Table of Content

21 July 2019, Volume 40 Issue 4

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Cutting-edge Orthopedic Technological and Academic Forum

Clinical strategy on reconstruction of thoracic and lumbar deformity in scoliosis surgery

Wu Yuxuan, Hai Yong, Pan Aixing

2019, 40(4):  491-496.  doi:10.3969/j.issn.1006-7795.2019.04.001

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Interactions between spine,ligament and muscle contribute to the balance of human body. Patients with spinal deformity often have various degree of imbalance and suffer from fatigue,pain and disability when imbalance is out of range. In the treatment of spinal deformity,it is important to reconstruct sagittal alignment for restoring spinal balance,improving clinical outcome, and lowering the risk of post-operative complications.

Surgical treatment of degenerative rigid cervical kyphosis by anterior trans-intervertebral osteotomy

Cui Wei, Wang Lei, Ma Song, Liu Baoge

2019, 40(4):  497-502.  doi:10.3969/j.issn.1006-7795.2019.04.002

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Objective To review technique, evaluate surgical outcomes and the treatment strategy of anterior trans-intervertebral osteotomy (ATIVO) for degenerative rigid cervical kyphosis.Methods A retrospective analysis was performed based on 47 cases of degenerative cervical kyphosis from 2012 to 2016, using ATIVO for deformity correction. Totally 29 males, 18 females, aged 38-73 years. AVTIO was performed for total of 83 segments (16 cases of C3/4, 24 cases of C4/5, 25 cases of C5/6, 16 cases of C6/7, 2 cases of C7/T1). There were 17 cases in single segment, 24 cases in double segment (6 cases in jumping segment), and 6 cases in 3 segments. Intervertebral disc and posterior longitudinal ligament (PLL) were removed through the intervertebral space. Bilateral saddle joints were partially resected and released. The osteotomy surface of the vertebral body was about 10-15 degrees, at least 2/3 endplate was retained. To improve kyphosis correction, intraoperative intervertebral distractor and, cage with appropriate size and angle was used, the pillow was adjusted and the neck extension angle was changed. Self-locking cage or cage with plate were used for fusion and fixation. Microscopy and high-speed drill were used to perform osteotomy. IONM was performed by using DSEP, MEP and free-run EMG. The C2-C7 Cobb angle, cervical sagittal vertical axis (cSVA) and osteotomy effect were evaluated by X-ray and CT before and after operation. Visual Analogue Score (VAS), Neck Disability Index (NDI),modified Japanese Orthopaedic Association Score (mJOA) were used to evaluate the clinical efficacy.Results All 47 patients were followed up for at least one year, with an average follow-up time of 20 months (12 months to 5 years). The average operative time was 109 minutes (55-140 minutes) and the bleeding volume was 46 mL (25-110 mL). There were 3 cases of shoulder pain, 5 cases of C5 nerve root palsy and no vertebral artery injury. At the last follow-up, VAS, NDI and mJOA were improved to 2.6±1.7, 34.8±21.6, 14.5±1.3 (paired T test, P<0.01) by 7.2±1.5, 64.5±17.4 and 10.5±0.9 before operation. CT showed that the osteotomy segment was bone union. The C2-C7 Cobb angle was changed from 13.6±5.1 to -7.4±3.6 degrees; the average segmental correction angle was 7.4° (5.3°-9.6°) per segment, and the C2-C7 SVA was changed from (55.7±13.8)mm to (31.4 ±8.2)mm (P<0.01).Conclusion The ATIVO technique has satisfied clinical outcomes for rigid degenerative cervical kyphosis. The advantages of AVTIO is:it could correct cervical kyphosis, restore the overall curvature of the cervical spine, and prevent from the trend of sagittal imbalance. The AVTIO procedure has minor bone loss and does not affect the fusion rate. It can be performed with multiple segments to improve the effect of deformity correction. It is suitable for cervical kyphotic deformities caused by intervertebral disc and saddle joint.

Clinical efficacy and cervical sagittal balance after posterior open-door laminoplasty with mini-plate and anchor

Li Dongyue, Hai Yong, Liu Yuzeng, Guan Li, Meng Xianglong

2019, 40(4):  503-509.  doi:10.3969/j.issn.1006-7795.2019.04.003

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Objective To investigate clinical efficacy and cervical sagittal balance after posterior open-door laminoplasty with mini-plate and anchor.Methods From January 2016 to December 2017, 61 patients with multilevel cervical spondylotic myelopathy were retrospectively studied in our department. According to the different fixation methods, all patients were divided into cervical posterior open-door Centerpiece fixation group(group A, 29 cases)and cervical posterior open-door anchor fixation group(group B, 32 cases).The important clinical data were recorded, including operation time, intraoperative bleeding volume, Visual Analogue Score (VAS) of cervical pain, Japanese Orthopaedic Association (JOA) score, improvement rate of spinal nerve function and Neck Disability Index (NDI) of cervical spine at pre- and post-operation of 12 months. This parameters were compared at pre-operation, 3 days and 12 months after surgery, which were the distance between the vertical axis of C2 sagittal plane and the posterior superior edge of C7 (C2-7 SVA), the inclusion angle of tangent between C2 and C7 trailing edge (C2-7 Cobb angle), and the intersection angle between the upper edge of T1 and the horizontal line (T1 Slope).Results The age, disease duration, VAS, JOA score and NDI score were no statistical difference between the two groups before operation(P>0.05). There were no significant difference in operation time and bleeding volume between the two groups(P>0.05). After surgery, the VAS and NDI score in the two groups were significantly lower than those before operation, but the JOA score was higher. At 12 months after surgery,the NDI score in group A was better than that in group B(P<0.05), while there was no statistical difference in the others between the two groups (P>0.05).In radiological parameters, compared with pre- and post-operation, C2-7 SVA and T1 Slope in both groups increased, while the C2-7 Cobb angle decreased(P<0.05). But there were statistical differences in C2-7 SVA at 12 months after operation(P<0.05), while other parameters were no differences (P>0.05). Before and 12 months after operation, C2-7 SVA difference was negatively correlated with NDI score difference (P<0.05). Conclusion Both surgical methods caused anteversion of cervical spine, but cervical sagittal balance and function after mini-plate is better than that of anchor.

Meta analysis of cortical bone trajectory screw and pedicle screw in posterior thoracic and lumbar fusion

Zhang Tianqing, Zhang Xino, Han Bo, Li Yue, Pan Aixing, Liu Tie, Hai Yong, Guan Li, Liu Yuzeng

2019, 40(4):  510-516.  doi:10.3969/j.issn.1006-7795.2019.04.004

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Objective To evaluate the application of cortical bone trajectory screw (CBT) and traditional pedicle screw (PS) in posterior thoracic and lumbar surgery with Meta analysis. Methods A comparative study of all CBT and PS before February 2019 was searched with Pubmed and Wanfang data. Inclusion criteria:1Comparative study of CBT and PS in posterior thoracic and lumbar fusion;2All of them were operated by hand and did not involve special navigation system;3Posterior open surgery. Exclusion criteria:1Combined anterior and posterior surgery;2A special navigation system was used;3A percutaneous nailing technique was used. The data were extracted and sorted with Excel software and Revman 5.3.5 was used for data analysis. The subjects included fusion, intraoperative estimated blood loss, volume, operation time, hospitalization time, postoperative complications, and Oswestry Disability Index (ODI) score. Results A total of 13 literatures including 12 English and 1 Chinese literatures were included in this study, with 2 randomized controlled trial (RCT) and the rest cohort studies. The total number of people included was 855. ①Last fusion:there was no good reason to believe that there was a difference in integration. ②The amount of intraoperative blood loss:the intraoperative bleeding of CBT was lower than that of PS, with significant difference. ③Operation time:in posterior open surgery, the operation time of CBT was significantly lower than that of PS, with statistically significant difference. ④Hospital stay:compared with PS surgery group, hospitalization time after CBT operation was shorter, with statistically significant difference. ⑤Concurrent development syndrome:the overall incidence of complications of CBT surgery was lower than that of PS, with statistical significance. However, there was no good reason to support the difference in the incidence of intraoperative dural leakage between the two groups. ⑥The ODI score of the last follow-up:there was no good reason to support the difference between CBT and PS in the last ODI score after operation. Conclusion The results of this study show that CBT is superior to PS in evaluating blood loss, complications, operation time and hospitalization time during operation, but in dural injury and fusion rate, there was no sufficient reason to confirm the difference in ODI score after the last follow-up.

A comparative analysis of IPP test and traditional method on the diagnosis of sacroiliac joint dysfunction

Lyu Zhen, Hong Yi, Bai Jinzhu, Zhang Junwei, Tang Hehu, Wang Fangyong, Liu Shujia, Chen Shizheng, Liu Jiesheng

2019, 40(4):  517-521.  doi:10.3969/j.issn.1006-7795.2019.04.005

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Objective To explore the effect and clinical significance of abbreviations for three clinical trials which include iliac pronation test,pubic tubercle tenderness test,and plantar fascia tenderness test (IPP test) on the diagnosis of sacroiliac joint dysfunction by comparing with traditional diagnostic methods.Methods From June 2018 to March 2019,30 patients with sacroiliac joint dysfunction and 30 normal controls were selected to receive the IPP method and traditional diagnostic method respectively,which including several examinations of sacroiliac joint dysfunction, finally,the diagnosis was confirmed by sacroiliac joint injection. The sensitivity,specificity,receiver operating characteristic (ROC) area and sensitivity of the two diagnostic methods for sacroiliac joint dysfunction were compared. Results There was no significant difference between the experimental group and the control group on sex (10 males,20 females:12 males and 18 females) (χ²=0.287.38,P=0.592),and on age[(43.4±11.6) years vs (42.0±14.1)years] (t=0.400,P=0.691). The sensitivity,specificity and area under ROC curve of the traditional method were 33.3%,96.7% and 0.650 (P=0.046). The sensitivity,specificity and area under ROC curve of the IPP method were 76.7%,96.7% and 0.867 respectively (P<0.001). Also the sensitivity between the two diagnostic methods was significantly different (χ²=11.38,P=0.001).Conclusion The IPP method of sacroiliac joint dysfunction has higher diagnostic sensitivity. For patients suspected of sacroiliac joint dysfunction,comprehensive physical examination should be carried out to make early diagnosis,avoid missed diagnosis and reduce the risk of fail back surgery syndrome.

Modified open-door laminoplasty with C₃ laminectomy and reconstruction of C_4-7 spinous processes

Zhang Genai, Hou Yu, Chen Yingchun, Ding Lixiang

2019, 40(4):  522-527.  doi:10.3969/j.issn.1006-7795.2019.04.006

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Objective To improve the open-door laminoplasty based on the preservation of the semispinalis cervicis, and to investigate the curative effect and to explore whether the complications can be reduced. Methods Reconstruction group(45 cases) and common group (39 cases), followed up for 18-24 months. The range of motion, Japanese Orthopedic Association Scoring System (JOA) score and severity of axial symptoms were compared after surgery. Results There was no significant difference in the loss of range of motion between the two groups (9.4°±4.1° vs 11.6°±7.8°) and the recovery rate of JOA score (57.7% vs 54.4%) (P>0.05). However, there was a significant difference between the incidence of axial symptoms before and after surgery of the two groups (P<0.05). Conclusion Reconstruction of the spinous processes of C_4-7 can further reduce the incidence of axial symptoms while retaining the C₂ spinous process.

Characteristics of posterior condylar offset and ratio in osteoarthritis and relationship between posterior condylar offset/posterior condylar offset ratio and posterior tibial slope

Zeng Junjie, Guo Ai

2019, 40(4):  528-532.  doi:10.3969/j.issn.1006-7795.2019.04.007

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Objective To analyze the difference of posterior condylar offset(PCO) and posterior condylar offset ratio(PCOR) in different sex or level groups and figure out the relationship between the PCO/PCOR and posterior tibial slope(PTS). Methods Totally 200 patients diagnosed with osteoarthritis of knee during February 2018 to June 2018 were rolled in, including 63 men(112 knees) and 137 women(249 knees). The osteoarthritis level was evaluated, PCO and anterior-posterior dimension(ACP) of distal femur was measured and the PCOR(PCO/ACP) was evaluated through anterior and lateral radiographs of the knee. Two-ways ANOVA was used to analyze the difference of PCO/PCOR in different groups, Pearson relation analysis was used to analyze the relationship between the PCO/PCOR and PTS. Results The PCO of male was larger than level-matched female; there was no difference in PCOR between male and female. There was no difference in PCO and PCOR of female among three levels. The male in level Ⅱ have smaller PCO than level Ⅲ and IV (P=0.004, P=0.008), no more difference found between level Ⅲ and IV; and there was no difference exists in PCOR of male among three levels. PCO was not related to PTS in neither sex nor level groups, the relationship between the PCOR and PTS only depends on the level rather than the sex, and this relationship only exists in level Ⅱ(r=0.226 9, P=0.02). Conclusion The osteoarthritis progression has much more influence on male than female. Hyperostosis and osteophyte have no effect on anatomical characteristics of distal femur, but on the anatomical relationship between femur and tibia. The relationship between PCOR and PTS is gradually disappearing with disease progression.

Gynecological Endocrinology and Menopause

Effect of tamoxifen on Ki-67 expression in breast tumor tissue of nude mice transfected with progesterone receptor membrane component 1

Zhang Lingyan, Ruan Xiangyan, Cai Guiju, Gu Muqing, Alfred O. Mueck

2019, 40(4):  533-538.  doi:10.3969/j.issn.1006-7795.2019.04.008

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Objective To investigate the effect of tamoxifen (TAM) on the expression of proliferative index Ki-67 in breast cancer tissue of MCF-7 breast cancer model transfected with progesterone receptor membrane component 1 (PGRMC1) and its mechanism. Methods MCF-7 cells of breast cancer were cultured, incubated and subcultured, transfected with PGRMC1 (MCF-7-HA-PGRMC1) or empty plasmid (MCF-7-HA-vector), and then they were inoculated into randomly grouped castrated nude mice, including experimental group and control group. Estradiol (E2) sustained release tablets were embedded in 48 castrated nude mice for 48h,then the above two kinds of cells were inoculated into nude mice as experimental group and control group respectively. Additionaly placebo, progesterone, tamoxifen, tamoxifen and progesterone were administrated to each group. After 56 days of implantation, euthanasia was performed. Breast tumor tissues were removed completely under aseptic operation and Ki-67 expression was detected with immunohistochemistry. Results Ki-67 expression in tumor tissues of the experimental group significantly increased compared with that of the control group (P<0.001). In the experimental group, compared E2, E2+TAM combined therapy could reduce the expression of Ki-67 in tumor tissues, with statistically significant difference (P<0.001). However, E2 + progesterone did not promote the expression of Ki-67 (P>0.05). The expression of Ki-67 in E2+progesterone+TAM group significantly lower than that in estradiol +alone (P<0.001). Conclusion PGRMC1 increased the expression of Ki-67 and accelerate cell proliferation. Tamoxifen therapy antagonized pgrmc1-induced proliferation of breast tumor cells by reducing the expression of Ki-67.

Tamoxifen treated breast cancer xenograft in nude mice and uterine pathological changes

Wang Yuejiao, Ruan Xiangyan, Gu Muqing, Cai Guiju, Li Xue, Zhang Lingyan, Alfred O. Mueck

2019, 40(4):  539-543.  doi:10.3969/j.issn.1006-7795.2019.04.009

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Objective To investigate the pathological changes of uterus in nude mice with breast cancer xenograft treated with tamoxifen (TAM), and effect of progesterone treatment on the proliferation of breast cancer and therapeutic efficacy of tamoxifen. Methods Prospective, randomized, placebo-controlled four-arm study in xenotransplantations:MCF7 cells were injected into nude mice. Estradiol (E2) pellets were implanted. After 43 days, the breast cancer xenograft was treated with progesterone (P) or TAM or TAM plus P or placebo. All four groups (6 mice/group) were further monitored for 56 days. After 56 days, the mice were sacrificed and take the tumor and uterus. Fresh tissue was immediately stored in 4% paraformaldehyde for hematoxylin and eosin (HE) staining and tumor growth curve mapping.Results Tumor growth curve showed that progesterone group did not promote additional proliferation of breast cancer compared with placebo group (P>0.05). Breast cancer tissue volume decreased significantly after tamoxifen treatment (P<0.01). The HE staining result showed that the tumor tissue was loose connective and the number of tumor cells decreased. Endometrium HE staining showed that the number of glands increased, and glands cells were hyperchromatic, some of which presented atypia and pathological results of endometrial dysplasia. Compared with the placebo group, the number of endometrial glands increased significantly after tamoxifen treatment (P<0.01), while that of the progesterone group did not increase (P>0.05). Conclusion In the nude mice with breast cancer, the tumor volume was significantly reduced after tamoxifen treatment, but the glands were increased, indicating endometrial dysplasia. Progesterone alone did not promote the obvious proliferation of xenotransplantations, without obvious endometrial hyperplasia, Therefore the application of progesterone did not significantly antagonize tamoxifen.

A study on the relationship between ovarian tissue viability and time under normal temperature after thawing

Jin Fengyu, Ruan Xiangyan, Alfred O. Mueck, Du Juan, Li Yanglu, Cheng Jiaojiao, Wang Husheng

2019, 40(4):  544-548.  doi:10.3969/j.issn.1006-7795.2019.04.010

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Objective To estimate the thawed ovarian tissue viability and explore the feasibility of short distance transportation after thawing different periods at room temperature conditions. Methods Thirteen patients in total,9 samples (2 mm in diameter) were obtained from each patient. One fresh sample was performed follicle counts and the other 8 samples were cryopreservatethawed and randomly divided into 4 groups depends on the time after thawing,that means group 1(0 min), group 2(20 min), group 3(40 min), group 4(60 min). Viable follicle counts,steroid hormone lactic acid and glucose metabolism were performed. Results There were no statistical differences in follicles viability between the fresh group and 4 groups after thawing. And no statistical differences in follicles viability,steroid hormone, lactic acid and glucose metabolism between 4 groups after thawing. Conclusion The ovarian tissue viability did not be impaired after thawing at room temperature in one hour.

Clinical application of mini-hysteroscopy in infertility patients

Ruan Xiangyan, Zhang Luping, Dai Yinmei, Wang Husheng, Jin Fengyu, Gu Muqing, Cheng Jiaojiao, Ju Rui, Min Min, Thomas Roemer

2019, 40(4):  549-553.  doi:10.3969/j.issn.1006-7795.2019.04.011

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Objective To investigate the clinical application of mini hysteroscopy in infertility patients. Methods From Sep 2017 to Jan 2019, 159 cases of infertility patients were enrolled, who have accepted mini-hysteroscopy examination in the Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. The patients who had primary ovary insufficiency, tubal infertility were excluded, patients with hysteroscopy contradiction, such as acute or sub-acute vaginal tract inflammation, endometrium lesion or endometrium carcinoma, severe cardiovascular, liver or kidney insufficiency were excluded. Twelve patients lost follow. 110 patients were eventually included in the analysis. The patient's age, body mass index (BMI), infertility etiology, preoperative and postoperative stimulate ovulation cycle, pregnancy state and pregnancy time were recorded. The effect of outpatient mini-hysteroscopy on ovulation induction cycle was analyzed in pregnant patients.Results The average age of 110 patients was 31.95±4.86 years old. 77 (70%) patients were found to have intrauterine abnormalities, while 33 (30%) patients were found to have normal intrauterine cavity. 37 cases of pregnancy, accounting for 33.63%. The median of ovulation induction cycles before and after surgery were respectively 3 (0-15)and 1 (0-3), with statistically significant differences between the two groups(P<0.05). Among the 37 pregnant patients, 21 of them had no structural lesions in hysteroscopy. The ovulation induction cycle of these patients before and after hysteroscopy were respectively 5 (0-9) and 1 (0-3), with statistically significant differences between the two groups(P0.05). Conclusion Outpatient mini-hysteroscopy can not only timely detect the intrauterine abnormalities but also provide accurate diagnosis and treatment program, suggesting a great application value for the diagnosis of uterine factors and shorten the ovulation cycle in infertility patients. In polycystic ovarian syndrome (PCOS) patients, the pregnancy rate significantly increased in the short term after mini-hysteroscopy, and the mechanism remains to be explored.

Study on the effect of the ovarian tissue volume on estrous cycle and body weight in rats

Cheng Jiaojiao, Ruan Xiangyan, Zhou Qi, Li Yanglu, Du Juan, Jin Fengyu, Gu Muqing, Alfred O. Mueck

2019, 40(4):  554-559.  doi:10.3969/j.issn.1006-7795.2019.04.012

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Objective To investigate the effect of different ovarian tissue volume on estrous cycle and body weight in rats. Methods Totally 67 10-week-old Sprague-Dawley rats were divided into 6 groups according to removed different ovarian tissue volume after one week's acclimatization. Group A,sham operation group (n=12), Group B,the half of left ovary removed (n=12),Group C,the left whole ovary (n=12),Group D,the left whole ovary and the half of right ovary removed (n=12),Group E,the left whole ovary and the three quarters of right ovary removed (n=12),Group F,both left and right ovaries removed (n=7). The vaginal smear of the rats was monitored for 9 consecutive days at 4 weeks,8 weeks,and 12 weeks after partial ovarian resection,and the body weight of the rats was monitored on the day of surgery,4 weeks,6 weeks,8 weeks,10 weeks,and 12 weeks after surgery. The effects of the ovarian volumes on the estrous cycle and body weight of the rats were analyzed. Results There was a statistically significant difference in estrous cycle between the E group and the F group and the other 4 groups (P<0.05),and the estrous cycle days of Group E,Group F were higher than that of the other 4 groups. Rats of weight in Group F is higher than that in the other 5 groups (P<0.05). Conclusion Removed one and three quarters of ovary imposed an effect on the rat's estrous cycle, and bilateral oophorectomy imposed an effect on rat's body weight.

Effect of Diane-35 treatment on metabolism and sex hormone in women with polycystic ovary syndrome

Gu Muqing, Li Yanglu, Cheng Jiaojiao, Wang Husheng, Ruan Xiangyan, Jia Chanwei

2019, 40(4):  560-565.  doi:10.3969/j.issn.1006-7795.2019.04.013

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Objective To determine the effects of Diane-35 on body composition, glycolipid metabolism and liver and kidney function in patients with polycystic ovary syndrome (PCOS), and to analyze its efficacy and safety.Methods Totally 59 patients with polycystic ovary syndrome were enrolled in this study. Diane-35 was prescribed to them for 3 cycles. After 3 cycles, self-control was conducted, and the monitoring indicators were anthropometric indicators and blood pressure, sugar and lipid metabolism, sex hormone, liver and kidney function.Results Body weight, body mass index (BMI), waist circumference (WC), and hip circumference (HC) were significantly lower than those before pretreatment, while systolic blood pressure (SBP) and diastolic blood pressure (DBP) had no statistical difference. For sugar and lipid metabolism, there was no significant difference in total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), fasting blood glucose (FBG), fasting insulin (FINS) and homeostasis model insulin resistance index (HOMA-IR), fat distribution and percentage of fat. For sex hormone related indicators showed as follow:serum luteinizing hormone (LH), and free androgen index (FAI) decreased significantly; sex hormone binding globulin (SHBG) increased significantly; while total testosterone (TT), dehydroepiandrosterone sulfate (DHEA-S), androstenedione (AND), free testosterone (FT), serum follicle stimulating hormone (FSH) levels were not significantly different. For liver and kidney function:blood urea nitrogen (BUN) was decreased, but there was no significant difference in serum creatinine (Cr), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT). Conclusion Oral contraceptive pretreatment may have a weight-loss effect on PCOS patients, with no significant effect on blood pressure. It can reduce LH level, increase SHBG level and exert the biological effect of inhibiting androgen. Short-term oral contraceptives have no significant effect on liver and kidney function suggesting high safty.

Therapeutic effect of hypoxia-preconditioned human umbilical cord mesenchymal stem cell on premature ovarian insufficiency mouse model

Zhao Yue, Ruan Xiangyan, Wang Fengchun, Li Yanglu, Cheng Jiaojiao, Alfred O. Mueck

2019, 40(4):  566-571.  doi:10.3969/j.issn.1006-7795.2019.04.014

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Objective To investigate the therapeutic effect of hypoxia-preconditioned human umbilical cord mesenchymal stem cells (hUCMSCs) on premature ovarian insufficiency (POI) mice model. Methods hUCMSCs were isolated and cultured from umbilical cord, and POI mice model were induced by busulfan and cyclophosphamide. POI mice were treated with normal hUCMSCs and hypoxic pretreated hUCMSCs. At the end of the experiment, the levels of estradiol (E2), follicle stimulating hormone (FSH) and anti Mullerian hormone (AMH) in the plasma were measured, histopathological examination was performed on ovaries, and the number of follicles was counted. Results Plasma E2 and AMH levels in mice treated with hUCMSCs and hypoxic preconditioned hUCMSCs showed an increasing trend, with a significantly different in AMH levels (P<0.05) compared with the control group. The growth of follicles in the ovarian tissue of the hUCMSCs and hypoxic preconditioned hUCMSCs groups was significantly increased, and the atresia follicles were significantly decreased (P<0.05). The color of the ovary was ruddy, and the size was increased, with almost no necrosis. The follicles were large, with good transparency. The ovarian status of the normal control group was similar, and the number of growing follicles and atresia follicles in the treated groups became more normal. Conclusion hUCMSCs transplantation significantly improved the serum levels of high gonadotropin and low estrogen of POI mice, and promote follicular development.

Effect of orlistat combined intervention on androgen and glycolipid metabolism in overweight or obese polycystic ovary syndrome patients

Min Min, Ruan Xiangyan, Zhao Yue, Wang Husheng, Cheng Jiaojiao, Luo Suiyu, Xu Zhongting, Li Meng, Zhang Luping, Wang Yuejiao, Alfred O. Mueck

2019, 40(4):  572-577.  doi:10.3969/j.issn.1006-7795.2019.04.015

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Objective To investigate the effect of orlistat combined intervention on anthropometry,androgen,glucose and lipid metabolism in overweight or obese patients with polycystic ovary syndrome (PCOS). Methods Totally 75 overweight or obese PCOS patients[body mass index(BMI) ≥ 24kg/m²]were admitted to the Department of Endocrinology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,from May to September 2018,numbered according to the order of treatment and randomly divided into two groups.Group 1 included 50 patients,orlistat plus drospirenone and ethinylestradiol tablets(Ⅱ) (Yaz) comprehensive intervention;Group 2 included 25 patients treated with Yaz alone.The changes of anthropometry,androgen,glucose and lipid metabolism,liver and kidney function indexes before and after 3 months of treatment in the two groups were compared. Results After 3 months of treatment,the body weight,waist circumference,hip circumference and BMI of orlistat plus Yaz comprehensive intervention group and Yaz alone group were significantly decreased,but the decrease of orlistat plus Yaz comprehensive intervention group was significantly greater than those Yaz alone group(P<0.05).Among the hormone indicators, free testosterone (FT),sex hormone-binding globulin(SHBG) of the two groups were significantly changed, but there was no statistically significant difference in the degree of change between the two groups (P>0.05).Glucose and lipid metabolism,liver and kidney function were all changed, and there was no statistically significant difference between the two groups (P>0.05). Conclusion Orlistat combined with Yaz was superior to Yaz alone in decreasing the body weight and waist circumference of overweight or obese PCOS patients,providing a basis for clinical rational drug selection.

Application value of detection of thinprep cytology test and human papillomavirus E6/E7 mRNA in cervical disease screening

Wang Junfei, Shen Shuna, Zhu Ping

2019, 40(4):  578-581.  doi:10.3969/j.issn.1006-7795.2019.04.016

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Objective To investigate the application value of thinprep cytology test (TCT) combined with human papillomavirus (HPV)E6/E7 mRNA detection in cervical disease screening.Methods A total of 538 cases were detected with gynecological disorders received TCT,HPV E6/E7 and colposcopy cervical biopsy. To compare the diagnostic value of TCT or HPV E6/E7 mRNA alone with combined TCT and HPV E6/E7 mRNA in cervical lesion screening. Results Compared with pathological examination for cervical disease diagnosis, the sensitivity and specificity of TCT was 66.56% and 53.57% respectively, the sensitivity and specificity of HPV E6/E 7 mRNA was 74.84% and 77.68% respectively while the sensitivity and specificity of joint detection of TCT and HPV E6/E7 mRNA was 99.68% and 39.29% respectively. Conclusion The joint detection of TCT and HPV E6/E7 mRNA raises the sensitivity remarkably in cervical disease screening, reduces missed clinic diagnosis rate and contributes to clinic cervical disease screening.

Basic Research of Neurodegenerative Disease

Establishment and characterization of microtubule-associated protein tau over-expression cell and transgenic animal models

Ma Denglei, Zhang Xu, Luo Yi, Huang Rui, Li Yali, Li Lin, Zhang Lan

2019, 40(4):  582-587.  doi:10.3969/j.issn.1006-7795.2019.04.017

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Objective To construct and characterize tau and mutant tau protein cell and animal models. Methods Different plasmids were transfected into HEK293 cells,and cell models overexpressing wild-type tau or P301L/P301S mutant tau were constructed. rTg4510 mice (P301L mutant tau transgenic mice) and PS19 mice (P301S mutant tau transgenic mice) were introduced and bred. The expression of total tau and phosphorylated tau protein was detected with Western blotting. The expression of phosphorylated tau protein in the brain of transgenic mice was detected with immunohistochemistry. The morphology of HEK293 cells was observed with immunofluorescence. Results In this study,cell and animal models overexpressing tau were successfully constructed. The tau protein expression in these models were significantly increased,and the phosphorylation levels of tau protein were significantly higher than that of the control group. In the cell and animal models of different mutation types,changes in phosphorylation levels and microtubule morphology at different sites showed slight differences. Conclusion We successfully constructed P301L/P301S mutant tau cell and animal models with significant tau hyperphosphorylation and changes in cell microtubule morphology. These models might provide alternative for proper disease model in the studies of tau and tauopathies,such as Alzheimer's disease.

Effects of cornel iridoid glycoside on Alzheimer's disease-associated neuropathology in APP/PS1/Tau transgenic mice

Yang Cuicui, Bao Xunjie, Zhang Li, Li Yali, Li Lin, Zhang Lan

2019, 40(4):  588-595.  doi:10.3969/j.issn.1006-7795.2019.04.018

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Objective To observe the effects of Cornel iridoid glycoside (CIG) on pathology in the brain of 3×Tg mice. Methods The APP/PS1/Tau (3×Tg) mice were intragastrically administered with CIG (100 mg/kg, 200 mg/kg) once a day for 2 months. Congo red staining was used to observe the number and distribution of senile plaque in hippocampus. Western blotting was used to observe the expression of tau phosphorylation at Thr212 and Thr217. Immunohistochemistry and qRT-PCR were used to detect protein and transcription level of brain derived neurotrophic factor (BDNF). Nissl staining was used to observe the number of Nissl's body in hippocampus. Results Compared with the control group, the Aβ amyloid plaque deposition increased significantly in the 18-month-old model group, while 100 or 200 mg·kg^-1·d^-1 CIG treatment could reduce the plaque burden in the brain. The phosphorylation level of tau at Thr217 was significantly increased in the model group, while that at Thr212 was not significantly elevated. CIG treatment significantly antagonized the hyperphosphorylation of tau at Thr217. In the model group, the protein and mRNA levels of BDNF in hippocampus were decreased, and CIG could significantly restore the protein and mRNA levels of BDNF. CIG treatment could increase the number of Nissl's body in the brain. Conclusion CIG could reduce the deposition of Aβ in the brain, abnormal hyperphosphorylation of tau protein, restore the expression of BDNF in the brain, and protect neurons.

Ganoderma lucidum extract regulates autophagy induced by MPP⁺ in Neuro-2a cells

Ding Hui, Cai Yanning, Chen Biao

2019, 40(4):  596-601.  doi:10.3969/j.issn.1006-7795.2019.04.019

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Objective To investigate the protective effect of Ganoderma lucidum extract (GLE) on autophagy of Neuro-2a cells induced by 1-methyl-4-phenylpyridinium (MPP⁺). Methods Western blotting was used to detect the conversion of autophagy marker LC3 (LC3-Ⅱ/LC3-I), and fluorescence microscopy was employed to detect the formation of LC3 punctate aggregates. Western blot was used to detect the expression levels of AMPK/mTOR/ULK1, PINK1/Parkin and NIX/LC3 proteins. Results The laser confocal microscopy showed that LC3-Ⅱ cells in the MPP⁺ treatment group were clustered on the autophagosome membrane, with a point-like aggregation state observed, while no obvious point aggregation was observed in the GLE intervention group. The level of autophagy was evaluated as the ratio of point-aggregated positive cells of LC3 over the total cells. According to statistics, the percentage of LC3 positive cells with green dot distribution in the MPP⁺ group was significantly increased. This value was significantly reduced in the GLE group. Western blotting results showed that the ratio of LC3-Ⅱ/LC3-I in GLE group was significantly decreased, and the expression level of NIX protein was significantly increased. After GLE treatment, the abnormal expression of each protein in AMPKα/mTOR/ULK1 and PINK1/Parkin pathway caused by MPP⁺ injury could be significantly improved.Conclusion GLE inhibited the autophagy response of MPP⁺-induced Neuro-2a cells, regulated the abnormal expression of autophagy regulatory proteins AMPK/mTOR/ULK1 and PINK1/Parkin, suggesting that GLE may play a neuroprotective role by regulating autophagy.

Basic Research

Primary culture and detection of fibrosis associated proteins of endometriosis cells

Zhang Yanqin, Wu Di, Deng Mengqi, Chang Xiangyu, Miao Jinwei

2019, 40(4):  602-608.  doi:10.3969/j.issn.1006-7795.2019.04.020

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Objective To isolate and purify endometrial stromal cells from eutopic endometrium,ectopic tissue of patients with endometriosis (EMs) and normal endometrium. Detecting the expression of fibrosis-related protein in different tissues and corresponding stromal cells. Methods Fresh endometrial tissue was collected and modified EMs primary cell culture method was used. The cells were identified by immunohisto chemsistry. Western blotting was used to detect the consistency of fibrosis-related protein expression between the purified cells and the corresponding tissues. Results The primary isolation of stromal cells from endometrial tissue of EMs in situ was successful in 12 cases,the success rate was 100% (success index:cells adhered to the culture bottle and grew steadily). EMs ectopic tissue isolation and culture 12 successful 11 cases,the success rate of 91.7%. Eight cases of normal endometrial tissue were successfully isolated from 9 cases,with a success rate of 88.9%. There was no significant difference between human ectopic endometrial stromal cells (HEcESCs) and human eutopic endometrial stromal cells (HEuESCs) and normal human endometrial stromal cells (HEnESCs) under ordinary light microscope. But,Western blotting results showed that (P>0.05) the expression of fibrosis-related proteins in HEcESCs was significantly higher than that in HEuESCs and HEnESCs (P<0.01),and the expression of fibrosis-related proteins in stromal cells was consistent with there corresponding tissue levels. Conclusion The improved primary culture method of EMs cells can reduce the difficulty of EMs endometrial stromal cells culture,and maintain a high success rate of cell culture. The expression of fibrosis related protein in HEcESCs was significantly higher than that in HEuESCs and HEnESCs,that is mean,in patients with endometriosis,the ectopic lesions showed clear fibrosis at the tissue level.

Glycated albumin regulates renal injury-associated molecules and Toll-like receptor signaling pathway and the intervention effect of oleanolic acid

Duan Nan, Huang Chenwei, Pang Lu, Li Haixia

2019, 40(4):  609-614.  doi:10.3969/j.issn.1006-7795.2019.04.021

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Objective To investigate the effects of glycated albumin (GA) and oleanolic acid (OA) on the expression of kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL) and some molecules of Toll-like receptor (TLR) signaling pathway in human proximal tubular epithelial cells (HK-2 cells). Methods The HK-2 cells were treated with GA, GA and OA for 24 h. The mRNA levels of KIM-1, NGAL, p38 mitogen activated protein kinase (MAPK), interleukin-1 receptor-associated kinase 4 (IRAK4), TLR 1, TLR2, TLR7 and TLR9 were detected by real-time PCR. The releases of KIM-1 and NGAL in the supernatants were detected by ELISA. The protein levels of p38 MAPK, IRAK4, TLR1, TLR2, TLR7 and TLR9 were measured by Western blotting. Results Compared with control group, GA could significantly up-regulate the mRNA and the protein levels released in supernatants of KIM-1 and NGAL (P<0.05), and promoted the expression of p38 MAPK, IRAK4, TLR1, TLR2 mRNA and protein in HK-2 cells (P<0.05). OA treatment could significantly inhibit theses effects (P<0.05). Conclusion GA can up-regulate the expression and release of KIM-1 and NGAL, and activate the TLR signaling pathway, suggesting that GA could play an important role in regulating renal injury. OA had effective intervention effect on GA.

An evaluation of scientific research competitiveness of clinical medicine subject in Chinese universities based on factor analysis

Liu Yuting, Huang Fang

2019, 40(4):  615-620.  doi:10.3969/j.issn.1006-7795.2019.04.022

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Objective Selected 50 universities which have participated in the 2012 subject evaluation, to evaluate the competitiveness of its clinical research. Methods Selected the number of Web of Science documents, category normalized citation impact (CNCI), times cited, percentage of documents cited, percentage of documents cited in the top 1%, percentage of documents cited in the top 10%,percentage of hot papers. H index, the number of international cooperation papers, the number of F1000 documents index, based on factor analysis by SPSS software, two common factors were extracted, and comprehensive scores were calculated to analyze the scientific research competitiveness of the universities. Results From the perspective of the scale of scientific research productivity, the top three universities were Shanghai Jiaotong University, Peking University, and Fudan University. From the perspective of the high impact of scientific research, the top three universities were Nanjing University, Ningbo University and Nanjing University of Chinese Medicine. From the perspective of comprehensive scientific research competitiveness, the top ten universities were Shanghai Jiaotong University, Peking University, Fudan University, Sun Yat Sen University, Peking Union Medical College, Capital Medical University, Nanjing Medical University, Nanjing University, Central South University, Zhejiang the University. Conclusion It is suggested that each university should improve the competitiveness of clinical medical research from the aspects of the scale of scientific research productivity and the high impact of scientific research according to the actual situation of subject development.

Clinical Research

Clinical manifestation in Takayasu arteritis patients with history of tuberculosis

Pan Lili, Du Juan, Ren Yanlong, Liu Wenxian

2019, 40(4):  621-626.  doi:10.3969/j.issn.1006-7795.2019.04.023

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Objective To analyze the clinical manifestations, imaging and laboratory findings of Takayasu arteritis (TA) patients with history of tuberculosis. Methods The hospitalized patients with TA were divided into two groups according to the history of tuberculosis. The differences of clinical characteristics, imaging and laboratory manifestation were compared. Results Among 103 patients with Takayasu arteritis, 19 had history of tuberculosis, including 15 pulmonary tuberculosis, 2 tuberculous pleurisy, 1 endobronchial tuberculosis and 1 tuberculous peritonitis. There was no significant difference in clinical manifestations and laboratory findings between patients with or without history of tuberculosis. In the patients with history of tuberculosis, numano type V was the most common (63.16%), followed by Ⅱb (15.79%). The proportion of coronary artery involvement, pulmonary artery involvement and cardiac valvular lesion in TA patients with history of TB were 10.53%, 15.79% and 73.68%, respectively. Conclusion The rate of previous tuberculosis infection in patients with Takayasu arteritis is high, but there is no significant difference between the clinical features and those without tuberculosis history.

Measurement characteristics evaluation of SF-HSTCM and EQ-5D-3L among patients with stroke

Dai Lin, Wen Yucheng, Lu Taoying, Cai Jianxiong, Wang Lixin, Qin Min, Wu Darong

2019, 40(4):  627-634.  doi:10.3969/j.issn.1006-7795.2019.04.024

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Objective To evaluate the measurement characteristics and applicability of The Short Form-Health Scale of Traditional Chinese Medicine (SF-HSTCM) and The Three-level EuroQol Five-dimensional Questionnaire (EQ-5D-3L) for patients recovering from stroke. Methods The study followed a cross-sectional design. We investigated patients with stroke on the recovery stage. Questionnaires applied in the study included SF-HSTCM, EQ-5D-3L, Modified Rankin Scale (mRS) and Barthel Index (BI). We analyzed the reliability and validity of SF-HSTCM by the Cronbach's alpha coefficient and confirmatory factor, test-retest reliability of SF-HSTCM,EQ-5D-3L,mRS and BI,and consistency coefficient between patients and agent by interclass correlation coefficient, correlation between SF-HSTCM and EQ-5D-3L by convergent validity, discriminant validity of SF-HSTCM by nonparametric test. The impact of Social and demographic factors on score of BI and mRS was evaluated by multiple linear regression.Results A total of 205 people were investigated. The internal consistency of Cronbach's α among patients with stroke in the recovery phase was 0.895, intercorrelation coefficient of test-Retest reliability was 0.991. The test-retest reliability result of EQ-5D-3L showed that questionnaires of two surveys which was exactly the same,accounting for 90% of the total number. Conclusion SF-HSTCM and EQ-5D-3L can be used to evaluate the health status of the patients with stroke in the recovery phase.

Effects of diverse nutrient on intestinal biologic barrier of patients with active ulcerative colitis

Wu Huibo, Zhao Haiying, Zhu Shengtao, Wu Yongdong, Zhang Shutian

2019, 40(4):  635-639.  doi:10.3969/j.issn.1006-7795.2019.04.025

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Objective To evaluate the intervene effect of diverse nutrient on intestinal biologic barrier and the feasibility of applying diverse nutrient recipe in patients with acute ulcerative colitis (UC). Methods Totally 79 patients enrolled were randomly assigned to five groups, traditionary group (T-group), enteral nutrition group (E-group), microecologicalagent group (ME-group), immunostimulants group (IS-group), immune-enhanced enteral nutrition group (IEEN-group). Germiculture was used to detect the stool of all subjects before and after treatment, and the number of Bacterium lacticum,Bifidobacterium, Enterococci, Entericbacilli and yeasts were counted, then to compare the differences of intestinal flora composition and observe the remission situation. Results The clinical efficacy of the IEEN-group was better than that in the T-group. The improvement of intestinal flora of the IEEN-group was the best, then the E-group, then the ME-group and IS-group, the T-group was the last. The IEEN-group and the E-group may be beneficial to UC patients. Conclusion Application of different nutrient formulations in patients with active ulcerative colitis can improve the intestinal flora imbalance and protect intestinal barrier in patients with active ulcerative colitis.

Investigation of treatment protocol for cesarean scar pregnancy type I

Luo Lanrong, Li Changdong

2019, 40(4):  640-645.  doi:10.3969/j.issn.1006-7795.2019.04.026

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Objective To compare ultrasound-guided uterine curettage and uterine curettage after uterine artery embolization (UAE) for cesarean scar pregnancy(CSP)type I treatment. Methods We performed retrospective case control study,fifty-two patients were given ultrasound-guided uterine curettage as the study group,26 patients were given UAE followed by ultrasound-guided uterine curettage as the control group. Ultrasound examination was used for the diagnosis. Results The treatment success rate of the study group was 98%,and that of the control group was 100%. There was no significant difference of operation time and bleeding volume between the two groups. The decrease of serum human chorionic gonadotropin (HCG) both of two group were satisfactory. But at 1 day,7 days and 14days after operation, the decrease of serum HCG of study group was significantly slower than that of the control group. The time of blood HCG return to normal after operation of the study group and the control group was (24.38 ±9.23)days vs (19.12 ±4.23)days,and length of bleeding days after operation were (12.19±7.54)days and (8.58±3.01)days. The differences were significant. The days of menstrual recovery of the study group and the control group were (33.54 ±5.98)days and (32.69 ±5.13)days,respectively. There was no significant difference,but 30.8% menstrual reduction of the study group was significantly higher than 61.5% of the control group. In the study group,36.5% of abnormal mass in the lower anterior wall of uterine cavity can be found by ultrasound examination after the first menstruation was significantly higher than 15.4% that of the control group,but there was no difference of the size of the mass between the two groups. Conclusion CSP type I can be safely and effectively treated by ultrasound guided curettage. But surgery should be carried out in the hospital which are capable of salvage because bleeding risk of CSP is extremely high. For the treatment of CSP,monitoring the decrease of HCG is very important. Some patients showed slow descent of HCG in blood,which should be examined and treated promptly.

GPD1 represses colon cancer cell HCT-8 growth and indicates a favorable prognosis in colorectal cancer

Min Li, Li Hengcun, Guo Qingdong, Wang Xingyu, Zhang Shutian

2019, 40(4):  646-651.  doi:10.3969/j.issn.1006-7795.2019.04.027

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Objective To explore the role of glycerol-3-phosphate dehydrogenase 1 (GPD1) in the development of colorectal cancer and its relationship with clinical prognosis. Methods HCT-8 colon cancer cell line was used in this study. Cell function experiments were performed after GPD1 expression knockdown by using siRNA. Cell proliferation activity and colony formation ability were detected by MTS assay and colony formation assay respectively. The migration ability was determined applying wound scratch assay and transwell assay. The bioinformatics analysis of the TCGA database explored the relationship between the expression level of GPD1 and the clinical prognosis of colorectal cancer patients. The relationship between the low expression of GPD1 in colorectal cancer and the methylation level of its coding gene was also explored. Results After interference of GPD1 gene expression by siRNA, the proliferation ability of HCT-8 cells was significantly enhanced (P<0.01). The results of colony formation experiments showed that the colony number and size of HCT-8 cell colonies significantly increased after GPD1 siRNA treatment (P<0.01). The results of the wound scratch test and transwell assay showed that there was no significant change in the migration ability of GPD1 knockdown HCT-8 cells, indicating that GPD1 had no effect on the migration ability of colon cancer cells. Bioinformatics analysis showed that the overall survival (χ²=4.1, P=0.040) and disease-free survival (χ²=13.2, P<0.000 1) of patients with low expression of GPD1 were significantly lower than those with high expression of GPD1. Also, low expression level of GPD1 was identified as an independent risk factor for poor prognosis of colorectal cancer (P<0.05). Methylation analysis showed that the low expression of GPD1 in colorectal cancer tissues was negatively correlated with hypermethylation of its coding gene (P<0.05). Conclusion GPD1 plays a role in inhibiting cell proliferation and colony formation in colon cancer, and low expression of GPD1 is an independent predictor of poor prognosis in patients with colorectal cancer.

Differences of cognitive impairment pattern in the montreal cognitive assessment-basic in different age patients with mild Alzheimer's disease

Tang Yu, Hao Dandan, Qin Weiting, Wen Xiao, Li Fang

2019, 40(4):  652-655.  doi:10.3969/j.issn.1006-7795.2019.04.028

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Objective To investigate the difference of the Montreal Cognitive Assessment-Basic (MoCA-B) subitem score among different ages in patients with mild Alzheimer's disease(AD).Methods Totally 286 AD patients were recruited from outpatients and inpatients department of Neurology and Community Settings of Fuxing Hospital, from January 2017 to December 2017. Patients were divided into three groups according to their age:51-60(n=57), 61-70(n=112), 71-80(n=117). All the patients were administered with Mini-Mental State Examination(MMSE)and MoCA-B.Results There were no significant difference between three groups in gender, education, MMSE and MoCA-B. Comparing every item of MoCA-B in three groups, the abstraction and similarity task and delayed recall have significant difference(P<0.05). The patients less than 60 get a little higher score in delayed recall than the patients older than 60 (0.5±1.0 vs 0.1±0.4). But the difference of the score in less than one score, so there was not much clinical meaning in memory. For the abstract reasoning task, the patients less than 60 get higher score than the older patients(1.2±1.1 vs 0.7±1.1, 1.3±1.1 vs 0.7±1.1, respectively). The differences of the three groups were significant(P<0.05).Conclusion To interpret the score of every item of MoCA-B, we should pay attention to the possible influences of age, especially for the abstract reasoning task.

Clinical observation of fat-graft reconstruction by a novel "star flap "and inframammary fold recreation by liposuction

Song Yangang, Li Facheng, Huang Guilin

2019, 40(4):  656-660.  doi:10.3969/j.issn.1006-7795.2019.04.029

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Objective To evaluate aesthetic outcomes of nipple reconstruction by a novel designed "star flap" in breast reconstruction with free fat graft after total mastectomy and contribution of an inframammary fold recreation by liposuction to breast shape improvement. Methods From August 2017 to December 2018, 31 patients, present spontaneously to Plastic Surgery Hospital, Chinese Academy of Medical Sciences, who suffered from breast cancer and received unilateral or total mastectomy were included in this study. After breast reconstruction with autologous fat transplantation, a local star shaped flap was raised. There were 19 cases in the study group. Rolled free dermal-fat matrix harvested subcutaneously from reconstructed breast was implanted within the core of flap. Meanwhile, an inframammary fold was reconstructed by local liposuction.In the control group, 12 patients were randomly selected for breast reconstruction with autologous fat transplantation alone, without nipple and submammary fold reconstruction.At 7 days, 3 months and 6 months after reconstruction, the safety and effect was conducted to evaluate the efficacy of the outcomes. Results All patients who received nipple and inframammary fold reconstruction recovered well after surgery. Among them, 1 case had poor wound healing, respectively, after operation no nipple necrosis was found. Position of the reconstructed nipple were symmetrical with the contralateral side Shrinkage of the nipple projection was continuously observed, which resulted a more nature projection after 6 months. The degree of satisfaction (very satisfactory, satisfied, basically satisfied, unsatisfactory, very unsatisfactory) in the study group was 26.3%, 52.6%, 22.9%, 5.3% and 0%, respectively,while that in the control group was 0%, 18.1%, 45.5%, 36.4%, 8.3%,(Z=3.451, P=0.01). There was statistical difference in the distribution of satisfaction effect between the two groups.Conclusion The star flap buried with dermal-fat plug showed good postoperatively.In combined with inframammary fold recreation with liposuction,the design method is simple, easy to manipulate during the operation, and has good aesthetic quality after the operation. It can significantly improve patient satisfaction and is worthy of clinical application and promotion.

The 11th International Congress on Menopausal and Gynecological Endocrinological Issues

2019, 40(4):  666-666. 

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