Objective The vertical mammaplasty improves the breast morphology,and reduces the operative scar.However,the nipple-and-areola complex (NAC) has the risk of necrosis on those severe patients.In this report,we performed the vertical incision scar reduction mammaplasty based on Würinger's horizontal septum to reduce the NAC necrosis possibility.Methods Typical Lejour mosque-dome design was performed.The inferior part of glandular tissue and skin were excised.The NAC was elevated to normal position with medial-superior pedicle based on the horizontal septum.The breast morphology was modified with lateral and medial glandular pillar suturing using nonabsorbent thread.For reducing the vertical scar,the lower breast flap was thinned to induce the skin contraction.Results 27 patients with breast hypertrophy were operated from May 2009 to October 2012.1 patient had unilateral breast reduction,and 6 patients with 8 breasts had partial wound dehiscence.They were treated conservatively with topical dressings.No complete NAC necrosis occurred.Conclusions The vertical reduction mammaplasty based on Würinger's horizontal septum is a safe and effective approach,and the NAC necrosis possibility is reduced with this procedure.

OBJECTIVETo evaluate the therapeutic effect of pedicled muscular flaps combined with partial thoracotomy for treatment of pythorax-resulted wounds and defects.

METHODS35 cases with pythorax-resulted refractory infected wound and dead space, were retrospectively analyzed. The wound and dead space were eliminated with pedicled muscular flaps, including latissimus dorsi muscular flaps and serratus anterior muscle flaps in 21 patients, pectoralis major muscle flaps with rectus muscle flaps in 8 patients, latissimus dorsi muscul flaps and vertical rectus muscle flaps in other 6 patients.

RESULTS34 flaps survived completely except for 1 verticle rectus muscular flap with partial necrosis at distal end. Primary healing was achieved in 29 cases. The other 6 cases were discharged with drainage. Among the 6 cases, 3 cases healed spontaneously, 2 cases underwent reoperation, 1 case need long-term drainage in the fistula.

CONCLUSIONPedicled muscular flap, combined with partial thoracotomy can effectively treat refractory wound and dead space resulted by pythorax.

Combined Modality Therapy ; methods ; Empyema, Pleural ; surgery ; Humans ; Myocutaneous Flap ; transplantation ; Pectoralis Muscles ; transplantation ; Reoperation ; Retrospective Studies ; Superficial Back Muscles ; transplantation ; Thoracotomy ; methods ; Wound Healing

Objective To assess clinical features and treatment of angiosarcoma.Methods A retrospective study was carried out among seven patients hospitalized for angiosarcoma in the Department of Plastic Surgery,Zhongshan Hospital of Fudan University from January 2004 to March 2012.Clinical behaviors,therapeutic strategies and outcomes of angiosarcoma were analyzed in these patients.Results Of the seven patients,four were male,and three were female,with a median age of 67 years (range,37-77 years).Clinical presentations were various,including irregular ulcerous nodular masses in four patients,localized ulcer in one patient,and irregular erythematous nodules in two patients.All the patients were treated surgically with or without postoperative adjuvant therapy.Pathological examination revealed various degrees of differentiation and atypia of tumor cells,as well as obvious proliferation of endothelial cells,and all of these patients were diagnosed as angiosarcoma.Immunohistochemical analysis revealed a positive staining for CD31 and CD34.After surgical treatment,angiosarcoma recurred in four patients with the median time to the first recurrence being 3.5 months (range,1-6 months),cerebral metastasis occurred in one patient 5 months later,and two patients died.Conclusions Angiosarcoma is a rare and heterogeneous sarcoma with diverse clinical presentations.Local wide resection is the cornerstone of angiosarcoma treatment,and adjuvant therapy may improve its prognosis.

Objective To explore the application of standardized patients (SP) in practice course of diagnostics.Methods The two classes of 135 students majoring in clinical medicine were selected as research.After the practical course in inquiry,the questionnaires were used to compare the teaching effect between the traditional teaching and SP teaching.Meanwhile,the students evaluated and gave feedback on SP work.Results The questionnaires on teaching effect showed that 127 (94.8％) students believed that the SP teaching method could stimulate interest in inquiry,125 students (93.3％) thought it could increase the understanding and memory of the inquiry content.127 students (94.8％) thought it could improve the application ability of the inquiry method,128 students (95.5％) thought it could improve inquiry techniques,129 students (96.3％) thought it could enhance expression ability,89 students (66.4％) thought it could enhance cooperation with their classmates,117 students (87.3％) thought it could enhance the confidence in communication,115 students (85.8％) thought it could improve their ability in independent thinking and self-study,126 students (94.0％) thought it could improve the learning effect,117 (87.3％) students thought it could develop their clinical thinking ability,116 students (86.6％) thought it could improve the satisfaction to teaching form,111 students (82.8％) thought it could develop the ability to answer patients' problems in a manner which is easy for patients to understand,and 126 (94.0％) students thought it could improve the ability to interact with patients.All issues were significantly better than the traditional teaching method Compared with the traditional teaching method,the students' choices on various items have statistically significant differences (P＜0.05).Conclusion Applying SP teaching to the practice courses of diagnostics is helpful to improve the teaching effect and cultivate students' clinical thinking ability.Thus,it is a promising teaching method in medical undergraduate education and worthy of further discussion and popularization.

Objective To evaluate the influence of Danhong injection on endothelial progenitor cells ,inflammatory factor and neural function in patients with acute cerebral infarction .Methods 116 cases of patients with acute cerebral infarction in our hospi-tal from April 2016 to November 2016 were chosen for the research ,and were divided into research group (Danhong injection with routine treatment) and control group (routine treatment) ,the changes of endothelial progenitor cells ,neural function and inflamma-tory factors between two group were compared 30 d after treatment .Results Endothelial progenitor cells in peripheral blood be-tween two group had no statistically significant difference before treatment (P>0 .05) .After treatment ,endothelial progenitor cells of two group all increased ,and had a statistically significant difference compared with before (P< 0 .05) .Endothelial progenitor cells at 7 d ,14 d and 30 d after treatment of research group were higher than those of control group ,and the difference was statisti-cally significant (P< 0 .05) .NIHSS score before treatment between two group had no statistically significant difference (P>0 .05) .After treatment ,NIHSS score of two group all decreased ,and had statistically significant difference compared with before (P<0 .05) .NIHSS score at 7 d ,14 d and 30 d after treatment of research group were higher than those of control group ,and the difference was statistically significant (P<0 .05) .IL-6 and IL-10 levels before treatment between two group had no statistically sig-nificant difference (P>0 .05) .After treatment ,IL-6 and IL-10 levels of two group all decreased ,and had a statistically significant difference compared with before (P<0 .05) .IL-6 and IL-10 levels at 7 d and 14 d after treatment of research group were higher than those of control group ,and the difference was statistically significant (P<0 .05) .Conclusion Danhong injection could effec-tively improve the level of endothelial progenitor cells and inflammatory ,and promote the recovery of neural function .

Objective To introduce our experience about the breast reconstruction using latissimus dorsi (LD) flap combined with breast implant.The details of the operative method were prescribed.Methods During the LD mycutaneous breast reconstruction,the insertion of LD was cut off and rotated to fulfil ipsilateral axillary fossa.The breast reconstruction was performed using LD and breast implant.Results 237 cases of breast reconstruction were performed from 1998 to 2017.The axillary contour deformity was successfully restored.The results were satisfied and stable during the follow-up.Conclusions Using proximal LD flap to repair axillary fossa deformity is a safe,effective and easy operating method in LD and implant flap breast reconstruction.

Objective To explore the clinical outcomes of xenogenic acellular dermal matrix in immediate implant-based breast reconstruction following nipple/skin sparing mastectomy.Methods From January 2015 to June 2017,patients that underwent immediate implant-based breast reconstruction following nipple/skin-sparing mastectomy were retrospectively studied.Results 43 female patients with breast cancer were enrolled.A retrospective review was performed on patients that were reconstructed with either alloplastic reconstruction (group A,18 breasts) or xenogenic acellular matrix dermal (group B,25 groups).Differences in the average age,body mass index,numbers of diabetic patients,numbers of active smoker,and volume of implant between the two groups were not statistically significant (P＞0.05).All patients were followed up from 3 to 28 months,with the middle time of 18,7 months.Complications in both groups of patients were clinically recorded after operation.When comparing clinical outcomes,group A had fewer drain (523.17±62.18) ml vs (639.56±54.34)ml,and fewer days before drain removal (7.83±1.58) d vs (10.2±1.44) d.No significant difference was seen in terms of seroma,hematoma,delayed healing,infection,nipple necrosis,capsular contracture,or tumor recurrence.Conclusions The use of xenogenic acellular matrix dermal in immediate implant-based breast reconstruction following nipple/skin-sparing mastectomy is as safe and effective as alloplastic reconstruction.

Objective The vertical mammoplasty which improves the breast morphology and reduces the operative scar has become the first selection of breast reduction.However,the nipple-and-areola complex (NAC) had the risk of necrosis in those severe patients.In this report,we performed the vertical reduction mammoplasty based on Wu'ringer's horizontal septum to reduce the NAC necrosis possibility.Methods Typical Lejourmosque-dome design was performed.The inferior part of glandular tissue and the skin were excised.The NAC was elevated to normal position based on Wu'ringer's horizontal septum.The breast morphology was modified with vertical scar left.Results 79 patients were operated.4 patients had unilateral breast reduction.4 breasts had partial wound dehiscence.They were treated conservatively with topical dressing.No complete NAC necrosis occurred.Conclusions The vertical reduction mammoplasty based on Wu'ringer's horizontal septum is a safe and effective procedure.The NAC necrosis risk is reduced.This method deserves to be recommended.

ObjectiveTo establish a droplet digital PCR (ddPCR) method for detecting hepatitis B virus (HBV) covalently closed circular DNA (cccDNA). MethodsHBV cccDNA standard substance was constructed, and HBV cccDNA primers and probes were designed based on the structural differences between HBV cccDNA and relaxed circular DNA (rcDNA). HBV plasmid was amplified to obtain HBV cccDNA standard substance, and a ddPCR detection method was established with the standard substance after gradient dilution as the template for HBV cccDNA detection; the limit of detection and repeatability of this method were analyzed. Liver tissue samples were collected from 20 patients who attended Beijing YouAn Hospital, Capital Medical University, from June 2017 to October 2020, all of whom were diagnosed with HBV infection, and DNA of the samples was extracted and digested with plasmid-safe ATP-dependent DNA enzyme to obtain HBV cccDNA template; the ddPCR detection method was evaluated in clinical samples and was compared with the quantitative real-time PCR (qPCR) detection method. The chi-square test was used for comparison of categorical data between the two groups. ResultsThe HBV cccDNA detection method based on ddPCR was established, which accurately detected HBV cccDNA in standard substance after gradient dilution, with a limit of detection of 1 copy/μl, and the coefficients of variation of 1×103, 1×102, and 1×101 copies/μl standard substances were 441%, 3.98%, and 5.09%, respectively. HBV cccDNA was detected in the samples of 20 patients with HBV infection; the ddPCR detection method detected HBV cccDNA in 17 patients, with a positive rate of 85%, while the qPCR detection method detected HBV cccDNA in 11 patients, with a positive rate of 55%, and there was a significant difference between the two methods (χ2=4.286, P=0038). ConclusionThe established ddPCR method for detecting HBV cccDNA has a low limit of detection and good repeatability, which provides an effective tool for further clinical detection.

Objective:To establish a rapid and accurate method for the detection of Klebsiella pneumoniae carbapenemase (KPC) carbapenemase gene based on recombinase aided amplification (RAA)-CRISPR-Cas13a (CRISPR-Cas13a) technology. Methods:Twenty-five clinical isolates of carbapenem-resistant Klebsiella pneumoniae (CRKP) and five carbapenem-sensitive Klebsiella pneumoniae (CSKP) strains preserved in 2020-2021 in Beijing Chuiyangliu Hospital were randomly collected, and the total DNA samples of the strains was extracted. RAA primers specific for KPC DNA and CRISPR RNA (crRNA) were designed to establish a rapid and accurate method for the detection of KPC carbapenemase gene based on RAA-CRISPR-Cas13a technology. The method was evaluated by plasmids and clinical sample strains, and the detection was also performed by Quantitative real-time PCR (qPCR) method to compare the detection rate and consistency of the two methods. Results:The RAA-CRISPR-Cas13a method can detect KPC plasmids and samples with a sensitivity of 1 copy/μl, which is higher than that of qPCR (10 1 copies/μl). Among the 30 clinical strains (including 25 CRKP strains and 5 CSKP strains), 23 strains were detected to carry KPC gene by both RAA-CRISPR-Cas13a method and qPCR method, and 7 strains were not detected with KPC gene. The detection rate of KPC gene in the 25 CRKP strains was 92% (23/25). The positive coincidence rate of the two methods was 100% (23/23). Conclusions:This study combined RAA amplification technology with CRISPR-Cas13a technology to establish a rapid and accurate method for detecting KPC carbapenemase gene. The method is useful for accurate screening of KPC carbapenemase-producing strains. It has a wide application prospect in drug resistance monitoring and infection control.