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.

Acetabulum ; injuries ; surgery ; Fractures, Bone ; surgery ; Humans

Objective To observe the effect applicated of endoscopic sinus joint laryngoscope in laryngeal microsurgery.Methods 68 patients with laryngeal lesions were randomly divided into the multi-mirror combination group (34 cases) and the single laryngoscope group (34 cases).The multi-mirror combination group was taken with laryngeal microsurgery under endoscopic Joint laryngoscope.The single laryngoscope group was only taken with laryngeal microsurgery under laryngoscope.The efficacy and surgical situation of the two groups were compared.Results The total effective rate of the multi-mirror combination group was 97.06％,which was significantly higher than that of the single-laryngoscope group (85.30％) (x2 =4.031,P ＜ 0.05).Compared with the case of surgery and complications and recurrence rate,the multi-mirror combination group was superior to the single laryngoscope group (all P ＜ 0.05).Conclusion The endoscopic joint laryngoscope has the function of expanding the scope of the operative field and increasing the focus and clarity,and also has the advantages of small traumatic for patients,fewer complications,low recurrence rate,easy operation and high accuracy.

P-selectin is also known as CD62. It promotes the occurrence of ischemic cerebrovascular disease by mediating the activation of endothelial cells and platelets as well as the processes of the formation and development of atherogenesis. A number of studies have confirmed that P-selectin plays important roles in the occurrence and development of the risk factors (such as hypertension, diabetes, hypercholesterolemia, heart disease, smoking, alcohol abuse and hyperfibrinogenemia) for ischemic cerebrovascular disease. It remains to be confirmed by further studies whether P-selectin can be used as an independent risk factor for predicting the occurrence of ischemic cerebrovascular disease.

Objective To investigate the effects of mediastinal block(MB)on coronary atherogenesis and hemodynamics in rabbits with hyperlipoidemia.Methods Forty-eight male New Zealand white rabbits were randomly divided into 4 groups(n=12 each):control group received normal diet 150 g/d for 16 weeks,hypercholesterol group received hypercholesterol diet 150 g/d for 16 weeks,thoracic epidurial block(TEB)group received hypercholesterol diet 150 g/d for 16 weeks and TEB was performed from 13th to 16th week with 2% lidocaine 2 mg/kg twice a day,and MB group received hypercholesterol diet 150 g/d for 16 weeks and MB was performed from 13th to 16th week with 2% lidocaine 2 mg/kg twice a day.MAP was measured before and after 1st block was performed.The serum levels of total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-C)were measured on 1st day,and on4th,6th,8th and 16th week during the experiment.At the end of 16 th week,all rabbits were killed by air embolism.Heart was removed and kept in 10% formalin for a week.The ventricles were transversely sectioned at the level of papillary muscle and slices from the cross section of the ventricles were obtained for determination of the degree of atherosclerosis by microscopy.Results MAP was decreased significandy after TEB in TEB group,while there was no significant changes in MAP after MB in MB group(P＜0.05).The serum levels of TC,TG and LDL-C were significandy higher in hypercholesterol.TEB and MB groups than in control group(P＜0.05 or 0.01).The ratios of atherogenesis and intimal thickening were significantly lower in TEB and MB groups than in hyperoholesterol group(P＜0.01),there was no significant difference between TEB and MB groups.Conclusion Mediastinal block can inhibit the development of coronary atherogenesis in rabbits with hyperlipoidemia to a great degree similar to that of thoracic epidural block,but has no effect on hemodynamics.

OBJECTIVETo analyze the asymmetry of measurements in facial asymmetry patients with skull positioning posterior-anterior radiographs after orthodontic-orthognathic treatment.

METHODSPosterior-anterior cephalometric radiography and cephalometric analysis were performed in forty-five patients with different degrees of facial asymmetry. A single sample t-test was conducted to compare the asymmetry of measurements before treatment and individual normal occlusion. The measurement and reference values in facial asymmetry patients who underwent orthodontic-orthognathic treatment were summated by analyzing the correlation coefficient. The paired t-test was employed to compare the difference between the two groups before and after the treatment.

RESULTSFourteen measurements were significantly different before the treatment and individual normal occlusion (P < 0.05). Me[X] exhibited a higher correlation index of Ag[X] in forty-five cases. Twenty-eight patients showed the main asymmetry in the mandibular body, whereas fifteen patients in the ramus. Two patients showed the main asymmetry in both mandibular body and ramus. Fifteen measurements were significantly different before and after the treatment (P < 0.05).

CONCLUSIONFacial asymmetry is mainly concentrated in one-third of the surface, primarily manifested in the mandibular body. Orthodontic-orthognathic treatment is preferred when Ag[X] is greater than the minimum reference value of 11.31%, Go[X] is greater than 9.79%, and Me[X] is greater than 5.2 mm.

Objective To observe the clinical effect by using insulin detemir therapy in children and adolescents with type 1 diabetes mellitus(T1DM).Methods Thirty children and adolescents with T1DM were divided into 2 groups to receive Humulin R and Determir(observation group,n =15) or Humulin R and neutral protamine hagedorn (NPH) (control group,n =15)insulin therapy.Daily insulin dose,glycemic variability,incidence of non-severe and severe hypoglycemia events after the institution of insulin therapy were collected.Results The daily doses of insulin were (1.16 ± 0.30) U/kg in the observation group and(1.21 ± 0.35) U/kg in the control group,respectively.There was no clinically important change between 2 groups(t =0.526,P ＞ 0.05).Within-subject variation in fasting plasma glucose was significantly lower in observation group(29％)than that in control group(65％) (t =5.296,P ＜0.01).One case of severe hypoglycemia event occurred in the observation group,but 5 cases occurred in the control group(t =4.863,P ＜ 0.0l).Two cases of nocturnal hypoglycaemia(22:00-7:00) events occurred in the observation group,7 cases occurred in the control group(t =4.506,P ＜ 0.01).Conclusions Institution of insulin detemir therapy is associated with low within-subject variation in fasting plasma glucose and decreased rates of severe and nocturnal hypoglycemia while dose of insulin did not increase.This makes insulin detemir a valuable new tool for the treatment of children and adolescents with T1 DM.

Objective To investigate MSCT findings of hepatic focal nodular hyperplasia(FNH),and improve its diagnostic value. MethodsThree-phasia MSCT scans of 16 cases with FNH confirmed by pathology were reviewed retrospectively. ResultsThere was single in 13 cases,double in 3 cases.17 lesions is hypodensity and 3 lesions is isodensity on plain MSCT.During MSCT enhancement all lesions were markedly and homogeneously enhanced in arterial phase.isodensity in portal and delay plase.1 lesion found scar. ConclusionDynamic contrast-emhanced MSCT could show the charcteristics of FNH.

Objective To retrospectively compare the clinical results of locking plate of proximal humerus (LPPH) and traditional AO plates in treatment of proximal humerus fractures in aged osteoporotic population. Methods From July 2002 to May 2005, 37 old osteoporotic patients with humerus fractures were treated with LPPH and traditional AO plates respectively in our department. The results were compared retrospectively. Results Follow-ups were conducted six weeks, 12 weeks and one year postoperatively to assess shoulder scores, bone healing and necrosis of humerus head. Comparison showed that the results for LPPH group were statistically better than those for traditional AO plate group in rate of implant loosening and SPADI (shoulder pain and disability index) scores. Conclusion LPPH has an obvious advantage over traditional AO plate in treatment of proximal humerus fractures in aged osteoporotic people.