Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder caused by mutations in the NF1 gene located at 17q11.2. Plexiform neurofibromas (PN) are one of the common clinical manifestations of NF1, known as NF1-related plexiform neurofibromas (NF1-PN). Head and neck NF1-PN account for 42.9% of all cases. Tumors grow rapidly during childhood and adolescence, and they can exhibit widespread growth, causing severe head, face, and neck deformities, organ dysfunction, and even loss of function. NF1-PN have the potential to transform into malignant peripheral nerve sheath tumors (MPNSTs), known as NF1-associated MPNST (NF1-MPNST). Histopathology is the gold standard for diagnosing NF1-PN, magnetic resonance imaging (MRI) is the preferred imaging examination for NF1-PN, and PET/CT examination is a reliable method for early detection and diagnosis of NF1-MPNST. Genetic testing plays an important role in early diagnosis of tumors, monitoring tumor progression, genetic counseling, and molecular level treatment and management of the disease. This article proposes the goals and principles for treating NF1-PN in the head and neck region. The main treatment methods currently used are surgery and medication. Surgical treatment includes surgical resection, and tissue flap repair or allogeneic transplantation of composite tissue after surgical resection. The mitogen-activated protein kinase inhibitors (MEK) inhibitor Selumetinib is an effective medication used to treat NF1-PN patients aged 3 years and older with symptoms and who are unable to undergo surgery. A Phase Ⅱb trial of mirdametinib, a small-molecule inhibitor, has been completed in adults and children, and it is considered well tolerated in both groups. CRISPR/Cas9 technology is expected to become an effective means of NF1-PN gene therapy. The treatment method of NF1-MPNST is similar to that of soft tissue sarcoma. However, the safety of complete resection of extra-large tumors, protection of important tissues and organs during surgery, effective control of intraoperative bleeding, reconstruction of soft and hard tissue defects in the head and neck; prospective, multicenter, randomized, double-blind, controlled clinical trials of MEK inhibitors, as well as the use of CRISPR/Cas9 technique for gene therapy NF1-PN, are all current challenges. This article summarizes recent advances and ongoing challenges in the treatment of head and neck NF1-PN, aiming to provide a reference for clinicians and researchers.

Defects in the lip and perilabial regions can be caused by lip oncosurgery. Currently, there is a lack of clear classification and principles for repairing and reconstructing the lip and perilabial defects after lip tumor resection surgery. Lip defects are categorized into three types based on their extent by author: partial lip defects, full-thickness lip defects, and full-thickness lip defects with surrounding lip defects. The partial lip defects include four types: labial vermilion defects, labial cutaneous defects, labial mucosal defects, and through-and-through labial defects. There are four types of full-thickness lip defects, including less than half of labial defects, one half of labial defects, subtotal labial defects, and total labial defects. There are three types of full-thickness lip defects with surrounding lip defects, including through-and-through commissure and cheek defects, total labial and nasal defects, and total labial and chin defects. Different types of defects in the lip and perilabial region should be repaired during radical surgery for lip tumors. The methods of repair and reconstruction of lip and perilabial defects include primary closure, skin or mucosal grafting, local flaps, regional flaps, pedicle flaps, free flaps, and allogeneic dermal matrix (ADM). Multiple tissue flaps can also be combined for repair and reconstruction. Among them, the anteriorly based ventral tongue flap is an ideal tissue flap for repairing and reconstructing labial vermilion defects. The Abbe-Estlander flap is a very important technique for repairing and reconstructing lip defects. The combination of bilateral mental neurovascular V-Y island advancement flap and an anteriorly based ventral tongue flap for reconstruction of the total lower lip defect is a reliable and effective method. The Estlander flap, foldable supraclavicular fasciocutaneous island flap, or foldable facial-submental artery island flap can be used to repair the through-and-through labial commissure and cheek defects. Large perilabial defects such as total labial and chin defects or total labial and nasal defects require repair using pectoralis major muscle flaps, trapezius muscle flaps, free tissue flaps, or even a combination of multiple flaps. This article proposes the classification of lip and perilabial defects following oncosurgery and systematically elaborates on the functional repair and reconstruction of the defects, which has certain guiding and promotional application value for clinical practice.

Objective:To evaluate the treatment strategies and outcomes for contracted nasal deformity.Methods:A retrospective review was conducted of the patients with contracted noses who underwent surgery at the Department of Plastic and Aesthetic Surgery, the Second Xiangya Hospital of Central South University, between January 2021 and January 2024. Based on the pathologic-anatomic features and severity of the deformity, patients were categorized as having mild, moderate or severe contraction. Mild cases received extensive subcutaneous dissection and framework reconstruction with various grafts. Moderate cases underwent preoperative nasal-skin distraction and intra-operative reconstruction with lower lateral or septal cartilage. Severe cases, in addition to reconstruction of the lower lateral cartilage and nasal septum, underwent individualized repair, including mucosal or cutaneous defect resurfacing. Postoperative follow-up assessed nasal appearance, complications and recurrence of contraction. Nasal aesthetics were quantified with visual analogue scale (VAS, 0-10 points; higher scores = less deformity), and patient satisfaction with the rhinoplasty outcome evaluation (ROE) questionnaire (0 = very dissatisfied, 100 = very satisfied) before surgery and at final follow-up. Paired t-test was used for VAS and ROE comparisons; categorical variables were analyzed with the χ2 test. A P-value < 0.05 denoted statistical significance. Results:A total of 96 patients were included, comprising 7 males and 89 females, aged (27.4 ± 8.0) years (19-58 years). There were 64 cases of mild, 19 cases of moderate, and 13 cases of severe contracted nose deformities. Postoperative follow-up(14.0 ± 4.6) months (6-19 months). No cases of abnormal nasal appearance, infection, necrosis, scar hyperplasia, or recurrence of contracted nose were observed during follow-up. Significant improvements in nasal aesthetic outcomes were observed. The VAS scores for mild, moderate, and severe contracted noses increased significantly from preoperative values of 4.7 ± 1.0, 3.0 ± 1.2, and 2.2± 1.1 to postoperative values of 8.6 ± 0.7, 8.9 ± 0.7, and 8.2 ± 0.9, respectively (all P < 0.01). Similarly, the ROE scores improved significantly from 59.1 ± 10.0, 34.2 ± 12.1, and 28.5± 6.3 preoperatively to 90.2 ± 9.5, 91.5 ± 7.5, and 93.3 ± 5.8 postoperatively (all P < 0.01). Conclusion:Selecting appropriate surgical methods based on the pathological and anatomical characteristics and severity of contracted nose deformities can achieve favorable outcomes. Postoperative nasal aesthetic appearance is significantly improved, and patient satisfaction is high.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

Objective: To explore the clinical characteristics and diagnosis and treatment plans of neurofibromatosis type 1 (NF1), and to provide references for clinical diagnosis and treatment. Methods : The clinical manifestations and treatment of an 8-year-old female patient with NF1 was reported. A literature review was conducted to summarize the clinical characteristics and therapeutic strategies of NF1. Multiple NF1s occurred on the right cheek, orbit, and eyelid, and recurred after surgical resection. The tumor caused ptosis, incomplete closure, and vision loss in the upper eyelid of the right eye. After a multidisciplinary assessment determined that radical resection was not feasible, selumetinib sulfate targeted therapy was adopted (25 mg, Po, bid), 28 days constitute one treatment course, and 14 courses have been completed, combined with symptomatic ocular treatments, such as Befusu. Result: The follow-up showed that the tumor volume did not continue to increase (stable disease), the uncorrected vision of the right eye improved (0.05 vs 0.1), and no drug-related adverse reactions occurred during the treatment period. The literature review summarizes the diverse clinical manifestations of NF1, with café-au-lait macules, multiple neurofibromas, and Lisch nodules being hallmark features. Currently, surgical intervention remains the most commonly employed and primary therapeutic approach for NF1; however, for patients who do not meet the criteria for surgery, alternative treatment strategies should be considered. MEK inhibitors, such as selumetinib, demonstrate significant efficacy in inhibiting the growth of NF1-associated plexiform neurofibromas, with tumor volume reductions of at least 20% observed in 70% of pediatric patients in the SPRINT clinical trial. Furthermore, these inhibitors exhibit favorable long-term safety profiles. Conclusion Café-au-lait macules, multiple neurofibromas, and Lisch nodules are hallmark features of NF1. Selumetinib is safe and effective for NF1 in the head and neck of children, and it is the preferred treatment option for patients who are not suitable for surgery. Long-term follow-up monitoring of tumor changes and drug safety is required.

Objective:To investigate the expression of NADPH oxidase(Nox)in chronic obstructive pulmonary disease(COPD).Method:The rats were randomly divided into control group,COPD group,COPD medium exercise group and COPD intensive exercise group,with 10 rats in each group.The expression of NADPH oxidase,hypoxia induc-ible factor-1 alpha(HIF1α),inflammatory factors tumor necrosis——factor alpha(TNFα),interleukin-6(IL-6),matrix metalloproteinase 2(MMP-2)and matrix metalloproteinase 9(MMP-9)were detected by immunohistochemistry.Result:Compared with the control group,the expression of NADPH oxidase subtypes Nox1,Nox2,Nox5,HIF1α,TNFα,IL-6,MMP-2 and MMP-9 in COPD group increased significantly.Medium exercise reduced the expression of Nox2,Nox5,HIF1α and MMP-9 in COPD animal model,while intensive exercise reduced the expression of Nox1,Nox2,Nox5,HIF1α,TNFα,IL-6 and MMP-9.Conclusion:Rehabilitation exercise down regulated the expression of NADPH oxidases in lung,reduced the expression of downstream inflammatory factors and matrix metalloproteinase.The protective function of rehabili-tation exercise might achieve by inhibiting the expression of hypoxia inducible factor.

Objective:To investigate the expression of NADPH oxidase(Nox)in chronic obstructive pulmonary disease(COPD).Method:The rats were randomly divided into control group,COPD group,COPD medium exercise group and COPD intensive exercise group,with 10 rats in each group.The expression of NADPH oxidase,hypoxia induc-ible factor-1 alpha(HIF1α),inflammatory factors tumor necrosis——factor alpha(TNFα),interleukin-6(IL-6),matrix metalloproteinase 2(MMP-2)and matrix metalloproteinase 9(MMP-9)were detected by immunohistochemistry.Result:Compared with the control group,the expression of NADPH oxidase subtypes Nox1,Nox2,Nox5,HIF1α,TNFα,IL-6,MMP-2 and MMP-9 in COPD group increased significantly.Medium exercise reduced the expression of Nox2,Nox5,HIF1α and MMP-9 in COPD animal model,while intensive exercise reduced the expression of Nox1,Nox2,Nox5,HIF1α,TNFα,IL-6 and MMP-9.Conclusion:Rehabilitation exercise down regulated the expression of NADPH oxidases in lung,reduced the expression of downstream inflammatory factors and matrix metalloproteinase.The protective function of rehabili-tation exercise might achieve by inhibiting the expression of hypoxia inducible factor.

Objective:To evaluate the treatment strategies and outcomes for contracted nasal deformity.Methods:A retrospective review was conducted of the patients with contracted noses who underwent surgery at the Department of Plastic and Aesthetic Surgery, the Second Xiangya Hospital of Central South University, between January 2021 and January 2024. Based on the pathologic-anatomic features and severity of the deformity, patients were categorized as having mild, moderate or severe contraction. Mild cases received extensive subcutaneous dissection and framework reconstruction with various grafts. Moderate cases underwent preoperative nasal-skin distraction and intra-operative reconstruction with lower lateral or septal cartilage. Severe cases, in addition to reconstruction of the lower lateral cartilage and nasal septum, underwent individualized repair, including mucosal or cutaneous defect resurfacing. Postoperative follow-up assessed nasal appearance, complications and recurrence of contraction. Nasal aesthetics were quantified with visual analogue scale (VAS, 0-10 points; higher scores = less deformity), and patient satisfaction with the rhinoplasty outcome evaluation (ROE) questionnaire (0 = very dissatisfied, 100 = very satisfied) before surgery and at final follow-up. Paired t-test was used for VAS and ROE comparisons; categorical variables were analyzed with the χ2 test. A P-value < 0.05 denoted statistical significance. Results:A total of 96 patients were included, comprising 7 males and 89 females, aged (27.4 ± 8.0) years (19-58 years). There were 64 cases of mild, 19 cases of moderate, and 13 cases of severe contracted nose deformities. Postoperative follow-up(14.0 ± 4.6) months (6-19 months). No cases of abnormal nasal appearance, infection, necrosis, scar hyperplasia, or recurrence of contracted nose were observed during follow-up. Significant improvements in nasal aesthetic outcomes were observed. The VAS scores for mild, moderate, and severe contracted noses increased significantly from preoperative values of 4.7 ± 1.0, 3.0 ± 1.2, and 2.2± 1.1 to postoperative values of 8.6 ± 0.7, 8.9 ± 0.7, and 8.2 ± 0.9, respectively (all P < 0.01). Similarly, the ROE scores improved significantly from 59.1 ± 10.0, 34.2 ± 12.1, and 28.5± 6.3 preoperatively to 90.2 ± 9.5, 91.5 ± 7.5, and 93.3 ± 5.8 postoperatively (all P < 0.01). Conclusion:Selecting appropriate surgical methods based on the pathological and anatomical characteristics and severity of contracted nose deformities can achieve favorable outcomes. Postoperative nasal aesthetic appearance is significantly improved, and patient satisfaction is high.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

Objective:To evaluate the effectiveness of surgical methods for correcting pollybeak deformity in Chinese rhinoplasty.Methods:A retrospective chart review was conducted for patients who underwent pollybeak correction between January 2021 and December 2022 at the Department of Plastic and Aesthetic (Burn) Surgery, the Second Xiangya Hospital of Central South University. Individualized correction was tailored based on the etiology and severity of the nasal deformity of each patient, involving techniques such as resection of the anterior part of the nasal septum, reconstruction of nasal tip support, reconstruction of the middle part of the nasal vault, and excision of skin in the upper region of the nasal tip. A modified classification system for pollybeak deformity, the supratip fullness rating scale (SFRS), was developed to evaluate supratip fullness (0-3 points, with higher scores indicating more apparent deformity). The patients aesthetic outcomes were assessed by surgeons using the visual analogue scale (VAS) (0-10 points, with higher scores indicating more apparent deformity), and patient self-assessed using the rhinoplasty outcome evaluation (ROE) questionnaire (0-100 points, with higher scores indicating higher satisfaction). The measurement data of normal distribution was expressed as Mean±SD and analyzed by paired t-test; the measurement data of non-normal distribution was expressed as M( Q1, Q3) and analyzed by Wilcoxon signed rank test. Results:In a cohort study of 53 rhinoplasty patients (7 male, 46 female; age range 19-45 years, mean 29 years), comprising 15 primary and 38 secondary surgeries, nasal tip deformities were evaluated. Deformities were classified as mild (5 cases), moderate (25 cases), and severe (23 cases). Over a follow-up period of 6-17 months (mean 9.5 months), significant aesthetic improvements in the nasal tip region were observed. The SFRS scores decreased from 2(2, 3) preoperatively to 0(0, 0) postoperatively ( Z = -6.58, P < 0.001), and VAS scores decreased from 7.47±1.73 to 1.79±1.67 ( t = -25.61, P < 0.001). High patient satisfaction was indicated by a mean ROE score of 82.45±11.55. No significant complications, such as nasal tip ptosis, skin necrosis, or scar hyperplasia, were reported. Conclusion:Selecting an appropriate surgical method based on the severity and cause of pollybeak deformity can achieve satisfactory outcomes. Post-operative patients exhibit significant aesthetic improvement in the upper nasal tip area, resulting in high patient satisfaction.