Effect of botulinum toxin A on fat breastaugmentation: a preliminary randomized controlled clinical study / 中华医学美学美容杂志

Objective:To explore whether botulinum toxin A (BTX-A) can improve the retention rate of fat transplantation in fat breast augmentation.Methods:Each patient was divided into control side and experimental side according to the random number table in 14 patients studied. The experimental group received autologous fat and BTX-A combined transplantation on both sides of the breast, while the control side only received autologous fat transplantation. The fat was added with the same volume of normal saline as BTX-A in the control group. All patients were followed up and the effects of BTX-A were evaluated objectively via the comparison of the remained bilateral fat graft volumes that were obtained through a digital three-dimensional reconstructions technique. Moreover, the improvement of each breast appearance and complication were assessed by the physician and patients who were blinded to the recipient treatment assignment.Results:The outcome of the fat breast augmentation was evident for both groups at the follow-up with no evidence of fat embolism, vascular/nervous injury, infection and prolonged bruising. In one of the 14 patients (control group), fat liquefaction necrosis occurred in one side of the breast; after active treatment, it returned to normal, and three patients had different degrees of mass. The analysis on the three-dimensional reconstruction data and the assessments from both the physicians and patients showed significant differences in the fat graft retention volume between the BTX-A group (51.10±20.56)% and the control group (33.06±14.77)%. Nevertheless, there was no significant difference in the incidence of complications between the two sides.Conclusions:Autogenous fat breast augmentation is safe and effective. This study result has shown that BTX-A can significantly improve the retention rate of fat transplantation but cannot reduce the incidence of complications.

Clinical significance of MRI in preoperative examination of gynecomastia / 中华医学美学美容杂志

Objective To explore the significance of preoperative MRI in the detection of gynecomastia before surgery.Methods From November 2016 to August 2018,we used preoperative MRI to determine surgical options to treat 38 cases of adolescent and post-adolescent patients with gynecomastia.After operation we followed up the patients for 6 months to 1 year.Results The breast had good shape,smooth chest wall,natural contour,and no complications such as hematoma,nipple and areola sensory disturbance.No surgical traces remained in the chest and no recurrence occurred during the follow-up.All patients were satisfied with the surgical effect and chest wall shape.Conclusions Preoperative MRI can clearly show the type of breast development,the proportion of fat and breast tissue,to guide the clinical personalized design of surgical procedures.It can be used as a routine pre operative examination for gynecomastia.

Clinical effect of nanofat on improving superficial rhytides of face and neck and dark lower eyelids / 中华医学美学美容杂志

Objective To evaluate the clinical effect of nanofat on superficial rhytides of face and neck and dark lower eyelids.Methods From September 2014 to January 2017,a total of 86 cases were collected in our hospital for voluntary nanofat transplantation on superficial rhytides and dark lower eyelids.This was a retrospective study,which included 18 cases of eye wrinkles,14 cases of forehead wrinkles,neck wrinkles in 14 cases,and 22 cases of dark lower eyelids.First of all,we harvested mircofat through liposuction,and then transformed mircofat to nanofat.At last,nanofat was grafted into intradermal layer of the skin with sharp needles.We took the standard photographs of the patients.After six months follow-up,doctors and patients evaluated the short term and long-term postoperative effect.Results No serious complications occurred in all patients.Postoperative evaluation of facial and neck superficial wrinkles showed that the satisfactory rate of doctors and patients after one month,was 85.9％and 84.3％,and after 6 months 87.5％ and 84.3％,respectively.Postoperative evaluation of dark lower eyelids showed that the satisfactory rate of doctors and patients after one month was 45.5％ and 36.4％,and after 6 months 81.8％ and 86.4％,respectively.Conclusions Nanofat can rectify the superficial rhytides of face and neck and dark lower eyelids in some patients.However,for some patients the effect is not satisfied.

Transaxillary dual-plane breast augmentation under endoscope combined with autologous fat transplantation / 中华医学美学美容杂志

Objective To investigate the feasibility and clinical effect of transaxillary dual-plane breast augmentation under endoscope combined with autologous fat transplantation.Methods From January 2015 to December 2015,88 patients who accepted augmentation mammoplasty were divided into control group (from January to June) and observation group (from July to December).Patients in control group only accepted transaxillary dual-plane breast augmentation and transaxillary dual-plane breast augmentation combined with autologous fat transplantation was used for patients in observation group.Patients' basic information,surgery-related indicators,recovery situations,complications and patients' satisfactory data were collected.34 patients in control group and 38 patients in observation group were followed up.Results For surgery-related indicators and recovery situations,statistically significant difference was not found in the blood lost,duration of drainage tube and postoperative stay (P＞0.05),but was found in operation time (P＜0.05).And there was no significant difference in terms of surgical effects between two groups (P＞0.05).There were no complications such as hematoma,infection,capsular contracture in two groups.25 patients in observation group were performed B ultrasonic examination 6 months after operation.Multiple cysts were found at the cleavage in only 1 patient and were cured by suction.And the rest B ultrasonic results were negative for pathologic findings such as calcifications,cysts and masses.Conclusions Autologous fat transplantation is useful in minimizing the unaesthetic appearance of the cleavage and the bad feeling of the inframammary fold and thus a proper solution for the patient's breasts with thin soft tissue.

Analysis of nipple-areola blood supply in patients with breast hypertrophy and normal population / 中华整形外科杂志

Objective@#To explore the nipple-areola complex blood supply mode in hypertrophic breasts, and to obtain the pertinent knowledge of vascular anatomy for breast reduction surgery as well as the analysis of similarities and differences between hypertrophic and normal breasts. Comparing the blood supply of nipples-areola complex between these two groups for analyzing their similarities and differences.@*Methods@#Three dimensional reconstruction of the arteries in breast were performed in 50 patients between September 2015 and August 2017 with breast hypertrophy by computed tomographic angiography (CT angiography). The distribution pattern and the source direction of each main blood vessel was observed, counted and analyzed. Then, the data of breast hypertrophy patients were compared with the previous data about nipple-areola blood supply in normal population (the definition of main vessel: entering the breast gland or reaching the nipple-areola surrounding area, and diameter larger than 1 mm). Statistical description was taken for comparison.@*Results@#135 main vessels were observed in 100 breasts (50 patients). They mainly originate from the internal thoracic artery (69, 51.1%), lateral thoracic artery (37, 27.4%) and thoracoacromial artery(16, 11.9%), as well as a small amount from the brachial artery (7, 5.2%) and axillary artery(6, 4.4%). No main supply vessels from the posterior intercostal artery have been found. The patterns of breast blood supply varied among individuals, and high asymmetry ratio in the same individual was also observed. The internal superior (left: 30.7%, right: 34.2%) and superior lateral quadrant (Left: 29.2%, Right: 20%) of the breast was the most likely area for the main vessel to pass, followed by the breast lateral (Left: 16.9%, Right: 18.5%), lower inner (Left: 4.6%, Right: 5.7%), central (Left: 4.6%, Right: 4.2%), and superior (Left: 1.5%, Right: 2.8%). Differences existed in main vessels between normal breasts and hypertrophic breasts, either for source arteries or the distribution of breast. There was no main blood supply from the intercostal arteries or across the outer inferior quadrant.@*Conclusions@#The blood supply of the nipple-areola is not completely consistent between the hypertrophic breast and the normal size breast, and the blood supply pattern of the hypertrophic breasts is complex and diverse. CT angiography might be used before breast reduction surgery for clarifying the direction of the main vessels, so as to preserve more blood supply for nipple-areola, and to prevent nipple-areola necrosis.

Tongue flap combined with local mucosal flap for repairing palate fistulae / 中华医学美学美容杂志

Objective To introduce a modified surgical technique for repairing palate fistulae.Methods Based on the clinical categories of palate fistulae,local mucosal flap was designed,if possible,to reduce the area of the fistulae and reshape the fistulae.Then the thin tongue flap with anterior pedicle was designed for repairing the palate fistulae,without much limitation of tongue movement and excessive tension of tongue flap pedicle short lingual frenulum correction was performed firstly to release the motion of tongue,if necessary.The donor site was closed directly.Three weeks later division of the tongue flap,as well as detailed appearance correction of tongue,was carried out at the same time.Results 12 cases were treated,and followed up for 6-12 months.For all the cases,the defect of fistulae was totally repaired,while aesthetics appearance of tongue was satisfactory,and no interference with speech with the use of tongue as donor site.Oral hygiene and mastication were unimpaired.No patient described disability of sensory or gustatory postoperatively.Conclusions Tongue flap has sufficient blood supply,while impairment of donor site is minimal.The planning and procedure of surgery are relatively simple.It is an ideal flap in treatment of palate fistulae.

Clinical efficacy of superomedial pedicled mammaplasty based on Würinger's horizontal septum / 中华医学美学美容杂志

Objective To study the method and effect of superomedial pedicled mammaplasty based on Würinger's horizontal septum.Methods During August 2014 to August 2015,25 cases of cromastia were treated with septum-based mammaplasties with a superomedial pedicled and vertical incision.Based on the preoperation design,the superomedial pedicle was deepithelialized with preservation of the dermis and the subdermal plexus.The pedicle was dissected as described,the excess tissue was removed with the prepectoral fascia preserved.After remodeling the shape of mammary gland,the incision was sutured.Results There was no hematoma,no fat liquefaction and no partial or complete NAC necrosis.The pre and postoperative NAC sensibilities were comparable in all the patients.The patients were followed up for 6 to 12 months,and all the patients were satisfied with the therapeutic effect and expressed acceptance to the scar.Conclusions The breast reduction based on wellvascularized septum and superomedial pedicle is safe with minor scar,even in large breasts.This technique demonstrates ease of pedicle shaping and breast remodeling.The satisfied effect could be obtained for patients with severe ptosis of breasts just after operations and in future.

Protective effects of n-acetylcysteine against decabromodiphenyl ether-induced brain oxidative injury in mice / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To study the protective effects of N-acetylcysteine (NAC) against oxidative injury in the brain tissue of mice induced by decabromodiphenyl ether (PBDE-209) and the expression of mitogen activated protein kinase (MAPK)-related proteins in the hippocampus.</p><p><b>METHODS</b>Twenty-one male BALB/c mice were randomly divided into three groups with seven mice in each group: solvent control group, PBDE-209 group with gavage of 500 mg/kg PBDE-209, and PBDE-209 +NAC group which received intraperitoneal injection of 100 mg/kg NAC 0.5 h before exposure to PBDE-209. Mice were sacrificed 6 weeks after exposure. Malondialdehyde (MDA) level, superoxide dismutase (SOD) activity, and glutathione (GSH) level in the cerebral cortex, hippocampus, cerebellum, and striatum, as well as the protein expression of extracellular signal-regulated kinase (ERK), phosphorylated ERK (p-ERK), p38 MAPK (p38), and phosphorylated p38 (p-p38) in the hippocampus, were determined by Western blot.</p><p><b>RESULTS</b>Compared with the hippocampal and cerebellar levels of MDA in control group [(4.91±1.60) and (2.42±1.41) nmol/mg pro] and PBDE-209+NAC group [(6.16±1.03) and (2.83±0.85) nmol/mg pro], the MDA levels in PBDE-209 group [(12.12±6.39) and (4.24±1.15) nmol/mg pro] were significantly increased (P < 0.05). The striatum MDA level in PBDE-209 group [(12.92±4.30) nmol/mg pro] was significantly increased as compared with that of the control group [(4.05±2.23) nmol/mg pro] (P < 0.05). The hippocampal SOD activity of PBDE-209 group [(59.29±37.09) U/mg pro] was reduced significantly as compared with those of the control group [(93.28±21.75) U/mg pro] and PBDE-209+NAC group [(98.92±21.54) U/mgpro] (P < 0.05). The GSH levels in the cerebral cortex, striatum, and cerebellum in PBDE-209 group [(40.98±13.19), (24.46±11.30), and (3.55±1.55) mg GSH/g pro] were significantly reduced as compared with those of the control group [(75.79±26.51), (44.52±13.15) and (8.01±3.23) mg GSH/g pro] and the PBDE-209+NAC group [(89.86±28.39), (39.01±9.05) and (10.34±2.58) mg GSH/g pro] (P < 0.05). Western blot results showed that the ratios of p-p38/p38 and p-ERK/ERK in the hippocampus were significantly higher in the PBDE-209 group than in the control group and PBDE-209+NAC group (P < 0.05).</p><p><b>CONCLUSION</b>Antioxidant NAC has a protective effect against PBDE-209-induced brain injury in mice to some extent, and reduces the expression of MAPK-related proteins.</p>

Soft tissue repair of large defects of lower limbs with deep inferior epigastric perforator flap / 中华显微外科杂志

Objective To study the method and effect of deep inferior epigastric perforator flap(DIEP)in repairing the large defects of lower limbs.Methods Eight cases,from July 2009 to November 2011,including 3 cases of plantar skin defects with bone exposure after foot injuries,three cases of plate exposure after tibia fracture surgery and 2 cases of heel repeated ulceration after skin graft,were repaired by deep inferior epigastric perforator flap.Results All deep inferior epigastric perforator flaps survived with good functions,except 1 case whose distal with poor blood supply and the flap survived after treatmenting,three cases of flap bloated with good appearances after second operation.Conclusion DIEP is a proper option for repair of large defects of lower limbs.It has the advantages of abundant blood supply,large flap area,abdomen can suturing without abdominal complications.

Expression of DLC1 mRNA and protein in breast carcinoma and non-cancerous breast tissues and its relationship with Ki-67 / 临床与实验病理学杂志

Purpose To investigate the expression of DLC1 and its relationship with Ki-67 in cancerous and non-cancerous tissues of the breast.Methods In situ hybridization and immunohistochemiscal EnVision method were used to detect the expression of DLC1 mRNA and protein and Ki-67 in 52 invasive breast ductal carcinomas and 42 non-cancerous mammary tissues, including 22 mammary fibroadenomas and 20 paracancerous tissues.Results The positive rates of DLC1 mRNA and protein expression in the breast carcinomas (50% and 57.7%) was significantly lower than that in the non-cancerous mammary tissues (90.5% and 92.9%) (χ~2=17.518 and 10.729,P＜0.01).The expression of DLC1-mRNA was positively related to DLC1protein (r_s=0.379,P＜0.01). The positive rate of Ki-67 expression was 61.5% in the breast carcinomas, but no expression was observed in the all non-cancerous tissues (χ~2=39.186,P＜0.01).Correlation analysis showed that DLC1 expression was negatively correlated with Ki-67 expression (r_s=-0.507,P＜0.01).Conclusions Lower or no expression of DLC1 mRNA and protein may play an important role in the pathogenesis and progression in breast carcinoma. DLC1 may inhibit the proliferation of the breast carcinoma cells,which indicates that it may act as a new molecular marker of breast carcinoma.Combining detection of DLC1 and Ki-67 may be useful parameters for evaluating the biological behaviors of breast carcinoma.

Clinicopathologic features and diagnosis of metastatic carcinoma to the spleen / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features and diagnosis of metastatic carcinoma to the spleen (MCS).</p><p><b>METHODS</b>Four patients (1 man and 3 women, mean age 43.5 years) with MCS were analyzed clinicopathologically.</p><p><b>RESULTS</b>The four MCS patients accounted for 1.3% of 308 patients having spleen biopsy from 1959 to 1999. Their chief presentations were pain and mass in the left upper quadrant of the abdomen. The mass was located in the upper pole of the spleen (1 patient), the lower pole of the spleen (2), or the lower pole and hilum of the spleen (1). Macroscopically, all of the lesions were nodular. Histologic type of these MCSs included acinar cell carcinoma of the pancreas (2 patients), transverse colon adenocarcinoma (1), and hepatic cell carcinoma (1). Clinically, 1 patient was diagnosed as having MCS and 3 were misdiagnosed. According to Chinese literature, the clinicopathologic features of MCS were as follows: (1) 66.7% of the patients with MCS were aged 30 approximately 60 years, with a mean of 51.2 years. (2) 76.3% of the patients presented with pain in the left upper quadrant of the abdomen and 63.2% with splenomegaly and splenic masses. (3) Macroscopically, nodular lesions accounted for 68.4%. (4) Microscopically, 84.2% of the lesions were adenocarcinomas and 70.3% originated from carcinomas of the colon, liver, ovary and pancreas. (5) B-mode ultrasonography and/or CT showed occupying lesions or masses in the spleen in 76.7%, and MCS in 11.8%. (6) Clinically, 73.7% of the patients were misdiagnosed.</p><p><b>CONCLUSIONS</b>MCS is uncommon but its clinical misdiagnosis rate is high. Image examination is of value in clinical diagnosis. Cooperation of clinicians and pathologists may enhance the diagnostic level of MCS.</p>

Current status of and reflection on clinicopathologic autopsy / 中华医院管理杂志

In the last decade, the rate of clinicopathologic autopsies has dropped markedly whereas the rate of forensic pathologic autopsies performed as a result of medical disputes has risen by a big margin. In view of this, the authors analyze the causes and put forward appropriate measures. First of all, it is imperative for relevant departments of medical administration to attach importance to the issue and to strengthen legal system building. Next, it is important to pay attention to the development of the specialty of pathology and the cultivation of pathology personnel, improve the conditions for autopsies and bring the initiative of pathologists into full play. Thirdly, it is necessary to reinforce the spread of knowledge and education and be patient in making matters clear to the relatives of the dead.