New Atypical Manifestations and Prognostic Factors of Vibrio vulnificus Infection: a 10-Year Retrospective Study.

Vibrio vulnificus (V. vulnificus) infection is rare but potentially fatal. This study explored new atypical manifestations and prognostic factors of V. vulnificus-infected patients during hospitalization. We retrospectively reviewed the medical records of 33 patients diagnosed with V. vulnificus infection in Guangdong Province, China between 2010 and 2020. Multiple logistic regression and receiver operating characteristic (ROC) curve analyses were performed. The new atypical manifestations included cholangitis, urinary tract infection, and suppurative otitis media. Eleven of the 33 (33.3%) V. vulnificus-infected patients eventually died. Univariate analysis showed that patients with cardio-cerebrovascular diseases, lower platelet counts, and higher levels of C-reactive protein and procalcitonin (PCT) had statistically higher mortality. However, multivariate analysis showed that only the PCT level (P = 0.036) was statistically significant. In addition, the area under the ROC value estimate for PCT was 0.8816 (95% confidence interval (CI), 0.759-1.000; P = 0.0009). More than half of the patients with V. vulnificus infection died when PCT was > 20 ng/mL, while no patient died when PCT was ≤ 20 ng/mL. This study found new atypical manifestations of V. vulnificus infection. In addition, PCT was an effective and independent predictor of mortality in patients with V. vulnificus infection, allowing clinicians to conduct early risk stratification and determine the best therapeutic strategies.

Analysis of cutaneous Merkel cell carcinoma outcomes after different surgical interventions.

BACKGROUND: Current guidelines recommend local excision margin (EM) with 1 to 2 cm on primary Merkel cell carcinoma (MCC) sites. OBJECTIVE: We compared survival outcomes of patients with MCC who were treated with different surgical interventions. METHODS: A retrospective analysis of MCC cases in the Surveillance, Epidemiology, and End Results database was performed using the Kaplan-Meier, competing risk, and Cox proportional hazards regression model analyses. Influence of age, T stage, American Joint Committee on Cancer stage, adjuvant radiotherapy, and other subgroups were also analyzed by pairwise log rank test. RESULTS: Our results indicated a significant association between local destruction method and inferior survival, while an EM >2 cm showed significantly higher overall survival. In addition, the competing risk analysis depicted a similar trend as the Kaplan-Meier analysis, and considerably reduced estimated cumulative incidence. Further subgroup pairwise analysis demonstrated that the EM >2 cm method had better survival in patients who were <60 years of age, having smaller tumor diameters (T1 and T2) or having undergone adjuvant radiotherapy (P < .05). In contrast, different EMs did not show any significant association with survival rate in patients ≥75 years of age or stage III tumors. LIMITATIONS: This study was not prospectively randomized without relapse data. CONCLUSIONS: It is challenging to make optimal EM recommendations, because surgical options may depend on individual case situations. Further prospective randomized studies are warranted.

Identification of Long Non-coding and Messenger RNAs Differentially Expressed Between Primary and Metastatic Melanoma.

Purpose: Melanoma is the most aggressive and life-threatening cutaneous cancer. To explore new treatment strategies, it is essential to identify the mechanisms underlying melanoma tumorigenesis and metastasis. Methods: In the current study, we demonstrated altered expression of long non-coding RNA (lncRNA) and messenger RNA (mRNA) in melanoma using data from the Cancer Genome Atlas (TCGA) database. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment, and protein-protein interaction (PPI) analyses were conducted. We also constructed a functional lncRNA-mRNA regulatory network and Kaplan-Meier analysis. Results: We identified 246 differentially expressed (DE) lncRNAs and 856 DEmRNAs. A total of 184 DElncRNAs and 428 DEmRNAs were upregulated in metastatic melanoma, while all others were downregulated. Additionally, we investigated the co-expression pattern of 363 genes, among which 26 upregulated lncRNAs, 9 down- regulated lncRNAs, 49 upregulated mRNAs and 151 downregulated mRNAs were identified as being co-expressed with others. Survival analysis suggested high levels of 14 lncRNAs and 10 mRNAs may significantly increase or decrease overall survival. These differentially expressed genes are also potentially prognostic in melanoma. Conclusion: Our findings observe potential roles for lncRNAs and mRNAs during melanoma progression and provide candidate biomarkers for further studies.

[Emergency repair of skin and soft tissue defects of lower limbs with island fasciocutaneous flap supplied by superficial sural artery].

OBJECTIVE: To find a better method of emergency repair of skin and soft tissue defects in the lower leg, ankle and foot. METHODS: The distally based superficial sural artery flap was designed on the posterior aspect of the leg. From February 2000 to December 2003, 18 patients with skin and soft tissue detects of the lower leg, ankle and foot were treated with island fasciocutaneous flap supplied by superficial sural artery by emergency. The size of the flap ranged form 4 cm x 5 cm to 11 cm x 12 cm. RESULTS: The flaps survived totally in 16 cases and necrosed partially in 2 cases. After 1-2 year postoperative follow-up, the results were satisfactory except that in 2 flaps. CONCLUSION: The island fasciocutaneous flap supplied by superficial sural artery may provide a useful method for emergency repair of soft tissue defect of the lower limbs.