1.Regulatory effects of bio-intensity electric field on transformation of human skin fibroblasts.
Wen Ping WANG ; Ran JI ; Ze ZHANG ; Ya Ting WU ; Heng Shu ZHANG ; Qiong ZHANG ; Xu Pin JIANG ; Miao TENG
Chinese Journal of Burns 2022;38(4):354-362
Objective: To investigate the regulatory effects of bio-intensity electric field on the transformation of human skin fibroblasts (HSFs). Methods: The experimental research methods were used. HSFs were collected and divided into 200 mV/mm electric field group treated with 200 mV/mm electric field for 6 h and simulated electric field group placed in the electric field device without electricity for 6 h. Changes in morphology and arrangement of cells were observed in the living cell workstation; the number of cells at 0 and 6 h of treatment was recorded, and the rate of change in cell number was calculated; the direction of cell movement, movement velocity, and trajectory velocity within 3 h were observed and calculated (the number of samples was 34 in the simulated electric field group and 30 in 200 mV/mm electric field group in the aforementioned experiments); the protein expression of α-smooth muscle actin (α-SMA) in cells after 3 h of treatment was detected by immunofluorescence method (the number of sample was 3). HSFs were collected and divided into simulated electric field group placed in the electric field device without electricity for 3 h, and 100 mV/mm electric field group, 200 mV/mm electric field group, and 400 mV/mm electric field group which were treated with electric fields of corresponding intensities for 3 h. Besides, HSFs were divided into simulated electric field group placed in the electric field device without electricity for 6 h, and electric field treatment 1 h group, electric field treatment 3 h group, and electric field treatment 6 h group treated with 200 mV/mm electric field for corresponding time. The protein expressions of α-SMA and proliferating cell nuclear antigen (PCNA) were detected by Western blotting (the number of sample was 3). Data were statistically analyzed with Mann-Whitney U test, one-way analysis of variance, independent sample t test, and least significant difference test. Results: After 6 h of treatment, compared with that in simulated electric field group, the cells in 200 mV/mm electric field group were elongated in shape and locally adhered; the cells in simulated electric field group were randomly arranged, while the cells in 200 mV/mm electric field group were arranged in a regular longitudinal direction; the change rates in the number of cells in the two groups were similar (P>0.05). Within 3 h of treatment, the cells in 200 mV/mm electric field group had an obvious tendency to move toward the positive electrode, and the cells in simulated electric field group moved around the origin; compared with those in simulated electric field group, the movement velocity and trajectory velocity of the cells in 200 mV/mm electric field group were increased significantly (with Z values of -5.33 and -5.41, respectively, P<0.01), and the directionality was significantly enhanced (Z=-4.39, P<0.01). After 3 h of treatment, the protein expression of α-SMA of cells in 200 mV/mm electric field group was significantly higher than that in simulated electric field group (t=-9.81, P<0.01). After 3 h of treatment, the protein expressions of α-SMA of cells in 100 mV/mm electric field group, 200 mV/mm electric field group, and 400 mV/mm electric field group were 1.195±0.057, 1.606±0.041, and 1.616±0.039, respectively, which were significantly more than 0.649±0.028 in simulated electric field group (P<0.01). Compared with that in 100 mV/mm electric field group, the protein expressions of α-SMA of cells in 200 mV/mm electric field group and 400 mV/mm electric field group were significantly increased (P<0.01). The protein expressions of α-SMA of cells in electric field treatment 1 h group, electric field treatment 3 h group, and electric field treatment 6 h group were 0.730±0.032, 1.561±0.031, and 1.553±0.045, respectively, significantly more than 0.464±0.020 in simulated electric field group (P<0.01). Compared with that in electric field treatment 1 h group, the protein expressions of α-SMA in electric field treatment 3 h group and electric field treatment 6 h group were significantly increased (P<0.01). After 3 h of treatment, compared with that in simulated electric field group, the protein expressions of PCNA of cells in 100 mV/mm electric field group, 200 mV/mm electric field group, and 400 mV/mm electric field group were significantly decreased (P<0.05 or P<0.01); compared with that in 100 mV/mm electric field group, the protein expressions of PCNA of cells in 200 mV/mm electric field group and 400 mV/mm electric field group were significantly decreased (P<0.05 or P<0.01); compared with that in 200 mV/mm electric field group, the protein expression of PCNA of cells in 400 mV/mm electric field group was significantly decreased (P<0.01). Compared with that in simulated electric field group, the protein expressions of PCNA of cells in electric field treatment 1 h group, electric field treatment 3 h group, and electric field treatment 6 h group were significantly decreased (P<0.01); compared with that in electric field treatment 1 h group, the protein expressions of PCNA of cells in electric field treatment 3 h group and electric field treatment 6 h group were significantly decreased (P<0.05 or P<0.01); compared with that in electric field treatment 3 h group, the protein expression of PCNA of cells in electric field treatment 6 h group was significantly decreased (P<0.01). Conclusions: The bio-intensity electric field can induce the migration of HSFs and promote the transformation of fibroblasts to myofibroblasts, and the transformation displays certain dependence on the time and intensity of electric field.
Actins/biosynthesis*
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Cell Differentiation/physiology*
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Cell Movement/physiology*
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Electric Stimulation Therapy
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Electricity
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Fibroblasts/physiology*
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Humans
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Myofibroblasts/physiology*
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Proliferating Cell Nuclear Antigen/biosynthesis*
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Skin/cytology*
2.Questionnaire investigation of radiation rectal injury with anxiety, depression and somatic disorder.
Bo LIAN ; Xin Ping CAO ; Hai Jun DENG ; Jun JIANG ; Ke Wei JIANG ; Xin Xiang LI ; You Sheng LI ; Guo Le LIN ; Ji Hong LIU ; Shou Min BAI ; Feng WANG ; Zi Qiang WANG ; Ai Wen WU ; Yi XIAO ; Hong Wei YAO ; Wei Tang YUAN ; Wei ZHANG ; Zhen ZHANG ; Yan Bing ZHOU ; Teng Hui MA ; Qing Chuan ZHAO
Chinese Journal of Gastrointestinal Surgery 2021;24(11):984-990
Objective: To observe the incidence and treatment of radiation rectal injury complicated with anxiety, depression and somatic symptom disorder. Methods: A cross-sectional survey research method was carried out. Patients with radiation rectal injury managed by members of the editorial board of Chinese Journal of Gastrointestinal Surgery were the subjects of investigation. The inclusion criteria of the survey subjects: (1) patients suffered from pelvic tumors and received pelvic radiotherapy; (2) colonoscopy showed inflammatory reaction or ulcer in the rectum. Exclusion criteria: (1) patient had a history of psycho-somatic disease before radiotherapy; (2) patient was unable to use a smart phone, unable to read and understand the questions in the questionnaire displayed on the phone; (3) patient refused to sign an informed consent form. According to the SOMA self-rating scale, PHQ-15 self-rating scale, GAD-7 and PHQ-9 self-rating scale, the electronic questionnaire of "Psychological Survey of Radiation Proctitis" was designed. The questionnaire was sent to patients with radiation rectal injury managed by the committee through the WeChat group. Observational indicators: (1) radiation rectal injury symptom assessment: using SOMA self-rating scale, radiation rectal injury symptom classification: mild group (≤3 points), moderate group (4-6 points) and severe group (> 6 points); (2) incidence of anxiety, depression and physical disorder: using GAD-7, PHQ-9 and PHQ-15 self-rating scales respectively for assessment; (3) correlation of radiation rectal injury symptom grading with anxiety, depression, and somatic symptom disorder. Results: Seventy-one qualified questionnaires were collected, of which 41 (56.9%) were from Guangzhou. Among the 71 patients, 6 were males and 65 were females; the mean age was (55.7±9.3) years old and 48 patients (67.6%) were less than 60 years old; the median confirmed duration of radiation rectal injury was 2.0 (1.0, 5.0) years. (1) Evaluation of symptoms of radiation rectal injury: 18 cases of mild (25.4%), 27 cases of moderate (38.0%), and 26 cases of severe (36.6%). (2) Incidence of anxiety, depression and somatic disorder: 12 patients (16.9%) without comorbidities; 59 patients (83.1%) with anxiety, depression, or somatic disorder, of whom 2 patients only had anxiety, 1 patient only had depression, 9 only had somatic disorder, 2 had anxiety plus depression, 4 had anxiety plus somatic disorder, 2 had depression plus somatic disorder, and 40 had all three symptoms. (3) correlation of radiation rectal injury grading with anxiety, depression, and somatic symptom disorder: as compared to patients in mild group and moderate group, those in severe group had higher severity of anxiety and somatic symptom disorder (Z=-2.143, P=0.032; Z=-2.045, P=0.041), while there was no statistically significant difference of depression between mild group and moderate group (Z=-1.176, P=0.240). Pearson correlation analysis revealed that radiation rectal injury symptom score was positively correlated with anxiety (r=0.300, P=0.013), depression (r=0.287, P=0.015) and somatic symptom disorder (r=0.344, P=0.003). Conclusions: The incidence of anxiety, depression, and somatic symptom disorder in patients with radiation rectal injury is extremely high. It is necessary to strengthen the diagnosis and treatment of somatic symptom disorder, so as to alleviate the symptoms of patients with pelvic perineum pain and improve the quality of life.
Aged
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Anxiety
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Cross-Sectional Studies
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Depression
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Female
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Humans
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Male
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Middle Aged
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Quality of Life
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Rectum
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Surveys and Questionnaires
3.Analysis on specific effect of acupoints at the upper arms in treatment of scrofula and goiter.
Shan-Ze WANG ; Chao YANG ; Wei-Mei ZENG ; Teng-Hui ZHONG ; Xu-Dong ZHANG ; Jia-Xin QIN ; Lu CHENG ; Shu-Qi MI ; Ji-Ping ZHAO
Chinese Acupuncture & Moxibustion 2021;41(10):1171-1174
Through analyzing the indication distribution of the different acupoints located at the upper limbs recorded in
Acupuncture Points
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Arm
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Goiter
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Humans
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Meridians
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Tuberculosis, Lymph Node
4.Association of Overlapped and Un-overlapped Comorbidities with COVID-19 Severity and Treatment Outcomes: A Retrospective Cohort Study from Nine Provinces in China.
Yan MA ; Dong Shan ZHU ; Ren Bo CHEN ; Nan Nan SHI ; Si Hong LIU ; Yi Pin FAN ; Gui Hui WU ; Pu Ye YANG ; Jiang Feng BAI ; Hong CHEN ; Li Ying CHEN ; Qiao FENG ; Tuan Mao GUO ; Yong HOU ; Gui Fen HU ; Xiao Mei HU ; Yun Hong HU ; Jin HUANG ; Qiu Hua HUANG ; Shao Zhen HUANG ; Liang JI ; Hai Hao JIN ; Xiao LEI ; Chun Yan LI ; Min Qing LI ; Qun Tang LI ; Xian Yong LI ; Hong De LIU ; Jin Ping LIU ; Zhang LIU ; Yu Ting MA ; Ya MAO ; Liu Fen MO ; Hui NA ; Jing Wei WANG ; Fang Li SONG ; Sheng SUN ; Dong Ting WANG ; Ming Xuan WANG ; Xiao Yan WANG ; Yin Zhen WANG ; Yu Dong WANG ; Wei WU ; Lan Ping WU ; Yan Hua XIAO ; Hai Jun XIE ; Hong Ming XU ; Shou Fang XU ; Rui Xia XUE ; Chun YANG ; Kai Jun YANG ; Sheng Li YUAN ; Gong Qi ZHANG ; Jin Bo ZHANG ; Lin Song ZHANG ; Shu Sen ZHAO ; Wan Ying ZHAO ; Kai ZHENG ; Ying Chun ZHOU ; Jun Teng ZHU ; Tian Qing ZHU ; Hua Min ZHANG ; Yan Ping WANG ; Yong Yan WANG
Biomedical and Environmental Sciences 2020;33(12):893-905
Objective:
Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear.
Methods:
A retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients' medical records. Multivariable logistic regression models were used to estimate the odds ratio (
Results:
Overall, 158 (13.6%) patients were diagnosed with severe illness and 32 (2.7%) had unfavorable outcomes. Hypertension (2.87, 1.30-6.32), type 2 diabetes (T2DM) (3.57, 2.32-5.49), cardiovascular disease (CVD) (3.78, 1.81-7.89), fatty liver disease (7.53, 1.96-28.96), hyperlipidemia (2.15, 1.26-3.67), other lung diseases (6.00, 3.01-11.96), and electrolyte imbalance (10.40, 3.00-26.10) were independently linked to increased odds of being severely ill. T2DM (6.07, 2.89-12.75), CVD (8.47, 6.03-11.89), and electrolyte imbalance (19.44, 11.47-32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission (5.46, 3.25-9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes (6.58, 1.46-29.64) within two weeks.
Conclusion
Besides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes.
Adult
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Aged
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COVID-19/virology*
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China/epidemiology*
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Comorbidity
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Female
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Humans
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Male
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Middle Aged
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Retrospective Studies
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Severity of Illness Index
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Treatment Outcome
5.Metabolomic approach to evaluating the effect of the mixed decoction of kelp and licorice on system metabolism of SD rats.
Run-bin SUN ; Xiao-yi YU ; Yong MAO ; Chun GE ; Yang NA ; Ji-ye A ; Yu-ping TANG ; Jin-ao DUAN ; Zi-teng MA ; Xu-tong WU ; Xuan-xuan ZHU ; Guang-ji WANG
Acta Pharmaceutica Sinica 2015;50(3):312-318
The aim of the study is to evaluate the effects of the single and mixed decoction of Thallus laminariae (kelp) and Glycyrrhiza glabra (licorice) on the metabolism and their difference. The mixed decoction of kelp and licorice and the single decoction were made and intragastrically administered to the SD rats. The effect on system metabolism, the toxicity of liver and kidney were assessed by GC-MS profiling of the endogenous molecules in serum, routine biochemical assays and histographic inspection of tissues from SD rats, separately. The mixed decoction of kelp and licorice induced more obvious pathological abnormalities in SD rats than a single decoction of kelp, while the extracts of licorice did not show any pathological change. Neither the mixed, nor the single decoction showed abnormal histopathology. After intragastric administration of extracts for 5 days, the mixed decoction induced a decrease of ALT (no significant change in the groups of single decoction) and an increase of BUN (so did the single decoction of kelp). Metabolomic profile of the molecules in serum revealed that the metabolic patterns were all obviously affected for the three groups, i.e., the mixed and single decoction of kelp and licorice. The rats given with the single decoction of kelp showed a similar pattern to that of the mixed decoction, indicating that the kelp primarily contributed the perturbation of metabolism for the mixed decoction. All three groups induced a decrease of branched chain amino acids, TCA cycle intermediates and glycolysis intermediates (e.g., pyruvic acid and lactic acid) and an increase of 3-hydroxybutyric acid. Kelp decoction showed stronger potential in reducing TCA cycle intermediates and glycolysis intermediates than the other two groups, while the levels of branched chain amino acids were the lowest after licorice extracts were given. These results suggested that the effect of the mixed decoction on metabolism was closely associated with both kelp and licorice. The continuous administration of single decoction of kelp and the mixed decoction of licorice and kelp resulted in pathological abnormalities in kidney of SD rats. The mixed decoction of kelp and licorice distinctly perturbed sera molecules and hence system metabolism, which showed associated with those of kelp and licorice. Although the metabolic effect was associated with both kelp and licorice, the results suggested kelp contributed to it primarily.
Animals
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Glycyrrhiza
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chemistry
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Kelp
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chemistry
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Kidney
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drug effects
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Liver
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drug effects
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Metabolomics
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Plant Preparations
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pharmacology
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Rats
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Rats, Sprague-Dawley
6.Effect of ligustrazine on reverse cholesterol transport in foam cells.
Ji ZHU ; Yao-Hong TENG ; Ping-Er WANG ; Zhen YANG ; De-Zhao LU
China Journal of Chinese Materia Medica 2014;39(7):1255-1259
OBJECTIVETo discuss the intervention effect of ligustrazine on ox-LDL-induced foam cells from the perspective of reverse cholesterol transport.
METHODRAW264.7 cultured in vitro was induced with 20 mg x L(-1) ox-LDL to establish the foam cell model, and intervened with ligustrazine. The lipid accumulation in cells was observed by the oil red O dyeing. The changes in total cholesterol and cholesterol ester in the cells were detected with the colorimetric method. The fluorescent quantitative PCR and Western blot were used to detect the mRNA expressions of PPARgamma, LXRalpha and ABCA1.
RESULTLigustrazine could reduce total cholesterol and cholesterol ester in foam cells, inhibit the lipid accumulation, and increase the mRNA and protein expressions of PPARgamma, LXRalpha and ABCA1.
CONCLUSIONLigustrazine can promote the reverse cholesterol transport by increasing the gene expressions of PPARgamma, LXRalpha and ABCA1.
ATP Binding Cassette Transporter 1 ; genetics ; metabolism ; Animals ; Biological Transport ; drug effects ; Cell Line ; Cholesterol ; metabolism ; Drugs, Chinese Herbal ; pharmacology ; Foam Cells ; drug effects ; metabolism ; Gene Expression ; drug effects ; Mice ; PPAR gamma ; genetics ; metabolism
7.Comparative study on biomechanical properties of 3 kinds of rib internal fixators
Ji-ping TENG ; Zhi-yin YANG ; You-shuang CHENG ; Da NI ; Zhi-jun ZHU ; Tie-wen PAN
Journal of Medical Biomechanics 2014;29(3):E266-E270
Objective To study and compare biomechanical properties of a newly developed magnesium AZ31B alloy intramedullary nail (AZ31B) with that of imported Poly-L-lactic acid intramedullary nail (PLLA) and pure titanium rib plate (TPRP), so as to provide scientific evidences for better internal fixation in clinical operation. Methods Forty fresh adult ribs were used and divided into 4 groups randomly. Three groups were made lateral rib fracture in midaxillary line and fixed by AZ31B, PLLA and TPRP, respectively, while the group with normal ribs was used as control. Biomechanical properties of specimens in each group were measured and tested using experimental stress analysis. Results (1) Three-point bending strength of internal fixation with AZ31B was close to that of control group (P>0.05), but significantly different to that of TPRP group and PTRP group (P<0.05); (2) No significant differences in torsional strength were found between AZ31B group, PTRP group and control group (P>0.05), and the torsional strength of both AZ31B and PTRP was superior to that of PLLA (P<0.05). Conclusions The internal fixation with AZ31B is an ideal mode for treating rib fracture since AZ31B has larger flexural strength than PLLA and TPRP, and its torsional strength was close to PTRP and normal ribs. This study provides some support for future research on biomechanical properties of AZ31B.
8.Expression and function of vascular endothelial growth factor and angiopoietins in rat brain after cerebral ischemia.
Li-kun ZAN ; Yue-jia SONG ; Guo-xin TENG ; Heng LI ; Wei LIU ; Ying JIA ; Min ZHOU ; Yu-lan SUN ; Ji-ping QI
Chinese Journal of Pathology 2011;40(12):834-839
OBJECTIVETo examine the temporal and spatial expression of vascular endothelial growth factor (VEGF) and angiopoietins (Ang) in rat brain after cerebral ischemia, and to elucidate the roles they played in angiogenesis and vascular permeability.
METHODSRats were subjected to either middle cerebral artery occlusion (MCAO) or sham operation. Reverse transcriptase-polymerase chain reaction, Western blotting, and immunohistochemistry were used to detect the expression of VEGF, Ang-1 and Ang-2 at different time points after ischemia. CD31 was used to label endothelial cells after MCAO. Vascular permeability was determined by Evans blue.
RESULTSVEGF was markedly increased at 2 h, had an initial peak at 12 h (0.7249 ± 0.1933, P < 0.01), and a second peak at 7 days (0.5264 ± 0.1519, P < 0.01). Ang-2 mRNA and protein significantly increased after MCAO, both of them peaked at 12 h (0.6747 ± 0.2416, P < 0.01; 1.1197 ± 0.1780, P < 0.01). In contrast, Ang-1 mRNA and protein gradually decreased after MCAO, respectively reaching a minimum at 3 d (0.3220 ± 0.1427, P < 0.01) and 1 d (0.1298 ± 0.0293, P < 0.01). Changes in the expression of these factors correlated with the progress of angiogenesis and vascular permeability. Evans blue test revealed that the vascular permeability gradually increased, and peaked at day 1 after ischemia [(6.219 ± 0.887) µg/g, P < 0.01].
CONCLUSIONDynamic temporal changes in VEGF, Ang-1 and Ang-2 expression stimulate the cerebral angiogenesis after focal cerebral ischemia.
Angiopoietin-1 ; genetics ; metabolism ; Angiopoietin-2 ; genetics ; metabolism ; Animals ; Blotting, Western ; Capillary Permeability ; Immunohistochemistry ; Infarction, Middle Cerebral Artery ; metabolism ; pathology ; physiopathology ; Male ; Neovascularization, Physiologic ; RNA, Messenger ; metabolism ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Reverse Transcriptase Polymerase Chain Reaction ; Vascular Endothelial Growth Factor A ; genetics ; metabolism
9.Circadian variation of the incidence of upper gastrointestinal bleeding and its relationship with climatic factors.
Tie-Kuan DU ; Hou-Li WANG ; Teng-Da XU ; Xu JI ; Yan-Ping ZHANG
Acta Academiae Medicinae Sinicae 2009;31(3):339-343
OBJECTIVETo study the circadian patterns of the incidence of upper gastrointestinal bleeding (UGIB) and its relationship with climatic factors in Beijing.
METHODSWe searched all UGIB records from August 1, 2005 to July 31, 2007 from Beijing Emergency Center and tracked the meteorological data during the same period. The variation of the incidence of UGIB was compared based on day, month, and season. The relation between climatic factors and the incidence of UGIB was also analyzed.
RESULTSTotally 2 580 patients, including 1 888 males (73.2%) and 692 females (26.8%) were included in the study. The mean age was significantly different between males and females [(53.3 +/- 20.4) years vs. (63.3 +/- 20.7) years, P < 0.05]. The occurrence of UGIB were significantly different among different seasons (chi2 = 49.82, P < 0.01), months (chi2 = 83.43, P < 0.01), and hours (chi2 = 126.79, P < 0.01). UGIB cases were presented more frequently in winter and spring, especially in January. More UGIB cases were presented at night, especially from 8 pm to midnight. Partial correlation test showed that the incidence of UGIB significantly correlated with temperature (r = -0.3785, P = 0.001) and barametric pressure (r = -0.3002, P = 0.011). No correlation was found between UGIB incidence and wind speed (P = 0.086) and relative humidity (P = 0.971).
CONCLUSIONSThe incidence of UGIB varies in different months and seasons in Beijing. Its climate-related risk factors may include temperature and barametric pressure, but not include relative humidity and wind speed.
Adult ; Aged ; Aged, 80 and over ; China ; epidemiology ; Circadian Rhythm ; Female ; Gastrointestinal Hemorrhage ; epidemiology ; Humans ; Incidence ; Male ; Meteorological Concepts ; Middle Aged ; Seasons
10.Reduction mammaplasty with the superomedial glandular pedicle.
Li TENG ; Fei-nan ZHANG ; Jian-jian LU ; Guo-ping FENG ; Xiao-lei JIN ; Ying JI ; Jia-jie XU
Chinese Journal of Plastic Surgery 2007;23(5):369-372
OBJECTIVETo explore a new technique that keep function and good aesthetic shape after reduction mammaplasty.
METHODSThe superomedial glandular pedicle technique was applied with differing patterns of skin incision according to the degree of the mammary hypertrophy. The extra glandular tissue was removed from the lateral and inferior segment of the breast. The remaining superomedial glandular tissue was remodeled a conical shape. The skin incision was sutured after excision of excess skin.
RESULTS36 cases (72 breasts) were treated with this technique. The results were satisfactory and there were no complications. The breasts maintained a lasting and aesthetically pleasing shape and the nipple-areola preserved good sensation.
CONCLUSIONSThe superomedial glandular pedicle is a safe and effective technique that can provide long-lasting outcome. The design of the procedure can be adapted to a variety of skin incision patterns and breast morphologies.
Adult ; Breast ; surgery ; Female ; Humans ; Mammaplasty ; methods ; Middle Aged ; Young Adult

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