The spring-back phenomenon: does the final position of the nipple areola complex correspond to the pre-operative markings in reduction mammoplasty?

This study investigates whether tissue recoil or patient intrinsic factors influence the final position of the nipple areola complex (NAC) after reduction mammoplasty. The age, pre-operative ptosis, BMI and weight of the tissue resected were recorded as patient intrinsic factors in 37 patients undergoing reduction mammoplasty. The “spring-back” value was defined as the distance from the sternal notch to a nipple landmark on the breast meridian with the patient sitting up, minus the same measurement repeated with the patient recumbent to eliminate the pull of gravity on the breast. Spring back was measured pre-operatively for the nipple and nipple mark then post-operative for the nipple. The difference in centimeters between the final post-operative distance from the sternal notch to the nipple and the level intended by the pre-operative nipple mark was termed the “judgment error.” The final position of the post-operative nipple and the judgment error was compared to the spring-back values and patient intrinsic factors. Pre-operative ptosis was statistically related to increasing patient BMI and mass of tissue resected per breast. Pre-operative spring-back values for the nipple increased with increasing ptosis, BMI and decreasing age. Spring-back values were greater in the lower pole of the breast than in the upper pole. The final position of the nipple was higher than the pre-operative mark in 65% of cases, lower in 8% and as marked in 27% of cases. The post-operative NAC was, on average, 0.6 cm higher than planned pre-operatively. The post-operative distance from the sternal notch to the nipple increased with increasing pre-operative ptosis, mass of breast tissue resected per breast and all three spring-back values. The difference between the level of the pre-operative mark and the final nipple position showed a weak correlation with post-operative spring-back values. The parameters of ptosis, BMI, weight of tissue resected per breast and pre-operative nipple spring back reflect body habitus and breast size. Spring-back values vary between the upper and lower pole of the breast. The final NAC position was higher than that intended at pre-operative marking in the majority of cases. The surgeon instinctively marks the nipple lower in patients with greater pre-operative ptosis and in whom a larger resection is anticipated. Judgment error did not relate to intrinsic factors nor to pre-operative spring-back values; hence, these parameters cannot be applied as predictive tools for more accurate pre-operative marking of the nipple position. This study suggests that the pre-operative nipple mark should be placed, with the patient sitting up, at least 23 cm from the sternal notch and 0.6 cm lower than the final position estimated using the inframammary crease as a landmark. An invited commentary on this paper is available at .     

Early imaging in heart failure: Exploring novel molecular targets

Conclusions  Noninvasive imaging of neurohumoral upregulation in remodeled myocardium suggests that an imaging strategy can be developed for predicting the rate of remodeling and likelihood of HF development. This should allow a more judicious use of neurohumoral antagonists especially in subjects who do not have manifest HF.⁷⁴ In others specific targeted imaging may allow timely selection of individualized treatment strategies and ensure optimization of therapeutic intervention. Similar to ACE and AII receptors, multiple other targets in the hormonal cascades can identify the likelihood of adverse and favorable remodeling.⁷⁴     

美国OHMEDA麻醉机故障分析与排除

故障1故障现象:病人呼吸回路漏气。可能原因:1.手控时APL阀未关闭,2.钠石灰罐安装不严密,3.螺纹管损坏或接头松动,4.活瓣罩未拧紧,5.手动/自动转换开关失灵。解决方法:1.关闭半紧闭APL阀,2.重新安装半紧闭APL阀,3.更换新管或重新安装管路,4.重新拧紧活瓣罩。故障2故障现象:呼气     

雷公藤内酯对人胃癌细胞株FGC_(85)杀伤作用的光镜和电镜观察

本文应用核苷掺入技术及电镜观察首次证实雷公藤内酯对人胃癌细胞株 FGC_(85)的杀伤作用。用药早期,细胞数,分裂指数及 DNA,RNA 合成无明显变化,但出现核仁脱粒及核仁破碎等变化;晚期,电镜观察发现细胞以凋落方式死亡,药物主要作用于间期细胞,其杀伤机构的始动环节可能与核酸代谢障碍无关。     

Clinicopathological features of bladder cancer associated with chronic exposure to arsenic.

A high incidence of bladder cancer has been documented in an area of chronic arsenic (As) exposure. This study investigates the characteristics of As-associated (n = 49) and other (n = 64) bladder cancers. A higher histological grading was observed for the As-exposed tumours (P = 0.04), but no other difference in pathobiological features or prognosis was found between the two groups.     

多发性肌炎的动物模型及雷公藤多甙对其疗效的研究

目的　寻找一种多发性肌炎的良好动物模型及其有效的治疗药物。　　方法　给动物注射同种大鼠的肌匀浆 ,观察其活动状态 ;通过肌肉组织染色及ELISA法 ,研究肌肉的病理学变化 ,同时给动物喂服雷公藤多甙观察药物疗效。　　结果　部分动物表现肌无力和肌萎缩 ,大多数肌肉组织学检查示肌纤维炎性变 ;免疫组化检查可见肌膜、肌内膜和肌束膜中有IgG沉积。动物服雷公藤多甙后肌肉病变明显减轻 ,其疗效与强的松相似。　　结论　用同种大鼠肌匀浆免疫动物可诱导出多发性肌炎的动物模型 ;雷公藤多甙能有效地治疗多发性肌炎。     

人酪氨酸羟化酶基因真核表达载体的构建及在哺乳动物细胞中的表达

用限制性内切酶EcoRI从pKS(-)HTH_1切下全长为1.9 kb的人酪氨酸羟化酶基因,在T_4DNA连接酶的作用下连接在真核表达载体pCDNA_3的EcoR Ⅰ位点,构建成重组质粒pcD-NA_3HTH_1,该质粒转染COS-7细胞,免疫荧光组织化学染色证实酪氨酸羟化酶在其中的表达。