Skin graft and skin flap transplantation are the most widely used reparative and reconstructive method in plastic surgery. How to avoid the necrosis of skin graft and skin flap together with the improvement of survival quality of skin graft and skin flap have always been one of the basic problem in plastic surgery basic and clinical research. The emergence of adipose-derived stem cells has brought a new idea to solve this problem. In this paper, the isolation, identification and biological characteristics of adipose-derived stem cells, application of adipose-derived stem cells in skin graft and skin flap transplantation were reviewed. At the same time, the problems of adipose-derived stem cells and their future prospects were discussed.

The growth of puberty height is affected by many factors, among which the role of sex hormones is particularly important. The height increase in puberty accounts for about 20% of the final height in adulthood. It was previously believed that the final height of patients with disorders of sexual development was impaired due to the disorder of sex hormones. However, there are more classifications and subtypes of disorders of sexual development, and the growth patterns of patients with different subtypes of disorders of sexual development are also different. This article briefly reviews puberty bone growth, the effect of sex hormones on puberty bones, the sex hormone spectrum and growth pattern of patients with common disorders of sexual development, and the effect of growth hormone therapy.

Skin graft and skin flap transplantation are the most widely used reparative and reconstructive method in plastic surgery. How to avoid the necrosis of skin graft and skin flap together with the improvement of survival quality of skin graft and skin flap have always been one of the basic problem in plastic surgery basic and clinical research. The emergence of adipose-derived stem cells has brought a new idea to solve this problem. In this paper, the isolation, identification and biological characteristics of adipose-derived stem cells, application of adipose-derived stem cells in skin graft and skin flap transplantation were reviewed. At the same time, the problems of adipose-derived stem cells and their future prospects were discussed.

The growth of puberty height is affected by many factors, among which the role of sex hormones is particularly important. The height increase in puberty accounts for about 20% of the final height in adulthood. It was previously believed that the final height of patients with disorders of sexual development was impaired due to the disorder of sex hormones. However, there are more classifications and subtypes of disorders of sexual development, and the growth patterns of patients with different subtypes of disorders of sexual development are also different. This article briefly reviews puberty bone growth, the effect of sex hormones on puberty bones, the sex hormone spectrum and growth pattern of patients with common disorders of sexual development, and the effect of growth hormone therapy.

Objective:To explore the clinical effect of modified urethral anastomosis in penile reconstruction for female-to-male(FTM) transsexuals.Methods:A retrospective analysis was performed on the FTM transsexuals undergoing penile and urethral reconstruction in Second Affiliated Hospital of Naval Medical University from December 2016 to December 2020. In this method, lower abdominal flap and anterolateral thigh (ALT) flap were used to reconstruct the neophallus, and vaginal mucosa was used to reconstruct the urethra step by step. The 2 stage procedure was divided into 3 stage. During the second stage operation, a 2 cm wide flap bridge was reserved near the perineal end of the prefabricated urethral opening, which separated the prefabricated urethral from the urethra reserved at the pubic area. And the third stage urethral anastomosis was performed 6 months later. The urethral function after penile reconstruction was followed up to observe whether the patients had urinary fistula, standing urination and urethral patency.Results:A total of 6 FTM transsexuals, aged 29-40 years, were enrolled in the study. The operation was successful. Among them, the right ALT flap was used in 4 cases, and the left lower abdominal flap was used in 2 cases. In one case, partial flap necrosis was found in the distal part of the penis one week after the second stage surgery, which healed with free skin grafting after 2 weeks. During postoperative follow-up of 10-30 months, no urinary fistula occurred and all patients were able to urinate standing up, with no urethral stricture.Conclusions:The urethra was prefabricated with a lower abdominal flap or ALT flap, and then the procedure of phalloplasty and modified urethral anastomosis was performed in stages, which could reduce the incidence of urinary fistula and urethral stricture in FTM transsexuals.

Objective:To explore the clinical effect of modified urethral anastomosis in penile reconstruction for female-to-male(FTM) transsexuals.Methods:A retrospective analysis was performed on the FTM transsexuals undergoing penile and urethral reconstruction in Second Affiliated Hospital of Naval Medical University from December 2016 to December 2020. In this method, lower abdominal flap and anterolateral thigh (ALT) flap were used to reconstruct the neophallus, and vaginal mucosa was used to reconstruct the urethra step by step. The 2 stage procedure was divided into 3 stage. During the second stage operation, a 2 cm wide flap bridge was reserved near the perineal end of the prefabricated urethral opening, which separated the prefabricated urethral from the urethra reserved at the pubic area. And the third stage urethral anastomosis was performed 6 months later. The urethral function after penile reconstruction was followed up to observe whether the patients had urinary fistula, standing urination and urethral patency.Results:A total of 6 FTM transsexuals, aged 29-40 years, were enrolled in the study. The operation was successful. Among them, the right ALT flap was used in 4 cases, and the left lower abdominal flap was used in 2 cases. In one case, partial flap necrosis was found in the distal part of the penis one week after the second stage surgery, which healed with free skin grafting after 2 weeks. During postoperative follow-up of 10-30 months, no urinary fistula occurred and all patients were able to urinate standing up, with no urethral stricture.Conclusions:The urethra was prefabricated with a lower abdominal flap or ALT flap, and then the procedure of phalloplasty and modified urethral anastomosis was performed in stages, which could reduce the incidence of urinary fistula and urethral stricture in FTM transsexuals.

Objective To investigate the value of phase-contrast magnetic resonance imaging (PC-MRI)in evaluating pulmonary artery blood flow and right ventricular(RV)function in elderly patients with chronic obstructive pulmonary disease (COPD).Methods Twenty-four elderly patients with COPD admitted to Beijing Anzhen Hospital between February 2016 and June 2017 were enrolled in this retrospective study.Based on pulmonary artery pressure evaluated by right heart catheterization,COPD patients were divided into a pulmonary hypertension group (PH group,n =12)and a non-PH group(n=12).Pulmonary artery blood flow velocity and volume,pulmonary arterial compliance and right heart function parameters including ejection fraction,end diastolic volume,endsystolic volume and cardiac output,and 6-min walking distance evaluated by PC-MRI were compared between the two groups.Results There were significant differences in peak flow velocity[(88.1 ±16.0)cm/s vs.(59.8± 13.8) cm/s,P =0.005],flow volume [(80.7± 22.0) ml/s vs.(53.2± 26.7)ml/s,P=0.012],main pulmonary artery compliance[(42.3± 14.6)vs.(22.7± 10.8),P =0.001],right ventricular ejection fraction [(48.4 ± 13.4) ％ vs.(37.6 ± 11.1) ％,P =0.000],end-diastolic volume[(64.6±22.5)ml vs.(72.5±22.8)ml,P =0.030]and end-systolic volume[(50.6±33.1)ml vs.(41.7±33.1)ml,P =0.040]between the non-PH and PH groups,while there was no significant difference in cardiac output between the non-PH and PH groups[(34.2±10.8)ml vs.(34.4±8.3)ml,P =0.080].Pearson's correlation analysis showed that 6-minute walking distance had good correlations with right ventricular ejection fraction(r =0.49),forced expiratory volume in 1 s(FEV1)(r=0.60)and main pulmonary artery diameter(r=0.61).Conclusions PC-MRI is a noninvasive imaging method for quantitative analysis of pulmonary artery dynamics and right heart function for the elderly with COPD,and it can provide information for evaluating therapeutic effects and prognosis.

Objective To present our experience and techniques with the use of autologous costal cartilage grafts in Asian rhinoplasty,and to report the surgical results and complications in 86 consecutive rhinoplasty cases.Methods All operations were performed by the first author (Liu AT) with open approach,costal cartilages and perichondrium were used to reconstruct the nasal tip projection according to the tripod theory in rhinoplasty,after removing the previous injection material,L-shaped implant or hypertrophic scar tissue in the tip.Medical charts and operative records were reviewed retrospectively to summary the complications.Nasal dorsum augmentation was done by costal cartilage or I-shaped allograft,sometimes with anterior sheath of rectus abdominis.Patients' subjective satisfaction of the postoperative nasal appearance was self-evaluated with grading (1 worse,2 no change,3 improved,and 4 much improved).Results From September 2015 to March 2017,86 patients underwent rhinoplasty at our hospital.The postoperative follow-up duration was 6 to 20 months.Overall,functional and aesthetic outcome was satisfactory in most patients,and the mean score by the patients' self-evaluation was 3.3 ± 0.6.Graft exposure,mobility,or significant resorption,pneumothorax or significant donor-site pain were not observed.Conclusions Even with minimal complications and morbidities,autologous costal cartilage grafts in Asian rhinoplasty is a versatile and reliable graft material for nasal tip surgery in severe short or saddle nose,contracted nose due to previous L-shaped augmentation and revision rhinoplasty in which the septal cartilage has already been harvested.

Objective: To evaluate the value of cardiac MR imaging in chronic ischemie mitral regurgitation (IMR) in patients with myocardial infarction. Methods: All patients clinically diagnosed with coronary heart disease and myocardial infarction in our hospital from January 2016 to September 2018 were retrospectively selected, myocardial infarction time more than 3 months and confirmed to have necrotic myocardium by cardiac magnetic resonance examination. All patients underwent echocardiography at the same time. Based on the results of echocardiography, patients were divided into the myocardial infarction group without IMR (40 cases), the mild IMR group (39 cases) and the moderate to severe IMR group (51 cases). Cardiac MR and delayed enhancement (LGE) scan images were analyzed. Cardiac function indexes were measured and left ventricular LGE positive segments were recorded. The indexes of myocardial global longitudinal strain (GLS), global peripheral strain (GCS) and global radial strain (GRS) of left ventricle of IMR patients were measured by feature tracking(FT). Cardiovascular history, coronary artery stenosis and location of myocardial infarction were compared by chi-square test between the without IMR, mild IMR and moderate to severe IMR groups.Univariate analysis of variance was used to compare the measurement data of left ventricular myocardial infarction volume, left heart function and left ventricular myocardial globle strain, and LSD test was used for pair-wise comparison. Results: There was no difference in age, sex and cardiovascular history among the three groups. Comparison of myocardial infarction patients in the three groups: (1) There was no statistically significant difference in the myocardial infarction volume between the three groups (P=0.052), while the myocardial infarction volume tended to increase as the grade of mitral regurgitation increased. The number of patients with myocardial infarction in the inferior wall and the inferolateral wall in the moderate to severe IMR group were significantly higher than those of the other two groups (P<0.05), and there was no significant difference in the volume of myocardial infarction between the without IMR group and mild IMR group, and no difference in the number of patients with inferior wall and inferolateral wall. (2) Cardiac function measured by CMR: ejection fraction (EF) was significantly reduced in the moderate to severe IMR group compared with the without IMR group and the mild IMR group (P<0.05), the end diastolic volume (EDV) increased significantly and the end systolic volume (ESV) increased significantly (P<0.05). Mass of myocardium increased significantly (P<0.05); Stroke volume (SV) and cardiac output (CO) there was no significant difference among the three groups. (3) Comparison of the moderate to severe IMR group to the without IMR group and the mild IMR group respectively: left ventricular GLS and GRS decreased (P<0.05), the difference of the GCS was no statistically significant. There was no statistical difference in the three strain values between the without IMR group and the mild IMR group. Conclusion The globe myocardial strain of the left ventricle in myocardial infarction patients with chronic moderate to severe IMR was significantly impaired, the myocardial infarction in the inferior wall and the inferolateral wall in the level of the papillary muscle may be correlated with chronic moderate to severe IMR, and the myocardial infarction volume of the left ventricle may also be related.

Objective To evaluate the value of cardiac MR imaging in chronic ischemie mitral regurgitation (IMR) in patients with myocardial infarction. Methods All patients clinically diagnosed with coronary heart disease and myocardial infarction in our hospital from January 2016 to September 2018 were retrospectively selected, myocardial infarction time more than 3 months and confirmed to have necrotic myocardium by cardiac magnetic resonance examination. All patients underwent echocardiography at the same time. Based on the results of echocardiography, patients were divided into the myocardial infarction group without IMR (40 cases), the mild IMR group (39 cases) and the moderate to severe IMR group (51 cases). Cardiac MR and delayed enhancement (LGE) scan images were analyzed. Cardiac function indexes were measured and left ventricular LGE positive segments were recorded. The indexes of myocardial global longitudinal strain (GLS), global peripheral strain (GCS) and global radial strain (GRS) of left ventricle of IMR patients were measured by feature tracking(FT). Cardiovascular history, coronary artery stenosis and location of myocardial infarction were compared by chi?square test between the without IMR, mild IMR and moderate to severe IMR groups.Univariate analysis of variance was used to compare the measurement data of left ventricular myocardial infarction volume, left heart function and left ventricular myocardial globle strain, and LSD test was used for pair?wise comparison. Results There was no difference in age, sex and cardiovascular history among the three groups. Comparison of myocardial infarction patients in the three groups: (1) There was no statistically significant difference in the myocardial infarction volume between the three groups (P=0.052), while the myocardial infarction volume tended to increase as the grade of mitral regurgitation increased. The number of patients with myocardial infarction in the inferior wall and the inferolateral wall in the moderate to severe IMR group were significantly higher than those of the other two groups (P<0.05), and there was no significant difference in the volume of myocardial infarction between the without IMR group and mild IMR group, and no difference in the number of patients with inferior wall and inferolateral wall. (2) Cardiac function measured by CMR: ejection fraction (EF) was significantly reduced in the moderate to severe IMR group compared with the without IMR group and the mild IMR group (P<0.05), the end diastolic volume (EDV) increased significantly and the end systolic volume (ESV) increased significantly (P<0.05). Mass of myocardium increased significantly (P<0.05); Stroke volume (SV) and cardiac output (CO) there was no significant difference among the three groups. (3) Comparison of the moderate to severe IMR group to the without IMR group and the mild IMR group respectively: left ventricular GLS and GRS decreased (P<0.05), the difference of the GCS was no statistically significant. There was no statistical difference in the three strain values between the without IMR group and the mild IMR group. Conclusion The globe myocardial strain of the left ventricle in myocardial infarction patients with chronic moderate to severe IMR was significantly impaired, the myocardial infarction in the inferior wall and the inferolateral wall in the level of the papillary muscle may be correlated with chronic moderate to severe IMR, and the myocardial infarction volume of the left ventricle may also be related.