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Mechanical thrombectomy (MT) is a standard care for most acute ischemic stroke (AIS) patients. For AIS patients underwent MT, predicting the patients at high risk of unfavorable outcome and adjusting therapeutic strategies accordingly can greatly improve patient outcomes. We aimed to develop and validate a nomogram for individualized prediction of Chinese AIS patients underwent MT.We conducted a multicenter prospective study including 238 AIS patients who underwent MT from January 2014 to December 2018. The main outcome measure was three-month unfavorable outcome (modified Rankin Scale 3-6). A nomogram was generated based on multivariate logistic model. We assessed the discriminative performance by using the area under the receiver-operating characteristic curve and calibration of risk prediction model by using the Hosmer-Lemeshow test.In NAC nomogram,The NAC nomogram is the first nomogram developed and validated in Chinese AIS patients treated with MT and it may be used to predict 3 months unfavorable outcome for these patients.

A 37-year-old man complained of a refractory posterior malleolar ulceration on his left ankle. He was diagnosed with Werner syndrome according to the progeroid clinical features and genetic testing. To approach the ulceration, a free flow-through right anterolateral thigh perforator flap with anterolateral thigh cutaneous nerve was harvested. One year later, he was readmitted due to a new ulceration on his right ankle. We harvested the left anterolateral thigh perforator flap with anterolateral thigh cutaneous nerve to reconstruct the defect. After one more year of follow-up, there was no recurrence of ulcers, and the sensation of the flap recovered partially after 6 months. We conclude that free flow-through anterolateral thigh perforator flap is a feasible choice for the repair of foot ulcers in Werner syndrome.

Bandgap engineering offers opportunities for tailoring the properties of semiconductor materials for desired applications in microelectronics and optoelectronics. Alloys of different semiconductor materials can lead to the continuously tuning of the bandgap. Here, we report the bandgap engineering in layered InSe single crystals by substituting the Se atoms with S atoms. The formation of InSxSe1–x single crystal alloy with x ≤ 0.3 is evidenced by the X-ray diffraction and resonant Raman spectra. The photoluminescence (PL) spectra peak position blue shifts from ∼1.27 to ∼1.42 eV as S composition increases from 0 to 0.3 in the alloys, which is consistent with the bandgap shifts calculated by density functional theory. Temperature dependence of the PL spectra indicate that the presence of S atoms decreases the strength of the electron–phonon interaction but increases the average phonon energy in InSxSe1–x alloys. Our findings will open an intriguing avenue in understanding the fundamental physics in the III–...

As the financial report has entered the “era of annotation” (Fan and Zhang in Contemp Accout Res 29(1):38–42 2012), and the length of the unstructured information in the financial report has far exceeded the financial statements. In order to carry on the automatic analysis and processing to the text information in the financial report with the help of information technology, a combination of the information extraction and XBRL technology is needed to carry on the structured research to the text information in the Chinese financial report (Heidari and Felden in Proceedings of 10th international conference on DESRIST, LNCS 9073, 2015). Based on a self-built Chinese enterprise annual report corpus, this paper studies the characteristics and patterns of the disclosure language of accounting events in Chinese enterprises’ annual reports, which can be examplified in the “related transaction events”. This paper summarizes an expression framework of accounting event knowledge. The study is expected to lay the foundation for the study of annotated textual information extraction and automatic generation of XBRL financial reports, which shall be helpful to improve the quality of financial data and information sharing.

To minimize the voltage loss of non-fullerene organic solar cells (OSCs), it is important to modulate the energy levels of active materials and thus the photovoltage of the device. In this paper, we report a simple and effective approach to tune the energy levels of a state-of-the-art polymer P3TEA by switching the position of alkyl side chains and carboxylate substituents on the polymer backbone. The resulting polymer P3TAE exhibits a deep highest occupied molecular orbital (HOMO) level, contributing to a high open circuit voltage (VOC) of 1.20 V and a small voltage loss of 0.54 V when it is blended with a small molecule acceptor (SMA) FTTB-PDI4. Despite a small charge separation driving force, the P3TAE:FTTB-PDI4 blend exhibits efficient charge extraction, supported by relatively high external quantum efficiency (EQE) (∼60%) in the corresponding device. In addition, the P3TAE:FTTB-PDI4 blend shows relatively high electron mobility and domain purity, leading to a high fill factor (FF) in the device. As a result, the P3TAE:FTTB-PDI4-based solar cell exhibits a power conversion efficiency (PCE) of 8.10%, which is one of the highest achieved performances for single-junction OSCs with VOC higher than 1.20 V.

Starting from the assumption of bounded rationality in game, this article explores the evolution of XBRL adoption by enterprise to enterprise, and enterprises to Government from the perspective of evolutionary game. Research shows that without government guidance, enterprise adopting XBRL technology is affected by the adoption probability of relevant enterprises or industries. In the case of government guidance, the initial state of adoption of XBRL technology by the government and enterprises affects the evolution direction and speed of the system. System evolution has obvious “path dependence”. After a long period of repeated game XBRL technology adoption may be “unhealthy cycle” trend development. The results of the game have been found that influencing factors which are the probability of government mandatory adoption and the deep-seated factors that affect the adoption of XBRL technology in enterprises, for the government and business decision-making provide a reference from evolutionary direction and evolutionary stabilization strategy.

As the lightest solid element and also the simplest metal, lithium (Li) is one of the best representations of quasi-free electron model in both bulk form and the reduced dimensions. Herein, the controlled growth of 2D ultrathin Li nanosheets is demonstrated by utilizing an in situ electrochemical platform built inside transmission electron microscope (TEM). The as-grown freestanding 2D Li nanosheets have strong structure-anisotropy with large lateral dimensions up to several hundreds of nanometers and thickness limited to just a few nanometers. The nanoscale dynamics of nanosheets growth are unraveled by in situ TEM imaging in real-time. Further density-functional theory calculations indicate that oxygen molecules play an important role in directing the anisotropic 2D growth of Li nanosheets through controlling the growth kinetics by their facet-specific capping. The plasmonic optical properties of the as-grown Li nanosheets are probed by cathodoluminescence spectroscopy equipped within TEM, and a broadband visible emission is observed that contains contributions of both in-plane and out-of-plane plasmon resonance modes.

This paper studies how the inconsistent product attributes reviews affect the consumer purchase intention, and discusses the mediating role of information processing fluency and the moderating role of the relationship norm and the ambiguity tolerance. In this study, 3 experiments were conducted to examine the significant effect of inconsistent product attribute reviews on the purchase intention, and the mediating effect of information processing fluency. The relationship between the relationship norm and ambiguity tolerance was also examined. The experimental results validate the research hypothesis, and the research also discusses the theoretical contribution, the management inspiration and the future research direction.

Online review has been playing an important role in consumer decision making and enterprise marketing recently. This study focuses on two important issues. Firstly, how the ambivalence online review change consumer decision-making and purchase intension from the point view of different types of ambivalence online review. Secondly, how consumer of different involvement degree interprets the ambivalence online review of consumer decision. Finally, the following conclusions are obtained through the empirical study: 1) When the review about product functional attribute is positive, inter-attribute ambivalence is more significant for consumer’s purchasing intension, compared with intra-attribute ambivalence. When the review about product hedonic attribute is positive, intra-attribute ambivalence is more significant to consumer’s purchasing intension, compared with inter-attribute ambivalence. 2) The degree of consumer involvement has a moderating effect on the relationship between product attributes and type of ambivalence and consumer purchasing intention. When the review about product functional attribute is positive, inter-attribute ambivalence is more significant to consumer’s purchasing intension, compared with intra-attribute ambivalence of high level of consumer involvement. In contrast, intra-attribute ambivalence is more significant to consumer’s purchasing intension, compared with inter-attribute ambivalence for high level of consumer involvement. When the review about product enjoyment attribute is positive, intra-attribute ambivalence is more significant in consumer’s purchasing intension, compared with inter-attribute ambivalence of high low of consumer involvement, thus there are no different between intra-attribute ambivalence and inter-attribute ambivalence for low level of consumer involvement.

Background To investigate the feasibility and clinical efficacy of free vascularized iliac bone flap based on deep iliac circumflex vessels graft for the treatment of osteonecrosis of femoral head (ONFH) in young adults. Methods Eighteen patients (19 hips) undergoing ONFH were included from January 2016 to May 2017. After the debridement of the necrotic bones, the contralateral vascularized iliac bone flap was designed and harvested before grafting, in which the deep circumflex iliac vessels and the transverse branch (or ascending branch) of the lateral circumflex femoral artery and their accompanying veins were anastomosed. X-ray was obtained at 1, 3, 6, 9, and 12 months respectively for evaluation of the bone flap healing. Hip function was evaluated with Harris hip score at 18 months postoperatively. Results None of the patients is lost to follow-up. All the hips healed well except for four complications: one patient developed superficial wound infection, one patient had subcutaneous hematoma, and two patients developed anterolateral femoral cutaneous nerve injury. X-ray films at 12 months showed improvement in 13 hips (68.4%), five hips (26.3%) were unchanged, and one femoral head collapse with conversion to total hip arthroplasty (THA) at 14 months postoperatively (5.3%). Postoperative mean Harris hip scores were significantly improved compared to the preoperative results (P Conclusion Free vascularized iliac bone flap based on deep circumflex iliac vessels graft is an acceptable treatment option for young adult ONFH in mid-late stage with low conversion to THA rate at short-term follow-up.

The chemistry of carbon in aqueous fluids at extreme pressure and temperature conditions is of great importance to Earth's deep carbon cycle, which substantially affects the carbon budget at Earth's surface and global climate change. At ambient conditions, the concentration of carbonic acid in water is negligible; therefore, aqueous carbonic acid was simply ignored in previous geochemical models. However, by applying extensive ab initio molecular dynamics simulations at pressure and temperature conditions similar to those in Earth's upper mantle, we found that carbonic acid can be the most abundant carbon species in aqueous CO

Monolayer transition metal dichalcogenides (TMDCs) are an ideal platform for multi-carrier bound states, the excitons and trions of which have been well identified and investigated. However, the formation and identification of biexcitons with certain configurations are more complicated. Here, we report a strategy to generate the hole-trion bound state, i.e. excited-state biexcitons, in a graphene/WS

To explore the feasibility and effectiveness of radial collateral artery polyfoliate perforator flap in repair of resurfacing soft tissue defect of hand.Between September 2017 and September 2018, the radial collateral artery polyfoliate perforator flaps were transplanted to repair 5 cases of two adjacent wounds of hand and wide or irregular wounds. All patients were male, aged from 27 to 52 years, with an average of 42.5 years. The time from injury to admission was 4 hours to 3 weeks, with an average of 7.3 days. Causes of injury included traffic accident in 2 cases, crushing injury in 2 cases, and paint injection injury in 1 case. The wounds were located at the dorsum of hand in 3 cases, the dorsum of finger in 1 case, and the thumb and thumb web in 1 case. The area of wound ranged from 8 cm×6 cm to 10 cm×8 cm. The area of skin flap ranged from 6.0 cm×3.0 cm to 11.0 cm×4.5 cm, all of which carried the posterior cutaneous nerve of the arm, and the donor site was closed directly.All flaps survived and healed by first intention. All patients were followed up 3-11 months (mean, 6.5 months). The patients were satisfied with the appearance of hands. The flaps were not bulky, and the color and texture were similar to the hand. There was only linear scar in the donor site, no radial nerve injury occurred, and elbow joint function was not affected. One patient underwent finger-splitting and skin flap thinning at 6 months after operation.The radial collateral artery polyfoliate perforator flap is a good method for repairing two adjacent wounds and wide or irregular wounds of hand.探讨桡侧副动脉分叶穿支皮瓣修复手部创面的可行性与疗效。.2017 年 9 月—2018 年 9 月，采用桡侧副动脉分叶穿支皮瓣修复手部邻近 2 个创面或宽大、不规则创面 5 例。患者均为男性；年龄 27～52 岁，平均 42.5 岁。受伤至入院时间为 4 h～3 周，平均 7.3 d。致伤原因：交通事故伤 2 例，碾压伤 2 例，油漆高压注射伤 1 例。创面位于手背 3 例，指背 1 例，拇指和虎口 1 例。创面范围为 8 cm×6 cm～10 cm×8 cm。皮瓣切取范围为 6.0 cm×3.0 cm～11.0 cm×4.5 cm，均携带臂后侧皮神经。供区创面直接闭合。.术后皮瓣顺利成活，创面均Ⅰ期愈合。患者均获随访，随访时间 3～11 个月，平均 6.5 个月。患者对手部外观满意，皮瓣无臃肿，颜色、质地与手部接近。供区仅遗留线性瘢痕，无桡神经损伤发生，肘关节功能无影响。1 例患者于术后 6 个月行分指、皮瓣削薄术。.桡侧副动脉分叶穿支皮瓣是一种修复手部邻近 2 个创面或宽大、不规则创面的较好方法。.

The hexagonal boron nitride (hBN) encapsulation has been widely used in the electronics applications of 2D materials to improve device performance by protecting 2D materials against contamination and degradation. It is often assumed that hBN layers as a dielectric would not affect the electronic structure of encapsulated 2D materials. Here we studied few-layer MoS$_2$ encapsulated in hBN flakes by using a combination of theoretical and experimental Raman spectroscopy. We found that after the encapsulation the out-of-plane A$_{1g}$ mode is upshifted, while the in-plane E$_{2g}^1$ mode is downshifted. The measured downshift of the E$_{2g}^1$ mode does not decrease with increasing the thickness of MoS$_2$, which can be attributed to tensile strains in bilayer and trilayer MoS$_2$ caused by the typical experimental process of the hBN encapsulation. We estimated the strain magnitude and found that the induced strain may cause the K-Q crossover in the conduction band of few-layer MoS$_2$, so greatly modifies its electronic properties as an n-type semiconductor. Our study suggests that the hBN encapsulation should be used with caution, as it may affect the electronic properties of encapsulated few-layer 2D materials., Accepted by J. Phys. Chem. C, 18 pages and 5 figures

Due to the delicate tissue, small blood vessels and incomplete development of interarticular ligaments, skin and soft-tissue defects of the foot and ankle in pediatric patients remain a challenge for orthopedic and plastic surgeons. Anterolateral thigh perforator (ALTP) flap and deep inferior epigastric perforator (DIEP) flap are the most commonly used flaps for the repair of lower-extremity soft-tissue defects. The literature contains a shortage of evidence involving the differences between ALTP and DIEP flaps in the reconstruction of young patients with complex foot and ankle defects. This study was designed to determine which type of flap is better for foot and ankle repair in pediatric patients.From January 2004 to January 2018, 79 children younger than 14 years treated with DIEP flap (41 cases) or ALTP flap (38 cases) for composite defects of the feet and ankles were retrospectively investigated. The two groups were homogeneous in terms of age, the location of the defect, etiology, and flap area. Complications, scarring, cosmetic appearance, flap sensory recovery, and functional outcome were analyzed, and statistical analysis was performed.The ALTP group had shorter operation time (155.0 ± 12.0 min vs 212.2 ± 23.9 min), flap harvested time (39.6 ± 5.1 min vs 57.2 ± 10.4 min), and operative blood loss (143.4 ± 23.7 ml vs 170.7 ± 44.7 ml) than the DIEP group (P 0.05). In short-term follow-up, ALTP group showed a lower flap necrosis rate (5.3% vs 24.4%) and vascular insufficiency rate (2.6% vs 19.5%) than DIEP group (P 0.05). In long-term follow-up, ALTP group showed a lower late complication rate and better cosmetic, functional, scar outcomes than DIEP group (P 0.05).The study showed that an ALTP flap may brings better results than a DIEP flap in terms of short- and long-term complications, scarring, and morpho-functional outcomes for pediatric patients undergoing reconstruction of foot and ankle defects.

The chemistry of carbon in aqueous fluids at extreme pressure and temperature conditions is of great importance to Earth's deep carbon cycle, which substantially affects the carbon budget at Earth's surface and global climate change. At ambient conditions, the concentration of carbonic acid in water is negligible; therefore, aqueous carbonic acid was simply ignored in previous geochemical models. However, by applying extensive ab initio molecular dynamics simulations at pressure and temperature conditions similar to those in Earth's upper mantle, we found that carbonic acid can be the most abundant carbon species in aqueous CO2 solutions at ∼10 GPa and 1000 K. The mole percent of carbonic acid in total dissolved carbon species increases with increasing pressure along an isotherm, while its mole percent decreases with increasing temperature along an isobar. In CO2-rich solutions, we found significant proton transfer between carbonic acid molecules and bicarbonate ions, which may enhance the conductivity of the solutions. The effects of pH buffering by carbonic acid may play an important role in water-rock interactions in Earth's interior. Our findings suggest that carbonic acid is an important carbon carrier in the deep carbon cycle.

In this study, we synthesized arrayed NiCoS alloys as electrode material of supercapacitors via a customized hydrothermal reaction device assisted by pulse magnetic field and studied the effect of pulse magnetic field intensity on the morphology and electrochemical performances of NiCoS alloys. The results showed that the diameter of the rod-shaped NiCoS alloys reaches its minimum value of 10 nm and the arrangement of the arrayed grains is most regular at a peak current density of 9Adm−2 flowing through the electromagnetic induction coil. Consequently, the specific capacity of that sample reaches a maximum value of 161.2 mAhg−1 at 2Ag−1, which drops to 118.7 mAhg−1when the current density increases from 2Ag−1 to 10 Ag−1. The optimized sample also exhibits an excellent long-term cycling performance with a retention ratio of 84.6% over 5000 cycles in 2 M KOH electrolyte. The remarkable electrochemical performances may be attributed to the effect of pulse magnetic field on the nucleation and growth of NiCoS alloys, which could enlarge its surface area and improve its crystal dendrite quality.

XBRL (eXtensible Business Reporting Language) as an application of XML (eXtensible Markup Language) technology in the field of business reporting, uses information technology to add tags for the financial reporting metadata, to achieve unstructured data processing effectively. At first, this paper analyzes the XBRL technology framework, finds out the concepts and relationships between them, and accordingly designs the XBRL domain ontology model, then based on the model we have proposed, we choose OWL DL ontology description language and Protege3.4, take balance sheet as an example, and apply the XBRL ontology model to balance sheet to construct the taxonomy and instance, and thereby achieve the implementation of XBRL domain ontology construction. XBRL needs the integration of the accounting, engineering, computer, management and other disciplines, and the future research should be committed to solve the lack of semantic and reasoning mechanism to implement the further promotion and application of XBRL financial reporting.

Recent discoveries of dynamic ice VII and superionic ice highlight the importance of ionic diffusions in discriminating high-pressure (P) water phases. The rare event nature and the chemical bond breaking associated with these diffusions, however, make extensive simulations of these processes unpractical to ab initio and inappropriate for force field based methods. Using a first-principles neural network potential, we performed a theoretical study of water at 5–70 GPa and 300–3000 K. Long-time dynamics of protons and oxygens were found indispensable in discriminating several subtle states of water, characterized by proton’s and oxygen ion’s diffusion coefficients and the distribution of proton’s displacements. Within dynamic ice VII, two types of proton transfer mechanisms, i.e., translational and rotational transfers, were identified to discriminate this region further into dynamic ice VII T and dynamic ice VII R. The triple point between ice VII, superionic ice (SI), and liquid exists because the loosening of the bcc oxygen skeleton is prevented by the decrease of interatomic distances at high P’s. The melting of ice VII above ∼40 GPa can be understood as a process of two individual steps: the melting of protons and the retarded melting of oxygens, responsible for the forming of SI. The boundary of the dynamic ice VII and SI lies on the continuation line ice VII’s melting curve at low P’s. Based on these, a detailed phase diagram is given, which may shed light on studies of water under P’s in a wide range of interdisciplinary sciences.

To investigate the feasibility and efficacy of the Flow-through chimeric anterolateral thigh perforator (ALTP) flap for one-stage repair and revascularization in complex defects of the extremities.Between May 2014 and June 2017, 6 patients with soft tissue defects on the limbs combined with dead space, bone defects, or tendon and joint exposure, were reconstructed with the Flow-through chimeric ALTP flap. All 6 patients were male. The patients' mean age was 44 years (range, 26-60 years). The mechanisms of injury were traffic accidents in 4 cases, wringer injury in 1 case, and bruise injury caused by heavy object in 1 case. The defects located at the lower extremity in 5 cases and at the upper extremity in 1 case. The area of the wound ranged from 7 cm×4 cm to 26 cm×10 cm. There were 3 cases of bone defect, 3 cases of joint and tendon exposure, 2 cases of chronic osteomyelitis, and 2 cases of main artery injury. The muscle flap was inserted into the deep dead space, with perforator flap for superficial defect. The area of perforator flap ranged from 10 cm×5 cm to 28 cm×11 cm and the area of muscle flap ranged from 5 cm×2 cm to 20 cm×5 cm. The defects on the donor sites were closed directly.All the flaps were survival without infection and vascular crisis. The wounds of recipient and donor sites healed at first intention. The patients were followed up 3- 24 months (mean, 10 months). Good color and texture of flaps was achieved. The reconstructed main artery patency was achieved and the end of the affected limb was well transported. Only linear scar left on the donor site on thigh with no malfunction.The Flow-through chimeric ALTP flap can construct three-dimensional soft tissue defects without sacrificing the recipient vessels. The Flow-through chimeric ALTP flap is an reliable and ideal method for reconstruction of complex wounds in the limbs with dead space and with or without recipient major vessels injury.探讨 Flow-through 嵌合旋股外侧动脉降支穿支皮瓣移植修复四肢合并深部死腔的皮肤软组织缺损的可行性及疗效。.2014 年 5 月—2017 年 6 月，收治 6 例合并深部死腔、骨缺损或骨关节与肌腱外露的四肢皮肤软组织缺损患者。患者均为男性；年龄 26～60 岁，平均 44 岁。致伤原因：交通事故伤 4 例，机器绞轧伤 1 例，重物砸伤 1 例。损伤部位：下肢 5 例，上肢 1 例。创面范围 7 cm×4 cm～26 cm×10 cm。合并骨缺损 3 例，骨关节及肌腱外露 3 例，慢性骨髓炎 2 例，主干动脉损伤 2 例。采用 Flow-through 嵌合旋股外侧动脉降支穿支皮瓣移植修复，股外侧肌瓣填塞深部死腔，穿支皮瓣覆盖浅表创面。肌瓣切取范围 5 cm×2 cm～20 cm×5 cm，穿支皮瓣切取范围 10 cm×5 cm～28 cm×11 cm。供区直接闭合。.术后皮瓣均顺利成活，受区创面与供区切口均Ⅰ期愈合。患者均获随访，随访时间 3～24 个月，平均 10 个月。所有皮瓣颜色、质地良好，重建的主干动脉通畅，患肢末梢血运良好。皮瓣供区仅遗留线性瘢痕，股四头肌肌力正常，膝关节活动无影响。.Flow-through 嵌合旋股外侧动脉降支穿支皮瓣移植不仅能实现创面的立体修复，而且不牺牲受区主干血管，是修复四肢合并深部死腔、伴（或不伴）受区主干动脉缺损的有效方法之一。.

To explore the feasibility of the propeller flap withadipofascial tissue based on peroneal artery perforator for repairing the wound with a dead space in foot and ankle.Between January 2013 to December 2014,12 wounds with a dead space in foot and ankle were treated with the propeller flap with adipofascial tissue based on peroneal artery perforator after thorough debridement. The adipofascial tissue was used to fill the dead space, the propeller flap was used to cover the superficial wound. The defect at donor site was closed directly.The size of the propeller flap based on peroneal artery perforator ranged from 4 cm × 10 cm to 7 cm × 16 cm, the size of the adipofascial flap ranged from 2 cm × 4 cm to 5 cm × 7 cm. All flaps survived completely and the wounds healed primarily. The defects at donor sites got primary healing without complications. All patients were followed up for 5 to 21 months with an average of 8 months without recurrence of infection during the follow-up period. The appearance, texture, and color of the flaps were similar to those of the recipient sites. Good function of ankle was achieved.The propeller flap with adipofascial tissue based on peroneal artery perforator is a good option for reconstruction of foot and ankle wounds with dead space.

The phase diagram of water at extreme conditions plays a critical role in Earth and planetary science, yet remains poorly understood. Here we report a first-principles investigation of the liquid at high temperature, between 11 GPa and 20 GPa—a region where numerous controversial results have been reported over the past three decades. Our results are consistent with the recent estimates of the water melting line below 1,000 K and show that on the 1,000-K isotherm the liquid is rapidly dissociating and recombining through a bimolecular mechanism. We found that short-lived ionic species act as charge carriers, giving rise to an ionic conductivity that at 11 GPa and 20 GPa is six and seven orders of magnitude larger, respectively, than at ambient conditions. Conductivity calculations were performed entirely from first principles, with no a priori assumptions on the nature of charge carriers. Despite frequent dissociative events, we observed that hydrogen bonding persists at high pressure, up to at least 20 GPa. Our computed Raman spectra, which are in excellent agreement with experiment, show no distinctive signatures of the hydronium and hydroxide ions present in our simulations. Instead, we found that infrared spectra are sensitive probes of molecular dissociation, exhibiting a broad band below the OH stretching mode ascribable to vibrations of complex ions.

BACKGROUND This study investigates the feasibility and clinical impact of the microdissected thin perforator skin flap strategy on bulky and deformed skin flaps during second-stage revision surgery. METHODS Seventeen patients were selected and underwent the microdissected thin perforator skin flap technique to treat bulky and deformed skin flaps after free flap reconstruction between October 2013 and October 2015. Perforator vessels were isolated and protected under a microscope. Subdermal fat with a thickness of 4 mm to 7 mm was preserved, and excess adipose tissue was resected. RESULTS No skin flap necrosis was observed after the operation in all 17 patients, and all wounds healed without complications. Patients were followed up for 3 to 24 months, with an average follow-up time of 10 months. The skin flaps maintain normal color and texture. Both appearance and function of the recipient sites were improved significantly. CONCLUSIONS The utilization of microdissected thin perforator flap technique to further thin bulky skin flaps at the second stage can be effective in a single operation. The blood supply of all free flaps was preserved, with no evidence of necrosis or healing complications. This technique offers an effective approach for secondary thinning of bulky free flaps.