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The purpose of this study was to investigate the immunomodulatory effects of sulforaphane (SFN), a nuclear factor erythroid 2-related factor (Nrf2) pathway activator, on splenic macrophages' immunocompetence after hemorrhagic shock/resuscitation (HS/R).Male C57/BL6 wild-type mice (n = 6 per group) were subjected to either pressure-controlled hemorrhagic shock (HS) (MAP 35-45 mmHg) or a sham procedure surgery (without HS). After 90 min of HS, fluid resuscitation with withdrawn blood and 0.9% NaCl was performed. SFN (50 mg/kg body weight) was applied intraperitoneally immediately after the resuscitation phase as well as 24 h and 48 h thereafter, depending on group allocation. The mice were sacrificed at 6 h, 24 h, and 72 h after resuscitation. After sacrifice, spleens were harvested to perform Nrf2 immunofluorescence histology. Splenic macrophages were isolated and cultured to measure cytokine secretion in the cell culture supernatant. Furthermore, macrophages isolated after 24 h resuscitation were treated with 100 ng/ml bacterial lipopolysaccharide (LPS) to measure immunocompetence. Matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI) was performed to verify the distribution of SFN in the spleen after intraperitoneal injection.We showed that administered SFN reached the spleen within the first hour post-administration. Furthermore, we identified that SFN increased splenic Nrf2 activation and decreased cytokine expression in splenic macrophages after HS/R. In addition, we showed that SFN exhibited splenic anti-inflammatory properties of macrophages in vitro (IL-6/IL-10-ratio of the HS/R group: 51.79 ± 9.99 (at 6 h) and 15.70 ± 3.35 (at 24 h) vs. HS/R + SFN group: 20.54 ± 5.35 (at 6 h) and 8.60 ± 2.37 (at 24 h), (p0.05)). Furthermore, SFN improved in vitro splenic macrophage immunocompetence after HS/R, as evidenced by the increased secretion of inflammatory cytokines in response to LPS stimulation in vitro.Our study shows that SFN can reduce inflammatory cytokines secreted by splenic macrophages after HS/R and increase their immunocompetence toward a more anti-inflammatory profile.

Diabetes affects human health. This study aimed to investigate the molecular regulation mechanism of miR-139 on liver injury and oxidative stress in diabetic mice. The diabetic mice were divided into miR-139 inhibitor group, si-SIRT group, miR-139 mimic group, and the mRNA expression and protein level of miR-139 and SIRT1 were analyzed, respectively. Bioinformatics revealed the relationship between miR-139 and SIRT1. In addition, histological analysis and oxidation reaction indicators were performed on mouse livers induced by high glucose. After induction, a mouse diabetes model was established with highly expressed ALT. Bioinformatics found that miR-139 negatively regulated SIRT1. Furthermore, markers of hepatic oxidative stress were increased and blood glucose levels decreased in mice overexpressing miR-139. Up-regulation of miR-139 can protect the liver tissue of diabetic mice from oxidative stress injury by inhibiting the expression of SIRT1, and si-SIRT treatment reversed the increased blood glucose level and oxidative stress injury caused by the reduction of miR-139.

Eco-driving incorporating multiple signalized intersections simultaneously has been proven to substantially benefit Connected Vehicles (CVs) in energy performance. However, ignoring the dynamic variation of waiting queues before downstream intersections may prevent CVs from following the obtained speed profile on security grounds. In this paper, the dynamic variation of waiting queue is modelled and predicted based on shockwave theory and data-driven based traffic flow prediction. To formulate the waiting queues as additional time-varying constraints for optimization problem, an extended traffic signal model is constructed based on the prediction. Furthermore, a hierarchical optimization framework is proposed, under which the hybrid optimization problem is decomposed into a discrete problem and a continuous one. Monte Carlo simulation demonstrates that if the proposed eco-driving approach is implemented, failure to follow the reference speed profile decreases by 79.4%. Also, the fuel consumption can be saved by over 4% compared with approaches ignoring the waiting queue.

A defect caused by the radical resection of vulvar cancer requires repair with flap transplantation or vulvoplasty. However, in clinical practice, the surgeons encounter difficulties while using a flap to repair the wound. Therefore, this study aimed to present a review of our practice of post-surgical defect reconstruction in cases using different skin flaps.An observational study was performed involving 26 patients with vulvar cancer who were admitted to Sun Yat-Sen Memorial Hospital between February 2015 and February 2020 for surgical and reconstructive procedures. The clinical data of these 26 patients were analyzed. All patients underwent radical resection of vulvar cancer, followed by post-surgical defect repair using random flap or axial flap transplantation (even for very complex defects). The clinical variables collected and the assessment of efficacy included survival of the flap, history of dysfunction of the recipient area, such as scar contracture, and satisfaction of the patient with the shape after external vaginal surgery.Among the 26 cases in this study, all patients underwent 38 soft tissue reconstruction procedures for vulvar perineal defects during the study period. Squamous cell carcinoma was the most commonly diagnosed cancer (80.8%). The average size of the defect was 9.3×7 cm2. Rhomboid flaps were the most commonly used flaps for performing reconstruction in both the primary and recurrent groups. Poor wound healing was the most commonly discovered complication, which occurred in three of the 38 flaps (7.9%) used. Previous surgery or radiotherapy did not increase the rate of complications following successful reconstruction.Different skin flaps are effective premium options for post-surgical defect reconstruction, and the selective use of skin flaps for treating vulvar defects preserves the vulvar morphology and allows for relatively better functionality.

Hemorrhagic shock/resuscitation (HS/R) is closely associated with overwhelming oxidative stress and systemic inflammation. As an effective activator of the nuclear factor-erythroid factor 2 related factor 2 (Nrf2) pathway, sulforaphane (SFN) exerts antioxidant and anti-inflammatory effects. We explored SFN's effects on alveolar macrophages (AMs), systemic inflammation, and pulmonary damage in an isolated murine HS/R model. Male C57/BL6 wild type and transgenic antioxidant response element (ARE)-luciferase (luc) mice (both n = 6 per group) were exposed to either pressure-controlled HS/R (mean arterial pressure 35-45 mmHg for 90 mins) or sham procedure (surgery without HS/R) or were sacrificed without intervention (control group). Fluid resuscitation was performed via the reinfusion of withdrawn blood and 0.9% saline. Sulforaphane or 0.9% saline (vehicle) was administrated intraperitoneally. Mice were sacrificed 6 h, 24 h, or 72 h after resuscitation. Bioluminescence imaging of ARE-luc mice was conducted to measure pulmonary Nrf2 activity. Plasma was collected to determine systemic cytokine levels. Alveolar macrophages were isolated before measuring cytokines in the supernatant and performing immunofluorescence staining, as well as Western blot for intracellular Nrf2. Histological damage was assessed via the acute lung injury score and wet/dry ratio.Hemorrhagic shock/resuscitation was associated with pulmonary Nrf2 activation. Sulforaphane enhanced pulmonary Nrf2 activity and the Nrf2-activation of AM, while it decreased lung damage. Sulforaphane exerted down-regulatory effects on AM-generated and systemic pro-inflammatory mediators, while it did not have such effects on interleukin-10 (IL-10).In conclusion, SFN beneficially enhances pulmonary Nrf2 activity and promotes Nrf2 accumulation in AMs' nuclei. This may exert not only local protective effects but also systemic effects via the down-regulation of pro-inflammatory cytokines. The administration of Nrf2 activator post-HS/R may represent an innovative treatment strategy.

Treatment resistance of the tumors to photodynamic therapy (PDT) owing to O2 deficiency largely compromised the therapeutic efficacy, which could be addressed via modulating oxygen levels by using O2 self-enriched nanosystems. Here, we report on augmenting the O2-evolving strategy based on a biomimetic, catalytic nanovehicle (named as N/P@MCC), constructed by the catalase-immobilized hollow mesoporous nanospheres by enveloping a cancer cell membrane (CCM), which acts as an efficient nanocontainer to accommodate nitrogen-doped graphene quantum dots (N-GQDs) and protoporphyrin IX (PpIX). Inheriting the virtues of biomimetic CCM cloaking, the CCM-derived shell conferred N/P@MCC nanovehicles with highly specific self-recognition and homotypic targeting toward cancerous cells, ensuring tumor-specific accumulation and superior circulation durations. N-GQDs, for the first time, have been evidenced as a new dual-functional nanoagents with PTT and PDT capacities, enabling the generation of 1O2 for PDT and inducing local low-temperature hyperthermia for thermally ablating cancer cells and infrared thermal imaging (IRT). Leveraging the intrinsic catalytic features of catalase, such N/P@MCC nanovehicles effectively scavenged the excessive H2O2 to sustainably evolve oxygen for a synchronous O2 self-supply and hypoxia alleviation, with an additional benefit because the resulting O2 bubbles could function as an echo amplifier, leading to the sufficient echogenic reflectivity for ultrasound imaging. Concurrently, the elevated O2 reacted with N-GQDs and PpIX to elicit a maximally increased 1O2 output for augmented PDT. Significantly, the ultrasound imaging coupled with fluorescence imaging, IRT, performs a tumor-modulated trimodal bioimaging effect. Overall, this offers a paradigm to rationally explore O2 self-supply strategies focused on versatile nanotheranostics for hypoxic tumor elimination.

To investigate whether unilateral primary acquired nasolacrimal duct obstruction (PANDO) changes the volume and water fraction of both lacrimal glands, using three-dimensional fast spin echo (3D-FSE)-Cube-Flex images, and to identify whether the lacrimal gland is a target organ in this disease.3D-FSE-Cube-Flex images of both lacrimal glands in 25 healthy volunteers and 31 patients with unilateral PANDO were retrospectively reviewed. The differences in volume and water content in the lacrimal glands between the controls, non-PANDO side, and PANDO side groups were examined. Moreover, the associations between magnetic resonance imaging (MRI) parameters and disease duration were assessed with correlation analysis.The lacrimal gland volumes were not significantly different between the PANDO and non-PANDO side groups, compared to the control group (P = 0.484). However, the gland volumes tended to be increased bilaterally in patients with PANDO. In contrast, the gland water fractions in the PANDO and non-PANDO side groups were significantly higher than those in the control group (P = 0.009 and P = 0.014, respectively), and similar between the non-PANDO and PANDO side groups (P = 0.897). No correlation was found between the disease duration and the gland MRI parameters (volume and water fraction).Both lacrimal glands are affected by unilateral PANDO. A change in the water fraction of these glands appears to precede the change in volume and may be a sensitive early indicator.

BACKGROUND: The objective of the current study was to retrospectively examine the morphological magnetic resonance imaging (MRI) characteristics of the gluteus maximus of buttock augmentation at levels of predetermined anatomic points. METHODS: The present study was a retrospective cross-sectional study. Adult women who underwent high-quality MRI scanning at Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2018 to January 2021 were included in this work. The transverse MRI data measured at the inferior point of the sacroiliac joint, just above the femoral head, and at the ischial tuberosity were collected and statistically analyzed. RESULTS: Fifty-two cases (104 sides of female gluteus maximus) were included in the final analysis. The A point (surgery starting point) were 54.4±6.34 mm, 54.91±5.57 mm, and 73.91±5.57 mm away from the posterior midline at the level of inferior point of the sacroiliac joint, just above the femoral head, and at the ischial tuberosity, respectively. Accordingly, the thickness of the muscle at these locations was 16.0±4.17 mm, 23.4±4.40 mm, and 24.6±7.58 mm, respectively. The diameter of the implant did not exceed 14.18±1.22 cm. In addition, the gluteus maximus at the lowest point of the sacroiliac joint and above the femoral head exhibited an arc structure, which needs to be tilted to the deep plane during separation. CONCLUSIONS: Dissimilar from previous experience of blind dissection, the gluteus maximus muscle can be more scientifically and reasonably dissected using the indexes for gluteus augmentation supplied in this study.

Summary Background Penoscrotal extramammary Paget's disease is a rarely found intraepithelial adenocarcinoma in older male patients. The challenge for surgeons to perform high-quality post-surgery reconstruction is mostly case-dependent. Here, we present a review of post-surgical reconstruction practice in 21 cases using various scrotal skin flaps. Methods During the 10-year study period (from 2008 to 2018), all 21 male patients diagnosed with penoscrotal extramammary Paget's diseases at Sun Yat-sen memorial hospital were enrolled in this study. All patients underwent expanding resections guided by frozen sections and penoscrotal reconstructions using various scrotal skin flaps alone or combined with pubic skin flaps and partial thickness skin graft depending on individual defects. The patient's clinical data, specifically the diagnosis, surgical outcome, and follow-up evaluation were retrospectively analyzed. Results The size of skin lesions ranged from 4 × 5 cm to 16 × 18 cm approximately. Out of 21 total cases, 13 patients received combined scrotal and pubic flaps, three patients received single scrotal flaps, and five patients received scrotal flaps and partial thickness skin grafts. Limited flap tip necrosis (two cases) and wound dehiscence (one case) were observed, and secondary resections were performed in four cases with positive post-operative pathological results. All patients experienced complete wound healing and had well-maintained penile morphology and function. Conclusion Various scrotal skin flaps alone or combined with pubic skin flaps designed for individual lesion conditions in patients with penoscrotal extramammary Paget's disease are efficient for scrotal reconstruction. A good match of the local skin texture helps to maintain the morphology and function of the penis and scrotum.

Background: A defect caused by the radical resection of vulvar cancer requires repair with flap transplantation or vulvoplasty. Therefore, the aim of this study is to present a review of our practice of post-surgical defect reconstruction in cases using different skin flaps.Methods: An observational study was performed among 26 patients with vulvar cancer who were admitted to Sun Yat-Sen Memorial Hospital between February 2015 and February 2020 for surgical and reconstructive procedures. Clinical data of these 26 patients were analyzed. All patients underwent radical resection of vulvar cancer, followed by the repair of post-surgical defects by random flap or axial flap transplantation (even for very complex defects).Results: Among the 26 cases in this study, all patients received 38 soft tissue reconstruction procedures for vulvar perineal defects during the study period. Squamous cell carcinoma was the most commonly diagnosed cancer (80.8%). The average size of the defect was 9.3 ´ 7 cm2. Rhomboid flaps were the most commonly used flaps for performing reconstruction in both the primary and recurrent groups. Poor wound healing was the most commonly discovered complication that occurred in 3 of the 38 flaps (7.9%) used. Previous surgery or radiotherapy did not increase the rate of complications after proper reconstruction was performed.Conclusion: Expanding resection is an effective technique for treating vulvar cancer. Different skin flaps, are effective premium options for post-surgical defect reconstruction, and selective use of skin flaps for treating vulvar defects preserves the vulvar morphology and allows for relatively better functionality.

Our research explores the immunomodulatory effects of sulforaphane (SFN), a well-known nuclear factor erythroid 2-related factor 2 (Nrf2) pathway agonist, on the sterile inflammation of and ischemia-reperfusion injuries to the liver after hemorrhagic shock (HS) followed by resuscitation (R). Male C57/BL6 wild-type and transgenic ARE

Background In ear reconstruction, the difficulty lies in reestablishing the ear's bionic form with adequate skin coverage and an appropriate framework. Skin expansion and a porous polyethylene (i.e., Medpor) framework are often used for ear reconstruction. However, a long-term review of the combined application of the expanded skin and Medpor framework has not been reported. This article reviews ear reconstruction combining these two factors over the past 20 years in the authors' center to summarize the surgical technique and analyze the postoperative results and complications. Methods A retrospective review was performed that included all patients who underwent ear reconstruction with expanded skin and Medpor framework in the authors' center between 1998 and 2018. Results A total of 68 patients with microtia who were admitted to the authors' center for surgical ear reconstruction were included, and 70 ears were reconstructed. Fifty-seven of the patients (83.82 percent) felt satisfied with their reconstructed ear, five patients (7.35 percent) were not satisfied with the reconstructed ear, and six patients (8.82 percent) had the frameworks removed. Fifteen patients (22.06 percent) developed complications, including framework exposure (13.24 percent), infection (4.41 percent), scar hypertrophy (4.41 percent), and hematoma (2.94 percent). Conclusions Framework exposure limits the combined application of expanded skin flap and Medpor framework when reconstructing the ear without additional fascial interposition. Using a temporoparietal fascia or postauricular fascia flap during the operation is effective to decrease the exposure rate; however, this complication cannot be completely avoided. Using postauricular fascia and skin graft may lead to scar hypertrophy; thus, these techniques should be used with caution. Clinical question/level of evidence Therapeutic, IV.

BACKGROUND To explore the efficacy and safety of interferon-α-2b and interleukin-2 combined with chemotherapy in treating patients with metastatic melanoma. METHODS The patients with metastatic melanoma in control group (n=52) were treated with conventional DDAVC chemotherapy regimen, while those in combination group (n=52) received biotherapy with interferon-α-2b and interleukin-2 in addition to the chemotherapy in control group. At the end of the treatments, the serum immune function indicators, short-term efficacy and incidence of adverse reactions were compared between the two groups of patients, and patient's survival was followed up and recorded. RESULTS At 1 week after treatment, it was found that the overall response rate in combination group was substantially higher than that in control group (P=0.027). Besides, according to the serologic test results at 1 week after the chemotherapy, T lymphocyte subset activity was enhanced in patients in combination group compared with that before chemotherapy, with no statistically significant difference (P>0.05), but it was notably weakened in control group in comparison with that before chemotherapy (P

Malignant melanoma (MM) causes 80% of skin cancer-related deaths and becomes the most lethal type of skin cancer. The molecular mechanism of MM is still not clear. This study aimed to reveal the relationship between MM and EIF3H. Clinical specimens were collected to preliminarily explore the role of EIF3H in MM. MM cell lines with EIF3H knockdown were constructed for investigating the effects of EIF3H on cell proliferation, apoptosis, cell cycle and cell motility. Mice xenograft model was constructed for verification in vivo. We found that EIF3H was obviously upregulated in MM tissues compared with normal skin tissues, which was correlated with tumor stage and risk of lymphatic metastasis. The in vitro results indicated that silencing EIF3H in MM cells could significantly suppress cell proliferation, promote cell apoptosis and induce cell cycle arrest. Moreover, EIF3H knockdown significantly restrained cell motility through regulating EMT-related proteins. The effects of EIF3H knockdown were also verified in mice xenograft model, which were represented by slower growth rate, smaller volume and lighter weight of tumors. Therefore, EIF3H was identified as a critical factor in the development and progression of MM which may be used as a novel therapeutic target in the treatment of MM.

BACKGROUND: The prognostic role of the red blood cell distribution width (RDW) on an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is incompletely understood.OBJECTIVE: To investigate the effect of the RDW on in-hospital and 1-year mortality after an AECOPD.DESIGN: For 442 AECOPD patients, the RDW was measured and clinical characteristics, comorbidities and laboratory measurements were recorded. The RDW that discriminated survivors and non-survivors was determined using a receiver operator characteristic (ROC) curve. The risk factors for in-hospital and 1-year mortality were identified through logistic regression analysis and Cox regression analysis, respectively.RESULTS: Of 442 study patients, 31 died, and 411 survived while in hospital. The area under the ROC curve for RDW for in-hospital death was 0.726 (95%CI 0.631-0.822), with sensitivity of 0.71 and specificity of 0.64 for a cut-off point of 13.75%. An RDW ≥13.75% was a risk factor for in-hospital mortality (relative risk 4.30, 95%CI 1.98-9.58; P < 0.001). Univariate and multivariate Cox regression analysis showed that an RDW ≥13.75% was an independent risk factor for death at 1 year (univariate analysis, hazard ration [HR] 2.33, 95%CI 1.55-3.51; multivariate analysis, HR 1.64, 95%CI 1.08-2.50).CONCLUSION: The RDW was a strong and independent risk factor for in-hospital and 1-year death for AECOPD patients.

The safe and stable operation of the power system has become an increasingly critical issue as the large-scale of wind power integration and its long-distance transmission. Splitting control (or islanding control) of the power system is an important prevention measure to mitigate the system collapses. In general, the oscillation center (i.e. the point of which voltage is the lowest in the power gird) is applied to searching the splitting boundary. However, fast responses, low inertia, and asynchronous operation of the doubly fed induction generator (DFIG) might change the migration mechanism of oscillation centers. This paper tries to analyze the impact of DFIG characteristics on oscillation center migration. First, Thevenin equivalent circuit equation of DFIG is established, based on which the characteristic admittance of DFIG under out-of-step oscillation is analyzed. Then by substituting the characteristic admittance of DFIG into the oscillation center migration function, results manifest that the distribution range of the oscillation center is extended, and the splitting location keeps away from the point of common coupling (PCC). Finally, simulations on 2-area 4-machine system and IEEE 118-bus system integrated with wind farms verify the correctness and effectiveness of the theoretical analysis.

To evaluate the effects, particularly the incidence of anastomotic fistula, of a pedicled dartos flap around the urethral orifice in the treatment of urethroplasty of mid-shaft hypospadias. A total of 46 cases of congenital mid-shaft hypospadias were included in this study. The patients ranged in age from 0.7 to 25.4 years and the average was 5.8 years. The patients received penis chordee correction. A transverse preputial island flap was developed for urethral reconstruction. The proximal dartos of the urethral orifice was used to develop a pedicled dartos flap, which was transposed to cover and strengthen neourethral anastomosis. The ventral penile skin defect was repaired by another flap. The 46 patients were examined during follow-up visits for 6 months to 3 years. An anastomotic fistula was observed in one case (2.2 %). Scar healing without fistula was observed in another patient due to poor blood supply to part of the ventral penile skin. No other incidences of fistula, urethral rupture, flap necrosis, wound infections, urinary tract (meatal) stenosis, or urethral diverticulum were observed in the patients. A pedicled dartos flap around the urethral orifice can take advantage of well-vascularized local tissue to add a protective layer to the proximal aspect of the neourethral anastomosis for reducing the incidence of anastomotic fistula in mid-shaft hypospadias repair using a transverse preputial island flap. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

BACKGROUND: COPD is associated with cardiovascular and renal dysfunction. Cystatin C (CysC) is a biomarker of renal function and an independent risk factor for all-cause and cardiovascular mortality among elderly persons. The aim of the study was to examine the prognostic role of CysC for in-hospital mortality in subjects with a COPD exacerbation. METHODS: Upon admission, serum CysC levels and arterial blood gas analysis from 477 subjects with a COPD exacerbation were measured. Clinical characteristics were also recorded. A receiver operating characteristic curve analysis was used to determine the level of CysC that discriminated survivors from non-survivors. Univariate and multiple logistic regression analyses were used to identify the risk factors for in-hospital mortality. To reduce the influence of confounders, subgroup analyses were performed according to the comorbidities, including states of heart failure, renal dysfunction, and pH, PaCO2, and PaO2 levels. RESULTS: During the in-hospital period, 59 subjects died, and 418 subjects recovered. The decedent group showed lower pH (7.27 ± 0.17 vs 7.38 ± 0.06, P < .001), higher CysC (2.21 ± 1.05 mg/L vs 1.39 ± 0.54 mg/L, P < .001), higher PaCO2 (77 ± 39 mm Hg vs 48 ± 14 mm Hg, P < .001), and lower PaO2 (74 ± 32 mm Hg vs 84 ± 26 mm Hg, P < .001) levels. The area under the receiver operating characteristic curve for the CysC prediction of death was 0.77 (95% CI 0.70–0.84). CysC values ≥1.59 mg/L were associated with significantly higher in-hospital mortality (relative risk = 5.49, 95% CI 3.24–9.32, P < .001). Multiple logistic regression analysis showed that pH

Background The surgical treatment of hypospadias contains urethral reconstruction and correction of penile curvature. In some severe type of hypospadias, it also needs correction of penoscrotal transposition and cleft of scrotum. However, there are few literatures that refer to the correcting of deformity of glanular dislocation. Objective This study aimed to correct the deformity of glanular dislocation in patients with hypospadias with up-to-tip technique and double wing flaps. Methods From May of 2011 to September of 2012, 49 patients who underwent hypospadias with glanular dislocation repairing received up-to-tip technique to correct the deformity of glanular dislocation in our department by a single surgeon (J.Z.). An X-shaped incision was made in the ventral median of glans, and the glans was dissected from the penis cavernosus, then 2 wing-shaped flaps appeared. The 2 sides of flaps were rotated and lifted with new urethra inside. The divergent glans flaps were closed with vertical mattress suture. Follow-up was from 12 to 30 months. Results All patients had excellent cosmetic results immediately after the operation. The glans was straight and was upturned obviously. The wing flaps of glans were partially dehisced in 2 (4.08%) cases after the operation. The other patients had good wound healing. No urethral stricture in distal urethra was observed. Conclusions Up-to-tip technique and double wing flap can effectively correct the deformity of glanular dislocation in the patients with hypospadias. After the operation, the glans configuration was improved.

To help surgical trainees reach a deep understanding of plastic operations, we developed and evaluated an economical and convenient model using plasticine for plastic surgical training. From Sep of 2012 to Dec of 2014, we invited 57 medical interns to participate in a program designed for the qualitative evaluation of this model. In this program, 57 interns were asked to simulate certain surgical operations under guidance of the experienced staff of our department using the plasticine model. The value of the plasticine model was evaluated through questionnaire surveys. Their acceptance of the plasticine model, as well as the benefits and the flaws, was evaluated by the questionnaire survey. All the participants completed the training session as well as the questionnaire, all of whom felt that the plasticine model had increased their familiarity with the surgical procedure they were assigned. By remodeling plasticine, the trainees understood either the brief surgical procedures or some confusing operative details in plastic surgery. In the questionnaire surveys, the trainees showed considerable consensus with the training program. The flaws of this method were also listed. The flaws generally reflected that “it is difficult to model into a vivid image” and “it is not suitable for all the operation”. Overall, the plasticine model is accepted by the participants in this survey. This model is economical and versatile, and could be used as a complementary training tool for novices in simulated operation training of plastic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .