Objective To investigate the effects of icariin on high glucose-induced autophagy and apoptosis of podocytes,and the regulating effects on mammalian target of rapamycin(mTOR)/serine-threonine kinase(Akt)/cyclic adenosine monophosphate response element binding protein(CREB)pathway.Methods The mouse podocytes MPC5 were taken and divided into five groups:normal control group(5.5 mmol·L-1 glucose),high glucose group(30 mmol·L-1 glucose),icariin group(30 mmol·L-1glucose+5 μmol·L-1icariin),GDC-0349 group(30 mmol·L-1glucose+50 μmol·L-1 GDC-0349),icariin+GDC-0349 group(30 mmol·L-1 glucose+5 μmol·L-1 icariin+50 μmol·L-1 GDC-0349).Cultured for 48 hours,the tetramethylazozolium salt method was used to detect the viability of MPC5 cells;acridine orange staining was used to observe the autophagy of MPC5 cells;apoptosis of MPC5 cells was detected by flow cytometry;Western blotting was used to detect the expression of autophagy[microtubule associated protein one light chain 3(LC3)II,LC3Ⅰ,autophagy-related protein(Beclin-1)],apoptosis[Bcl-2 related X protein(Bax),B cell lymphoma-2(Bcl-2)]and mTOR/Akt/CREB pathway-related proteins of MPC5 cells.Results Compared with the normal control group,the cell viability,expression levels of Bcl-2,phosphorylated mTOR(p-mTOR)/mTOR,phosphorylated Akt(p-Akt)/Akt,phosphorylated CREB(p-CREB)/CREB protein of MPC5 cells in the high glucose group were significantly decreased(P＜0.05),the autophagy ability was enhanced,the autophagosome showed orange fluorescence,and the apoptosis rate,LC3Ⅱ/LC3Ⅰ,Beclin-1,Bax protein expression levels were significantly increased(P＜0.05).Compared with the high glucose group,the cell viability,LC3Ⅱ/LC3Ⅰ,Beclin-1,Bcl-2,p-mTOR/mTOR,p-Akt/Akt,p-CREB/CREB protein expression levels of MPC5 cells in icariin group were significantly increased,the autophagy ability was further enhanced,the number of autophagosomes was increased,the autophagosomes showed brick red fluorescence(P＜0.05),the apoptosis rate and Bax protein expression level were significantly decreased(P＜0.05),and the cell viability,LC3Ⅱ/LC3Ⅰ,Beclin-1,Bcl-2,p-mTOR/mTOR,p-Akt/Akt and p-CREB/CREB proteins expression levels of MPC5 cells in GDC-0349 group were significantly decreased,the autophagy ability was weakened,the number of autophagosomes was reduced,the autophagosomes showed orange fluorescence(P＜0.05),and the apoptosis rate and Bax protein expression level were significantly increased(P＜0.05);icariin+GDC-0349 could reverse the effect of icariin on high glucose induced MPC5 cells(P＜0.05).Conclusion Icariin promotes elevated glucose-induced podocyte autophagy and inhibits apoptosis by activating the mTOR/Akt/CREB pathway.

[Abstract] In the early stage of the application of platelet apheresis technology, there was a concern that high-frequency platelet apheresis might lead to the risk of lymphocyte depletion in blood donors. With the advances in platelet apheresis technology and improvements in collection purity and efficiency, this concern was waning. In recent years, with the wide application of leucocyte-reduced platelets apheresis, this issue has once again become a concern and research hotspot in the international blood transfusion research field. We briefly review this concern and focus on the research progress in recent years and put forward some suggestions to reduce this potential risk and of further research.

Objective:To explore the feasibility of smart phone real-time picture exchange-assisted telecytopathology for rapid on-site evaluation (tele-ROSE), and the role of tele-ROSE in improving the diagnostic efficiency of endoscopic physicians.Methods:Data of patients who underwent endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) from April 2020 to May 2021 in Qilu Hospital of Shandong University were retrospectively collected. Patients who didn't receive ROSE from April 2020 to October 2020 were enrolled in the non-ROSE group, and those who underwent ROSE from November 2020 to May 2021 were enrolled in the ROSE group, of which endosonographers used WeChat on the smartphone to send ROSE images to cytopathologists from November 2020 to March 2021 were the mobile phone group, and those whose ROSE results independently diagnosed by trained endosonographers from April 2021 to May 2021 were the self-ROSE group. Basic information, ROSE results, postoperative pathology and follow-up were compared, and the diagnostic effectiveness of tele-ROSE was analyzed.Results:A total of 188 cases were included, of which 179 cases (95.2%) were solid pancreatic lesions and 9 (4.8%) were enterocoelia lesions. There was no significant difference in the puncture time among the non-ROSE, mobile phone and self-ROSE groups [3 (3, 4) VS 3 (3, 4) VS 3 (2, 4), H=1.320, P=0.517]. With the final diagnosis as the golden standard, the sensitivity, the specificity, the accuracy, the positive predictive value, the negative predictive value and Kappa value of the non-ROSE group were 80.6% (58/72), 89.5% (17/19), 82.4% (75/91), 96.7% (58/60), 54.8% (17/31), and 0.6 respectively. The corresponding indices in the ROSE group were 97.4% (74/76), 100.0% (21/21), 97.9% (95/97), 100.0% (74/74), 91.3% (21/23), and 0.9 respectively, those of the mobile phone group were 95.2% (40/42), 100.0% (10/10), 96.2% (50/52), 100.0% (40/40), 83.3% (10/12), and 0.9 respcetively, and those of the self-ROSE group were 100.0% (34/34), 100.0% (11/11), 100.0% (45/45), 100.0% (34/34), 100.0% (11/11), and 1.0 respectively. The sensitivity ( P=0.002), the accuracy ( P=0.001) and the negative predictive value ( P=0.009) of the ROSE group were significantly higher than those of the non-ROSE group, and there was no significant difference in other diagnostic efficacy indices ( P>0.05). There was no significant difference between the mobile phone group and the self-ROSE group in diagnostic efficacy ( P>0.05). Conclusion:Instant smartphone-assisted tele-ROSE through WeChat can well meet the needs of pathologists and endoscopic physicians. After the application of tele-ROSE training, the diagnostic accuracy of endoscopic physicians is equivalent to that of cytopathologist, which helps to obtain more sufficient specimens under endoscopy and improve the diagnostic accuracy of EUS-FNA.

Objective:To study the current status of research in the field of iodine nutrition for pregnant women and to detect the hot spots and future trends in the field of iodine nutrition for pregnant women.Methods:Using "pregnant women" and "iodine" as search terms, we searched the literature related to iodine nutrition in pregnant women from January 2000 to December 2021 in China Knowledge Network (CNKI) database, Wanfang database and Chinese Medical Journal Full Text Database. CiteSpace 6.2.2.0 software was used to sort out the publication status, core authors and research hotspots of the papers.Results:A total of 879 valid papers were included, with an overall number of publications increasing trend from 2000 - 2021 and a decline after 2017. Among the 879 papers, 29 first authors were core authors (M≈3), and 109 papers were published, accounting for 12.40% of the total literature; several research groups with relatively stable collaborative relationships had been formed, with the larger collaborative team of Chen Zupei and Zhang Wanqi at Tianjin Medical University. Keyword co-occurrence analysis showed that pregnant women, urinary iodine, and iodine nutrition were high-frequency keywords; keywords with mediated centrality > 0.07 were pregnant women (0.48), pregnancy (0.40), urinary iodine (0.37), iodine deficiency disorders (0.25), iodine nutrition (0.20), thyroid (0.12), thyroxine (0.10), infants and children (0.09). The analysis of the emergent words showed that the evolution of iodine nutrition research themes in pregnant women was broadly based on studies of iodine nutrition monitoring results in key populations such as newborns and infants from 2000 - 2011, studies such as the range of thyroxine reference values during pregnancy from 2012 - 2016, and changes in iodine nutrition status of pregnant women and children after adjustment of iodized salt concentration from 2017 - 2021. The clustering results showed that a total of 355 keywords were aggregated to yield 10 clusters, and the average profile value of clusters (Silhouette) > 0.8, which was a reasonable clustering result; the study topics can be divided into three major categories, iodine nutrition and goiter monitoring results in key populations, thyroid hormones and pregnancy outcomes during pregnancy, and studies on thyroid-related diseases.Conclusions:Iodine plays an important role in the health of pregnant women and their offspring, and changes in the iodine nutrition status of pregnant women should be closely monitored. In response to the new trends of change that are currently present, multidisciplinary cooperation should be developed to respond to social concerns and jointly promote the maintenance of iodine nutrition in pregnant women at appropriate levels.

Objective:To study the clinical effect of dynamic reconstruction of lower lip defect after squamous cell cancer resection by using unilateral Gillies fan flap and perioral muscle restoration.Methods:From Feburary 2017 to January 2020, 8 patients (6 female and 2 male, aged 55-81, 62.9 in average)diagnosed lower lip squamous cell carcinoma were accepted treatment in the Department of Otolaryngology Head & Neck Surgery, the First Affiliated Hospital of Xiamen University. All the moderate lower lip defect after cancer resection were repaired with unilateral Gillies fan flap with perioral muscle restoration under general anesthesia. The length of the vermilion of the upper lip in the Gillies fan flap was designed to be 1/3 of the length of the vermilion of the lower lip defect. The composite axial flap was prepared with the blood supply from contralateral upper lip artery-ipsilateral upper lip artery-mouth corner part of facial artery-ipsilateral lower lip artery.The end of all the perioral muscles were also prepared. After reconstruction of the continuity of the orbicularis oris, the ends of these perioral radiation muscles were restored in the position where they should be in the reconstructed lip.These perioral muscles training were undergone for 6 months after operation. After the reconstructed lip tend to be stable, measurement and calculation were carried out to evaluate the appearance, opening and closing functions of the mouth.Results:In our series of 8 cases, the length of the vermilion of the upper/lower lip was 52.4 mm(46.0-60.0 mm) in average; the circumference of the vermilion was 104.8 mm(92-120 mm)in average; the length of the defect of lower lip was 27.6 mm (21.0-35.0 mm)in average, 52.5% (42.0-67.3%) of the vermilion of lower lip. Six cases were using the right-side flap, and the other 2 cases were left. The length of the vermilion of the upper lip in the Gillies fan flap was 9.5 mm(7.0-12.0 mm)in average.All cases healed well with inconspicuous scar. No infection, hematoma or other surgical complications.No local or distant recurrence of cancer was observed during the follow-up period. Numbness of the lower lip happened posto-peration, and gradually disappeared 6 months later.Evaluation was conducted according to the measurement result preoperatively and 6 months postoperatively. (1) Appearance: the reconstructed lips were naturally symmetrical. Both side of the mouth corner were in the same horizontal level. The upper lip was lengthened with average increase of 6.8 mm and average increase rate of 15.9%. The lower lip was lengthened with average increase of 15.4 mm and average increase rate of 45.3%. In the rest situation, the circumference of the lips decreased by 5.5 mm in average compared with that preoperatively, which was 94.9% of the lip preoperatively, basically rehabilitate to the shape preoperatively.(2) Mouth-opening function: 1 week postoperation, the opening shape of mouth in all the cases was skewed with an about 1.5 fingers mouth-opening. Six months later, the opening shape of mouth was basically symmetrical round with a 3 fingers mouth-opening; in maximum mouth opening situation, the circumference of the lips decreased by 46.5 mm in average compared with that preoperatively, which was 73.1% of the lip in maximum mouth opening situation preoperatively, basically meeting physiological needs. (3) Mouth-closing function: All patient shave complete mouth-closing function and speech function.No leakage when making closed lip sound and whistling. All patients were satisfied with the oral appearance and the function of opening and closing mouth.Conclusions:Unilateral Gillies fan flap with perioral muscle restoration is a reliable method to repair the moderate full-thickness defect of the lower lip after cancer resection. After dynamic reconstruction of the perioral muscle group, the insufficient tissue of lips can be extended to obtain sufficient mouth opening, natural corner of the mouth and symmetrical lip appearance.

Objective:To study the clinical effect of dynamic reconstruction of lower lip defect after squamous cell cancer resection by using unilateral Gillies fan flap and perioral muscle restoration.Methods:From Feburary 2017 to January 2020, 8 patients (6 female and 2 male, aged 55-81, 62.9 in average)diagnosed lower lip squamous cell carcinoma were accepted treatment in the Department of Otolaryngology Head & Neck Surgery, the First Affiliated Hospital of Xiamen University. All the moderate lower lip defect after cancer resection were repaired with unilateral Gillies fan flap with perioral muscle restoration under general anesthesia. The length of the vermilion of the upper lip in the Gillies fan flap was designed to be 1/3 of the length of the vermilion of the lower lip defect. The composite axial flap was prepared with the blood supply from contralateral upper lip artery-ipsilateral upper lip artery-mouth corner part of facial artery-ipsilateral lower lip artery.The end of all the perioral muscles were also prepared. After reconstruction of the continuity of the orbicularis oris, the ends of these perioral radiation muscles were restored in the position where they should be in the reconstructed lip.These perioral muscles training were undergone for 6 months after operation. After the reconstructed lip tend to be stable, measurement and calculation were carried out to evaluate the appearance, opening and closing functions of the mouth.Results:In our series of 8 cases, the length of the vermilion of the upper/lower lip was 52.4 mm(46.0-60.0 mm) in average; the circumference of the vermilion was 104.8 mm(92-120 mm)in average; the length of the defect of lower lip was 27.6 mm (21.0-35.0 mm)in average, 52.5% (42.0-67.3%) of the vermilion of lower lip. Six cases were using the right-side flap, and the other 2 cases were left. The length of the vermilion of the upper lip in the Gillies fan flap was 9.5 mm(7.0-12.0 mm)in average.All cases healed well with inconspicuous scar. No infection, hematoma or other surgical complications.No local or distant recurrence of cancer was observed during the follow-up period. Numbness of the lower lip happened posto-peration, and gradually disappeared 6 months later.Evaluation was conducted according to the measurement result preoperatively and 6 months postoperatively. (1) Appearance: the reconstructed lips were naturally symmetrical. Both side of the mouth corner were in the same horizontal level. The upper lip was lengthened with average increase of 6.8 mm and average increase rate of 15.9%. The lower lip was lengthened with average increase of 15.4 mm and average increase rate of 45.3%. In the rest situation, the circumference of the lips decreased by 5.5 mm in average compared with that preoperatively, which was 94.9% of the lip preoperatively, basically rehabilitate to the shape preoperatively.(2) Mouth-opening function: 1 week postoperation, the opening shape of mouth in all the cases was skewed with an about 1.5 fingers mouth-opening. Six months later, the opening shape of mouth was basically symmetrical round with a 3 fingers mouth-opening; in maximum mouth opening situation, the circumference of the lips decreased by 46.5 mm in average compared with that preoperatively, which was 73.1% of the lip in maximum mouth opening situation preoperatively, basically meeting physiological needs. (3) Mouth-closing function: All patient shave complete mouth-closing function and speech function.No leakage when making closed lip sound and whistling. All patients were satisfied with the oral appearance and the function of opening and closing mouth.Conclusions:Unilateral Gillies fan flap with perioral muscle restoration is a reliable method to repair the moderate full-thickness defect of the lower lip after cancer resection. After dynamic reconstruction of the perioral muscle group, the insufficient tissue of lips can be extended to obtain sufficient mouth opening, natural corner of the mouth and symmetrical lip appearance.

Objective:To study the clinical effect of dynamic reconstruction of lower lip defect after squamous cell cancer resection by using unilateral Gillies fan flap and perioral muscle restoration.Methods:From Feburary 2017 to January 2020, 8 patients (6 female and 2 male, aged 55-81, 62.9 in average)diagnosed lower lip squamous cell carcinoma were accepted treatment in the Department of Otolaryngology Head & Neck Surgery, the First Affiliated Hospital of Xiamen University. All the moderate lower lip defect after cancer resection were repaired with unilateral Gillies fan flap with perioral muscle restoration under general anesthesia. The length of the vermilion of the upper lip in the Gillies fan flap was designed to be 1/3 of the length of the vermilion of the lower lip defect. The composite axial flap was prepared with the blood supply from contralateral upper lip artery-ipsilateral upper lip artery-mouth corner part of facial artery-ipsilateral lower lip artery.The end of all the perioral muscles were also prepared. After reconstruction of the continuity of the orbicularis oris, the ends of these perioral radiation muscles were restored in the position where they should be in the reconstructed lip.These perioral muscles training were undergone for 6 months after operation. After the reconstructed lip tend to be stable, measurement and calculation were carried out to evaluate the appearance, opening and closing functions of the mouth.Results:In our series of 8 cases, the length of the vermilion of the upper/lower lip was 52.4 mm(46.0-60.0 mm) in average; the circumference of the vermilion was 104.8 mm(92-120 mm)in average; the length of the defect of lower lip was 27.6 mm (21.0-35.0 mm)in average, 52.5% (42.0-67.3%) of the vermilion of lower lip. Six cases were using the right-side flap, and the other 2 cases were left. The length of the vermilion of the upper lip in the Gillies fan flap was 9.5 mm(7.0-12.0 mm)in average.All cases healed well with inconspicuous scar. No infection, hematoma or other surgical complications.No local or distant recurrence of cancer was observed during the follow-up period. Numbness of the lower lip happened posto-peration, and gradually disappeared 6 months later.Evaluation was conducted according to the measurement result preoperatively and 6 months postoperatively. (1) Appearance: the reconstructed lips were naturally symmetrical. Both side of the mouth corner were in the same horizontal level. The upper lip was lengthened with average increase of 6.8 mm and average increase rate of 15.9%. The lower lip was lengthened with average increase of 15.4 mm and average increase rate of 45.3%. In the rest situation, the circumference of the lips decreased by 5.5 mm in average compared with that preoperatively, which was 94.9% of the lip preoperatively, basically rehabilitate to the shape preoperatively.(2) Mouth-opening function: 1 week postoperation, the opening shape of mouth in all the cases was skewed with an about 1.5 fingers mouth-opening. Six months later, the opening shape of mouth was basically symmetrical round with a 3 fingers mouth-opening; in maximum mouth opening situation, the circumference of the lips decreased by 46.5 mm in average compared with that preoperatively, which was 73.1% of the lip in maximum mouth opening situation preoperatively, basically meeting physiological needs. (3) Mouth-closing function: All patient shave complete mouth-closing function and speech function.No leakage when making closed lip sound and whistling. All patients were satisfied with the oral appearance and the function of opening and closing mouth.Conclusions:Unilateral Gillies fan flap with perioral muscle restoration is a reliable method to repair the moderate full-thickness defect of the lower lip after cancer resection. After dynamic reconstruction of the perioral muscle group, the insufficient tissue of lips can be extended to obtain sufficient mouth opening, natural corner of the mouth and symmetrical lip appearance.

Objective:To study the clinical effect of dynamic reconstruction of lower lip defect after squamous cell cancer resection by using unilateral Gillies fan flap and perioral muscle restoration.Methods:From Feburary 2017 to January 2020, 8 patients (6 female and 2 male, aged 55-81, 62.9 in average)diagnosed lower lip squamous cell carcinoma were accepted treatment in the Department of Otolaryngology Head & Neck Surgery, the First Affiliated Hospital of Xiamen University. All the moderate lower lip defect after cancer resection were repaired with unilateral Gillies fan flap with perioral muscle restoration under general anesthesia. The length of the vermilion of the upper lip in the Gillies fan flap was designed to be 1/3 of the length of the vermilion of the lower lip defect. The composite axial flap was prepared with the blood supply from contralateral upper lip artery-ipsilateral upper lip artery-mouth corner part of facial artery-ipsilateral lower lip artery.The end of all the perioral muscles were also prepared. After reconstruction of the continuity of the orbicularis oris, the ends of these perioral radiation muscles were restored in the position where they should be in the reconstructed lip.These perioral muscles training were undergone for 6 months after operation. After the reconstructed lip tend to be stable, measurement and calculation were carried out to evaluate the appearance, opening and closing functions of the mouth.Results:In our series of 8 cases, the length of the vermilion of the upper/lower lip was 52.4 mm(46.0-60.0 mm) in average; the circumference of the vermilion was 104.8 mm(92-120 mm)in average; the length of the defect of lower lip was 27.6 mm (21.0-35.0 mm)in average, 52.5% (42.0-67.3%) of the vermilion of lower lip. Six cases were using the right-side flap, and the other 2 cases were left. The length of the vermilion of the upper lip in the Gillies fan flap was 9.5 mm(7.0-12.0 mm)in average.All cases healed well with inconspicuous scar. No infection, hematoma or other surgical complications.No local or distant recurrence of cancer was observed during the follow-up period. Numbness of the lower lip happened posto-peration, and gradually disappeared 6 months later.Evaluation was conducted according to the measurement result preoperatively and 6 months postoperatively. (1) Appearance: the reconstructed lips were naturally symmetrical. Both side of the mouth corner were in the same horizontal level. The upper lip was lengthened with average increase of 6.8 mm and average increase rate of 15.9%. The lower lip was lengthened with average increase of 15.4 mm and average increase rate of 45.3%. In the rest situation, the circumference of the lips decreased by 5.5 mm in average compared with that preoperatively, which was 94.9% of the lip preoperatively, basically rehabilitate to the shape preoperatively.(2) Mouth-opening function: 1 week postoperation, the opening shape of mouth in all the cases was skewed with an about 1.5 fingers mouth-opening. Six months later, the opening shape of mouth was basically symmetrical round with a 3 fingers mouth-opening; in maximum mouth opening situation, the circumference of the lips decreased by 46.5 mm in average compared with that preoperatively, which was 73.1% of the lip in maximum mouth opening situation preoperatively, basically meeting physiological needs. (3) Mouth-closing function: All patient shave complete mouth-closing function and speech function.No leakage when making closed lip sound and whistling. All patients were satisfied with the oral appearance and the function of opening and closing mouth.Conclusions:Unilateral Gillies fan flap with perioral muscle restoration is a reliable method to repair the moderate full-thickness defect of the lower lip after cancer resection. After dynamic reconstruction of the perioral muscle group, the insufficient tissue of lips can be extended to obtain sufficient mouth opening, natural corner of the mouth and symmetrical lip appearance.

Objective:To study the clinical effect of dynamic reconstruction of lower lip defect after squamous cell cancer resection by using unilateral Gillies fan flap and perioral muscle restoration.Methods:From Feburary 2017 to January 2020, 8 patients (6 female and 2 male, aged 55-81, 62.9 in average)diagnosed lower lip squamous cell carcinoma were accepted treatment in the Department of Otolaryngology Head & Neck Surgery, the First Affiliated Hospital of Xiamen University. All the moderate lower lip defect after cancer resection were repaired with unilateral Gillies fan flap with perioral muscle restoration under general anesthesia. The length of the vermilion of the upper lip in the Gillies fan flap was designed to be 1/3 of the length of the vermilion of the lower lip defect. The composite axial flap was prepared with the blood supply from contralateral upper lip artery-ipsilateral upper lip artery-mouth corner part of facial artery-ipsilateral lower lip artery.The end of all the perioral muscles were also prepared. After reconstruction of the continuity of the orbicularis oris, the ends of these perioral radiation muscles were restored in the position where they should be in the reconstructed lip.These perioral muscles training were undergone for 6 months after operation. After the reconstructed lip tend to be stable, measurement and calculation were carried out to evaluate the appearance, opening and closing functions of the mouth.Results:In our series of 8 cases, the length of the vermilion of the upper/lower lip was 52.4 mm(46.0-60.0 mm) in average; the circumference of the vermilion was 104.8 mm(92-120 mm)in average; the length of the defect of lower lip was 27.6 mm (21.0-35.0 mm)in average, 52.5% (42.0-67.3%) of the vermilion of lower lip. Six cases were using the right-side flap, and the other 2 cases were left. The length of the vermilion of the upper lip in the Gillies fan flap was 9.5 mm(7.0-12.0 mm)in average.All cases healed well with inconspicuous scar. No infection, hematoma or other surgical complications.No local or distant recurrence of cancer was observed during the follow-up period. Numbness of the lower lip happened posto-peration, and gradually disappeared 6 months later.Evaluation was conducted according to the measurement result preoperatively and 6 months postoperatively. (1) Appearance: the reconstructed lips were naturally symmetrical. Both side of the mouth corner were in the same horizontal level. The upper lip was lengthened with average increase of 6.8 mm and average increase rate of 15.9%. The lower lip was lengthened with average increase of 15.4 mm and average increase rate of 45.3%. In the rest situation, the circumference of the lips decreased by 5.5 mm in average compared with that preoperatively, which was 94.9% of the lip preoperatively, basically rehabilitate to the shape preoperatively.(2) Mouth-opening function: 1 week postoperation, the opening shape of mouth in all the cases was skewed with an about 1.5 fingers mouth-opening. Six months later, the opening shape of mouth was basically symmetrical round with a 3 fingers mouth-opening; in maximum mouth opening situation, the circumference of the lips decreased by 46.5 mm in average compared with that preoperatively, which was 73.1% of the lip in maximum mouth opening situation preoperatively, basically meeting physiological needs. (3) Mouth-closing function: All patient shave complete mouth-closing function and speech function.No leakage when making closed lip sound and whistling. All patients were satisfied with the oral appearance and the function of opening and closing mouth.Conclusions:Unilateral Gillies fan flap with perioral muscle restoration is a reliable method to repair the moderate full-thickness defect of the lower lip after cancer resection. After dynamic reconstruction of the perioral muscle group, the insufficient tissue of lips can be extended to obtain sufficient mouth opening, natural corner of the mouth and symmetrical lip appearance.

Objective:To study the clinical effect of dynamic reconstruction of lower lip defect after squamous cell cancer resection by using unilateral Gillies fan flap and perioral muscle restoration.Methods:From Feburary 2017 to January 2020, 8 patients (6 female and 2 male, aged 55-81, 62.9 in average)diagnosed lower lip squamous cell carcinoma were accepted treatment in the Department of Otolaryngology Head & Neck Surgery, the First Affiliated Hospital of Xiamen University. All the moderate lower lip defect after cancer resection were repaired with unilateral Gillies fan flap with perioral muscle restoration under general anesthesia. The length of the vermilion of the upper lip in the Gillies fan flap was designed to be 1/3 of the length of the vermilion of the lower lip defect. The composite axial flap was prepared with the blood supply from contralateral upper lip artery-ipsilateral upper lip artery-mouth corner part of facial artery-ipsilateral lower lip artery.The end of all the perioral muscles were also prepared. After reconstruction of the continuity of the orbicularis oris, the ends of these perioral radiation muscles were restored in the position where they should be in the reconstructed lip.These perioral muscles training were undergone for 6 months after operation. After the reconstructed lip tend to be stable, measurement and calculation were carried out to evaluate the appearance, opening and closing functions of the mouth.Results:In our series of 8 cases, the length of the vermilion of the upper/lower lip was 52.4 mm(46.0-60.0 mm) in average; the circumference of the vermilion was 104.8 mm(92-120 mm)in average; the length of the defect of lower lip was 27.6 mm (21.0-35.0 mm)in average, 52.5% (42.0-67.3%) of the vermilion of lower lip. Six cases were using the right-side flap, and the other 2 cases were left. The length of the vermilion of the upper lip in the Gillies fan flap was 9.5 mm(7.0-12.0 mm)in average.All cases healed well with inconspicuous scar. No infection, hematoma or other surgical complications.No local or distant recurrence of cancer was observed during the follow-up period. Numbness of the lower lip happened posto-peration, and gradually disappeared 6 months later.Evaluation was conducted according to the measurement result preoperatively and 6 months postoperatively. (1) Appearance: the reconstructed lips were naturally symmetrical. Both side of the mouth corner were in the same horizontal level. The upper lip was lengthened with average increase of 6.8 mm and average increase rate of 15.9%. The lower lip was lengthened with average increase of 15.4 mm and average increase rate of 45.3%. In the rest situation, the circumference of the lips decreased by 5.5 mm in average compared with that preoperatively, which was 94.9% of the lip preoperatively, basically rehabilitate to the shape preoperatively.(2) Mouth-opening function: 1 week postoperation, the opening shape of mouth in all the cases was skewed with an about 1.5 fingers mouth-opening. Six months later, the opening shape of mouth was basically symmetrical round with a 3 fingers mouth-opening; in maximum mouth opening situation, the circumference of the lips decreased by 46.5 mm in average compared with that preoperatively, which was 73.1% of the lip in maximum mouth opening situation preoperatively, basically meeting physiological needs. (3) Mouth-closing function: All patient shave complete mouth-closing function and speech function.No leakage when making closed lip sound and whistling. All patients were satisfied with the oral appearance and the function of opening and closing mouth.Conclusions:Unilateral Gillies fan flap with perioral muscle restoration is a reliable method to repair the moderate full-thickness defect of the lower lip after cancer resection. After dynamic reconstruction of the perioral muscle group, the insufficient tissue of lips can be extended to obtain sufficient mouth opening, natural corner of the mouth and symmetrical lip appearance.