Plasmonic responses in Janus bAsP with elliptic-to-hyperbolic transition: an ab-initio study.

Plasmonic responses in materials with actively tunable elliptic-to-hyperbolic transition are rare in nature. Based on ab-initio calculations, we have theoretically predicted that Janus black arsenic phosphorus (bAsP) supports both elliptic and hyperbolic in-plane surface plasmon polaritons in the infrared after being doped with electrons. In the elliptic regime, anisotropic plasmonic responses have been observed, which can be explained by the anisotropic dispersions at the bottom of the conduction bands. In the hyperbolic regime, the total permittivity along the armchair/zigzag edge is negative/positive, which is the result of positive interband permittivities and largely different Drude plasma frequencies along two directions making the total permittivities change signs at different photon energies. In this material, changing the topology (elliptic or hyperbolic) of the plasmonic responses via doping is possible. Then, strains along the zigzag and armchair directions have been applied to modify the band structures as well as the plasmonic responses. Since plasmonic responses are mostly related to the bands near the Fermi energy, a relatively small strain along the zigzag direction can make bAsP become an indirect-bandgap material and change the Drude plasma frequencies under proper doping. With both strain and doping present in this material, we have even found a special case of hyperbolicity where the total permittivity in the zigzag/armchair direction is negative/positive, which is opposite to the normal case. In the end, we have extended our investigations to bAsP-graphene heterostructures. Since bAsP is a Janus material, such direct contact can change the Fermi energy through charge transfer making this heterostructure support strong plasmons without extra doping. Our investigations propose bAsP as a promising Janus material platform for plasmonic applications.

[Imaging evaluation of cerebrospinal fluid otorrhea associated with inner ear malformation in children].

Objective: To explore the imaging evaluation of cerebrospinal fluid (CSF) otorrhea associated with inner ear malformation (IEM) in children. Methods: The clinical data of 28 children with CSF otorrhea associated with IEM confirmed by surgical exploration in Beijing Children's Hospital, from Nov, 2016 to Jan, 2021, were analyzed retrospectively,including 16 boys and 12 girls, aged from 8-month to 15-year and 8-month old, with a median age of 4-year old. The shapes of stapes were observed during the exploration surgery, and the imaging features of temporal bone high resolution CT(HRCT) and inner ear MRI pre- and post-operation were analyzed. Results: In 28 children with CSF otorrhea, 89.3%(25/28) had stapes footplates defect during exploration. Preoperative CT showed indirect signs such as IEM, tympanic membrane bulging, soft tissue in the tympanum and mastoid cavity. IEM included four kinds: incomplete partition type I (IP-Ⅰ), common cavity (CC), incomplete partition type Ⅱ (IP-Ⅱ), and cochlear aplasia (CA); 100%(28/28) presented with vestibule dilation; 85.7%(24/28) with a defect in the lamina cribrosa of the internal auditory canal. The direct diagnostic sign of CSF otorrrhea could be seen in 73.9%(17/23) pre-operative MRI: two T2-weighted hyperintense signals between vestibule and middle ear cavity were connected by slightly lower or mixed intense T2-weighted signals, and obvious in the coronal-plane; 100%(23/23) hyperintense T2-weighted signals in the tympanum connected with those in the Eustachian tube.In post-operative CT, the soft tissues in the tympanum and mastoid cavity decreased or disappeared as early as one week. In post-operative MRI, the hyperintense T2-weighted signals of tympanum and mastoid decreased or disappeared in 3 days to 1 month,soft tissues tamponade with moderate intense T2-weighted signal were seen in the vestibule in 1-4 months. Conclusions: IP-Ⅰ, CC, IP-Ⅱ and CA with dilated vestibule can lead to CSF otorrhea. Combined with special medical history, T2-weighted signal of inner ear MRI can provide diagnostic basie for most children with IEM and CSF otorrhea.HRCT and MRI of inner ear can also be used to evaluate the effect of surgery.

[The relationship of resilience with cognitive function in patients with first-episode schizophrenia].

Objective: To investigate the correlation between resilience and cognitive function in patients with schizophrenia. Methods: Fifty-nine patients with first-episode schizophrenia and 86 healthy controls were enrolled. Patients with schizophrenia were enrolled from the psychiatric outpatient and inpatient Department of the Third Affiliated Hospital of Sun Yat-sen University from September 2017 to January 2020, while healthy controls were recruited through advertising. The levels of resilience and cognitive function were compared between the two groups.Meanwhile, the partial correlation analysis of resilience and cognitive function of the two groups was performed. Results: There was no statistically significant difference in gender, marriage and age between the two groups (all P>0.05), and there were 39 males and 20 females with an average age of (23.8±7.4) years in the schizophrenia group, while 47 males and 39 females with an average age of (22.9±4.7) years in the healthy control group. However, there was a significant difference inyears of education between the two groups (P<0.05). The total score of resilience [(56.9±16.7) vs(68.0±14.4)] and scores ofthree factorsin patients with schizophrenia were significantly lower than that in healthy controls(all P<0.05). The total score of MATRICS Consensus Cognitive Battery (MCCB)[(23±12) vs (42±11)] and each subscale score in patients with schizophrenia were significantly lower than that in healthy controls(all P<0.05). Partial correlation analysis showed that the total score of resilience and tenacity were correlated with symbol coding of schizophrenia(partial correlation coefficients were 0.286, 0.289, respectively, both P<0.05). The total score of resilience and the scores of tenacity, strength and optimism were all correlated with emotion management ability of schizophrenia(partial correlation coefficients were 0.334, 0.271, 0.382, 0.308, respectively, all P<0.05). In the healthy controls, the total score of resilience, tenacity and optimism were correlated with symbol coding(partial correlation coefficients were 0.268, 0.225, 0.291, respectively, all P<0.05). Strength and optimism were correlated with Hopkins verbal learning test (HVLT)(partial correlation coefficients were 0.268, 0.225, respectively, both P<0.05). Strength was correlated with spatial span, continuous performance test(partial correlation coefficients were 0.244, 0.217, respectively, bothP<0.05). The total scores of resilience and tenacity, strength and optimism were correlated with emotional management ability(partial correlation coefficients were 0.306, 0.230, 0.286, 0.289, respectively, all P<0.05), while the total scores of resilience, strength and optimism were correlated with the total score of MCCB(partial correlation coefficients were 0.291, 0.359, 0.287, respectively, all P<0.05). Conclusion: The current study suggests that resilience and cognitive function of patients with first-episode schizophrenia areimpaired significantly. Resilience in patients with schizophrenia isrelated to partial neurocognitive function and emotion management ability in social cognitive function.

[The effects of PDK1-Akt signaling pathway intervention on cardiomyocyte HCN4 ion channels].

Objective: To explore the effects of 3-phosphate dependent protein kinase 1-protein kinase B (PDK1-Akt) signaling pathway on the transcription, expression and function of cardiac hyperpolarized activated cyclic nucleotide gated 4 (HCN4) ion channels. Methods: Atrial myocytes were obtained from healthy male wild-type C57 mice and heart-specific PDK1 knockout mice (PDK1-KO) by enzymolysis. Then the atrial myocytes were divided into blank control group and PDK1-KO group. In further studies, the isolated atrial myocytes were cultured and further divided into drug control group (treated with dimethyl sulfoxide (DMSO)) and PDK1 knockdown group (treated with 1 µg/ml PDK1 short hairpin RNA (shRNA) interference plasmid), SC79 group (treated with 8 µmol/ml SC79), GSK2334470 group (treated with 10 nmol/L GSK2334470) and PDK1 knockdown+SC79 group (8 µmol/ml SC79 and 1 µg/ml PDK1 shRNA interference plasmid). Real time quantitative PCR (qRT-PCR) was used to detect the mRNA expression levels of PDK1 and HCN4, Western blot was used to detect the protein expression levels of PDK1, Akt and HCN4, the whole cell patch clamp was used to detecte the current density of HCN, and immunofluorescence was used to detecte the expression of HCN4 protein on atrial cells. Results: (1) the expression levels of HCN4 mRNA (1.46±0.03 vs. 0.99±0.01, P<0.001) and protein (1.14±0.02 vs. 1.00±0.06, P=0.017) in PDK1-KO group were higher than those in blank control group. The HCN current density in PDK1-KO group was higher than that in blank control group((-17.47±2.00) pA/pF vs. (-12.15±2.25) pA/pF, P=0.038). (2) The functions of PDK1 shRNA and specific Akt agonist SC79 were verified by comparing the PDK1 knockdown group and SC79 group with the drug control group. The results showed that the expression levels of PDK1 mRNA and protein in PDK1 knockdown group were lower than those in drug control group, and the expression level of phosphorylated Akt (Thr 308) protein in SC79 group was higher than that in drug control group. (3) The expression levels of HCN4 mRNA (3.61±0.46 vs. 1.00±0.08, P<0.001) and protein (2.33±0.11 vs. 1.00±0.05, P<0.001) in GSK2334470 group were higher than those in drug control group. (4) To reduce the effect of drug-miss target, the cultured atrial myocytes were transfected with shRNA plasmid of PDK1 and intervened with SC79. The results showed that the expression of HCN4 mRNA in PDK1 knockdown group was higher than that in the drug control group (1.76±0.11 vs. 1.00±0.06, P<0.001), and PDK1 knockdown+SC79 group (1.76±0.11 vs. 1.33±0.07, P=0.003). In PDK1 knockdown+SC79 group, the mRNA expression level was also higher than that in the drug control group (1.33±0.07 vs. 1.00±0.06, P<0.001). The expression level of HCN4 protein in PDK1 knockdown group was higher than that in drug control group (1.15±0.04 vs. 1.00±0.05, P=0.003). As for the The expression level of HCN4 protein, there was no significantly statistical difference between the PDK1 knockdown+SC79 group and the drug control group (P>0.05), but PDK1 knockdown+SC79 group was lower than PDK1 knockdown group (0.95±0.01 vs. 1.15±0.04, P<0.001). In patch clamp experiments, the results showed that the HCN current density was (-13.27±1.28) pA/pF in the drug control group, (-18.76±2.03) pA/pF in the PDK1 knockdown group, (-13.50±2.58) pA/pF in the PDK1 knockdown+SC79 group; the HCN current density of PDK1 knockdown group was higher than that of drug control group (P<0.001), but there was no significant difference between PDK1 knockdown+SC79 group and drug control group (P>0.05). (5) The results of immunofluorescence showed that the brightness of green fluorescence of PDK1 knockdown group was higher than that of drug control group, indicating that the expression of HCN4 localized on cell membrane was increased. However, the green fluorescence of PDK1 knockdown+SC79 group was lighter than that of PDK1 knockdown group, suggesting that the expression of HCN4 in PDK1-knockdown cell membrane decreased after further activating Akt. Conclusion: PDK1-Akt signaling pathway is involved in the regulation of HCN4 ion channel transcription, expression and function.

[Correlation of the peripheral serum complement protein levels and cognitive function in first-episode drug-naive patients with schizophrenia].

Objective: To explore the role of peripheral serum complement protein in the pathogenesis of cognitive impairment by analyzing the correlation between peripheral serum levels of complement protein and cognitive function in first-episode drug-naive patients with schizophrenia. Methods: A total of 66 first-episode drug-naive schizophrenics (schizophrenia group) from the Third Affiliated Hospital of Sun Yat-sen University and 88 healthy volunteers (control group) were enrolled. Peripheral serum levels of complements (C3, C4 and CH50) were separately examined by liposome immunoassay and turbidimetric inhibition immunoassay. The MATRICS Consensus Cognitive Battery (MCCB) was used to assess the cognitive function. Results: Peripheral serum levels of C4, but not C3 and CH50, were significantly lower in patients with schizophrenia [0.20(0.16, 0.25) g/L] than those in the control group [0.23 (0.19, 0.27) g/L] (P<0.05). Moreover the peripheral serum levels of C3, C4 and CH50 were positively correlated with MCCB verbal fluency (r=0.258, r=0.283 and r=0.330, all P<0.05), and the peripheral serum levels of CH50 were negatively correlated with attention and alertness (r=-0.257, P<0.05). Conclusion: The decrease of peripheral serum complement C4 protein levels may be involved in the mechamism of cognitive impairment in schizophrenia.

Up-regulation of exosomal miR-106a may play a significant role in abdominal aortic aneurysm by inducing vascular smooth muscle cell apoptosis and targeting TIMP-2, an inhibitor of metallopeptidases that suppresses extracellular matrix degradation.

OBJECTIVE: Abdominal aortic aneurysm (AAA) rupture is a dramatic and lethal clinical condition with a high risk of death. Emerging evidence indicates a role for miRNAs in AAA pathogenesis, therefore we aimed to identify miRNAs that differently expressed in exosomes from AAA patients and explore the underlying mechanisms of how miR-106a plays its role in this disease. PATIENTS AND METHODS: Exosomes were isolated from plasma of AAA patients, as well as from the tissue-conditioned culture medium. The exosomal expression profiles of several miRNAs including miR-106a were analyzed by quantitative RT-PCR. To determine the potential role of miR-106a in the pathogenesis of AAA, miR-106a was overexpressed in vascular smooth muscle cells (VSMCs), and then cell viability and apoptosis were evaluated by performing CCK-8 assay and flow cytometry, respectively. Afterwards, enzyme-linked immunosorbent assay (ELISA) was applied to assess the expression levels of some proteins involved in the modulation of extracellular matrix (ECM) homeostasis. Furthermore, the target gene of miR-106a was predicted and verified through Dual-Luciferase reporter assay. RESULTS: MiR-106a was up-regulated in exosomes from plasma of those patients with AAA as compared with healthy peers. Likely, increased level of miR-106a was observed in exosomes released from AAA tissue in comparison to those from adjacent normal tissues. Enhanced expression of miR-106a in VSMCs suppressed cell viability but promoted cellular apoptosis, whereas inhibition of miR-106a in VSMCs resulted in a significant decrease in the percentage of apoptotic cells compared to the control group. In addition, the protein levels of matrix metalloproteinases (MMPs, including MMP-2 and MMP-12) secreted from VSMCs were significantly up-regulated, while their inhibitor TIMP-2 was down-regulated due to miR-106a overexpression. Finally, TIMP-2 was validated subsequently as the direct target of miR-106a through Dual-Luciferase reporter assay. CONCLUSIONS: In aggregate, our results suggest that increased expression of miR-106a promotes VSMC cell apoptosis and down-regulates TIMP-2 through directly targeting its 3'-UTR, which in turn restores MMP production and ultimately accelerates ECM degradation. Therefore miR-106a is proposed to play a crucial role in AAA development and this will provide an update on the understanding of the clinical value of miRNAs as novel therapeutic targets for the treatment of this disease.

[Analysis of curative effect of transoral radiofrequency ablation microsurgery on glottic carcinoma with anterior commissure involvement at the early stage].

Objective: To explore the key technique and outcome of transoral radiofrequency ablation microsurgery for early stage of glottic carcinoma with anterior commissure involvement (ACI). Methods: A retrospective analysis was conducted on 31 patients, who were diagnosed as early stage glottic carcinoma during January 2010 to March 2016 in ENT Department. According to whether the anterior commissure was involved or not, two groups were divided. There were eleven cases with ACI (stages T1a, T1b, and T2). Twenty cases without ACI (stages Tis, T1a, and T2). All the patients received transoral radiofrequency ablation microsurgery and followed up closely.Only one case received radiotheraphy after surgery. SPSS19.0 software was used to analyze data. Results: The follow-up time was 12-67 months, and the median follow-up time was 30 months. Nine among 11 cases with ACI obtained good oncologic outcomes, initial local recurrence was identified in 2/11 cases, including 2 cases of T2. Two cases ultimately required salvage total laryngectomy. Meanwhile, initial local recurrence was identified in 2/20 cases without ACI, including 1 case of T1a and 1 case of T2. One case underwent elective neck dissection, and another one received salvage total laryngectomy.Compared to the patients without ACI, it seemed that the cases with ACI always accomponied with a little higher initial local recurrence and lower overall laryngealpreservation, but the difference had no significance (P>0.05). Conclusions: Transoral radiofrequency ablation microsurgery is an effective treatment for glottic carcinoma with ACI. Its advantages, such as more flexibility and deformability, make it more feasible to operate at the narrow space of anterior commissure assisted with laryngeal endoscopy.Good oncologic outcomes can be obtained by this technique with lower initial local recurrence as well as higher overall laryngeal preservation rate.

Correlations of TNF-α gene promoter polymorphisms with the risk of thymoma-associated myasthenia gravis in a northern Chinese Han population.

This study was performed with the aim to investigate the correlations of tumor necrosis factor-alpha (TNF-α) gene promoter polymorphisms with the risk of thymoma-associated myasthenia gravis (T-MG) in a northern Chinese Han population. Between June 2005 and June 2015, 305 MG patients (150 males and 155 females, MG group) and 293 healthy volunteers (negative control (NC) group) were enrolled in this study. Among the MG patients, there were 121 patients with thymoma-associated MG (T-MG group) and 184 without T-MG (NT-MG group). Enzyme-linked immunosorbent assay (ELISA) was used for the serum TNF-α level. Polymerase chain reaction-restriction fragment length polymorphism was conducted to determine genotype and allele frequencies of TNF-α gene promoter -1031T/C, -857C/T and -863C/A. The haplotype was analyzed with the SHEsis software. Logistic regression analysis was performed for correlations between TNF-α gene promoter polymorphisms and the risk of T-MG. The T-MG group had higher frequencies of the CT/TT genotype and T allele of -857C/T than the NT-MG and NC groups. The frequencies of the CC genotype and C allele of -1031T/C were higher in the T-MG group than in the NT-MG and NC groups, and higher in male patients in the T-MG group than in male patients in the NC group. TTA and TTC haplotypes exhibited lower frequencies in the T-MG group than in the NT-MG group. The ocular MG patients exhibited lower frequencies of the TT genotype and T allele of -857C/T than the generalized MG patients did. The TNF-α level was elevated in the T-MG group compared with that in the NC and NT-MG groups, indicating that the TC+CC and CT+TT genotypes were increased compared with the TT and CC genotypes in the -1031T/C and -857C/T, respectively. Logistic regression analysis suggested that expressions of anti-acetylcholine receptor antibodies, Osserman's classification, -1031T/C and -857C/T polymorphisms and the TTA haplotype were the independent risk factors for T-MG. These findings reveal that TNF-α -1031T/C and -857C/T polymorphisms and the TTA haplotype may be correlated with the occurrence of T-MG in a Northern Chinese Han population.

[Complications analysis of adenoidectomy and tonsillectomy assisted with ablation on children].

Objective:To analyze the complications of adenotonsilectomy assisted with coblation in children. Method:Complications of 2 089 cases of children with adenoid and tonsil surgery assisted with coblation, in our hospital nearly 10 years, were analyzed by epidemiological methods through the method of retrospective analysis. Result:①the sex ratio of male to female was 2.08：1, average age (5.87±3.12) years old, and most of 2 089 cases 76.35% (1 595/2 089) were 3-7 years old; ②all cases underwent adenoidectomy. Different surgery methods of tonsil consisted of three groups as partial resection associated with ablation was 69.17% (1 445/2 089), ablation (channeling) alone was 22.26% (465/2 089) and total resection was 8.57% (179/208). The amount of bleeding in operation was (8.52±3.18)ml, average operation time was (30.15±8.26) minutes, the postoperative pain score was (3.77±1.61); ③The incidence of postoperative complications: postoperative bleeding (all were secondary bleeding cases) rate was 0.24% (5/2 089), recurrence rate was 0.14% (3/2 089), prevertebral lymphadenitis was 0.96% (20/2 089), the other was 0.29% (torus hyperplasia in 2 cases, dyspnea in 2 cases, 1 cases of angle of mouth burned, nasopharyngeal adhesion in 1 cases). Postoperative fever rate was 9.81% (205/2 089). Conclusion:coblation technique is a good method for the treatment of children's adenoids and tonsil diseases with high efficiency and low complications. But improving the operation procedure proficiency level and skills of operation is an important link to reduce complications.

[Clinical effect analysis of adenoidectomy and tonsillectomy assisted with ablation on children].

Objective:This study aims to explore the clinical effect of adenoidectomy and tonsillectomy assisted with ablation on children.Method:The investigation took the form of retrospective review of 2 089 cases of children applied with adenoidectomy and tonsillectomy assisted with ablation in our hospital in recent 10 years. We obtained data of these children with epidemiological methods based on analyzing the status of general information and operation selections, and then analyzing the scores of snoring and breath preoperation and postoperation.Result:①General information of 2 089 cases followed with: the ratio of male and female was 2.08∶1，the average onset age was（5.87±3.12）years old, mostly ranged from 3 to 7 years old, which consists of 76.35%（1595/2089）of the group.②Different surgery methods of tonsil consisted of three groups as: partial resection associate with ablation was 69.17%(1445/2089), ablation alone was 22.26%(465/2089) and partial resection alone was 8.57%(179/2089) of the group.③A high level scores of snoring and breath more frequently found in preoperative cases than in postoperative cases(P <0.01).There are no differentiation among the scores of above three groups(P >0.05).The postoperative effect evaluation were related to allergic rhinitis, recurrent of tonsillitis, obesity, circular occipital hyperplasia and nasopharyngeal adhesion.Conclusion:The results suggested that surgery assisted with ablation has its advantage in adenoidectomy and tonsillectomy. Individual therapy for different children will improve the curative effect and relieve the pain of operation, thus is worth a wide application.

[Photodynamic therapy by topical drup for the treatment of juvenile onset laryngeal papillomatosis].

Objective:To observe the therapeutic effect of photodynamic therapy(PDT) on the treatment of juvenile onset laryngeal papillomatosis. Method:Twenty-eight cases of children with laryngeal papilloma were treated,only 2 cases for the first time, and the rest were repeatedly treated outside our hospital, the average hospital surgery were more than 4 times. Under self retaining laryngoscope and microscope and endoscope assisted by semiconductor laser and plasma and cold instrument method，visible tumor resection and local affixed deposited 20% 5-aminolevulinic acid(photosensitizer) 3 hours later, with 635 nm semiconductor laser photodynamic,200-280 mW and can volume density of 80 to 120 J/cm², 20 min irradiation. PDT should be repeated after 25 days until no visible tumor.Then,2 times PDT must be done. Result:In 28 cases, 24 cases were followed up for more than 1 years(12 cases were followed up for 3 years),19 had no recurrence, the cure rate was 79.2%(19/24)；5 cases recurrence, and the recurrence rate was 20.8%(5/24)，among them,2 cases were abandoned because of the relapse，the other 3 cases were cure after 3 times of PDT.The main complications were adhesion of larynx. Conclusion:The preliminary effect of PDT by topical drug for the treatment of juvenile onset laryngeal papillomatosis is encouraging. The principle of PDT and the principle of the recurrence of laryngeal papilloma in children were also introduced in this paper.

Comparison of high-intensity focused ultrasound therapy under nasal endoscopy guidance versus first-line drug treatment in patients with persistent allergic rhinitis.

The aim of this study was to determine whether high-intensity focused ultrasound (HIFU) therapy under nasal endoscopy guidance could provide better efficacy and safety in patients with persistent allergic rhinitis (PAR) than the first-line drugs recommended by the World Health Organization. A total of 120 adult patients with PAR were randomly divided into 2 groups (N = 60 each). One group underwent HIFU therapy under nasal endoscopy guidance using an ultrasound rhinitis therapeutic machine. The other group served as the control group and was treated with corticosteroid nasal spray and oral cetirizine hydrochloride. All patients underwent follow-up treatment for 1 year, after which the efficacy and safety were evaluated. There was no significant difference between the two groups (P > 0.05) in the total effective rate. Moreover, no complications such as nasal adhesion, septal perforation, mucosal atrophy, and hyposmia were observed, indicating that HIFU was as effective as the first-line drug treatments recommended by the World Health Organization for symptom relief in PAR patients. The treatment efficacy, repeatability, safety, economical aspects, ease of performance, and few complications of HIFU therapy strongly suggest that HIFU should be routinely incorporated into clinical practice.

Analysis of a series of patients with varicose vein recurrence.

OBJECTIVE: Varicose veins of the lower extremities is a common clinical condition. Although surgical treatment is often successful, the recurrence rate remains high. This retrospective study evaluated the reasons for postoperative recurrence of varicose veins by analysing ultrasonography and venography findings in patients with recurrent disease. METHODS: A series of consecutive cases of recurrent varicose veins of the lower limbs was reviewed. Data collected included clinical characteristics, symptoms and vascular imaging. RESULTS: The study included 109 legs with recurrent varicose veins (92 patients): 101/109 legs (92.7%) showed perforating vein insufficiency and 86/109 (78.9%) showed reflux of the superficial femoral vein, of varying degrees of severity. Residual saphenous vein was recorded for 82 legs (75.2%), while 19 (17.4%) had blocked iliac veins due to post-thrombotic syndrome. CONCLUSIONS: Several factors that may contribute to varicose vein recurrence have been identified. These include failure to ligate perforating veins and initial failure to perform the appropriate surgical intervention. Prevention of varicose vein recurrence after surgical correction requires a more extensive use of preoperative imaging, to tailor surgical intervention to suit individual patients.