Objective:To evaluate the efficacy and safety of 1 064 nm Nd:YAG picosecond laser of dual-mode with auxiliary functional product introduction in treatment of melasma.Methods:A prospective study was conducted from March 2022 to September 2023 at the Department of Cosmetic Dermatology, Guangzhou Zesee Plastic Surgery Hospital, including 46 female patients with melasma, aged 26-53 (38.5±7.0) years. Patients were randomly divided into two groups using a random number table: experimental group (1 064 nm Nd:YAG picosecond laser dual-mode treatment followed by the introduction of functional product) and control group (1 064 nm Nd:YAG picosecond laser of dual-mode treatment followed by the introduction of 0.9% NaCl), with 23 patients in each group. By using the melasma area and severity index (MASI) score, the physician′s global assessment and the patient′s satisfaction evaluation as evaluation indicators, the treatment effects were assessed at different time points. Adverse reactions were recorded in both groups.Results:At 4 and 12 weeks after the third treatment, the MASI scores in the experimental group were lower than those of the control group ( P<0.001). At 4 weeks after the third treatment, the rate of moderate or above improvement in pigment spots was 95.7% (22/23) in the experimental group, which was higher than the 69.6% (16/23) in the control group ( P=0.011). At 12 weeks after the third treatment, the rate of moderate or above improvement in the experimental group was 30.4% (7/23), which was higher than the 8.7% (2/23) in the control group ( P=0.006). At 24 weeks after the third treatment, the rate of moderate or above improvement in the experimental group was 13.0% (3/23), which was higher than the 0% (0/23) in the control group ( P=0.015). At 4 weeks after the third treatment, the satisfactory rate in the experimental group was 73.9% (17/23), which was higher than the 43.5% (10/23) in the control group ( P=0.009). At 12 weeks after the third treatment, the satisfactory rate in the experimental group was 69.6% (16/23), which was higher than the 39.1% (9/23) in the control group ( P=0.040). At 24 weeks after the third treatment, the satisfactory rate in the experimental group was 56.5% (13/23), which was higher than the 4.4% (1/23) in the control group ( P=0.002). One patient in the experimental group experienced mild itching on the cheek on the second day post-treatment. In the control group, two patients experienced mild itching and erythema on the second day post-treatment. No serious adverse reactions, such as blisters, scabs, or pigmentation, were observed in either group during the treatment or follow-up periods. Conclusion:The 1 064 nm Nd:YAG picosecond laser of dual-mode with auxiliary functional product introduction in treatment of melasma has a better efficacy, with a shorter recovery period and fewer adverse reactions.

Objective:To evaluate the efficacy and safety of 1 064 nm Nd:YAG picosecond laser of dual-mode with auxiliary functional product introduction in treatment of melasma.Methods:A prospective study was conducted from March 2022 to September 2023 at the Department of Cosmetic Dermatology, Guangzhou Zesee Plastic Surgery Hospital, including 46 female patients with melasma, aged 26-53 (38.5±7.0) years. Patients were randomly divided into two groups using a random number table: experimental group (1 064 nm Nd:YAG picosecond laser dual-mode treatment followed by the introduction of functional product) and control group (1 064 nm Nd:YAG picosecond laser of dual-mode treatment followed by the introduction of 0.9% NaCl), with 23 patients in each group. By using the melasma area and severity index (MASI) score, the physician′s global assessment and the patient′s satisfaction evaluation as evaluation indicators, the treatment effects were assessed at different time points. Adverse reactions were recorded in both groups.Results:At 4 and 12 weeks after the third treatment, the MASI scores in the experimental group were lower than those of the control group ( P<0.001). At 4 weeks after the third treatment, the rate of moderate or above improvement in pigment spots was 95.7% (22/23) in the experimental group, which was higher than the 69.6% (16/23) in the control group ( P=0.011). At 12 weeks after the third treatment, the rate of moderate or above improvement in the experimental group was 30.4% (7/23), which was higher than the 8.7% (2/23) in the control group ( P=0.006). At 24 weeks after the third treatment, the rate of moderate or above improvement in the experimental group was 13.0% (3/23), which was higher than the 0% (0/23) in the control group ( P=0.015). At 4 weeks after the third treatment, the satisfactory rate in the experimental group was 73.9% (17/23), which was higher than the 43.5% (10/23) in the control group ( P=0.009). At 12 weeks after the third treatment, the satisfactory rate in the experimental group was 69.6% (16/23), which was higher than the 39.1% (9/23) in the control group ( P=0.040). At 24 weeks after the third treatment, the satisfactory rate in the experimental group was 56.5% (13/23), which was higher than the 4.4% (1/23) in the control group ( P=0.002). One patient in the experimental group experienced mild itching on the cheek on the second day post-treatment. In the control group, two patients experienced mild itching and erythema on the second day post-treatment. No serious adverse reactions, such as blisters, scabs, or pigmentation, were observed in either group during the treatment or follow-up periods. Conclusion:The 1 064 nm Nd:YAG picosecond laser of dual-mode with auxiliary functional product introduction in treatment of melasma has a better efficacy, with a shorter recovery period and fewer adverse reactions.

Objective: To examine the effectiveness and safety of application of the ureteral access sheath in the treatment of middle or lower ureteral calculi in patients with large-volume benign prostatic hyperplasia above grade Ⅲ, which is expected to avoid the simultaneous or staged treatment of benign prostatic hyperplasia via eliminate the difficult angle and resistance of ureteroscopy caused by severe prostatic hyperplasia. Methods: From April 2018 to December 2020, the clinical data of 27 patients with massive benign prostatic hyperplasia above grade Ⅲ and middle and lower ureteral calculi treated with indwelling ureteral access sheath plus ureteroscopy holmium laser lithotripsy at Department of Urology, Zhejiang Quhua Hospital were retrospectively analyzed and followed up. All the patients were male, aged (69.7±12.8) years (range: 55 to 87 years). Prostate volume measured by transrectal ultrasound was (94.8±16.2) cm³ (range: 85 to 186 cm³). The ureteral access sheath was indwelled in advance, and then the semirigid ureteroscopy was introduced through the working channel of the sheath. Holmium laser lithotripsy was performed, and intraoperative and postoperative complications were recorded. Urinary abdominal plain X-ray or CT urography were performed at 1-and 2-month postopaerative to evaluate the residual stones and clinical efficacy. Results: The ureteral access sheath was placed and holmium laser lithotripsy under a semirigid ureteroscopy was performed successfully in all the 27 patients. In 2 patients, a second session of auxiliary procedure was required due to the large load of preoperative stones and residual stones after surgery, among whom 1 patient received extracorporeal shock wave lithotripsy and 1 patient underwent extracorporeal shock wave lithotripsy plus ureteroscopic lithotripsy. The stone free rate at 1-and 2-month postoperative were 92.6% (25/27) and 100% (27/27), respectively. There were no severe complications such as ureteral avulsion and perforation, perirenal hematoma, septic shock, severe hematuria, urinary retention, iatrogenic ureteral stricture occurred during and after the surgery. The ureteral calculus was wrapped by polyps heavily in 1 patient, he was diagnosed as ureteral stenosis 1 month postoperative, receiving laparoscopic resection of ureteral stricture plus anastomosis 3 months postoperative. Conclusions: In the operations of middle and lower ureteral calculi in patients with large-volume prostatic hyperplasia above grade Ⅲ, the ureteral access sheath can be placed first to effectively eliminate the difficult angle and resistance of ureteroscopy caused by severe prostatic hyperplasia, and then semirigid ureteroscopic lithotripsy can be safely performed. It could avoid the treatment of benign prostatic hyperplasia at the same time or by stages.
Aged ; Aged, 80 and over ; Humans ; Lithotripsy ; Lithotripsy, Laser ; Male ; Middle Aged ; Prostatic Hyperplasia/complications* ; Retrospective Studies ; Treatment Outcome ; Ureteral Calculi/surgery* ; Ureteroscopy

Objective:To investigate the clinical effects of perforator flaps in the repair of limb defects.Methods:Anterolateral thigh perforator flap (ALTP), deep inferior epigastric perforator flap (DIEP), posterior in- terosseous artery perforator flap (PIAP), thoracodorsal artery perforator flap (TDAP), medial sural artery perforator flap (MSAP) and radial collateral artery perforator flap (RCAP) were used to repair 56 cases of limb wounds from Novem- ber, 2016 to October, 2018. The sizes of soft tissue defect were ranged from 1.5 cm×1.5 cm to 10.0 cm×24.0 cm, while the sizes of flap were ranged from 2.0 cm×2.0 cm to 11.0 cm×25.0 cm. The recipient sites were all sutured di- rectly. The flaps survived and wound healing were observed postoperatively. Appearance, texture, recovery of the limb function, shape and function of donor site were followed-up regularly.Results:One case of venous crisis occurred on the 3rd day after inferior epigastric artery perforator flap surgery, and survived after exploratory surgery with the necrosis in the distal part of the flap, which healed after dressing. Other 55 flaps all survived. Both recipient site and donor site healed in primary union. The color of the flaps was normal. The skins were soft, and the functions of the limbs recovered well. Only a linear scar remained in the donor area without dysfunction.Conclusion:The perforator flap surgery is reliable for limbs repair and can be promoted and applied.

With the development of specialization and specialist differentiation of modem medicine,the developing mode of "reducing and specializing" has promoted the explosive growth of medical knowledge.Meanwhile,the medical practice based on medical knowledge is being fragmented,and medical activities are gradually moving away from the'people-oriented'core value.Therefore,current medical modality needs to be transformed into a "holistic medicine" stage,which also requires reforms of medical personnel cultivation,including the emphasizes of holistic view as well as multidisciplinary integration.Medical schools are exploring paths to achieve holistic medicine-oriented education and training of students.Currently,the concept of holistic medicine have begun to permeate in medical curriculum design and teaching method innovationand yet needs to befurther deepened in understanding and practicing the essence of the holistic medical modality in the future.

Objective To investigate the cosmetic outcome of treatments for mentalis scars with expanded skin flaps.Methods From the experiences of past 26 cases in our department,we summarised the technique for treating the mentalis scars with expanded skin flaps.For simple mentalis scars or localized inferior facial scars,the mentalis,bottom jaw or facial skin were expanded and the expander kept superior to the neck-jaw angle.Otherwise the expander would only fill the angle and the expanding efficiency was reduced.For severe mentalis,neck or facial scars without extra normal treating skin,expanded deltopectoral flaps were chosen to cover the wound after cicatrectomy with pedicles which were cut 3 weeks later.Results All the local ordistant expanded flaps survived successfully in the 26 cases with optimistic outcomes.Conclusions Application of local or distant expanded flaps is a useful technique for mentalis scars treatment.

Objective To develop new repairing techniques for acquired inferior palpebral region defects. Methods Expanded forehead flaps were used to reconstruct the inferior palpebral defects or post-excision wound surface and the flaps were pedicled with supra-trochlea vessels or ramus frontalis arteriae temporalis superficialis. As for supra-trochlea vessels, contralateral ones were prior to the homolateral ones. The incision site located in the scalp and the major axis of the expander parallel to the forehead. Firstly, the leisions were cut and the subcutaneous tissues loosed to regain the anatomy position of inferior palpebra. Secondly, the expanded flaps were transfered onto the defects by the wound sizes with the supra-trochlea vessels as their pedicles. At last, the pedicles were cut 3 weeks later.For ramus frontalis arteriae temporalis superficialis, the flap was transfered with a subdermal pedicle and the donor site was closed directly. Results There were 10 cases in the present group, 6 for supratrochlea vessels and the 4 others for ramus frontalis arteriae temporalis superficialis. All the flaps survived successfully. 3 cases returned with optimistic outcomes 6 months later. Conclusion The expanded forehead flaps are fit for repairing the inferior palpebral defects, which can successfully avoid ectropion. This technique is very useful for reconstructing the texture of the site of defects.

Objective To explore the technique of massive facial scar revision. Methods All 12 patients in the group were treated with expanded deltopectoral skin flap. In the primary surgery, expander was implanted underneath deltopectoral flap region through an incision inferior to the clavi-cle. The skin perforators of transverse cervical artery and thoracoacromial artery were ligated during surgery, and the internal thoracic artery was carefully preserved. After the deltopectoral skin flap was fully expanded, the second surgery was performed and the facial scar was released and the normal ana-tomic position of eyes, nose and month was restored. The deltopectoral skin flap was planed according to the size of the defect. The excised facial scar was converted to the flap pedicle and a hinge-like con-nection was formed. The flap was delayed and three weeks after the second surgery, the pedicle was divided. The flap from the pedicle was applied for the mental region scar revision. Results Unilateral or bilateral dehopectoral skin flaps were employed for the repair of extensive facial scar in 12 patients. Satisfactory results were achieved in all these patients. Conclusion Expanded deltopectoral skin flap is a good technique for the repair of extensive facial scar.

Objective To explore the aesthetic effect of the applying the expanded skin flap to re-pair facial defects produced by removal of nevus, hemangioma, scars and so on. Methods The experience of the treating 67 patients with facial lesions using the expanded flaps were reviewed. The proper expand-ers were chosen according to the scope of the facial lesion. The incision was located at the scar region and the dissection was executed in the superficial layer of the SMAS. The interspace was larger than the ex-pander by 1.0～1.5 cm. After exact hemostasis, the expanders and negative pressure drainage tubes were placed into the interspace. The design of the facial expanded skin flap included the advance, rotation, and transposition of skin flap and so on. The advance of skin flap took fully use of the expanded skin flap without the donor site defect. The transposition of skin flap also took fully use of the expanded skin flap, furthermore, it overcame the displacement and the disfiguration caused by the applying of the advance skin flap and rotation skin flap. The incisions in face were designed to a minimal extent and parallel to the Lan-ger line. Results All of the 67 cases got aesthetic satisfied results with all the flaps surviving. Conclusion The application of expanded skin flaps is proved to be an effective way of repairing facial wound when there is enough normal facial skin for expansion.

Objective To investigate the influence of gene transfection antiangiogenesis on microvessel and relative cytokine of hypertrophic scar of rabbits' ear.Methods The hypertrophic scar of rabbtis' ear was reproduced.On the 10th day after epithelization,Ad-METH-1 was injected into tissue of scar.30 days later,the microvessel of scar-tissue was detected by microcirculation microscope.Meanwhile.H&E and immunohistochemical stains were performed.Then the results were analyzed.Results 30 days after Ad-METH-1 injection.in experimental groups,the microvascular count of scar tissue was 12.38±2.56,the percentage of VEGF positive cells was 17.64%,and the percentage of bFGF positive cell was 18.24%:while in the control groups,the microvascular count of scar tissue was 48.12±6.46.the percentage of VEGF positive cell was 31.34%.and the percentage of bFGF positive eell was 28.26%.Results revealed that the count of microvessel of scar tissue in the experimental groups was lower than that in the control groups,between which there was the difference in statistics(P＜0.01).and that the percentage of VEGF and bFGF positive cells of scar tissue in the expenmental groups were lower than that in the control groups.between which there was the difference in statistics(P＜0.05).Conclusion Ad-METH-1 has marked inhibitory effects on scar tissue hyperplasia of rabbits' ear,angiogenesis and expression of VEGF and bFGF.Using antiangiogenesis therapy at the early phase could inhibit the formation of hypertrophic scar.Gene transfection antiangiogenesis therapy could bid fair to become an effective method to prevent and treat hypertrophic scar.