ObjectiveTo evaluate the methodological quality and reporting quality of published guidelines/consensuses on traditional Chinese medicine （TCM）/integrated traditional Chinese and Western medicine diagnosis and treatment of nonalcoholic fatty liver disease （NAFLD）， and to provide a basis for formulating guidelines/consensuses on TCM/integrated traditional Chinese and Western medicine diagnosis and treatment of NAFLD in the future. MethodsDatabases including PubMed， Embase， Web of Science， CNKI， Wanfang Data， and CBM and the websites of China Association of Chinese Medicine and China Association of Integrative Medicine were searched for related articles published up to September 1， 2024. Two clinical researchers independently assessed the methodological quality and reporting quality of the guidelines/consensuses on TCM/integrated traditional Chinese and Western medicine diagnosis and treatment of NAFLD by using Appraisal of Guidelines for Research and Evaluation Ⅱ （AGREE Ⅱ） and Reporting Items for Practice Guidelines in Healthcare （RIGHT）. ResultsA total of nine guidelines/consensuses were included after literature screening， with four guidelines and five expert consensuses. The scores of different domains assessed by AGREE Ⅱ for the nine guidelines/consensuses were as follows： scope and purpose （47.1%）， stakeholder involvement （41.0%）， rigor of development （21.6%）， clarity of presentation （40.2%）， applicability （19.0%）， and editorial independence （19.6%）. The recommendation level of the articles was B level （recommended after revision） for four articles and C level （not recommended） for five articles. The RIGHT assessment showed high reporting rates for “Basic Information” and “Background”， while other areas needed to be improved. Currently， there was no international standard for the guidelines/consensuses on TCM/integrated traditional Chinese and Western medicine diagnosis and treatment of NAFLD， and the quality of these guidelines/consensuses needed to be enhanced to ensure comprehensiveness and credibility. ConclusionThere is still potential for improving the quality of guidelines/consensuses on TCM/integrated traditional Chinese and Western medicine diagnosis and treatment of NAFLD， and AGREE Ⅱ and RIGHT checklists should be strictly followed to ensure the fairness， scientific rigor， and transparency of these guidelines/consensuses.

Pneumococcal vaccine plays a key role in preventing diseases such as pneumonia and meningitis caused by Streptococcus pneumoniae(S.pneumoniae).Capsular polysaccharide,C-polysaccharide and phosphorus content are important indicators for quality control of polysaccharide antigens in vaccine development and production.In this study,a quantitative 1H NMR and 31P NMR method based on a single internal standard hexamethylphosphoramide(HMPA)was developed to achieve simultaneous determination of capsular polysaccharide,C-polysaccharide and phosphorus content in 6A,6B,18C,19A,19F and 23F S.pneumoniae polysaccharide antigens.Using the internal reference comparison method,the effect of solubility of polysaccharide on quantitative 1H NMR determination was investigated.It was found that the determination results of quantitative 1H NMR were affected by the viscosity and concentration of polysaccharide solution.It was found that high viscosity polysaccharides at 3-15 mg/mL and low viscosity polysaccharides at 5-25 mg/mL were the optimal detection solution concentration range.This"one internal standard three quantitative"NMR method has good precision,specificity and accuracy,and provides a valuable new strategy for the quality control of pneumococcal vaccine.

Breast augmentation using polyacrylamide hydrogel (PAHG) was widely used in China. We present the first case of delayed breast inflammation after 2019 novel coronavirus(2019-nCoV) infection in a patient who recieved breast augmentation with PAHG 20 years ago, without any other predispositions. The 45-year-old female patient complained of severe breast swelling and pain three weeks after 2019-nCoV infection. The swelling extended from the upper clavicle to the upper abdomen. Delayed inflammation reaction was diagnosed, followed by emergency surgery. During the surgery, the injected material was observed to gush out in a form of greenish and thin paste, with a foul odor. The wound had extensive diffuse oozing and hemoglobin decreased significantly. The patient was discharged one week after surgery. During a three-month follow-up, she experienced weakness and fatigue with no complications. There are still many unknown areas of the impact of 2019-nCoV on human foreign bodies and immune system, which is diverse and complex. Reporting various possible symptoms and mechanisms is conducive to improving the level of awareness and intervention of plastic surgeons.

Breast augmentation using polyacrylamide hydrogel (PAHG) was widely used in China. We present the first case of delayed breast inflammation after 2019 novel coronavirus(2019-nCoV) infection in a patient who recieved breast augmentation with PAHG 20 years ago, without any other predispositions. The 45-year-old female patient complained of severe breast swelling and pain three weeks after 2019-nCoV infection. The swelling extended from the upper clavicle to the upper abdomen. Delayed inflammation reaction was diagnosed, followed by emergency surgery. During the surgery, the injected material was observed to gush out in a form of greenish and thin paste, with a foul odor. The wound had extensive diffuse oozing and hemoglobin decreased significantly. The patient was discharged one week after surgery. During a three-month follow-up, she experienced weakness and fatigue with no complications. There are still many unknown areas of the impact of 2019-nCoV on human foreign bodies and immune system, which is diverse and complex. Reporting various possible symptoms and mechanisms is conducive to improving the level of awareness and intervention of plastic surgeons.

Objective:To investigate the effect of vitamin D supplementation on weight loss efficacy and insulin resistance (IR) in obese patients.Methods:It was a randomized controlled trial. A total of 190 obese patients with vitamin D deficiency were selected from the obesity clinic of Tianjin Union Medical Center from March to December in 2023. The patients were divided into control group (95 cases) and vitamin D group (95 cases) according to random number table. The control group was given energy-limited high-protein diet combined with moderate intensity exercise, and the vitamin D group was supplemented with vitamin D on the basis of the control group, 14 000 U/week for 24 weeks. A total of 25 dropped out of the study from the two groups for various reasons. Finally, 79 cases in the control group and 86 cases in the vitamin D group were included in the analysis. Independent sample t test and rank sum test were used to compare serum 25 hydroxyvitamin D [25 (OH) D] level, body weight, body mass index, fat mass, visceral fat area, fasting blood glucose, fasting insulin and glycated hemoglobin (HbA 1c) between the two groups at baseline and after intervention. Homeostasis model insulin resistance index (HOMA-IR) was used to evaluate the degree of insulin resistance (IR), and the effects of vitamin D supplementation on weight loss efficiency and IR in those patients were analyzed. Results:There was no significant differences in serum 25(OH)D level between the two groups before intervention ( P>0.05); the serum 25(OH)D level in the vitamin D group was significantly higher than that in the control group after intervention [(30.90±7.55) vs (16.00±4.34) μg/L] ( t=-15.35, P<0.001). The body weight, body mass index, fat mass, visceral fat area, fasting blood glucose, fasting insulin, HbA 1c, and HOMA-IR were all significantly lower after the intervention than those before the intervention in both groups [control group: (93.32±13.47) vs (98.95±14.31) kg, (33.74±5.09) vs (35.80±5.52) kg/m 2, (39.77±11.87) vs (44.12±12.79) kg, (183.76±40.95) vs (204.01±32.18) m 2, 5.00 (4.55, 5.67) vs 5.24 (4.68, 6.42) mmol/L, 16.78 (13.94, 24.30) vs 22.56 (15.95, 31.2) mU/L, 5.55%±0.53% vs 6.05%±0.99%, 4.11 (3.14, 5.57) vs 5.51 (3.61, 8.49); vitamin D group: (88.14±17.66) vs (104.43±22.02) kg, (31.02±5.10) vs (36.66±5.98) kg/m 2, (35.51±12.87) vs (46.67±13.33) kg, (166.50±49.50) vs (213.64±40.14) m 2, 4.70 (4.35, 5.07) vs 5.17 (4.77, 6.30) mmol/L, 13.18 (9.87, 18.84) vs 21.67 (15.78. 32.74) mU/L, 5.43%±0.48% vs 6.21%±1.22%, 2.88 (1.99, 4.21) vs 5.19 (3.82, 9.27)], and the body weight, body mass index, adiposity, visceral fat area, fasting blood glucose, fasting insulin, and HOMA-IR were all significantly lower in vitamin D group than those in the control group [(88.14±17.66) vs (93.32±13.47) kg, (31.02±5.10) vs (33.74±5.09) kg/m 2, (35.51±12.87) vs (39.77±11.87) kg, (166.50±49.50) vs (183.76±40.95) m 2, 4.70 (4.35, 5.07) vs 5.00 (4.55, 5.67) mmol/L, 13.18 (9.87, 18.84) vs 16.78 (13.94, 24.30) mU/L, and 2.88 (1.99, 4.21) vs 4.11 (3.14, 5.57), respectivley] (all P<0.05). The IR remission rate was significantly higher in the vitamin D group than that in the control group after the intervention (37.3% vs 15.3%) ( χ2=8.071, P=0.002). Conclusion:Supplementation of vitamin D on the basis of energy-limited high-protein diet combined with moderate intensity exercise can significantly improve the efficacy of weight loss and IR in obese patients with vitamin D deficiency.

Objective:To explore the safety and efficacy of prophylactic superdrainage using superficial inferior epigastric vein (SIEV) in delayed single-pedicled deep inferior epigastric perforator (DIEP) flap breast reconstruction.Methods:The clinical data of all patients who underwent single-pedicle DIEP flap delayed breast reconstruction in Department of Comprehensive Breast Plasty Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from May 2018 to August 2022 were retrospectively analyzed. According to whether SIEV-internal thoracic vein anastomosis was performed, they were divided into superdrainaged group and non-superdrainaged group. The diameter of SIEV and the time required for anastomosis were recorded. The total operation time, flap ischemia time, hospital stay, the rates of flap diffuse congestion, overall complications and second operation were compared between the two groups. The relative risks of flap diffuse congestion, complications and second operation were calculated. SPSS 24.0 software was used for data analysis. Measurement data was expressed as Mean±SD, independent sample t test was used for analysis. Counting data was expressed as %, and χ2 test was used for analysis. P<0.05 was considered statistically significant. Results:A total of 45 patients were included, including 26 patients in the non-superdrainaged group and 19 patients in the superdrainaged group. The total operation time was (7.7±1.9) h and (8.4±1.5) h, the flap ischemia time was (89.5±10.4) min and (92.6±12.3) min, and the hospital stay was (6.6±1.8) d and (6.6±2.0) d, respectively. There were no significant differences ( P>0.05). In the superdrainaged group, the diameter of SIEV was (2.5±0.3) mm, and manual suture was used. The time required for anastomosis of one SIEV was (12.2±2.3) min. The rates of diffuse congestion, recipient site complications, donor site complications and second operation were 7.7%(2/26), 15.4%(4/26), 7.7%(2/26) and 15.4%(4/26) in the non-superdrainaged group, and 0(0/19), 5.3%(1/19), 10.5%(2/19) and 5.3%(1/19) in the superdrainaged group, respectively. There were no significant differences between the two groups ( P>0.05). The relative risks were 3.7, 2.9, 0.7 and 2.9, respectively. Conclusion:Prophylactic superdrainage using SIEV is safe and effective. It can minimize the potential rate of diffuse venous congestion and secondary surgery, and not at the expense of increased flap ischemia time and abdominal complications in the meanwhile.

In deep inferior epigastric perforator (DIEP) flap breast reconstruction, diffuse venous congestion caused by non-pedicle causes, such as lack of effective communication between deep and superficial venous systems, is very rare. In this paper, a case of young woman who underwent DIEP breast reconstruction after breast cancer mastectomy was reported. Imaging findings showed the absence of bilateral dominant perforators and the lack of communication between the deep and superficial venous system. During operation, the superficial inferior epigastric vessels were dissected in advance. Indocyanine green angiography showed arterial perfusion insufficiency and venous congestion.The flap was successfully salvaged by supercharging/draining with superficial inferior epigastric vessels, preserving the abdominal function of the young patient to the greatest extent.

Objective:To introduce the efficacy and surgical experience of barbed sutures in wound closure of abdominoplasty.Methods:A prospective study of patients who underwent abdominoplasty in Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from August to December 2021 was carried out. Barbed sutures and corresponding techniques were used for wound closure. These patients were included in the study group. Also, patients who underwent abdominoplasty from January to Jule 2021 and did not use barbed sutures were retrospectively included in the control group. Baseline data, surgical details, and follow-up records were reviewed and collected for statistical analysis. Normal distribution measurement data were expressed as Mean±SD, and independent sample t-test was used for comparison between the two groups. Count data were expressed as cases (%) and analyzed by Chi-square test or Fisher exact test. Results:Twenty female patients aged 31-51 years old with body mass index (BMI) of (23.2±2.5) kg/m 2 were included in the study group, followed up for 6-8 months. The control group included 18 female patients, aged 32-55 years old, with BMI of (23.9±3.7) kg/m 2, and were followed up for 6-12 months. The abdominoplasty incision length of the study group was (36.5±4.5) cm and that of the control group was (35.0±3.4) cm, and there was no statistical significance between the two groups ( P>0.05). The closure time of the study group was (51±7) min, significantly shorter than that of the control group [(98±15) min]( P<0.01). In the study group, 2 patients [10.0%(2/20)] had delayed wound healing caused by incision fat liquefaction. In the control group, delayed wound healing occurred in three patients (3/18), which was caused by incision fat liquefaction (1 case) and suture extrusion (2 cases). There was no significant difference in postoperative wound complication rates between the two groups ( P>0.05). The Vancouver scar scale at three-month follow-up was scored (5.9±1.3) in the study group, (5.6±1.2) in the control group, with no significant difference ( P>0.05). The follow-up visits observed no abdominal wall bulge, hernia, or hypertrophic scar. All patients reported satisfying aesthetic outcomes. Conclusion:Barbed sutures significantly shorten the wound closure time in abdominoplasty. The described closure technique is safe and beneficial for efficiency.

Objective:This study aimed to explore the clinical application value of the indication selection criteria for bi-pedicled deep inferior epigastric arterial perforator flap(DIEP) versus pedicled transverse rectus abdominis myocutaneous flap(TRAM) combined with DIEP for breast reconstruction.Methods:The clinical data of patients who underwent delayed bi-pedicled abdominal flap breast reconstruction after breast cancer surgery in the Department of Oncoplastic and Reconstructive Breast Surgery and Department of Mammoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2008 to April 2022 were retrospectively analyzed. According to the indications for each procedure, corresponding blood supply source was selected. Subsequently, patients were divided into two groups: bi-pedicled DIEP group and pedicled TRAM+ DIEP combined flap group according to the type of blood supply source. The indication selection criteria for pedicled TRAM+ DIEP combined flap was as follows: lack of two groups of recipient vessels; no dominant perforator in the abdominal donor site; previous abdominal liposuction or abdominal surgery with large dissection range and severe scar; patients were unable to tolerate prolonged surgery or had high risk factors for microsurgery. A comparison of breast reconstruction surgery characteristics was conducted between the two groups. Independent-samples t-test, rank sum test, Chi-square test and Fisher’s exact probability method were used to analyze various data including age, body mass index (BMI), time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy, history of chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length, preoperative and postoperative conditions, as well as postoperative complications. Statistical significance was defined at P<0.05. Results:A total of 54 patients who underwent unilateral breast reconstruction were included in this study with a mean age of 42.2 years (range, 30-59 years). The pedicled TRAM+ DIEP combined flap group consisted of 21 patients with a mean age of 42.7 years (range, 33-56 years) while the bi-pedicled DIEP group comprised 33 patients with a mean age of 41.8 years (30-59 years). Out of the 54 patients, a total of 38 were eventually followed up, comprising 14 in the pedicled TRAM+ DIEP combined flap group and 24 in the bi-pedicled DIEP group. The average follow-up duration for the pedicled TRAM+ DIEP combined flap group was 42 months (range, 6-69 months). Abdominal bulge occurred in one patient, while another patient experienced abdominal hernia. The average follow-up duration for the bi-pedicled DIEP group was 47 months (6-179 months), with no reported cases of abdominal bulge or abdominal hernia. There were no statistically significant differences observed between the two groups regarding age, BMI, time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy or chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length or time to ambulation (all P>0.05). However, there was a statistically significant difference noted in duration of surgery between the pedicled TRAM+ DIEP combined flap group and bi-pedicled DIEP group [6.0(5.5-6.5) hours vs. 8.5(8.0-8.8) hours] ( P<0.01). Comparison analysis revealed no statistically significant differences in terms of partial flap necrosis (0/21 vs. 1/33), abdominal incision dehiscence (2/21 vs. 2/33), abdominal bulge (1/14 vs. 0 /24) or abdominal hernia (1/1 vs. 0/24) between the two groups ( P>0.05). Conclusion:For patients who needed bilateral vascular pedicled lower abdominal wall for breast reconstruction, utilizing a pedicled TRAM+ DIEP combined flap did not increase surgical complication risks. The proposed indication selection criteria for using a pedicled TRAM + DIEP combined flap outlined in this study could serve as guidance when choosing methods for bi-pedicled abdominal flap breast reconstruction.

Objective:To preliminarily evaluate the outcome of fat grafting breast augmentation using filtration-adsorption technique.Methods:Patients undergoing autologous fat grafting (AFG) breast augmentation between July of 2020 and March of 2021 were retrospectively reviewed at Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College. Patients with complete data who followed up for at least 3 months were included. The lipoaspirates were processed with filtration-adsorption technique and AFG breast augmentation were performed (filtration-adsorption group), and then sedimentation method which was commonly used clinically was set as the control group (sedimentation group). During the follow-up, breast palpation and ultrasound inspection were performed, and the breast volumetric change between preoperative and postoperative was quantitatively compared by three-dimensional scanning technique. Demographic and surgical details were statistically analyzed. Postoperative breast volume retention rates and complication rates were calculated and compared. Normally distributed continuous variables were described in the form Mean±SD, and t-test was used for analysis. Non-normal distributed continuous variables were described in the form of M ( Q1, Q3) and analyzed by Mann-Whitney U test. The classified data were analyzed by Fisher exact probability test. Results:A total of 20 female patients (40 breasts) were included, including 10 patients (20 breasts) aged (31.4±2.5) years in sedimentation group and 10 patients (20 breasts) aged (28.5±4.4) years in the filtration-adsorption group. The fat injection volume in the filtration-adsorption group was 151.1 (125.0, 175.0) ml, and 165.0 (151.3, 196.3) ml in sedimentation group, respectively, with no statistical significance ( P>0.05). The breast volume retention rate in filtration-adsorption group was (62.93±14.06)%, which was significantly higher than that in sedimentation group (24.97±11.02)% ( P<0.01). During postoperative breast ultrasound examination, 2 breasts in sedimentation group had palpable nodules (< 6 mm), 1 breast had ultrasonically detectable but clinically inaccessible nodules (< 4 mm), while only 1 breast in the filtration-adsorption group had an oil cyst (4 mm×2 mm). The complication rate in the filtration-adsorption group was lower than that in sedimentation group[5.0%(1/20) vs. 15.0%(3/20), P>0.05]. Conclusion:The filtration-adsorption technique is an ideal method for fat grafting, which would multiply the volume retention rate in large-volume AFG breast augmentation and reduce the rate of complications.