Objective:To explore the epidemiologic characteristics and the possible risk factors of microtia in China. Meanwhile, the significant variables related to severe cases are integrated into a predictive nomogram.Methods:A total of 593 patients with congenital microtia from July 2015 to July 2018 were included. Patients conforming to congenital microtia with or without associated malformations were enrolled in this study, and patients with clear chromosomal syndromes were excluded. Questionnaire surveys were conducted among the parents to collect the demographic information and risk factors for exposure during perinatal period. Using Chi-Square and Fisher’s tests to statistically analyze the frequencies of variables. Univariate and multivariate logistic regression analysis were used to select variables related to severe cases for constructing nomogram. Concordance index (C-index), calibration plot, Hosmer-Lemeshow test, and receiver operating characteristics (ROC) curve were used to assess the nomogram model.Results:Of the patients, 456 (76.9%) were male and 137 (23.1%) were female. Right side was involved in 329 cases (55.5%), left side in 217 cases (36.6%) and both sides in 47 cases (7.9%). Among them, 16 cases were familial and the rest were sporadic. Multiple deformations were in 392 cases (66.1%). Maternal illness in early pregnancy( OR=2.205, 95% CI: 1.020-4.020)and parternal drinking history( OR=2.221, 95% CI: 1.329-3.677)were independent risk factors for severe microtia. While mother aged from 26 to 35 years old ( OR=0.507, 95% CI: 0.281-0.913; OR=0.258, 95% CI: 0.125-0.531) and father living in plain area( OR=0.512, 95% CI: 0.288-0.913)may be protective factors. All the significant predictors were combined into a predictive nomogram. The C-index was 0.703(95% CI: 0.646-0.760). The calibration plotshowed good performance of the nomogram, and the model passed Hosmer-Lemeshow goodness-of-fit test ( χ2=4.512, P=0.808). ROC curve analysis revealed a high sensitivity and specificity. Conclusions:The majority of microtia patients are male, sporadic, occur on right side, and often associated with other malformations. This nomogram predicting severe microtia based on multiple parental risk factors was with good discrimination and accuracy, which could provide scientific guidance for individualized prevention in clinical practice.

Objective:To investigate the effect of different strategies on auricle reconstruction in microtia with very low hairline according to the skin condition of retroauricular mastoid region and the degree of temporal bone development.Methods:The clinical data of patients with very low hairline congenital microtia admitted to the Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2014 to June 2019 were retrospectively analyzed. Surgical plan: the patients with moderate temporal bone development and thin and poor elasticity skin were treated with retroauricular skin expansion combined with laser hair removal; the patients with moderate temporal bone development and thick and loose skin were treated with fasciocutaneous flap expansion combined with laser hair removal; the patients with poor temporal bone development were treated with temporal superficial fascia combined with Medpor frame for one-time reconstruction. All patients were followed up to investigate their satisfaction with the three-dimensional structure and subunit morphology of the reconstructed ear, and the complications were recorded.Results:A total of 68 patients, 55 males and 13 females, aged from 5 to 22 years old, with an average of 10.4 years old, were included in this study. Among them, 22 patients were treated with retroauricular skin expansion combined with laser hair removal, 41 patients were treated with retroauricular fasciocutaneous flap expansion combined with laser hair removal, and 5 patients were treated with temporoparietal superficial fascia combined with Medpor frame for one-stage reconstruction. The follow-up ranged from 10 to 24 months (average 13 months). The three-dimensional structure and local subunits of 66 cases of reconstructed ears were in good shape, and the operation area recovered well without obvious scar hyperplasia and chest deformity. Among them, 6 patients remained a small amount of hair after laser hair removal treatment, and the satisfactory effect was achieved after re-hair removal treatment. The satisfaction rate of patients was 97.1% (66/68). Two cases of auricle reconstruction by retroauricular skin expansion combined with laser hair removal showed cartilage exposure after operation, and recovered with temporoparietal fascial flap after. No subcutaneous hematoma, poor skin graft survival, cartilage absorption, deformation and other complications occurred in all cases.Conclusions:According to the skin condition and temporal bone development degree of patients with very low hairline, different treatment schemes can obtain better auricle shape, improve postoperative patient satisfaction and reduce complications.

Objective:To explore the epidemiologic characteristics and the possible risk factors of microtia in China. Meanwhile, the significant variables related to severe cases are integrated into a predictive nomogram.Methods:A total of 593 patients with congenital microtia from July 2015 to July 2018 were included. Patients conforming to congenital microtia with or without associated malformations were enrolled in this study, and patients with clear chromosomal syndromes were excluded. Questionnaire surveys were conducted among the parents to collect the demographic information and risk factors for exposure during perinatal period. Using Chi-Square and Fisher’s tests to statistically analyze the frequencies of variables. Univariate and multivariate logistic regression analysis were used to select variables related to severe cases for constructing nomogram. Concordance index (C-index), calibration plot, Hosmer-Lemeshow test, and receiver operating characteristics (ROC) curve were used to assess the nomogram model.Results:Of the patients, 456 (76.9%) were male and 137 (23.1%) were female. Right side was involved in 329 cases (55.5%), left side in 217 cases (36.6%) and both sides in 47 cases (7.9%). Among them, 16 cases were familial and the rest were sporadic. Multiple deformations were in 392 cases (66.1%). Maternal illness in early pregnancy( OR=2.205, 95% CI: 1.020-4.020)and parternal drinking history( OR=2.221, 95% CI: 1.329-3.677)were independent risk factors for severe microtia. While mother aged from 26 to 35 years old ( OR=0.507, 95% CI: 0.281-0.913; OR=0.258, 95% CI: 0.125-0.531) and father living in plain area( OR=0.512, 95% CI: 0.288-0.913)may be protective factors. All the significant predictors were combined into a predictive nomogram. The C-index was 0.703(95% CI: 0.646-0.760). The calibration plotshowed good performance of the nomogram, and the model passed Hosmer-Lemeshow goodness-of-fit test ( χ2=4.512, P=0.808). ROC curve analysis revealed a high sensitivity and specificity. Conclusions:The majority of microtia patients are male, sporadic, occur on right side, and often associated with other malformations. This nomogram predicting severe microtia based on multiple parental risk factors was with good discrimination and accuracy, which could provide scientific guidance for individualized prevention in clinical practice.

Objective:To investigate the effect of different strategies on auricle reconstruction in microtia with very low hairline according to the skin condition of retroauricular mastoid region and the degree of temporal bone development.Methods:The clinical data of patients with very low hairline congenital microtia admitted to the Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2014 to June 2019 were retrospectively analyzed. Surgical plan: the patients with moderate temporal bone development and thin and poor elasticity skin were treated with retroauricular skin expansion combined with laser hair removal; the patients with moderate temporal bone development and thick and loose skin were treated with fasciocutaneous flap expansion combined with laser hair removal; the patients with poor temporal bone development were treated with temporal superficial fascia combined with Medpor frame for one-time reconstruction. All patients were followed up to investigate their satisfaction with the three-dimensional structure and subunit morphology of the reconstructed ear, and the complications were recorded.Results:A total of 68 patients, 55 males and 13 females, aged from 5 to 22 years old, with an average of 10.4 years old, were included in this study. Among them, 22 patients were treated with retroauricular skin expansion combined with laser hair removal, 41 patients were treated with retroauricular fasciocutaneous flap expansion combined with laser hair removal, and 5 patients were treated with temporoparietal superficial fascia combined with Medpor frame for one-stage reconstruction. The follow-up ranged from 10 to 24 months (average 13 months). The three-dimensional structure and local subunits of 66 cases of reconstructed ears were in good shape, and the operation area recovered well without obvious scar hyperplasia and chest deformity. Among them, 6 patients remained a small amount of hair after laser hair removal treatment, and the satisfactory effect was achieved after re-hair removal treatment. The satisfaction rate of patients was 97.1% (66/68). Two cases of auricle reconstruction by retroauricular skin expansion combined with laser hair removal showed cartilage exposure after operation, and recovered with temporoparietal fascial flap after. No subcutaneous hematoma, poor skin graft survival, cartilage absorption, deformation and other complications occurred in all cases.Conclusions:According to the skin condition and temporal bone development degree of patients with very low hairline, different treatment schemes can obtain better auricle shape, improve postoperative patient satisfaction and reduce complications.

Objective:To explore the effects of psychological suggestive therapy combined with diet restriction therapy on resilience and glycolipid metabolism in elderly patients with coronary heart disease and type 2 diabetes mellitus.Methods:A total of 200 elderly patients with coronary heart disease and type 2 diabetes mellitus were recruited from June 2017 to March 2019. They were divided into control group and study group according to the random number table method, with 100 cases each. However, during the whole research cycle, some patients affected by various factors dropped out of the study, and the final number of patients was 92 cases in the study group and 87 cases in the control group. The study group received psychological suggestive therapy combined with dietary restriction therapy on the basis of the control group. The psychoelasticity of patients was assessed by concise psychoelasticity scale by physicians trained before and after intervention, and the changes of glucose and lipid metabolism were investigated before and after intervention.Results:After intervention, the scores of resilience (19.39 ± 3.29), self-improvement (16.56 ± 3.00), optimism (15.02 ± 2.50) in the study group were higher than those in the control group (15.97 ± 3.77, 10.58 ± 2.40, 9.20 ± 3.12), with significant differences ( t value was 4.459, 6.762, 6.220, P < 0.05). After intervention, the blood glucose index of the study group was generally better than that of the control group. After intervention, FPG, 2hFPG and HbA1c in the study group were (5.02 ± 0.45) mmol / L, (8.94 ± 1.43) mmol / L, (5.87 ± 0.65)% respectively, and those in the control group were (6.29 ± 1.71) mmol / L, (9.65 ± 1.4) mmol / L, (7.21 ± 1.05)% respectively, with statistically significant differences ( t value was 4.682, 5.214, 5.696, P < 0.05). After intervention, ApoA1, TG, HDL-C and LDL-C were (1.58 ± 0.32)mmol/L, (1.61 ± 0.58)mmol/L, (2.11 ± 0.85)mmol/L, (2.09 ± 0.67) mmol / L in the study group, and in the control group ApoA1, TG, HDL-C and LDL-C were (1.13 ± 0.33)mmol/L, (1.98 ± 0.69)mmol/L, (1.82 ± 0.63)mmol/L, (2.71 ± 0.79) mmol/L respectively ( t value was 3.036-4.256, P < 0.05). Conclusion:Psychological suggestive therapy combined with dietary restriction therapy can effectively improve the resilience of elderly patients with coronary heart disease and type 2 diabetes mellitus, control the level of glycolipid metabolism, stabilize the condition and promote early recovery.

Objective:To find the chromosomal malfomations among microtia patients and the neighbouring genes of chromosomal aberrations or genes in the extra or deleted chromosome fragments would be screened to investigate the possible causative genes.Methods:According to the inclusion criteria, case group was selected from microtia patients referred to Plastic Surgery Hospital, Chinese Academy of Medical Science, between January 2012 and January 2014, and the control group was the normal people of similar age received plastic surgery in the same hospital in the same time who did not have any congenital genetic disease. Blood samples of two groups were collected, and genomic DNA was extracted, then copy number variation (CNV) analysis was performed in the two groups with gene chip technology and associated software for large fragment chromosomal malformations. The variations of chromosome copy number were recorded to further analyze the type and length of chromosome structure variation. The genes at the loci of break points were further screened referring to B allele frequency to interpret associated genes related to the occurrence of microtia. Fisher exact test were used for statistical analysis, and the difference was statistically significant ( P< 0.05). Results:942 patients with congenital microtia were included in the case group, 695 males and 247 females, aged (11.4±3.2) years; 1 802 normal controls, 1 290 males and 512 females, aged (11.6±4.9) years. Large chromosomal fragments variations were detected in 5 patients in chromosome in case group( P=0.003). The difference between the two groups was statistically significant( P=0.003). Three cases were found to carry an extra X chromosome. Among the 3 cases, one patient suffered from XXY karyotype and the other 2 patients X trisomy. Two cases were proved to be associated with chromosome structural variations. The malformations of the first case presented partial duplication of the long arm of chromosome 13 and 14. On searching for causative genes, OTX2, BMP4 and GSC were detected to be in the chromosome structural variations. The second case presented to be partial duplication of the long arm of chromosome 5. FGF pathway associated genes FGF18, FGFR4, FGF1 and BMP pathway associated genes FST, MSX2, SMAD5 were incorporated in the extra duplicated chromosome for possible gene dosage effect. Conclusions:The results indicated the possible association of chromosome abnormity and microtia and provide new insights in microtia-associated chromosome instability. Ten related genes were involved in the occurrence of microtia through various ways.

Objective:To find the chromosomal malfomations among microtia patients and the neighbouring genes of chromosomal aberrations or genes in the extra or deleted chromosome fragments would be screened to investigate the possible causative genes.Methods:According to the inclusion criteria, case group was selected from microtia patients referred to Plastic Surgery Hospital, Chinese Academy of Medical Science, between January 2012 and January 2014, and the control group was the normal people of similar age received plastic surgery in the same hospital in the same time who did not have any congenital genetic disease. Blood samples of two groups were collected, and genomic DNA was extracted, then copy number variation (CNV) analysis was performed in the two groups with gene chip technology and associated software for large fragment chromosomal malformations. The variations of chromosome copy number were recorded to further analyze the type and length of chromosome structure variation. The genes at the loci of break points were further screened referring to B allele frequency to interpret associated genes related to the occurrence of microtia. Fisher exact test were used for statistical analysis, and the difference was statistically significant ( P< 0.05). Results:942 patients with congenital microtia were included in the case group, 695 males and 247 females, aged (11.4±3.2) years; 1 802 normal controls, 1 290 males and 512 females, aged (11.6±4.9) years. Large chromosomal fragments variations were detected in 5 patients in chromosome in case group( P=0.003). The difference between the two groups was statistically significant( P=0.003). Three cases were found to carry an extra X chromosome. Among the 3 cases, one patient suffered from XXY karyotype and the other 2 patients X trisomy. Two cases were proved to be associated with chromosome structural variations. The malformations of the first case presented partial duplication of the long arm of chromosome 13 and 14. On searching for causative genes, OTX2, BMP4 and GSC were detected to be in the chromosome structural variations. The second case presented to be partial duplication of the long arm of chromosome 5. FGF pathway associated genes FGF18, FGFR4, FGF1 and BMP pathway associated genes FST, MSX2, SMAD5 were incorporated in the extra duplicated chromosome for possible gene dosage effect. Conclusions:The results indicated the possible association of chromosome abnormity and microtia and provide new insights in microtia-associated chromosome instability. Ten related genes were involved in the occurrence of microtia through various ways.

Objective: To explore a 1∶1 2D printing method of rib cartilage based on CT scanning in assisting ear framework fabrication for auricular reconstruction. Methods: From January 2016 to January 2017, 73 cases of microtia aging from 5 to 7 referred to our department. A 1∶1 2D printing of rib cartilage based on CT scanning was applied in preoperative assessment and measurments of bilateral sixth, seventh and eighth costal cartilage were completed before the surgery. Personalized rib cartilage ear framework fabrication was determined by the measurements. Results: Among the 73 cases, 58 cases received auricular reconstruction successfully. There were 15 patients whose rib cartilages did not meet the requirements and postponed the surgery. The patients who underwent auricular reconstruction were followed up for 6 to 12 months (average, 9 months). During the follow-up, 52 cases had satisfactory outcomes in size, shape, symmetry and details. No deformation of reconstructed ears or chest wall was found during the follow-up. Conclusions The 1∶1 2D printing based on CT scanning is a simple and timesaving way to evaluate the rib cartilage. It can be beneficial to save the amount of cartilage and improve the personalized ear framework fabrication.

Objective Based on the different physiological characteristics of the mastoid skin and soft tissue in congenital microtia malformation ,the different ear reconstructivemethod were respectively applied for the individuals with microtia .And the feasibility of personalized treatment to microtia patients was explored in this study .Method Considering different thickness and tightness in mastoid hairless skin and soft tissue,2129 microtia patients were received the skin expansionmethod of ear reconstruction surgery , while 1321 cases were treated with Nagata ' s technique, and 330 cases with skin and fascia expansionmethod . Result With average 10-month follow-up,1944 ( 91.31％) cases using the mastoid skin expansionmethod were satisfied with the outcome of the reconstructed ear including three dimensional position and subunit appearance.305(92.42％)cases using the skin and fascia expansionmethod were satisfied with theresult .1264 (95.69％) cases using Nagata ' s two—stagemethod received satisfactory outcomes .49 ( 3.71％) cases showed partial exposure of the cartilage framework .There were no postoperative complications , such as chest wall deformity or affected normal physical function .Conclusion Based on the different physiological characteristics of the mastoid skin and soft tissue ,it's beneficial to select individualized operationalmethod in ear reconstruction for congenital microtia among Chinese patients .

Objective Based on the different physiological characteristics of the mastoid skin and soft tissue in congenital microtia malformation ,the different ear reconstructivemethod were respectively applied for the individuals with microtia .And the feasibility of personalized treatment to microtia patients was explored in this study .Method Considering different thickness and tightness in mastoid hairless skin and soft tissue,2129 microtia patients were received the skin expansionmethod of ear reconstruction surgery , while 1321 cases were treated with Nagata ' s technique, and 330 cases with skin and fascia expansionmethod . Result With average 10-month follow-up,1944 ( 91.31％) cases using the mastoid skin expansionmethod were satisfied with the outcome of the reconstructed ear including three dimensional position and subunit appearance.305(92.42％)cases using the skin and fascia expansionmethod were satisfied with theresult .1264 (95.69％) cases using Nagata ' s two—stagemethod received satisfactory outcomes .49 ( 3.71％) cases showed partial exposure of the cartilage framework .There were no postoperative complications , such as chest wall deformity or affected normal physical function .Conclusion Based on the different physiological characteristics of the mastoid skin and soft tissue ,it's beneficial to select individualized operationalmethod in ear reconstruction for congenital microtia among Chinese patients .