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.
Objective To explore the regulator factor of osteogenes is induced by the fibroblast in vitro so as to provide enough seeding cells for the bon e tissue engineering. Methods The fibroblasts were isolated and purified from granu lation of New Zealand rabbits, and they were incubated in the media offibronectin (FN) 10, 20, 40, 60 and 80 μg/ml, respectively, in the experimenta l grou ps 1- 5，but there was no FN in the control group. The markers for osteogenic features were investigated by fibroblast morphogenesis,calcium nodules formationratios,labeling of tetracycline fluorescence, labeling of 3H-TdR, determination of o steocaline, and labeling of 3H-proline within 2 weeks. Results The morphologic al changes of the fibroblasts were manifested as transference from a long spindle to a round or multiple form, shifted nucleus increased in number, confluenced and formed multilayered structure. There was a piling-up of calcium crystals that were gradually merged into foggy substances. The foggy substances increased and formed nodules. The calcium nodules formation ratios were as follows: 15.35％± 3.45％in the control group, and 53.73％± 9.49％, 75.21％± 9.80％, 98.34％± 15.2 0％, 61.83％± 10.04％, and 45.11％± 8.70％ in the experimental groups 1.5 ,respectively. There was a significant difference between the control group and the 5 experimental groups at 14 days (Plt;0.05), and a significant differenc e be tween the experimental group 3 and the other experimental groups at 14 days (Plt;0.05). The histochemical study on the nodules with the specific labeling of tet racycline fluorescence indicated that the nodules were composed of new bones. Conclusion Fibronectin can stimulate the fibroblast to prolifer ate, secrete osteocaline, and synthesize collagen fibrils. Fibronectin, in an optimal dose of 40 -60 μg/ml, is capable of inducing the fibroblast to form the bone.
With the development and improved availability of low-dose computed tomography (LDCT), an increasing number of patients are clinically diagnosed with lung cancer manifesting as ground-glass nodules. Although radical surgery is currently the mainstay of treatment for patients with early-stage lung cancer, traditional anatomic lobectomy and mediastinal lymph node dissection (MLND) are not ideal for every patient. Clinically, it is critical to adopt an appropriate approach to pulmonary lobectomy, determine whether it is necessary to perform MLND, establish standard criteria to define the scope of lymph node dissection, and optimize the decision-making process. Thereby avoiding over- and under-treatment of lung cancer with surgical intervention and achieving optimal results from clinical diagnosis and treatment are important issues before us.
ObjectiveTo elucidate the correlation between radiological tumor size (RTS) and pathological tumor size (PTS), and to evaluate the accuracy of clinical T staging. Methods Data on patients who underwent complete resection between September 2018 and June 2019 were retrospectively collected. The correlation between RTS and PTS was analyzed by and we assessed the agreement between clinical and pathologic T staging. Results Finally, 1 880 patients were included. There were 778 males and 1 102 females at average age of 57±11 years. In the entire cohort, the RTS and PTS was 19.1±13.5 mm and 17.7±14.0 mm, respectively (P<0.001). The RTS and PTS showed a strong linear correlation with the Pearson’s correlation coefficient calculated as 0.897. The mean RTS was significantly larger than PTS (P<0.001) in tumors≤3 cm, but significantly smaller in tumors>4 cm. The overall concordance rate between clinical and pathological T staging was 65.6%. Clinical staging failed to detect T4 disease in 29.4% (5/17) of patients. Male patients and the presence of cavities within nodules were independent significant factors leading to inaccurate clinical T staging. Conclusions The correlation between the tumor sizes measured on thin-section computed tomography and pathologic specimens varies with the real tumor size. Methods and techniques for improving clinical T staging accuracy is in urgent need.
Along with the popularity of low-dose computed tomography lung cancer screening, an increasing number of early-stage lung cancers are detected. Radical lobectomy with systematic nodal dissection (SND) remains the standard-of-care for operable lung cancer patients. However, whether SND should be performed on non-metastatic lymph nodes remains controversy. Unnecessary lymph node dissection can increase the difficulty of surgery while also causing additional surgical damage. In addition, non-metastatic lymph nodes have been recently reported to play a key role in immunotherapy. How to reduce the surgical damage of mediastinal lymph node dissection for early-stage lung cancer patients is pivotal for modern concept of "minimally invasive surgery for lung cancer 3.0". The selective mediastinal lymph node dissection strategy aims to dissect lymph nodes with tumor metastasis while preserving normal mediastinal lymph nodes. Previous studies have shown that combination of specific tumor segment site, radiology and intraoperative frozen pathology characteristics can accurately predict the pattern of mediastinal lymph node metastasis. The personalized selective mediastinal lymph node dissection strategy formed from this has been successfully validated in a recent prospective clinical trial, providing an important basis for early-stage lung cancer patients to receive more personalized selective lymph node dissection with "precision surgery" strategies.
Recently, an editorial in Cell Research illuminated the concept of the curative time window for lung adenocarcinoma. Within this window, patients could achieve 100.0% 5-year or 10-year post-operative recurrence-free survival. Adenocarcinoma in situ and minimally invasive adenocarcinoma in pathology, as well as pure ground-glass opacity in radiology could be regarded as the curative time window. However, not all the patients can catch this time window. A precise understanding of this concept helps elevate the curative rate for lung cancer patients and mitigate the risks of overdiagnosis and overtreatment. This article delves into the accurate comprehension of the surgical curative time window for lung adenocarcinoma, proposed a clinical strategy for early-stage lung adenocarcinoma, and introduced clinical procedures comprising of this time window. It offers fresh insights into the timing of surgical interventions for lung adenocarcinoma.
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.
Objective To evaluate the current status of classification and repair methods for dural injury caused by spinal surgery or trauma, providing new strategies and ideas for the clinical repair of dural injury and the development of related materials. MethodsThe literature related to dural injury both at home and abroad in recent years was thoroughly reviewed and analyzed in order to draw meaningful conclusions. ResultsThere have been numerous retrospective studies on dural injury, but there is a scarcity of prospective and multi-center studies, resulting in a low level of evidence-based research. The incidence and risk factors of dural injury have primarily been studied in relation to common degenerative spinal diseases of the cervical and lumbar spine, with insufficient research on thoracic spine-related diseases. Currently, a universally recognized method for grading and classifying dural injury has not been established, which hampers the development of clinical guidelines for their repair. Furthermore, although there are repair materials and surgical strategies available to address clinical issues such as suture leakage and surgical repair of dural injury in complex locations, there is a lack of comprehensive clinical research and evidence-based data to validate their scientificity and reliability. ConclusionRegardless of the classification of dural injury, suture remains the most important repair method. It is important to further develop new patches or sealants that can meet clinical needs and reduce the difficulty of repair.
Cardiotocography (CTG) is a commonly used technique of electronic fetal monitoring (EFM) for evaluating fetal well-being, which has the disadvantage of lower diagnostic rate caused by subjective factors. To reduce the rate of misdiagnosis and assist obstetricians in making accurate medical decisions, this paper proposed an intelligent assessment approach for analyzing fetal state based on fetal heart rate (FHR) signals. First, the FHR signals from the public database of the Czech Technical University-University Hospital in Brno (CTU-UHB) was preprocessed, and the comprehensive features were extracted. Then the optimal feature subset based on the k-nearest neighbor (KNN) genetic algorithm (GA) was selected. At last the classification using least square support vector machine (LS-SVM) was executed. The experimental results showed that the classification of fetal state achieved better performance using the proposed method in this paper: the accuracy is 91%, sensitivity is 89%, specificity is 94%, quality index is 92%, and area under the receiver operating characteristic curve is 92%, which can assist clinicians in assessing fetal state effectively.