Objective:To construct the risk prediction nomogram model of acute kidney injury (AKI) with R language and traditional statistical methods based on the large sample clinical database, and verify the accuracy of the model.Methods:It was a a retrospective case control study. The patients who met the diagnostic criteria of AKI in Tongji Hospital of Tongji University from January 1 to December 31, 2021 were screened in the clinical database, and the patients with monitored serum creatinine within 48 hours but without AKI were included as the control group. The demographic data, disease history, surgical history, medication history and laboratory test data were collected to screen the risk factors of AKI in clinic.Firstly, based on multivariate logistic regression analysis and forward stepwise logistic regression analysis, the selected risk factors were included to construct the nomogram model. At the same time, cross validation, bootstrap validation and randomly split sample validation were used for internal verification, and clinical data of patients in the sane hospital after one year (January to December, 2022) were collected for external verification. The receiver-operating characteristic curve was used to determine the discrimination of the model, and calibration curve and decision curve analysis were carried out to evaluate the accuracy and clinical net benefit, respectively.Results:A total of 5 671 patients were enrolled in the study, with 1 884 AKI patients (33.2%) and 3 787 non-AKI patients (66.7%). Compared with non-AKI group, age, and proportions of surgical history, renal replacement therapy, hypertension, diabetes, cerebrovascular accident,chronic kidney disease, drug use histories and mortality in AKI group were all higher (all P<0.05). Multivariate logistic regression analysis showed that the independent influencing factors of AKI were surgical history, hypertension, cerebrovascular accident, diabetes, chronic kidney disease, diuretics, nitroglycerin, antidiuretic hormones, body temperature, serum creatinine, C-reactive protein, red blood cells, white blood cells, D-dimer, myoglobin, hemoglobin, blood urea nitrogen, brain natriuretic peptide, aspartate aminotransferase, alanine aminotransferase, triacylglycerol, lactate dehydrogenase, total bilirubin, activated partial thromboplastin time, blood uric acid and potassium ion (all P<0.05). Finally, the predictive factors in the nomogram were determined by forward stepwise logistic regression analysis, including chronic kidney disease, hypertension, myoglobin, serum creatinine and blood urea nitrogen, and the area under the curve of the prediction nomogram model was 0.926 [95% CI 0.918-0.933, P<0.001]. The calibration curve showed that the calibration effect of nomogram was good ( P>0.05). The decision curve showed that when the risk threshold of nomogram model was more than 0.04, the model construction was useful in clinic. In addition, the area under the curve of receiver-operating characteristic curve predicted by nomograph model in external validation set was 0.876 (95% CI 0.865-0.886), which indicated that nomograph model had a high discrimination degree. Conclusion:A nomogram model for predicting the occurrence of AKI is established successfully, which is helpful for clinicians to find high-risk AKI patients early, intervene in time and improve the prognosis.

Objective:To investigate the clinical effect of jujube core-shaped tissue resection technique in the treatment of alar reduction.Methods:A retrospective analysis was performed for the clinical data of patients who underwent alar reduction from February 2019 to June 2022. A spindle-shaped incision line was designed along the outer edge of the base of the nasal lobule, with a width of 4-5 mm and a length of 8-12 mm. The incision line was 1-2 mm away from the alar groove, and the inner side of the design line was extended to the inside of the nasal vestibule. After the incision was made, the subcutaneous tissue was undermining dissected with curved sharp scissors, and the shape of the extended excision tissue was similar to that of jujube core. After reduction, the incision was closed with vertical mattress suture. The surgical effect and complications were followed up after surgery, and an independent attending plastic surgeon evaluated the outcome and scarring based on photos before and at the last postoperative follow-up using the global aesthetic improvement scale (GAIS) and the Vancouver scar scale (VSS). GAIS is graded as 1, 2, 3, 4, and 5 points, and the lower the score, the better the improvement(≤3 points as effective improvement). VSS includes four parameters: color (0-3 points), thickness (0-4 points), vascular distribution (0-3 points), and softness (0-5 points). The higher the score, the more significant the scar is.Results:A total of 20 patients were enrolled, including 6 males and 14 females, aged 20 to 33 years, with an average age of 24.9 years. Before the operation, there were different degrees of alar flare and alar hypertrophy. After surgery, 13 patients had mild swelling, ecchymosis, which resolved after 3 days. There were no major complications as infection, incision dehiscence, and delayed healing. After 3 to 16 months of postoperative follow-up, 2 patients gradually developed cartilage deformation and affected the appearance of the nostrils 6 to 9 months after surgery due to the combination of rib-based rhinoplasty, and the satisfactory results were obtained after revision surgery. The symmetry of the nostrils was significantly improved. The GAIS score of 20 patients was (1.20±0.41) points, of which, 16 patients were rated as 1 point and 4 patients were rated as 2 points, all of which met the improvement criteria, and the VSS score was (1.45±0.60) points, in which the average score for color, thickness, vasculature and compliance are 0.60, 0.05, 0.55 and 0.30 points respectively.Conclusion:The application of jujube core-shaped tissue resection technique for alar reduction can increase the amount of tissue removal with the same incision width, which can not only fully narrow the alar effectively but also correct the hypertrophy of the alar tissue.

Facial rhytidectomy is one of the most complex and unpredictable procedures in the field of cosmetic and plastic surgery, aiming to rejuvenate the face. The facial rejuvenation surgery began in the early 20th century. The purpose of the surgery is to alleviate the aging characteristics of the skin, fascia, fat and other tissues of the face and neck by surgical means. In China, due to historical development and other factors, it started late. From the late 1980s to the early 1990s, Song Yeguang and other pioneers took the lead in venturing into this field. With the significant growth of the economy and the increasing attention from both medical professionals and marketing to cosmetic surgery, surgeons in this era have made substantial contributions to the systematic and standardized advancement of rhytidectomy surgery. However, with the understanding of the aging process of the face and the in-depth study of the changes in the anatomy and tissue structure of the face and neck, surgical techniques have evolved from simple to complex, and gradually improving over time. Through long-term observation of the surgical outcomes, the surgical technique has evolved from complex to simple. The purpose of this paper is to summarize the evolution of rhytidectomy in China by reviewing the literature from previous years.

Objective:To investigate the clinical outcome of biplanar botulinum toxin type A injection in alleviating platysmal bands.Methods:From November 2022 to May 2023, the clinical data of patients with platysmal bands treated by botulinum toxin type A injection in Department of Face and Neck Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, and Department of Plastic Surgery, Chengdu Badachu Cosmetic Hospital were retrospectively analyzed. The platysmal bands were marked, while patients were grinning, before injection. Using a 13 mm 30 G needle, 20 U/ml botulinum toxin was injected into the muscle layer along the bands from the clavicle direction. The dose was 1 U at a single point every 1.5 cm. Using a 3 mm 30 G needle, 10 U/ml botulinum toxin was injected into the deep surface of dermis along the bands with a single point dose of 0.5 U. Effects were evaluated by overall subjective satisfaction of patients, which were categorized into 4 grades: very satisfied, satisfied, dissatisfied, very dissatisfied. In addition, accessment by a third-party physician with global aesthetic improvement scale (GAIS) (1-5 points, the lower the score, the more significant the improvement is) and Geister platysmal band scale (0-4 points, the higher the score, the more severe the platysmal band is). Normal distribution data was represented by Mean±SD.Results:A total of 19 patients were included, including 3 males and 16 females, with the average age of 36.1 years. After a mean follow-up of 1.3 months (1-5 months), the overall subjective satisfaction was 100%(19/19). The GAIS score of third-party physicians was 1.12±0.33. 100%(19/19) of patients received a rating over moderate improvement(significant improvement in 17 cases and moderate improvement in 2 cases). The Geister platysmal band score decreased from preoperative 3.65 ± 0.33 to postoperative 0.76 ± 0.44. No serious complications were found except 5 cases of local congestion and 2 cases of injection pain, which were relieved in 1 week and 3 hours respectively. 2 cases felt mild neck weakness, but neck activity was not affected. The adverse symptoms all completely resolved spontaneously within 4 weeks. All patients have no mouth deviation, difficulty speaking, facial paralysis, allergies, or other noticeable complications.Conclusion:The injection of botulinum toxin type A in dual-plane of platysmal intramuscular layer and deep intradermal layer can effectively alleviate platysmal bands and achieve neck rejuvenation.

Objective:To investigate the clinical effect of jujube core-shaped tissue resection technique in the treatment of alar reduction.Methods:A retrospective analysis was performed for the clinical data of patients who underwent alar reduction from February 2019 to June 2022. A spindle-shaped incision line was designed along the outer edge of the base of the nasal lobule, with a width of 4-5 mm and a length of 8-12 mm. The incision line was 1-2 mm away from the alar groove, and the inner side of the design line was extended to the inside of the nasal vestibule. After the incision was made, the subcutaneous tissue was undermining dissected with curved sharp scissors, and the shape of the extended excision tissue was similar to that of jujube core. After reduction, the incision was closed with vertical mattress suture. The surgical effect and complications were followed up after surgery, and an independent attending plastic surgeon evaluated the outcome and scarring based on photos before and at the last postoperative follow-up using the global aesthetic improvement scale (GAIS) and the Vancouver scar scale (VSS). GAIS is graded as 1, 2, 3, 4, and 5 points, and the lower the score, the better the improvement(≤3 points as effective improvement). VSS includes four parameters: color (0-3 points), thickness (0-4 points), vascular distribution (0-3 points), and softness (0-5 points). The higher the score, the more significant the scar is.Results:A total of 20 patients were enrolled, including 6 males and 14 females, aged 20 to 33 years, with an average age of 24.9 years. Before the operation, there were different degrees of alar flare and alar hypertrophy. After surgery, 13 patients had mild swelling, ecchymosis, which resolved after 3 days. There were no major complications as infection, incision dehiscence, and delayed healing. After 3 to 16 months of postoperative follow-up, 2 patients gradually developed cartilage deformation and affected the appearance of the nostrils 6 to 9 months after surgery due to the combination of rib-based rhinoplasty, and the satisfactory results were obtained after revision surgery. The symmetry of the nostrils was significantly improved. The GAIS score of 20 patients was (1.20±0.41) points, of which, 16 patients were rated as 1 point and 4 patients were rated as 2 points, all of which met the improvement criteria, and the VSS score was (1.45±0.60) points, in which the average score for color, thickness, vasculature and compliance are 0.60, 0.05, 0.55 and 0.30 points respectively.Conclusion:The application of jujube core-shaped tissue resection technique for alar reduction can increase the amount of tissue removal with the same incision width, which can not only fully narrow the alar effectively but also correct the hypertrophy of the alar tissue.

Facial rhytidectomy is one of the most complex and unpredictable procedures in the field of cosmetic and plastic surgery, aiming to rejuvenate the face. The facial rejuvenation surgery began in the early 20th century. The purpose of the surgery is to alleviate the aging characteristics of the skin, fascia, fat and other tissues of the face and neck by surgical means. In China, due to historical development and other factors, it started late. From the late 1980s to the early 1990s, Song Yeguang and other pioneers took the lead in venturing into this field. With the significant growth of the economy and the increasing attention from both medical professionals and marketing to cosmetic surgery, surgeons in this era have made substantial contributions to the systematic and standardized advancement of rhytidectomy surgery. However, with the understanding of the aging process of the face and the in-depth study of the changes in the anatomy and tissue structure of the face and neck, surgical techniques have evolved from simple to complex, and gradually improving over time. Through long-term observation of the surgical outcomes, the surgical technique has evolved from complex to simple. The purpose of this paper is to summarize the evolution of rhytidectomy in China by reviewing the literature from previous years.

Objective:To investigate the clinical outcome of biplanar botulinum toxin type A injection in alleviating platysmal bands.Methods:From November 2022 to May 2023, the clinical data of patients with platysmal bands treated by botulinum toxin type A injection in Department of Face and Neck Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, and Department of Plastic Surgery, Chengdu Badachu Cosmetic Hospital were retrospectively analyzed. The platysmal bands were marked, while patients were grinning, before injection. Using a 13 mm 30 G needle, 20 U/ml botulinum toxin was injected into the muscle layer along the bands from the clavicle direction. The dose was 1 U at a single point every 1.5 cm. Using a 3 mm 30 G needle, 10 U/ml botulinum toxin was injected into the deep surface of dermis along the bands with a single point dose of 0.5 U. Effects were evaluated by overall subjective satisfaction of patients, which were categorized into 4 grades: very satisfied, satisfied, dissatisfied, very dissatisfied. In addition, accessment by a third-party physician with global aesthetic improvement scale (GAIS) (1-5 points, the lower the score, the more significant the improvement is) and Geister platysmal band scale (0-4 points, the higher the score, the more severe the platysmal band is). Normal distribution data was represented by Mean±SD.Results:A total of 19 patients were included, including 3 males and 16 females, with the average age of 36.1 years. After a mean follow-up of 1.3 months (1-5 months), the overall subjective satisfaction was 100%(19/19). The GAIS score of third-party physicians was 1.12±0.33. 100%(19/19) of patients received a rating over moderate improvement(significant improvement in 17 cases and moderate improvement in 2 cases). The Geister platysmal band score decreased from preoperative 3.65 ± 0.33 to postoperative 0.76 ± 0.44. No serious complications were found except 5 cases of local congestion and 2 cases of injection pain, which were relieved in 1 week and 3 hours respectively. 2 cases felt mild neck weakness, but neck activity was not affected. The adverse symptoms all completely resolved spontaneously within 4 weeks. All patients have no mouth deviation, difficulty speaking, facial paralysis, allergies, or other noticeable complications.Conclusion:The injection of botulinum toxin type A in dual-plane of platysmal intramuscular layer and deep intradermal layer can effectively alleviate platysmal bands and achieve neck rejuvenation.

Objective:To investigate the clinical application of a cartilage graft fixation method in the context of rib-based rhinoplasty.Methods:The clinical data of patients who underwent costal cartilage based rhinoplasty in the Center of Rhinoplasty and Nasal Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2020 to January 2022 were retrospectively analyzed. A 20 ml syringe needle was used to drill several micropores about 1 mm in diameter on the surface of the cartilage grafts prior to its placement. "septal extension grafts with micropores" were prepared, and the preparation of the remaining grafts was conventional.Results:A total of 30 female patients aged 21-45 years, with an average age of 36 years underwent primary or repaired autogenous costal cartilage rhinoplasty without severe damage to the nasal septum cartilage (at least retention of L-shaped scaffolds larger than 10 mm) were enrolled. All operations were successful, the cartilage scaffold was stable and durable. There were no serious complications such as infection, septal hematoma and cartilage exposure. Postoperative patients were followed up for a duration of 6-24 months. Two out of 30 patients were not satisfied with the postoperative appearance. During the revision surgery, the septal perichondrium was separated, mucosal tissue had grown into the bilateral holes which further verified of the feasibility of drilling. The other patients were satisfactied with the results.Conclusion:Nasal septum extension graft based on drilling technique is beneficial to maintain the long-term stability of cartilage scaffold after comprehensive costal cartilage nasal surgery, which justifies its application in comprehensive nasal plastic surgery.

Objective:To evaluate the clinical effect of microbotox injection of botulinum toxin type A in improving the fine lines of lower eyelid skin and achieving the rejuvenation of the eye area.Methods:The clinical data of patients with mildly sagging lower eyelid skin and fine wrinkles admitted to Facial and Neck Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Deparment of Plastic and Cosmetic Surgery, Guangyuan Central Hospital; Department of Dermatology, People’s Hospital of Qingshen County; Department of Plastic and Cosmetic Surgery, Dujiangyan People’s Hospital; Devision of Women’s Healthcare, Panzhihua Maternal and Child Hospital; Chengdu Badachu Cosmetic Hospital from August 2022 to January 2023 were analyzed retrospectively. Using the microbotox injection method, the botulinum toxin type A with a diluted concentration of 8 U/ml was micro-injected into the dermis layer or between the dermis and the superficial muscle layer at an interval of 0.6 cm, and a single point injection of 0.2 U. The injection range was the anatomical distribution range of the orbicularis oculi muscle. After treatment, patients were followed up to investigate patient satisfaction, which was divided into very satisfied, satisfied, dissatisfied and very dissatisfied, and to calculate subjective satisfaction (percentage of the number of very satisfied and satisfied cases in the total number of cases). At the same time, a independent physician used the global aesthetic improvement scale (GAIS) to evaluate the effect based on the patient’s photos before treatment and during follow-up. 5 indicates as worse than before, 4 as no improvement, 3 as were slight improvement, 2 as moderate improvement, and 1 as significant improvement. SPSS 24.0 software was used for descriptive analysis of the data.Results:A total of 23 patients were enrolled, including 1 male and 22 females, aged (36.4±2.5) years old. The follow-up was 1-6 months, with an average of 1.4 months, and the subjective satisfaction of patients was 100% (23/23). The result of the independent physician evaluation were as follows: the overall cosmetic improvement score of the observers was 1.26±0.54, 100% (23/23) of the patients reached the standard of obvious or moderate improvement. In terms of complications, 2 patients presented local epidermis bruises after injection, who recovered within 1 week; 1 patient complained of pain after injection, which was significantly relieved 12 hours later. No ectropion, symblepharon, facial palsy, dry eyes, or other complications were observed.Conclusion:Application of botulinum toxin type A microbotox injection can improve periorbital wrinkles and improve skin texture at the same time, and the therapeutic effect is definite.

Objective:To investigate the clinical application of a cartilage graft fixation method in the context of rib-based rhinoplasty.Methods:The clinical data of patients who underwent costal cartilage based rhinoplasty in the Center of Rhinoplasty and Nasal Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2020 to January 2022 were retrospectively analyzed. A 20 ml syringe needle was used to drill several micropores about 1 mm in diameter on the surface of the cartilage grafts prior to its placement. "septal extension grafts with micropores" were prepared, and the preparation of the remaining grafts was conventional.Results:A total of 30 female patients aged 21-45 years, with an average age of 36 years underwent primary or repaired autogenous costal cartilage rhinoplasty without severe damage to the nasal septum cartilage (at least retention of L-shaped scaffolds larger than 10 mm) were enrolled. All operations were successful, the cartilage scaffold was stable and durable. There were no serious complications such as infection, septal hematoma and cartilage exposure. Postoperative patients were followed up for a duration of 6-24 months. Two out of 30 patients were not satisfied with the postoperative appearance. During the revision surgery, the septal perichondrium was separated, mucosal tissue had grown into the bilateral holes which further verified of the feasibility of drilling. The other patients were satisfactied with the results.Conclusion:Nasal septum extension graft based on drilling technique is beneficial to maintain the long-term stability of cartilage scaffold after comprehensive costal cartilage nasal surgery, which justifies its application in comprehensive nasal plastic surgery.