Narrative cave art in Indonesia by 51,200 years ago.

Previous dating research indicated that the Indonesian island of Sulawesi is host to some of the oldest known rock art1-3. That work was based on solution uranium-series (U-series) analysis of calcite deposits overlying rock art in the limestone caves of Maros-Pangkep, South Sulawesi1-3. Here we use a novel application of this approach-laser-ablation U-series imaging-to re-date some of the earliest cave art in this karst area and to determine the age of stylistically similar motifs at other Maros-Pangkep sites. This method provides enhanced spatial accuracy, resulting in older minimum ages for previously dated art. We show that a hunting scene from Leang Bulu' Sipong 4, which was originally dated using the previous approach to a minimum of 43,900 thousand years ago (ka)3, has a minimum age of 50.2 ± 2.2 ka, and so is at least 4,040 years older than thought. Using the imaging approach, we also assign a minimum age of 53.5 ± 2.3 ka to a newly described cave art scene at Leang Karampuang. Painted at least 51,200 years ago, this narrative composition, which depicts human-like figures interacting with a pig, is now the earliest known surviving example of representational art, and visual storytelling, in the world3. Our findings show that figurative portrayals of anthropomorphic figures and animals have a deeper origin in the history of modern human (Homo sapiens) image-making than recognized to date, as does their representation in composed scenes.

Management of overactive bladder: consensus statements from the Hong Kong Urological Association and the Hong Kong Geriatrics Society.

Overactive bladder (OAB) is a common urological disease with a high prevalence in older adult populations. Antimuscarinic drugs have been the most common treatment for OAB for more than a decade, but their anticholinergic side-effects and potential impact on cognitive function among older patients are usually underestimated. This consensus aimed to provide practical recommendations concerning OAB management, with a particular emphasis on older patients. A joint consensus panel was formed by representatives of the Hong Kong Urological Association and the Hong Kong Geriatrics Society. Literature searches regarding OAB and its management were performed in PubMed and Ovid. Several working meetings were held to present and discuss available evidence, develop consensus statements, and vote for the statements. A modified Delphi method was used in this consensus process. To address questions regarding various aspects of OAB, 29 consensus statements were proposed covering the following areas: diagnosis, initial assessment, non-pharmacological treatments, considerations before administration of pharmacological treatments, various pharmacological treatments, combination therapy, and surgical treatment. Twenty-five consensus statements were accepted.

[Randomized controlled study on the application effect of a new type of intravenous radiofrequency closed therapy system made in China and an imported system].

Objective: To compare the application effect of domestic and imported intravenous radiofrequency closure system in the treatment of primary varicose veins of lower extremities. Methods: This single-center prospective, non-inferiority randomized controlled trial was performed in the Department of Vascular Surgery, the Fourth Affiliated Hospital, Zhejiang University School of Medicine from January 2021 to January 2022. Patients with primary varicose veins of lower extremities who met the ataxation criteria were randomly assigned to the experimental group(domestic novel venous radiofrequency closure system) or the control group(imported venous radiofrequency closure system) in a ratio of 1∶1. The two groups of subjects were compared in terms of target vein closure rate, technical success rate, system operation performance, incidence of adverse events and incidence of serious adverse events(SAE) within 6 months after surgery. Quantitative data were compared by Mann-Whitney U test, and categorical data were compared by χ2 test and non-inferiority test. Results: A total of 80 subjects were included in the trial (41 in the experimental group and 39 in the control group), including 27 males and 53 females, aged (M(IQR)) 55(23) years (range:40 to 78 years). There were 48 cases of left lower limb and 32 cases of right lower limb. The technical success rate and system control performance between the groups were 100%.The incidence of adverse events (58.5% (24/41) vs. 61.5% (24/39), χ2=0.075, P=0.784), and the incidence of SAE (7.3% (3/41) vs. 5.1% (2/39), χ2=0.163, P=0.686) within 6 months after surgery in experimental group and control group had no statistical significance. There was one device-related adverse event in each of the two groups. In the experimental group, one patient developed endovenous heat-induced thrombosis after surgery and recovered after taking rivaroxaban tablets. One patient in the control group had pain in the upper right thigh for more than 1 day after operation, which was cured after using analgesic cream. No device-related SAE occurred. The venous closure rate of the experimental group was 100% (38/38) at 6 months after surgery, and that of the control group was 97.4% (37/38). The difference between the two groups was 2.63% (95%CI:-3.19 to 8.45, Z=4.865, P<0.01), and the 95%CI lower limit of the difference in target venous closure rate between two groups was greater than the non-inferiority threshold of -10.00%. Conclusion: The early application effect of the new domestic intravenous radiofrequency closure system in patients with primary varicose veins of lower extremities is in line with expectations, it is not inferior to the imported system.

[Bibliometric and visual analysis of pneumoconiosis based on Cite Space].

Objective: Through the bibliometrics analysis and visual analysis of Chinese and English literature related to pneumoconiosis through CiteSpace, to understand the research situation, research trend and hotspots of pneumoconiosis, so as to provide reference for further research. Methods: In August 2022, CNKI (China National Knowledge Infrastructure) data baseand Web of Science core collection database were used as data sources for literature retrieval. Cite Space.5.8.R3c software was used to analyze the cooperation between authors and institutions, keyword co-occurrence analysis, keyword clustering analysis and keyword emergence analysis. Results: A total of 4726 Chinese literature and 2490 English literature related to pneumoconiosis were included; The annual publication volume of Chinese literature shows a fluctuating downward trend, while the annual publication volume of English literature shows a fluctuating upward trend. The Institute of Labor Health and Occupational Disease of the Chinese Academy of Preventive Medical Sciences and the Institute of Occupational Health and Poisoning Control of the Chinese Center for Disease Control and Prevention have the highest publication volume (55 articles) in the institutional cooperation network; The National Institute for Occupational Safety and Health (NIOSH) in the United States has the highest publication volume (153 articles) in the institutional collaboration network. The results of keyword co-occurrence, clustering, and prominence analysis show that Chinese literature focuses more on clinical research on pneumoconiosis, while English literature focuses more on experimental research related to the pathogenesis of pneumoconiosis. Conclusion: In the related field of pneumoconiosis research, the experimental research and clinical research on the pathogenesis are the main research hotspots.

[Application of V-Y advancement flap with facial artery perforator for the repair of midface skin defects].

Objective: To investigate the efficacy of V-Y advancement flap with facial artery perforator for the repair of midface skin defects. Methods: A retrospective analysis was performed on 18 patients with facial skin cancer, including 11 males and 7 females, aged 65-83 years, who underwent the repair of midface skin defects using V-Y advancement flap with facial artery perforator in the Department of Head and Neck Surgery, Affiliated Cancer Hospital of Nantong University from January 2020 to April 2023. Medium, large or complex midface skin defects developed after surgical resections of the primary lesions. According to the defect site, size, location information of facial vessels, a V-Y advancement flap with appropriate shape was designed for each case. During the operation, the facial vessels and their perforators were retained in the pedicle of the flap, the facial nerve branches were dissected and protected, and the further denuded pedicle was determined according to actual amount of advancement. After the flap was advanced, the facial defect area was repaired without tension, and the anatomical positions and functions of the eyes, nose and mouth were restored as far as possible. Postoperative follow-ups were conducted to observe the survival rate of the flaps, postoperative complications, recurrences and metastases of tumors. Results: Midface defects of 3.0 cm×3.5 cm-6.5 cm×7.5 cm were observed after tumor resections, which involved one or more subregions. The sizes of the flaps were 3.5 cm×9.0 cm-7.0 cm×18.0 cm. All flaps were completely alive except for one with temporary local bruising. With following-up of 4-40 months, 5 of the 12 patients with lower eyelid and inner canthus invasions had lower eyelid ectropion, but no exposed keratitis was found; one case with poorly differentiated squamous cell carcinoma had lymph node metastasis in the submandibular region and underwent neck dissection again; no recurrence or metastasis occurred in the remaining cases. Conclusion: The V-Y advancement flap with facial artery perforator can be used to repair medium, large or complex midface skin defects, with a high survival rate, and the operation method is safe and reliable.

[An intelligent model for classifying supraventricular tachycardia mechanisms based on 12-lead wearable electrocardiogram devices].

OBJECTIVE: To develop an intelligent model for differential diagnosis of atrioventricular nodal re-entrant tachycardia (AVNRT) and atrioventricular re-entrant tachycardia (AVRT) using 12-lead wearable electrocardiogram devices. METHODS: A total of 356 samples of 12-lead supraventricular tachycardia (SVT) electrocardiograms recorded by wearable devices were randomly divided into training and validation sets using 5-fold cross validation to establish the intelligent classification model, and 101 patients with the diagnosis of SVT undergoing electrophysiological studies and radiofrequency ablation from October, 2021 to March, 2023 were selected as the testing set. The changes in electrocardiogram parameters before and during induced tachycardia were compared. Based on multiscale deep neural network, an intelligent diagnosis model for classifying SVT mechanisms was constructed and validated. The 3-lead electrocardiogram signals from Ⅱ, Ⅲ, and Ⅴ1 were extracted to build new classification models, whose diagnostic efficacy was compared with that of the 12-lead model. RESULTS: Of the 101 patients with SVT in the testing set, 68 were diagnosed with AVNRT and 33 were diagnosed with AVRT by electrophysiological study. The pre-trained model achieved a high area under the precision-recall curve (0.9492) and F1 score (0.8195) for identifying AVNRT in the validation set. The total F1 scores of the lead Ⅱ, Ⅲ, Ⅴ1, 3-lead and 12-lead intelligent diagnostic models in the testing set were 0.5597, 0.6061, 0.3419, 0.6003 and 0.6136, respectively. Compared with the 12-lead classification model, the lead-Ⅲ model had a net reclassification index improvement of -0.029 (P=0.878) and an integrated discrimination index improvement of -0.005 (P=0.965). CONCLUSION: The intelligent diagnostic model based on multiscale deep neural network using wearable electrocardiogram devices has an acceptable accuracy for classifying SVT mechanisms.

Copy Number Alterations Predict Development of OSCC from Oral Leukoplakia.

Oral leukoplakia (OLK) is a common type of potentially malignant disorder. Early identification of the malignancy potential leads to a better management of OLK and prediction of development of oral squamous cell carcinoma (OSCC). However, there has been no effective biomarker to assess the risk of malignancy in OLK. Genomic copy number alteration (CNA) is a complex chromosomal structural variation in the genome and has been identified as a potential biomarker in multiple cancers. This study aimed to develop a predictive model for the malignant transformation risk of OLK by copy number analysis. A total of 431 OLK samples with long-term follow-up (median follow-up of 67 mo) from multiple academic centers were analyzed for CNAs. CNA events increased with the severity of hyperplasia, mild dysplasia, moderate dysplasia, and severe dysplasia. More CNA events were present in patients with OLK who later developed OSCC than in those with OLK who did not. By multivariate Cox regression analysis, the OLK of the CNA scorehigh group showed an increased risk of malignant transformation than the CNA scorelow group (P < 0.001). A CNA score model was developed to accurately predict the prognosis (area under the receiver operating characteristic curve [AUC] = 0.879; 95% confidence interval [CI], 0.799-0.959) and was validated using data from 2 external centers (AUC = 0.836, 95% CI, 0.683-0.989; AUC = 0.876, 95% CI, 0.682-1.000), and all of them showed better prediction performances than histopathological grade in assessing the transformation risk of OLK. Furthermore, we performed CNA models among 4 subgroups of OLK with hyperplasia, mild dysplasia, moderate dysplasia, and severe dysplasia and found that CNA score can accurately predict malignant transformation of different subgroups. CNA score may be a useful biomarker to predict malignant transformation of OLK. Subtyping of OLK by the CNA score could contribute to better management of OLK and predicting development of OSCC.

Adaptation of plants to high-calcium content kart regions: possible involvement of symbiotic microorganisms and underlying mechanisms / Adaptação de plantas a regiões de kart com alto teor de cálcio: possível envolvimento de microrganismos simbióticos e mecanismos subjacentes

Abstract Rhizosphere microorganisms and endophytes can help their hosts absorb nutrients and regulate the levels of plant hormones. Moreover, they can modulate the expressions of host genes, assist hosts in eliminating reactive oxygen species (ROS) and secreting volatile organic compounds. Therefore, rhizosphere microorganisms and endophytes are considered as determinant factors driving processes involved in the growth of host plants. However, the physiological and ecological functions, as well as the molecular mechanism underlying the behavior of rhizosphere microorganisms and endophytes in their role in the adaptive capacity of host plants in the karstic high-calcium environment have not been systematically studied. This review summarizes the physiological and molecular mechanisms of rhizosphere microorganisms and endophytes which help host plants to adapt to various kinds of adverse environments. The adaptive capacities of plants growing in adverse environments, partly, or totally, depends on microorganisms co-existing with the host plants.

Resumo Os microorganismos e endófitos da rizosfera podem ajudar seus hospedeiros a absorver nutrientes e regular os níveis de hormônios vegetais. Além disso, eles podem modular as expressões dos genes hospedeiros, auxiliar os hospedeiros na eliminação de espécies reativas de oxigênio (ROS) e secretar compostos orgânicos voláteis. Portanto, microorganismos e endófitos da rizosfera são considerados determinantes dos processos envolvidos no crescimento de plantas hospedeiras. No entanto, as funções fisiológicas e ecológicas, bem como o mecanismo molecular subjacente ao comportamento dos microrganismos e endofíticos da rizosfera no seu papel na capacidade adaptativa das plantas hospedeiras no ambiente cárstico de alto teor de cálcio, não foram sistematicamente estudados. Esta revisão resume os mecanismos fisiológicos e moleculares de microrganismos e endófitos da rizosfera que ajudam as plantas hospedeiras a se adaptarem a vários tipos de ambientes adversos. As capacidades adaptativas das plantas que crescem em ambientes adversos, em parte ou totalmente, dependem de microrganismos coexistentes com as plantas hospedeiras.

Adaptation of plants to high-calcium content kart regions: possible involvement of symbiotic microorganisms and underlying mechanisms

Abstract Rhizosphere microorganisms and endophytes can help their hosts absorb nutrients and regulate the levels of plant hormones. Moreover, they can modulate the expressions of host genes, assist hosts in eliminating reactive oxygen species (ROS) and secreting volatile organic compounds. Therefore, rhizosphere microorganisms and endophytes are considered as determinant factors driving processes involved in the growth of host plants. However, the physiological and ecological functions, as well as the molecular mechanism underlying the behavior of rhizosphere microorganisms and endophytes in their role in the adaptive capacity of host plants in the karstic high-calcium environment have not been systematically studied. This review summarizes the physiological and molecular mechanisms of rhizosphere microorganisms and endophytes which help host plants to adapt to various kinds of adverse environments. The adaptive capacities of plants growing in adverse environments, partly, or totally, depends on microorganisms co-existing with the host plants.

Resumo Os microorganismos e endófitos da rizosfera podem ajudar seus hospedeiros a absorver nutrientes e regular os níveis de hormônios vegetais. Além disso, eles podem modular as expressões dos genes hospedeiros, auxiliar os hospedeiros na eliminação de espécies reativas de oxigênio (ROS) e secretar compostos orgânicos voláteis. Portanto, microorganismos e endófitos da rizosfera são considerados determinantes dos processos envolvidos no crescimento de plantas hospedeiras. No entanto, as funções fisiológicas e ecológicas, bem como o mecanismo molecular subjacente ao comportamento dos microrganismos e endofíticos da rizosfera no seu papel na capacidade adaptativa das plantas hospedeiras no ambiente cárstico de alto teor de cálcio, não foram sistematicamente estudados. Esta revisão resume os mecanismos fisiológicos e moleculares de microrganismos e endófitos da rizosfera que ajudam as plantas hospedeiras a se adaptarem a vários tipos de ambientes adversos. As capacidades adaptativas das plantas que crescem em ambientes adversos, em parte ou totalmente, dependem de microrganismos coexistentes com as plantas hospedeiras.

Inhibitory effect of liposomal quercetin on acute hepatitis and hepatic fibrosis induced by concanavalin A

Immune response plays an important role in the development of hepatic fibrosis. In the present study, we investigated the effects of quercetin on hepatitis and hepatic fibrosis induced by immunological mechanism. In the acute hepatitis model, quercetin (2.5 mg/kg) was injected iv into mice 30 min after concanavalin A (Con A) challenge. Mice were sacrificed 4 or 24 h after Con A injection, and aminotransferase tests and histopathological sections were performed. Treatment with quercetin significantly decreased the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Consistent with this observation, treatment with quercetin markedly attenuated the pathologic changes in the liver. A hepatic fibrosis model was also generated in mice by Con A challenge once a week for 6 consecutive weeks. Mice in the experimental group were treated with daily iv injections of quercetin (0.5 mg/kg). Histopathological analyses revealed that treatment with quercetin markedly decreased collagen deposition, pseudolobuli development, and hepatic stellate cells activation. We also examined the effects of quercetin on the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and transforming growth factor beta (TGF-β) pathways by immunohistochemistry and real-time reverse transcriptase-polymerase chain reaction (RT-PCR). NF-κB and TGF-β production was decreased after treatment with quercetin, indicating that the antifibrotic effect of quercetin is associated with its ability to modulate NF-κB and TGF-β production. These results suggest that quercetin may be an effective therapeutic strategy in the treatment of patients with liver damage and fibrosis.

The concept of two-dimensional electrophoresis-guided purification proven by isolation of rhodocetin from Calloselasma rhodostoma (Malayan pit viper)

Two-dimensional gel electrophoresis (2DE) is an important tool for investigating the complexity of snake venom proteomes. Apart from applications based on whole proteome analysis, we suggest that 2DE can be used as an assay to guide the progress of protein purification. The aim of this study was to prove the feasibility of this concept by using it to purify rhodocetin from Calloselasma rhodostoma venom. Rhodocetin (α subunit) spot on the 2DE profile of C. rhodostoma venom was first identified and confirmed by mass spectrometry, with a molecular mass of 16 kDa and calculated pI of 5.16. Rhodocetin was subsequently purified by successive anion-exchange and gel filtration chromatography. Every peak from both chromatography profiles was collected and tested on 2DE. The presence of rhodocetin (α subunit) spot in the 2DE profile of the peak DP2 indicated the presence of the protein. The purified compound was used to spike the crude venom. A spiked spot with a 1.6-fold increase in intensity was observed and its position matched to that of rhodocetin (α subunit) on the 2DE profile. Together, these spots confirmed the identity of the purified compound as rhodocetin. Hence, our results have demonstrated the effectiveness of the concept we now term 2DE-guided purification.(AU)

Neuropilin-1 is overexpressed in osteosarcoma and contributes to tumor progression and poor prognosis

AIM: Neuropilin (NRP)-1, a co-receptor for vascular endothelial growth factor (VEGF), plays an important role in angiogenesis and malignant progression of many cancers. However, the involvement of NRP-1 in osteosarcoma is not completely understood. The aim of this study was to investigate the expression pattern and clinical significance of NRP-1 in human osteosarcoma. METHODS: NRP-1 mRNA and protein expression levels were detected by RT-PCR and Western blot assays, respectively, using 166 pairs of osteosarcoma and noncancerous bone tissues. Then, the association of NRP-1 expression with clinicopathological factors or survival of osteosarcoma patients was further evaluated. RESULTS: RT-PCR and Western blot assays revealed that NRP-1 expression in osteosarcoma tissues was significantly higher than that in corresponding noncancerous bone tissues at both mRNA and protein levels (both P < 0.001). In addition, high NRP-1 expression more frequently occurred in osteosarcoma tissues with advanced clinical stage (P = 0.006), positive distant metastasis (P = 0.01) and poor response to chemotherapy (P = 0.006). Moreover, osteosarcoma patients with high NRP-1 expression had significantly shorter overall survival and disease-free survival (both P < 0.001) when compared with patients with the low expression of NRP-1. On Cox multivariate analysis, NRP-1 overexpression was an independent and significant prognostic factor to predict poor overall survival and disease-free survival (both P = 0.001). CONCLUSION: This is the first study to reveal that NRP-1 overexpression may be related to the prediction of metastasis potency, response to chemotherapy and poor prognosis for osteosarcoma patients, suggesting that NRP-1 may serve as a prognostic marker for the optimization of clinical treatments (AU)

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Increased expression of CD24 is associated with tumor progression and prognosis in patients suffering osteosarcoma

OBJECTIVE: As a small heavily glycosylated mucin-like glycosyl-phosphatidylinositol-anchored cell surface protein, CD24 plays an important role in carcinogenesis of various human malignancies. However, its involvement in osteosarcoma is still unclear. The aim of this study was to investigate the expression pattern and the clinical significance of CD24 in human osteosarcoma. METHODS: CD24 mRNA and protein expression levels were, respectively, detected by RT-PCR and Western blot assays using 30 pairs of osteosarcoma and noncancerous bone tissues. Then, immunohistochemistry was performed to analyze the association of CD24 expression in 166 osteosarcoma tissues with clinicopathological factors or survival of patients. RESULTS: CD24 expression at mRNA and protein levels were both significantly higher in osteosarcoma tissues than those in corresponding noncancerous bone tissues (both P < 0.001). In addition, CD24 protein was positively expressed in 129 of 166 (77.7 %) osteosarcoma specimens with a cytoplasmic and membraneous staining, and also increased in the osteosarcoma specimens with advanced clinical stage (P = 0.01) and positive distant metastasis (P = 0.005). The univariate and multivariate analyses showed that osteosarcoma patients with high CD24 expression had poorer overall and disease-free survival, and high CD24 expression was an independent prognostic factor for both overall and disease-free survival. CONCLUSION: The aforementioned findings offer convincing evidence for the first time that the increased expression of CD24 is correlated with tumor ggressiveness and tumor metastasis of osteosarcoma, and this molecule is an independent prognostic marker for osteosarcoma patients (AU)

Bases anatómicas vasculares de los colgajos perforantes cutáneos / Vascular anatomical basis of perforator skin flaps

En las últimas dos décadas, el uso de colgajos perforantes musculocutaneos se ha incrementado a medida que los microcirujanos se han familiarizado con la técnica y estos colgajos se han convertido en una parte de la evolución de la Microcirugía. Como se basan en perforantes musculocutaneas o septocutaneas individuales, el microcirujano reconstructivo debe tener la información anatómica detallada para planificar la transferencia de colgajos perforantes. El fin de este trabajo es la revisión de las diversas técnicas angiográficas disponibles para estudiar la anatomía vascular del cuerpo humano y presentar nuestra técnica habitual de inyección vascular. Exhibiremos ejemplos ilustrativos utilizando la técnica de la inyección de gelatina de óxido de plomo para visualizar la anatomía relevante de los sitios donantes de colgajos perforantes. La técnica de la inyección de gelatina de óxido descrita por Salmon y Rees y Taylor, puede ser utilizada para inyecciones arteriales o venosas, pero la hemos utilizado primariamente para inyección arterial. Los pasos para la inyección se describen detalladamente en el trabajo. En los pasados 5 años hemos disecado un total de 21 cadáveres frescos tras estudios de inyección arterial de gelatina de óxido de plomo. Se han revisado un total de 7000 radiografías. Presentamos los resultados dela búsqueda anatómica en las áreas de cabeza, cuello, miembros superiores, torso y miembros inferiores. La técnica de la inyección de gelatina de óxido de plomo es simple y económica a su vez; la técnica de análisis computarizado es barata y las técnicas de análisis informático son directas y proveen excelente visualización de la arquitectura de la piel humana. Los delicados detalles identificados utilizando esta técnica de inyección proveen información útil a los cirujanos para planificar transferencias de piel, músculo, hueso y nervio, y por tanto favorecen nuestra comprensión de la anatomía vascular clínicamente relacionada de los colgajos perforantes (AU)

Over the past 2 decades the use of musculocutaneous perforator flaps has increased worldwide as microsurgeons have become more comfortable with the technique. Perforator flaps have now become well established as a part of the evolution of microsurgery. Since perforator flaps are based on individual musculocutaneous or septocutaneous perforators, it is imperative that the reconstructive microsurgeon has the detailed anatomical information necessary to plan perforator flap transfers. The goal of this paper is to review the various angiographic techniques which are available to study the vascular anatomy of the human body and to present our current vascular injection technique. We will show illustrative examples using the lead oxide gelatin injection technique to elucidate the relevant anatomy of perforator flap donor sites. The lead oxide gelatin injection technique has been previously reported by Salmon and Rees and Taylor. The injection technique may be used for arterial or venous injections but we have primarily used it for arterial injections. The injection steps are detailed in the paper. Over the past five years we have dissected a total of 21 human fresh cadavers after lead oxide gelatin arterial injection studies. A total of over 7000 radiographs have been reviewed and summarized. We present summarized results of the anatomical research in the areas of head and neck, upper limb, torso and lower limb regions. The lead oxide gelatin injection technique is simple and inexpensive and the computer analysis technique is straight forward and provides excellent visualization of the architecture of the human skin. The fine details identified using this injection technique provides useful information to surgeons planning transfers of skin, muscle, bone and nerve and therefore our understandingly of clinically related vascular anatomy of perforator flaps can be improved (AU)