Influence of hypercholesterolemia on the risk of chronic kidney disease in the middle-aged and elderly population and gender differences / 中华肾脏病杂志

Objective:To explore the influence of hypercholesterolemia on the risk of chronic kidney disease (CKD) in the middle-aged and elderly population and the gender differences.Methods:The data came from the "Epidemiological Survey of Chronic Kidney Disease among Adults in Urban Communities in Henan Province". The subjects came from 20 communities in Henan Province, aged ≥45 years old. Groups were based on the quartile of total blood cholesterol level and gender. Multivariate logistic regression and Cochran-Armitage trend test were used to analyze the effect of hypercholesterolemia on the risk of CKD and its gender differences.Results:A total of 4 779 subjects were enrolled into the study, with 1 934 males (40.5%) and 2 845 females (59.5%). The age was (61.3±7.7) years old and the blood cholesterol was (5.0±1.0) mmol/L. The prevalence rates of hypercholesterolemia, albuminuria, and reduced estimated glomerular filtration rate (eGFR) were 10.7%(305/2 845), 6.4%(182/2 845) and 2.8%(79/2 845) in females and 12.7%(245/1 934), 6.9%(133/1 934) and 2.3%(45/1 934) in males respectively. Compared with Q1 group, the prevalence of reduced eGFR in females were higher in Q2 and Q4 groups (both P<0.05). Among males, the prevalence of albuminuria and reduced eGFR increased with increasing blood cholesterol quartile (Cochran-Armitage trend test Z=12.231, 8.862, both P<0.001). Multivariate logistic regression analysis showed that hypercholesterolemia was an independent influencing factor for albuminuria and reduced eGFR ( OR=1.49, 95% CI 1.08-2.07, P=0.016 and OR=1.65, 95% CI 1.03-2.65, P=0.037, respectively). In subgroup analysis of different genders, female hypercholesterolemia was an independent influencing factor for albuminuria and reduced eGFR, while male hypercholesterolemia was not an independent influencing factor ( OR=1.54, 95% CI 0.96~2.46, P=0.075; OR=1.89, 95% CI 0.93-3.89, P=0.082, respectively). Further subgroup analysis based on the interquartile range of serum cholesterol levels found that female hypercholesterolemia was an independent influencing factor for reduced eGFR in the Q2 and Q4 groups ( OR=2.35, 95% CI 1.29-7.61, P=0.003; OR=2.51, 95% CI 1.38-8.39, P=0.001). In males, hypercholesterolemia was an independent influencing factor for albuminuria in the Q2, Q3 and Q4 groups ( OR=1.80, 95% CI 1.01-3.41, P=0.047; OR=1.85, 95% CI 1.02-3.35, P=0.044; OR=2.33, 95% CI 1.33-4.33, P=0.002). Conclusions:Hypercholesterolemia is an independent risk factor for CKD in middle-aged and elderly population, and there are gender differences, which provides a new idea for clinical prevention and control of CKD.

Reasons of asymmetry after blepharoplasty and comparison around repair / 中华医学美学美容杂志

Objective:To probe into the causes, reconstructive strategies, and repair outcomes of asymmetric eyelid configuration after blepharoplasty.Methods:All 73 patients (14 males and 59 females) with asymmetric double eyelid after blepharoplasty were recruited between July 2013 and June 2018 from Department of Plastic and Burns Surgery, West China Hospital, Sichuan University. The patients aged from 18 years to 42 years with the median age of 27 years. The new double eyelid line was designed pre-operation. Releasing subcutaneous adhesion of upper eyelid entirely, trimming inferior orbicularis oculi, adjusting and comparing the attachment position of bilateral levator aponeurosis were performed during surgery. Patients and surgeons marked the appearance of double eyelid both before and after repair operation, results of which were analyzed by t-test.Results:All 73 patients obtained improved double eyelid with primary healing. During follow-up from 8 to 12 months, repaired double eyelid showed satisfactory configuration with smooth natural double eyelid line and symmetric bilateral double eyelid. Of the 73 patients, 3 (4.1%) complaint rough double eyelid line, for whom re-fixation through small incision were adopted and no complication was observed during follow-up time. Scores by patients and surgeons were both significantly better after surgery.Conclusions:Analyzing the causes of asymmetric eyelid after double-eyelid blepharoplasty and repairing it contribute to aesthetic pleasing reconstructed double eyelid.

Multicentric clinical study of clinical phenotypic analysis of microtia / 中华整形外科杂志

Objective@#This study collected and analyzed data from patients with microtia in multiple clinical centers to obtain the incidence characteristics of microtia in Chinese.@*Methods@#Data from 746 patients with microtia were collected from six hospitals, including theThird Hospital of Hebei Medical University, Hunan Provincial People′s Hospital, the Second Hospital of Hebei Medical University, Weihai Municipal Hospital, West China Hospital Sichuan University, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2016 to December 2017. These data included the results of physical examination and the results of auxiliary examination such as electrocardiogram, chest CT, and abdominal ultrasound. Then, the accompanying malformations of the microtia were statistically analyzed and discussed. Data were entered and processed using SPSS 19.0 statistical software. The relationship between microtia deformities and associated malformations was analyzed by Pearson χ2 test. P<0.05 was considered statistically significant.@*Results@#A total of 746 patients with microtia were included, including 513 males and 233 females, aged 5-27 years old. There were 678 cases of unilateral microtia, 68 cases of bilateral microtia; 128 cases of Ⅰ degree, 564 cases of Ⅱ degree, and 54 cases of Ⅲ degree. In addition, 336 cases (45%) were associated with dysplasia of other systems. Detected anomalies were 321 cases of the ear, face, and neck, 261 cases of musculoskeletal system and 76 cases of cardiovascular system, 30 cases of anomalies of the urogenital system, eye, 27 cases of respiratory system, 7 cases of central nervous system, 5 case of digestive system and 1case of diaphragmatic hernia. The proportion of male and female with microtia was 47.0% (241/513) and 40.8% (95/233), respectively, and there was no significant difference in between (χ2=2.493, P=0.114); The composition ratios of unilateral and bilateral associated malformations were 45.7% (310/678) and 38.2% (26/68 ), and there was no significant difference in between (χ2=1.400, P=0.237); The composition ratios of Ⅰ, Ⅱ, Ⅲ degree-associated malformations were 39.8% (51/128), 42.6% (240/564), and 83.3% (45/54), and the difference was statistically significant (χ2= 34.794, P<0.001).@*Conclusions@#Microtia has significant clinical heterogeneity with a higher proportion of associated malformations. A higher incidence of associated deformities in patients with severe microtia was observed. Systematic examination is required, which will be helpful to clinical therapy and etiology analysis.

Analysis of clinical efficacy in using expanded retroauricular flap to fully cover reconstructed cartilage scaffold / 中华整形外科杂志

Objective@#In order to achieve superior aesthetic outcomes of reconstructed ear, analyze and summarize clinical therapeutic effect in completely applying expanded retroauricular flap to encapsulate cartilage scaffold in total auricular reconstruction.@*Methods@#From January 2016 to October 2017, fifty-three congenital microtia patients were treated. A kidney-shaped tissue expander with 50 ml capacity was embedded under retroauricular skin in the first-stage. After excessive expansion to 70 ml and remaining stable for 4 weeks, secondary operation was performed to completely encapsulate cartilage scaffold with expanded retroauricular skin. Postoperative follow-up was carried out on a routine basis.@*Results@#All patients had undergone operations successfully with primary healing of incision. Blood supply of the retroauricular flaps was excellent, and cartilage scaffolds totally survived with no infection and absorption. Satisfactory aesthetic outcome along with clear structure, reasonable symmetry and suitable auriculocephalic angle was acquired in all cases. No color aberration was observed between the front and back side of reconstructed ear. Scars of retroauricular incisions and costal cartilage harvesting incisions were unconspicuous.@*Conclusions@#Only using expansive retroauricular flap to fully cover reconstructed cartilage scaffold is reasonable and simple without skin grafting, which is worthy of more application in microtia treatment.

Adenovirus-active matrix metalloproteinase-2 cDNA affects human proliferating hemangioma growth in nude mice An in vivo experiment / 中国组织工程研究

BACKGROUND: Evidence exists that inhibition of matrix metanoproteinase-2(MMP-2) secretion in the proliferating hernangioma tissue by transfection of adenovirus-active MMP-2(Ad-aMMP-2) cDNA would become an important means for treatment of proliferating hemangioma.OBJECTIVE: To investigate the influences of Ad-aMMP-2 cDNA transfection on human proliferating hemangioma growth in nude mice.DESIGN, TIME AND SETTING: A randomized, grouping, and controlled observation was performed in West China Hospital of Sichuan University between August 2003 and September 2004.MATERIALS: Eighteen BALB/c-nu/nu nude mice, weighing approximately 20 g, were included. Cavernous hemangioma specimen pathologically confirmed as proliferating hemangioma was resected from one 52-day-old female child patient.METHODS: The freshly reseoted human proliferating hemangioma specimen was sliced into small pieces with a size of 5 mm×4 mm×3 mm and subcutaneously implanted into the back of 18 nude mice within 1 hour to develop mouse models of hemangioma.Forty-five days after hemangioma implantation, 15 successful hemangioma nude mice were treated by intratumoral administration of adenovirus green fluorescent protein (Ad-GFP1 n = 51 Ad-GFP group), adenovirus-active MMP-2 (n = 5, Ad-aMMP-2 group), or the same amount of phosphate buffered saline (PBS1 n = 51 control group). Intratumoral administration was performed once every other day, for a total of 4 times.MAIN OUTCOME MEASURES: Observation of tumor volume and compadson of tumor necrosis area among 3 groups; detection of GFP expression in nude mouse; gross, hematoxylin-eosin staining, and transmission etectron microscope observation of tumor tissue morphology; determination of MMP-2 cDNA expression and microvascular density by immunohistochemistry; and detection of growth cycle and apoptosis of tumor cells by flow cytometry.RESULTS:①Ad-aMMP-2 could inhibit hemangioma growth in vivo, without marked adverse reactions. Tumor necrosis of different degrees was found in each group, and tumor necrosis area was significantly greater in the Ad-aMMP-2 group than in the control and Ad-GFP groups (P < 0.01). ②Histological sections displayed GFP gene expression in the Ad-GFP group. ③Gross observation results revealed relatively large tumor tissue in the control and Ad-GFP groups and relatively small tumor tissue in the Ad-aMMP-2 group. Hernatoxylin-eosin staining results showed that in the control and Ad-GFP groups, endothelial cells aggregated together in strip-shaped or lump-shaped appearance, and in the Ad-aMMP-2 group, there were many necrotic loci arranging in lamellar-shape appearance. Transmission electron microscope results revealed vascular endothelial cells with normal morphology in the control group and tumor cells with apparent nucleoli in the Ad-GFP group, while in the Ad-aMMP-2 group, some vascular endothelial cells exhibited chromatin pycnosis in the nucleus, forming apoptotic bodies.④ MMP-2 expression and microvascular density were significantly reduced in the Ad-aMMP-2 group than in the Ad-GFP and control groups (P < 0.05). ⑤The percentage of tumor cells in G0/G1 phase was significantly higher (P < 0.05), while the proliferating index was significantly decreased, in the Ad-aMMP-2 group than in the Ad-GFP and control groups. The Ad-aMMP-2 group exhibited higher apoptosis rate of tumor cells (P < 0.05), as well as more markedly increasing apoptosis index, than the control and Ad-GFP groups.CONCLUSION: It is feasible to block human proliferating hemangioma growth by transfeotion of Ad-aMMP-2 cDNA. The included mechanisms are to inhibit vascular endothelial cells to secrete MMP-21 thereby leading to local ischemia.

Treatment of sacrococcygeal decubitus ulcers by two period operations of myocutaneous flap transposition:Reports of 19 cases / 中国组织工程研究

AIM:Researches have shown that musculocutaneous flap or fascial flap could well treat refractory bedsore in a long term. This study observed the clinical experience in the treatment of sacrococcygeal ulcers. METHODS:From January 2000 to January 2006,19 patients with sacrococcygeal ulcers,who received myocutaneous flap transposition in Department of Burns and Plastic Surgery,West China Hospital of Sichuan University,were selected. The informed consent was obtained from all patients. The surgery included two stages. At the first stage,debridement and eschar excision were performed. At the second stage,the surgery was undergone after selecting the myocutaneous flap type according to the patients' age,ulcer position,and ulcer extent. Twenty-one wounds were repaired by gluteus maximus myocutaneous flaps,and the flap size was 13 cm ?11 cm-17 cm?14 cm;8 by long-head of biceps femoris flaps of 10 cm?6 cm-13 cm?6 cm. After operation,the patients were placed on turn-over bed for 14 days and followed regularly. RESULTS:All flaps survived and the wounds in 18 cases healed at the first stage. Hematocele underlying flap occurred in one patient with urinemia,and healed by dressing exchange. After a follow-up of 5 months to 3 years,no patient had a recurrence;the color and texture of the flaps were good,and he appearance was satisfactory. CONCLUSION:The technique of two period operation treatment of myocutaneous flap transposition can accelerate the healing of sacrococcygeal ulcers and improves the success rate of operation.