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Objective:To study the optimization of defecation treatment in patients with chronic constipation under different positions and angles by "simulation contrast agent".Methods:The clinical data of 78 patients with chronic constipation in Handan Central Hospital from April 2020 to April 2022 were retrospectively analyzed. Among them, 26 patients were examined by 90°conventional defecography position (conventional position group), 26 patients by 60° to 89° defecography position (61° to 89° position group), and 26 patients by 30° to 59° Asian squat defecography position (Asian squat position group). The results of defecography, constipation score and defecography abnormality were compared among the three groups.Results:The encysted rectum, internal rectal intussusception and descending distance of perineum in 61° to 89° position group and Asian squat position group were significantly lower than those in conventional position group: (2.71 ± 0.25) and (2.11 ± 0.66) mm vs. (3.06 ± 0.23) mm, (9.06 ± 1.78) and (8.55 ± 2.81) mm vs. (10.22 ± 1.59) mm, (11.52 ± 2.70) and (10.52 ± 2.93) mm vs. (12.52 ± 3.43) mm, the indexes in Asian squat position group were significantly lower than those in 61° to 89° position group, and there were statistical differences ( P<0.01); the anal right angle and the anal right angle in force discharge state in 61° to 89° position group and Asian squat position group were significantly higher than those in conventional position group: (120.47 ± 3.35)° and (122.44 ± 3.33)° vs. (118.19 ± 3.66)°, (19.99 ± 3.47)° and (20.25 ± 2.69)° vs. (18.77 ± 2.79)°, the indexes in Asian squat position group were significantly higher than those in 61° to 89° position group, and there were statistical differences ( P<0.01); there was no statistical difference in resting anal right angle among the three groups ( P>0.05). The Longo outlet obstructive constipation score, Wexner constipation score and constipation severity score in 61° to 89° position group and Asian squat position group were significantly lower than those in conventional position group: (14.41 ± 2.66) and (12.24 ± 3.49) scores vs. (16.64 ± 3.37) scores, (13.79 ± 2.74) and (12.83 ± 3.08) scores vs. (15.76 ± 3.56) scores, (13.34 ± 2.72) and (12.31 ± 2.52) scores vs. (16.08 ± 3.57) scores, the indexes in Asian squat position group were significantly lower than those in 61° to 89° position group, and there were statistical differences ( P<0.01). The detection rates of abnormal defecography in conventional position group, 61° to 89° position group and Asian squat position group were 96.15% (25/26), 84.62% (22/26) and 69.23% (18/26), and there was statistical difference ( P<0.05); among them, the detection rate of abnormal defecography in Asian squat position group was significantly lower than that in conventional position group, and there was statistical difference ( P<0.05). Conclusions:The defecation function and imaging indexes are optimized in patients with chronic constipation based on the guidance of "simulation contrast agent" adopted the Asian squat position, and their significantly.
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Airborne pollen is a common allergen that causes allergic reactions. Researches have shown that airborne pollen may be an independent risk factor for ischemic stroke. The possible mechanisms of airborne pollen induced ischemic stroke include inflammation and oxidative stress response, atherosclerosis, blood hypercoagulability and thrombosis, and can increase the risk of ischemic stroke by promoting the occurrence of hypertension, respiratory and cardiovascular events.
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ObjectiveTo investigate the efficacy and mechanism of berberine hydrochloride （BBH） against lung cancer cells through the mevalonate （MVA） pathway. MethodHuman lung cancer A549 cells and mouse Lewis lung carcinoma （LLC） cells were used as research subjects. Cell proliferation and cell counting kit-8 （CCK-8） assay were performed to detect the inhibitory effect of BBH （10， 20， 30， 40， 50 μmol·L-1） on the proliferation of the two kinds of cells （48 h）. Then cell scratch assay was used to explore the influence of BBH （40 μmol·L-1） on the migration of A549 and LLC cells （24， 48 h）， and colony formation assay was conducted to compare the colony formation ability of the cells under different concentrations of BBH （10， 20， 40 μmol·L-1）. Moreover， the effects of BBH （40 μmol·L-1） on the content of acetyl-coenzyme A （A-CoA） and total cholesterol （TC） in A549 and LLC cells were determined by kit assay. AutoDock Vina was used for the dock of BBH and MVA pathway regulatory protein， sterol regulatory element-binding protein 2 （SREBP2）. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was used to observe the effects of BBH （40 μmol·L-1） on the mRNA expression of nine genes related to the MVA pathway in A549 and LLC cells： hydroxymethylglutaryl-CoA synthase 1 （HMGCS1）， hydroxymethylglutaryl-CoA Reductase （HMGCR）， mevalonate kinase （MVK）， phosphomevalonate kinase （PMVK）， mevalonate 5-pyrophosphate decarboxylase （MVD）， farnesyl diphosphate synthase （FDPS）， squalene epoxidase （SQLE）， farnesyl-diphosphate farnesyltransferase 1 （FDFT1）， and geranylgeranyl diphosphate synthase 1 （GGPS1）. Western blot was performed to clarify the effects of BBH （40 μmol·L-1） on the expression of three key proteins of the MVA pathway： HMGCS1， HMGCR， and FDFT1. The Cancer Genome Atlas （TCGA） database was searched to analyze the relationship between HMGCS1， HMGCR， FDFT1 and transcription gene SREBF2 in non-small cell lung cancer （NSCLC）. ResultCompared with the conditions in the control group， the proliferation， migration， and colony formation of A549 and LLC cells in the BBH group were decreased （P<0.01）， while the cell apoptosis rate was increased （P<0.01）. Molecular docking showed that BBH had good binding activity with SREBP2. In addition， the content of A-CoA and TC of the MVA pathway was reduced （P<0.01）. BBH down-regulated the mRNA expression of HMGCS1， HMGCR， MVK， PMVK， MVD， FDPS， SQLE， FDFT1， and GGPS1 in A549 and LLC cells （P<0.01）， and lowered the levels of HMGCS1， HMGCR， and FDFT1 proteins （P<0.05， P<0.01）. In NSCLC patients， HMGCS1， HMGCR， and FDFT1 were highly correlated with SREBF2 （R=0.54， R=0.57， and R=0.48）. ConclusionBBH can inhibit the proliferation， migration， and colony formation of A549 and LLC cells and promote cell apoptosis， which may be related to the regulation of MVA pathway by BBH binding to SREBP2.
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Fibroblast growth factor receptors (FGFRs) have emerged as promising targets for anticancer therapy. In this study, we synthesized and evaluated the biological activity of 66 pyrazolo[3,4-
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A serious complication of penile girth enhancement with acellular dermal matrix(ADM) patch is large area penile skin necrosis. Since the penile skin has characteristics such as thin, elasticity, pliability, and durability to withstand erection and friction, the repair surgery is often difficult to achieve good results. Furthermore, the implantation of ADM patch increases the difficulty of surgery. From March 2014 to August 2019, a total of 13 patients with skin necrosis after penile girth enhancement with ADM patch were treated in our center.The debridement and change dressing, according to the condition of the necrotic skin of penis, were performed in all patients. 7 patients used the repairing method of scrotal skin flap via one side scrotal artery, 6 patients used the repairing method of full thickness skin graft. The penile function was not affected with 6 to 12 months′ follow-up after surgery and the curative effect was satisfactory.
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Objective:To investigate the repair method and curative effect of iatrogenic penis skin necrosis of varying degrees.Methods:From June 2016 to December 2018, a total of 20 patients with varying degrees of iatrogenic penis skin necrosis were treated in our center. According to the area of the necrotic skin of penis, different treatment methods were selected: 2 patients with change dressing; 9 patients with relaxation suture; 7 patients with scrotal skin flap based on one side anterior scrotal artery; 2 patients with penile embedded in scrotum and secondary repair.Results:All patients were cured, there was no infection and flap necrosis. All of the patients were satisfied with the appearance of the penis, the flaps of anterior scrotal artery flap and scrotal pedicle embedding the penis survived well and the penis erectile function was not affected during the follow-up for 6 to 12 months.Conclusions:For patients of varying degrees of iatrogenic penis skin necrosis, individualized treatment should be adopted, which can effectively repair the penile defects and achieve satisfactory effect.
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Objective:The clinical characteristics of critical COVID-19 patients with pneumothorax after mechanical ventilation were retrospectively analyzed to provide reference for epidemic prevention and treatment.Methods:A retrospective analysis was made on 130 cases of COVID-19 critically patients admitted from January 1, 2020 to February 13, 2020 in Jinyintan Hospital of Wuhan.The clinical characteristics, mechanical ventilation related pneumothorax and treatment were analyzed.Results:Among the 130 patients with COVID-19 in critical condition, 7 (5.38%)cases had mechanical ventilation related pneumothorax (including bilateral and unilateral pneumothorax). All the 7 pneumothorax patients received bedside closed drainage, oxygen saturation and oxygen partial pressure were significantly improved after closed thoracic drainage.No statistical differences were found in other indexes (pH, lactic acid, PCO 2, oxygenation index). Conclusion:For large critical COVID-19 care centers, the involvement of thoracic surgeons are recommended to deal with the thoracic complications associated with mechanical ventilation. After the occurrence of pneumothorax, if there are no other obvious contrainstances, thoracic closed drainage should be given in time.
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Objective:To investigate the clinical effect of platelet rich plasma combined with autologous fat free grafting in penile enlargement.Methods:From February 2015 to April 2016, In our department, 18 patients (aged 21-42 years, average 30.5 years) underwent penile thickening. Platelet rich plasma was prepared from peripheral venous blood, Then liposuction in the thigh root to obtain autologous fat and purification, Platelet rich plasma combined with autologous fat mixture with 1∶3 ratio, then injected between the superficial fascia and deep fascia of penile.Results:18 patients Were followed up for 6 to 12 months postoperatively, The penile circumference increased by 2.80 cm average, patients were satisfied with the appearance of the penis, No complications occured such as infection and fat liquefaction, less fat absorption, of which 10 cases were married sex life satisfactory.Conclusions:Platelet rich plasma combined with autologous fat free grafting penile enlargement contributes to the survival of grafting fat and reduces fat absorption. The penis appearance is fine with satisfactory effect.
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Objective:To investigate the method and effect of acellular dermal matrix (ADM) allograft combined with fat grafting for penile augmentation.Methods:The first phase of enhancing the penile augmentation was using the dual plane approach with acellular dermal matrix, and the second phase was injecting autologous fat into the layer between dartos fascia and buck fascia.Results:23 patients were followed up for 6 months after operation, their penile circumference at flaccid after the operations (11.08±1.67) cm was increased significantly compared to that before the operations (7.87±1.08) cm. All patients were satisfactory with the cosmetic and functional results, and no fat liquefaction, necrosis and other complications happened.Conclusions:Acellular dermal matrix allograft combined with fat injection is an effective and safe way for penile augmentation, which has the characteristics of good shape and few complications.
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@#Objective To explore the safety and feasibility of the application of video-assisted thoracic surgery (VATS) anatomic segmentectomy in single-stage bilateral thoracic surgery for the treatment of bilateral localized bronchiectasis. Methods From June 2014 to June 2018, 19 patients with bilateral localized bronchiectasis underwent single-stage bilateral thoracic surgery with VATS anatomic segmentectomy, including 11 males and 8 females aged 38.0±12.5 years. The clinical efficacy of the surgery was evaluated. Results All surgeries were successfully completed, of which 17 were bilateral VATS, 2 were unilateral VATS with the other lateral converted to thoracotomy. The average number of bilateral resected segments was 4-8 (5.9±1.2). Mean operation time was 330.0±40.0 min and mean blood loss was 150.0±60.0 mL. Mean ventilator-assisted breathing time was 6.0±1.8 h, mean duration of chest-tube placement was 4.0±1.0 d and mean hospital stay time was 14.0±1.5 d. Three patients suffered pulmonary infection and 1 patient received tracheotomy. No perioperative death occurred. Arterial oxygen pressures on postoperative day (POD) 1 (F=340.18, P<0.05) and POD 3 (F=131.26, P<0.05) were significantly lower than that before operation, arterial carbon dioxide pressures on POD 1 (F=46.62, P<0.05) and POD 3 (F=48.21, P<0.05) were significantly higher than that before operation, and pulse oximeter saturation on POD 1 was significantly lower than that before operation (F=210.82, P<0.05). The patients were followed up for one to five years without recurrence. Conclusion Application of VATS anatomic segmentectomy in single-stage bilateral thoracic surgery for the treatment of bilateral localized bronchiectasis is safe and feasible with strictly selected patients. Postoperative airway management is very important. The surgery is worthy of wide clinical practice.
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Cerebral developmental venous anomaly (DVA) is a kind of benign vascular malformation that mainly occurs supratentorially.Its diagnosis mainly depends on imaging examination.It is often misdiagnosed or missed because of low incidence and atypical clinical manifestations.This article reviews the etiology,pathogenesis,clinical manifestations,imaging features,and prognosis of DVA.
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OBJECTIVE： To study the protective effects of Qizhi tongluo capsules and their 9 ingredients decomposed recipes for promoting blood circulation and removing blood stasis （PBCRBS） on cerebral ischemia-reperfusion injury model rats， and to lay a foundation for studying the active components of Qizhi tongluo capsules through decomposed recipes. METHODS： Totally 60 SD rats were randomly divided into sham operation group （0.5％ CMC-Na）， model group （0.5％ CMC-Na）， Qizhi tongluo capsules without the ingredients for PBCRBS group [0.389 g/（kg·d）]， the ingredients of Qizhi tongluo capsules for PBCRBS group [0.253 g/（kg·d）] and Qizhi tongluo capsules group [0.500 g/（kg·d）]， with 12 rats in each group. The rats were given relevant medicine intragastrically， once a day， for consecutive 14 d. 2 h after last medication， except for sham operation group， cerebral ischemia- reperfusion injury model was induced by suture method in each group. The neurological function score was measured according to Bederson score 2 h after ischemia and 24 h after reperfusion. The area of cerebral infarction was calculated by TTC staining. The contents of NO， MDA， LDH and SOD in cerebral tissue of rats were measured by biochemical method. The contents of IL-1β and TNF-α in cerebral tissue of rats were detected by ELISA. RESULTS： Compared with sham operation group， the neurological function score， the infarct area and the contents of NO， MDA， LDH， IL-1β and TNF-α in cerebral tissue were significantly increased in model group （P＜0.05）. The content of SOD in cerebral tissue were decreased significantly （P＜0.05）. Compared with model group， the neurological function score of rats was decreased significantly in each administration group （P＜0.05）； the area of cerebral infarction， the contents of NO， MDA， LDH， IL-1β and TNF-α in cerebral tissue were decreased significantly （P＜0.05）， while the content of SOD in cerebral tissue was increased significantly （P＜0.05）. Compared with Qizhi tongluo capsules group， the area of cerebral infarction， the contents of NO， MDA， LDH， IL-1β and TNF-α in cerebral tissue were increased in the ingredients of Qizhi tongluo capsules for PBCRBS group and Qizhi tongluo capsules without the ingredients for PBCRBS group （P＜0.05）， the content of SOD was decreased significantly （P＜0.05）. CONCLUSIONS： The formulation of Qizhi tongluo capsules and their 9 ingredients decomposed recipes for PBCRBS （without 9 ingredients for PBCRBS） have protective effects on cerebral ischemia-reperfusion injury in rats. Although the protective effects of decomposed recipes for PBCRBS is not as good as that of the whole prescription， the protective effects of whole formulation were decreased significantly. It shows that the drugs for PBCRBS play an important role in protecting the function of cerebral ischemia reperfusion injury. It is of certain significance to separate the ingredients for PBCRBS to clarify the effect of Qizhi tongluo capsules.
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Objective@#To investigate the effect of mediastinal lymph node resection, metastasis status and treatment on the prognosis of patients with stage Ⅲ-pN2 non-small cell lung cancer (NSCLC).@*Methods@#Clinical data of 206 patients who were pathologically diagnosed as stage Ⅲ-pN2 NSCLC in Tongji Hospital from July 2006 to Dec 2009 were retrospectively analyzed and followed up. Log rank test and Cox proportional hazards regression model were used to analyze the prognostic significance of mediastinal lymph node excision, metastasis state and treatment.@*Results@#The median overall survival (OS) time of the whole group was 29.6 months, and the median disease-free survival (DFS) time was 27.2 months. Univariate analysis showed that the less number of mediastinal lymph node stations with metastasis (single station), the less number of mediastinal lymph nodes involved (less than 2), and postoperative chemotherapy were associated with longer postoperative OS and DFS time (P<0.05 for all). The patients with skip metastasis, negative metastasis of subcarinal lymph node, the lower mediastinal lymph node metastasis rate (MLNR<33%) and postoperative radiotherapy had longer OS and DFS time than those without these factors (P<0.05 for all). Multivariate analysis showed that metastasis of subcarinal lymph node, MLNR and postoperative chemotherapy were the independent prognostic factors for patients with stage Ⅲ-pN2 NSCLC (P<0.05 for all).@*Conclusion@#Metastasis of subcarinal lymph nodes and the higher MLNR might shorten the postoperative survival time of NSCLC patients with stage Ⅲ-pN2, whereas postoperative chemotherapy prolongs the survival time.
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Objective@#To investigate the effect of UCHL5 on proliferation and apoptosis of breast cancer cells.@*Methods@#SW527 cells were infected with lentiviral vector carrying short hairpin RNA to delete the expression of UCHL5. 3-(4, 5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) assay was used to examine cell proliferation, and subcutaneous transplantation experiments were performed to detect tumor growth. Cell apoptosis was detected using Annexin V/ Propidium iodide (PI) double staining. The correlation between UCHL5 expression and the expressions of proliferation and apoptosis associated genes was analyzed using TCGA breast invasive carcinoma data set. The relationship between UCHL5 expression and breast cancer patients′survival was analyzed using Kaplan-Meier Plotter online tool.@*Results@#After knockdown of UCHL5, A values of SW527 cells on day 2 and day 4 were 0.822±0.017 and 1.045±0.023, respectively, which were significantly lower than 0.976±0.016 and 1.284±0.025 of control cells on day 2 and day 4 (P<0.001). In vivo xenografted mouse model, the volume in UCHL5-suppressed group was (166.90±75.05) mm3, significantly smaller than (329.80±35.84) mm3 in control group (P=0.029). Flow cytometry analysis showed the apoptotic rate of SW527 cells was (8.60±1.13)% after knockdown of UCHL5, significantly higher than (2.95±0.07)% of control group (P=0.020). TCGA database analysis showed that the expression of UCHL5 was positively correlated with the expressions of genes related to cell proliferation, in paralled with the increased expression of UCHL5, the expression of the pro-apoptosis associated genes was decreased. Kaplan-Meier Plotter analysis demonstrated that the overall survival and relapse-free survival of breast cancer patients with high expression of UCHL5 were much shorter (all P<0.001).@*Conclusions@#Down-regulation of UCHL5 inhibits the proliferation and tumor formation and promotes apoptosis of SW527 cells. High expression of UCHL5 may predict poor prognosis of breast cancer patients.
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Background:TLR4/NF-κBp65 signaling pathway plays an important role in triggering inflammatory response,and regulates releasing of cytokines in acute pancreatitis. However,the role of this pathway in inflammation in severe acute pancreatitis(SAP)associated with acute kidney injury(AKI)is not clear. Aims:To investigate the effect of TLR4/NF-κBp65 signaling pathway on AKI in experimental SAP. Methods:Thirty-two male Sprague-Dawley rats were randomly assigned into 4 groups(8 each):normal control group,SAP 6 h,12 h,and 18 h groups. SAP was induced by retrograde injection of 4% sodium taurocholate into biliopancreatic duct. Serum levels of creatinine(Cr)and blood urea nitrogen (BUN)were measured dynamically. Pathological changes of kidney were observed macro- and microscopically. Serum levels of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were determined by ELISA,and the localization and expressions of TLR4 and NF-κBp65 in kidney were determined by immunohistochemical staining and Western blotting. Results:Compared with normal control group,the kidney injuries in SAP groups were gradually aggravated with disease progression;meanwhile,serum levels of Cr,BUN,TNF-α and IL-6 increased significantly,and the expressions of TLR4 and NF-κBp65 in kidney became more intensive(P all <0.05). Expressions of TLR4 and NF-κBp65 in kidney were positively correlated with the serum levels of Cr,BUN,TNF-α and IL-6. Conclusions:In experimental SAP,the changes of TLR4 and NF-κBp65 expressions in kidney are coincidence with the severity of kidney injury and the serum levels of proinflammatory cytokines,which indicates that TLR4/NF-κBp65 signaling pathway plays an important proinflammatory effect in disease progression of SAP associated with AKI.
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Objective To study the effect of continuous positive airway pressure (CPAP) treatment on the endothelial function in patients with obstructive sleep apnea (OSA). Methods This study strictly followed the PRISMA principle. PubMed, Web of Science and the Cochrane Collaboration Database were searched on randomized controlled trials (RCT) which assessed the effects of CPAP on endothelial function of OSA patients from 1992 to 2013. The parameters of endothelial function evaluation included endothelium-dependent vasodilation function (EDV) and endothelium-independent vasodilation function (EIV). EDV was used to detect flow mediated dilation (FMD) and reactive hyperemia index (RHI), and EIV was used to detect nitroglycerin-induced dilation (GTN-ID). Results A total of 4 articles (137 patients) were selected. Meta-analysis results showed that CPAP significantly altered the overall EDV: standardized mean difference ( SMD )＝1.42, 95% CI 0.45 to 2.38, P＝0.004; and the FMD was significantly improved: weighed mean difference ( WMD ) ＝ 3.94, 95% CI 1.30 to 6.57, P ＝ 0.003. CPAP did not significantly alter the GTN-ID: WMD ＝ -0.71, 95% CI 2.69 to 1.26, P ＝ 0.48. Conclusions Using CPAP to treat OSA patients is beneficial to promoting overall EDV improvement, but the EIV has not improved significantly.
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Fornix infarction is a kind of cerebral infarction in special sites with memory disorder as its main manifestation, which is rare in clinical practice. Because the isolated fornix infarction is not often accompanied by obvious positive signs of nervous system, the patients complained fewer symptoms. The related manifestations were mostly provided by family members, which is prone to misdiagnosis and missed diagnosis. This article reviews fornix infarction from the aspect of anatomy, blood supply, infarction etiology, clinical manifestations, possible mechanisms, and imaging features by summarizing the available case reports.
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Objective To study the effect and mechanism of senegenin on proliferation and differentiation of neural stem cells (NSCs). Methods The primary cultured NSCs were divided into the high-dose, medium-dose, low-dose group and normal control group (NC). The complete medium containing 10, 20 and 40 μmol/L senegenin was added to senegenin low-, middle-, and high- dose groups, and the NC group was routinely cultured. After 4 days of culture, CCK8 assay was used to detect cell viability, and microscopy was performed and the number of neurospheres was counted. Western blot was used to detect the expression of Nestin, TUJ1, GSK-3β, and p-GSK-3β (Ser9), and immunofluorescence staining was used to visualized Nestin and TUJ1. Results Compared with the control group, the number of NSCs neurospheres (32.78 ± 6.30, 40.93 ± 8.34, 45.37 ± 7.96 vs. 26.48 ± 5.19) and the proliferation (127.50% ± 9.31%, 138.13% ± 6.88%, 151.25% ± 9.38% vs. 100.00% ± 5.63%) in the low-, middle- and high-doses of senegenin group significantly increased (P<0.05 or P<0.01).The expression of TUJ1(2.21 ± 0.14,3.10 ± 0.16,3.30 ± 0.15 vs.1.00 ± 0.00)in the low-,middle- and high-doses of senegenin group significantly increased (P<0.05); and the expression of Nestin (0.36 ± 0.04,0.53 ± 0.05,0.46 ± 0.05 vs.1.00 ± 0.00)significantly decreased(P<0.05).The ration of p-GSK-3β(Ser9)/GSK-3β(2.31 ± 0.17,3.41 ± 0.11,3.59 ± 0.16 vs.1.00 ± 0.00)in the low-,middle-and high-doses of senegenin group significantly increased(P<0.01).The cell number of Nestin+(50.29 ± 3.18,45.28 ± 6.23,38.72 ± 5.31 vs. 75.27 ± 6.03) in the low-, middle- and high-doses of senegenin group significantly decreased (P<0.05 or P<0.01), and the cell number of TUJ1+(32.23 ± 4.36,38.23 ± 6.01,46.23 ± 4.36 vs.20.31 ± 5.23)significantly increased (P<0.01). Conclusions The senegenin may promote the proliferation and differentiation of NSCs through the activation of Wnt pathway.
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Objective To investigate the effect of superomedial pedicle reduction mammaplasty in the treatment of severe gynecomastia.Methods 24 males with severe gynecomastia were involved in this study,who underwent superomedial pedicle reduction mammaplasty.Results All the patients were followed up for one to two years,and there were no complications such as skin necrosis,nippleareolar complex (N A C) hypaesthesia,hematoma or infection occurred.Minimal wound dehiscence occurred in two cases,and the rest cases were healed well.Conclusions Superomedial pedicle reduction mammaplasty in the treatment of severe gynecomastia could achieve satisfactory results,and good breast shapes are produced.
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Objective To discuss the reasons of iatrogenic nipple-areola necrosis and to investigate clinical effect of nipple-areola reconstruction by three-bladed flap combined with free skin graft.Methods Between May 2012 and May 2015,13 patients with nipple-areola necrosis caused by iatrogenic reasons were treated with our new method.We designed a skate flap on the new nipple site.After incising skin,three-bladed flap was cross-stitched to form a new nipple.New areola was reconstructed by free skin graft,which was obtained from perineum or contralateral areola,and margin of the donor area was sutured after proper free from surrounding tissues.Being deducted subcutaneous tissue,the full-thickness skin graft was sutured around the nipple just like letter O.After operation,the areola area was pressurized bandaging,and the nipple was drawn by silk at least one month.Results The incisions were all primary healing.Over a mean period of 8 months (range 6-18),all patients were satisfied with the results.No significant asymmetry occured.The average nipple retraction rate was 10.03％.In 13 patients,there was no infection,bleeding or hematoma and skin flap necrosis.Conclusions Nipple-areola necrosis occurs when the blood supply is not protected carefully during a breast plastic surgery.Therefore,we take full advantage of the scar tissue which has hyperpigmentation.Reconstructive nipple-areola complex has good shape,and there is no need to tattoo after operation.