Objective:This study intends to explore the clinical outcomes of liposuction combined with a vacuum-assisted biopsy device in the treatment of Simon grade Ⅰ or Ⅱ gynecomastia (GYN) caused by glandular proliferation and excrescent fat deposition.Methods:The clinical data of Simon grade Ⅰ or Ⅱ GYN caused by glandular proliferation and excrescent fat deposition treated by liposuction and vacuum-assisted biopsy device in the Department of Plastic and Reconstructive Surgery of the Ninth People’s Hospital Affiliated to Medical College of Shanghai Jiao Tong University from June 2016 to June 2019 were analyzed retrospectively. Surgical procedures: A 5-mm skin incision was made at the lower outer margin of the breast, through which the excrescent fat deposition was removed by liposuction. In addition, a vacuum-assisted biopsy device was applied to remove the residual glandular tissue. The operation time, liposuction volume, removed glandular tissue weight, blood loss, drainage volume, drainage duration, patient satisfaction, and complications were observed and recorded. The patients were followed up from June to December 2020. Patients were asked to grade the cosmetic outcome between 0 and 5 (0 was extremely dissatisfied, 5 was extremely satisfied). The data were sorted out and analyzed by SPSS 19.0, and the data were expressed as Mean±SD or M ( P25, P75). Results:A total of 27 patients with 51 breasts were enrolled in this study. Unilateral operation time, liposuction volume, removed glandular tissue weight, blood loss, drainage volume, drainage duration were (45.3±11.1) min, (206.0±66.7) ml, (28.9±9.5) g, (10.0±4.3) ml, (78.8±33.9) ml and (2.3±0.4) d respectively. Bruising occurred in 9 breasts. No other complications were observed. The postoperative follow-up time was 21.0 (17.0, 28.0) months, and the score of patient satisfaction was 4.98±0.14.Conclusions:Liposuction combined with vacuum-assisted biopsy device can be used as a feasible and minimally invasive approach to treat the Simon grade Ⅰ or Ⅱ GYN caused by glandular proliferation and excrescent fat deposition, which is safe and reliable with few complications, excellent cosmetic results, and high patient satisfaction. However, it has some shortcomings, such as hemostasis under the indirect vision.

Objective:This study intends to explore the clinical outcomes of liposuction combined with a vacuum-assisted biopsy device in the treatment of Simon grade Ⅰ or Ⅱ gynecomastia (GYN) caused by glandular proliferation and excrescent fat deposition.Methods:The clinical data of Simon grade Ⅰ or Ⅱ GYN caused by glandular proliferation and excrescent fat deposition treated by liposuction and vacuum-assisted biopsy device in the Department of Plastic and Reconstructive Surgery of the Ninth People’s Hospital Affiliated to Medical College of Shanghai Jiao Tong University from June 2016 to June 2019 were analyzed retrospectively. Surgical procedures: A 5-mm skin incision was made at the lower outer margin of the breast, through which the excrescent fat deposition was removed by liposuction. In addition, a vacuum-assisted biopsy device was applied to remove the residual glandular tissue. The operation time, liposuction volume, removed glandular tissue weight, blood loss, drainage volume, drainage duration, patient satisfaction, and complications were observed and recorded. The patients were followed up from June to December 2020. Patients were asked to grade the cosmetic outcome between 0 and 5 (0 was extremely dissatisfied, 5 was extremely satisfied). The data were sorted out and analyzed by SPSS 19.0, and the data were expressed as Mean±SD or M ( P25, P75). Results:A total of 27 patients with 51 breasts were enrolled in this study. Unilateral operation time, liposuction volume, removed glandular tissue weight, blood loss, drainage volume, drainage duration were (45.3±11.1) min, (206.0±66.7) ml, (28.9±9.5) g, (10.0±4.3) ml, (78.8±33.9) ml and (2.3±0.4) d respectively. Bruising occurred in 9 breasts. No other complications were observed. The postoperative follow-up time was 21.0 (17.0, 28.0) months, and the score of patient satisfaction was 4.98±0.14.Conclusions:Liposuction combined with vacuum-assisted biopsy device can be used as a feasible and minimally invasive approach to treat the Simon grade Ⅰ or Ⅱ GYN caused by glandular proliferation and excrescent fat deposition, which is safe and reliable with few complications, excellent cosmetic results, and high patient satisfaction. However, it has some shortcomings, such as hemostasis under the indirect vision.

Consolidated bioprocessing (CBP) is a multi-step process in a bioreactor, which completes hydrolase production, enzymatic hydrolysis, and microbial fermentation. It is considered to be the most promising process for the production of second-generation biofuels because of its simple steps and low cost. Due to the complexity of lignocellulose degradation and the butanol synthesis pathway, few wild microorganisms can directly utilize lignocellulose to synthesize butanol. With the development of synthetic biology, single-bacterium directly synthesizes butanol using lignocellulose by introducing a butanol synthesis pathway in the cellulolytic Clostridium. However, there are still some problems such as heavy metabolic load of single bacterium and low butanol yield. Co-culture can relieve the metabolic burden of single bacterium through the division of labor in different strains and can further improve the efficiency of butanol synthesis. This review analyzes the recent research progress in the synthesis of biobutanol using lignocellulose by consolidated bioprocessing from both the single-bacterium strategy and co-culture strategy, to provide a reference for the research of butanol and other biofuels.
1-Butanol ; Biofuels ; Butanols ; Fermentation ; Lignin/metabolism*

Objective:To explore how to enhance the strength of science and technology of research-oriented hospital using goal management, thereby effectively promoting the construction and development of research hospitals.Methods:This paper studies the goal management measures and their effectiveness through data analysis, analyzes the problems of scientific research, goal management measures and changes in scientific research before and after the implementation measures over the years.Results:The goal management significantly enhances the scientific and technological strength. Total amount of research funding kept increasing year by year. Goal accountability management effectively improve the participation in individual scientific research activities. The implementation of high-quality papers goal management has a significant role in promoting the researchers to publish their achievements in domestic journals with international influence.Conclusions:Goal management plays an important role in the improvement of the scientific and technological strength of the hospital, which can effectively promote the construction and development of the research-oriented hospitals connotation. Goal management can serve as a powerful grasper for the research-oriented hospital to improve the scientific research capacity.

Objective:To evaluate the clinical characteristics and prognosis of gallbladder cancer (GBC) patients in China.Methods:This retrospective multicenter cohort study enrolled 3 528 consecutive GBC patients diagnosed between January 2010 to December 2017 in 15 hospitals from 10 provinces. There were 1 345 (38.12%) males and 2 183 (61.88%) females.The age of diagnosis was (63.7±10.8) years old (range: 26 to 99 years old) .There were 213 patients (6.04%) in stage 0 to Ⅰ, whereas 1 059 (30.02%) in stage Ⅱ to Ⅲ, 1 874 (53.12%) in stage Ⅳ, and 382 (10.83%) unavailable. Surgery was performed on 2 255 patients (63.92%) . Three hundred and thirty-six patients received chemotherapy or radiotherapy (9.52%; of which 172 were palliative); 1 101 (31.21%) received only supportive treatment.The patient source, treatment and surgery, pathology, concomitant gallstone, and prognosis were analyzed.Results:Among the 3 528 GBC patients, 959 (27.18%) were from East China, 603 (17.09%) from East-North China, 1 533 (43.45%) from Central China, and 433(12.27%) from West China. Among the 1 578 resectable tumor, 665 (42.14%) underwent radical surgery, 913 (57.86%) underwent surgery that failed to follow the guidelines.Eight hundred and ninety-one (56.46%) patients were diagnosed before surgery, 254 (16.10%) during surgery, and 381 (24.14%) after surgery (time point of diagnosis couldn′t be determined in 52 patients) .Among the 1 578 patients with resectable tumor, 759 (48.10%) had concomitant gallstone.Among the 665 patients underwent radical surgery, 69 (10.4%) showed positive resection margin, 510 (76.7%) showed negative resection margin, and 86 (12.9%) unreported margin status.The 5-year overall survival rate (5yOS) for the 3 528-patient cohort was 23.0%.The 5yOS for patients with resectable tumor was 39.6%, for patients with stage ⅣB tumor without surgery was 5.4%, and for patients with stage ⅣB tumor underwent palliative surgery was 4.7%.Conclusions:More than half GBC patients in China are diagnosed in stage Ⅳ.Curative intent surgery is valuable in improving prognosis of resectable GBC.The treatment of GBC needs further standardization.Effective comprehensive treatment for GBC is in urgent need.

Objective:To evaluate the clinical characteristics and prognosis of gallbladder cancer (GBC) patients in China.Methods:This retrospective multicenter cohort study enrolled 3 528 consecutive GBC patients diagnosed between January 2010 to December 2017 in 15 hospitals from 10 provinces. There were 1 345 (38.12%) males and 2 183 (61.88%) females.The age of diagnosis was (63.7±10.8) years old (range: 26 to 99 years old) .There were 213 patients (6.04%) in stage 0 to Ⅰ, whereas 1 059 (30.02%) in stage Ⅱ to Ⅲ, 1 874 (53.12%) in stage Ⅳ, and 382 (10.83%) unavailable. Surgery was performed on 2 255 patients (63.92%) . Three hundred and thirty-six patients received chemotherapy or radiotherapy (9.52%; of which 172 were palliative); 1 101 (31.21%) received only supportive treatment.The patient source, treatment and surgery, pathology, concomitant gallstone, and prognosis were analyzed.Results:Among the 3 528 GBC patients, 959 (27.18%) were from East China, 603 (17.09%) from East-North China, 1 533 (43.45%) from Central China, and 433(12.27%) from West China. Among the 1 578 resectable tumor, 665 (42.14%) underwent radical surgery, 913 (57.86%) underwent surgery that failed to follow the guidelines.Eight hundred and ninety-one (56.46%) patients were diagnosed before surgery, 254 (16.10%) during surgery, and 381 (24.14%) after surgery (time point of diagnosis couldn′t be determined in 52 patients) .Among the 1 578 patients with resectable tumor, 759 (48.10%) had concomitant gallstone.Among the 665 patients underwent radical surgery, 69 (10.4%) showed positive resection margin, 510 (76.7%) showed negative resection margin, and 86 (12.9%) unreported margin status.The 5-year overall survival rate (5yOS) for the 3 528-patient cohort was 23.0%.The 5yOS for patients with resectable tumor was 39.6%, for patients with stage ⅣB tumor without surgery was 5.4%, and for patients with stage ⅣB tumor underwent palliative surgery was 4.7%.Conclusions:More than half GBC patients in China are diagnosed in stage Ⅳ.Curative intent surgery is valuable in improving prognosis of resectable GBC.The treatment of GBC needs further standardization.Effective comprehensive treatment for GBC is in urgent need.

Objective To summarize experience in the treatment of chronic refractory empyema with autologous myocutaneous flap implantation.Methods From January 2004 to December 2017,26 patients had been treated with autologous myocutaneous flap implantation in Shanghai Pulmonary Hospital for chronic refractory empyema.Among them,24 were men and 2 were women.The mediam age was 50.1 years(14-74 years).21 of them had medical histories of lung resection because of basic diseases(most of which accepted surgeries in other hospitals).Complications appeared after surgeries.15 of them had bronchopleural fistula while windowing,which could not be cured by conservative treatments such as drainage.Then we performed open-window thoracostomy and long-time dressing.6 of 21 had experienced pneumonectomy.Other 5 patients did not have primary operational histories.They experienced dressing by windowing because of chronic refractory empyema after the in effective conservative treatments like drainage without pulmonary re-expansion.Results No respiratory complications occurred in these patients.The catheters were successfully removed within 5 days and the patients were discharged within 3-6 weeks after the operations.The median follow-up period was 9 months.24 cases were successful with no recurrence of empyema or flap necrosis,the other 2 cases underwent recurrence of empyema.Conclusion The application of autologous myocutaneous flaps for the treatment of chronic refractory empyema is an effective and continuously improving method.

Objective: To investigate the clinical effects of immediate nipple reconstruction with a local mastectomy flap in secondary breast reconstruction by deep inferior epigastric artery perforator (DIEP) flap. Methods: A free bipedicle DIEP flap was raised and folded upward to form the breast. Meanwhile, a deepithelialized lower mastectomy flap with a distant skin paddle was elevated and pulled throughout the reconstructed breast. The skin paddle was carefully sutured to the position of future nipple. Three weeks later, the pedicle of mastectomy flap was divided, and the paddle was modeled to form the new nipple. Results: From February 2011 to June 2016, 42 patients who had previously undergone unilateral modified mastectomies underwent the breast reconstructions and immediate nipple reconstructions. All flaps survived postoperatively. The average projection of the reconstructed nipple was measured as (16.3±2.4) mm immediately after the operation and gradually decreased to (8.4±1.3) mm by one year follow up. 35 patients ranked the aesthetic appearance of the reconstructed nipple and breast very good or good. Conclusions The immediate nipple reconstruction with a local mastectomy flap and breast reconstruction by DIEP flap could achieve a good breast shape and maintain a long term residual nipple projection, which results in considerable patient satisfaction.

Acute gangrenous cholecystitis is a histologic diagnosis,mostly diagnosed by intraoperative or postoperative pathology.In China,as the aging population increases,the incidence of the disease increases steadily.AGC is still an indication of surgical treatment for acute cholecystitis(AC),but the diagnosis and treatment of AGC remains a challenge for clinical surgeons.However,preoperative clinical data such as age, gender,hypertension,diabetes,coronary heart disease,cholelithiasis disease history,laboratory examination and radiographic results are helpful in early diagnosis and reasonable surgical timing selection.