Maternal Common Cold or Fever During Pregnancy and the Risk of Orofacial Clefts in the Offspring: A Systematic Review and Meta-analysis.

The common cold and/or an associated fever during pregnancy have/has been suspected to harm the developing fetus. We sought possible correlations between a maternal common cold or fever during pregnancy and the risk of orofacial clefts in the offspring.We systematically searched PubMed and Embase using appropriate keywords, and we checked the reference lists of retrieved articles. We used random-effects models to estimate overall relative risks.Incidence of orofacial clefts.We included 13 case-control studies. Modest but statistically significant associations were found between a maternal common cold and cleft lip with or without a cleft palate (CL/CP) (odds ratio [OR] 2.17; 95% confidence interval [CI] 1.66-2.83) and a cleft palate only (CPO) (OR 3.08; 95% CI 1.5-6.34). Furthermore, maternal fever was also associated with an increased risk of CL/CP (OR 1.91, 95% CI 1.3-2.8) and CPO (OR 1.48, 95% CI 0.83-2.63) in the offspring. Further analyses of maternal influenza (alone) yielded similar results.Although evidence of heterogeneity should be carefully evaluated, our findings suggest that maternal common cold or fever during pregnancy may be associated with a greater risk of CL/CP or CPO in the offspring. Future cohort studies using valid assessments of maternal common cold exposure during pregnancy that consider the severity of fever are needed to clarify the contribution of maternal common cold or fever status to the risk of orofacial clefts in children.

Yinzhihuang attenuates ANIT-induced intrahepatic cholestasis in rats through upregulation of Mrp2 and Bsep expressions.

BACKGROUND: The treatment of intrahepatic cholestasis has been limited, and development of an effective drug is needed. Clinical studies have shown that Yinzhihuang (YZH), a traditional Chinese decoction, enhances bilirubin clearance. The goal of this study was to determine the protective effect of YZH on experimental intrahepatic cholestasis in young rats and to explore its underlying molecular mechanisms. METHODS: Intrahepatic cholestasis in rats was induced by α-naphthylisothiocyanate (ANIT) on days 1 and 8. The rats received YZH, ursodeoxycholic acid (UDCA), or vehicle for 9 d and were killed on either day 3 or day 10. Serum biomarkers, liver histology, and the distribution of protein and mRNA expression of Mrp2 and Bsep were analyzed. RESULTS: YZH treatment resulted in decreased levels of serum biomarkers except γ-glutamyl transpeptidase, attenuated liver histological injuries, increased protein expressions of Mrp2 and Bsep, and upregulated expressions of Mrp2 and Bsep mRNAs. The effects of YZH on serum biomarkers (aminotransferase, alanine aminotransferase, and direct bilirubin), liver histology, and Mrp2 mRNA expressions were significantly greater and earlier than those of UDCA. CONCLUSION: Our results suggest that YZH has protective effect against ANIT-induced intrahepatic cholestasis in rats, through upregulation of Mrp2 and Bsep expressions.

Short-term effects of meteorological factors on pediatric hand, foot, and mouth disease in Guangdong, China: a multi-city time-series analysis.

BACKGROUND: Literature shows inconsistency in meteorological effects on Hand, foot, and mouth disease (HFMD) in different cities. This multi-city study aims to investigate the meteorological effects on pediatric HFMD occurrences and the potential effect modification by geographic factors. METHODS: Based on daily time-series data in eight major cities in Guangdong, China during 2009-2013, mixed generalized additive models were employed to estimate city-specific meteorological effects on pediatric HFMD. Then, a random-effect multivariate meta-analysis was conducted to obtain the pooled risks and to explore heterogeneity explained by city-level factors. RESULTS: There were a total of 400,408 pediatric HFMD cases (children aged 0-14 years old) with an annual incidence rate of 16.6 cases per 1,000 children, clustered in males and children under 3 years old. Daily average temperature was positively associated with pediatric HFMD cases with the highest pooled relative risk (RR) of 1.52 (95 % CI: 1.30-1.77) at the 95th percentile of temperature (30.5 °C) as compared to the median temperature (23.5 °C). Significant non-linear positive effects of high relative humidity were also observed with a 13 % increase (RR = 1.13, 95 % CI: 1.00-1.28) in the risk of HFMD at the 99th percentile of relative humidity (86.9 %) as compared to the median value (78 %). The effect estimates showed geographic variations among the cities which was significantly associated with city's latitude and longitude with an explained heterogeneity of 32 %. CONCLUSIONS: Daily average temperature and relative humidity had non-linear and delayed effects on pediatric HFMD and the effects varied across different cities. These findings provide important evidence for comprehensive understanding of the climatic effects on pediatric HFMD and for the authority to take targeted interventions and measures to control the occurrence and transmission of HFMD.

The impact of relative humidity and atmospheric pressure on mortality in Guangzhou, China.

OBJECTIVE: Although many studies have examined the effects of ambient temperatures on mortality, little evidence is on health impacts of atmospheric pressure and relative humidity. This study aimed to assess the impacts of atmospheric pressure and relative humidity on mortality in Guangzhou, China. METHODS: This study included 213,737 registered deaths during 2003-2011 in Guangzhou, China. A quasi-Poisson regression with a distributed lag non-linear model was used to assess the effects of atmospheric pressure/relative humidity. RESULTS: We found significant effect of low atmospheric pressure/relative humidity on mortality. There was a 1.79% (95% confidence interval: 0.38%-3.22%) increase in non-accidental mortality and a 2.27% (0.07%-4.51%) increase in cardiovascular mortality comparing the 5th and 25th percentile of atmospheric pressure. A 3.97% (0.67%-7.39%) increase in cardiovascular mortality was also observed comparing the 5th and 25th percentile of relative humidity. Women were more vulnerable to decrease in atmospheric pressure and relative humidity than men. Age and education attainment were also potential effect modifiers. Furthermore, low atmospheric pressure and relative humidity increased temperature-related mortality. CONCLUSION: Both low atmospheric pressure and relative humidity are important risk factors of mortality. Our findings would be helpful to develop health risk assessment and climate policy interventions that would better protect vulnerable subgroups of the population.

Microsurgical correction of progressive facial hemiatrophy using free anterolateral thigh adipofascial flap.

BACKGROUND: The etiology of progressive facial hemiatrophy is unclear according to resent research. The diseases lack effective treatments. The purpose of this study was to introduce a technique that restores the cosmetic amelioration effectively using free anterolateral thigh adipofascial flap through anastomosis. METHODS: From September 1999 to June 2011, a total of 14 patients were subjected to correction with revascularized free anterolateral thigh adipofascial flaps at the first stage. Some of them performed additional procedures, such as dermal fat flap filling, lipoinjection, liposuction, and thinning of the flap, were used for secondary minor deformities after the first-stage operation. The donor sites were closed primarily without skin grafting or other flap transplantation. RESULTS: All of the flaps survived, and the effect is stable during the follow-ups. Patients were quite satisfied with the symmetry and plumpness of the reconstructed faces. The donor sites were sutured directly and healed at the first stage; there were no obvious morbidities and dysfunctions. CONCLUSIONS: The anterolateral thigh adipofascial flap can provide adequate tissue with reliable blood supply, pliability, ease of revision, and minimal morbidity and dysfunction at the donor site. It is a safe, stable, and effective technique for hemifacial atrophy.

[Application of melanocytes and bone marrow mesenchymal stem cells in tissue engineered skin construction].

OBJECTIVE: To explore the method of constructing tissue-engineered skin using melanocytes and bone marrow mesenchymal stem cells (BMSCs) in vivo. METHODS: Melanocytes were isolated from human foreskin. BMSCs were isolated from human bone marrow. Both of them were co-cultured at a ratio of 1:10, and then were implanted into the collagen membrane to construct the tissue-engineered skin, which was applied for wound repair in nude mice. The effectiveness of wound repair and the distribution of melanocytes were evaluated by morphological observation, in vivo 4,6-diamidino-2-phenylindole, dihydrochloride (DAPI) fluorescent staining tracing, HE staining, S-100 immunohistochemistry, and transmission electron microscopy. RESULTS: The wounds were satisfactorily repaired among the nude mice. The melanocytes were distributed in the skin with normal structure, as confirmed by DAPI fluorescent staining tracing, HE staining, S-100 immunohistochemistry, and transmission electron microscopy. CONCLUSION: Melanocytes and BMSCs, after proper in vitro culture at an appropriate ratio, can construct the tissue-engineered skin with I type collagen membrane.

Anterolateral thigh adipofascial flap for correction of facial contour deformities and micromastia.

The anterolateral thigh (ALT) flap has gained popularity, yet the donor site remains problematic. With increased knowledge of the vascular anatomy, we anticipated that we would be able to contour the ALT adipofascial flap when reconstructing facial deformities and micromastia without sacrificing skin at the donor site. A total of 24 cases of hemifacial atrophy and 1 case of micromastia underwent anterolateral thigh adipofascial flap transplantation with vascular anastomosis. All surgical reconstructions resulted in satisfactory results with minimal donor-site morbidity. The anterolateral thigh adipofascial perforator flap is an ideal choice for autologous tissue reconstruction with primary defatting.

Clinical application of the anterolateral thigh flap for soft tissue reconstruction.

The purpose of this article is to describe the author's experience using the anterolateral thigh (ALT) flap for the reconstruction of a variety of soft tissue defects. The flap utility and donor site morbidity were evaluated in 126 cases from March 1985 to August 2007. The ALT flaps were harvested as either free fasciocutaneous, free adipofascial, fasciocutaneous island, or reversed fasciocutaneous island flaps to repair facial, neck, breast, trunk, and extremity defects. In 40 cases (32%), the skin vessels were found to be septocutaneous perforators, and in 86 cases (68%), they were found as musculocutaneous perforators. Of the 126 flaps, 121 survived completely, providing a success rate of 96.0%. There were four cases undergoing multidetector-row computed tomographic angiography (CTA) for preoperative perforator mapping, and all perforators were confirmed intraoperatively. In conclusion, the ALT flap is a versatile and reliable flap that could well be a priority option for soft tissue reconstruction. CTA can provide more valuable and accurate anatomic information about the pedicle and perforators, making it safer and faster to harvest a targeted ALT perforator flap with less donor site morbidity.

[Application of ultrasonography in the detection of nasal interdomal fat pad].

OBJECTIVE: To evaluate the application of ultrasonography in the detection of nasal interdomal fat pad (IFP). METHODS: Thirty-eight patients who underwent open rhinoplasty and other surgeries in our hospital were enrolled in this study. All patients were studied by ultrasonography to evaluate the shape, structure, size, and location of IFP. The results of ultrasonography were compared with intraoperative findings. RESULTS: The boundaries between IFP and the subcutaneous fat were clear under ultrasonography in 32 patients (84.2%), but were not clear in 6 patients (15.8%) who had undergone injection rhinoplasty (n=2) or augmentation rhinoplasty (n=4). As shown by ultrasonography,the average length,width,and height of IFP were (11.81∓1.28) mm, (2.49∓0.57) mm, and (1.90∓0.61) mm, respectively,which were not significantly different between male and female patients (P>0.05). In addition, the length, width, and height of IFP were significantly larger in nasorostral hypertrophy group than in normal group (P0.05). CONCLUSION: Ultrasonography can accurately evaluate the size and morphology of IFP pre-operatively, and therefore is helpful to ensure the success of rhinoplasty.

Pediatric living donor liver transplantation decade progress in Shanghai: Characteristics and risks factors of mortality.

BACKGROUND: Pediatric living donor liver transplantation (LDLT) has become the gold standard for patients with end-stage liver disease. With improvements in organ preservation, immunosuppression, surgical and anesthesia techniques, the survival rates and long-term outcomes of patients after LDLT have significantly improved worldwide. However, data on anesthetic management and postoperative survival rate of pediatric LDLT in China are rare. AIM: To review the status of pediatric LDLT in Shanghai and investigate the factors related to anesthetic management and survival rate in pediatric LDLT. METHODS: We conducted a retrospective observational study to investigate the status of pediatric LDLT in Shanghai by reviewing 544 records of patients who underwent pediatric LDLT since the first operation on October 21, 2006 until August 10, 2016 at Renji Hospital and Huashan Hospital. RESULTS: The 30-d, 90-d, 1-year, and 2-year survival rates were 95.22%, 93.38%, 91.36%, and 89.34%, respectively. The 2-year patient survival rate after January 1, 2011 significantly improved compared with the previous period (74.47% vs 90.74%; hazard ratio: 2.92; 95% confidence interval (CI): 2.16-14.14; P = 0.0004). Median duration of mechanical ventilation in the intensive care unit (ICU) was 18 h [interquartile range (IQR), 15.25-20.25], median ICU length of stay was 6 d (IQR: 4.80-9.00), and median postoperative length of stay was 24 d (IQR: 18.00-34.00). Forty-seven (8.60%) of 544 patients did not receive red blood cell transfusion during the operation. CONCLUSION: Pediatric end-stage liver disease (PELD) score, anesthesia duration, operation duration, intraoperative blood loss, and ICU length of stay were independent predictive factors of in-hospital patient survival. Pediatric end-stage liver disease score, operation duration, and ICU length of stay were independent predictive factors of 1-year and 3-year patient survival.

Treatment of divided eyelid nevus with island skin flap: report of ten cases and review of the literature.

PURPOSE: Three different techniques used in 10 cases of divided eyelid nevus and the results are reported and discussed. METHODS: A retrospective study of 10 patients who had undergone treatment of divided eyelid nevus with skin flap between March 2003 and March 2008 was conducted. According to the location, shape, and size of the upper and lower eyelids nevus orbicularis oculi musculocutaneous flap, postauricular superficial musculoaponeurotic system (SMAS)-pedicled flap, or reversal superficial temporal artery (STA) flap was designed to repair the eyelid defects. RESULTS: Ten patients were treated in this series with 10 oculi musculocutaneous flaps, 3 postauricular SMAS-pedicled flaps, and 3 reversal STA flaps. One postauricular SMAS-pedicled flap and 1 reversal STA flap showed distal flap venous refluence (reflux) obstruction and partial epidermal necrosis in the early postoperative stage, but after active treatment, they healed well and needed no surgical revision. All the other flaps survived well. Four flaps showed slight trapdoor deformation needing no revision. No other complication developed during the follow-up periods of 6 to 36 months. All the donor sites were closed directly and healed well with inconspicuous scarring. This series has exhibited satisfactory cosmetic and functional results. CONCLUSIONS: Treating divided eyelid nevus with well-selected skin flaps is satisfying with excellent color and texture matching, normal eyelid function, and inconspicuous donor deformity.

Determination of residual acrylamide in medical polyacrylamide hydrogel by high performance liquid chromatography tandem mass spectroscopy.

OBJECTIVE: To determine residual acrylamide in medical polyacrylamide hydrogel by high performance liquid chromatography tandem mass spectroscopy (HPLC-MS). METHODS: After (13)C3 labeled acrylamide was added, the sample was extracted with water and then cleaned up with Extrelut 20. The polyacrylamide hydrogel sample and 20 clinical cases were analyzed by HPLC-MS/MS and isotope dilution quantifying technique in selected reaction monitoring (SRM) mode. RESULTS: Acrylamide was separated from polyacrylamide hydrogel. The concentration of acrylamide in polyacrylamide hydrogel ranged from 3.9 x 10(-9) to 3.1 x 10(-8) g/L in the 20 clinical cases. The peak area was favorable linear and the range was up to 3000 microg/L. The recovery rate was 103.1% with a relative standard deviation (RSD) of 6.20%, when the mark level was 50 microg/L. CONCLUSION: HPLC-MS is a rapid, accurate, and sensitive method for the determination of residual acrylamide in medical polyacrylamide hydrogel.

Surgical strategy for congenital blepharophimosis syndrome.

BACKGROUND: So far, most of the surgical techniques for congenital blepharophimosis syndrome are two-stage procedures. In this study, we investigated a modified one-stage procedure to reduce the suffering of patients. METHODS: From 2003 to 2005, we adopted an one-stage technique combining blepharoptosis correction with medial canthoplasty in 16 patients with congenital blepharophimosis syndrome (10 male, 6 female; aged from 6 to 21). All the patients had bilateral severe blepharoptosis, epicanthus inversus, and flat dorsum nasi. The movement of the upper lid was 0 to 3 mm, vertical length of the eye fissure 2 to 4 mm, horizontal length 13 to 22 mm, and the distance between the eyes was 35 to 39 mm. The patients were followed up for one half to 2 years after the operation. RESULTS: In all the patients, after the operation, the horizontal length of the eyelid > 25 mm, the vertical length > 6 mm. and the distance between the eyes < 35 mm. The appearance of their double eyelids was satisfying. CONCLUSION: The modified one-stage technique combining blepharoptosis correction with medial canthoplasty can achieve favorable outcomes for patients with congenital blepharophimosis syndrome.

[Application of breast conservative therapy in breast cancer patients with nipple discharge].

OBJECTIVE: To study the feasibility of breast conserving treatment in breast cancer patients with nipple discharge. METHODS: Retrospective analysis were carried out in 7 cases of breast cancer patients with nipple discharge who were treated by central segmental resection with latissimus dorsi myocutaneous transfer. RESULTS: No flap necrosis is happened, and cosmetic outcome was excellent in all 7 patients. Average follow-up was 7 months, there was no local recurrence and distant metastasis. CONCLUSION: Central segmental resection with latissimus dorsi myocutaneous transfer as the local treatment strategy for breast cancer patients with nipple discharge is feasible and safe.

[Vulvar form reconstruction in extended radical vulvectomy of vulvar carcinoma].

OBJECTIVE: To evaluate the method of vulvar reconstruction after extended vulvectomy. METHODS: Retrospectively, fourteen cases of vulva carcinoma were treated by radical wide local excision, and the defects were repaired with anterolateral thigh flap and inferior pedicle rectus abdominal myocutaneous flap. After the flap was harvested, it was put on the defect through the tunnel between the donor and the recipient site and the vulvae was reconstructed. RESULTS: All the flaps were survived except 1 anterolateral thigh flap with partial necrosis. One patient was infected at the groin incision but the flap and the grafted skin were survived. The patients were treated with change of the dressing and recovered after skin grafting. All other incisions were healed with first intention. The partial necrosis area was about 4 cm x 6 cm, it healed at 36 postoperative days after free skin grafting. The reconstructed vulvae were plump and elastic. It appeared like the normal vulvae and there was no contraction of the vagina. CONCLUSIONS: Vulvar reconstruction with the anterolateral thigh flap and rectus abdominal flaps after the radical vulvectomy could make the patients recover easily. It produces almost normal appearance and function of the vulvae, reduces the time of wound healing. The patient could have the next therapy more quickly and the quality of life improves. It has wide application value in clinics.

Reconstruction of distal foot wounds with reverse first dorsal metatarsal artery flap.

Reconstruction of the distal portion of the foot has always represented a difficult problem in plastic surgery. We report a distally based dorsalis pedis island flap based on the first dorsal metatarsal artery, which has been successfully used to treat the distal portion of the foot in eight patients. The size of flaps ranged from 3 cm x 4 cm to 6 cm x 7 cm. In seven patients, the transferred flaps survived completely and in one flap there was superficial marginal necrosis. There was no donor site morbidity. All the patients had no difficulty in wearing shoes and were walking within 6 weeks. We suggest that the reverse first dorsal metatarsal artery flaps is a good option to reconstruct the wound of distal foot.

[Repairment of the large wound of endometriosis in the abdominal wall].

OBJECTIVE: To explore the plastic surgical repairment of the large wound of endometriosis in the abdominal wall. METHOD: Since March 2003 to December 2004, 6 patients were treated with abdominoplasty and V-Y plasty for the wounds of the endometriosis in the abdominal wall. RESULTS: The endometriotic foci were removed thoroughly with pretty abdominal contour. No complications were observed. CONCLUSION: Abdominoplasty and V-Y plasty are good methods to repair the wounds of the endometriosis in the abdominal wall.

Reduction mammaplasty and correction of ptosis: dermal bra technique.

A new technique for reduction mammaplasty or mastopexy techniques is presented, which the authors call the dermal bra. The surgical steps are described point by point. A series of 36 patients underwent reduction mammaplasty or mastopexy by means of this technique from January of 1998 to April of 2001. Thirty-two patients were followed; 28 presented satisfactory results, including a good mammary appearance, invisible scar, good and stable breast projection, and lasting results. Nipple-areola complex sensitivity was unchanged in all 32 patients. The overall complication rate was 12.5 percent (one patient suffered purse-string suture exposure, and three had a cutaneous rend). The advantages and disadvantages of this technique are discussed.