Reconstuctive strategy of the defect of anterior rectus fascia and rectus abdominus muscle / 中华医学美学美容杂志

Objective:To discuss the reconstuctive strategy of the defect of anterior rectus fascia and rectus abdominus muscle in the clinical practice.Methods:Between November 2009 and Janurary 2020, clinical data of 24 female patients that underwent 29 anterior rectus fascia and rectus abdominus muscle reconstructions of defect were reviewed retrospectively. The median age was 42.5 years (range, 35-60 years), including 20 breast reconstructions, 2 pelvic reconstructions, 1 thoracic defect after tumor resection and 1 abdominal defect after tumor resection. According to the location and size of the anterior rectus fascia and rectus abdominus muscle defect, three reconstructive methods were applied: 6 direct clousres were applied if the width of defect was less than half of the anterior rectus fascia, 21 polypropylene mesh onlay reconstructions were applied for which the width of defect was or more than half of the anterior rectus fascia, and 2 direct suture closure were applied for the simple rectus abdominus muscle defect.Results:All the patients healed eventfully without abdominal wound complications, such as infection, hematoma, dehiscence. The patients were followed up for a median period of 30 months (range, 5-126 months). 1 patient died of breast cancer recurrence and matastasis at 36 months postoperatively. No patient developed a mesh infection or required mesh removal secondary to infection or foreign body reaction. There was no abdominal wall hernia, 1 patient developed abdominal bulge without further treatment because of no abdominal wall discomfort.Conclusions:The key of successful operation is different reconstructive methods applied to reconstruct the integrity and stability of abdominal wall, based on the location and size of the anterior rectus fascia and rectus abdominus muscle defect.

Impact of aesthetic suture techniques training in improving the suture quality of non-plastic surgeons / 中华医学美学美容杂志

Objective:To investigate the effect and necessity of aesthetic suture techniques training in improving the suture quality of non-plastic surgeons.Methods:The well-planned aesthetic suture techniques training programs were run in non-plastic surgery senior residents and attending surgeons at Peking University People＇s Hospital from January 2017 to January 2019. There were 120 senior residents and attending surgeons included (aged from 25-32 years, average 28.9 years, with 66 males and 54 females). Mixed teaching methods were used such as video shows, lectures, surgery live show and scenario simulation. Baseline tests were taken before the training. Suture quality tests were taken when the trainings came to the end. Self-assessments were carried out both before and after the trainings.Results:Eight rounds of aesthetic suture techniques training were accomplished and 120 trainees were included in all. One hundred and two trainees passed the test while eight failed, while 10 trainees were absent in some courses or the final test. The passing rate was 85.0%. The scales of suture tools and material selection, incision design, subcutaneous tissue suture quality, tension relaxation, aesthetic suture appearance, and flexibility of different suture techniques were sharply improved after the training in both subjective and objective assessments.Conclusions:The aesthetic suture techniques training is effective in improving the suture quality of non-plastic surgeons, which is worthy to generalize in resident training.

The application of Pacman flap in reconstruction for skin and soft tissue defects / 中华整形外科杂志

Objective@#To introduce the experience in skin and soft tissue defects reconstruction using Pacman flap.@*Methods@#From April 2015 to April 2018, clinical data of 18 patients using Pacman flap for soft tissue defect repair were reviewed. They were 8 males and 10 females, aged from 18 to 87 years (median age of 60 years). Eight patients had benign lesions, but 10 patients had malignant tumors. The defects were on face (n=12), trunk (n=3), and limbs (n=3). The size of tissue defects ranged from 0.9 cm×0.9 cm to 10.0 cm×9.0 cm. The flap was designed along edge of the defect. Two proximal triangular flap were separated, and sutured in contraposition. The rest of the flap was advanced to cover the defect.@*Results@#The postoperative follow-up period ranged from 2 months to 20 months (median time of 9 months). All flap survived without necrosis. Hematoma occurred in 2 patients, were healed after debridement. All patients were satisfied with the aesthetic and functional outcomes.@*Conclusions@#The technique of Pacman flap is a simple and effective method to repair the skin and soft tissue defects.

Analysis of satisfaction and quality of life of 54 patients after breast reconstruction: a retrospective study / 中华整形外科杂志

Objective@#This is a study to evaluate complication rate, satisfaction and quality of life after breast reconstruction under different classifications. The classification criteria are the timing of operation, surgical procedures, and patients′age.@*Methods@#By reviewing the surgical cases from August 2004 to June 2018, the authors summarized the data of 102 patients with breast reconstruction of the same surgeon in Peking University People′s Hospital and Plastic Surgery Hospital (Institute) CAMS PUMC. Fifty-four patients who met the inclusion criteria and completed the BREAST-Q breast reconstruction module scale, were divided into immediate group or delayed group, according to the timing of operation; divided into abdomen group or other procedures group, according to the surgical procedure; and divided into the young patients′group or senior patients′group according to age. The index were (1) postoperative complication rate, (2)satisfaction with breasts, psychosocial well-being, physical well-being of chest and abdomen, sexual well-being, satisfaction with outcome, satisfaction with information, satisfaction with care (based on the BREAST-Q scale).@*Results@#Complication rate was 9.1%(1/11) in the immediate group, 16.3%(7/43) in the delayed group, 14.7%(5/34) in the abdomen group, 15.0%(3/20) in other procedures group, 13.6%(3/22) in the young patients′group, and 15.6%(5/32) in the senior patients′group. There was no significant difference in the incidence of complications (P>0.05). The postoperative scores of satisfaction with breasts, psychological well-being and sexual well-being were significantly higher in the immediate group than in the delayed group(P=0.026, P<0.001 and P=0.001, respectively). The score of postoperative physical well-being of chest was significantly higher in the abdomen group than other procedures group(P=0.020). The score physical well-being of abdomen was lower compared with the preoperative in the abdomen group (P<0.001). The score of physical well-being of abdomen was lower in the senior patients′group than that of the young patients′group (P=0.010).@*Conclusions@#The complication incidence of breast reconstruction patients was similar among different groups. The breast reconstruction surgery can significantly improve satisfaction and quality of life of patients. To some extent, immediate breast reconstruction can reduce the psychological and physiological effects of breast loss on patients, leading to higher postoperative satisfaction. Breast reconstruction with abdominal flaps can provide patients with better chest health but poor abdomen health. Although elderly patients undergoing breast reconstruction will have poor physical well-being of abdomen, they can still achieve higher satisfaction of operation.

Application of dual-pedicle abdominal flap for unilateral breast reconstruction / 中国修复重建外科杂志

Objective: To explore the effectiveness of dual-pedicle abdominal flap for unilateral breast reconstruction. Methods: Between March 2014 and March 2018, a clinical data of 19 female patients underwent dual-pedicle abdominal flap reconstruction because of unilateral mastectomy defect was reviewed retrospectively. The median age was 45 years (range, 32-51 years), including 3 immediate breast reconstruction and 16 delayed breast reconstruction, and left side in 7 cases and right side in 12 cases. Unilateral breast reconstruction were performed for 8 patients with unilateral pedicle transverse rectus abdominis musculocutaneous (TRAM) flap and contralateral free TRAM flap, for 3 patients with pedicle TRAM flap and contralateral deep inferior epigastric perforator (DIEP) flap, for 7 patients with bilateral DIEP flaps, for 1 patient with free muscle-sparing TRAM flap and contralateral DIEP flap. The size of abdominal flap ranged from 24 cm×7 cm to 43 cm×13 cm. The donor sites were closed directly. Results: Vascular crisis ocuurred in 1 flap and relieved after surgical exploration. The other flaps survived. Poor wound healing in abdominal incision occurred in 1 patient and was successfully treated with debridement. The other donor sites healed without any other complication. The patients were followed up with a median period of 12 months (range, 4-42 months). Four patients received reparative operation of their reconstructive breast, and 2 patients received mamopexy of the contralateral breast due to mastoptosis. The abdominal BREAST-Q score was 84.1±11.7, chest score was 86.5±8.9, and breast score was 67.6±16.4 at last follow-up. Conclusion: The dual-pedicle abdominal flap for unilateral breast reconstruction provides adequate soft tissue volume and good blood supply. It is a reliable and effective breast reconstructive method for patients who need large tissue volume to make symmetric with the contralateral breast, or slim patients with few tissue in the donor site, or patients with scars in the donor site, especially vertical abdominal scars.

Experince of ICGA-guided breast reconstruction with abdominal flap / 中华整形外科杂志

Objective@#This article provides an overview of our experience using indocyanine green angiography (ICGA) in breast reconstruction with abdominal flap to ascertain the application value of ICGA and its usage in decreasing postoperative complications.@*Methods@#A total of 21 breast reconstructions with intraoperative ICGA were analyzed retrospectively, including 7 bilateral deep inferior epigastric perforator (DIEP) flaps, 5 pedicled transverse rectus abdominis myocutaneous (TRAM) flaps with contralateral free TRAM flaps, 4 pedicled TRAM flaps with contralateral DIEP flaps, 3 unilateral DIEP flaps and 2 unilateral pedicled TRAM flaps. According to different breast reconstruction methods, ICGA were applied respectively after flap harvesting and vessel anastomosis, in order to evaluate the blood supply of flaps and vessel perfusion.@*Results@#A total of 52 ICGA were performed and recorded intraoperatively without any indocyanine green-associated complications. The operation methods were modified according to ICGA findings in 6 of 21 cases. The distal part of flaps were discarded due to poor perfusion in 2 cases (1 DIEP flap and 1 TRAM flap), additional free vessel anastomosis were needed in 2 cases to ensure sufficient blood supply, 2 vascular complication including 1 vascular occlusion and 1 vascular thrombosis were found and managed in time. During the follow-up (range from 3 to 30 months, median of 16 months), no vascular crisis was reported. All flaps survived satisfactorily without partial or whole flap necrosis or wound infection.@*Conclusions@#Intraoperative ICGA can provide real-time information of flap′s blood supply and vessel perfusion to evaluate the conditions of flaps and vascular anastomosis, which can help surgeons take actions accordingly to increase the successful rate of breast reconstruction.

Microsurgery skills training strategy: part one—non-living animal models training / 中华整形外科杂志

Microsurgery techniques have allowed the development of many new therapeutic methods in plastic surgery, but are difficult to master without hard training. It is very important to set up a standardized microsurgery curriculum and training system for broadening surgical skills training and investigating the plastic surgery specialist training strategy. In our experiences, a series of training models are needed, like non-animal models, non- living animal models, live animal models and so on. This paper shows the training strategy for the primary stage of microsurgery training, non-animal model and non-living animal model training.

Microsurgery skills training strategy: part one—non-living animal models training / 中华整形外科杂志

Microsurgery techniques have allowed the development of many new therapeutic methods in plastic surgery, but are difficult to master without hard training. It is very important to set up a standardized microsurgery curriculum and training system for broadening surgical skills training and investigating the plastic surgery specialist training strategy. In our experiences, a series of training models are needed, like non-animal models, non- living animal models, live animal models and so on. This paper shows the training strategy for the primary stage of microsurgery training, non-animal model and non-living animal model training.

Microsurgery skills training strategy: part one—non-living animal models training / 中华整形外科杂志

Microsurgery techniques have allowed the development of many new therapeutic methods in plastic surgery, but are difficult to master without hard training. It is very important to set up a standardized microsurgery curriculum and training system for broadening surgical skills training and investigating the plastic surgery specialist training strategy. In our experiences, a series of training models are needed, like non-animal models, non- living animal models, live animal models and so on. This paper shows the training strategy for the primary stage of microsurgery training, non-animal model and non-living animal model training.

Experince of supermicrosurgical lymphaticovenular anastomosis with intraoperative indocyanine green lymphangiography / 中华整形外科杂志

Objective@#To figure out the clinical application value of indocyanine green (ICG) lymphangiography in supermicrosurgical lymphaticovenular anastomosis.@*Methods@#A total of 6 supermicrosurgical lymphaticovenular anastomosis with intraoperative ICG lymphangiography were performed during April 2015 to May 2017 and were analyzed retrospectively. All the cases are female (range from 30 to 54 years old, median of 46.5 years old), including 3 cases for prevention and 3 cases for treatment of lymphedema.@*Results@#A total 6 supermicrosurgical lymphaticovenular anastomosis were performed with intraoperative ICG lymphangiography to make sure the influx of lymph fluid to the vein. During the median of 23 months follow-up (range from 7 to 32 months), the 3 preventive cases did not show upper limb lymphedema and the 3 theraputic cases were relieved at different levels.@*Conclusions@#Intraoperative ICG lymphangiography can provide real-time information to locate suitable lymph vessels and ascertain the anastomotic patency in supermicrosurgical lymphaticovenular anastomosis, thus improve the operation effectiveness.

Association study between catechol-O-methyltransferase Val158Met polymorphism and the memory function of schizophrenia treated with Aripiprazole / 中华行为医学与脑科学杂志

Objective To investigate the association between catechol-O-methyltransferase (COMT) Val158Met polymorphism and the memery function of schizophrenia treated with Aripiprazole.Methods Schizophrenic patients were diagnosed in according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV).A total of 78 Chinese Han subjects were involved in this study.The polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) was used to identify COMT genotypes.The Chinese revised version of Wechsler Memory Scale (WMS-RC) was used twice to evaluate the memory function of patients treated with Aripiprazole alone before and after drug treatment for 8 weeks.ANOVA,rank sum test and t-test were used to statistical analysis.Results There was statistical difference of cumulative memory among the three groups (F=12.371,P=0.002),and Met/Met genotype showed much poorer cumulative memory than Val/Met and Val/Val genotypes (Z=-3.168,-2.641 ; P=0.002,0.008,respectively) Memory function was significantly improved after patients been treated with Aripiprazole except the associative memory(P＜0.05).Met/Met genotype showed more improvement of cumulative memory than other genotypes after Aripiprazole treatment (t=4.203,P＜0.01 ; t=3.024,P ＜0.01,respectively).Conclusions There may be a relationship between COMT Val158Met polymorphism and the memory function of schizophrenia in Aripiprazole treatment.Met/Met genotype of schizophrenia showed worst cumulative memory but best responsiveness in Aripiprazole treatment.

Combining CpG and Al(OH)3 enhances the immunogenicity of hepatitis C virus recombinant ptotein combined vaccine / 中华微生物学和免疫学杂志

Objective To research CpG and Al(OH)3 adjuvants enhancing immunogenicity of hepatitis C virus(HCV) recombinant ptotein combined vaccine(TIE).Methods BALB/c mice were immunized with candidate vaccine TFE using CpG,Al(OH)3,Al(OH) 3 + CpG,or freund's adjuvant(FA) as the adjuvant.Five mice were sacrificed after 10 d of the last immunization.Specific antibodies in sera were tested by enzyme-linked immunosorbent assay(ELISA).Splenic cells were isolated and levels of IFN-γ,IL-4 and cytotoxic T lymphocyte(CTL) cytotoxicity assay were messuredin vitro.The remaining mice were subcutaneouly injected with 1 × 106 SP2/0-NS3 cells on the back to investigate the protective effects.The differences of means between groups were compared by LSD-t test.Results The specific CTL activity of TFE + A1(OH) 3 + CpG group was higher than TFE + FA group and TFE + CpG group(P ＜ 0.05).The level of IFN-γsecreting cells in TFE + Al(OH)3 + CpG group was higher than that in TFE + M(OH)3 group or TFE + CpG group(P ＜ 0.05).Conclusion Combining Al(OH) 3 and CpG could enhance specific cellular immunogenicity of candidate HCV vaccine TFE.TFE + M(OH) 3 + CpG could effetively prevent the attack of tumor cell SP2/0-NS3 expressing nonstructural protein NS3 of HCV.

Immunoprotection analysis of hepatitis C virus recombinant protein / 中华传染病杂志

Objective To investigate immune responses and protective effect induced by two recombinant proteins of hepatitis C virus(HCV)in BALB/c mice.Methods BALB/c mice were immunized with recombinant proteins HCV-T and(or)HCV-F4HVR1 three times.Specific antibodies in sera were tested by enzyme-linked immunosorbent assay(ELISA).Five mice were sacrificed after 14 days of the last immunization.Splenic cells were isolated and levels of interferon(IFN)-γ,interleukin(IL)-4 and cytotoxic T lymphocyte(CTL)cytotoxicity assay were measured in vitro.The remaining mice were subcutaneously injected with 1.0×106 SP2/0-NS3 cells on the back to investigate the protective effects.The differences of means between groups were compared by LSD-t test.Results Compared with phosphate bufter saline(PBS)group,combined immunization with HCV-T and HCV-F4HVR1 induced higher levels of specific IgG against HCV-F4HVR1(t=3.815,3.762,P＜0.05),HCV-NS3-specific CTL response(t=3.971,P＜0.05)and IL-4(t=3.512,3.417,P＜0.05)and IFN-γ(t=3.813,3.426,3.671,P＜0.05)secretions.Conclusion High levels of specific humoral immunity and cellular immunity are induced in vivo after combined immunization with HCV-T and HCV-F4 HVR1,which could effectively prevent from the attack of SP2/0-NS3 cells.

Immunogenicity and protective effect induced by co-immunization with HCV recombinant protein antigens / 中华微生物学和免疫学杂志

Objective To investigate the cellular and humoral immune responses and protective effect induced by co-immunization with two multi-epitope combinant antigens. Methods Mice were co-im-munized with the muhi-epitope HCV-T and HCV-E1 antigens three times. Sera antibodies IgG, IgG1 and IgG2a were tested by ELISA. Spleens from BALB/c mice immunized were removed 10 days after the last im-munization. CTL activity was assessed using LDH cytotoxicity assay kit. IFN-γ- and IL-4-secreting cells were quantified using ELISPOT kit. Two weeks after the final immunization, the mice were challenged sub-cutaneously(s, c. ) at the back with 106 SP2/0-NS3 cells, and protective effect was observed. For therapy, 106 SP2/0-NS3 cells were implanted into the back of BALB/c mice. Seven days later, mice were immuniza-tion three times. Therapy effect was observed. Results Co-immunization with HCV-T and HCV-E1 induced high tiers of HCV-El-specific IgG, IgG1 and IgG2a antibodies, and high level of CTL activity. Synergistic effect in frequencies of both specific IFN-γ-secreting cells and IL-4-secreting cells was observed in mice co-immunized. Prophylactic as well as therapeutic administration of mT + mE1 in mice led to protecting mice against SP2/0-NS3 cells. These results suggested that mT + mE1 was potential as a prophylactic as well as therapeutic HCV vaccine. Conclusion Co-immunization with HCV-T + HCV-EI induced protective humor-al and cellular immune response. HCV-T + HCV-E1 was potential as a recombinant HCV vaccine.