Objective:To explore the clinical outcome and applicability of the comb flap technique and stepwise design concept in plastic aesthetic and reconstructive surgery.Methods:The clinical data of patients who underwent plastic aesthetic and reconstructive surgery with the comb flap technique in Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to December 2022 were retrospectively analyzed. The application of the comb flap technique follows the concept of stepwise design, that was, preoperative and intraoperative design and adjustment were carried out step by step and in sequence, and the design was combined with the surgical procedure. Its main operations included: an incision was designed along the edge of the target area, the tissue flap was widely separated at the base of the target area. The tissue flap was cut in sequence perpendicular to the cutting edge and temporarily sutured and fixed, the edge was cut and fixed. During the operation, the tension of the incision and the local appearance could be adjusted. The incisal edge was finely sutured, and the temporary suture was finally removed. The healing of surgical incision and complications were observed after the operation, and the facial recovery and surgical effect were followed up.Results:Six patients were enrolled, including 3 males and 3 females, aged from 2 to 58 years. One patient underwent upper eyelid tightening and lower eyelid blepharoplasty through subeyebrow incision. One patient underwent middle and lower face rhytidectomy. One patient underwent thick lip thinning and right facial liposuction. One patient underwent facial congenital melanocytic nevi resection. One patient underwent eyebrow congenital melanocytic nevus resection. One patient underwent facial flap repair. All patients had primary healing of incision, and no surgery-related complications occurred. All patients were followed up for 3 to 18 months, and all patients were satisfied with the surgical effect.Conclusion:The application of comb flap technique and stepwise design concept in plastic aesthetic and reconstructive surgery can delicately adjust the alignment of the incision margin, make the tension evenly distributed, and reduce the risk of scar formation and deformity after the operation. It has a wide range of clinical applications and good applicability.

Objective:To explore the clinical outcome and applicability of the comb flap technique and stepwise design concept in plastic aesthetic and reconstructive surgery.Methods:The clinical data of patients who underwent plastic aesthetic and reconstructive surgery with the comb flap technique in Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to December 2022 were retrospectively analyzed. The application of the comb flap technique follows the concept of stepwise design, that was, preoperative and intraoperative design and adjustment were carried out step by step and in sequence, and the design was combined with the surgical procedure. Its main operations included: an incision was designed along the edge of the target area, the tissue flap was widely separated at the base of the target area. The tissue flap was cut in sequence perpendicular to the cutting edge and temporarily sutured and fixed, the edge was cut and fixed. During the operation, the tension of the incision and the local appearance could be adjusted. The incisal edge was finely sutured, and the temporary suture was finally removed. The healing of surgical incision and complications were observed after the operation, and the facial recovery and surgical effect were followed up.Results:Six patients were enrolled, including 3 males and 3 females, aged from 2 to 58 years. One patient underwent upper eyelid tightening and lower eyelid blepharoplasty through subeyebrow incision. One patient underwent middle and lower face rhytidectomy. One patient underwent thick lip thinning and right facial liposuction. One patient underwent facial congenital melanocytic nevi resection. One patient underwent eyebrow congenital melanocytic nevus resection. One patient underwent facial flap repair. All patients had primary healing of incision, and no surgery-related complications occurred. All patients were followed up for 3 to 18 months, and all patients were satisfied with the surgical effect.Conclusion:The application of comb flap technique and stepwise design concept in plastic aesthetic and reconstructive surgery can delicately adjust the alignment of the incision margin, make the tension evenly distributed, and reduce the risk of scar formation and deformity after the operation. It has a wide range of clinical applications and good applicability.

Objective To investigate the effects of Polygonatum kingianum on wound healing and nuclear factor-erythroid 2-related factor 2(Nrf2)/heme oxygenase-1(HO-1)signaling pathway in diabetic skin injury rats.Methods Diabetic rat models were established and 48 rats were randomly divided into model group,sitagliptin group(10 mg·kg-1),Polygonatum kingianum water extract low dose group(2 g·kg-1),Polygonatum kingianum water extract high dose group(8 g·kg-1)and Polygonatum Kingianum alcohol extract low and high dose group(2 g·kg-1 and 8 g·kg-1).8 in each group;Another control group was set up.After 4 weeks of intragastric administration,all rats established back skin wounds,and continued to be administered for 14 days after operation.At the end of the experiment,the rats were killed,and blood glucose,glycosylated hemoglobin(GHb),plasma levels of H2O2,MDA,SOD,GSH and wound margin skin tissue T-AOC,SOD,MDA levels were measured.The relative expression of Nrf2 and HO-1 mRNA in wound margin skin tissue was measured by fluorescence quantitative method.Results Compared with the model group,the levels of SOD and GSH in plasma and the relative expressions of Nrf2 and HO-1 mRNA in wound margin skin tissue in the low and high dose groups of ethanol extract of Polygonatum kingianum,and the low and high dose groups of water extract of Polygonatum kingianum were increased(P<0.01,P<0.001).The levels of glycosylated hemoglobin(GHb)in plasma and MDA in wound margin tissue were decreased(P<0.05,P<0.01,P<0.001).The level of T-AOC in the high dose group was increased(P<0.01).The SOD level of skin tissue in the low dose group of Polygonatum kingianum water extract was increased(P<0.01),and the level of H2O2 in the low dose group was decreased(P<0.01).Conclusion Polygonatum canaliculatum can up-regulate Nrf2/HO-1 signaling pathway,regulate excessive oxidative stress,and promote wound healing.

BackgroundFunctional near-infrared spectroscopy （fNIRS） is a new generation of imaging tool that can be used to assist the diagnosis of psychiatric disorders. However， whether the patterns of prefrontal cortex activation observed by fNIRS are specific for different psychiatric disorders remains to be explored. ObjectiveTo investigate the characteristics of prefrontal cortex activation in patients with depression， anxiety disorder， bipolar disorder and schizophrenia in verbal fluency task （VFT） using fNIRS. MethodsFrom September to December 2021， 39 patients with schizophrenia， 205 patients with depressive disorder， 212 patients with anxiety disorder and 77 patients with bipolar disorder meeting the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） were recruited in the outpatient and inpatient department of West China Hospital， Sichuan University. fNIRS was used to monitor the prefrontal cortex hemodynamic changes of patients under VFT， and the clinical symptoms of patients were assessed by Symptom Checklist 90 （SCL-90） and Hypomania Checklist-32 items（HCL-32）. Differences in mean oxyhemoglobin （HbO₂） concentration and the initial slope from 2 to 7 second during VFT were compared among patients with different diseases， and the correlation between mean HbO₂ concentration/initial slope and clinical symptoms was analyzed by partial correlation analysis. ResultsThe concentration of HbO₂ in channel 4 （Z=2.828， P=0.028） and channel 6 （Z=2.912， P=0.022） in patients with depression were significantly higher than those in patients with schizophrenia. Patients with anxiety had significantly higher changes in mean HbO₂ concentration in channel 4 （Z=3.154， P=0.010）， channel 5 （Z=3.021， P=0.015）， channel 6 （Z=2.980， P=0.017） and of all channels （Z=2.881， P=0.024） than those of schizophrenia patients. There was a statistically significant difference in the initial slope of channel 3 between patients with depressive disorder and those with bipolar disorder （Z=2.691， P=0.039）. Among patients with bipolar disorder， the anger-hostility scores of SCL-90 were negatively correlated with the mean HbO₂ concentration changes in channel 4 （r=-0.505， P=0.004）， channel 6 （r=-0.390， P=0.004）， channel 15 （r=-0.546， P=0.002）， channel 16 （r=-0.550， P=0.002） and the mean HbO₂ concentration changes of all channels （r=-0.491， P=0.006）. ConclusionPatients with schizophrenia had lower activation in frontopolar and orbitofrontal region than patients with depression and anxiety disorder， and the initial slope of the right frontopolar， inferior frontal and orbitofrontal region in patients with depression is higher than patients with bipolar disorder. In addition， patients with bipolar disorder had less activation in the frontopolar and orbitofrontal lobe， the insular cover of Broca's area and the upper outer frontal cortex， and were more irritable and hostile. ［Funded by 1·3·5 Project for Disciplines of Excellence-Clinical Research Incubation Project， West China Hospital， Sichuan University （number， ZYJC21083）］

Objective: Subthreshold attention-deficit/hyperactivity disorder (ADHD) has been suggested to be a “morbid condition” which also needs medical attention. Methods: The present study recruited 89 children with subthreshold ADHD (sADHD), 115 children with diagnosed ADHD (cADHD), and 79 healthy controls (HC) to explore the clinical manifestation, executive functions (EFs) of sADHD, and the caregiver strain. The clinical manifestation was evaluated through clinical interviews and parent-reports. Executive functions were assessed both experimentally and ecologically. Caregiver strain was measured by a parent-reported questionnaire. Results: For the clinical manifestation, both sADHD and cADHD indicated impairments when compared with HC. The comorbidities and the scaled symptoms indicated that the externalizing behaviors were relatively less serious in sADHD than cADHD, whereas the internalizing behaviors between two groups were comparable. For ecological EFs, sADHD scored between cADHD and HC in inhibition and working memory. For experimental EFs, sADHD was comparable to cADHD in inhibition, shifting, and was worse than cADHD in verbal working memory. For the caregiver strain, all scores of sADHD were between that in cADHD and that in HC. Conclusion Our present findings supported the suggestion of subthreshold ADHD as “morbid condition,” which should be treated with caution in clinical practice, especially for the internalizing behaviors and some key components of EFs.

OBJECTIVE To study active components and antitussive effect of aboveground part of Pinellia ternata （non- medicinal stems and leaves）， and compare them with the underground part of P. ternata （medicinal underground tubers）， providing scientific basis for the comprehensive utilization and product development of P. ternata. METHODS TLC， GC， HPLC and UPLC- MS/MS were used for qualitative and quantitative analysis of amino acids， volatile oil， total flavonoids and succinic acid from the aboveground and underground parts of P. ternata. The antitussive effects of the aboveground and underground parts of P. ternata were compared and studied through cough inducing experiment with concentrated ammonia water. RESULTS Results of TLC showed that at the corresponding positions on the chromatograms of the reference substances of P. ternata， and arginine， alanine， valine， leucine and rutin control， the aboveground and underground parts of P. ternata showed spots of the same color. Results of GC showed that the similarity among characteristic chromatograms of volatile oil from aboveground and underground parts of P. ternata was 0.767； results of HPLC and UPLC-MS/MS showed that compared with underground parts of P. ternata， the contents of succinic acid， quercetin， kaempferol and isorhamnetin increased by 0.15%， 0.15%， 0.09% and 0.03%， and aspartate content decreased by 2.5 mg/g. Pharmacodynamics results showed that compared with model control group， the cough incubation period of rats was prolonged significantly in administration groups （P＜0.05）， and the cough frequency within 3 min was significantly decreased （P＜0.05）； there was no statistical significance in the cough frequency within 3 min among administration groups （P＞0.05）. CONCLUSIONS The composition of amino acids， volatile oils and total flavonoids in aboveground part of P. ternata are similar to underground part of P. ternata， while the content of aspartic acid is lower than that in underground part. The aboveground part of P. ternata can prolong the cough incubation period of rats and reduce the number of coughs， which has a certain antitussive effect， but the effect is slightly weaker than that of the underground part.

Objective:To investigate the effects of sodium fluoride on growth and development and serum oxidative stress of offspring rats.Methods:Twenty-four clean female SD rats and 24 clean male SD rats were selected, weighting 180 - 220 g, and mating in the same cage for 10 d according to 1 ∶ 1 for male and female. According to body weight by random number table method, the female rats were divided into control group, low-dose fluoride group, and high-dose fluoride group, 8 rats in each group. They were drunk 0, 100 and 200 mg/L sodium fluoride solution prepared with purified water, respectively, and they all ate standard feed. The female rats were exposed to fluoride from the 0th day of pregnancy to the 3rd week after the offspring rats were born (before weaning). After weaning, 10 female offspring rats were selected from each group and continued to be exposed to fluoride in the same amount and manner until the 12th week after birth. The body weight, body length and hind limb length of the offspring rats were measured every week before weaning and every two weeks after weaning. After 12th week of exposure to fluoride, blood samples were taken from abdominal aortas to detect the levels of serum superoxide dismutase (SOD), malondialdehyde (MDA), inducible nitric oxide synthase (iNOS), glutathione peroxidase (GSH-Px) and total antioxidant capacity (T-AOC).Results:At the 2nd week after birth, the body weight [(24.87 ± 3.36) g], body length [(6.37 ± 0.52) cm] and hind limb length [(2.27 ± 0.13) cm] of the offspring rats in high-dose fluoride group were lower than those in control group [(29.23 ± 4.19) g, (6.92 ± 0.47), (2.44 ± 0.16) cm, P < 0.05], but there was no statistically significant difference between low-dose fluoride group and control group and high-dose fluoride group ( P > 0.05). At 3rd to 12th weeks after birth, the body weight, body length and hind limb length of the offspring rats in high-dose fluoride group were lower than those in low-dose fluoride group and control group ( P < 0.05), the low-dose fluoride group were lower than those in control group ( P < 0.05). Serum SOD, GSH-Px and T-AOC levels in control group [(176.51 ± 29.55), (985.23 ± 164.80) U/ml, (0.864 ± 0.167) mmol/L] were higher than those in low-dose fluoride group [(127.98 ± 24.41), (776.53 ± 107.85) U/ml, (0.639 ± 0.110) mmol/L] and high-dose fluoride group [(99.75 ± 14.56), (425.14 ± 78.67) U/ml, (0.441 ± 0.072) mmol/L], the levels of MDA and iNOS [(3.37 ± 0.73) nmol/ml, (189.00 ± 44.67) pg/ml] were lower than those in low-dose fluoride group [(8.22 ± 1.38) nmol/ml, (305.60 ± 73.41) pg/ml] and high-dose fluoride group [(14.81 ± 1.81) nmol/ml, (431.00 ± 91.19) pg/ml], the differences were statistically significant ( P < 0.05); the levels of serum SOD, GSH-Px and T-AOC in high-dose fluoride group were lower than those in low-dose fluoride group, and the levels of MDA and iNOS were higher than those in low-dose fluoride group ( P < 0.05). Conclusion:Excessive fluoride can increase the serum oxidative stress level of offspring rats, which may affect the growth and development of offspring rats.

Infantile hemangioma is a benign tumor which develops shortly after birth. An early diagnosis and treatment should be performed for baby with facial hemangioma to avoid mental burden and family burden in the future. Therefore early prevention of the diseaseisvery important. In this review, we summarized the prenatal risk factors in the recent articles. Among those, the main factors included history of miscarriage, artificial insemination, chorionic villus sampling, vaginal bleeding in early pregnancy, placental abnormalities, progesterone use during pregnancy, gestational hypertension, gestational diabetes, smoking during pregnancy, alcohol consumption. It may be helpful for clinical or basic research in the future.

Infantile hemangioma is a benign tumor which develops shortly after birth. An early diagnosis and treatment should be performed for baby with facial hemangioma to avoid mental burden and family burden in the future. Therefore early prevention of the diseaseisvery important. In this review, we summarized the prenatal risk factors in the recent articles. Among those, the main factors included history of miscarriage, artificial insemination, chorionic villus sampling, vaginal bleeding in early pregnancy, placental abnormalities, progesterone use during pregnancy, gestational hypertension, gestational diabetes, smoking during pregnancy, alcohol consumption. It may be helpful for clinical or basic research in the future.

Objective:To investigate the effects of osteocalcin (BGP) on bone growth and development and the expression levels of related hormones in offspring rats under the intervention of sodium fluoride.Methods:Twenty-four clean female SD rats and 24 clean male SD rats were selected, weighing 180-220 g, and the rats were mated in a 1∶1 cage for 10 d. The fluorosis rat model was established by drinking the fluorosis water method, female rats were divided into 3 groups according to body weight by random number table method, each group of 8 rats, including the high-dose, low-dose and control groups, with sodium fluoride of 200, 100, 0 mg/L in drinking water. The female rats were exposed to fluoride from the 0th day of pregnancy to the 3rd week after the offspring rats were born (before weaning). After weaning, 10 male offspring rats were selected from each group and continued to be exposed to fluoride in the same amount and manner until the 12th week after birth. The body weight and length of the offspring rats were measured every week before weaning and every two weeks after weaning. Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum BGP, parathyroid hormone (PTH), calcitonin (CT), and alkaline phosphatase (ALP) contents in the offspring rats of each group exposed to fluoride for 12 weeks.Results:In the 2nd week of fluoride exposure, the body weights [(27.25 ± 3.57), (26.27 ± 4.48) g] and body lengths [(6.92 ± 0.46), (6.50 ± 0.54) cm] of the low-dose and high-dose groups were lower than those of the control group [(31.32 ± 3.62) g, (7.19 ± 0.26) cm, P < 0.05], but there were no significant differences in body weights and lengths between the high-dose group and the low-dose group ( P > 0.05). From the 3rd week of fluoride exposure, the body weight and length of the high-dose group were lower than those of the low-dose group and the control group ( P < 0.05). Serum BGP, PTH and ALP contents [(5.42 ± 0.26) mg/L, (157.53 ± 32.21) ng/L, (36.62 ± 6.01) U/L] in the control group were lower than those of the low-dose group [(6.15 ± 0.29) mg/L, (212.26 ± 51.97) ng/L, (50.68 ± 6.11) U/L] and high-dose group [(7.31 ± 0.77) mg/L, (274.21 ± 60.32) ng/L, (74.99 ± 9.08) U/L], and CT content [(182.40 ± 17.39) ng/L] was higher than those of the low-dose and high-dose groups [(135.77 ± 14.06), (70.09 ± 13.49) ng/L], and the differences were statistically significant ( P < 0.05); serum BGP, PTH and ALP contents in the high-dose group were higher than those in the low-dose group, and the CT content was lower than that in the low-dose group ( P < 0.05). Conclusion:Sodium fluoride may be involved in regulating the expression of related hormones by promoting the secretion of BGP, thereby affecting the bone growth and development of offspring rats.