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To evaluate aesthetic outcomes in patients with bilateral trapezius hypertrophy treated by botulinum toxin type A (BTxA) injection for aesthetic reconstruction of the upper trapezius. From May 2015 to May 2016, 30 women with a short neck shape resulting from bilateral trapezius hypertrophy were treated with botulinum toxin type A (BTxA) injection at the most affected area of the upper trapezius. Pre- and postoperative values of SACDF (irregularly shaped area of the four points A, C, D, and F) and SACDE (irregularly shaped area of the four points A, C, D, and E), responses to patients’ and doctors’ Global Aesthetic Improvement Scale (GAIS) questionnaires for neck aesthetic assessment, as well as reported adverse events, were recorded and analyzed. Duration of follow-up ranged from 4 to 12 months. Subjects experienced non-severe adverse events and complete recovery after a single BTxA injection. In patients’ GAIS questionnaires, “very much improved” accounted for 53%, “much improved” accounted for 13%, and “improved” accounted for 27%. In doctors’ GAIS questionnaires, “very much improved” accounted for 27%, “much improved” accounted for 33%, “improved” accounted for 33%, and “no change” accounted for 7%. The overall degree of improvement was high. Statistically significant differences were observed with respect to the “very much improved” response to GAIS questionnaires between patients and doctors (P = 0.035). A single injection of BTxA for aesthetic reconstruction of the upper trapezius is safe and effective in patients with bilateral trapezius hypertrophy. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

This study aimed to analyze the clinical manifestations of patients with pyogenic liver abscess and characteristics of pathogenic that caused their infections, in order to provide guidance for the identification of the pathogens that cause liver abscess and selection of antibiotics for treatment of this disease. In the present study, the clinical characteristics, laboratory results, as well as the species and drug resistance of pathogens in patients with bacterial liver abscesses admitted to our hospital from January 2013 to December 2015 were retrospectively analyzed. The patients were treated by ultrasound or CT-guided percutaneous portal vein catheterization and drainage combined with intravenous infusion of antibiotics (the third-generation cephalosporins, the coformulation of carbapenem and dehydropeptidase-I inhibitors, or the coformulation of tazobactam and piperacillin). A total of 178 patients were diagnosed with liver abscess by B ultrasound or CT. The abscesses mostly occurred in elderly male patients and patients with diabetes mellitus. The major clinical and hematological features were fever (163/178, 91.2%), single focal abscess (146/178, 82.0%), elevated white blood cell count, and percentage of neutrophils (136/178, 76.4%). A total of 102 nonrepetitive strains of bacteria were isolated, including Klebsiella pneumoniae (82 strains, 80.3%), Escherichia coli (8 strains), Pseudomonas aeruginosa (2 strains), Acinetobacter baumannii (1 strain), and Gram-positive cocci (9 strains). Susceptibility to antimicrobial drugs was determined by analyzing the minimum inhibitory concentration, and among the 8 cultured E coli strains, 5 strains that could produce extended-spectrum β-lactamase (ESBLs) were among the most commonly seen nosocomial infections. In the present study, bacterial liver abscesses were mostly community-acquired, and K pneumoniae was highly susceptive to the commonly used antibiotics. Five patients had poor outcomes due to infectious shock or the accompanying liver cancer. In other patients, after treatment, the body temperature and the inflammatory indices, such as the total white blood cell count and C-reactive protein, returned to normal levels, and the area of abscess decreased. Most of the bacterial liver abscesses were caused by K pneumoniae, in which only a few strains exhibited resistance to the commonly used antibiotics. The use of ultrasound- or CT-guided percutaneous drainage combined with antibiotics was an appropriate way to treat the liver abscesses of these patients.

Axillary osmidrosis results in social and psychological problems. Liposuction-assisted techniques used as treatments have been reported to have high recurrence rates. This study aims at introducing the aggressive suction–curettage technique in comparison to the open excision procedure. From February 2009 to February 2014, 130 patients were randomly divided into two groups (experimental and control groups). The experimental group was treated with aggressive suction–curettage, while the control group was treated with an open excision. Postoperative assessment (skin necrosis, hematoma, scars and malodour recurrence) and patient satisfaction were surveyed and analyzed. A lower necrosis rate was observed in patients who received aggressive suction–curettage (1.88 %, p

Although the strategy of "Cre/LoxP-based reversible immortalization" holds great promise to overcome the cellular senescence of primary cell cultures for their further use, a secondary gene transfer for Cre expression is usually utilized to trigger the excision of the immortalizing genes in a large number of cells, thus presenting a formidable hurdle for large-scale application. We modified the strategy by utilizing a tricistronic retroviral vector pLCRSTP, in which Cre-ER, simian virus 40 large T antigen (SV40LTAg) oncogene, and a reporter gene were flanked by the same pair of LoxA sites. Five immortalized rat pancreatic β cell clones transduced with pLCRSTP, and six immortalized rat pancreatic β cell clones co-transduced with pLCRSTP and another vector encoding the human telomerase reverse transcriptase (hTERT) gene, were obtained, respectively. The Cre-ER protein could be induced to translocate from the cytoplasm to the nucleus by 4-hydroxytamoxifen to make SV40LTAg, hTERT and the Cre-ER gene itself excise without a secondary gene transfer. Our studies suggest that this system is useful to expand rat β cells and may allow for large-scale production due to its simpler manipulation.

To investigate the effect of sumoylation of alpha-synuclein by SUMO-1 on the mitochondria subcellular localization of alpha-synuclein and its degradation via ubiquitin-proteasome system.Primers of wild-type, A53T pathogenic mutant and K96R mutant of human alpha-synuclein were designed to amplify the corresponding cDNAs without stop codon. The cDNAs were cloned into pGEM T-easy vector, analyzed by using enzyme mapping and DNA sequencing, and subcloned into pEGFP-N1 vector. The recombinant plasmids of pEGFP-alpha-synuclein-WT, pEGFP-alpha-synuclein-A53T and pEGFP-alpha-synuclein-K96R were transfected into HEK293 cells by lipofectamine method. The expression of the alpha-synuclein protein was measured by immunofluorescence and confocal microscope. Then mitochondria staining as well as immunofluorescence were utilized to investigate the effect of wild-type, A53T mutant and sumoylation of alpha-synuclein on mitochondria subcellular localization of alpha-synuclein. The effect of sumoylation of alpha-synuclein on its degradation via the ubiquitin-proteasome system in the cells was assayed by Western-blot.The enzyme mapping suggested that the eukaryotic expression plasmids for human wild-type, A53T and K96R mutants of the alpha-synuclein gene were constructed successfully. By immunofluorescence and confocal microscope, it was observed that alpha-synuclein-WT and alpha-synuclein-A53T proteins aggregated in cytoplasm, and alpha-synuclein-K96R protein aggregation was decreased in cytoplasm of cultured cells. The alpha-synuclein proteins of wild-type, A53T and K96R mutants were co-localized with mitochondria. Western-blot analysis revealed that both wild-type and A53T mutant affected the amount of the ubiquitinated proteins.Neither overexpression of wild-type and A53T pathogenic mutant alpha-synuclein, nor sumoylation of alpha-synuclein, affected the subcellular localization in the mitochondria. However, overexpression of wild-type and A53T mutant alpha-synuclein affected the amount of the ubiquitinated proteins.

Various techniques are used to repair circular defects in special positions on the face. Simple closure will yield unsatisfactory results because of skin tension. As an ideal method of reconstruction, various flaps are used to provide a versatile and safe alternative. The authors applied double opposing-rhomboid flaps, which provided for closure of a circular skin defect without alteration to the original shapes of the vital structures and resulted in an imperceptible scar. With careful designing, 21 patients with circular defects caused by skin tumor excisions to special facial positions have attained effective functional and aesthetic results using this method since 2004.

Severely inverted nipples are invaginated deeply and present many aesthetic, functional, and psychological problems. Many methods have been proposed for correction of this deformity. The authors describe a new simple method using two broad triangular areolar dermofibrous flaps. This method affords sufficient tissue to fill the dead space. Furthermore, it furnishes bulk to drive up the nipple, and because the cross lay of the flap and the epidermis make the areola circular and small, it provides sufficient areolar tissue for reconstruction of the defective nipple. The manipulation of postoperative “donut” traction is simple and useful. This method was used to correct 14 nipples of 9 patients successfully without any postoperative problems and with minimal scars and no recurrence of inversion. It is an ideal surgical procedure for the severely inverted nipple.

Statins provide effective secondary prevention of cardiovascular events after acute coronary syndrome (ACS). Current guidelines recommend that statins be initiated in ACS patients before hospital discharge. In this retrospective study, we investigated the influence of early compared with late in-hospital initiation of statin therapy on the clinical outcomes of ACS patients. Two hundred and ten ACS patients who had no history of statin treatment before hospitalization were enrolled. The patients were divided into early (statin treatment initiated ≤ 2 days after admission) and late (statin treatment initiated > 2 days after admission and before discharge) statin groups. We examined the association between early statin use and clinical outcomes in these patients using Cox proportional hazards models. Four months after discharge, event-free survival was 85% in the early statin group and 79% in the late statin group. In multivariate analyses, Killip IV classification and abnormal renal function were independent predictors of the composite endpoint of cardiovascular death, recurrent myocardial infarction, angina requiring rehospitalization, revascularization, and stroke. Early statin treatment had no significant influence (hazard ratio: 1.11; 95% confidence interval: 0.54 to 2.25; P = 0.78) on the composite endpoint 4 months after discharge. At 12 months after discharge, early statin treatment still had no significant influence on the composite endpoint (hazard ratio: 1.53; 95% confidence interval: 0.83 to 2.81; P = 0.17). We concluded that ensuring all eligible ACS patients begin statin therapy during their hospital stay is more important than emphasizing immediate statin use after admission.

To evaluate the clinic outcome and indications of sternocleidomastoid (SCM) myocutaneous flap for reconstruction after resection of carcinoma in floor of mouth.Thirty-two patients underwent SCM myocutaneous flap for reconstruction of the floor of mouth were reviewed. According to the clinical data and the follow-up, the appearance and function were analyzed.Only one myocutaneous flap was partial necrosis in termination of the flap, and growth with granular. In eight cases, partial epidermal loss over the skin paddle occurred with secondary healing with mucosal epithelium. All patients had oral diet with good separation of the oral floor and the tongue, and had no difficulty in speech intelligibility. The patients' appearance, function and the overall quality of life were improved.The SCM myocutaneous flap appears to be easy to use and suitable for reconstruction of the defect after resection of oral floor carcinoma, the indications of this flap should be selected carefully.

Three main techniques are used to excise sebaceous cysts: conventional wide excision, minimal excision, and punch biopsy excision. A new method with two steps is proposed. First, a laser is used to make a small hole for removal of the content. Then the cyst wall is removed entirely with a minimal excision about 1 month later. With this method, the cyst is completely removed with only a small scar. It offers a good alternative for eradication of uninfected cysts, especially large cysts or cysts located in areas of thick skin or cosmetic concern.