Objective:To investigate the clinical application effects of the pedicled anterior intercostal artery perforator flap in breast reconstruction after breast-conserving surgery for breast cancer.Methods:This study was a retrospective observational study. From January to December 2023, 16 female breast cancer patients who met the inclusion criteria were hospitalized in the Department of Breast Surgery of the Affiliated Hospital of Southwest Medical University, with the age of (48±8) years. The pedicled anterior intercostal artery perforator flap was used for breast reconstruction of patients after breast-conserving surgery. After complete resection of tumor tissue, a "crescent-shaped" incision was designed at the inframammary fold. The pedicled anterior intercostal artery perforator flap was harvested based on the tumor location and the defect area after tumor removal. The flap was de-epithelialized, coapted, and rotated anterogradely or retrogradely to fill the defect. The donor site wound was closed with layered sutures. The following parameters were recorded: breast tissue loss volume during surgery, surgical duration, retention duration of the drainage tube, positive proportion of tumors in the breast incision margin tissue, breast loss ratio, flap survival, and incidence ratio of complications after operation. Patients were followed up for local recurrence or distant metastasis of tumor. At the last follow-up, the Ueda score was used to evaluate cosmetic outcomes of reconstructed breasts after breast-conserving surgery, and the Breast-Q scale version 2.0 was applied to assess patients' satisfaction and quality of life with breast reconstruction after breast-conserving surgery.Results:The breast tissue loss volume during surgery in this group of patients was 20-128 (59±34) cm3, the surgical duration was 105-200 (143±27) min, the retention duration of the drainage tube was 3-7 (4.6±1.0) d, and the positive proportion of tumors in the breast incision margin tissue was 1/16, with breast loss ratio of 0. After the surgery, the patient's transplanted flaps all survived. One patient had postoperative fat liquefaction in the surgical area, and the incidence ratio of postoperative complications was 1/16. The patients were followed up for 3-12 (11±4) months, and no local breast cancer recurrence or distant metastasis occurred. At the last follow-up, the cosmetic score of breast reconstruction after breast-conserving surgery were excellent in 6 cases, good in 8 cases, and fair in 2 cases, with an excellent and good ratio of 14/16. At the last follow-up, the highest score in the evaluation of patients' satisfaction with breast reconstruction and quality of life after breast-conserving surgery was the satisfaction with the surgeons, with a score of 59-100 (91±13), followed respectively by physiological health of the chest with a score of 60-100 (77±14), psychological health with a score of 35-100 (74±20), breast satisfaction with a score of 55-100 (73±13), satisfaction with information acquisition with a score of 53-100 (70±14), and sexual health with a score of 34-100 (70±23).Conclusions:The pedicled anterior intercostal artery perforator flap is safe and reliable for breast reconstruction after breast-conserving surgery for breast cancer, and can achieve high cosmetic effects and patient satisfaction. This flap is simple in design, easy to operate and highly reproducible, and is worthy of clinical promotion and application.

Objective:To investigate the clinical application effects of the pedicled anterior intercostal artery perforator flap in breast reconstruction after breast-conserving surgery for breast cancer.Methods:This study was a retrospective observational study. From January to December 2023, 16 female breast cancer patients who met the inclusion criteria were hospitalized in the Department of Breast Surgery of the Affiliated Hospital of Southwest Medical University, with the age of (48±8) years. The pedicled anterior intercostal artery perforator flap was used for breast reconstruction of patients after breast-conserving surgery. After complete resection of tumor tissue, a "crescent-shaped" incision was designed at the inframammary fold. The pedicled anterior intercostal artery perforator flap was harvested based on the tumor location and the defect area after tumor removal. The flap was de-epithelialized, coapted, and rotated anterogradely or retrogradely to fill the defect. The donor site wound was closed with layered sutures. The following parameters were recorded: breast tissue loss volume during surgery, surgical duration, retention duration of the drainage tube, positive proportion of tumors in the breast incision margin tissue, breast loss ratio, flap survival, and incidence ratio of complications after operation. Patients were followed up for local recurrence or distant metastasis of tumor. At the last follow-up, the Ueda score was used to evaluate cosmetic outcomes of reconstructed breasts after breast-conserving surgery, and the Breast-Q scale version 2.0 was applied to assess patients' satisfaction and quality of life with breast reconstruction after breast-conserving surgery.Results:The breast tissue loss volume during surgery in this group of patients was 20-128 (59±34) cm3, the surgical duration was 105-200 (143±27) min, the retention duration of the drainage tube was 3-7 (4.6±1.0) d, and the positive proportion of tumors in the breast incision margin tissue was 1/16, with breast loss ratio of 0. After the surgery, the patient's transplanted flaps all survived. One patient had postoperative fat liquefaction in the surgical area, and the incidence ratio of postoperative complications was 1/16. The patients were followed up for 3-12 (11±4) months, and no local breast cancer recurrence or distant metastasis occurred. At the last follow-up, the cosmetic score of breast reconstruction after breast-conserving surgery were excellent in 6 cases, good in 8 cases, and fair in 2 cases, with an excellent and good ratio of 14/16. At the last follow-up, the highest score in the evaluation of patients' satisfaction with breast reconstruction and quality of life after breast-conserving surgery was the satisfaction with the surgeons, with a score of 59-100 (91±13), followed respectively by physiological health of the chest with a score of 60-100 (77±14), psychological health with a score of 35-100 (74±20), breast satisfaction with a score of 55-100 (73±13), satisfaction with information acquisition with a score of 53-100 (70±14), and sexual health with a score of 34-100 (70±23).Conclusions:The pedicled anterior intercostal artery perforator flap is safe and reliable for breast reconstruction after breast-conserving surgery for breast cancer, and can achieve high cosmetic effects and patient satisfaction. This flap is simple in design, easy to operate and highly reproducible, and is worthy of clinical promotion and application.

Objective:To explore the disturbance of metal element balance in mice after exposure to radon.Methods:Mice were randomly divided into control group, radon exposure of 30 WLM group, 60 WLM group and 120 WLM groups, with 10 mice in each group. After radon exposure with the cumulative dose, the lung function of mice was detected by a non-invasive pulmonary function testing instrument. Mice blood was taken from eyeballs. The lungs, heart, liver, kidney and spleen were also collected. HE staining was used to observe the pathological changes of lung tissue. Inductively coupled plasma mass spectrometry (ICP-MS) was used to detect the content of metal elements, including essential trace elements in the body: chromium (Cr), molybdenum (Mo), cobalt (Co), selenium (Se), copper (Cu), zinc (Zn), manganese (Mn), nickel (Ni), and potentially toxic elements: arsenic (As), tin (Sn), lead (Pb), aluminum (Al), mercury (Hg), cadmium (Cd), and silver (Ag).Results:Compared with the control group, lung ventilation function of the radon-exposed mice was decreased, alveolar structure was destroyed, and the contents of pulmonary metal elements Cr, Al, Pb, Sn( F=0.34, 0.66, 3.14, 1.16, P<0.05) and essential trace elements Mn, Cr, Zn, and Mo in the blood were decreased( F=0.65, 1.44, 0.97, 2.08, P<0.05), while the elements of Cu, Mo, Se and As in the lungs were increased( F=1.31, 1.26, 0.81, 2.04, P<0.05), and the element contents in other tissues also fluctuated. Conclusions:Inhalation of a certain cumulative dose of radon can reduce the lung ventilation function of mice and induce lung inflammation, as well reduce the content of essential trace elements in the lung and blood so that the content of metal elements in the body fluctuates.

Objective To explore the value of the minimum apparent diffusion coefficient (ADC-min) value in the diagnosis of ductal carcinoma in situ (DCIS) and invasive cancer of breast.Methods One hundred and forty nine cases of breast cancer verified by histopathology were included in this retrospective study.All the patients underwent dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) and diffusion weighted imaging (DWI) before the biopsy.The ADC min value and its correlation with invasive ductal carcinoma(IDC),DCIS and IDC-DCIS were analyzed.Results The mean ADC-min values for IDC,IDC-DCIS and DCIS were (0.95±0.16)×10-3 mm2/s,(1.07±0.13)×10-3 mm2/s and (1.24±0.18)×10-3 mm2/s,respectively.The ADC-min value of the three groups showed an increasing trend and there were significant differences (F=32.08,P＜0.01).The optimal cutoff ADC-min value was 1.02 × 10-3 mm2/s to differentiate DCIS from invasive cancer with a sensitivity of 95.0％ and a specificity of 63.6％.Conclusion The ADC min values are significantly different among IDC,IDC-DCIS and DCIS.It may be used as a reliable tool to differentiate DCIS and invasive cancer of breast.

Objective To explore the value of magnetic resonance perfusion imaging of 3D arterial spin labeling(3D-ASL)in the diagnosis of transient ischemic attack(TIA).Methods 78 of patients were diagnosed TIA on MR routine scan [T1 WI,T2 WI,T2-FLAIR,diffusion weighted imaging(DWI)],magnetic resonance angiography(MRA)and 3D arterial spin labeling(3D-ASL).The re-sult were analyzed by Chi-square test.Results In 78 patients,the abnormal routine scan was 0 case(0%);abnormal MRA 41 cases (52.6%);abnormal 3D-ASL 47 cases(60.2%);combination with each other were 60 cases(76.9%).29 cases with artery stenosis and abnormal ASL,12 case with artery stenosis and normal ASL,19 cases with normal vascular and abnormal ASL,18 cases with normal vascular and normal ASL.Conclusion 3D-ASL is better than routine magnetic resonance sequences in the diagnosis of TIA,which is convenient and should be a routine scanning sequence of TIA.3D-ASL,MRA and DWI have their own advantages and disadvantages, combination use can improve the diagnosis accuracy of TIA.

Objective To explore the normal range of the insula volume of Chinese adults of the Han nationality and its relationship with age, which provide morphological data for the construction of database for Chinese Standard Brain.Methods This is a clinical multi-center study.One thousand Chinese healthy volunteers (age range = 18 to 70) recruited from 16 hospitals were divided into 5 groups, i.e.,Group A ( age range = 18 to 30), B ( age range = 31 to 40 ), C ( age range = 41 to 50 ), D ( age range =51 to 60), and E (age range =61 to 70).Each group contained 100 males and 100 females.All of the volunteers were scanned by MR using T1 weighted three-dimensional magnetization prepared rapid acquisition gradient echo sequence.After three dimension data reconstruction, the volumes of bilateral insula were manually measured.The volume of bilateral insula were compared by paired sample t test.The insula volumes were compared between male and female by independent sample t test, and the differences among 5 age groups were compared by one-way ANNOVA.The relationship between the volumes of insula and age,sex or cerebral volume were analyzed using bivariate correlation, respectively.Results The left snd right side volume of insula before standarized were (7764±1165) and (7387±1128) mm3 respectively, after standarized were (8413±1201 ) and (7871±1140) mm3 respectively.The left insula volume were significant larger than that of right(t = - 10.565, - 16.014,P <0.01 ).The left and fight volume of insula were (8146±1181 ) and (7735±1113) mm3 for male, and (7393±1022) mm3 and (7050±1038) mm3for female.The left and right insula volumes for male were larger than the female's(t = 10.934,9.945 ,P <0.01 ).The left and right insula volume of male after standarized were (8779±1230 ) and (8224±1081 )mm3, female were (8043±1054) and (7515±1091 ) mm3 ,the left and right insula volume of male were larger than the female's ( t = 4.858,4.632, P < 0.01 ).The left insula volumes among Group A, B, C, D,E before standarized were ( 8268±1221 ), ( 8067±1107 ), ( 7869±1109), ( 7603±1111 ), ( 6997±934 )mm3 respectively,the right were (8028±1156), (7636±1075), (7294±986), (7249±1068), (6717±916) mm3 respectively, there were significant differences among 5 groups between left and right insula volume(F= -0.361,-0.337,P <0.01 ).The left insula volume of A,B,C,D,E after standarized were ( 9093±1105 ), ( 8679±965 ), ( 8810±1136), ( 8202±980), ( 7273±940 )mm3, the right were ( 8694±1005), (8136±1100), (8034±910), (7496±990), (6989±932) mm3, there were significant differences among 5 groups between left and right insula volume(F = -0.490, -0.512,P < 0.01 ).There was significant negative correlation between the volume and age ( before standarizded:r = -0.361, -0.337, after standardized r = -0.490, -0.512, P<0.05).Before and after standardized, there was significant correlation between the volume of right and left insula and cerebral volume ( r = 0.470,0.459, P < 0.05 ).Before and after standardized, there was significant correlation between the volume of right and left insula and weight( r = 0.141, 0.092, P < 0.05 ).Conclusions 1.5 T MR scanner has high resolution, for distinguishing the white matter from the gray matter, and provide morphological data of insula for the construction of database for Chinese Standard Brain.

Objective To evaluate the shear stiffness of brain by MR elastography (MRE) in healthy Chinese volunteers and to assess the association between the cerebral shear stiffness and age. Methods Brain MRE studies were performed on 105 healthy volunteers. The shear stiffness of brain parencham was measured by local frequency estimation (LFE) algorithm. The differences of the shear stiffness between white matter(WM) and grey matter(GM) were analyzed by independent sample t test; the differences of brain parenchyma shear stiffness between male and female were estimated by independent sample t test. Spearman test was used to analyze the correlation between age and the shear stiffness of parenchyma; the volunteers were divided into two groups (age ≤ 40 and age > 40) and the correlation between age and shear stiffness of parencbyma in each group were analyzed separately. Results The shear stiffness of whiter matter [(23.1±5.7) kPa] was higher than that of grey matter[(11.3±2.6) kPa], and the difference was significant (t = 19.34, P < 0.01). In male, the shear stiffness of WM and GM was (23.4±5.8) kPa and (11.4±2.8) kPa respectively; while in female, it was (22.8±5.6) kPa and (11.1±2.5) kPa respectively. No sex differences were found in the stiffness of white matter or gray matter (t = - 0.534, - 0.606, P > 0.05). An age-dependent trend was observed in the stiffness of grey matter(r =0.315, P < 0.01),while not in whiter matter (r = 0.183, P > 0.05). When the shear stiffness of subjects no more than 40 years old was analysed, the age-dependent trend of shear stiffness was found both in white matter and gray matter(r = 0.251,0.235, P < 0.05); While in subjects over 40 years old, the age-dependent rend of shear stiffness was not found in white matter or gray matter(r = 0.181, - 0.001, P > 0.05). Conclusions The shear stiffness of WM is significantly higher than that of GM. No obvious sex difference was found in the stiffness of brain parenchyma. The shear stiffness of GM increases with age; the age-related increase of shear stiffness of WM was only found in subjects under 40 years old.

time (r = 0. 070, -0.003, -0. 195,0. 177,P 0.05). Conclusions Compared with omnivore's, the shear stiffness of brain parenehyma was lower in vegetarians. The shear stiffness of brain parenchyma may be affected by the diet.

Objective To investigate the diagnostic value of CTP-SI in acute stroke less than 9 hours.Methods In present study."one-stop shop"CT examination were performed in 34 patients with symptoms of acute stroke in le88 than 9 hours.We divided patients into two groups according to with and without delayed perfusion on CTP-SI.and compared ASPECTS (Alberta Stroke Program Early CT Score Study)scores on non-contrast CT(NCCT),arterial phase CTP-SI,venous phase CTP-SI with follow-up imaging.The ASPECTS were analyzed on arterial phase CTP-SI and veIlous phase CTP-SI using Wilcoxon rank-sum test.then compared with the follow up imaging ASPECTS using multiple linear regression.Results The median(min-max)scores of ASPECTS on NCCT,arterial phase CTP-SI,venous phase CTP-SI and follow-up imaging were 9.0(6.0-10.0),6.5(1.0-8.0),8.0(3.0-10.0)and 7.0(0-10.0)in group with delayed perfusion,respectively,and 9.0(1.0-10.0),8.5(1.0-10.0),8.5(1.0-10.0)and 8.0 (0～10.0)in group without delayed perfusion respectively.ASPECTs scores measured on arterial phase CTP-SI did not differ from venous phase CTP-SI in group without delayed perfusion ( Z = - 1.00, P =0.317), while there was significant difference in group with delayed perfusion (Z = -3.08, P = 0.002 ).There were significant correlation with ASPECTS scores measured on NCCT, arterial phase CTP-SI and venous phase CTP-SI to follow-up imaging ASPECTS (r =0.899,0.926,0.928,P ＜0.01 ) in group without delayed perfusion; ASPECTS measured in venous phase CTP-SI showed the best correlation to follow-up imaging ASPECTS (r = 0.762, P = 0.004) in group with delayed perfusion.Multiple linear regression showed that the correlation in only venous phase CTP-SI with foUow-up imaging ASPECTS was statistically significant:in group without delayed perfusion, Beta = 0.966, P ＜ 0.001 ; in group with delayed perfusion,Beta = 0.765, P = 0.004. Conclusion Presence of delayed porfusion in CTP-SI is quite important in identifying ischemic penumbra, which plays a critical role in imaging-guided thrombolytie therapy.

Objective To assess the diagnostic value of determining infarct core and penumbra using CT perfusion source images (CTP-SI) mismatch model in hemispheric stroke less than 9 hours.Methods "one-stop shop" CT examination including non-contrast enhanced CT (NCCT), CTP, CT angiography (CTA) were performed in 24 patients with symptoms of stroke less than 9 hours.The Alberta Stroke Program Early CT Score (ASPECTS) were analyzed on arterial phase CTP-SI and venous phase CTP SI using Wilcoxon rank-sum test, then compared with the follow up imaging ASPECTS using multiple linear regression.Results The median (min-max) scores of ASPECTS on arterial phase CTP-SI, venous phase CTP-SI and follow-up imaging were 9.0 ( 2.0-10.0 ), 9.3 ( 6.5-10.0 ) and 9.0 ( 7.0-10.0 ),respectively. ASPECTS measured on arterial phase CTP-SI significantly differed from the ASPECTS on venous phase CTP-SI ( Z =-2.812, P = 0.005 ).Moreover, the linear regression analysis showed significant correlation between the ASPECTS on venous phase CTP-SI and follow up imaging ASPECTS ( Beta =0.715,P = 0.003 ).Conclusion CTP-SI mismatch model provides a method of choice in predicting penumbra and infarct core in hemispheric stroke.