Objective:To introduce a reliable and easy method of philtrum crest and philtrum repairing in secondary repair of cleft lip.Methods:Lift the upper lip flap after removing the scar on upper lip. Then the superficial orbicularis oris muscle was carefully separated, which formed the abnormal muscular eminence in the affected side after the first cleft lip repair. The pedicle of the orbicularis oris muscle the reconstructing philtrum crest. The lingual orbicularis oris muscle flap was lifted and curled from outside. The superficialorbicularis oris muscle was cut in philtrum longitudinally and turned outward. The two evertedorbicularisoris muscle flaps were sutured on both sides and fixed them on the reconstructing philtrum crest. The exposed deep orbicularis oris muscle in philtrum was sutured with the upper dermis, which formed the prominentphiltrum crest and deeper philtrum.Results:We reviewed the hospital records of patients from July 2008 to November 2021. In total, 201 patients were included in this study. All of these patients underwent the reconstruction of philtrum crest and philtrum with orbicularis oris muscle intertangling and philtrum plasty in secondary cleft lip repairing. During the treatment, the patients had no complications such as infection, hematoma and flap necrosis.198 patients were observed from 1 months to 36 months (7.8 months on average). All of them improved in different degrees in early postoperative period. Most reconstructed philtrum crest was raised and basically symmetrical with the contralateral side in shape. The philtrum was clear and the scar was not obvious. The reconstructed philtrum crest would decrease with time. 91.7% (90/98) patients were satisfied with the postoperative effects after three months.Conclusions:The method of reconstruction of philtrum crest and philtrum with orbicularis oris muscle intertangling and philtrum plasty in secondary cleft lip repairing is safe and effective. The long term postoperative effect is stable with high satisfaction as well. As a result, this method can be used as the philtrum crest and philtrum correction scheme for secondary cleft lip repairing.

Cognitive pre-rehabilitation can maintain and improve perioperative cognitive function and reduce postoperative neurocognitive disorders in elderly patients. This article will elaborate on the concept and pathogenesis of perioperative neurocognitive disorders and the content and existing shortcomings of cognitive pre rehabilitation, so as to provide references for the research and application of cognitive pre rehabilitation in elderly patients in China.

Objective:To explore the feasibility of CT angiography (CTA) in investigating vascular dilatation of anterior choroidal artery (AChA) and posterior communicating artery (PComA) in patients with Moyamoya syndrome (MMS).Methods:From July 2017 to July 2018, the clinical and imaging data of MMS patients with brain CTA and DSA performed were analyzed retrospectively. According to DSA results, 71 MMS patients were divided into unilateral MMS group (20 cases, 20 hemispheres) and bilateral MMS group (51 cases, 102 hemispheres). There were 20 cases in unilateral MMS group, 10 males and 10 females, with an average age of (45±9) years; 51 cases in bilateral MMS group, 24 males and 27 females, with an average age of (44±12) years. The hemispheres were divided into dilated group and non-dilated group according to the dilatation of AChA or PComA. Kappa analysis was used to evaluate the consistency of two inspection methods to judge the expansion of AChA. The lumen diameters of PComA, P1 and P2 segments of posterior cerebral artery were measured on CTA images, and the ratio of PComA/P1 and PComA/P2 were calculated. The repeatability of CTA measures was evaluated by intra-group correlation coefficient. Independent sample t-test was used to compare CTA measurement results between PComA dilated group and non-dilated group, and ROC curve was drawn to calculate the best threshold for diagnosis of PComA expansion. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CTA measures were calculated. Results:The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CTA diagnosis of AChA expansion inunilateral MMS were all 100.00%. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CTA diagnosis of AChA expansionin bilateral MMS were 90.00%, 93.90%, 93.14%, 78.26% and 97.47%. Compared with DSA, there was no significant difference in the diagnostic performance of AChA expansion between single and bilateral MMS diagnosed by CTA ( P>0.05). The two methods had strong consistency (Kappa value was 1.00 and 0.79 respectively, P<0.01). A total of 46 patients (69 cerebral hemispheres) were included in the evaluation of PComA. PComA/P1 (1.09±0.41) and PComA/P2 (0.86±0.13) in the dilated group were significantly higher than those in the non-dilated group (0.71±0.21 for PComA/P1 and 0.75±0.23 for PComA/P2). The differences were statistically significant ( t=-4.59, -2.50, P<0.05). The best threshold in diagnosing PComA expansion was 0.87 (PComA/P1) and 0.76 (PComA/P2), and the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 84.62%, 83.33%, 84.06%, 86.84%, 80.65% and 79.49%, 60.00%, 71.01%, 72.09% and 69.23%, respectively. Compared with DSA, the Kappa value of CTA measures in diagnosis of PComA expansion was 0.68 (PComA/P1) and 0.40 (PComA/P2), respectively, and the difference was statistically significant ( P<0.05). Conclusions:CTA has a strong consistency with DSA in evaluating the AChA expansion in MMS. When the PComA/P1 ratio on CTA is greater than 0.87, it can be used as the diagnosis criterion for PComA expansion.

OBJECTIVE To investigate the incidence rate of nasal septum fracture and it's influence on the effect of nasal bone reduction. METHODS Retrospective analysis of 212 cases of nasal fracture compared with nasal septum deviation were carried out. Among these cases 112 treated with nasal bone reduction only was called group A; the other cases were treated with nasal reduction concomitantly with septoplasty. Among them 58 cases were diagnosed with nasal septum fracture, it was called group B; 42 cases were diagnosed with nasal septum deviation, it was called group C. The postoperative nasal deformity rate was assessed, and the intraoperative findings of nasal septum contrast with preoperative CT diagnosis was analysed. RESULTS Three months after the operation, 27 cases (24.1%) of nasal deformity were found in group A; 9(9.0%) cases of nasal deformity were found in group B+C; septum fracture was found in 58 cases (100%) in group B and 30(71.8%) cases in group C introperatively. The diagnosis rate of nasal septum fracture by CT was 58.0%, while it's incidence rate was 88.0%. CONCLUSION More nasal septum fractures were observed introperatively than CT findings, and septoplasty concomitantly with nasal bone reduction can obviously reduce the rate of nasal deformity.

Objective To summary the microsurgical strategies and techniques of petroclival meningiomas by trans-subtemporal combined with suboccipital retrosigrnoid keyhole approaches to raise the removal rate and improve the prognosis.Methods The clinical data of consecutive 26 patients with petroclival meningiomas,admitted to our hospital from January 2011 to December 2015 and accepted microsurgical treatment,were reviewed retrospectively;7 of them were guided by neuronavigation,8 were performed under neuroelectrophysiological monitoring,and 11 were guided by neuronavigation combined intraoperative MRI or neuroelectrophysiological monitoring.The operative methods and techniques,tumor resection rate and Kamofsky performance scale (KPS) scores before and after operation were analyzed.Results Of all patients who underwent surgical treatment by trans-subtemporal combined with suboccipital retrosigmoid keyhole approaches,gross total tumor resection (Simpson Ⅰ-Ⅱ) was achieved in 23 patients (88.5％),subtotal (Simpson Ⅲ-Ⅳ) in 3 patients (1 1.5％).Six patients (23.1％) had cranial nerve deficit postoperatively.No mortality which related with operation was noted.Patients were followed up for 3-35 months,23 patients had KPS scores ≥70,and 3 patients had KPS ＜70;no tumor recurrence or progression was noted.Conclusion The trans-subtemporal combined with suboccipital retrosigmoid keyhole approaches are safe,effective and minimally invasive for resection of petroclival meningiomas;mastering the operation strategies and intraoperative skills is conducive to improve the efficacy of surgery.

Objective:With the development of modern skull base minimally invasive technology mature and neural radio surgery techniques,it is necessary to re-examine the therapeutic strategy for the treat-ment of petroclival meningiomas.To sum up the operative experience and methods in microsurgical resec-tion of petroclival meningiomas by the combining trans-subtemporal and suboccipital retrosigmoid keyhole approach.To explore the minimally invasive operation approach of petroclival meningiomas,to raise the removal degree and to improve the postoperative result using this approach.Methods:The clinical data of the consecutive 21 patients with the petroclival meningiomas were reviewed retrospectively.The meth-od,degree of tumor resection,techniques of the combining keyhole approach,Karnofsky performance score (KPS)before and after operation were also analyzed.The neuronavigation guided operation was performed in 9 cases,and 12 cases were operated in the neuroelectrophysiological monitoring.Results:Total excision of the tumor resection (Simpson,Ⅰ -Ⅱlevels)was conducted in 18 cases (85.7%,18 /21),and 3 patients underwent close resection (Simpson Ⅲ level,14.3%,3 /21).Postoperative three-dimensional CT showed good lock bone flap restoration;Postoperative pathology confirmed meningioma. Postoperative cranial nerve dysfunction or new original nerve dysfunction were aggravated in 5 cases (23.8%),including transient trochlear nerve (3 cases),abducent nerve (1 case),and the motor branch of trigeminal nerve paralysis (1 case).Abducent nerve paralysis (1 case)appeared,with hearing impairment.After the 3-month follow-up,11 cases had the same KPS aspreoperation,7 cases improved,and 3 cases not improved.The KPS score was 77.14 ±23.12 on average,and there was no statistically significant difference compared with that before operation (P >0.05 ).The postoperative follow-up for half a year showed fluent speaking and writing in 19 cases (KPS 70 or higher),and general recovery in 2 cases (KPS <70).The postoperative follow-up for 3 -29 months showed no tumor recur-rence or progress.Conclusion:The combining trans-subtemporal and suboccipital retrosigmoid keyhole approach is simple,safe,and minimally invasive,and an ideal operation approach of petroclival menin-gioma.To master the operation skills and the intraoperative matters needing attention in the operation,is favorable to improve the resection rate and curative effect.

A PP plastic film for food packaging (0. 1 mm) was prepared by adding two antioxidants of 2,6-di-tert-butyl-4-methyl-phenol(BHT) and pentaerythritol tetrakis ( 3-( 3, 5-di-tert-butyl-4-hydroxyphenyl ) propionate)(Irganox 1010) with different concentrations into polypropylene (PP) resin, then mixing extrusion granulate by the double screw plastic extruder and hot pressing the film at 190℃. The migration amount of the two antioxidants in food simulants (95% ethanol) was determined by high performance liquid chromatography (HPLC) with diode array detector (PDA) (detection wavelength is 282 nm). The migration of BHT was detected and Irganox 1010 was not detected. Based on the large amount of experimental data, the migration model was fitted by a software, then the migration model of antioxidant BHT was established, the applicability of the two migration model was compared with the actual data. The results showed that the fitting degree ( R2 ) of Weibull model to the actual migration result was greater than 0. 99 and better than Piringer model. It was found that there was a mathematical relationship as τ≈12. 2 ( L2/D) between parameters of Weibull model and Piringer model.

Objective To explore the feasibility of prediction of subacute infarct lesion volumes by processing ADC maps based on ADC cut-off values in patients with acute stroke.Methods MRI was performed in 20 patients with clinically diagnosed acute infarct less than 6 h after stroke onset.The MRI included a DWI and conventional MRI.The follow-up MR examinations of all the patients were carried out within 4-7 days after admission.The brain tissue, which showed abnormal high intensity both in DWI at the baseline and FLAIR at the reexamination , was regarded as the area of the initial ischemia core.Graphic-penumbra was regarded as the difference between initial DWI and follow-up FLAIR.The ADC values of the ischemia core, graphic-penumbra and the contralateral normal brain tissue , the relative ADC (rADC) were measured.The rADC value of the graphic-penumbra was defined as the ADC cut-off values.GE medical system based on ADC cut-off values was also tested in these patients to obtain ADC maps.The lesion volumes, the abnormal area seen on the DWI , ADC maps and follow-up FLAIR, were also measured.rADC values in different areas were analyzed by paired Student t test.Relationship between baseline DWI , ADC map and follow-up FLAIR was analyzed using Spearman rank-order correlation test , and Kruskal-Wallis H test was used to compare the volumes among three groups.Results Absolute ADC and rADC values gradually increased from the core to the periphery of the ischemic lesion.The absolute ADC values statistically differed from those on the contralateral side for both ischemia core and graphic-penumbra.The rADC values were significantly decreased in the ischemia core ( 0.620 ±0.116 ) compared with the graphic-penumbra values (0.809 ±0.097;t =8.083,P <0.01).The lesion volume of follow-up FLAIR [16.3 (4.7, 29.0) cm3 ] correlated highly with both volume predicted with the ADC map [13.5 (4.8, 25.4) cm3] (r=0.967, P<0.01) and baseline DWI volume [11.0 (4.4,30.4) cm3] (r=0.950, P<0.01).There was no difference between the volume of DWI , ADC map and follow-up FLAIR(H=0.168, P>0.05).Conclusions Data shows the high feasibility of prediction of subacute infarct lesion volumes by processing ADC maps based on ADC cut-off values in patients with acute stroke , without intravenous contrast material, and it provides a new method for outcome prediction.

OBJECTIVE: To report the experience of canalplasty in treatment of stenosis or atresia of the external auditory canal. METHOD: A retrospective review was performed on 10 patients (10 ears) that underwent canalplasty. The lesions located in bony segment in 1 case, cartilaginous segment in 3 cases, both in cartilaginous and bony segments in 6 cases, in which 4 cases accompanied with the middle ear diseases. All patients received the canalplasty surgery, and tympanoplasty was applied simultaneously if the patient had otitis media. RESULT: Follow-up was conducted for 8-50 months respectively, 8 of the external auditory canal was wide and tympanic membrane gained a good shape, 2 case had stenosis or atresia reoccurrence after the operation. CONCLUSION Appropriate approach and elimination of the lesions thoroughly are key points for the canalplasty.
Adult ; Aged ; Constriction, Pathologic ; surgery ; Ear Canal ; abnormalities ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

OBJECTIVETo construct a tissue-engineered skin flap using composite skin and adipose tissue constructed by adipose-derived stem cells(ASCs).

METHODSHuman ASCs isolated from adipose tissue were cultured and identified for their adipogenic, osteogenic and chondrogenic differentiation potentials. ASCs were then mixed with collagen gel for adipogenic induction and observed 15 days later with inverted microscope, oil-red O staining and HE staining. To construct the composite skin, keratinocytes and fibroblasts were isolated from human foreskin. The fibroblasts were mixed with collagen gel and cultured for 5 days, and keratinocytes were seeded on the gel for 4 days before transfer of the culture to air-liquid interface for culture for another 10 days. The adipose tissue and composite skin were then assembled according to the structure of normal skin and cultured for 3 days with HE staining observation.

RESULTSThe cultured ASCs were capable of adipogenic, osteogenic and chondrogenic differentiation, and adipogenic induction of the ASCs-gel complex for 15 days resulted in adipogenic differentiation of the ASCs in gel. The assembled tissue-engineered skin consisted of 3 layers, including a suprabasal layer formed by the stratified and differentiated keratinocytes, the middle layer and sublayer containing numerous cells, and a underlying sublayer formed by the adipogenic ASCs.

CONCLUSIONTissue-engineered skin flap can be constructed by assembling composite skin and adipose derived from cultured keratinocytes, fibroblasts, and ASCs.

Adipocytes ; cytology ; Adipose Tissue ; cytology ; Cell Culture Techniques ; Cells, Cultured ; Fibroblasts ; cytology ; Humans ; Keratinocytes ; cytology ; Stem Cells ; cytology ; Surgical Flaps ; Tissue Engineering