regarding age, BMI, time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy or chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length or time to ambulation (all P>0.05). However, there was a statistically significant difference noted in duration of surgery between the pedicled TRAM+ DIEP combined flap group and bi-pedicled DIEP group [6.0(5.5-6.5) hours vs. 8.5(8.0-8.8) hours] ( P<0.01). Comparison analysis revealed no statistically significant differences in terms of partial flap necrosis (0/21 vs. 1/33), abdominal incision dehiscence (2/21 vs. 2/33), abdominal bulge (1/14 vs. 0 /24) or abdominal hernia (1/1 vs. 0/24) between the two groups ( P>0.05). Conclusion:For patients who needed bilateral vascular pedicled lower abdominal wall for breast reconstruction, utilizing a pedicled TRAM+ DIEP combined flap did not increase surgical complication risks. The proposed indication selection criteria for using a pedicled TRAM + DIEP combined flap outlined in this study could serve as guidance when choosing methods for bi-pedicled abdominal flap breast reconstruction.

Objective:This study aimed to explore the clinical application value of the indication selection criteria for bi-pedicled deep inferior epigastric arterial perforator flap(DIEP) versus pedicled transverse rectus abdominis myocutaneous flap(TRAM) combined with DIEP for breast reconstruction.Methods:The clinical data of patients who underwent delayed bi-pedicled abdominal flap breast reconstruction after breast cancer surgery in the Department of Oncoplastic and Reconstructive Breast Surgery and Department of Mammoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2008 to April 2022 were retrospectively analyzed. According to the indications for each procedure, corresponding blood supply source was selected. Subsequently, patients were divided into two groups: bi-pedicled DIEP group and pedicled TRAM+ DIEP combined flap group according to the type of blood supply source. The indication selection criteria for pedicled TRAM+ DIEP combined flap was as follows: lack of two groups of recipient vessels; no dominant perforator in the abdominal donor site; previous abdominal liposuction or abdominal surgery with large dissection range and severe scar; patients were unable to tolerate prolonged surgery or had high risk factors for microsurgery. A comparison of breast reconstruction surgery characteristics was conducted between the two groups. Independent-samples t-test, rank sum test, Chi-square test and Fisher’s exact probability method were used to analyze various data including age, body mass index (BMI), time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy, history of chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length, preoperative and postoperative conditions, as well as postoperative complications. Statistical significance was defined at P<0.05. Results:A total of 54 patients who underwent unilateral breast reconstruction were included in this study with a mean age of 42.2 years (range, 30-59 years). The pedicled TRAM+ DIEP combined flap group consisted of 21 patients with a mean age of 42.7 years (range, 33-56 years) while the bi-pedicled DIEP group comprised 33 patients with a mean age of 41.8 years (30-59 years). Out of the 54 patients, a total of 38 were eventually followed up, comprising 14 in the pedicled TRAM+ DIEP combined flap group and 24 in the bi-pedicled DIEP group. The average follow-up duration for the pedicled TRAM+ DIEP combined flap group was 42 months (range, 6-69 months). Abdominal bulge occurred in one patient, while another patient experienced abdominal hernia. The average follow-up duration for the bi-pedicled DIEP group was 47 months (6-179 months), with no reported cases of abdominal bulge or abdominal hernia. There were no statistically significant differences observed between the two groups regarding age, BMI, time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy or chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length or time to ambulation (all P>0.05). However, there was a statistically significant difference noted in duration of surgery between the pedicled TRAM+ DIEP combined flap group and bi-pedicled DIEP group [6.0(5.5-6.5) hours vs. 8.5(8.0-8.8) hours] ( P<0.01). Comparison analysis revealed no statistically significant differences in terms of partial flap necrosis (0/21 vs. 1/33), abdominal incision dehiscence (2/21 vs. 2/33), abdominal bulge (1/14 vs. 0 /24) or abdominal hernia (1/1 vs. 0/24) between the two groups ( P>0.05). Conclusion:For patients who needed bilateral vascular pedicled lower abdominal wall for breast reconstruction, utilizing a pedicled TRAM+ DIEP combined flap did not increase surgical complication risks. The proposed indication selection criteria for using a pedicled TRAM + DIEP combined flap outlined in this study could serve as guidance when choosing methods for bi-pedicled abdominal flap breast reconstruction.

Objective: To investigate the satisfaction and well-being of Chinese women with breast deficiency, and to analyze the relevant influencing factors. Methods: A cross-sectional study was conducted using a self-designed questionnaire to investigate the women with breast deficiency, visiting the Plastic Surgery Hospital of Chinese Academy of Medical Sciences from November 2013 to August 2018. The BREAST-Q BR (breast reconstruction) pre-operation and post-operation modules were used to assess the quality of life. Results: A total of 139 effective questionnaires were collected, including 83 patients before BR surgery and 56 post. There was no difference in quality of life in different ages, marital status, education levels, working status, and causes of breast deficiency. Mean scores of satisfaction with breasts, psychosocial well-being and sexual well-being of patients after breast reconstruction were significantly higher than those of patients without reconstruction (P=0.000), but there was no statistical difference in physical well-being-chest score. The physical well-being abdomen scores of patients with abdominal flap reconstruction was lower than that of the patients without reconstruction (P=0.007). With regard to analysis of specific items, compared with preoperative patients, patients with abdominal flap reconstruction reported lower scores in the items related to abdominal muscle weakness (P<0.05). Conclusions The breast deficiency resulting from Poland syndrome, breast cancer and other causes, can lead to a significant decrease in quality of life. Breast reconstruction can improve satisfaction with breast, psychosocial and sexual well-being in women with breast deficiency. The abdomen well-being of patients with abdominal flap reconstruction is decreased. Therefore, more attention should be paid to retain abdominal muscles to maintain abdominal shape and motor function during operation.

Objective:The purpose of this study was to introduce an endoscopic approach to harvest latissimus dorsi muscle(LDM)flap using a single transverse axillary incision and evaluate its safety and efficacy to repair the chest deformities of Poland syndrome.Methods:Poland syndrome patients were recruited prospectively to repair the thoracic wall deformity plus breast reconstruction(combined with breast implant insertion) using the endoscopic approach to transfer LDM flap with single transverse axillary incision in the Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from October 2015 to January 2018. Information including patient demographics, LDM area, implant size, contralateral symmetry surgery, operative time(endoscopic time for LDM flap harvesting, endoscopic anterior subcutaneous pocket creating time and total time), the survival of LDM flap, deformity of thoracic wall and back and post-operative complications were collected. The pain visual analog scale was used to assess the severity of postoperative pain. The Breast-Q reconstruction module was used to evaluate patients’ psychosocial well-being and satisfaction with the outcome. The disabilities of the arm, shoulder, and hand (DASH) outcome questionnaire was used to evaluate patient upper extremity disabilities. A paired t-test was utilized to analyze the difference between the preoperative and postoperative score of the Breast-Q and DASH questionnaire. Results:Twenty-eight patients were recruited in this study, including 11 males and 17 females aged (22.5±3.9) years old with a body mass index of (20.5±6.1) kg/m 2. Two patients received contralateral implant augmentation and two received fat grafting for breast symmetry. The postoperative follow-up time was (50.4±23.1) months. All the reconstructed breasts or thoracic walls was in a good shape. All the LDM flap survived with good blood supply. The postoperative pain was mild, and there was no obvious abnormality of the thoracic wall and back. The area of harvested LDM flap was (437.2±110.0) cm 2. The size of the implant used for breast reconstruction was (240.4±46.0) ml. Total operation time was (169.4±16.1) minutes for patients without contralateral symmetrical surgery. The endoscopic time for LDM flap harvesting was (69.0±13.9) minutes. The endoscopic anterior subcutaneous pocket creating time was (32.8±6.0) minutes. The postoperative drain time was (7.6±1.4) days. The postoperative complications included one case of early seroma, one case of wound dehiscence, one case of flap malposition. The pain visual score of the patient was 2.7±0.5 on the first day after the operation and decreased to 0.8±0.4 after 1 week. The score of satisfaction with breast before surgery was 27.8±20.8, psychosocial well-being score was 49.6±17.0. The postoperative score of satisfaction with breast was 63.1±11.6, and psychosocial well-being score was 68.1±16.7. The postoperative score of satisfaction with breast ( t=-9.000, P=0.008) and psychosocial well-being ( t=-6.543, P<0.001) were significantly higher than those before surgery. The score of DASH was 3.7±3.3 before surgery and 4.0±3.7 after surgery respectively, with no statistically significant differences ( t=-1.160, P=0.276). All patients were highly satisfied with the result of the surgery. Conclusions:The endoscopic approach to transfer latissimus dorsi muscle flap using a single transverse axillary incision provides a safe and efficient way to repair thoracic wall deformities in Poland syndrome patients with a high satisfaction rate, a better aesthetic outcome, and a minimal complications rate.

Objective:The purpose of this study was to introduce an endoscopic approach to harvest latissimus dorsi muscle(LDM)flap using a single transverse axillary incision and evaluate its safety and efficacy to repair the chest deformities of Poland syndrome.Methods:Poland syndrome patients were recruited prospectively to repair the thoracic wall deformity plus breast reconstruction(combined with breast implant insertion) using the endoscopic approach to transfer LDM flap with single transverse axillary incision in the Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from October 2015 to January 2018. Information including patient demographics, LDM area, implant size, contralateral symmetry surgery, operative time(endoscopic time for LDM flap harvesting, endoscopic anterior subcutaneous pocket creating time and total time), the survival of LDM flap, deformity of thoracic wall and back and post-operative complications were collected. The pain visual analog scale was used to assess the severity of postoperative pain. The Breast-Q reconstruction module was used to evaluate patients’ psychosocial well-being and satisfaction with the outcome. The disabilities of the arm, shoulder, and hand (DASH) outcome questionnaire was used to evaluate patient upper extremity disabilities. A paired t-test was utilized to analyze the difference between the preoperative and postoperative score of the Breast-Q and DASH questionnaire. Results:Twenty-eight patients were recruited in this study, including 11 males and 17 females aged (22.5±3.9) years old with a body mass index of (20.5±6.1) kg/m 2. Two patients received contralateral implant augmentation and two received fat grafting for breast symmetry. The postoperative follow-up time was (50.4±23.1) months. All the reconstructed breasts or thoracic walls was in a good shape. All the LDM flap survived with good blood supply. The postoperative pain was mild, and there was no obvious abnormality of the thoracic wall and back. The area of harvested LDM flap was (437.2±110.0) cm 2. The size of the implant used for breast reconstruction was (240.4±46.0) ml. Total operation time was (169.4±16.1) minutes for patients without contralateral symmetrical surgery. The endoscopic time for LDM flap harvesting was (69.0±13.9) minutes. The endoscopic anterior subcutaneous pocket creating time was (32.8±6.0) minutes. The postoperative drain time was (7.6±1.4) days. The postoperative complications included one case of early seroma, one case of wound dehiscence, one case of flap malposition. The pain visual score of the patient was 2.7±0.5 on the first day after the operation and decreased to 0.8±0.4 after 1 week. The score of satisfaction with breast before surgery was 27.8±20.8, psychosocial well-being score was 49.6±17.0. The postoperative score of satisfaction with breast was 63.1±11.6, and psychosocial well-being score was 68.1±16.7. The postoperative score of satisfaction with breast ( t=-9.000, P=0.008) and psychosocial well-being ( t=-6.543, P<0.001) were significantly higher than those before surgery. The score of DASH was 3.7±3.3 before surgery and 4.0±3.7 after surgery respectively, with no statistically significant differences ( t=-1.160, P=0.276). All patients were highly satisfied with the result of the surgery. Conclusions:The endoscopic approach to transfer latissimus dorsi muscle flap using a single transverse axillary incision provides a safe and efficient way to repair thoracic wall deformities in Poland syndrome patients with a high satisfaction rate, a better aesthetic outcome, and a minimal complications rate.