Objective To explore a surgical procedure of reduction mammary plasty to assure the viability and sensory of the nipple-areolar complex (NAC) after transposition and to keep the lactiferous function partly. Methods Reduction was accomplished by using perforating vascular branches from the pectoralis major muscle and its fascia supplying the nipple and breast parenchyma instead of the subdermal plexus. The central vascular pedicle supplying the nipple-areola complex was preserved. And the sensory nerve of the NAC was not injured. The erection of the nipple could be observed in operation. Lactation was possible because of preservation of the lactiferous ducts. The technique had been used in 17 patients since 1996. Results The nipple-areola complex was safely transposed with great freedom, and the amount of resection was accurately adjusted for symmetry. No cases of nipple-areola complex sensory change occurred postoperatively in all 17 patients. Breast-feeding was possible at least in one patient after operation. Conclusion This method is ideal for the patients, which keeps the viability and sensory of the nipple-areolar complex and the function of lactation. In another case, the amount of resection is easily adjusted for symmetry.

Objective To create a stable and reliable model for cerebral ischemia.Methods (1)Distal middle cerebral artery occlusion (dMCAO) model: SD rats of 270-350 g in weight were anesthetized using isoflurane.Both common carotid arteries (CCA) were exposed and occluded for 30 min.Via a bone window between the left eye and ear, the exposed left middle cerebral artery was cauterized and cut during bilateral CCA occlusion.(2) Evaluation of the model: microPET study was performed at 10 h after surgery.microMRI scan were done at 24 h.TTC staining were done at 48 h.Behavioral tests, including vibrissaeelicited forelimb placement test, were done from day 2 to 60 after surgery.Tissue damage was evaluated using cresyl-violet staining Mortality was also observed.Results Infarction areas were 54.50% ± 3.15%(95% CI:49.49-59.51 ) using microPET scanning, 45.30% ± 2.35% (95% CI:42.94-47.86) using microMRI scanning, 43.39% ± 2.33% (95% CI:40.94-45.84)using TTC staining, and 30.10% ±2.22% (95% CI:28.05-32.15) using CV staining.The behavioral test scores were lower in the ischemic group than in the sham control group.This dMCAO model was successfully performed in all rats, and the mortality rate was 0.Conclusions Our results suggest that permanent dMCAO plus bilateral CCA occlusion for 30 min can produce a stable and reliable model suitable for research on cerebral ischemia.

Objective To develop the state-owned enterprise worker's stressor scale and assess its reliability and validity.Methods Combined qualitative and quantitive methods,the state-owned enterprise worker's stressor scale was developed based deep interviews.Data were collected from 6400 state-owned enterprise workers in China.The initial sample was split randomly into two samples (n 1 =2835 ; n 2 =2834).The first data were used to set for exploratory factor analysis (EFA) and the second data were used for confirmatory factor analysis (CFA).3 subscales (anxiety,depression and somatization) of symptom checklist 90(SCL-90) were used for testing criterion validity.Results The state-owned enterprise worker's stressor scale got 4 factors and 15 items,including job stressor,relationship stressor,development stressor and family stressor.The Cronbach α coefficients of the full scale and its four factors were 0.66 ～ 0.86.The results of CFA showed RMSEA =0.066,NFI =0.97,NNFI =0.97,CFI =0.97,IFI =0.97,GFI =0.95.In addition,stressor and its four factors had significant positive correlations with anxiety,depression and somatization (r =0.29-0.43,P ＜ 0.01).Conclusion The stateowned enterprise worker's stressor scale meets psychometric criteria and is an effective tool.

Objective To study the clinicopathological and immunophenotypical features of gastrointestinal stromal tumor (GIST). Methods A SP Immunohistochemical method was selected to detect the 71 cases of GIST for a panel of antibodies CD117, CD34, Vim, Act, S-100. Results The patient's ages ranged from 21 years to 86 years (mean 55 years) including 34 male and 37 female. Most cases were diagnosed by bellyache and alimentary tract bleeding. Tumor size varied from 0.3 cm to 23 cm (mean 5.8 cm). GIST were composed of spindle cells and (or) epithelioid cells. Various sized eosinophilic globules were observed between the tumor cells and were designated as skeinoid fibers. The positive rate by immunohistochemical methods for CD117 and CD34 were 94.4 % and 73.2 % respectively. Conclusion GIST predominantly occurred in middle aged or older patients over 40 years. The histological characters are similar to smooth muscle tumor and schwannoma. CD117 and CD34 are more specific and sensitive markers. GIST may have been derived from interstitial cell of cajal or show differentiation toward interstitial cell of Cajal.

Objective To investigate the relationship between apparent diffusion coefficient (ADC)value of rectal adenocarcinoma on DWI and its pathological grading.Methods The ADC values of 46 rectal adenocarcinomas were measured and compared with their histopathological grades.Results The 46 rectal adenocarcinomas included well differentiated adenocarcinomas in 14,moderate-ly differentiated ones in 20,and poorly differentiated ones in 12.The ADC values of well,moderately and poorly differentiated ade-nocarcinomas were (1.125±0.103)×10 -3 mm2/s,(1.030±0.098)×10 -3 mm2/s and (0.922±0.091)×10 -3 mm2/s,respective-ly,exhibiting a statistical difference (χ2 =1 7.35 1,P =0.000).Mann-Whitney U test showed that difference in ADC value between different histopathological grades was statistically significant.Conclusion ADC value of rectal adenocarcinoma can be used as a bio-marker for cell grading to guide treatment decision and prognosis assessment.

BACKGROUND:Extraction methods of human amniotic mesenchymal stem cells are inconsistent in the number of cells.
OBJECTIVE:To explore the optimal method to in vitro isolate and culture human amniotic mesenchymal stem cells.
METHODS:Under sterile conditions, ful-term cesarean fetal amniotic membrane was cut into pieces, then to isolate human amniotic mesenchymal stem cells by seven methods in four experiments. In experiment 1, human amniotic mesenchymal stem cells were isolated by the fol owing three methods:(1) 0.05 g/L trypsin digestion for 10 minutes fol owed by 0.75 g/L col agenase digestion for 60 minutes;(2) 0.75 g/L col agenase I for 120 minutes;(3) co-digestion with 0.05 g/L trypsin and 0.75 g/L col agenase for 60 minutes. In experiment 2, the samples were digested with 0.05 g/L trypsin digestion for 30 minutes fol owed by 0.75 g/L col agenase digestion for 30 minutes. In experiment 3, the samples were digested by two methods:(1) 0.05 g/L trypsin digestion for 30 minutes×2, fol owed by 0.75 g/L col agenase digestion for 60 minutes;(2) 0.05 g/L trypsin digestion for 40 minutes×2, fol owed by 0.75 g/L col agenase digestion for 60 minutes. In experiment 4, the samples were digested with 0.05 g/L trypsin digestion for 30 minutes×2, fol owed by 1 g/L col agenase digestion for 60 minutes. Fol owing morphology observation under a microscope, we studied the most suitable method for isolating human amniotic mesenchymal stem cells.
RESULTS AND CONCLUSION:Digestion with 0.05 g/L trypsin for 30 minutes twice fol owed by 1 g/L of col agenase digestion of 60 minutes was the most suitable isolation and culture condition in vitro. cells became elongated fusiform or star-shaped with rich cytoplasm, and nuclei were round with 1-3 nuts. We can harvest the most number of human amniotic mesenchymal stem cells using the method described in experiment 4.

Objective: To analyze the clinical features and outcomes of cardiac resynchronization therapy (CRT) in patients with dilated-phase hypertrophic cardiomyopathy (DHCM). Methods: A total of 16 DHCM patients received CRT in our hospital from 2007-03 to 2016-01 were retrospectively studied to analyze their clinical features and outcomes. Results: There were 12 male and 4 female patients at the mean age of (53.3±13.5) years. Pre-operative QRS duration of ECG was (158.7±32.2) ms, left ventricular ejection fraction (LVEF) was (33.6±6.3) %, the patient with NYHA class I, II, III and IV were 1, 5, 8 and 2 respectively. 13 patients received new CRT device, 3 received upgraded device and 8 (50%) combining atrial fibrillation (AF). The patients were followed-up for (2.56±2.13) years, 5 of them died including 3 of heart failure, 1 of sudden death and 1 of stroke. At 6 months follow-up time, 7 patients had the response to CRT which was defined by the improvement of NYHA class≥1 and the absolute elevation of LVEF≥5%; NYHA class improved from (2.69±0.79) to (2.38±0.89), P=0.02; LVEF increased from (33.6±6.3) % to (40.03±9.83) %, P=0.01. Conclusion: DHCM patients with CRT indication had the higher incidence to suffer from AF, those were more in patients with traditional pacemaker or ICD upgrading. DHCM patients with CRT had the poor general prognosis, while there was still certain proportion of patients had the response to CRT.

Glucagon like peptide-1(GLP-1) is a category of peptide secreted by intestine. The finding of GLP-1 was originated from the observation of "Incretin" phenomenon in 1960s. Besides lowering plasma glucose, GLP-1 can protect pancreas,improve cardiovascular outcome,and play a role in regulating appetite,as well as lower body weight. Given that food intake regulation mechanism modulated by GLP-1 remains uncertain,it is postulated that the central nervous system has played a vital role in this mechanism. In the present review,we focused on the following aspects about central nervous system's role in GLP-1's regulation of appetite:(1)The brain nuclei related to appetite regulation;(2) The brain nuclei related to blood glucose regulation; (3) The brain nuclei related to food intake reward behavior;(4) the role of food-related peptides and GLP-1;(5) How the GLP-1 receptor expression nuclei regulates the food intake.

Objective To investigate the relationships between the apolipoprotein E (ApoE) gene polymorphisms and both the location and size of cerebral infarction.Methods A case-control study was chosen; 162 cerebral infarction patients,admitted to our hospital from September 2011 to November 2012,and 120 normal controls were chosen; their blood samples were detected by multiple polymerase chain reaction-ligase detection reaction (PCR-LDR) to analyze the ApoE gene polymorphisms.Its differences of genotype distribution or allele frequencies in different locations of cerebral infarction were analyzed,and the relationships between allele frequencies and volume of cerebral infarction was analyzed.Results No significant difference was found either in ApoE genotype distributions or allele frenquencies between the cerebral infarction patients and controls (P＞0.05); the ApoE genotype distributions or allele frenquencies showed no significant difference among patients having different locations of cerebral infarction (P＞0.05).A significant difference was observed in the average infarction volume between E4/X carriers (the E4/3 and E4/4 genotype combination,[15.7±2.3] cm3) and E3/3 carries ([10.2±2.1] cm3) and E2/X carriers (the E2/2 and E2/3 genotype combination,[9.5± 1.8] cm3,P＜ 0.05); and the ratio of massive cerebral infarction of E4/X carriers (56％) was significantly higher than E3/3 or E2/X carriers (26.3％,P＜0.05).Conclusions There is no correlation between ApoE genotype polymorphisms and cerebral infarction location; however it may be associated with infarction volume.The E4/X carriers are more prone to massive cerebral infarction,and its volume is larger than that of E2 and E3.

Objective:To analyze the patterns of antibacterial agents in Chinese children surveyed by the China multi-center monitoring network for the application of antibacterial agents in children and neonates in 2019 by using World Health Organization (WHO) Access, Watch, Reserve and Not-recommended (AWaRe) and typical anatomical/therapeutic/chemical (ATC) in this study.Methods:The cross-sectional method was adopted.A multi-center cross-sectional survey was conducted on one day from September to December 2019.The information of all inpatients taking antibiotics was uploaded to the network-based data collection system (https: //garpec-31.mobilemd.cn/login.aspx? relogin=true). This study covered 13 hospitals from 10 provinces and cities in China.All hospitalized children in the Respiratory Department, Infectious Disease Department, General Surgery Department, Pediatric Intensive Care Units, Neonatal Intensive Care Units and Neonatology joined in this survey.The clinically used antibacterial agents were classified by AWaRe and ATC, and the AWaRe and ATC distributions of antibacterial agents prescribed for Chinese children and neonates were described.Results:Of the 2 644 antibiotic prescriptions included from 13 hospitals, 2 134 (80.71%) were for children and 510 (19.29%) were for neonates.Of all antibiotic prescriptions, there were 368 (13.92%) Access antibiotics prescriptions, 1 973 (74.62%) Watch prescriptions, 60 (2.27%) Reserve prescriptions and 243 (9.19%) Not-recommended prescriptions.The top-five antibiotics prescribed for children and neonates were third-generation cephalosporins (1 056, 39.94%), macrolides (492, 18.61%), carbapenems (275, 10.40%), beta lactam-beta lactamase inhibitors (246, 9.30%), and second-generation cephalosporins (136, 5.14%). The use ratios of Access, Watch, Reserve and Not-recommended antibiotics in each center ranged from 0 to 30.00%, 36.67% to 97.20%, 0 to 17.02% and 0 to 33.33%, respectively.In 1 360 antibiotic prescriptions for children and neonates with pneumonia, there were 152 (11.18%) Access antibiotics, 1 051 (77.28%) Watch antibiotics, 37 (2.72%) Reserve antibiotics, and 120 (8.82%) Not-recommended antibiotics.The top-five antibiotics prescribed for children with pneumonia were third-generation cephalosporins (522, 38.38%), macrolides (388, 28.53%), beta lactam-beta lactamase inhibitors (141, 10.37%), carbapenems (117, 8.6%) and penicillins (49, 3.60%).Conclusions:Watch antibiotics and broad spectrum antibiotics such as third-generation cephalosporins and macrolides prone to induce resistance are the main antibacterial agents used in Chinese children and neonates with pneumonia.Broad-spectrum antibiotics may be overused in Chinese children and neonates.