Objective To investigate the relationship between the expression of programmed death ligand 1(PD-L1)and hypoxia inducible factor-1α(HIF-1 α)with the clinical pathological characteristics and prognosis of gastric cancer patients.Methods The cancer tissues of 100 gastric cancer patients who underwent radical gastrectomy at the First Hospital of Handan City from July 2019 to July 2020 were selected as the research subjects,and their adjacent tissues(normal tissues ≥ 5 cm from the cancer tissues)were as the control group.Immunohistochemical detection of PD-L1 and HIF-1 α was performed by SP method.Spearman correlation analysis was used to analyze PD-L1 and HIF-1 α in gastric cancer tissues.Kaplan-Meier method was used to analyze the 3-year survival relationship of gastric cancer patients.The influencing factors of prognosis and death in patients with gastric cancer were analyzed by univariate and multivariate Cox regression.Results Among 100 gastric cancer patients,52 were PD-L1 positive and 48 were negative;67 were HIF-1 α positive and 33 were HIF-1 α negative,the positive expression rates of PD-L1 and HIF-1α in gastric cancer tissues were 52.00％and 67.00％,respectively,which were obviously higher than those in adjacent tissues(11.00％、18.00％),the difference was statistically significant(P＜0.05).Spearman correlation analysis showed that the expression of PD-L1 was positively correlated with that of HIF-1α in gastric cancer tissues(r=0.730,P＜0.001).The expressions of PD-L1 and HIF-1α in patients with gastric cancer were correlated with TNM stage,lymph node metastasis and local invasion(P＜0.05).The 3-year overall survival rate of gastric cancer patients was 48.00％after surgery,and the 3-years survival rate of patients with positive expression of PD-L1 and HIF-1α were 28.85％and 31.34％,which were lower than those of patients with negative expression of PD-L1 and HIF-1α(68.75％and 81.82％)(Log rank x2=25.155,P＜0.001.Log rank x2=24.552,P＜0.001).Moreover,positive expression of PD-L1 and HIF-1α,TNM staging of Ⅲ-Ⅳ,lymph node metastasis,and local infiltration were independent risk factors for prognosis and death in gastric cancer patients(P＜0.05).Conclusion Both PD-L1 and HIF-1α are highly expressed in cancer tissues of gastric cancer patients,and they are positively correlated.They are also associated with clinical pathological features such as TNM staging,lymph node metastasis,and poor prognosis.

Objective:To explore the training methods to improve the cosmetic suture technique of junior surgeons.Methods:The training course of cosmetic suture techniques was carried out for junior residents such as plastic surgery professional graduate students and standardized training residents, through the study of the basic knowledge of cosmetic suture and the practical training of minimally invasive principles, to help them master cosmetic suture techniques systematically for the need of future clinical practice. Compared with the level of operation skills before and after cosmetic suture training in different groups (graduate students of plastic surgery and other majors, standardized training residents of plastic surgery and other majors), the residents' performance had been significantly improved. The incisions healing after half a year follow-up in cases they sutured were observed.Results:After cosmetic suture training, the suture skills of the students were significantly improved, and there was a significant correlation with the time of clinical practice. The incidence of incisions inflammation and postoperative scar formation in the cases sutured by the students with practice for 6 months was significantly lower than those for 1 month (6.42% vs 21.67%, 1.13% vs 5.56% respectively).Conclusions:The training of cosmetic suture techniques is very important to improve the professional ability of junior residents in plastic and cosmetic surgery, and it needs a long time practice to master the suture skills.

This study introduces that we have established a clinical case database of scar prevention and treatment with medical histories, diagnosis and treatment ideas, and case expansion according to the scar diseases that professional postgraduates of plastic surgery need to master, and applied it to the practical teaching for plastic surgery postgraduates. Through the comprehensive evaluation from three aspects of mastering basic knowledge, applying knowledge and developing discipline, it's suggested that the professional postgraduates can better grasp the knowledge of scar prevention and treatments after learning from the clinical scar database, and the application of the teaching case database has further improved students' teaching and learning participations and innovative thinking abilities.

Objective:To investigate the clinical effect of botulinum toxin type A injection in the prevention and treatment of frontal traumatic scars immediately after operation.Methods:From January 2016 to January 2018, among the 152 patients with frontal trauma admitted to the Department of Plastic Surgery, Daping Hospital, Army Military Medical University, patients with wounds almost perpendicular to the Langer line were selected. Immediately after debridement and suture, botulinum toxin type A was injected with a concentration of 2 U botulinum toxin per 0.10 ml of solution, 0.05 to 0.10 ml (1 to 2 U) per 1 cm was injected into the frontal muscle according to frontal muscle strength.With reference to the observer scar assessment scale and Vancouver scar scale, the color, width, texture, thickness, pain, and itching of the postoperative scar of the frontal wound were evaluated at follow-up.Results:A total of 44 patients were included, 22 males and 22 females, aged (31.5 ± 8.4) years old, with a wound length of 1-12 cm(average, 3.5 cm) and a Botox injection volume around wounds of 0.10-0.90 ml (2-18 U) . The patients were followed up for 6 to 24 months. One patient had mild to moderate ptosis, which completely disappeared within one month. Within 6 weeks after operation, the scars in 44 patients were pink and hard. 3-6 months later, the scars gradually became soft, narrow and flat with similiar skin color, no pain and itching left in 42 patients. The satisfaction rate was 95.5% (42/44). Two patients were dissatisfied because of scar pigmentation and width.Conclusions:Immediate injection of botulinum toxin type A after debridement and suture of the frontal trauma wound can effectively prevent and improve scar appearance with a high rate of satisfaction.

Objective:To investigate the clinical effect of botulinum toxin type A injection in the prevention and treatment of frontal traumatic scars immediately after operation.Methods:From January 2016 to January 2018, among the 152 patients with frontal trauma admitted to the Department of Plastic Surgery, Daping Hospital, Army Military Medical University, patients with wounds almost perpendicular to the Langer line were selected. Immediately after debridement and suture, botulinum toxin type A was injected with a concentration of 2 U botulinum toxin per 0.10 ml of solution, 0.05 to 0.10 ml (1 to 2 U) per 1 cm was injected into the frontal muscle according to frontal muscle strength.With reference to the observer scar assessment scale and Vancouver scar scale, the color, width, texture, thickness, pain, and itching of the postoperative scar of the frontal wound were evaluated at follow-up.Results:A total of 44 patients were included, 22 males and 22 females, aged (31.5 ± 8.4) years old, with a wound length of 1-12 cm(average, 3.5 cm) and a Botox injection volume around wounds of 0.10-0.90 ml (2-18 U) . The patients were followed up for 6 to 24 months. One patient had mild to moderate ptosis, which completely disappeared within one month. Within 6 weeks after operation, the scars in 44 patients were pink and hard. 3-6 months later, the scars gradually became soft, narrow and flat with similiar skin color, no pain and itching left in 42 patients. The satisfaction rate was 95.5% (42/44). Two patients were dissatisfied because of scar pigmentation and width.Conclusions:Immediate injection of botulinum toxin type A after debridement and suture of the frontal trauma wound can effectively prevent and improve scar appearance with a high rate of satisfaction.

OBJECTIVE:To prepare and characterize Ibuprofen (IBU) nano-powder,and to investigate its transdermal ability in vitro. METHODS:Using chloroform-ethanol(7:3,V/V)as organic phase,deionized water as aqueous phase and polysorbate 80 as surfactant,the emulsification method was used to prepare IBU nano-powder. Laser granulometric analysis,Fourier transform in-frared spectroscopy(FT-IR),X-ray diffraction(XRD),differential scanning calorimetry(DSC)were used to characterize IBU na-no-powder. IBU nano-powder was compared with bulk drug in respects of saturation solubility,dissolution rate and transdermal rate in vitro. RESULTS:The optimum condition was as follows that the concentration of polysorbate 80 was 5 mg/mL;the volume ra-tio of water phase-organic phase was 40:1;the concentration of IBU was 250 mg/mL;homogenate speed was 5000 r/min;homog-enate time was 2 min. Prepared IBU nano-powder was polyporous crumbly coralliform,and its chemical structure kept stable;the nano-powder changed from crystal to amorphous state;the particle size was 179.6 nm,and drug-loading amount was 8.99%;satu-ration solubility,dissolution rate and transdermal rate of IBU nano-powder were 148,1.23 and 4.08 times of bulk drug. CONCLU-SIONS:The prepared IBU nano-powder shows good water-solubility and percutaneous permeability.

Objective To analyze retrospectively the HRCT signs in the patients with invasive pulmonary aspergillosis and evaluate the value of HRCT in the diagnosis of invasive pulmonary aspergillosis.Methods The cilinical and HRCT images of 30 cases with invasive pulmonary aspergillosis diagnosed by fiber bronchoscopy, CT guided biopsy or sputum culture were collected.HRCT images were analyzed and the HRCT signs were summarized by two experienced chest imaging radiologists.Results 19 patients had a variety of CT signs, the sign of tree in bud was seen in 8 cases, bronchial stenosis 6 cases, bronchiectasis 8 cases, ground-glass opacity 8 cases, acinic nodules 10 cases, nodular lesions 12 cases, acinar nodules with halo sign 4 cases, nodules with halo sign 9 cases, cavity 10 cases.11 cases only had a single CT sign, the sign of tree in bud was seen in 2 cases, bronchiectasis 2 cases, ground-glass opacity 1 case, acinar nodules 2 cases, nodules with halo sign 2 cases, cavity 2 cases.The occurrence rates of various signs in 30 cases were as follows, the sign of tree in bud was 33.3%, bronchial stenosis 20%, bronchiectasis 33.3%, ground-glass opacity 30%, acinar nodule 40%, nodular lesion 46.6%, halo sign 53.3%,cavity 40%.Conclusion The main HRCT signs in the patients with invasive pulmonary aspergillosis includes tree in bud, bronchial stenosis, bronchiectasis, ground-glass opacity, acinar nodules, nodal lesions,pulmonary cavity and halo sign.The signs of bronchiectasis with tree in bud sign, acinar nodule and halo sign in the HRCT images are highly specific in the diagnosis of invasive pulmonary aspergillosis.

Objective To investigate the clinical application and effect of pick-stab skill in eyebrow embroidery.Methods From July 2015 to January 2016,36 cases were selected to receive eyebrow embroidery with pick-stab skill in our department,including 1 male and 35 females.The cosmetic outcomes,complications and satisfaction rate were observed in these cases.Results In these 36 cases,14 cases were colored in one time,19 cases were colored twice,and 3 cases were more than 3 times.All patients were followed up for 6 months.The color of the eyebrow was natural,and the blue color was not existed.Conclusions The pick-stab skill in eyebrow embroidery is worthy in clinic with better cosmetic effect,higher success rate and safety.

Objective To observe the efficacy and safety of topical 2％ propranolol cream for strawberry hemangiomas in proliferative phase.Methods Sixty infants with strawberry hemangiomas in proliferative phase were included in this study.There were 18 males and 42 females aged 30 days to 12 months.The lesions were located in head and neck (n=30),trunk (n=19) and extremities (n =11).All the infants received the 2％ propranolol cream treatment three times per day.The infants were required a regular return visit every month.The changes of tumor size,texture and color were monitored and recorded.The adverse effects after medication were observed and managed accordingly.The short-term results were evaluated using a 4-grade system.Results All the infants were followed up for 12 months.Among 60 infants,the Ⅰ,Ⅱ,Ⅲ and Ⅳ grade curative effects were 2,17,33 and 8 cases,respectively.All the infants had no drug adverse reaction.Conclusions The effect of topical 2％ propranolol cream for strawberry hemangiomas in proliferative phase is reliable,with little side effects.It will be popularized in clinical application.

Objective To investigate the safety and efficacy of CO2 fractional laser combined with 5-aminolevulinic acid (ALA)-mediated photodynamic therapy (ALA-PDT) for the treatment of refractory flat wart.Methods The 80 patients with facial flat wart were randomly divided into observation group (40 cases) and control group (40 cases).The observation group was treated with CO2 fractional laser combined with 5-ALA-PDT,and the control group was treated with 5-ALA-PDT only.Those with residual lesions after the first treatment were treated with the second or third times.The interval duration between treatments was 2 weeks.The efficacy and the adverse reaction were evaluated after the 2-week,4-week and 6-month after the last treatment.Results Compared with prior treatment,the facial lesions achieved complete response and improvement.The total effective rate of the observation group were 90.0％ (36/40) and 72.5％ (29/40) for the control group,the difference was statistically significant (P＜0.05).There were 2 cases of pigmentation occurred in observation group and 3 cases in control group.The complications including infection and hypertrophic scar were seldom occurred in the two groups.Conclusions The safety and efficacy of CO2 fractional laser combined with ALA-PDT are better than that with ALA-PDT only in the treatment of refractory flat wart.