Objective:To discuss the procedure for correction of inverted nipple using tiny incision with primary breast ducts reserved.Methods:A total of 35 patients (63 sides) with primary inverted nipples from January 2006 to March 2019 were reviewed retrospectively. Tiny radial incisions were made on the areola around the base of the inverted nipple which had been pulled out. Without skin removed, shorten fiber bundles which caused nipple inverted were totally cut and released. While the primary breast ducts were preserved, purse-string suture was taken around the base of the nipple. The nipple protector was prepared by ourselves, and the nipple was pulled and suspended for 2-6 months.Results:Sixty-three sides of 35 patients with inverted nipples were successfully corrected by this minimally invasive surgery. There was no nipple necrosis. One patient developed mild swelling 3 weeks after operation, and the swelling subsided after symptomatic anti-inflammatory treatment. The average follow-up period was 39 months. After removing the nipple protector, 2 sides (2/63) had a certain degree of recurrence. The rest of the nipples had ideal shape, no obvious scar, good nipple feeling, and retained the possibility of lactation.Conclusions:The procedure for correction of inverted nipple using tiny incision with primary breast ducts reserved has advantages of minimal invasion, safety, less pain, while retaining the possibility of lactation in the future. The clinical effect is satisfactory. It is especially suitable for the correction of type Ⅰ and type Ⅱ inverted nipples.

Objective:To investigate the application value and clinical effect of tissue expansion in post-mastectomy breast reconstruction.Methods:From January 2013 to May 2019, 173 patients (38.2±8.0 years old) with body mass index (BMI) of (21.5±2.1) kg/m 2 were treated in Peking University Third Hospital. There were 76 cases on the right side and 97 cases on the left side; 8 cases underwent nipple sparing mastectomy, and 165 cases underwent modified radical mastectomy; 150 cases received chemotherapy and 9 cases received radiotherapy. In the first stage, immediate or delayed chest wall soft tissue expansion was performed. In the second stage, implant replacement, autologous tissue transplantation, or the combination of these two methods was performed to complete the breast reconstruction. All patients were followed up and the clinical effect was evaluated by Harris evaluation method. Results:Among 173 cases, 95 cases were provided immediate reconstruction, and 78 cases were applied delayed reconstruction. The period of tissue expansion was (7.7±3.2) months. During the second stage of reconstruction, implant exchange was conducted in 105 cases, 48 cases received implant exchange with autologous fat injection, 17 cases were performed implant exchange with endoscopy-assisted latissimus dorsi muscle transfer, and 3 cases were applied deep inferior epigastric perforator flap (DIEP) transplantation. The average follow-up time was 12.6 months (3.5-41.0 months). One patient had local tumor recurrence, and the implant was finally removed. The reconstruction effects were evaluated by Harris method, which showed that 23 cases had excellent appearance, 129 cases were good, 13 cases were fair, 7 cases were poor, and 88.4% (152/172) patients were good or above.Conclusions:Tissue expansion plays an important role as a transfer station in post-mastectomy breast reconstruction. In the second stage, the breast reconstruction method can be flexibly selected. Tissue expansion has a wide range of indications, and is especially suitable for immediate post-mastectomy breast reconstruction. Good result can be obtained by using this technique.

Objective:To investigate the application value and clinical effect of tissue expansion in post-mastectomy breast reconstruction.Methods:From January 2013 to May 2019, 173 patients (38.2±8.0 years old) with body mass index (BMI) of (21.5±2.1) kg/m 2 were treated in Peking University Third Hospital. There were 76 cases on the right side and 97 cases on the left side; 8 cases underwent nipple sparing mastectomy, and 165 cases underwent modified radical mastectomy; 150 cases received chemotherapy and 9 cases received radiotherapy. In the first stage, immediate or delayed chest wall soft tissue expansion was performed. In the second stage, implant replacement, autologous tissue transplantation, or the combination of these two methods was performed to complete the breast reconstruction. All patients were followed up and the clinical effect was evaluated by Harris evaluation method. Results:Among 173 cases, 95 cases were provided immediate reconstruction, and 78 cases were applied delayed reconstruction. The period of tissue expansion was (7.7±3.2) months. During the second stage of reconstruction, implant exchange was conducted in 105 cases, 48 cases received implant exchange with autologous fat injection, 17 cases were performed implant exchange with endoscopy-assisted latissimus dorsi muscle transfer, and 3 cases were applied deep inferior epigastric perforator flap (DIEP) transplantation. The average follow-up time was 12.6 months (3.5-41.0 months). One patient had local tumor recurrence, and the implant was finally removed. The reconstruction effects were evaluated by Harris method, which showed that 23 cases had excellent appearance, 129 cases were good, 13 cases were fair, 7 cases were poor, and 88.4% (152/172) patients were good or above.Conclusions:Tissue expansion plays an important role as a transfer station in post-mastectomy breast reconstruction. In the second stage, the breast reconstruction method can be flexibly selected. Tissue expansion has a wide range of indications, and is especially suitable for immediate post-mastectomy breast reconstruction. Good result can be obtained by using this technique.

Objective To evaluate the clinical effect of circumvertical mastopexy with internal shaping using inferior dermal-glandular flap for correction of breast ptosis.Methods From April 2010 to November 2017,33 cases of breast ptosis were treated in our department.The patients required nipple elevation of 3-6 cm and had unpleasing result after circumareolar mastopexy were treated with the technique of circumvertical lift with breast suspension and internal shaping with inferior dermal-glandular flap which pedicle was on the inframammary crease and tack technique for removing excessive skin precisely.Results 33 cases had their drainage tubes removed at the 2～3 days and suture removed at the 12～14 days postoperatively.All had primary healing of incision and no complications such as necrosis of NAC and dehiscence of incision occurred.Elastic bra was asked to wear for three to six months and then stable shape was achieved.Follow-up lasted for 6-60 months.All cases were satisfied with their new breast shape.Conclusions Circumvertical mastopexy with internal shaping using inferior dermal-glandular flap is a simple and effective method with relatively short scar and good shape for correction of the medium grade breast ptosis.

Objective: To investigate the clinical effect and safety of tramadol hydrochloride sustained-release tablets for subcutaneous venous malformation polidocanol sclerotherapy. Methods: The experimentation was designed in block randomization. 106 patients with subcutaneous venous malformations from May 2016 to November 2017, which in line with the inclusion criteria, were randomly divided into experimental group and control group, with 53 cases in each group. Experimental group patients took 100 mg tramadol hydrochloride sustained-release tablet 1 hour before operation, while control group patients took nothing. Both group underwent polidocanol foam injection therapy guided by the color ultrasound, to observe the effect of operative analgesia, postoperative analgesia (VAS grade) and complications. The data was analyzed by SPSS 19.0 software. Comparison between two groups was done with independent sample t test and P<0.05 was considered statistically significant. Results: The pain sensation(VAS grade) in surgery in experimental group(3.02±1.118)were significantly reduced than control group(6.30±1.514) (t=-12.701, P=0.000). 2 hours after operation the pain sensations decreased in both groups, but experimental group(0.23±0.577)were still better than which in control group(0.60±0.987)(t=-2.403, P=0.018). Three patients of experimental group(5.7%) felt mild nausea, and no other severe complications nor adverse effects occured. Conclusions Oral tramadol hydrochloride sustained-release tablets is one of safe, simple and effective way to achieve satisfactory preemptive analgesia for venous malformation polidocanol foam sclerotherapy.

Objective To explore the social factors of health among staff of urban workers in Liaoning province and to provide scientific evidence for preparing propagation strategies. Methods Two thousand five hundred urban workers were surveyed using stratified, random sampling in Dandong city and Yingkou city of Liaoning province. The participants were investigated through questionnaires. Results Two thousand four hundred forty eight valid questionnaires were obtained. The self-rated health score of the respondents was 84.37 ± 13.72. The results of multiple linear reason showed that those with low family income satisfaction (B = -2.923,P = 0.019,95％ CI:-5.360——0.485),many working hours per day (B = -3.749,P = 0.023,95％ CI:-6.98——0.518),poor leadership (B = -3.688,P =0.014,95％ CI:-6.608——0.768),and low job satisfaction (B = -2.012,P = 0.034,95％ CI:-3.869——0.156) had lower self-rated health scores. However,those with more harmonious families (B = 3.105,P = 0.017,95％ CI:0.565-5.645) and types of social support (B = 2.684,P = 0.003,95％ CI:0.926-4.442) had higher self-rated health scores. Conclusion Social factors affecting health among staff of urban workers in Liaoning province are family income satisfaction,working hours per day,leadership approval degree,job satisfaction, social support and others.

Objective To study the pathological mechanism of aseptic necrosis of breast tissue after long-term breast augmentation injected with polyacrylamide hydrogel (PAHG).Methods We included patients who had no obvious clinical symptoms and underwent surgical removal of the PAHG in our hospital,excluding patients with a history of breast prosthesis implantation.Extracts were collected,and then underwent a careful gross observation and serial sections followed by HE,Mallory,and toluidine blue staining,to observe the histological structure of collagen fibers and inflammatory cells.Immunohistochemistry for CD31 and a-smooth muscle actin (a-SMA) antibody was used to further identify vascular endothelial cells and vascular smooth muscle cells,respectively.Analysis of the correlation between injection time and the incidence of different pathological changes were done.Results We included 22 females (mean age 39.14 years,range 22-55 years) who requested surgical removal of the PAHG.The mean duration of PAHG injection was 9.27 years (range 4-14 years).They had no clinical symptoms or only had induration,deformation and displacement.The basic pathological changes of local tissue included foreign body reaction and chronic inflammation,fibrosis and tissue necrosis;and half of the tissue had also histological changes,such as small vascular smooth muscle layer thickening,lumen stenosis,etc.No significant correlation was found between the pathological changes and the duration of the disease and the clinical symptoms.Conclusions Patients with PAHG injection for augmentation mammoplasty can histopathological changes of local tissues even without experiencing discomfort.The tissue necrosis in some patients may be caused by foreign body reaction and inflammatory reaction.It may also be due to local ischemia caused by small vascular smooth muscle hyperplasia,luminal stenosis etc.

Objective To explore a more efficient surgical method to cure axillary osmidrosis through a comparative study on results from two surgical treatments of axillary osmidrosis in the armpit area.Methods 72 patients were randomized into two groups,in which 36 patients (group A) with micro-incision simple liposuction and 36 patients (group B) with dissection and excision of subcutaneous tissue from axillary folds.The clinical outcomes in the two groups were comparatively analyzed,based on surgery time,effect,complications,scarring and recovery time.Results The total efficiency of axillary osmidrosis treatment was 100％ after 6-12 months clinical follow-up towards two groups.There was no significantly statistical difference on the effect of both groups.Micro-incision simple liposuction was obviously superior to dissection and excision of subcutaneous tissue from axillary folds based on surgery time,complications,recovery time,scarring and armpit hair survival rate.The two groups were significantly different (P＜0.05).Conclusions Minimally invasive simple liposuction,as a treatment for axillary osmidrosis is a method with more effectiveness and reliability.It is a more acceptable approach to patients in view of safety and convenience,smaller and invisible scarring,fewer complications,and less recovery time.

Objective To evaluate the difference of PC values based on GBZ 97-2002 and on GBZ 97-2009 for lung cancer cases in Chinese uranium miners.Methods Using 19 lung cancer data ascertained in the past epidemiological study,PC values were calculated according to GBZ 97-2002 and GBZ 97-2009.Results In the 19 lung cancer cases,those cases that could not be judged as radiogenic cancers based on GBZ 97-2002,but may be judged as radiogenic cancers with GBZ 97-2009.The probability was enlarged by 1.1 times at least.The major reason was that the used value was the upper limit of 95％ in GBZ 2009 but the median in 2002.Conclusions Compared to GBZ 97-2002,the criteria value of PC in GBZ 97-2009 drops obviously.

Objective To study arterial distribution of rectus abdominis musculocutaneous flap and to evaluate whether it can be divided into several units for reconstruction. Methods The arteries of the rectus abdominis musculocutaneous flap were studied on 60 sides of cadavers by dissection and angiography. Results The superior epigastric artery (SEA) and the inferior epigastric artery (IEA) continued in a longitudinal direction. Most of their branches took on a typical spiral configuration and communicated with each other within muscle above the level of umbilicus. Many perforating arteries penetrated through the anterior rectus sheath to get to the overlying skin, but the highest concentration of major perforators were in the paraumbilical area. The inferior epigastric artery was more significant than superior epigastric artery in supplying the skin of the musculocutaneous flap. Based on thefstudies of the vascular anatomy of muscles, we could classify arterial distribution into 3 types: type Ⅰ (SEA 26.5 %, IEA 34.6%) revealed a single main intramuscular artery: type Ⅱ (SEA 64.7 %, IEA 48.1%) had two major intramuscular branches; type Ⅲ (SEA 8.8%, IEA 17.3 %) revealed three intramuscular branches. Our anatomic studies showed that the superior and inferior epigastric artery bifurcated or divided into more than two main branches in the majority of cases (SEA 73.5%, IEA 65.4%). Conclusion The rectus abdominis musculocutaneous flap could often be divided into several regions for breast construction which is based on the distribution of each branch of the artery.