Prognostic significance of metastatic lymph nodes ratio in patients with gastric adenocarcinoma after curative gastrectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>We evaluated the impact of the number of metastatic lymph nodes and the metastatic lymph nodes ratio (the ratio between metastatic lymph nodes and total dissected lymph nodes, MLNR) in patients with gastric adenocarcinoma following curative gastrectomy and also analyzed the relationship between the number of removed lymph nodes and prognosis in node-negative gastric cancer.</p><p><b>METHODS</b>From January 2005 to December 2010, 1 390 patients who were diagnosed with gastric adenocarcinoma and underwent curative gastrectomy were included. In particular, lymph node metastasis was not present in 515 patients. The number of metastatic lymph nodes and the metastatic lymph nodes ratio were selected for univariate and multivariate analyses to evaluate their influences on the disease outcome. The survival curve was presented according to the number of removed lymph nodes in node-negative gastric cancer using Kaplan-Meier plots.</p><p><b>RESULTS</b>The overall 5-year survival rate was 54% in this group. Univariate analysis revealed that age category, macroscopic appearance, histological grade, tumor size, depth of primary tumor invasion, number of metastatic lymph nodes, metastatic lymph nodes ratio, tumor, nodes, metastasis-classification (TNM) stage and status of lymphovascular, and vessel invasion have significant impact on survival. The number of metastatic lymph nodes and the metastatic lymph nodes ratio both have significant impact on survival (P < 0.001). However, in multivariate analyses, only the metastatic lymph nodes ratio was identified to be an independent prognostic factor (P < 0.001). The number of removed lymph nodes in node-negative was a strong prognostic factor of survival, the more lymph nodes dissected, the better the survival.</p><p><b>CONCLUSIONS</b>The metastatic lymph nodes ratio has more significant prognostic value for survival in patients with gastric cancer following curative gastrectomy than the number of metastatic lymph nodes. The number of removed lymph nodes might be an important prognostic factor for gastric cancer without lymph node metastasis.</p>

Treatment for mentalis scars with expanded skin flaps / 中华医学美学美容杂志

Objective To investigate the cosmetic outcome of treatments for mentalis scars with expanded skin flaps.Methods From the experiences of past 26 cases in our department,we summarised the technique for treating the mentalis scars with expanded skin flaps.For simple mentalis scars or localized inferior facial scars,the mentalis,bottom jaw or facial skin were expanded and the expander kept superior to the neck-jaw angle.Otherwise the expander would only fill the angle and the expanding efficiency was reduced.For severe mentalis,neck or facial scars without extra normal treating skin,expanded deltopectoral flaps were chosen to cover the wound after cicatrectomy with pedicles which were cut 3 weeks later.Results All the local ordistant expanded flaps survived successfully in the 26 cases with optimistic outcomes.Conclusions Application of local or distant expanded flaps is a useful technique for mentalis scars treatment.

Reconstruction of inferior palpebral defects with expanded skin flaps / 中华医学美学美容杂志

Objective To develop new repairing techniques for acquired inferior palpebral region defects. Methods Expanded forehead flaps were used to reconstruct the inferior palpebral defects or post-excision wound surface and the flaps were pedicled with supra-trochlea vessels or ramus frontalis arteriae temporalis superficialis. As for supra-trochlea vessels, contralateral ones were prior to the homolateral ones. The incision site located in the scalp and the major axis of the expander parallel to the forehead. Firstly, the leisions were cut and the subcutaneous tissues loosed to regain the anatomy position of inferior palpebra. Secondly, the expanded flaps were transfered onto the defects by the wound sizes with the supra-trochlea vessels as their pedicles. At last, the pedicles were cut 3 weeks later.For ramus frontalis arteriae temporalis superficialis, the flap was transfered with a subdermal pedicle and the donor site was closed directly. Results There were 10 cases in the present group, 6 for supratrochlea vessels and the 4 others for ramus frontalis arteriae temporalis superficialis. All the flaps survived successfully. 3 cases returned with optimistic outcomes 6 months later. Conclusion The expanded forehead flaps are fit for repairing the inferior palpebral defects, which can successfully avoid ectropion. This technique is very useful for reconstructing the texture of the site of defects.

Influence of transforming growth factor-beta 1 on mitochondrial deoxyribonucleic acid 4 977 bp deletion of human dermal fibroblasts / 中国组织工程研究

BACKGROUND: Ultraviolet light (UVA) has a close relationship with photoaging, and mitochondrial damage is a basis of coil senescence and death.OBJECTIVE: To explore the influence of UVA on the mitochondrial deoxyribonucleic acid of human skin fibroblasts, in addition, to discuss whether transforming growth factor β1 (TGF-β1) could relieve mitochondrial DNA (mtDNA) deletion. DESIGN, TIME AND SETTING: The experiment was performed at Department of Plastic Surgery, the First Affiliated Hospital of Fourth Military Medical University from March 2007 to April 2008.MATERIALS: TGF-β1 was purchased from PerProtech Company; rnitochondrial DNA 4 977 bp primer was synthesized by Shanghai Sangon Biological Engineering Technology & Services Co., Ltd; UVA light was produced by Beijing Optical Instruments Factory; and the ultraviolet radiation meter was provided by Photoelectric Instrument Factory of Beijing Normal University.METHODS: Young adult's fibroblasts were obtained from 12 cases with posthectomy. Then the cells were divided into control,UVA irradiation (30, 60, 90 J/cm~2) groups. The mitochondrial DNA 4 977 bp deletion was detected by semi-quantitative PCR. After that, TGF-β1 with different doses (0.1, 1, 10 βg/L) were used to interfere the cells with UVA 90 J/cm~2 irradiation.MAIN OUTCOME MEASURES: DNA 4 977 bp deletion under different doses cumulative irradiation, as well as the effect of TGF-β1 on mtDNA 4 977bp deletion after irradiates UVA90 J/cm~2 were observed.RESULTS: Mitochondrial DNA 4 977 bp had deleted when irradiated with cumulative dose of 60 J/cm~2 UVA, the deletion was aggravated when the UVA dose arrived at 90 J/cm~2, The absorbance value, PCR electrophoresis and band scanning showed that the deletion of mitochondrial DNA 4 977 bp was reduced after adding TGF-β1 at 2 hours prior to irritation in the large dose (10 μg/L) group. However, the difference between the medium and small dose groups had no obviously significance.CONCLUSION: A certain dose of TGF-β1 (10 μg/L) has protective effect on mtDNA 4 977 bp deletion.

Application of deltopectoral skin flap in the repair of extensive facial wound secondary to massive scar re-vision / 中华医学美学美容杂志

Objective To explore the technique of massive facial scar revision. Methods All 12 patients in the group were treated with expanded deltopectoral skin flap. In the primary surgery, expander was implanted underneath deltopectoral flap region through an incision inferior to the clavi-cle. The skin perforators of transverse cervical artery and thoracoacromial artery were ligated during surgery, and the internal thoracic artery was carefully preserved. After the deltopectoral skin flap was fully expanded, the second surgery was performed and the facial scar was released and the normal ana-tomic position of eyes, nose and month was restored. The deltopectoral skin flap was planed according to the size of the defect. The excised facial scar was converted to the flap pedicle and a hinge-like con-nection was formed. The flap was delayed and three weeks after the second surgery, the pedicle was divided. The flap from the pedicle was applied for the mental region scar revision. Results Unilateral or bilateral dehopectoral skin flaps were employed for the repair of extensive facial scar in 12 patients. Satisfactory results were achieved in all these patients. Conclusion Expanded deltopectoral skin flap is a good technique for the repair of extensive facial scar.

Influence of Ad-METH-1 on microvessel and relative cytokine of hypertrophic scar / 中华医学美学美容杂志

Objective To investigate the influence of gene transfection antiangiogenesis on microvessel and relative cytokine of hypertrophic scar of rabbits' ear.Methods The hypertrophic scar of rabbtis' ear was reproduced.On the 10th day after epithelization,Ad-METH-1 was injected into tissue of scar.30 days later,the microvessel of scar-tissue was detected by microcirculation microscope.Meanwhile.H&E and immunohistochemical stains were performed.Then the results were analyzed.Results 30 days after Ad-METH-1 injection.in experimental groups,the microvascular count of scar tissue was 12.38±2.56,the percentage of VEGF positive cells was 17.64%,and the percentage of bFGF positive cell was 18.24%:while in the control groups,the microvascular count of scar tissue was 48.12±6.46.the percentage of VEGF positive cell was 31.34%.and the percentage of bFGF positive eell was 28.26%.Results revealed that the count of microvessel of scar tissue in the experimental groups was lower than that in the control groups,between which there was the difference in statistics(P＜0.01).and that the percentage of VEGF and bFGF positive cells of scar tissue in the expenmental groups were lower than that in the control groups.between which there was the difference in statistics(P＜0.05).Conclusion Ad-METH-1 has marked inhibitory effects on scar tissue hyperplasia of rabbits' ear,angiogenesis and expression of VEGF and bFGF.Using antiangiogenesis therapy at the early phase could inhibit the formation of hypertrophic scar.Gene transfection antiangiogenesis therapy could bid fair to become an effective method to prevent and treat hypertrophic scar.

Application of expanded skin flap in facial aesthetic and plastic surgery / 中华医学美学美容杂志

Objective To explore the aesthetic effect of the applying the expanded skin flap to re-pair facial defects produced by removal of nevus, hemangioma, scars and so on. Methods The experience of the treating 67 patients with facial lesions using the expanded flaps were reviewed. The proper expand-ers were chosen according to the scope of the facial lesion. The incision was located at the scar region and the dissection was executed in the superficial layer of the SMAS. The interspace was larger than the ex-pander by 1.0～1.5 cm. After exact hemostasis, the expanders and negative pressure drainage tubes were placed into the interspace. The design of the facial expanded skin flap included the advance, rotation, and transposition of skin flap and so on. The advance of skin flap took fully use of the expanded skin flap without the donor site defect. The transposition of skin flap also took fully use of the expanded skin flap, furthermore, it overcame the displacement and the disfiguration caused by the applying of the advance skin flap and rotation skin flap. The incisions in face were designed to a minimal extent and parallel to the Lan-ger line. Results All of the 67 cases got aesthetic satisfied results with all the flaps surviving. Conclusion The application of expanded skin flaps is proved to be an effective way of repairing facial wound when there is enough normal facial skin for expansion.

Mechanisms of Dexamethasone to Protect Flaps from an Ischemia-Reperfusion Injury / 中国修复重建外科杂志

Objective To study the effect of dexamethasone to protect flaps from an ischemia-reperfusion injury and elucidate its mechanism of regulating the death course of the neutrophils. Methods The rats were randomly divided into 3 groups.The vein of the rat was clamped for 8 h after the flap had formed. Group A: the normal flap; Group B: the saline control flap; Group C: the treatment flap with dexamethasone. The survival area of the flaps was measured at 7 days; the apoptotic and necrotic neutrophils,tumor necrosis factor α (TNF-α), and interleukin 10 (IL-10) concentrations were measured. Results The flap survival are as in Groups A and C were larger than those in Group B. The apoptotic neutrophils in Group B were fewer than those in Groups A and C on the 1st and 3rd days after operation; however, they were more in number in Group B than in groups A and C on the 6th day. The necrotic cells in Group B were more in number than those in Groups A and C. In Group B, the plasma TNF-α concentration reached the maximum level at 1 h,while the IL-10 level reached the lowest 3 h after the reperfusion. In Group C, the TNF-α concentration was lower than that in Group B and decreased dramatically at 6 h. The IL-10 concentration was the lowest at 1 h, and increased rapidly at 3 h.Thus,ischemia-reperfusion could injure the flaps, probably through the abnormal action of the neutrophils, such as the disordered secretion of the cytokines and abnormal death course of the neutrophils. Conclusion Dexamethasone can protect the flap from an ischemia-reperfusion injury by its regulation for the neutrophil function.

Effect of laminin and type Ⅳ collagen on proliferation of Schwann cells / 中国组织工程研究

BACKGROUND: Schwann cells play an important role in regeneration of peripheral nerves and the extracellular matrix(ECM) is also important to growth of Schwann cells.OBJECTIVE: To explore the effects of laminin and type Ⅳ collagen on the adhesion and proliferation of Schwann cells.DESIGN: A controlled trial in groups with Schwann cell as subject.SETTING: Plastic Surgery Laboratory of the Fourth Military Medical University of Chinese PLA.MATERIALS: The trial was conducted in the Plastic Surgery Laboratory of Xijing Hospital Affiliated to the Fourth Military Medical University of Chinese PLA from January through April in 1995. The Schwann cells were extracted from newborn rabbits.METHODS: The culture plates were coated with laminin and type Ⅳ collagen. While in the control group, the antibody of laminin and collagen Ⅳ,collagen Ⅰ and polylysine were added respectively. The Schwann cells of the same concentration were cultured in plates of each group. The cells attachment rate in each group ,was determined after 2, 6, 24 hours respectively. After 72 hours 3H-TdR were incorporated into culture matrix fluid and double channel liquid scintillation counter was used for measurement of radiactivity count per minute.MAIN OUTCOME MEASURES: ① Attachment rate of Schwann cell. ②3H-TdR counting.RESULTS: The attachment rates in laminin and collagen Ⅳ groups (66%and 59% ) were higher than those of the type Ⅰ collagen and polylysine groups(45% and 43% ) after 2-hour culturing. Those in laminin antibody and collagen Ⅳ antibody groups were lower. The incorporation value were (10.0±2.7)×103, (1.3±0.3)×103, (10.4±2.4)×103, (1.4±0.5) ×103, (5.8±2.7)×103, (3.3±1.0)×103 per minute respectively in laminin, laminin antibody, collagen Ⅳ, collagen Ⅳ antibody, collagen Ⅰ and polylysine groups. The incorporation values in laminin and collagen Ⅳgroups were higher than controls.CONCLUSION: Laminin and type Ⅳ collagen promote the attachment and proliferation of Schwann cells in vitro. This study provides experimental basis for applying the action of Schwann cell to the nerve tissue engineering.

Comparison of ultrastructural changes of skin between continuous tissue expansion and conventional tissue expansion / 中华整形外科杂志

<p><b>OBJECTIVE</b>To observe the ultrastrual changes of the skin between the continuous tissue expansion and the conventional tissue expansion.</p><p><b>METHODS</b>Twelve white piglets were used for this study on an animal model of tissue expansion with the continuous tissue expansion group and the conventional tissue expansion group. The tissue samples in each group were harvested and prepared for the transmission electron microscope observation.</p><p><b>RESULTS</b>The interspace among basal cells and spinose cells was increasing and the numbers of cell conjunctures were decreasing in the both groups. However, these changes in the continuous tissue expansion group were more obvious than in the conventional tissue expansion group. In the dermal layer of the skin, the ultrastructure of collagen fibers were basically normal. But, the fibroblasts and capillary endothelia cells were more activated in the continuous tissue expansion group, compared with the conventional tissue expansion group. The fibroblast apoptosis and collagenolysis spots were observed in both of the groups, while the red blood cells were also found in the tissue leaked outsides from the blood vascular cavities.</p><p><b>CONCLUSION</b>Tissue expansion may result in tissue growth and tissue degeneration in the same time.</p>

Rhinoplasty of unilateral cleft lip / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the technique for unilateral cleft lip nasal deformities.</p><p><b>METHODS</b>Through the traditional columella margin incision, the alar cartilage and the lateral nasal cartilage were exposed. After the mucosa between the two cartilages was divided, a mucosa-cartilage flap was developed and anchored, moving the lateral crus upwardly and medially, correcting the nasal deformity.</p><p><b>RESULTS</b>52 cases of primary nasal deformities and 18 cases of secondary nasal deformities were corrected with this technique. Satisfactory results were achieved.</p><p><b>CONCLUSION</b>This technique is recommendable, which is more likely to restore the physiological characters of the nose than the conventional technique.</p>

Investigation on contraction mechanism of expanded tissue / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the contraction mechanism of expanded tissue.</p><p><b>METHODS</b>White domestic pigs were employed to establish tissue expansion model. Tissue samples were taken after expansion for contraction measurements and histopathological observation.</p><p><b>RESULTS</b>Dermis and capsule were the main positions of contraction. In the dermal layer, elastic fibers and myofibroblasts proliferated greatly and alpha-Actin enhanced in the myoepidermal cells and capillary endothelial cells during expansion. In the capsule, the direction of elastic and collagen fibers arranged crossly and formed into special contractible structure.</p><p><b>CONCLUSION</b>Elastic fibers, myofibroblasts and alpha-Actin enhancement of cells were the substantial materials of tissue contracture increases. The results suggest that suitable tension must be applied into expanded flaps for anti-contraction.</p>

Computer-aided tissue expansion 3D profilometry and surgery planning system / 中华整形外科杂志

<p><b>OBJECTIVE</b>To develop and evaluate the computer-aided system in measurement of expanded skin and preoperative planning.</p><p><b>METHODS</b>Stereophotogrammetric technique was used to gain the 3D image-pairs, from which the contours of the expanded sites were restored. The 3D surface data were provided to the specially developed "computer-aided tissue expansion 3D profilometry and surgery planning system", to calculate the expansion area and help the preoperative design.</p><p><b>RESULTS</b>The system has been applied clinically in 16 tissue expansion sites of 11 patients with fairly good results since March 1999. Compared with the traditional method, this system is accurate, repeatable and feasible.</p><p><b>CONCLUSION</b>This technique is useful and promising for improving the operation of tissue expansion.</p>

The expanded distant skin flap and its application / 中华整形外科杂志

<p><b>OBJECTIVE</b>To summarize and present the experiences and results of the expanded distant skin flaps used in plastic and reconstructive operations.</p><p><b>METHODS</b>102 patients who had undergone expanded distant skin flap transfer were reviewed and followed up.</p><p><b>RESULTS</b>Good results were obtained. Especially when there was no sufficient normal skin close to the lesion or defect, the distant skin flaps were employed. The expanded distant skin flap can be directly transferred as a pedicle skin flap or an island skin flap. It can be indirectly transferred with an intermediary carrier or as a free skin flap.</p><p><b>CONCLUSION</b>The expanded distant skin flaps have many advantages, indications, worthy of recommendation.</p>

Expanded and prefabricated forehead skin flap with grafted mucosa liner for eyelids reconstruction / 中华医学美学美容杂志

Objective To explore a new method for reconstruction o f full-thickness defect of eyelid. Methods The composed skin flap which was lined the expanded forehead skin flap with oral mucosa were transferr ed to the defect of eyelid and then sutured anatomically to the eyelid skin. Fou r months later, the composed flap was divided to reconstruct upper and lower eye lids and put an artificial eye into it. Results The appearance and function of the eyelid was partly recovered. Conclusion The reconstruction of full-thickness eyelid defect with expanded and prefabricated skin flap with grafted mucosal liner is better and reliable.

Effects of intermittent conventional and continuous pressure-controlled tissue expansion on cell proliferation and apoptosis / 中华医学美学美容杂志

Objective To investigate the cell dynamic changes of conventional intermittent tissue expansion (CITE) and continuous pressure controlled tissue expansion (CPTE). Methods Domestic pigs were chosen for CITE and CPTE models. Immunohistochemical technique was used to detect proliferative cells, DNA fragments in situ labeling for apoptotic cells, and H E stain for total fibroblast counting. Results Proliferative index of basal cell increased during expansion. The peak value of 78.5% reached at the ninth day in the CITE group versus 84.2 % at fourth day in the CPTE group. Proliferation index in both groups decreased after expansion. Fibroblast proliferation, apoptosis and total fibroblast density increased slowly in both groups during and after expansion. At the sixth day, total fibroblast densities in CITE group (38.1 cells/H) and in CPTE group (40.9 cells/H) were significantly increased, compared with 34.93 cells/H in the normal skin. There were obvious proliferation and apoptosis phenomena in epidermal cells and skin adnexa. Conclusion Tissue expansion has both effects of proliferation and apoptosis on cell dynamics. Continuous tissue expansion can induce tissues growing much effectively.

Histological structure of fibrous capsule around expanders and its clinical significance / 中华医学美学美容杂志

Objective To study the fibrous capsule structure and its change after expansion.Methods Twelve minipigs were chosen for establishing the animal models of conventional intermittent tissue expansion (CITE) and continuous pressure tissue expansion (CPTE). The capsule samples were taken for measurement and histological examination.Results The thickness and the contraction rates of capsules in CPTE group were significantly less than those of CITE group. The capsule consisted of four layers, in which a large amount of collagen and elastic fibers existed and some small arteries, veins and capillaries were well developed. After expanded flaps were transplanted, capsules contained in flaps were partially degenerated except elastic fiber layer and fibrolaminar layer, but capsules on the wound bed almost all degenerated. Conclusion The results suggest that capsules have contractive and blood supply abilities. Capsulectomy is able to decrease flap contraction. Large expanded flaps are better to have the capsule reserved. No efforts shall be done to the capsules on wound beds.

Influnence of 17-? estradiol and progesterone on synthesis of transforming growth factor beta-1 in hyperplastic scar fibroblasts / 中华医学美学美容杂志

Objective To study the influnence of estrogen and progestin on scar formation. Methods By culturing hyperplastic scar fibroblast(HSFB), we investigated TGF ? 1 synthesis by immunohistochemical staining and image analysis. Results The detectable level of TGF ? 1 in HSFB treated with 17 ? E 2 was higher than that of the control significantly( P 0.05). Conclusion In vitro, 17 ? E 2 can stimulate TGF ? 1 synthesis in HSFB significantly.

Significance of detecting TNFα and IL-1 after skin avulsion o f hind leg in pigs / 第三军医大学学报

Objective　To study the role of TNFα in the plasm a and skin and IL-1 in the serum in the formation of secondary thrombosis after skin avulsion. Methods　After avulsive flap at size of 12 cm×4 cm was inflicted on the hind legs of pigs, skin specimens and venous blood sam ples were taken at various time points. The contents of TNFα in plasma and skin were determined with radio-immunoassay, and the activity of serum IL-1 wi th 3［H］-TdR. Results　The TNFα contents in the plasma and skin were increased significantly after avulsion（P<0.01），which were (41 5±24) ng/L and (298±18.5) ng/L respectively on the 3rd day after the injury. T he activity of IL-1 in the serum was increased (P<0.05) and was (2.59± 0.85 ) ng/L on day 3. Conclusion　The changes of TNFα contents and I L-1 activity in blood and skin play important roles in the inducetion and aggra vation of secondary tissue necrosis and early thrombosis after skin avulsion.

Effects of laminin and collagen Ⅳ on the attachment and proliferation of Schwann cell / 中华显微外科杂志

Objective To detect the effects of laminin and type Ⅳ collagen on the attachment and proliferation of Schwann cells Method The plated were covered by laminin and collagen Ⅳ, the control groups were added antibody of laninin and collagen Ⅳ, collagen Ⅰ and polylysine The same concentration of Schwann cells were cultured in each groups plates The rates of cells attachment of each group were determined after 2,6,24 hours After 72 hours 3*"H TdR were mixed into culture matrix fluid and the cpm were mensurate Results The attachment rates of Laminin and collagen Ⅳ groups were higher than that of the control groups and the amount of mixed 3*"H TdR were also higher than that of control groups Conclusion Laminin and collagen Ⅳ promote the attachment and proliferation of Schwann cells