ObjectiveTo explore the reasonable utilization of residual ear tissue after total ear reconstruction with total expansion method in patients with microtia of concha cavity, in order to obtain the best appearance.MethodsThe clinical data of 150 patients with microtia of concha cavity between January 2012 and January 2017 were retrospectively analyzed. There were 92 males and 58 females, with an average age of 11.1 years (range, 6.5-35.0 years). The shallow upper auriculocephalic angle was found after the first stage expander embedding and the second stage total expansion, and the third stage auricular reconstruction was carried out 6-12 months later. The residual earlobe was transferred through Z-plasty to reconstruct the lobe. An arc incision was made to release and deepen the upper auriculocephalic angle. And then a skin flap pedicled on the upper part of the residual ear was formed and then transferred to cover the wound on the auriculocephalic angle. The residual ear cartilage tissue flaps with subcutaneous tissue pedicle were inserted into the lacuna under the framework to increase the height of the scaffold. The remaining residual ear skin flaps were sutured to cover the wound of concha.ResultsA epidermis blister in diameter of 0.5 cm was found in 1 patient’s flap at 7 days after operation, and healed after 2 weeks of dressing change. The other patients’ flaps survived well. All the patients were followed up 6-12 months, with an average of 9.6 months. The auriculocephalic angle in the upper part of the reconstructed ear was obviously deepened, the height of the reconstructed ear was increased. The symmetry of the ears was better than before. The concha was not obviously contracted and the appearance of the reconstructed ear was satisfactory. The hair on the upper surface of the reconstructed ear decreased obviously, and the hairline around the ear moved up.ConclusionThe transfer of the upper residual auricular skin flap and residual auricular cartilage in patients with microtia of concha cavity can not only deepen the auriculocephalic angle, but also increase the height of the upper framework. The symmetry between the reconstructed auricle and the normal auricle is better than before.
ObjectiveTo investigate the mechanism of impeded wound healing by exogenous hyaluronan (HA). Methods Wound healing models were established on 18 adult rabbit ears, which were randomly divided into 3 groups, the 2% HA treated-group (group A), the 1% HA treated-group(group B), and the PBS control-group (group C). The process of wound healing was observed morphologically and histologically. The expression of α-smooth muscle actin in fibroblast was measured by immunohistochemical method. Results ①The mean values of wound healing time of groups A, B and C were (11.7±0.6), (11.3±0.6), and (10.8±1.0) days respectively. Wound contraction was greater in group C than in group A and group B. ②Compared with PBS controls, the collagen fibril was slender and arrayed regularly in HA treated wound. ③ The expression of α-smooth muscle actin was greater in group C than in groups A and B. Conclusion It is one of reasons of impeded wound healing that exogenous HA inhibits the expression of α-smooth muscle protein and wound contraction. There exists dose-dependant effect.
Objective To investigate whether there is an off-hours effect on the endovascular treatment (EVT) process for patients with acute ischemic stroke (AIS) after emergency admission to the hospital. Methods We retrospectively analyzed AIS patients who were admitted to the West China Hospital of Sichuan University on the stroke green channel between September 2019 and August 2023 and planned to perform emergency EVT. The patients were divided into working-hour and off-hour groups according to their admission time. The clinical information, door-to-puncture time (DPT), door-to-head/neck imaging time (DIT) and door-to-blood test time (DBT) of the two groups patients were compared, and subgroup analysis was conducted according to whether they arrived at the hospital at night, before and after the guideline update, and whether they were in the coronavirus disease 2019 epidemic period. Results A total of 586 AIS patients with large vessel occlusion were included, including 220 patients admitted during working hours and 336 patients admitted during off-working hours. There was no statistically significant difference in the basic information and EVT process time between patients admitted during working hours and patients admitted during off-working hours (P>0.05). Subgroup analysis showed that in patients admitted during off-working hours, there was no statistically significant difference in the basic information and EVT process time between patients arrived at the hospital at night and patients did not arrive at the hospital at night (P>0.05). Before and after the guideline updated, there was no statistically significant difference in the basic information and EVT process time between patients admitted during working hours and patients admitted during off-working hours (P>0.05). No matter whether it is in the coronavirus disease 2019 epidemic period, there was no statistically significant difference in the basic information and EVT process time between patients admitted during working hours and patients admitted during off-working hours (P>0.05). Conclusions There is no off-hours effect on the EVT process time after AIS patients arrive at the hospital. In the future, more stroke centers of different levels are needed to further explore the impact of off-hours effect on emergency diagnosis and treatment of AIS patients.
【Abstract】 Objective To investigate the angiogenesis in hypertropic scar tissue of rabbit ears at different periods and to explore a new method to prevent hyperplastic scar. Methods Nineteen Japanese white rabbits(weigthing 2.0-2.5 kg) were made animal models of hypertropic scar of ear. At 10th, 30th, 60th and 90 days, after epithel ization, the microvessel and microcirculation in hyperplastic scar of 8 rabbits were studied by microcirculation microscope and laser Doppler flowmetry. The other 11 rabbits’ right or left ears were randomly chosen into experimental group and control group. At 10 days after epithel ization,40 μL of adenovirus extracellular protein with metalloprotease and thrombospondin 1 domains (Ad-METH1) was injected into tissue of scar along the perimeter of the scar in experimental group. The same volume of empty adenovirus was injected in control group. After 30 days of injection, the gross appearance of 10 rabbits’ ears scar was recorded, the number of microvessel in scarwas counted and HE stainning of scar tissue was performed in experimental and control groups. One additional rabbit was used to evaluate the mRNA and protein expression of METH1 by RT-PCR and Western blot after 3 days of injection. R e sults The average number of microvessel at 10, 30, 60 and 90 days after epithel ization was 42.37 ± 3.89, 49.46 ± 4.13, 33.12± 4.34 and 13.24 ±2.31, respectively; the average value of microcirculatory perfusion at 10, 30, 60 and 90 days after epithetl ization was (37.75 ±2.11), (59.87 ± 6.46), (44.53 ± 6.14) and (29.21 ± 1.84)PU; the density of microvessels and perfusion of microcirculation in scar tissues during prol iferative stage (from 10 to 60 days after epithel ization) were markedly higher than that during mature period (90 days after epithel ization, P lt; 0.05).At 10 to 30 days after epithel ization, the histol igical features of scar showed early stage of prol iferation and prol iferative stage appearance; at 60 days after epithel ization, it is still in prol iferative stage, while some of scars were in mature phase; at 90 days after epithel ization, the histol igical features of scar were mature period appearance. At 3 days after Ad-METH1 injection, METH1 gene was successfully expressed at both mRNA and protein levels in experimental group, but not in control group. At 30 days after injection, the gross appearanceobservation showed that scars in experimental group were flat and soft with the color close to normal, but scars incontrol group were obvious and hard. The number of microvessel of scar tissue was 12.38±2.56 in experimental group and 48.12±6.46 in control group, showing statistically significant difference between two groups(P lt; 0.01). In experimental group, HE staining shows that the density of microvessel and the number of fibroblasts were greatly decreased and collagen fibers arranged regularly. In control group, plenty of fibroblasts and abundant microvessels were observed. Thick and tight collagen fibers were seen in the outer layer of dermis with a irregular arrangement. Conclusion Theanti-angiogenesis by Ad-METH1 may have a promising appl ication in the prevention of human hyperthropic scar.
【Abstract】 Objective To study the image of the muscular and cutaneous branches of supratrochlear artery by internal and external carotid angiography and to design the frontal flap for nasal reconstruction. Methods The muscular and cutaneous branches of supratrochlear artery of 30 adults were investigated through internal and external carotid angiography and three-dimensional reconstruction of vessels to explore the courses of branches of supratrochlear artery and their communication with supraorbital artery. According to image observation, the frontal flap was designed and used to perform nasal reconstruction in 11 cases of nasal defects, including 7 males and 4 females with an average age of 23 years (range, 15-48 years). The nasal defect ranged from 3.0 cm × 2.5 cm to 5.0 cm × 3.5 cm. Results Internal carotid angiography and three-dimensional imaging of the vessels showed that supratrochlear artery was found in 30 patients, with a diameter of (0.9 ± 0.6) mm. The superficial cutaneous branch appeared constantly with a diameter of (0.7 ± 0.3) mm. Deep muscular branch traveled among frontal muscle, with a diameter of (0.5 ± 0.5) mm and a length of (32.0 ± 6.2) mm, and it was missing in 4 patients, the branches communicated with each other and with supraorbital artery. All flaps survived with good appearance and without cartilage exposure. After 4 months to 3 years of follow-up, the postoperative aesthetic appearance and function of nasal tip, alar, and columella were satisfactory; the height and slope length of the external nose were moderate; and the reconstructed nose had good texture and normal ventilation function without constriction of naris. Conclusion Imaging studies support the fact that supratrochlear artery has constant cutaneous branch. The application of frontal flap pedicled with cutaneous branch can improve the effectiveness of nasal reconstruction.
ObjectiveTo investigate the blood pressure level and prevalence of hypertension in middle-aged people with positive family history of hypertension in Chengdu area, compare the differences between middle-aged people with positive family history of hypertension and middle-aged people with negative family history of hypertension, and explore the influencing factors of hypertension in middle-aged people with positive family history of hypertension.MethodsFrom September 2013 to March 2014, the stratified sampling method was used to survey 3 096 middle-aged people aged 40-59 years in Chengdu. Their height, weight, blood pressure, blood glucose, and blood lipids were measured. Questionnaire surveys were conducted using a uniformly designed questionnaire. The blood pressure levels and hypertension prevalences were compared between people with and without positive family history of hypertension. The influencing factors of hypertension in middle-aged people with positive family history of hypertension were analyzed using multiple logistic regression.ResultsThere were significant differences between the middle-aged people with positive family history of hypertension and the ones with negative family history of hypertension in systolic blood pressure [(137.4±22.4) vs. (118.0±11.3) mm Hg (1 mm Hg=0.133 kPa), P<0.001], diastolic blood pressure [(84.1±12.2) vs. (73.9±7.7) mm Hg, P<0.001], and prevalence of hypertension (28.6% vs. 22.2%, P<0.001). Ageing [odds ratio (OR)=1.107, 95% confidence interval (CI) (1.071, 1.144), P<0.001], monthly personal income ≥3 000 yuan [OR=1.566, 95%CI (1.003, 2.445), P=0.048], and abdominal obesity [OR=1.658, 95%CI (1.091, 2.520), P=0.018] were the risk factors for hypertension in middle-aged males with positive family history. Ageing [OR=2.257, 95%CI (1.202, 4.025), P=0.026] and overweight or obesity [OR=2.365, 95%CI (1.653, 3.385), P<0.001] were the risk factors, and physical exercise [OR=0.529, 95%CI (0.304, 0.918), P=0.024] was the protective factor for hypertension in middle-aged females with positive family history.ConclusionsThe prevalence of hypertension is high in middle-aged population with positive family history of hypertension in Chengdu and is significantly higher than that in the ones with negative family history of hypertension. Strengthening health education on hypertension-related knowledge, and reasonably controlling waist circumference and body weight may have positive significance in preventing or delaying the occurrence of hypertension in people with positive family history of hypertension.