An Innovative Approach to Classifying and Treating Axillary Scar Contracture.

BACKGROUND: Axillary cicatricial contracture is a debilitating condition that can greatly impair shoulder joint function. Therefore, timely correction of this condition is imperative. In light of Ogawa's prior classification of axillary cicatricial contracture deformities, we have proposed a novel classification system and reconstruction principles based on a decade of treatment experience. Our proposed system offers a more comprehensive approach to correcting axillary cicatricial contracture deformities and aims to improve patient outcomes. METHODS: Our study included 196 patients with a total of 223 axillary cicatricial contracture deformities. The range of shoulder abduction varied between 10 and 120 degrees. Our treatment approach included various methods such as the lateral thoracic flap, transverse scapular artery flap, cervical superficial artery flap, medial upper arm flap, latissimus dorsi flap, Z-shape modification, and the use of local flaps combined with skin grafting. After 2 weeks, the sutures were removed, and patients were instructed to start functional exercises. To categorize the deformities, we divided them into 2 types: axillary-adjacent region cicatricial contracture (type I) and extended area contracture (type II). RESULTS: For each subtype, a specific treatment method was chosen based on a designed algorithm decision tree. Out of the total cases, 133 patients underwent treatment with various types of local flaps, including Z-plasty, whereas 63 patients received treatment involving skin grafting and different types of local flaps. At the time of discharge, the abduction angle of the shoulder joint ranged from 80 to 120 degrees. Among the 131 patients who were followed up, 108 of them adhered to a regimen of horizontal bar exercises. After a 1-year follow-up period, the abduction angle of the shoulder joint had significantly improved to a range of 110-180 degrees. CONCLUSIONS: We have proposed a novel classification method for the correction of axillary cicatricial contracture deformity. This approach involves utilizing distinct correction strategies, in conjunction with postoperative functional exercise, to ensure the effectiveness of axillary reconstruction.

Ultrapulse Fractional CO 2 Laser With Different Fluences and Densities in the Prevention of Periorbital Laceration Scars: A Split-Scar, Evaluator-Blinded Study.

BACKGROUND: Periorbital laceration can result in complex, permanent scars, and even lead to serious complications such as cicatricial ectropion. Early intervention with laser devices has been suggested as a novel modality to reduce scar formation. However, no consensus exists regarding the optimal treatment parameters for scar management. This study evaluated the efficacy and safety of ultrapulse fractional CO 2 laser (UFCL) with different fluences and densities in preventing periorbital surgical scars. OBJECTIVE: To assess the efficacy and safety of UFCL with different fluences and densities in the prevention of periorbital laceration scars. METHODS: A prospective, randomized, blinded study was conducted on 90 patients with periorbital laceration scars of 2 weeks old. Four treatment sessions of UFCL were administered to each half of the scar at 4-week intervals, with halves treated with high fluences with low density versus low fluences with low-density treatment. Vancouver Scar Scale was used to assess the 2 portions of each individual scar at baseline, final treatment, and 6 months. The patient's 4-point satisfaction scale was used to evaluate the patient's satisfaction at baseline and 6 months. Safety was evaluated by registration of adverse events. RESULTS: Eighty-two of 90 patients completed the clinical trial and follow-up. There was no significant difference in Vancouver Scar Scale and satisfaction score between different laser settings between the two groups ( P > 0.05). Adverse events were minor and no long-term side effects were noted. CONCLUSIONS: Early application of UFCL is a safe, strategy to significantly improve the final traumatic periorbital scar appearance. Objective evaluation of scars did not identify differences in scar appearance between high fluences with low density versus low fluences with low density of UFCL treatment. LEVEL OF EVIDENCE: Level III.

A comprehensive reconstruction strategy for moderate to severe faciocervical scar contractures.

The focus of treatment of faciocervical scar contractures includes cervical reconstruction and elimination of hypertrophic scars. Unfortunately, most previous studies have neglected the esthetic appearance of scars. In this study, we tried to combine surgical therapy and ultrapulse fractional CO2 laser (UFCL) to eliminate facial scars while restoring neck reconstruction and to establish the optimal conventional management for faciocervical contracture. Thirty-eight individuals were enrolled and divided into two groups. After received cervical release surgeries, comprehensive UFCL therapy group received treatment of UFCL at 3-month intervals, silicone sheets, and pressure garments, while another group only received treatment of silicone sheeting and compression. Twelve months after the termination of therapy, faciocervical scars of both two groups were assessed by two uninvolved physicians according to the Vancouver Scar Scale (VSS), and patients' satisfaction survey was also recorded by the study participants using a patient four-point satisfaction scale. Thirty-six patients completed the treatment and follow-up. The results show that the VSS scores of both two groups decreased after 12 months, but comprehensive UFCL therapy group dropped more significantly than the conventional treatment group at follow-up session, which was statistically significant (P < 0.001), and the patient satisfaction was higher than that of the conventional treatment group. This comprehensive treatment combined of surgery, UFCL, silicone sheets, and pressure garments works as an effective and esthetic reconstruction for moderate to severe postburn faciocervical scar contractures.

Combination therapy of refractory keloid with ultrapulse fractional carbon dioxide (CO2 ) laser and topical triamcinolone in Asians-long-term prevention of keloid recurrence.

Keloid often recur after treatment, and recent studies in keloid management favor the combination therapy of laser-assisted drug delivery over monotherapy. Unfortunately, the previous researches lack long-term follow-up. In this prospective study, 41 individuals with refractory keloids underwent eight treatment sessions at 4 weeks intervals consisting of ultrapulse fractional carbon dioxide laser (UFCL), followed by postoperative application topical triamcinolone acetonide (40 mg/ml). Four follow-up moments were chosen, with follow-up of 24 months. The effects of combination therapy on scar pliability, thickness, relief, vascularization, surface area, pain, and itchiness were examined by means of the Patient and Observer Scar Assessment Scale (POSAS). 38 patients completed the full 24 months of follow-up after the whole treatment. The results reveal a fast and abiding improvement of keloid scars after the combination therapy. The mean keloid POSAS scores showed a decreasing trend in subsequent times. All POSAS components improved significantly between baseline and 24 months after start of therapy (P < .05). Long-term follow-up results demonstrate that combination keloid therapy using UFCL and tropical triamcinolone has overall significant improvement and low recurrence rate with a long-term stable results.

The role of Th1/Th2 cell chemokine expression in hypertrophic scar.

The aim of this study was to study the role of Th1/Th2 cell-associated chemokines in the formation of hypertrophic scars in rabbit ears. Twenty-six New Zealand white rabbits were used to establish the hypertrophic scar model of rabbit ear and the normal scar model of rabbit's back. Two rabbits were sacrificed on days 0 and 21, 28, 35, 42, 49, 56, and 63 after operation. The specimens were stained with haematoxylin-eosin (HE). Scar elevation index (SEI) was used to detect the expression of 10 chemokines related to Th1/Th2 cells in both scar formation expressions. Real-time polymerase chain reaction (PCR) results showed that two chemokines (CXCL10, CXCL12) were highly expressed during the formation of normal scar, and there was almost no expression during the formation of hypertrophic scar (*P < 0.05). The chemokines (CCL2, CCL3, CCL4, CCL5, CCL7, CCL13, CX3CL1) were almost non-expressed in the formation of normal scars but were expressed for a long time in the formation of hypertrophic scars. The four chemokines, CCL2, CCL4, CCL5, and CX3CL1, maintained a long-term high expression level during the formation of hypertrophic scars (P < 0.01). There were also three chemokines (CCL14, CCL19, CCL21) that were almost undetectable in normal scarring, but there was transiently low-level expression (P < 0.05) only during the peak proliferative phase in proliferative scarring. Th1/Th2 cell-associated chemokines are different in the type, quantity and expression, and maintenance time of rabbit ear hypertrophic scars.

[Dynamic inflammatory response in a critically ill COVID-19 patient treated with corticosteroids].

OBJECTIVE: To investigate the effect of corticosteroids therapy on the inflammatory response in a critically ill coronavirus disease 2019 (COVID-19) patient. METHODS: A 55-year old female patient with critical ill COVID-19 was admitted in Taizhou Hospital on January 19, 2020. The patient was treated with methylprednisolone 80 mg on the 2nd day after admission. Thereafter, the dose was adjusted in a timely manner and the therapy lasted for 13 days. The peripheral lymphocyte subsets (CD3+T, CD4+ T, CD8+ T, NK cells, B cells), as well as serum levels of lymphocyte factors (IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ) were dynamically monitored. RESULTS: On D1 of admission, the numbers of peripheral blood CD3+ T, CD4+ T, CD8+ T, and NK cells were significantly lower than the normal range. With the improvement of the disease, the numbers of CD3+ T, CD8+ T and CD4 + T cells gradually recovered and showed a linear growth trend (linear fitting equation: Y=18.59X+109.4, P<0.05). On D2 of admission, the patient's IL-6 and IL-10 levels were significantly higher than normal values, IFN-γ was at a normal high value, and then rapidly decreased; IL-2, IL-4, and TNF-α were all in the normal range. On the D6 and D7, the IL-6 and IL-10 decreased to the normal range for the first time. On the D18, the sputum virus nucleic acid test was negative for the first time, and the fecal virus nucleic acid test was still positive; on the D20 the sputum and fecal virus nucleic acid test were both negative. On D34, the patient recovered and was discharged. At the discharge the muscle strength score of the patient was 44 and the daily life ability evaluation was 90. CONCLUSIONS: In the absence of effective antiviral drugs, early use of appropriate doses of corticosteroids in critically ill patient with COVID-19 can quickly alleviate inflammatory response and improve clinical symptoms, however, it may reduce the number of T cells, and to adjust the dose in time is necessary.

Diacetyl Hexamethylene Diamine (CAHB) Exerts Pro-Apoptotic and Anti-Proliferative Function in Leukemic T Lymphocytes via Downregulating PI3K/Akt Signaling.

BACKGROUND T cell acute lymphoblastic leukemia (T-ALL) is an aggressive hematologic malignancy caused by abnormal proliferation of immature T cell progenitors. Chemotherapy of T-ALL usually consists of induction, consolidation, and long-term maintenance. Diacetyl hexamethylene diamine (CAHB) is a newly developed agent that induces the differentiation of malignant cells and deprives their clonal growth ability. Since its effect on T-ALL has not been previously determined, we evaluated its potential function in the Jurkat cell line. MATERIAL AND METHODS MTT assay was conducted to evaluate the cytotoxicity and anti-proliferative effect of CAHB. The apoptosis level of CAHB-treated Jurkat cells was evaluated using flow cytometry via staining with Annexin V/PI or cleaved-caspase-3. The alteration of mitochondrial membrane potential was determined by flow cytometry. The expression of Bax and Bcl-2 was evaluated by RT-PCR and Western blot. Western blot was also used to assess the activation of Akt. RESULTS CAHB inhibited the proliferation and promoted the apoptosis of Jurkat cells in a time- and dose-dependent manner by decreasing activation of Akt, reducing the mitochondrial membrane potential, and downregulating the Bcl-2/Bax ratio. CONCLUSIONS Our data suggest that CAHB might be regarded as a novel treatment agent for T-ALL since it can induce apoptosis and inhibit proliferation of the T-ALL cell line at a relatively low level.

[Clinical and laboratory analysis of a neonate with Down syndrome and a novel GATA1 gene mutation].

OBJECTIVE: To analyze the clinical and molecular biological characteristics of a neonate with myeloid proliferation related to Down syndrome (DS). METHODS: The neonate, who was suspected for Down syndrome, was analyzed in terms of clinical feature, peripheral blood cell morphology, fluorescence in situ hybridization (FISH), immunological classification and other laboratory tests. On hundred and fourteen leukemia-related genes were subjected to next-generation sequencing (NGS). RESULTS: Laboratory test revealed obvious abnormal liver function and coagulation function, anemia, and extreme leukocytosis. Cell smear indicated significantly increased progenitor cells, which conformed to proliferation of megakaryocytes. FISH showed trisomy 21. By NGS, c.220+dupT, a novel mutation, was identified in exon 2 of the GATA1 gene, which encodes a N-terminal activation domain and has a frequency of 95.8%. No mutation was identified among the remaining 113 genes. CONCLUSION: The neonate had DS and GATA1 gene mutation. High percentage of circulating blasts should be considered as transient myelodysplasia but not congenital leukemia.

Input Training Matters in L2 Syntactic Representation Entrenchment: Evidence from a Follow-Up ERP Study.

The usage-based theory highlights the important role of linguistic input in language acquisition, and assumes that syntactic representations could be entrenched through usage or exposure. In the present study, we used the event-related potential technique to investigate the long-term effect of input training on second language (L2) syntactic representations entrenchment, using English subject-verb agreement structures as the stimuli. Results showed that 3 months after the training of the specific subject-verb agreement structures, a significant P600 was observed in the key region (the verb) of the sentences with syntactic violations in the experimental group, but not in the control group. This indicates that linguistic input training contributes to syntactic representations entrenchment, which can be sustained for a relatively long period, indicating a long-term effect of input training. The results suggest that linguistic input is a causal variable in L2 online syntactic processing, supporting the usage-based theory.

Imiquimod regulating Th1 and Th2 cell-related chemokines to inhibit scar hyperplasia.

Immunological factors play important roles in the occurrence of hypertrophic scars. Imiquimod can be used as an immunosuppressive agent to regulate the function of T-helper (Th) cell subsets Th1 and Th2. In this article, we explored the impact of imiquimod on scar hyperplasia through Th cells. A rabbit ear hypertrophic scar model was built. Four round wounds were cut in each rabbit's ears ventrally with a diameter of 1 cm and bilateral symmetry. All the right ear wounds were treated with 5% imiquimod cream. The blank control group contained all the left ear wounds, which were treated with Vaseline ointment at the same time. Haematoxylin and eosin and Masson staining showed that imiquimod collagen deposition was significantly reduced compared with the control group, scar index (SEI) showed that the proliferative degree reached its peak on the 28th day after operation in blank group, and the degree of hyperplasia was significantly higher than that of the imiquimod group (P < .05). Real-time Polymerase chain reaction results showed that the imiquimod induced the expression of Th2 cell-related chemokines CCL2, CCL3, CCL5, CCL7, and CCL13 at each time point, which were significantly lower than that of the blank control group, and the expressions of Th1 cell-associated chemokines CXCL10 and CXCL12 at each time point was significantly higher than the blank control group (P < .05). Imiquimod can be used to regulate the expression of Th1 and Th2 cell-associated chemokines to control scar hyperplasia.

Enhancement of teaching outcome through neural prediction of the students' knowledge state.

The neural mechanism for the dyadic process of teaching is poorly understood. Although theories about teaching have proposed that before any teaching takes place, the teacher will predict the knowledge state of the student(s) to enhance the teaching outcome, this theoretical Prediction-Transmission hypothesis has not been tested with any neuroimaging studies. Using functional near-infrared spectroscopy-based hyperscanning, this study measured brain activities of the teacher-student pairs simultaneously. Results showed that better teaching outcome was associated with higher time-lagged interpersonal neural synchronization (INS) between right temporal-parietal junction (TPJ) of the teacher and anterior superior temporal cortex (aSTC) of the student, when the teacher's brain activity preceded that of the student. Moreover, time course analyses suggested that such INS could mark the quality of the teaching outcome at an early stage of the teaching process. These results provided key neural evidence for the Prediction-Transmission hypothesis about teaching, and suggested that the INS plays an important role in the successful teaching.

Statistical analysis of factors affecting re-operative times in paediatric patients with scar deformity after deep second-degree burn injury.

Deep second-degree burn injuries pose a challenge for treating scar deformity in developing paediatric patients. Some patients underwent several re-operations during their development. There was no literature reporting which factors affect re-operative times. In this article, we intend to analyse possible influential factors that are responsible for re-operative times in paediatric patients with scar deformity after deep second-degree burn injuries. From 2010 to 2016, 177 paediatric cases with a history of deep second-degree burn injury who underwent re-operation once, twice, and equal to or more than thrice were recruited to this study, with age ranging from 0 to 18 years. The following factors were analysed: age, gender, size of scar, method for reconstruction, location, postoperative anti-scar treatment, preschool group, school group, combined deformity, and combined method for reconstruction. One-way ANOVA and multi-way ANOVA analysis were used as statistical tools to analyse the above factors and re-operative times. There were 83 male cases and 94 female cases, with an average age of 7.47 years. Statistical significance was achieved for the size of scar (P = 0.000), operation method (P = 0.001), and combined deformity (P = 0.026) under 1-way ANOVA in different re-operative times. The operation methods for the head and neck area (P < 0.05) and the lower extremities (P < 0.05) are critical factors for multi-factor variance analysis in different re-operative times. Multivariate logistic regression analysis also demonstrated that the size of scar was an independent risk factor for the number of operations. Combined operative method was a protective risk factor for the number of operations. There was no statistical significance obtained for other factors. Size of scar, operation method, and combined operation method are the risk factors for re-operative times, while operation methods for the head and neck area and lower extremities are the critical factors for re-operative times. We can use the combined method to resolve scar-related problems in order to reduce re-operative times.

Retrospective study of the application of acellular dermis in reconstructing full-thickness skin defects.

The purpose of the article is to evaluate the acellular dermis' utility in reconstructing full-thickness defects after scar contracture releasing and giant nevus resection. From the year 2012 to 2014, 18 consecutive patients underwent composite graft (thin autograft and alloderma) transplantation. Among these patients, 16 patients suffered from burned scar contracture in the upper extremities, and two young cases were met with giant nevus on the upper extremity. Ten of 13 adult cases with upper extremity scar affection were chosen for a comparative study. Twenty hands were randomly allocated into group A and group B. The thick autograft was used to repair one upper extremity in group B, and the composite grafts were used to cover the other upper extremity in group A. Besides appraisal of the recipient sites' function and aesthetics, donor sites were also estimated after a mean of 12 months' follow-up through the Vancouver Scar Score Scale. After evaluation in the above comparative study through the Vancouver Score Scale, in the recipient evaluation, no statistical difference was found in the pigmentation score between two groups, while statistical difference was achieved in other aspects (vascularity, pliability, height). In the donor site's evaluation, statistical difference was established between the two groups in all facets. One adult patient was dissatisfied with the hypertrophic scar on the donor site, and about almost a half of the area became a hypertrophic scar in the recipient site. No atrophic change occurred; one little girl, suffering from large nevus, was operated on by removing nearly the whole giant nevus on the upper limb. Unfortunately, she presented with finger tip necrosis occurring. The finger tip was not ultimately preserved and was repaired with an abdomen flap. Acellular dermal matrix is an excellent option and a useful tool for reconstructing large full-thickness skin defects after releasing burned scar contracture and removing giant nevus. With thin-skin graft meshed, a donor site's presentation brings courage to patients, while recipient sites can reach nearly the same elasticity and function compared to thick-grafted skin.

The clinical experience for treating post-burn depigmentation with tiny epidermal particles graft.

The critical problem of post-burn depigmentation is the lacking normal melanocytes. Auto-skin grafting and autologous non-cultured epidermal cell suspension have been used to improve the appearance. However, a large amount of skin graft is required of donor sites in the former method, while the latter method is thought to be complicated and costly. This study is designed to generalise the experience of tiny epidermal particles graft (TEPG) for treating post-burn depigmentation. From 2012 to 2013, 30 consecutive patients with depigmentation caused by burn injuries were divided into I and II group. I group: 15 cases (11 males and 4 females) were treated by the TEPG. II group: 15 patients (10 males and 5 females) were treated by suction blister epidermal skin graft (SBEG). Imagine-Pro Plus software was used to evaluate the size of repigmentation (RP) 12 months post-surgery. SPSS software 13.0 was used to evaluate the data. The optimum rate of RP was defined as more than 75% (RP > 75%) when excellent RP was defined as more than 90% (>90%). All patients were followed up for 12 months. The mean size of RP in two groups demonstrated that there were statistically significant differences in pigmentation between the two groups (P = 0·002), while there was no significant difference in the other factors (gender, site and age). No infection occurred in the recipient site. Pathological result showed that melanocytes existed at the basal layer of resurfacing skin. Optimum RP (RP > 75%) was seen in 12 patients in I group and 9 patients in II group. Excellent RP was achieved in 14 cases in I group and 10 patients in II group. Excellent RP can be obtained by the abovementioned two surgical techniques. In contrast to SBEG, TEPG is less traumatic, and definite effects can be guaranteed. It is a preferred treatment, especially for those patients who suffer from large depigmented lesions.

Clinical experience of surgically treating giant neurofibromatosis-1.

The surgical treatment for giant neurofibromatosis-1 (NF-1) requires comprehensive measures. Presently, there is no systematic description of surgical treatment. Because of its high level of risk, we want to share our clinical experience. From 2011 to 2014, patients (n = 8, 5 female and 3 male patients, aging from 31 to 45 years-old) were included in the study. The tumours were located on the trunk (n = 5) or face (n = 3). In addition to routine examination, blood storage was also prepared. Preoperative consultation from related departments was critical at first. Related artery embolisation was also carried out. In the operation, we checked thromboelastography, based on which reasonable blood component transfusion was implemented. Autologous blood transfusion was also ready. An instrument of copper needle or ring ligation was used to reduce haemorrhage before the surgery. Protruding or drooping portions of the tumours were excised. A pressurised bandage was applied when the surgery was completed. After the surgery, besides the routine monitoring of vital signs, re-haemorrhage should be detected in time. Then, we should decide whether blood transfusion or surgery was required again. Expanders were implanted in one female patient with facial injuries before removing the tumour. Then, expanded flaps were applied to repair the secondary wound. According to the above clinical route, after an average of 1-year follow-up, no patients died, and other unforeseen events did not occur. Wounds healed well in all patients. The tumor was excised as much as possible. No facial nerve paralysis occurred in the facial sites. Expanded flaps necrosis WAS not encountered. It is essential to design the educational clinical route for treating NF-1 when a giant protruding tumour is advised to be excised, which can minimise the risk of surgery and assure us of the maximum range of resection.

Retrospective study of primary reconstruction of facial traumatic events.

Facial traumatic events are commonly encountered in plastic and reconstructive surgery. Primary reconstruction is a reliable procedure with function and aesthetic considerations. We conduct a retrospective study of the experience of reconstructing facial traumatic defects in the first stage. One hundred and thirty-two cases (aged 18-65) with facial traumatic events were recruited in the study from 2008 to 2014. Facial traumatic events included injured soft tissue, maxillofacial fractures and facial nerve rupture, which were repaired primarily. After primary reconstruction, encouraging functional and aesthetic outcomes were attained. Ten cases were re-operated to reconstruct partial nasal defect. Four patients who had trouble with disabled occluding relations sought help from dentists. Inconspicuous scar and function restoration were presented. Facial wounds should be reconstructed in the first stage as far as possible. Then, satisfactory functional and aesthetic results can be achieved. However, combined injury should be carefully considered in those traumatic cases before we carry out the reconstructive surgery on the face.

Retrospective study of experience of craniofacial reconstruction.

Reconstruction is a basic task in craniofacial plastic surgery. Different methods must be used to meet the aspirations of surgeons and patients with different defects and deformities. We make a retrospective study of our experience of craniofacial reconstruction. In accordance with 10 years' clinical experience, direct suturing, skin graft transfer, nerve anastomosis, expanded pedicled or random flaps, facial local random flaps, reduction of mandibular fracture and correction of congenital craniofacial deformities were included in this case series. These types of treatment were applied to reconstruct facial defects or deformities according to different circumstances of patients. Directed by rational design and treatment, reconstructive surgery can be executed to treat different cases with different circumstances. A total of 891 different cases with different facial circumstances were treated with different methods: direct suturing (n = 93), skin graft transfer(n = 104), nerve anastomosis (n = 38), expanded pedicled or random flaps(n = 310), facial local random or pedicled flaps(n = 231), reduction of mandibular fracture(n = 112) and correction of congenital craniofacial deformities(n = 13). Reconstructive technique must be directed by reliable methods and special guidelines in Plastic Surgery. Three guidelines are summarised: reconstruction in the first stage and returning injured tissue to its origin site as far as possible for traumatic events; adjacent tissue must be prior to other distant tissue for reconstructive choice; and reconstruction at different stages after careful design.

Management of Breast Deformity After Removal of Injectable Polyacrylamide Hydrogel: Retrospective Study of 200 Cases for 7 Years.

BACKGROUND: Polyacrylamide hydrogel (PAAG), once used as an injection for breast augmentation, has been banned in the medical field for cosmetic purposes for more than 10 years in China. But a large number of breasts have characteristic deformities due to the gel's feature of erosion. Our aim is to explore a retrospective study on PAAG's long-term effects on women, ensuing breast deformity and the strategy for breast plasticity after removing the gel in our center from 2007 to 2014. METHODS: From 2007 to 2014, 200 patients, whose breasts were injected with PAAG, underwent the operation to remove the injectable material. Complications were summarized. Ultrasound or MRI was performed before the operation to disclose the general distribution of the gel and the muscle and gland infiltration. According to the gel distribution, muscle and gland infiltration, infection, gel residue, and other factors, the patients were treated, respectively, with or without prosthesis implantation surgery after the removal of the gel. According to the decision about whether or when to undergo prosthesis implantation, the patients were classified into three types: group I-prosthesis implantation at the first stage, group II-prosthesis implantation at the second stage, and group III-only removing the material without prosthesis implantation. The scores of the BREAST-Q program were used to evaluate the preoperative and postoperative differences. RESULTS: Seventy-seven patients underwent prosthesis implantation at the first stage and 61 patients were operated on by placing the prosthesis at the second stage. A total of 62 patients only underwent the PAAG removal operation. By BREAST-Q evaluation, changes are summarized in Tables 1, 2, and 3 between mean preoperative scores and mean postoperative scores through categories of satisfaction with appearance of breasts, psychosocial wellbeing, sexual wellbeing, and physical wellbeing, in which all categories were presented with statistical significance (p < 0.001). Table 1 Patient demographics General patient data Number Number of patients 200 Age range 25-48 Follow-up period 6-12 months Injection material  Domestic material 84 (42 %)  Imported material 93 (46.5 %)  Domestic + imported 23 (11.5 %) Injection site  Regular hospital 47 (23.5 %)  Clinics 153 (76.5 %) Complication  Inflammation 10 (2 %)  Pain 75 (37.5 %)  Induration 155 (77.5 %)  Shift 50 (25 %)  Deformation 17 (8.5 %)  Bilateral asymmetry 48 (24 %)  Deposition milk 2 (1 %)  Psychological fear 150 (75 %)  Systemic symptoms 34 (17 %)  Single complication 25 (16.97 %)  Two or more complications 160 (80 %)  Preoperative aspiration 48 (24 %) Table 2 Group I-changes in mean preoperative scores and mean postoperative scores Category Preoperatively (n = 77) Postoperatively (n = 77) p Satisfaction with appearance of breasts 18.8 ± 16.2 81.6 ± 13.1 <0.001 Psychosocial wellbeing 39.5 ± 20.2 84.5 ± 19.3 <0.001 Sexual wellbeing 38.7 ± 23.1 77.2 ± 20.5 <0.001 Physical wellbeing 42.4 ± 16.3 81.7 ± 10.5 <0.001 Table 3 Group II-changes in mean preoperative scores and mean postoperative scores Category Preoperatively (n = 61) Postoperatively (n = 61) p Satisfaction with appearance of breasts 19.6 ± 15.3 82.5 ± 11.1 <0.001 Psychosocial wellbeing 38.9 ± 19.3 83.6 ± 20.1 <0.001 Sexual wellbeing 37.6 ± 22.4 79.3 ± 20.4 <0.001 Physical wellbeing 41.3 ± 15.1 82.2 ± 9.9 <0.001 CONCLUSIONS: Timely removal is critical for women who have received the PAAG removal operation. However, the surgery may destroy the shape of the breast. It is recommended that preoperative communication and local tissue condition are guidelines for surgeons to choose conservative or aggressive surgery. A balance must be maintained between removing the gel as much as possible and retaining soft tissue to reshape breasts. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Analysis of XRD Spectral Structure and Carbonization of the Biochar Preparation.

XRD spectroscopy is an important means of research material inside the crystalline structure of the material. In this study it was analyzed with X-ray sources in terms of manner of preparation of different materials carbon crystal structure of biological characteristics and charring mechanism. The results showed that: Biochar contain d101 and d002 crystal face diffraction peak of carbon graphite-like microcrystalline cellulose, but after charring precipitated salt with different materials, and have a big difference, such as ox dung, castor dregs and furfural dregs of CaCO3 carbon content than other organisms, but only ox dung and castor dregs containing CaMg (CO3)2. Corn stover charcoal preferentially decompose hemicelluloses and cellulose microcrystalline graphite with increasing temperature so with the degree of crystallinity which becomes more stable conversion of carbon compounds. Wherein the mineral salt as a pyrolysis carbonization temperature, gradually precipitated by metals oxides→Acetales→carbonate, and with increasing temperature the content of CaCO3 also increase. After different methods of carbonization, charring its mechanism is different from the first dry charring can promote the decomposition of hemicellulose, high temperature microwave treatment is highly volatile, mainly promoting substances multiple bond rupture decomposed substance carbonate precipitates relatively small. Comprehensive illustrated by X-ray diffraction study biochar may well feature the internal structure of the crystalline, can effectively reflect the cracking mechanism of carbonization process.

The Modification of Five-Flap Z-Plasty for Web Contracture.

BACKGROUND: Web contractures are fairly commonly encountered in those who have suffered from burn injury or other trauma. Numerous local flaps have been adopted previously. The five-flap Z-plasty is one that has been used frequently. To release the scar as much as possible, based on the traditional design, we developed a modified technique of the five-flap Z-plasty to reconstruct the axillary and elbow web contractures. Hence, the length of the axis of the cicatrix could be much lengthened. METHODS: Twenty patients (12 females and 8 males, 7 to 48 years-old) with 27 web contractures were arranged for the operation using the new flap. The contractures were formed on by burn injury in 17 patients, surgery in 2 patients, and traumatic cicatrix in 1 case. All patients were operated on using a modified five-flap Z-plasty to reach the aim of maximum contracture relaxation. RESULTS: All flaps survived well. No flap tip necrosis occurred. Good function was gained in all patients postoperatively by the one year average follow-up. There was no recurrence. The contracture band was freed satisfactorily. CONCLUSION: The technique is very easy to execute and can be used both in web and linear contractures. With the virtue of extending the length of the scar axis to a higher degree compared to the traditional method, we suggest this modified five-flap Z-plasty application. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.