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Objective@#To investigate the clinical effects of immediate nipple reconstruction with a local mastectomy flap in secondary breast reconstruction by deep inferior epigastric artery perforator (DIEP) flap.@*Methods@#A free bipedicle DIEP flap was raised and folded upward to form the breast. Meanwhile, a deepithelialized lower mastectomy flap with a distant skin paddle was elevated and pulled throughout the reconstructed breast. The skin paddle was carefully sutured to the position of future nipple. Three weeks later, the pedicle of mastectomy flap was divided, and the paddle was modeled to form the new nipple.@*Results@#From February 2011 to June 2016, 42 patients who had previously undergone unilateral modified mastectomies underwent the breast reconstructions and immediate nipple reconstructions. All flaps survived postoperatively. The average projection of the reconstructed nipple was measured as (16.3±2.4) mm immediately after the operation and gradually decreased to (8.4±1.3) mm by one year follow up. 35 patients ranked the aesthetic appearance of the reconstructed nipple and breast very good or good.@*Conclusions@#The immediate nipple reconstruction with a local mastectomy flap and breast reconstruction by DIEP flap could achieve a good breast shape and maintain a long term residual nipple projection, which results in considerable patient satisfaction.
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Objective To observe the therapeutic effect of Tiji'ao or gemcitabine combined with nedaplatin and concurrent three?dimensional conformal radiotherapy in the treatment of stage III non?small cell lung cancer( NSCLC)?Methods A total of 92 patients with stage III NSCLC who were treated in the Heze Municipal Hospital from January 2013 to September 2015 were selected,and according to the envelope method were randomly divided into Tiji'ao + nedaplatin + three?dimensional conformal radiotherapy( S?1 + NDP + 3D?CRT) group ( Observation group, n = 46 ) and gemcitabine + nedaplatin + three?dimensional conformal radiotherapy(GEM+NDP+3D?CRT) group(Control group,n=46)?Rradiotherapy and chemotherapy trearment were performed concurrent,the short?term curative effect,the improvement of the quality of life and the safety of the two groups were compared?Results Six months after treatment,the curative efficiency( RR) of Observation group and Control group was 76?09%(35/46) and 78?26%(36/45) respectively,clinical benefit rate(DCR) was 95?65%( 44/46 ) and 93?48%( 43/46 ) respectively, there were no statistically significant differences between two groups( X2=0?062,0?517,P>0?05)?There was no significant difference between RR of squamous cell carcinoma and adenocarcinoma in Observation group( 77?78%( 21/27) vs?73?68%( 14/19) ,χ2=0?103,P>0?05) ,and there was no significant difference between RR of squamous cell carcinoma and adenocarcinoma in Control group( 80?00%( 20/25) vs?76?19%( 16/21) ,χ2=0?097,P>0?05)?There was no significant difference between Observation and Control groups in term of clinical improvement rate( 63?04%( 29/46) vs?56?52%( 26/46),χ2=0?489,P>0?05)?There were no significant differences between Observation and Control groups in terms of incidence of Gastrointestinal reactions,RP and esophagitis(86?96%(40/46) vs?78?26%(36/46), 84?78%(39/46) vs?91?3% ( 42/46), 86?96%( 40/46) vs?86?96%( 40/46);χ2 = 3?95, 4?35, 0?34;P>0?05);but in terms of bone marrow suppression, reduction in incidence of white blood cells ( WBC ) , thrombocytopenia in Observation group were 80?43%( 37/46 ) , 69?57%( 32/46 ) , in the control group were 91?3%( 42/46) , 93?48% ( 43/46 ) , there were significant differences between the two groups (χ2 =10?43, 19?37,P<0?05 )?Conclusion For stage Ⅲ non?small cell lung cancer combined with platinum?based chemotherapy concurrent three?dimensional conformal radiotherapy, Tiji'ao and gemcitabine have equivalent efficacy,but Tiji'ao has mild side effects,easy to oral absorption,easy to elderly patients with tolerance?But long?term efficacy remains to be further follow?up
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BACKGROUND:In consideration of skin as the largest organ al over the body and its abundant vessels and vessel plexuses, there would be sufficient adult stem cels for tissue engineering. OBJECTIVE:To investigate the osteogenic potential of dermis-derived bone morphogenetic protein receptor subtype IB (BMPR-IB) positive cels. METHODS:In current study, histochemical analysis was adopted to study the localization and expression of BMPR-IB+ cels in skin. Fresh skin samples were digested into single cel suspension. Then, the surface marker BMPR-IB was used to isolate cel subpopulation by magnetic activated cel sorting from freshly prepared single cel suspension. After that, the osteogenic potential in vitro andin vivo was tested. Alkaline phosphatase staining and alizarin red staining were performed after osteogenic inductionin vitro. The BMPR-IB+ cels were seeded onto coral scaffolds, and the scaffolds were used to repair critical-sized calvarial defects of mice. Histochemical analysis was performed at 6 weeks postoperatively and micro-CT analysis was carried out at 24 weeks postoperatively to evaluate the ability of bone repairment. RESULTS AND CONCLUSION:We localized BMPR-IB cels in situ by immunohistochemistry that turned out to be expressed in the reticular layer of dermis and by single cels. Cel subpopulation which expressed BMPR-IB could be sorted by magnetic activated cel sorting. Alkaline phosphatase staining was obviously positive and lots of calcium modules were confirmed by alizarin red staining after osteogenic induction, indicating that BMPR-IB+ cels had the osteogenic potentialin vitro. Histochemical analysis demonstrated that plenty of new bone formation was found in BMPR-IB+ cels group after 6 weeks in vivo. Micro-CT analysis revealed that BMPR-IB+ cels-coral scaffold complex could repair calvarial defects successfuly after 24 weeksin vivo. These results indicated that dermis-derived BMPR-IB+ cels possessed adequate osteogenic potential. Moreover, they might be promising seed cels for bone tissue engineering.
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Objective To analyze the clinical and dosimetric risk factors for acute radiation esophagitis (ARE) in non-small cell lung cancer (NSCLC) patients treated with three-dimensional conformal radiotherapy (3D-CRT),and to find significant risk factors for clinical therapy.Methods A total of 102 NSCLC patients treated with 3D-CRT were retrospectively analyzed.ARE was scored according to the Radiation Therapy Oncology Group (RTOG) criteria with grade 2 or worse.Patients were divided into non-concurrent chemoradiotherapy group and concurrent chemoradiotherapy group.The clinical and dosimetric factors associated with grade 2 or worse ARE were analyzed using univariate logistic regression,multivariate logistic analysis and receiver operating characteristic ( ROC ) curve.Results There were no grade 4 or5 ARE observed in the 102 patients.Nineteen developed grade 2,15 developed grade 3.In nonconcurrent chemoradiotherapy group,multivariate analysis showed that V55 was the only risk factor of grade 2/3 ARE.For ROC curve analysis,the cut-off point of V55 was 16.0 while the area under ROC curve was 0.870 ( 95 ％ CI:0.782 - 0.957,P ＜ 0.05 ).In concurrent chemoradiotherapy group,multivariate analysis showed that V35 and chemotherapy regimens during radiotherapy were risk factors of grade 2/3 ARE.The cut-off point of V35 was 23.75 while the area under ROC curve was 0.782 (95％ CI:0.636 -0.927,P ＜0.05).Vinorelbine and cisplatin regimen showed low incidence of ARE contrast with gemcitabine/docetaxel and cisplatin regimens (33.3％ and 66.7％ ).Conclusions V55 is the only statistically significant risk factor associated with grade 2 or worse ARE for patients who don't accepted concurrent chemotherapy.V35 and chemotherapy regimens during radiotherapy are statistically significant risk factors associated with grade 2 or worse ARE for patients who accept concurrent chemotherapy.Vinorelbine and cisplatin regimen during radiotherapy shows low incidence of ARE.
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Objective To evaluate therapeutic effects and complications of concurrent three-dimensional conformal radiotherapy (3DCRT) and chemotherapy in patients with limited-stage small cell lung cancer (LSCLC).Methods From June 2000 to August 2005, 93 histologically proved LSCLC patients were randomized into two groups:3DCRT group (n =46) and conventional group (n =47).In both groups, patients received one cycle chemotherapy, followed by concurrent chemoradiotherapy and then received consolidate chemotherapy.Chemotherapy was four to six cycles of PE regimen.Conventional irradiation field was setup in conventional group, while in 3 DCRT group clinical target volume (CTV) only involved visible tumor and adjacent lymphatic region.Radiotherapy was delivered at 2 Gy per fraction, 5 fractions per week to a median total dose of 60 -64 Gy.Those who achieved a complete response were treated with prophylactic cranial irradiation (PCI) with 30 Gy in 10 fractions.Results The follow-up rate was 100% in both groups.The number of patients completed 1-, 2-and 3-year follow-up were 36, 34 and 16 in 3DCRT group, 14, 7 and 8 in conventional group, respectively.The complete and overall response rate were 52% and 89% in 3DCRT group, while 47% and 85% in conventional group, respectively.The 1-, 2-and 3-year survival rates were 78%, 35% and 15% in 3DCRT group, 72%, 30% and 17% in conventional group, respectively.The median survival time was 23.2 and 22.8 months, respectively.There was no statistical difference in short-term (Χ~2 = 0.34 ,P = O.759) and long-term outcomes (Χ~2 = 0.18 ,P = 0.92).In 3DCRT group, the incidence of grade 1 +2 acute radiation pneumonitis and esophagitis, grade 1 +2 and grade 3 chronic radiation pneumonitis were lower than those in conventional group.There was no grade 3 or 4 acute radiation pneumonitis or esophagitis, or grade 4 chronic radiation pneumonitis in both groups.There was no difference in grade 1 + 2, grade 3 or grade 4 acute myelo-suppression between the two groups.Conclusions In the treatment of LSCLC, concurrent 3DCRT and chemotherapy can achieve satisfactory short-term and long-term outcomes with acceptable complications.