Subcutaneous pedicled propeller flap technique for microscopic reconstruction of eyelid defects

AIM:To describe the subcutaneous pedicled propeller flap technique for the microscopic reconstruction of eyelid defects and evaluate its outcomes.METHODS:The clinical data of 23 patients(23 eyes)who underwent microscopic reconstruction of eyelid defects with the subcutaneous pedicled propeller flap technique were retrospectively analyzed.All patients underwent eyelid tumor resection and one-stage microscopic reconstruction with the subcutaneous pedicled propeller flap for anterioror posterior-layer eyelid defects.The survival rate of the propeller flap,eyelid function and appearance,tumor recurrence rate,and patient satisfaction were evaluated after the surgery.RESULTS:The patients consisted of 12 men and 11 women,aged 31–82y(mean,58.9y).The longest followup time was 5y,and the shortest was 3mo.All the propeller flaps survived well.There was no significant difference in color and luster between the flap and adjacent tissues,and there was no dog ear phenomenon.No obvious scarring was observed.There were no obvious abnormalities of eyelid morphology or function,and no adverse complications such as exposure keratitis,entropion,ectropion,ptosis,and eyelid retraction.No tumor recurrence was found at the time of the last follow-up.All patients were satisfied with the surgical results.CONCLUSION:The subcutaneous pedicled propeller flap technique for the microscopic reconstruction of eyelid defects has satisfactor y outcomes in terms of eyelid function and esthetics,and merits clinical application.

Optical coherence tomography angiography of optic disc perfusion in non-arteritic anterior ischemic optic neuropathy

AIM: To compare the optic disc blood flow of non-arteritic ischemic optic neuropathy(NAION) eyes with normal eyes. METHODS: The optic disc blood flow densities of diagnosed non-acute phase NAION eyes(21 eyes, 14 individuals) and normal eyes(19 eyes, 12 individuals) were detected via Optovue optical coherence tomography angiography(OCTA). The optic disc blood flow was measured via Image J software. Correlations between optic disc perfusion and visual function variables were assessed by linear regression analysis.RESULTS: The average percentage of the optic disc nonperfusion areas in the non-acute phase NAION patients(17.84%±6.18%) was increased, when compared to the normal control eyes(8.61%±1.65%), and the difference was statistically significant(P<0.01). Moreover, there was a proportional correlation between the visual field mean defect(MD) and the optic disc non-perfusion area percentage, and the relationship was statistically significant(t=3.65, P<0.01, R^2=0.4118). In addition, the critical correlation between the best corrected visual acuity(BCVA) and the optic disc non-perfusion area percentage was statistically significant(t=4.32, P<0.01, R^2=0.4957).CONCLUSION: The optic disc non-perfusion area percentages detected via OCTA in NAION eyes were significantly increased when compared with the normal eyes. Both the BCVA and MD were correlated with the optic disc flow detected, revealing that OCTA may be valuable in the diagnosis and estimation of NAION.

基于不同时间点观察针刺对脑缺血再灌注损伤大鼠海马组织Beclin-1及Caspase-3表达的影响

Objective:To observe the changes in the neurological score,infarct size,and autophagy-and apoptosisrelated indicators following the acupuncture treatment of rats with cerebral ischemia-reperfusion injury(CIRI) in order to investigate the effects of acupuncture on autophagy and apoptosis in the hippocampal tissue of CIRI rats Methods:In this study,170 Sprague-Dawley rats were randomly assigned to the normal group(n=34),sham group(n=34),and model establishment group(n=102).A CIRI rat model was established in the model establishment group.The rats of the model establishment group were then randomly and equally allocated to the middle cerebral artery occlusion/reperfusion group(MCAO/R group),acupuncture group(AC group),and edaravone group(ED group)(n=34 each).Each group was further subdivided into the 24-h and 72-h subgroups(n=17 each).The rats of the MCAO/R group were immobilized for 30 min and administered with an intraperitoneal injection of 0.9% sodium chloride solution.The rats of the AC group were immobilized,and they received acupuncture at the "Dazhui(GV 14)","Shuigou(GV 26)",and" Baihui(GV 20)" and an intraperitoneal injection of 0.9% sodium chloride solution,with the acupuncture needles left in place for 30 min.The rats of the ED group were immobilized for 30min and administered with an intraperitoneal injection of edaravone(5 mg/kg).All interventions were performed once every 12 h.Investigations of the neurological score,infarct size using triphenyl tetrazolium chloride staining,hippocampal Caspase-3 protein expression by lmmunohistochemical assay,hippocampal Beclin-1 expression by Western blotting,autophagosomes in the hippocampus by transmission electron microscopy,and apoptotic rate in the brain tissue of the ischemic side using the terminal deoxynucleotidyl transferase dUTP nick end labeling assay were performed both before and after the interventions.Results:Before intervention,the neurological score of the model establishment group was significantly lower than that of the normal and sham groups(P<0.01).After 24 h and 72 h,the neurological scores of the ED and AC groups were significantly increased(P<0.01),whereas the infarct size ratio were smaller(P<0.05 or P<0.01) and the apoptotic rates and Caspase-3 expression were lower(P<0.01) when compared with the MCAO/R group.The hippocampal Beclin-1 expression in the ED and AC groups was downregulated after 24 h of intervention(P<0.05) but upregulated after 72 h of intervention(P<0.05 and P<0.01,respectively).In the ED and AC groups,72 h of intervention led to significant increases in the neurological score(P<0.01) and significant reductions in the apoptotic rate and Caspase-3 expression(P<0.05 or P<0.01),but no significant changes in the Beclin-1 expression(P<0.05) when compared with 24 h of intervention.Moreover,the AC group showed a significant decrease in the infarct size ratio(P<0.01).Electron microscopy revealed that after 24 h of intervention,only individual lysosome structures could be observed in the tissues of the AC and ED groups.After 72 h of intervention,co-existence of autophagosomes and lysosomes was observed in the ED group,whereas co-existence of lysosomes and autolysosomes was observed in the AC group.Conclusion:Acupuncture significantly improved the neurological score and reduced the infarct size in the CIRI rats.The mechanisms of these effects could be attributed to the regulation of autophagy and inhibition of apoptosis in the hippocampal tissue as well as the duration of the intervention to a certain extent.