Bio-orthogonal engineered peptide: A multi-functional strategy for the gene therapy of osteoporotic bone loss.

Osteoporosis is a degenerative disease affecting millions of elderly people globally and increases the risk of bone fractures due to the reduced bone density. Drugs are normally prescribed to treat osteoporosis, especially after surgical treatment of osteoporotic fractures. However, many anti-osteoporotic drugs produce deleterious side effects. The recent development of gene therapy utilizing oligonucleotides (ONs) has spurred the development of new therapies for osteoporosis. Nevertheless, most ONs lack the capability of cell penetration and lysosome escape and hence, intracellular delivery of ON remains a challenge. Herein, a novel strategy is demonstrated to efficiently deliver ON to cells by combining ON with the cell-penetrating peptide (CPP) via the bio-orthogonal click reaction. Several dopamine (DOPA) groups are also introduced into the fabricated peptide to scavenge intracellular reactive oxygen species (ROS). Owing to favorable properties such as good cytocompatibility, cell penetration, lysosome escape, ROS scavenging, and osteoclastogenesis suppression, the hybrid CPP-DOPA-ON peptide improves the osteoporotic conditions significantly in vivo even when bone implants are involved. This strategy has great potential in the treatment of osteoporosis and potentially broadens the scope of gene therapy.

Dose-Dependent Effects in Plasma Oncotherapy: Critical In Vivo Immune Responses Missed by In Vitro Studies.

Cold atmospheric plasma (CAP) generates abundant reactive oxygen and nitrogen species (ROS and RNS, respectively) which can induce apoptosis, necrosis, and other biological responses in tumor cells. However, the frequently observed different biological responses to in vitro and in vivo CAP treatments remain poorly understood. Here, we reveal and explain plasma-generated ROS/RNS doses and immune system-related responses in a focused case study of the interactions of CAP with colon cancer cells in vitro and with the corresponding tumor in vivo. Plasma controls the biological activities of MC38 murine colon cancer cells and the involved tumor-infiltrating lymphocytes (TILs). In vitro CAP treatment causes necrosis and apoptosis in MC38 cells, which is dependent on the generated doses of intracellular and extracellular ROS/RNS. However, in vivo CAP treatment for 14 days decreases the proportion and number of tumor-infiltrating CD8+T cells while increasing PD-L1 and PD-1 expression in the tumors and the TILs, which promotes tumor growth in the studied C57BL/6 mice. Furthermore, the ROS/RNS levels in the tumor interstitial fluid of the CAP-treated mice are significantly lower than those in the MC38 cell culture supernatant. The results indicate that low doses of ROS/RNS derived from in vivo CAP treatment may activate the PD-1/PD-L1 signaling pathway in the tumor microenvironment and lead to the undesired tumor immune escape. Collectively, these results suggest the crucial role of the effect of doses of plasma-generated ROS and RNS, which are generally different in in vitro and in vivo treatments, and also suggest that appropriate dose adjustments are required upon translation to real-world plasma oncotherapy.

Nanostructured Conductive Polypyrrole for Antibacterial Components in Flexible Wearable Devices.

The power generated by flexible wearable devices (FWDs) is normally insufficient to eradicate bacteria, and many conventional antibacterial strategies are also not suitable for flexible and wearable applications because of the strict mechanical and electrical requirements. Here, polypyrrole (PPy), a conductive polymer with a high mass density, is used to form a nanostructured surface on FWDs for antibacterial purposes. The conductive films with PPy nanorods (PNRs) are found to sterilize 98.2 ± 1.6% of Staphylococcus aureus and 99.6 ± 0.2% of Escherichia coli upon mild electrification (1 V). Bacteria killing stems from membrane stress produced by the PNRs and membrane depolarization caused by electrical neutralization. Additionally, the PNR films exhibit excellent biosafety and electrical stability. The results represent pioneering work in fabricating antibacterial components for FWDs by comprehensively taking into consideration the required conductivity, mechanical properties, and biosafety.

Subjective and Objective Evaluation of Speech in Adult Patients With Repaired Cleft Palate.

OBJECTIVE: To explore the speech outcomes of adult patients with repaired cleft palate through subjective perception evaluation and objective acoustic analysis, and to compare the differences in pronunciation characteristics between speakers with complete velopharyngeal closure (VPC) and velopharyngeal insufficiency (VPI) patients. PARTICIPANTS AND INTERVENTION: Subjective evaluation indicators included speech intelligibility, nasality and consonant missing rate, for objective acoustic analysis, we used speech sample normalization and objective acoustic parameters included normalized vowel formants, voice onset time and the analysis of 3-dimensional spectrogram and spectrum, were carried out on speech samples produced by 3 groups of speakers: (a) speakers with velopharyngeal competence after palatorrhaphy (n=38); (b) speakers with velopharyngeal incompetence after palatorrhaphy (n=70), (c) adult patients with cleft palate (n=65) and (d) typical speakers (n=30). RESULTS: There was a highly negative correlation between VPC grade and speech intelligibility (ρ=-0.933), and a highly positive correlation between VPC and nasality (ρ=0.813). In subjective evaluation, the speech level of VPI patients was significantly lower than that of VPC patients and normal adults. Although the nasality and consonant loss rate of VPC patients were significantly higher than that of normal adults, the speech intelligibility of VPC patients was not significantly different from that of normal adults. In acoustic analysis, patients with VPI still performed poorly compared with patients with VPC. CONCLUSIONS: The speech function of adult cleft palate patients is affected by abnormal palatal structure and bad pronunciation habits. In subjective evaluation, there was no significant difference in speech level between VPC patients and normal adults, whereas there was significant difference between VPI patients and normal adults. The acoustic parameters were different between the 2 groups after cleft palate repair. The condition of palatopharyngeal closure after cleft palate can affect the patient's speech.

Effect of Sleep Position on Sleep-Disordered Breathing in Young Children With Unrepaired Incomplete Cleft Palates.

Children with cleft lip/palate are usually faced with upper airway problems after surgical repair. The severity of upper airway obstruction is more likely associated with the age and preoperative diagnosis of obstructive sleep apnea (OSA). This study aimed to investigate the severity of OSA in toddlers before palatoplasty from the perspective of polysomnography. In this retrospective cohort study, 97 children with unrepaired cleft palate and habitual prone sleeping were identified with a mean age of 1.6 years (SD 0.6) and divided into 2 age groups (1.5 year or younger and older than 1.5 year). Detailed information was collected including demographics, sleep parameters, and respiratory disturbances. Polysomnography results showed these children were at high risks of OSA with averagely moderate severity at night during their early childhood [apnea-hypopnea index 7.2±3.2 events/hour; obstructive apnea index (OAI) 6.5±2.8 events/hour]. Positional OAI was greatly lower in prone than that in laterals or in supine. Far more sleep time was spent in prone than in supine (42.9%±42.2% versus 8.5%±15.7%), which were consistent with parental reporting of prone sleeping habits. There were no significant differences found between the 2 age groups in respiratory disturbances such as apnea-hypopnea index, OAI, mean oxygen saturation, and nadir oxygen saturation ( P =0.097-0.988). Thus, prone sleeping with a history of snoring might be indicators for early screening for OSA in the cleft population. Adequate attention should be paid to their upper airway and, if available, overnight polysomnography should be performed to ascertain their potential respiratory problems before repair surgery.

Cold air plasma improving rheumatoid arthritis via mitochondrial apoptosis pathway.

Rheumatoid arthritis (RA) has plagued physicians and patients for years due to the lack of targeted treatment. In this study, inspired by the commonality between rheumatoid arthritis fibroblast-like synoviocytes (RA-FLS) and cancer cells, the therapeutic effects of cold air plasma (CAP) on RA are studied systematically and thoroughly. In/ex vivo results show that CAP with the proper dosage significantly relieves symptoms including synovial hyperplasia, inflammatory infiltration, and angiogenesis and eliminates the root cause by triggering the self-antioxidant capability of the surrounding tissue. The mechanism on the molecular and cellular level is also revealed that the spontaneous reactive oxygen species (ROS) cascade induces the mitochondrial apoptosis pathway on RA-FLS. This study reveals a new strategy for targeted treatment of RA and the mechanistic study provides the theoretical foundation for future development of plasma medicine.

Balancing the biocompatibility and bacterial resistance of polypyrrole by optimized silver incorporation.

Polypyrrole (PPy) which is a conductive polymer with excellent biocompatibility has enormous potential in implantable electronics. However, pristine PPy does not have sufficient bacterial resistance and hence, bacterial infection poses serious threats in vivo. Silver is an excellent antibacterial agent but the optimal concentration is critical because excessive silver is detrimental to human health. In this study, electrochemical polymerization is carried out to fabricate PPy coatings and silver ions (Ag) are introduced by plasma immersion ion implantation (PIII). The optimal Ag ion fluence is determined by monitoring the antibacterial efficiency and cytotoxicity. Our results show that the optimal balance between the antibacterial ability and cytocompatibility can be attained from sample Ti-PPy@Ag-4 implanted with a silver ion fluence of 4 × 1016 ions cm-2. In addition to retaining good cytocompatibility, 92% of the bacteria Staphylococcus aureus (S. aureus) can be eliminated. The intricate balance between antibacterial effects and biocompatibility arises from the levels of intracellular reactive oxygen species (ROS) in S. aureus and MC3T3-E1 osteoblasts on Ti-PPy@Ag-4. The antibacterial capability and biocompatibility are verified by the subcutaneous infection model in rats in vivo. The results reveal a simple strategy to improve the bacterial resistance of polymers such as PPy while not compromising the inherent biosafety of the materials. To the best of our knowledge, this is the first attempt to functionalize PPy by Ag PIII to create the proper balance between the antibacterial capacity and biosafety of biomedical implants.

Subjective and Objective Evaluation of Speech in Adult Patients with Unrepaired Cleft Palate.

OBJECTIVE: To explore the speech outcomes of adult patients through subjective perception evaluation and objective acoustic analysis, and to compare the differences in pronunciation characteristics between speakers with adult patients with unrepaired cleft palate and their non-cleft peers. PARTICIPANTS AND INTERVENTION: Subjective evaluation indicators included speech intelligibility, nasality, and consonant missing rate, whereas objective acoustic parameters included normalized vowel formants, voice onset time, and the analysis of three-dimensional spectrogram and spectrum, were carried out on speech samples produced by 2 groups of speakers: (a) speakers with unrepaired cleft palate ( n = 65, mean age = 25.1 years) and (b) typical speakers ( n = 30, mean age = 23.7 years). RESULTS: Compared with typical speakers, individuals with unrepaired cleft palate exhibited a lower speech intelligibility with higher nasality and consonant missing rate, the missing rate is highest for the 6 consonants syllables The acoustic parameters are mainly manifested as differences in vowel formants and voice onset time. CONCLUSIONS: The results revealed important acoustical differences between adult patients with unrepaired cleft palate and typical speakers. The trend of spectral deviation may have contributed to the difficulty in producing pressure vowels and aspirated consonants in individuals with speech disorders related to cleft palate.

Repair of Asymmetric Bilateral Cleft lip: 1 Stage or 2 Stage.

OBJECTIVE: To verify the advantages and indications of 1-stage and 2-stage repair for asymmetric bilateral cleft lip (BCL). DESIGN: Retrospective study. SETTING: From January 2004 to December 2016 in our department. PATIENTS: Patients with BCL. MAIN OUTCOME MEASURE(S): Over 6 months after the operation, the surgery outcomes were evaluated and graded by 2 experienced surgeons. RESULTS: The result of surgery was evaluated using the scoring method of Mortier et al and Anastassov and Chipkov. Among 133 patients with asymmetric BCL, 61 (45.9%) had 1-stage repair and 72 (54.1%) had 2-stage repair. Sixty-eight (51.1%) patients had complete-incomplete cleft lip (CL), and those who underwent 1-stage repair showed a trend of better outcome (P = .028). Fifty (37.6%) patients with incomplete-microform CL showed no significant difference between the outcomes of 2 surgery plans (P = .253). In 15 (11.3%) patients with complete-microform CL, only one had 1-stage repair with a score of 8.5. The other 14 patients with 2-stage repair were scored 3.68 ± 1.28. Two-stage repair was preferable when the deformity degree was very different on 2 sides, as it could reduce unnecessary scar tissue and extend the nasal columella. One-stage repair could help to achieve the anatomical reduction of the orbicularis oris and a better contour of the vermilion tubercle. CONCLUSION: One-stage repair is recommended for patients with complete-incomplete CL and incomplete-microform CL. Two-stage repair for patients with complete-microform CL is preferred in our center, but more studies are required to support this conclusion.

Programmed surface on poly(aryl-ether-ether-ketone) initiating immune mediation and fulfilling bone regeneration sequentially.

The immune responses are involved in every stage after implantation but the reported immune-regulated materials only work at the beginning without fully considering the different phases of bone healing. Here, poly(aryl-ether-ether-ketone) (PEEK) is coated with a programmed surface, which rapidly releases interleukin-10 (IL-10) in the first week and slowly delivers dexamethasone (DEX) up to 4 weeks. Owing to the synergistic effects of IL-10 and DEX, an aptly weak inflammation is triggered within the first week, followed by significant M2 polarization of macrophages and upregulation of the autophagy-related factors. The suitable immunomodulatory activities pave the way for osteogenesis and the steady release of DEX facilitates bone regeneration thereafter. The sequential immune-mediated process is also validated by an 8-week implementation on a rat model. This is the first attempt to construct implants by taking advantage of both immune-mediated modulation and sequential regulation spanning all bone regeneration phases, which provides insights into the fabrication of advanced biomaterials for tissue engineering and immunological therapeutics.

An Observational Study to Evaluate Association Between Velopharyngeal Anatomy and Speech Outcomes in Adult Patients With Severe Velopharyngeal Insufficiency.

OBJECTIVE: By measuring velopharyngeal structure and evaluating speech intelligibility, to explore and observe the association between velopharyngeal anatomy and speech outcomes in these patients. METHODS: Thirty-one adult patients with velopharyngeal insufficiency after the primary palatoplasty aged 18 to 35 years (mean 22.03 years) were enrolled as the study group. The patients had significant hypernasality and audible nasal emission. The degree of velopharyngeal closure assessed by electronic nasopharyngeal fiberoptic endoscopy was grade III. Cephalometric analysis was performed on lateral cephalograms to measure velopharyngeal structure, including hard palate length (ANS-PNS), velar length (PNS-U), pharyngeal depth (PNS-PPW), and oropharyngeal airway space (U-MPW). Their speech intelligibility was evaluated through the Mandarin Chinese speech intelligibility test, and each speech sample was examined by 2 speech and language pathologists. The results were assessed with the SPSS 23.0 software package, and regression analysis was used to examine the relationship between velopharyngeal structure and speech outcomes. RESULTS: A significant negative correlation was confirmed between speech intelligibility and pharyngeal depth. Pharyngeal depth also showed a linear relationship with speech intelligibility, and there was no significant correlation between speech intelligibility and other measures (hard palate length, velar length, oropharyngeal airway space). CONCLUSIONS: In the velopharyngeal anatomy, only pharyngeal depth was associated with speech intelligibility in adult patients with severe velopharyngeal insufficiency, this is consistent with our clinical observation. It suggests that appropriate reduction of pharyngeal depth during palatopharyngoplasty may have a good effect on the speech recovery in patients with cleft palate and patients with velopharyngeal insufficiency after palatorrhaphy.

The Preventive and Control Recommendations on Patient With Cleft Lip and Palate During COVID-19 Pandemic in Shanghai.

ABSTRACT: As Corona Virus Disease 2019 (COVID-19) has been gradually controlled domestically, various industries began to resume production in an orderly way. Attention should be paid to the disease and population characteristics of patients with cleft lip with/without palate during diagnosis and treatment. This article summarized and provided prevention and control recommendations on management strategies during hospitalization and protective measures of patients and healthcare workers, hoping to minimize the spread of disease and create a relatively safe environment for medical work.

Plasma-activated interfaces for biomedical engineering.

As an important phenomenon to monitor disease development, cell signaling usually takes place at the interface between organisms/cells or between organisms/cells and abiotic materials. Therefore, finding a strategy to build the specific biomedical interfaces will help regulate information transmission and produce better therapeutic results to benefit patients. In the past decades, plasmas containing energetic and active species have been employed to construct various interfaces to meet biomedical demands such as bacteria inactivation, tissue regeneration, cancer therapy, and so on. Based on the potent functions of plasma modified surfaces, this mini-review is aimed to summarize the state-of-art plasma-activated interfaces and provide guidance to researchers to select the proper plasma and processing conditions to design and prepare interfaces with the optimal biological and related functions. After a brief introduction, plasma-activated interfaces are described and categorized according to different criteria including direct plasma-cells interfaces and indirect plasma-material-cells interfaces and recent research activities on the application of plasma-activated interfaces are described. The authors hope that this mini-review will spur interdisciplinary research efforts in this important area and expedite associated clinical applications.

A three dimension magnetic bio-char composite-based quick, easy, cheap, effective, rugged and safe method for multi-pesticides analysis of vegetables.

To improve the efficiency of high-throughput analysis, a three-dimensional (3D) magnetic Fe3O4-biochar composite was synthesized and used as adsorbent of QuEChERS pretreatment method for the analysis of 49 pesticide residues in vegetables containing complex pigments. The structure evolution mechanism of Fe3O4-biochar was discussed and the structural morphology was confirmed by a series of characterization methods. Multivariate approach was employed to optimize the extraction parameters including sample amount, solvent volume, NaCl amount, extraction time, anhydrous MgSO4 amount, adsorbent amount, purification time. The results revealed that extraction time and Fe3O4-biochar amount had significant influences on the recovery yield of pesticides and the 20 min extraction time and 13.9 mg Fe3O4-biochar are optimal conditions. Under these conditions, the Fe3O4-biochar exhibited better cleanup of matrix co-extracts than conventional adsorbents, which reduced matrix effect and simplified extraction process. Moreover, the adsorption mechanism was further probed and turned out that the aromatic sheets on Fe3O4-biochar dominated the π-π EDA (electron donor-acceptor) interaction for interfering substances. The proposed extraction method exhibited good linearity with correlation coefficient greater than 0.9902. The limits of quantitation (LOQs) were in the range of 0.03-0.67 µg kg-1. The average recoveries were between 81.3% and 117.3% with relative standard deviation (intra-day RSD = 0.5-7.5% and inter-day RSD = 0.6-6.9%). All results highlighted the excellent potential of Fe3O4-biochar strategy in analysis of pesticide residues in vegetables containing complex pigments.

The status and characteristics of urinary stone composition in China.

OBJECTIVES: To explore characteristics of urinary stone composition in China, and determine the effects of gender, age, body mass index (BMI), stone location, and geographical region on stone composition. PATIENTS AND METHODS: We prospectively used Fourier-transform infrared spectroscopy to analyse stones from consecutive patients presenting with new-onset urolithiasis at 46 hospitals in seven geographical areas of China, between 1 June 2010 and 31 May 2015. Chi-squared tests and logistic regression analyses were used to determine associations between stone composition and gender, age, BMI, stone location, and geographical region. RESULTS: The most common stone constituents were: calcium oxalate (CaOx; 65.9%), carbapatite (15.6%), urate (12.4%), struvite (2.7%), and brushite (1.7%). CaOx and urate stones occurred more frequently in males, whereas carbapatite and struvite were more common in females (P < 0.01). CaOx and carbapatite were more common in those aged 30-50 and 20-40 years than in other groups. Brushite and struvite were most common amongst those aged <20 and >70 years. The detection rate of urate increased with age, whilst cystine decreased with age. Obese patients were more likely to have urate stones than carbapatite or brushite stones (P < 0.01). CaOx, carbapatite, brushite, and cystine stones were more frequently found in the kidney than other types, whereas urate and struvite were more frequent in the bladder (P < 0.01). Stone composition varied by geographical region. CONCLUSIONS: The most common stone composition was CaOx, followed by carbapatite, urate, struvite, and brushite. Stone composition differed significantly in patients grouped by gender, age, BMI, stone location, and geographical region.

Median Cleft of the Lower Lip and Mandible: Clinical Experience and Surgical Treatment.

Median cleft of lower lip and mandible is a rare congenital craniofacial malformation and has been described as isolated clinical reports. Fewer than 100 cases have been reported in the world literature so far, and the first case was reported by French scholar Monroe in 1819. The authors report a patient with median complete cleft of the lower lip and mandible which we made a special repair surgery for him, surgical effect satisfied with the restoration of appearance and function ideal. Therefore, the appropriate period and method of surgical management are very important.

Application of Computer-Aided Design and Customized Implants in the Reconstruction of Pyriform Aperture Defects Secondary to Unilateral Cleft Lip and Palate.

PURPOSE: To design and develop customized implants with the rapid prototyping (RP) technique in order to reconstruct the defected pyriform aperture. METHODS: A 3-dimensional digital model was reconstructed with the software proplan CMF based on the computed tomography data of the patient's skeleton. Then an individualized implant was designed by computer-aided design (CAD) and prepared with the RP technique. A total of 5 patients (3 males and 2 females) with unilateral secondary nasal deformities received the customized implants in this study. RESULTS: All the implants closely matched the surface of the defects. During the 12- to 24-month follow-up period, all the patients reported satisfactory outcomes except for 1 patient where exposure of the implant was observed and had to be removed 3 months after the surgery. CONCLUSION: With high precision and matching degree, individualized implants designed by CAD and prepared with the RP technique can be used to overcome the limitations of ready-made materials and improve the accuracy of the surgical procedure in reconstructing the defected pyriform aperture.

An optimized transurethral catheterization cystometry in mice and comparison with classic suprapubic catheterization cystometry.

AIMS: The aim of this study is to establish an optimized, minimally invasive transurethral catheterization cystometry (TUCC) and a novel urethral pressure profile (UPP) measurement for mice. METHODS: The optimized TUCC and the UPP measurement were first established. This optimized TUCC was then performed in 16 anesthetized female mice and compared with the suprapubic catheterization cystometry (SCC) in parallel after suprapubic catheters implantation (SCI; on zero, third, and seventh day, respectively). Finally, the optimized TUCC and novel UPP measurement were applied to investigate in another eight mice of partial bladder outlet obstruction (pBOO) model. The urodynamic parameters including micturition pressure (MP), basal pressure (BP), threshold pressure (TP), bladder capacity (BC), micturition volume (MV), residual urine (RV), bladder compliance (COM), maximum urethral pressure (MUP), bladder pressure curve and UPP were recorded. Statistical cross-comparisons of parameters for two kinds of cystometries and pBOO model were performed. RESULTS: Compared with the optimized TUCC before SCI, the MV, RV, BC, and MP decreased significantly on the seventh day after SCI (270.4-132.5 µL, 46.13-20.09 µL, 316.4-152.5 µL, 30.01-24.34 cmH2 0, respectively). After SCI, the BP, MP, TP, MV, RV, BC, and COM showed no significant difference between the TUCC and SCC at the same time point. The MUP increased significantly after pBOO operation (19.1-46.6 cmH2 0, P < 0.05). CONCLUSIONS: The minimally invasive TUCC along with UPP measurement could be widely applied to study the bladder function of mice as a feasible, repeatable, and accessible method.

Subcutaneous C Shape Muscular Flap for Correcting the Depression of Alar Base in Affected Side in Patients With Unilateral Complete Cleft Lip/Palate During Primary Surgery.

PURPOSE: The depression of alar base in affected side in patients with unilateral complete cleft lip/palate (CL/P) is one of common clinical features. In this study, the authors try to explore the effect of subcutaneous C shape muscular flap for correcting the depression of alar base in affected side in patients with unilateral complete CL/P during primary surgery. METHODS: A total of 30 patients with unilateral complete CL/P who received primary correction of the lip nose deformity were included in this study. The C flap was used to drop and lengthen the height of upper lip in unaffected side, and the subcutaneous muscular flap was dissected from the C flap and positioned at the alar base in the affected side of upper lip to correct the depression. Then the surgical effect was evaluated based on clinical examination during follow-up. RESULTS: Alar base symmetry was obtained in 26 patients of this case series, and 4 patients showed slight improvement in alar base symmetry. No major complications such as flap necrosis, infection, or hypertrophic scars were observed during surgery and follow-up. No additional incisions and operative time were necessary. CONCLUSION: The subcutaneous C shape muscular flap described in this article could offer enough muscular support and markedly correct the depression of nostril and alar base in affected side in primary lip nose repair with no additional incisions and operative time for patients with unilateral complete CL/P.

Analysis of Postoperative Bleeding After Posterior Pharyngeal Flap Pharyngoplasty.

The aim of this study was to analyze the location and cause of postoperative bleeding after posterior pharyngeal flap pharyngoplasty and to investigate the surgical techniques with the goal of treating the bleeding. The patients received posterior pharyngeal flap pharyngoplasty in the Cleft Lip and Palate Treatment and Research Center of Shanghai Jiaotong University School of Medicine from January 2003 to December 2014, and postoperative bleeding in the surgical area was retrospectively analyzed. According to the record of the exploration of hemostasis, the locations and causes of the bleeding were summarized. In the 12-year study, a total of 1037 patients received posterior pharyngeal flap pharyngoplasty, including 621 males and 416 females with ages ranging from 4 to 40 years and a mean age of 13.7 years. Among these patients, 7 individuals (0.68%) experienced significant postoperative bleeding with the exploration of hemostasis. All patients were male, aged 5 to 26 years with a mean age of 15.7 years, and all were sent back to the operating room for exploration of hemostasis under general anesthesia. The sites of bleeding included 2 patients (28.6%) of the soft palate, 2 patients (28.6%) of the pharyngeal flap pedicle, and 3 patients (42.8%) of the nasopharynx. In posterior pharyngeal flap pharyngoplasty, particular attention should be paid to the protection of the blood vessels in the soft palate and the treatment of the vascular pedicle. Postoperative bleeding is very dangerous and generally requires immediate exploration in the operating room under general anesthesia.