Objective To systematically evaluate the efficacy and safety of plum-blossom needle therapy for vitiligo by using the systematic review and meta analysis.Methods The randomized controlled trials(RCT)on plum-blossom needle for treating vitiligo were systematically retrieved from the databases of the PubMed,China Biological Medicine Database,CNKI,Wanfang Data and VIP database from the database estab-lishment to June 2,2022.The literatures were screened according to the inclusion and exclusion criteria.The finally included literatures conducted the data extraction.The RevMan 5.4 software was used for conducting the data analysis.The methodological quality evaluation on the included trials was performed by the ROB tool.The GRADE method was used to assess the evidence level.Results A total of 7 trials involving 469 pa-tients were finally included.The meta analysis results showed that the plum-blossom needle combined with other therapies(including laser or ultraviolet irradiation,tacrolimus ointment,compound Kaliziran tincture)was superior to the other therapies alone in the aspects of improving vitiligo skin lesion including reducing the of white spot skin lesion area(MD=-1.11,95％CI:-1.92 to-0.30,P=0.007),increasing the repigment-ation rate of vitiliginous lesions(MD=18.09,95％CI:1.55 to 34.63,P=0.030)and enhancing the pigment deposition in vitiligo lesions(MD=0.92,95％CI:0.32 to 1.52,P=0.003),and improving the patients'quali-ty of life(MD=-7.48,95％CI:-8.04 to-6.92,P＜0.001),and the differences were statistically signifi-cant.In terms of safety,there was no statistically significant difference in adverse events between plum blos-som acupuncture combined with other therapies and other therapies alone(RR=1.20,95％CI:0.77 to 1.84,P=0.420).Conclusion Low or very low evidence shows that plum-blossom needle combined with other therapies for treating vitiligo may enhance the effect in the aspects of improving the white spot skin lesions and quality of life in the patients with vitiligo,moreover which is relatively safe.

Background::Evaluating the impact of digestive system diseases is vital for devising effective prevention strategies. However, comprehensive reports on the burden of digestive system diseases in China are lacking. Our study aimed to provide an overview of the burden and trends of digestive system diseases from 1990 to 2019 in China and its provinces.Methods::This cross-sectional study utilized the Global Disease Burden Study 2019 to estimate the incidence, mortality rate, disability-adjusted life years (DALYs), years of life disability, years of life lost, and changes in the burden of digestive diseases across Chinese provinces from 1990 to 2019. The analysis of disease burden primarily examines the characteristics of sub-disease distribution, time trends, age distribution, and sex distribution. Additionally, we compared provincial age-standardized DALYs for digestive diseases with the expected rates based on the socio-demographic index (SDI).Results::In 2019, there were 499.2 million cases of digestive system diseases in China, resulting in 1,557,310 deaths. Stomach cancer, colon and rectal cancer, and esophageal cancer are the top three diseases associated with mortality and DALY related to digestive system diseases. Meanwhile, cirrhosis and other chronic liver diseases, gastroesophageal reflux disease, and gallbladder and biliary diseases are the top three kinds of diseases with the highest prevalence among digestive system diseases. The risk of gastric cancer sharply increases among men after the age of 40 years, leading to a significant disparity in burden between men and women. As the SDI increased, the DALYs associated with digestive system diseases in China and its provinces showed a downward trend.Conclusion::Our study highlights the inverse correlation between DALYs associated with digestive system diseases and the SDI.

Objective To analyze the burden and trends of esophageal cancer in China from 1990 to 2021,and compare them with Japan and South Korea.Methods Based on the global burden of disease 2021 database,the incidence,mortality,and disability-adjusted life years(DALYs)of esophageal cancer and the corresponding age-standardized rates in China from 1990 to 2021 were analyzed and descriptively studied according to different ages and genders,and compared with Japan and South Korea.The estimated annual percentage change and relative variation were used to evaluate the trend of the burden of esophageal cancer.Four risk factors,including smoking,alcohol consumption,low-vegetable diet,and chewing tobacco,were included and the proportions of esophageal cancer DALYs and death burden attributable to each risk factor were analyzed.Breakdown analysis method was used to analyze the contribution of population growth,population aging,and epidemiological changes to the incidence of esophageal cancer.The age-period-cohort model was used to analyze the effect trends of age,period,and birth cohort on the incidence of esophageal cancer.Pearson correlation analysis was used to evaluate the correlation between age-standardized DALYs rate and socio-demographic index(SDI).The number of incident cases and age-standardized incidence rate(ASIR)of esophageal cancer in China over the subsequent 20 years were predicted by autoregressive integrated moving average model.Results In 2021,the number of incident cases,number of deaths,and DALYs of esophageal cancer in China were 320 805,296 443 and 6 898 666,respectively,with increases of 54.61%,40.61%,and 17.88%over 1990.In 2021,the ASIR,age-standardized mortality(ASMR),and age-standardized DALYs rate of esophageal cancer in China were 15.04/100 000,14.13/100 000,and 317.18/100 000,respectively,which were higher than those in Japan(6.22/100 000,3.81/100 000,and 84.34/100 000,respectively)and South Korea(3.52/100 000,2.29/100 000,and 50.15/100 000,respectively).The burden of esophageal cancer in males was higher than that in females in the 3 countries.In 2021,smoking and alcohol consumption were the 2 major risk factors for esophageal cancer death in China;the increase in the number of incident cases was mainly caused by population growth and population aging.In addition,the ASIR of esophageal cancer in China increased with age,peaking at 85-89 years old.From 1990 to 2021,SDI was negatively correlated with age-standardized DALYs rate of esophageal cancer in China,Japan,and South Korea.It was predicted that by 2041,the ASIR of esophageal cancer in China would continue to decrease to 9.14/100 000,but the number of incident cases would increase to 398 200.Conclusion The burden of esophageal cancer in China remains substantial.In the future,it will be crucial to strengthen the prevention and control of risk factors such as smoking and alcohol consumption.Additionally,efforts should be made to promote early screening,diagnosis,and treatment,particularly among high-risk populations.

OBJECTIVE: To explore the feasibility of using indocyanine green angiography in mapping the superficial temporal vessels and assisting design and harvesting of the superficial temporal artery based forehead flap. METHODS: A clinical data of 14 patients with facial soft tissue defects repaired with superficial temporal artery based forehead flaps between October 2015 and November 2022 was retrospectively analyzed. There were 9 males and 5 females with a median age of 9.5 years (range, 3-38 years). The forehead flaps were used to reconstruct facial soft tissue defects following excision of facial scar (8 cases) or congenital melanocyte nevus (6 cases). The size of defects ranged from 3 cm×2 cm to 24 cm×9 cm. Before operation, the indocyanine green angiography was used to map the superficial temporal artery and vein, and to analyze the relationship of the arteries and veins. The forehead flaps with unilateral superficial temporal fascia as the pedicle was transferred to repair the small facial defect in 2 cases. The facial pedicle contained the frontal branch of the superficial temporal artery and 2 cm of the superficial temporal fascia around the vessel, and the tiny accompanying vein of the frontal branch of the superficial temporal artery was used as the outflow of the flap. The forehead flaps with the skin pedicle including bilateral or unilateral superficial temporal fascia and the overlying skin was pre-expanded and transferred to repair the large facial defect in 12 cases. The skin pedicle contained the frontal branch of superficial temporal artery and one of main branches of superficial temporal vein. Among the 12 cases, the frontal branch of superficial temporal vein was used as the outflow in 4 cases, and the parietal branch was used as the outflow in 8 cases. The size of the flaps ranged from 3 cm×2 cm to 30 cm×13 cm. The skin pedicles were divided at 3 weeks after the flap transfer. RESULTS: Indocyanine green angiography could clearly showed the course and branching of the superficial temporal artery and vein. Individual differences existed in the location where the frontal branch of the superficial temporal artery entered the forehead. The superficial temporal vein had great variability and did not follow the artery. One patient had expander-related complication, which resulted in 3-cm flap necrosis. The necrotic tissue was debrided and repaired with skin grafting. The other flaps totally survived and the incisions healed by first intention. All patients were followed up 2-24 months, with a median of 11.5 months. The color, texture, and thickness of the flaps matched well with those of recipient sites. Hypertrophic scar was not observed in recipient or donor site. All patients were satisfied with the reconstructive outcomes. CONCLUSION Indocyanine green angiography can clearly visualize the course and the branches of the superficial temporal arteries and veins, which can help surgeons understand the position, distribution, and concomitant relationship of the superficial temporal vessels, and make a rational surgical plan of the forehead flap.
Male ; Female ; Humans ; Child, Preschool ; Child ; Adolescent ; Young Adult ; Adult ; Temporal Arteries/surgery* ; Indocyanine Green ; Forehead/surgery* ; Retrospective Studies ; Skin Transplantation ; Angiography ; Soft Tissue Injuries/surgery* ; Perforator Flap/blood supply* ; Treatment Outcome

Objective:To investigate the effectiveness of sequential flap transfer technique in the reconstruction of extensive faciocervical scar.Methods:The clinical data of patients with extensive faciocervical scar admitted to the Scar Comprehensive Treatment Center of Plastic Surgery Hospital of Chinese Academy of Medical Sciences from June 2010 to April 2022 were retrospectively analyzed. Pre-expanded medial arm flap or supraclavicular artery perforator plus flap were harvested and used as the first flap to repair the defects left by faciocervical scar resection. Latissimus dorsi myocutaneous flaps or thoracodorsal artery perforator flaps were harvested from the ipsilateral back and used as the second flap to repair the donor sites of the first flap. Donor sites at the back were directly sutured. The survival of flaps, the morphology of donor sites and recipient sites and the scar of donor site were followed up.Results:A total of 13 patients, aged from 5 to 36 years (median age, 14 years), were included, including 8 males and 5 females. Twelve of the 13 cases were post-burn scar, including facial scars in 5 cases, cervical scar in 1 case and faciocervical scar in 6 cases. One case of scar was caused by radiotherapy for facial hemangioma. The size of defects after scar resection and release ranged from 12.0 cm × 8.0 cm to 24.5 cm × 8.0 cm. The operation was successfully completed in all cases. Three pre-expanded supraclavicular artery perforator plus flaps and 10 pre-expanded medial arm flaps, measuring 23.0 cm × 7.0 cm to 27.0 cm ×14.0 cm, were used as the first flap; five latissimus dorsi myocutaneous flaps and eight thoracodorsal artery perforator flaps, measuring 18.0 cm × 7.0 cm to 25.0 cm × 10.0 cm, were used as the second flap. One patient developed hematoma at two days after the pedicle division of medial arm flap and the flap survived completely after removal of the hematoma. Other flaps survived without complications and the incisions were healed in one stage. Patients were followed up for 1 to 48 months, with a median follow-up of 13 months. The color, texture, and thickness of flaps were similar to those of the recipient site. All patients were satisfied with the cosmetic result of recipient sites and donor sites.Conclusion:The sequential flap transfer technique could improve the reconstructive ability of pre-expanded medial arm flap and supraclavicular artery perforator plus flap in surgical treatment of extensive faciocervical scar, minimize the donor site morbidities, assist the closure of donor site and improve the overall outcomes.

Objective:To investigate the effectiveness of sequential flap transfer technique in the reconstruction of extensive faciocervical scar.Methods:The clinical data of patients with extensive faciocervical scar admitted to the Scar Comprehensive Treatment Center of Plastic Surgery Hospital of Chinese Academy of Medical Sciences from June 2010 to April 2022 were retrospectively analyzed. Pre-expanded medial arm flap or supraclavicular artery perforator plus flap were harvested and used as the first flap to repair the defects left by faciocervical scar resection. Latissimus dorsi myocutaneous flaps or thoracodorsal artery perforator flaps were harvested from the ipsilateral back and used as the second flap to repair the donor sites of the first flap. Donor sites at the back were directly sutured. The survival of flaps, the morphology of donor sites and recipient sites and the scar of donor site were followed up.Results:A total of 13 patients, aged from 5 to 36 years (median age, 14 years), were included, including 8 males and 5 females. Twelve of the 13 cases were post-burn scar, including facial scars in 5 cases, cervical scar in 1 case and faciocervical scar in 6 cases. One case of scar was caused by radiotherapy for facial hemangioma. The size of defects after scar resection and release ranged from 12.0 cm × 8.0 cm to 24.5 cm × 8.0 cm. The operation was successfully completed in all cases. Three pre-expanded supraclavicular artery perforator plus flaps and 10 pre-expanded medial arm flaps, measuring 23.0 cm × 7.0 cm to 27.0 cm ×14.0 cm, were used as the first flap; five latissimus dorsi myocutaneous flaps and eight thoracodorsal artery perforator flaps, measuring 18.0 cm × 7.0 cm to 25.0 cm × 10.0 cm, were used as the second flap. One patient developed hematoma at two days after the pedicle division of medial arm flap and the flap survived completely after removal of the hematoma. Other flaps survived without complications and the incisions were healed in one stage. Patients were followed up for 1 to 48 months, with a median follow-up of 13 months. The color, texture, and thickness of flaps were similar to those of the recipient site. All patients were satisfied with the cosmetic result of recipient sites and donor sites.Conclusion:The sequential flap transfer technique could improve the reconstructive ability of pre-expanded medial arm flap and supraclavicular artery perforator plus flap in surgical treatment of extensive faciocervical scar, minimize the donor site morbidities, assist the closure of donor site and improve the overall outcomes.

This article reports a case of using immediate implant placement and immediate restoration combined with measurable implant surgical guides to restore compromised maxillary incisors caused by dental trauma. Target restoration was designed in the exoCAD software preoperatively, intraoral measurements were obtained in three directions, and the correct position of virtual implants was determined in BlueSky Plan 4. Afterward, measurable implant guides were designed and fabricated by 3D printing. Under the guidance of the measurable implant surgical guides and intraoperative measurement, the entry point was determined, the axial direction was verified when drilling to half the depth, and the 3D position was verified when drilling to total depth. Implants were inserted followed by verification once again. The temporary restoration, which was designed based on the target restoration and emergence profile of the original teeth and milled preoperatively, was connected to the implant immediately after surgery. Postoperative accuracy analysis showed that the mean linear deviations between the actual implant position and the pre-planned position were (0.57±0.17) mm at the entry point and (0.82±0.27) mm at the apex, and the mean angular deviation was (1.86±0.89) °, demonstrating that precise implant placement and immediate restoration were implemented.
Humans ; Dental Implantation, Endosseous ; Dental Implants ; Surgery, Computer-Assisted ; Imaging, Three-Dimensional ; Software

Objective:To explore the indications and technical tips of defect reconstruction in the elbow and upper arm using the radial collateral artery perforator (RCAP) propeller flap.Methods:From October 2016 to December 2019, 6 patients underwent defect reconstruction using the RCAP propeller flaps. All patients were female, aged from 5 to 66 years, with an average of 31 years. All of the defects were repaired with radial collateral artery perforator propeller flap. Before the surgery, the RCAP was thoroughly explored using the hand-held ultrasound Doppler and marked on the skin. According to the size, shape and location of the defect, a RCAP propeller flap was elevated based on the chosen RCAP, rotated in a certain degree with the perforating point as the rotation point. The large paddle was used to repair the defect of the upper extremity, and the small paddle was used to assist in closing the donor site. The donor sites were sutured directly or repaired with free skin graft. Capillary filling test or indocyanine green SPY fluorescence imaging system was used to evaluate the blood supply of the flap immediately. The effect was observed.Results:The defect size ranged from 6.0 cm × 3.0 cm to 10.0 cm × 7.0 cm. The flap size ranged from 6.0 cm × 3.5 cm to 20.0 cm × 8.0 cm. All perforators were septocutaneous perforators. The pedicle of the pedicle ranged from 2.5 cm to 5.0 cm and the mean length was 3.6 cm. The flaps were rotated 180° in 5 patients, and 150° in one patient. The donor sites were sutured directly in 5 patients and repaired with free skin graft in one patient. Five flaps survived completely without any major complications. Wound infection occurred in one flap, which healed after debridement. All donor sites were closed primarily, except one which was covered by free skin grafting. All patients were followed up for 3 months to 3 years and the average follow-up time was 2.4 years. The appearance and texture of the flap were good, and the motion of elbow joint was normal. All patients were satisfied with the functional and aesthetic outcomes of the upper extremities. Tumor recurrence was not noticed in the oncologic patients.Conclusions:For selected patients, the RCAP propeller flap could be an alternative option for soft-tissue defect reconstruction in the upper extremity.

Objective:To explore the indications and technical tips of defect reconstruction in the elbow and upper arm using the radial collateral artery perforator (RCAP) propeller flap.Methods:From October 2016 to December 2019, 6 patients underwent defect reconstruction using the RCAP propeller flaps. All patients were female, aged from 5 to 66 years, with an average of 31 years. All of the defects were repaired with radial collateral artery perforator propeller flap. Before the surgery, the RCAP was thoroughly explored using the hand-held ultrasound Doppler and marked on the skin. According to the size, shape and location of the defect, a RCAP propeller flap was elevated based on the chosen RCAP, rotated in a certain degree with the perforating point as the rotation point. The large paddle was used to repair the defect of the upper extremity, and the small paddle was used to assist in closing the donor site. The donor sites were sutured directly or repaired with free skin graft. Capillary filling test or indocyanine green SPY fluorescence imaging system was used to evaluate the blood supply of the flap immediately. The effect was observed.Results:The defect size ranged from 6.0 cm × 3.0 cm to 10.0 cm × 7.0 cm. The flap size ranged from 6.0 cm × 3.5 cm to 20.0 cm × 8.0 cm. All perforators were septocutaneous perforators. The pedicle of the pedicle ranged from 2.5 cm to 5.0 cm and the mean length was 3.6 cm. The flaps were rotated 180° in 5 patients, and 150° in one patient. The donor sites were sutured directly in 5 patients and repaired with free skin graft in one patient. Five flaps survived completely without any major complications. Wound infection occurred in one flap, which healed after debridement. All donor sites were closed primarily, except one which was covered by free skin grafting. All patients were followed up for 3 months to 3 years and the average follow-up time was 2.4 years. The appearance and texture of the flap were good, and the motion of elbow joint was normal. All patients were satisfied with the functional and aesthetic outcomes of the upper extremities. Tumor recurrence was not noticed in the oncologic patients.Conclusions:For selected patients, the RCAP propeller flap could be an alternative option for soft-tissue defect reconstruction in the upper extremity.

Objective: To explore the flap design and clinical applications of the propeller flaps based on perforators from different branches of the lateral circumflex femoral artery in defect reconstruction. Methods: Between September 2009 and December 2018, 27 patients with soft tissue defects from lower extremities were involved in this study, including 15 males and 12 females, with an average age of 34.6 years old (range, 3 to 73 years old). Before surgery, the type of the flap to be used was designed preliminarily by evaluating the location, size and shape of the lesion or defect. The perforators of the lateral circumflex femoral artery were explored using an ultrasound Doppler probe, marked on skin. The computed tomographic angiography was also used to get more information of the branches of the lateral circumflex femoral artery when possible. The propeller flaps were divided into typeⅠ, Ⅱ, Ⅲ, and Ⅳ according to the perforators that originated from the transverse, descending, oblique, and rectus femoris branches of the lateral circumflex femoral artery, respectively. The type Ⅱ flap was subdivided into type Ⅱa and type Ⅱb flaps that were based on antegrade and reverse flow from the descending branch. The defects were reconstructed using the perforator propeller flap. Results: Twenty-seven patients underwent reconstruction of defects using the propeller flaps based on perforators from different branches of the lateral circumflex femoral artery including 3 type Ⅰ flap, 12 type Ⅱa, 2 type Ⅱb, 10 type Ⅲ and 3 type Ⅳ. The size, pedicle length and rotation angle of the flaps were 12 cm×6 cm to 30 cm×15 cm, 4 cm to 15 cm, and 60 to 180 degrees, respectively. Total necrosis occurred in one flap and small-sized distal necrosis in another one. Minor complications occurred in two flaps and the remaining propeller flaps survived completely. All patients were followed up from one to 25 months and mean follow-up time was 9.9 months. Tumor recurrence was noticed in one patient. All patients were satisfied with the final functional and aesthetic outcomes. Conclusions For appropriate cases, reconstruction of defects from the groin to the knee could be achieved by using the propeller flaps based on perforators from different branches of the lateral circumflex femoral artery, with advantages of easy-to-operate and minor donor-site morbidity.