Nipple-areola complex (NAC)-sparing mastectomies (NSM) have gained acceptance in the ifeld of breast oncology. The superior aesthetic outcomes of NSM explain their increased use and rising popularity. Technical considerations and challenges of this procedure are centered on nipple ischemia and necrosis. Patient selection, reconstructive strategies and incision placement have lowered ischemic complication rates. An understanding of the NAC vascular anatomy is, therefore, clinically relevant beyond NSM. In this paper, the relevant clinical anatomy is described, mainly focusing on the anatomy of the NAC. This article also covers how to identify and classify the in vivo blood supply to the NAC using breast MRI exams which provide valuable information for assessing vascular anatomy of the NAC. This includes the arterial iflling phase, venous drainage phase and 3-dimensional reconstructed maximum intensity projection (MIP) images. Finally, the indocyanine green (ICG) and a specialized infrared camera-computer system provide surgeons with a practical tool to assess real-time breast skin and NAC perfusion. Intraoperative evaluation of skin perfusion allows surgeons to detect ischemia and modify the operative approach to reduce the risk of nipple ischemia and necrosis.

Breast cancer is a type of heterogenetic neoplasm.Metabolic dysfunction plays a pivotal role in the pathogenesis and progress of breast cancer.N-3 polyunsaturated fatty acid (PUFA) could change fatty acid metabolism of breast cancer cells and modulate expression of oncogenes and anti-oncogenes through various ways.It may provide therapeutic opportunities in the treatment of chemotherapy,radiotherapy,endocrine therapy and molecule targeted therapy of breast cancer.

Urine samples from diabetic and healthy subjects were detected by H4 protein chip and surface-enhanced laser desorption/ionization time of flight mass spectrometry (SELDI-TOF-MS).Some significantly differential proteins between diabetic and controls were found.Four top-scored protein peaks were finally selected as the potential "fingerprints" for detection of early diabetic nephropathy by artificial neural network (ANN) classifier.

This paper summarized perioperative nursing care of three patients undergoing surgical tumor resection and anterolateral femoral skin flap repair,with tumors involving intra-and extra-cranial regions from scalp squamous cell carcinoma breaking through the skull directly into the brain. Three surgical procedures were successfully per-formed by cooperation between two surgical departments and the average duration was 7 hours. The effective preop-erative infection control,perfect surgical plan,intraoperative team collaboration,effective aseptic technique and tumor-free technique were key points for the success of the operations. Close postoperative observation and positive psy-chological nursing also guaranteed operation success.

Objective To evaluate the effect of sevoflurane preconditioning on the expression of heat shock protein 70 (HSP70) during renal ischemia-reperfusion in rats.Methods Twenty-four pathogen-free healthy adult male Sprague-Dawley rats,weighing 250-300 g,aged 2-3 months,were divided into 3 groups (n=8 each) using a random number table:sham operation group (group S),renal I/R group (group I/R) and sevoflurane preconditioning group (group SP).The animals were anesthetized with 2％ pentobarbital sodium 50 mg/kg.After the right kidney was removed,the left renal artery was clamped for 45 min followed by 2 h reperfusion to establish the model of renal I/R injury.In group SP,2.2％ sevoflurane was inhaled for 1 h followed by 10-min washout before the model was established.The animals were sacrificed at the end of rcpcrfusion,and kidneys were then removed for determination of the expression of HSP70 (by immunohistochemistry) and malondialdehyde (MDA) content in renal tissues (by thiobarbituric acid colorimetric method).Results Compared with group S,the expression of HSP70 in renal tissues was significantly up-regulated,and the MDA content in renal tissues was increased in t/R and SP groups (P＜0.05).Compared with group I/R,the expression of HSP70 in renal tissues was significantly up-regulated,and the MDA content in renal tissues was decreased in group SP (P＜0.05).Conclusion The mechanism by which sevoflurane preconditioning reduces renal I/R injury is related to up-regulation of HSP70 expression in rats.

Objective To investigate the effects of dipeptidyl peptidase 4(DPP-4) inhibitor on serum adiponectin (APN) and high sensitivity C-reactive protein (hs-CRP) in patients with type 2 diabetes mellitus.Methods 45 cases were type 2 diabetes were collected from department of endocrinology,wuxi second People's hospital of jiangsu province from January 2015 to April 2015.45 patients with type 2 diabetes mellitus were randomly divided into treatment group (n=23) and control group (n =22) , treatment group was treated with metformin combined with DPP-4 inhibitor and control group was treated without DPP-4 inhibitor.Before and after treatment,fasting plsma glucose(FPG),postprandial 2h glucose(2hPG),adiponectin, hs-CRP and homeostasis model assessment for insulin resistance(HOMA-IR) were measured.Results Adiponectin was significantly higher in treatment group than before(P<0.05),FPG,2hPG,hs-CRP and HOMA-IR were significantly lower than before(P<0.05).Adiponectin in treatment group was significantly higher than control group post-treatment(P<0.05).2hPG,hs-CRP and HOMA-IR in treatment group were siginificantly lower than control group post-treatment (P<0.05).Conclusion DPP-4 inhibitor could improve insulin resistance in type 2 diabetes mellitus by increasing serum adiponectin and decreasing serum Hs-CRP and HOMA-IR.

Objective To evaluate the common traditional Chinese medicine syndrome types, therapies and formulas of the wind of four fossae. This will provide reference for the formulation of the guideline for the diagnosis and treatment of traditional Chinese medicine in the wind of four fossae. Methods Delphi method using questionnaires were developed based on literature about TCM syndromes and treatment of the wind of four fossae. The questionnaire were sent to 25 experts nationwide for 2 rounds. The database of the collected data was established. The mean, full score ratio, rank sum and coefficient of variation were described and by SAS 6.12 statistical software. Results A total of 21 valid questionnaires were recovered in the first round and 23 valid questionnaires in the second round. The active coefficient of the experts was 84% and 92%, respectively. The results showed that syndromes of newborn heat, damp heat retention, spleen deficiency and blood dryness, wind dampness accumulating skin, blood deficiency and wind dryness demonstrated high concensus. The consistency scores' mean of 5 syndromes were 1.67, 1.90, 1.83, 1.71 and 1.90. The sum of degrees of 5 syndromes were 37, 40, 42, 36 and 40. The ratio of full scores of 5 syndromes were 0.81, 0.90, 0.87, 0.71 and 0.90. The coefficient of variations of 5 syndromes were 0.32, 0.16, 0.27, 0.27 and 0.16. The therapy of syndrome of newborn heat was clearing away the heart-fire and inducing diuresis by the sanxin daochi decoction; The therapy of syndrome of damp heat retention was clearing heat and removing dampness by longdan xiegan decoction; The therapy of syndrome of wind dampness accumulating skin was dispelling wind and eliminating dampness by xiaofeng san; The therapy of syndrome of spleen deficiency and blood dryness was enriching blood and moistening dryness by danggui decoction; The therapy of syndrome of blood deficiency and wind dryness was replenishing qi to invigorate the spleen and enriching blood to calm endogenous wind by shenling baizhu power and danggui decoction. Conclusion Questionnaire survey could quantify the opinions of experts, and provide reference for the establishment of guideline for the diagnosis and treatment of traditional Chinese medicine in the wind of four fossae.

Using the polymmerse chain reaction (PCR), we amplified the phytase gene phyA from Pichia pastoris GS115-phyA in Aspergillus niger NRRL3135 without the signal peptide sequence and intron sequence,. Then, it was cloned into pINA1297 vector to generate a recombinant vector of pINA1297-phyA. pINA1297-phyA was linearized and transformed into Yarrowia lipolytica po1h by the lithium acetate method. The positive transformants were obtained by YNB(casa) and PPB plates, after induced in YM medium at 28 degrees C for 6 day. The activity of the expressed phytase phyA reached 636.23 U/mL. The molecular weight of the enzyme was 130 kDa measured with SDS-PAGE analysis, whereas its molecular size reduced to 51 kDa after deglycosylation which is correspond with theoretical value. The enzymatic analysis of the recombinant phytase phyA revealed its optimal pH and temperature was 5.5 and 55 degrees C, which had high activity after incubated in pH ranged from 2.0 to 8.0 for 1 h. Moreover, its activity remained 86.08% after exposure to 90 degrees C for 10 min. It also was resistant to pepsin or trypsin treatment.
6-Phytase ; biosynthesis ; genetics ; Aspergillus niger ; genetics ; metabolism ; Pichia ; enzymology ; genetics ; Recombinant Proteins ; biosynthesis ; genetics ; Yarrowia ; genetics ; metabolism

Objective To investigate the proper procedure for repairing different urethrocutaneous fistulas after primary urethroplasty for hypospadias.Method There were 101 cases,whose age ranged from 27 months to 171 months (mean 61 months),underwent urethrocutaneous fistula repairing secondary to the primary hypospadiasis urethroplasty from January 2010 to December 2015.The methods of the repairing were chosen mainly on the site and the size of the fistula,which included three types.The coronal fistula with a thin band of tissue stretching between the glans wings was classified as type Ⅰ (n =24).For the rest of the small fistulas at penis coronal ditch and penis body,the small fistula (diameter ＜ 3 mm) was classified as type Ⅱ (n =57) and the large fistula (diameter ≥3 mm) was classified as type Ⅲ(n =30).The urethroplasty was performed in the type Ⅰ cases.The ligation and transfixion was performed in type lⅡ cases.And the tension free repairing with continuous suture was performed in type Ⅲ cases.De-epithelization dartos fascia flap or tunica vaginalis flap covering was performed in all cases.After removing the catheter,all cases were followed-up at least 1 year.The successive operation was termed as no complication,such as urethral stricture,urethral diverticulum and urethrocutaneous fistula.Result Totally 111 fistulas were repaired by the methods described above.The mean followed-up duration was 32 months (ranging 12-48months).Total recurrence of fistula was 11.7％ (13/111) in different type fistulas,including 16.7％(4/24) in type Ⅰ,3.5％ (2/57) in type Ⅱ and 23.3％ (7/30) in type 1Ⅲ.Conclusions Different classification and treatment of urethrocutaneous fistula after urethroplasty by the site and size of fistula can improve the outcome of the operation.It is necessary to cover the tissue tightly to a new urethra during the operation.