Dimerization of VirD2 binding protein is essential for Agrobacterium induced tumor formation in plants.

The Type IV Secretion System (T4SS) is the only bacterial secretion system known to translocate both DNA and protein substrates. The VirB/D4 system from Agrobacterium tumefaciens is a typical T4SS. It facilitates the bacteria to translocate the VirD2-T-DNA complex to the host cell cytoplasm. In addition to protein-DNA complexes, the VirB/D4 system is also involved in the translocation of several effector proteins, including VirE2, VirE3 and VirF into the host cell cytoplasm. These effector proteins aid in the proper integration of the translocated DNA into the host genome. The VirD2-binding protein (VBP) is a key cytoplasmic protein that recruits the VirD2-T-DNA complex to the VirD4-coupling protein (VirD4 CP) of the VirB/D4 T4SS apparatus. Here, we report the crystal structure and associated functional studies of the C-terminal domain of VBP. This domain mainly consists of α-helices, and the two monomers of the asymmetric unit form a tight dimer. The structural analysis of this domain confirms the presence of a HEPN (higher eukaryotes and prokaryotes nucleotide-binding) fold. Biophysical studies show that VBP is a dimer in solution and that the HEPN domain is the dimerization domain. Based on structural and mutagenesis analyses, we show that substitution of key residues at the interface disrupts the dimerization of both the HEPN domain and full-length VBP. In addition, pull-down analyses show that only dimeric VBP can interact with VirD2 and VirD4 CP. Finally, we show that only Agrobacterium harboring dimeric full-length VBP can induce tumors in plants. This study sheds light on the structural basis of the substrate recruiting function of VBP in the T4SS pathway of A. tumefaciens and in other pathogenic bacteria employing similar systems.

A case of anti-neutrophil cytoplasmic antibodies-associated vasculitis with ocular masses as the main manifestation / 中华肾脏病杂志

A case of anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) with ocular masses as the main manifestation was reported. The patient was a middle-aged female, the initial symptom was eye swelling, pulmonary nodules were found before eye surgery, and further examination revealed proteinuria, hematuria and renal insufficiency. Renal pathology showed ANCA-associated glomerulonephritis. The final diagnosis was eye, kidney and lung lesions caused by AAV. Treatment with glucocorticoids and cyclophosphamide resulted in improvement in eye, kidney, and pulmonary lesions. Atypical clinical manifestations of AAV may lead to delayed diagnosis, and attention should be paid to the exclusion of AAV for ocular masses of unknown cause.

Exploration on teaching and experiment reform of medical imaging technology course from the perspective of "Internet Plus-based teaching diagnosis and reform" / 中华医学教育探索杂志

Medical imaging technology course has the characteristics of strong professionalism, complicated content to understand, and quickly updated knowledge. In traditional teaching mode, it takes teachers a lot of time to prepare lessons, and the teaching tools are limited like only taking use of blackboard, model and wall maps, which not only makes teaching content boring but also hardly stimulates students' initiative. Teaching reform of medical imaging technology courses from the perspective of "Internet Plus-based teaching and diagnosis reform" involves teaching content, teaching concept, teaching mode, teaching evaluation and experiments, etc., in which computer-aided teaching, flipped classroom, micro-course and high-quality resource-sharing course are used to increase experimental content, reform experimental teaching methods, and create "real-situation" experimental environment as well as other teaching diagnosis and reform measures, aiming to explore a new teaching pattern that meets the development of students majoring in medical imaging technology and the demand for social talents.

Determination of dichloroacetic acid and trichloroacetic acid in urine using headspace gas chromatography / 预防医学

Objective@#To develop a headspace gas chromatography ( HS-GC ) assay for simultaneous determination of dichloroacetic acid ( DCA ) and trichloroacetic acid ( TCA ) in urine.@*Methods@#Urine samples (5 mL) were transferred to a 22 mL headspace bottle, added with 0.5 mL 10% sodium acetate solution , immediately sealed, and shaken evenly. The bottle was placed in the HS-GC system, and equilibrated at 90 ℃ for 60 minutes. The mixture was separated with the HP-INNOWAX chromatographic column, and the DCA and TCA concentrations were detected with the hydrogen flame detector.@*Results@#Under the optimal experimental conditions, the correlation coefficient of DCA and TAC was both > 0.999 0 within the range of 10-500.0 μg/L, and the lowest detection limits of DCA and TAC were 2.0 and 3.5 μg/L, with the spike recovery rate of 87.40% to 101.44%, and relative standard deviations of 1.89% to 3.25%. Of the 35 urine samples sampled from occupational populations, DCA and TCA were not detected.@*Conclusions@#The establishment of the HS-GAS assay through addition of sodium acetate and optimization of the headspace conditions, has high recovery and precision, which is effective to meet the requirements for daily determination of DCA and TCA in urine samples.

[Experimental study of the influence of expanded capsule on biomechanics of autograftedcostal cartilage].

OBJECTIVE: To explore the effect of the expanded capsule on biomechanics of the transplanted autologous costal cartilage. METHODS: Ten New Zealand white rabbits aged 3 months were involved and four 15 ml tissue expanders were implanted symmetrically on the back of each rabbit. After 1 month, expanded capsules were removed (experimental group) on the left side and were reserved (control group) on the right side. Meanwhile, the 6th and 7th costal cartilage without the perichondrium were taken out and each cartilage was divided into two pieces and put under the expanded capsule symmetrically. The cartilage at the upper sides and lower sides were taken out at 4 weeks and 8 weeks later, respectively. All the cartilages were sculptured for the demand of the machine text. The tension and compression property of the cartilages were assessed by the material testing machine (Instron 5967) and the results were analyzed statistically. RESULTS: 8 weeks lateral, the average ultimate tension strength was (4. 954 + 2. 8) MPa in experimental group and (2.939 + 0.842) MPa in control group. The average compressive strength was (58.74 ± 13.77) MPa in experimental group, and (47.61 ± 11.41) MPa in control group. The biomechanics property of the cartilages in the experimental group is better than the control group, and the differences were statistically significant. CONCLUSIONS: Removing the expanded capsule is benefical to maintain the biomechanics of autologous costal cartilage.

[Preliminary clinical research with thoracic deformities in microtia].

OBJECTIVE: To investigate the characteristics and incidence of the thoracic deformities in patients with microtia. METHODS: In Plastic Surgery Hospital, we conducted a retrospective study of the clinical and radiographical data of 300 patients with microtia from March 2013 to October 2014. Pearson χ2 test was used to analyze the relationship among deformities of ribs and spine, as well as microtia. RESULTS: A total of 78 (26.0%) patients were documented with rib deformities, 26 patients (8.7%) had spinal deformities, and 17 patients (5.7% )had both. The incidence of rib deformities in microtia I, II, and III was 7.1% (2/28), 26.7% (62/232) and 35.0% (14/40) respectively. The incidence of spinal deformities in microtia I, II, and III was 3.6% (1/28), 6.5% (15/232) and 25.0% (10/40 respectively. The patients with microtia III were found to have a higher incidence of ribs and spinal deformities than those with microtia II, patients with microtia II were found to have a higher incidence of ribs and spinal deformities than those with microtia I (P < 0.05). CONCLUSIONS: The incidence of ribs and spinal deformities is high in patients with microtia. The poorer one auricle developed, the higher the incidence of thoracic deformities.

Application of 24-hour dynamic electrocardiogram combined with cardiac troponin I in evaluating radiation-induced cardiac injury / 中华放射肿瘤学杂志

Objective:To investigate the value of 24-hour dynamic electrocardiogram combined with cardiac troponin I (cTnI) in evaluating the radiation-induced heart disease (RIHD) in chest tumor radiotherapy.Methods:From 2015 to 2018, 128 patients with chest tumor who received radiation therapy with/without chemotherapy in the Third People′s Hospital of Linyi were selected to undergo routine ECG examination, 24-hour dynamic ECG examination, cTnI and cardiac color Doppler ultrasound before radiotherapy, 30Gy radiotherapy, 50Gy radiotherapy, after radiotherapy and 3 months after radiotherapy, respectively. The detection rates of 24-hour dynamic electrocardiogram, routine electrocardiogram, cTnI, cardiac color Doppler ultrasound and 24-hour dynamic electrocardiogram combined with cTnI for RIHD were statistically compared. The correlation between glucose level, hypertension and coronary heart disease, combined with chemotherapy, radiation dose and the irradiated area of the heart and the incidence of RIHD was analyzed.Results:The detection rates for RIHD did not significantly differ between 24-hour dynamic electrocardiogram and routine electrocardiogram ( P>0.05), whereas the detection rates for arrhythmia, atrioventricular block, bundle branch block and ST-T changes of 24-hour dynamic electrocardiogram were significantly higher than those of routine electrocardiogram (all P<0.05). The detection rate of 24-hour dynamic electrocardiogram combined with cTnI was significantly higher compared with that of 24-hour dynamic electrocardiogram, routine electrocardiogram, cTnI or cardiac color Doppler ultrasound alone (all P<0.05). There was a significant difference in RIHD before and after radiotherapy ( P<0.05). The incidence rate of RIHD in the radiation therapy combined with chemotherapy group was significantly higher than those in the cisplatin chemotherapy and radiotherapy alone groups, especially in the epirubicin+cyclophosphamide group (45%, all P<0.05). The incidence rate of RIHD was similar between radiotherapy alone and radiotherapy combined with cisplatin chemotherapy (both P>0.05). After radiation therapy, the grade of RIHD was elevated in 40 cases (31.2%). Diabetes mellitus, hypertension, coronary heart disease, radiotherapy combined with chemotherapy, cardiac D mean and cardiac V 40Gy were the independent factors for the occurrence of grade 1-4 RIHD (all P<0.05). Conclusion:The 24-hour dynamic electrocardiogram combined with cTnI is of great value in the detection of RIHD induced by radiotherapy for chest tumors with high detection rate, simple operation and low cost, which is worthy of application in clinical practice.

Effect of sodium hyaluronate eye drops on IOL-Master 700 measurement parameters in moderate and severe dry eye and non dry eye patients / 中华实验眼科杂志

Objective:To assess the changes in IOL-Master 700 parameters after administering sodium hyaluronate eye drops to moderate and severe dry eye and non-dry eye patients.Methods:Non-randomized controlled clinical research was performed.Patients with moderate and severe dry eye and non dry eye were enrolled in this study, with 40 patients in each group.All patients underwent IOL-Master 700 bioassay before and 5, 10 and 15 minutes after the administration of 0.1% sodium hyaluronate eye drops.The differences in axial length (AL), central corneal thickness (CCT), corneal curvature, and intraocular lens (IOL) were compared before and after the administration.All subjects signed informed consent.Results:In the dry eye group, the AL, CCT and IOL power were increased and the K1 were decreased at 5 and 10 minutes after administering sodium hyaluronate eye drops (P<0.05/3). IOL power of 17.5% increased by 0.5 D at 5 minutes after administering sodium hyaluronate eye drops.Further, 22.5% IOL power increased by 0.5 D or 1.0 D at 10 minutes after administering sodium hyalruonate eye drops.At 15 minutes after the administration, the IOL-Master parameters returned to the pre-intervention level.For the non-dry eye group, the AL and CCT were increased at 5 minutes after administering sodium hyalruonate eye drops, and the IOL power was decreased (P<0.01). The IOL power was decreased by a maximum of 0.5 D. At 10 and 15 minutes after administering sodium hyalruonate eye drops, the AL and CCT were significantly higher than those before the administration (all at P<0.05/3), but there was no significant change in IOL power (P>0.05).Conclusions:The IOL power of moderate and severe dry eye patients is increased at 5-10 minutes after administering sodium hyaluronate eye drops, and the IOL power of non-dry eye patients is decreased within 5 minutes after the administration.

The review of common external birth defects / 中华整形外科杂志

Birth defects is one of the most important problems of human society. External birth defect is one of the major research fields of plastic surgery. This kind of disorders damages the body image of patients in mild or severe way, affects severely the social confidence of the patients themselves and their families. we summarized the research progress of the common external birth defects (the incidence top 10) from the aspects of pathogenesis, prevention, treatments and so on, in order to provide reference materials to the prevention and treatment of them.

Research progress in genetics of congenital microtia / 中华整形外科杂志

The occurrence and development of congenital microtia are the result of multiple factors and mechanisms, including genetic factors, living environment and lifestyle, etc. However, genetics is the key to understand the etiology of congenital microtia. In this paper, the genetics of microtia was reviewed in the aspects of epigenetics, gene polymorphism, chromosomal change, genetic change and signal pathway. The etiology of microtia was discussed and summarized.

Clinical observation of perineal rectosigmoidectomy for rectal prolapse / 中国基层医药

Objective@#To evaluate the clinical observation of rectal prolapse by partial perineal rectal sigmoidectomy.@*Methods@#Sixty patients with rectal prolapse who met the diagnostic criteria of rectal prolapse in Yiwu Central Hospital from April 2013 to June 2015 were selected as the research subjects.They were divided into two groups according to random number table, with 30 cases in each group.The observation group used Altemeier, and the control group underwent triple surgery (rectal mucosal ligation, periorbital injection, and anal ring retraction). The total effective rate after surgery was compared and analyzed.@*Results@#The operation of the two groups was successfully completed.The total effective rate of the observation group was 96.67%, which was significantly higher than 80.00% of the control group, the difference was statistically significant(χ2=5.856, P=0.048). The Wexner constipation score of the observation group was (1.4±1.6)points, which was significantly lower than that of the control group[(3.2±2.0)points, t=3.849, P<0.05]. The Wexner anal incontinence score of the observation group after 24 months was (2.9±1.8)points, which was significantly lower than that of the control group [(4.4±2.7)points, t=2.532, P<0.05]. The proportions of anastomotic bleeding, pelvic swelling and perianal eczema in the observation group were 0.00%, 0.00% and 3.33%, respectively, which were significantly lower than those in the control group(20.00%, 23.33% and 30.00%, χ2=4.630, 5.822, 7.680, all P<0.05).@*Conclusion@#Altemeier can significantly improve the quality of life of patients, with a high cure rate and good clinical results.

Clinical observation of perineal rectosigmoidectomy for rectal prolapse / 中国基层医药

To evaluate the clinical observation of rectal prolapse by partial perineal rectal sigmoidectomy.Methods Sixty patients with rectal prolapse who met the diagnostic criteria of rectal prolapse in Yiwu Central Hospital from April 2013 to June 2015 were selected as the research subjects.They were divided into two groups according to random number table ,with 30 cases in each group.The observation group used Altemeier ,and the control group underwent triple surgery ( rectal mucosal ligation ,periorbital injection,and anal ring retraction ).The total effective rate after surgery was compared and analyzed.Results The operation of the two groups was successfully completed.The total effective rate of the observation group was 96.67%,which was significantly higher than 80.00%of the control group,the difference was statistically significant ( χ2 ＝5.856,P ＝0.048).The Wexner constipation score of the observation group was (1.4 ±1.6) points,which was significantly lower than that of the control group [(3.2 ±2.0) points, t ＝3.849, P ＜0.05].The Wexner anal incontinence score of the observation group after 24 months was (2.9 ±1.8)points,which was significantly lower than that of the control group [(4.4 ±2.7) points, t＝2.532,P＜0.05].The proportions of anastomotic bleeding ,pelvic swelling and perianal eczema in the observation group were 0.00%,0.00%and 3.33%,respectively,which were significantly lower than those in the control group (20.00%,23.33%and 30.00%,χ2 ＝4.630,5.822,7.680,all P＜0.05).Conclusion Altemeier can significantly improve the quality of life of patients ,with a high cure rate and good clinical results.

Application of Bmp5 short ear mouse model in the study of congenital microtia / 中华整形外科杂志

Objective@#To study the construction of Bmp5 short ear homozygous mouse model and the feasibility of its application in the study of congenital microtia.@*Methods@#Twelve Bmp5 short-ear mouse were introduced from JAX laboratory in the United States. Ten pregnant Bmp5 short-ear mouse were obtained by breeding. DNA was extracted from the tail of 86 fetal rats aged 14.5 days and sequenced by Sanger method. Three pregnant mice were born normally, and the young mouse was fed conventionally. Three 40-day-old mice with auricle deformity and normal auricle were stained with Alcian blue, and the result were compared and analyzed.@*Results@#The auricle of Bmp5 short ear homozygous mouse was significantly shorter than that of their sibling normal auricles. Sanger sequencing showed that the point mutation of Bmp5 was the seventh base at the bottom of exon 2, and the base mutated from C to T. The result of Alcianblue staining showed that the size of homozygous mutant mouse was small and the development of sternum and ribs was obviously abnormal.@*Conclusions@#The model of Bmp5 short ear mouse can be completely suitable for the study of human congenital microtia. The model of Bmp5 short ear mouse is a suitable animal model to study the development mechanism of congenital microtia.

The expression and clinical significance of lncRNA-uc003jsd.1 in congenital microtia / 中华整形外科杂志

Objective@#To investigate the expression of long non-coding RNA(lncRNA) uc003jsd.1 in congenital microtia and its clinical significance.@*Methods@#Real-time quantitative polymerase chain reaction (Real-time PCR) was used to detect the expression of lncRNA-NR_028308 in the residual ear cartilage and normal ear cartilage of 8 patients with microtia.@*Results@#The expression of uc003jsd.1 was significantly higher in the residual ear cartilage (P=0.015) than paired normal tissues.@*Conclusions@#LncRNA-uc003jsd.1 is up-regulated in the cartilage of the congenital microtia, suggesting a certain relationship with the development of congenital microtia.

Application of Prkralear-3J mouse as an animal model in the study of congenital microtia / 中华整形外科杂志

Objective@#To explore the feasibility of using Prkralear-3J mouse (also known as: little ears 3 Jackson) as an animal model in the study of congenital microtia.@*Methods@#Six Prkralear-3J mice of the same litter were introduced from JAX laboratory in the United States. 13 pregnant Prkralear-3J mice were obtained through breeding. A total of 75 fetus tails with gestational age of 14.5 days were obtained, and DNA was extracted and sequenced by Sanger method. Three pregnant mice were normally produced, and the young mice were routinely reared after birth. Three 40-day-old mice with auricle deformity and normal auricle were used respectively to perform skeletal alcian blue staining and comparative analysis.@*Results@#The auricle of Prkralear-3J homozygous mice was significantly smaller than that of the wild-type mice, and the substructure morphology of the normal mouse auricle was lost. The mutation site was a G-to-A mutation on chromosome 76, 643, 218 bp (GRCm38), which was located after the third exon. The results of alcian blue staining showed that the overall body size of Prkralear-3J homozygous mouse was smaller than that of wild type mouse, and the bone development of limbs was basically normal, but it was thin and short, especially in the hind limbs, the ribs were smaller, the tailbone was shorter, and the skull was slightly smaller.@*Conclusions@#The Prkralear-3J mouse is a suitable animal model for studying the developmental mechanism of congenital microtia.

A study on psychosocial behavioral outcomes of microtia children and their parents after microtia reconstruction / 中华整形外科杂志

Objective@#To explore the psycho-social and behavioral outcomes of microtia children and psychological health of their parents after microtia reconstruction, and to observe the effects of microtia reconstruction on the psycho-social health of microtia children and their parents.@*Methods@#72 patients were recruited and investigated for their psycho-social behavioral problems with Achenbach′s Child Behavior Checklist (CBCL). Their parents were investigated for psychological health with symptom checklist 90 (SCL-90). The patients and their parents were both assessed with questionnaire before the after operation (6 to 12months post-operation).@*Results@#After microtia reconstruction, the scores of CBCL and SCL-90 decreased significantly.①As determined from CBCL, after operation the scores of activity and sociality ability of the patients increased with significant difference in statistics (P<0. 01). The behavioral problems raw scores were lower than that of pre-operation. The percentage of behavioral problems of the microtia children decreased significantly compared with that before operation, it was significant in statistics (P<0. 01). ②As determined from SCL- 90, it is found out that the general scores and the number of positive items of the parents with microtia children decreased with significant difference in statistics (P<0.01). The scores of SCL-90 factors decreased with a significant difference in statistics (P<0.05).@*Conclusions@#There was significant improvement in the psycho-social behavioral outcomes of microtia children and their patients after microtia reconstruction. There is a positive effect of microtia reconstruction on microtia children and their parents.

Correction of preauricular depression using the composite flap of microtic cartilage and soft tissue in tragus reconstruction / 中华整形外科杂志

Objective@#To summarize the clinical effect of using the composite flap of microtic cartilage and soft tissue in tragus reconstruction to correct preauricular depression.@*Methods@#From January 2015 to November 2016, we corrected preauricular depression of 523 patients with congenital microtia that were treated with tragus reconstruction by using the composite flap of residual ear cartilage and soft tissue.@*Results@#All the composite flap of residual ear cartilage and soft tissue were transplanted successfully. No blood circulation disorder and significant contracture occurred. All patients were followed up for 6-14 months with an average of 10 months. The reconstructed tragus looked projective and the preauricular depression was corrected, demonstrating a similar looking to the healthy side. The patients were satisfied with the results.@*Conclusions@#The residual ear tissue could form the composite flap of residual ear cartilage and tissue. Using the composite flap to fill the preauricular depression was effective, which was not easily absorbed. The residual ear tissue is the best resource for filling the preauricular depression. It should not be discarded in ear reconstructive surgery, but reserved for the next operation for tragus reconstruction.

Application of digital technology aided in auricle location and personalized framework design in ear reconstruction for microtia patients with craniomaxillofacial asymmetry / 中华整形外科杂志

Objective@#To seek an accurate and objective method to locate reconstructed auricles and design frameworks with digital technology for microtia patients with craniomaxillofacial asymmetry, improving the symmetry of the postoperative ears.@*Methods@#From September 2014 to February 2016, 50 unilateral microtia patients with craniomaxillofacial asymmetry who were scheduled for auricular reconstruction were included in the study. The digital models of the patients′ ears and heads were based on the scan data preoperatively, which were collected by the three dimensional(3D) photogrammetric scanning technique. The reconstructed auricle was positioned by the mirror image of the contralateral side on the digital models. Based on the location, the morphological parameters and the corrective parameters of the autogenous cartilage frameworks could be obtained. With the guidance of the above information, ear reconstruction with tissue expander could be carried out.@*Results@#Auricular and craniofacial morphology could be reflected vividly by the digital models. Meanwhile, the location and parameters of the reconstructed ear could be acquired. And the outcomes of the 50 reconstructed ears were satisfactory with symmetrical appearance. With 1 to 8 months (average 6.8 months) of follow-up, both the doctors and the patients were satisfied with the postoperative result.@*Conclusions@#Utilizing the location and parameters which were obtained from the digital models based on 3D photogrammetric scanning is an accurate and objective way to gain more symmetrical result in clinical ear reconstruction for microtia patients with craniomaxillofacial asymmetry.

Ultra-delicate split-thickness skin graft in continuity with full-thickness skin flap combined with Z-plasty for correction of cryptotia / 中华整形外科杂志

Objective@#To explore the curative effect of ultra-delicate split-thickness skin graft in continuity with full-thickness skin flap combined with Z-plasty for correction of cryptotia.@*Methods@#Four cases (six ears) were corrected by ultra-delicate split-thickness skin graft in continuity with full-thickness skin flap combined with Z-plasty method from 2016 to 2017. Following ear release, the flap is rotated into the defect and donor site covered by a razor-thin graft raised in continuity with the flap, the posterior flap was advanced and sutured with Z-plasty.@*Results@#All corrected auricles four cases (six ears) were followed up from 3 months to 1 year and abtained satisfactory and stable appearance.@*Conclusions@#The shape of auricle is natural and satisfactory after operation. The method is simple and no skin grafting is needed. The adhesion of the hidden muscles and cartilages were sufficiently released.

Strategy for dealing with failed reconstructed ears / 中华整形外科杂志

Objective@#To discuss the strategy for dealing with the failed reconstructed ears.@*Methods@#From January 2010 to January 2015, 14 cases (14 ears) were admitted to our department because of failed reconstructed ears. It was impossible to improve their appearance greatly just by adjusting the original structures. We had to take out the framework and re-reconstruct the ear with autologous costal cartilages. Depending on the conditions of soft tissue, we divided them into three groups: Group 1, 8 ears(57.1%), the soft tissue could be reused simultaneously after being dealt with appropriately although the original frameworks were distorted badly. We took out the original frameworks, harvested cartilages again, fabricated the new frameworks and wrapped them with the original soft tissue. Group 2, 4 ears(28.6%), the structures were damaged completely, just with the constricted scars and skin graft clinging on the mastoid bone. We wrapped the new framework with axial temporal superficial fascia flap and then covered the wound with skin graft; Group 3, 2 ears(14.3%), the structures were distorted seriously. The skin flap covering the framework constricted badly while the post-auricular fascia flap was unspent. We took out the framework, implanted the skin expander under the spread skin flap, and then re-reconstructed the ear with expansion method.@*Results@#13 of 14 cases( 92.9%)were rebuilt successfully. The new ears maintained the landmark subunits 1 month after surgery. In 1 case (7.1%) from group 3, the creased skin had a rupture during skin expansion period. The expander had been taken out, and then a new one was replaced 3 months later. Follow-up period was 3-12 months. The structures of all the 14 rebuilt ears were stable and much better than before.@*Conclusions@#Good results could be achieved when appropriate method was selected for failed reconstructed ear. The condition of soft tissue of distorted reconstructed ear should be considered.