Promotion of diced cartilage survival and regeneration with grafting of small intestinal submucosa loaded with urine-derived stem cells.

Cartilage absorption and calcification are prone to occur after the implantation of diced cartilage wrapped with autologous materials, as well as prolong the operation time, aggravate surgical trauma and postoperative pain during the acquisition process. Small intestinal submucosa (SIS) has suitable toughness and excellent degradability, which has been widely used in the clinic. Urine-derived stem cells (USCs), as a new type of stem cells, have multi-directional differentiation potential. In this study, we attempt to create the tissue engineering membrane material, termed USCs-SIS (U-SIS), and wrap the diced cartilage with it, assuming that they can promote the survival and regeneration of cartilage. In this study, after co-culture with the SIS and U-SIS, the proliferation, migration and chondrogenesis ability of the auricular-derived chondrocyte cells (ACs) were significantly improved. Further, the expression levels of chondrocyte phenotype-related genes were up-regulated, whilst that of dedifferentiated genes was down-regulated. The signal pathway proteins (Wnt3a and Wnt5a) were also participated in regulation of chondrogenesis. In vivo, compared with perichondrium, the diced cartilage wrapped with the SIS and U-SIS attained higher survival rate, less calcification and absorption in both short and long terms. Particularly, USCs promoted chondrogenesis and modulated local immune responses via paracrine pathways. In conclusion, SIS have the potential to be a new choice of membrane material for diced cartilage graft. U-SIS can enhance survival and regeneration of diced cartilage as a bioactive membrane material.

[Application of modified inferior pedicle technique with inverted T pattern for severe breast hypertrophy].

Objective: To explore the effectiveness of modified inferior pedicle technique with inverted T pattern for severe breast hypertrophy. Methods: Between January 2016 and May 2017, 15 patients of severe breast hypertrophy had undergone breast reduction using inferior pedicle technique with inverted T pattern combined with dermal suspension sling technique. The patients were 20 to 49 years old, with an average age of 31.6 years. Body mass index ranged from 24.9 to 32.5 kg/m 2, with an average of 30.8 kg/m 2. Among them, 11 cases had a history of childbearing. The degree of breast ptosis was rated as degree Ⅱ in 6 cases and degree Ⅲ in 9 cases. The unilateral breast reduced 615 g on average (range, 480-1 050 g). Results: The skin flap necrosis at the "T" trilateral junction occurred in 3 cases, and healed after dressing changes. The incisions of 12 cases healed and no fat liquefaction, hematoma, or seroma occurred. The sensation of nipple and areola declined at early period after operation in 2 cases, and gradually recovered. All patients were followed up 6-18 months (mean, 13 months). The shapes of bilateral breasts and the height and symmetry of nipple-areolar complex were good, and no obvious scar was found. The effectiveness was evaluated by surgeon and showed that there were 12 cases with satisfactory breast shape and 3 cases with unsatisfactory breast shape; 3 cases with obvious scare and 12 cases with insignificant scar; 13 cases with normal nipple sensation and 2 cases with hypoesthesia; 11 cases with symmetric nipples and 4 cases with asymmetric nipples. The effectiveness was evaluated by patients and showed that the satisfactory breast shape in 10 cases, relatively satisfactory breast shape in 4 cases, and unsatisfactory breast shape in 1 case; highly acceptable scar in 9 cases, moderately acceptable scar in 4 cases, and unacceptable scar in 2 cases; overall satisfactory in 10 cases, relatively satisfactory in 4 cases, and unsatisfactory in 1 case, with the overall satisfaction rate of 93.3% (14/15). Conclusion: For severe breast hypertrophy, the modified inferior pedicle technique with inverted T pattern can obtain satisfactory appearance and avoid the mastoptosis.

Epidemiologic Investigation of Burn Patients in Sichuan Province, China.

BACKGROUND We investigated the epidemiology of patients admitted to the Burn Center of West China Hospital during 2011-2016, to provide measures for burn prevention. MATERIAL AND METHODS We conducted a retrospective review of patients admitted to the Burn Center of West China Hospital during 2011-2016. We collected information on patient demographics, burn etiology, burn extent, place of injury, education level, and burn knowledge of patients. RESULTS A total of 1323 patients (1033 males and 290 females), mean age 35.4 years (range 10 days to 91 years), were admitted to our burn center. Among all patients, 214 were children aged 0-14 years, 998 were adults aged 15-59 years, and 111 were elderly adults over age 60 years. Scalds were the predominant cause of pediatric burns; however, flame burns were most common among adults and elderly patients. The injury location varied by age, with most burns occurring at work among adults; however, most children and elderly patients were burned at home. Educational levels were lower among adults from rural areas than those from urban areas, but both groups had little first aid knowledge. Furthermore, rural patients had received less vocational education and training than urban patients. CONCLUSIONS There has been a decrease in burn incidence in Sichuan Province. Flame injury should be a focus of attention in all age groups. Prevention programs for adults in the workplace are imperative. Burn prevention programs should continue to improve living conditions, especially for elderly people.

Correction of Tanzer Type IIB Constricted Ears via Z-shaped Double V-Y Advancement Flaps.

BACKGROUND: Correction of Tanzer type IIB constricted ears requires sufficient expansion of the auricular skin to cover the reconstructed cartilaginous framework. To obtain an adequately sized skin cover, skin flap transposition from periauricular donor sites has been described; however, it remains challenging to obtain enough skin to enable satisfactory reconstruction. Herein, we describe a novel method that uses 2 local flaps comprising superoauricular, retroauricular, and preauricular soft tissue to expand the skin cover and correct Tanzer type IIB deformity. METHODS: Fifteen constricted ears in 15 patients were treated via this novel method from June 2013 to July 2017. Two adjoining V-Y advancement flaps shaped like a backward "Z" were created to expand the skin envelope of the upper one-third of the ear. The advancement of these 2 flaps toward each other expanded the skin of the upper one-third of the ear by creating a skin arch, which was then used to wrap the reconstructed cartilaginous framework. The auricular cartilage was refashioned via a method that combined several previously reported techniques. RESULTS: A satisfactory outcome was achieved in all 15 constricted ears, with resultant improvements in size and shape, and an elevated auricular position. CONCLUSIONS: The preauricular, superoauricular, and retroauricular skin areas can be used to successfully expand the skin envelope of the upper auricle via the creation of 2 adjoining V-Y advancement flaps. This results in an ample skin cover with which to accommodate the auricular cartilaginous framework reconstructed by multiple techniques. This novel Z-shaped double V-Y advancement flap method can effectively correct Tanzer type IIB constricted ears.

[Effectiveness of perichondrial cutaneous graft of dorsal auricle for repairing facial melanocytic nevus excision defect].

OBJECTIVE: To investigate and compare the effectiveness of perichondrial cutaneous graft (PCCG) of dorsal auricle for repairing defect after excision of melanocytic nevus in different parts of the face. METHODS: Between February 2008 and October 2012, 29 cases of facial melanocytic nevus were admitted. There were 11 males and 18 females, aged 3-25 years (median, 11 years). The locations were the upper eyelid in 5 cases, the nose in 15 cases, and the buccal region in 9 cases. The size of the nevi ranged from 1.2 cm x 1.0 cm to 4.0 cm x 2.2 cm. Defects after excision of nevi were repaired by PCCG of the dorsal auricle, which size ranged from 1.5 cm x 1.5 cm to 4.2 cm x 2.5 cm. The postoperative effectiveness was scored by patients according to color match, scar formation, and flatness of the reception site. The satisfaction evaluations were compared by the score among different parts. RESULTS: All the PCCG survived. All the patients were followed up 7-15 months (mean, 10 months). All the reception site had good color match and acceptable scar formation. The nasal part had good flatness, and the upper eyelid had poor flatness. Score comparison showed no significant difference in color match between 3 parts (P > 0.05). Nasal part had significantly less scar formation than buccal region and upper eyelid (P < 0.05), but no significant difference between buccal region and upper eyelid (P > 0.05). Nasal part and buccal region both had significantly better flatness than upper eyelid (P < 0.05), but no significant difference between nasal part and buccal region (P > 0.05). The overall evaluation score of nasal part and buccal region was significantly higher than that of the upper eyelid group (P < 0.05), and the score of the nasal part was significantly higher than that of the buccal region (P < 0.05). CONCLUSION: PCCG of dorsal auricle has a good color match in repair of facial defect, especially in repair of nasal defect with good flatness and no obvious scar formation.

[Mentocervical reconstruction and effectiveness evaluation in treatment of mentocervical cicatricial contracture deformity].

OBJECTIVE: To investigate the procedures and effectiveness of platysma scar flap for reconstructing mentocervical appearance in patients with mentocervical cicatricial contracture deformity. METHODS: Between April 2004 and August 2011, 26 patients with mentocervical cicatricial contracture deformities were admitted. There were 15 males and 11 females, aged 12-31 years (mean, 18 years). The causes included scald injury in 19 cases and flame injury in 7 cases, including 23 cases of deep second degree burn and 3 cases of third degree burn. The time between injury and scar formation was 6-27 months (mean, 10 months). The mentocervical angle was (117.10 +/- 14.46) degrees, and the cervicomental angle was (143.38 +/- 15.68) degrees. The platysma scar flap transfer (8 cm x 7 cm to 10 cm x 8 cm in size) and skin grafting were performed to reconstruct mentocervical appearance. RESULTS: The flap and skin graft all survived and the incisions healed by first intention. All the patients were followed up 6 months-3 years (mean, 16 months). The mentocervical and cervicomental angles were significantly reduced to (89.31 +/- 6.30) degrees and (117.83 +/- 10.65) degrees respectively at 2 weeks after operation (P < 0.05), showing no significant difference when compared with normal mentocervical angle (90 degrees) and cervicomental angle (120 degrees) (P > 0.05). The satisfactory results of the mentocervical appearance and cervical extension function were obtained in 21 patients whose mentocervical and cervicomental angles were restored to normal. CONCLUSION: Platysma scar flap transfer is an effective method to reconstruct mentocervical appearance and reduce mentocervical and cervicomental angles in patients with mentocervical cicatricial contracture deformity.

Effect of heat shock protein 47 on collagen synthesis of keloid in vivo.

Keloid is regarded as a fibroproliferative disorder with excessive accumulation of extracellular matrix. However, the molecular mechanism of keloid formation is not well understood and no treatment modality is consistently effective. Heat shock protein 47 (HSP47) is known as a collagen-specific molecular chaperone which plays a critical role in collagen biosynthesis. Results of our previous in vitro experiments demonstrated that HSP47 might be an important reason for excessive collagen accumulation in regard to keloid formation. Our objective is to investigate whether HSP47 has an influence on collagen metabolism in animal keloid models. The constructed plasmids, carrying HSP47-small hairpin RNA (shRNA), were transfected into animal keloid models, in comparison with the control groups. After transfection, the mRNA and protein expression of HSP47 and collage type I were detected by quantitative real-time PCR and Western blot. Both the mRNA and protein levels of HSP47 in animal keloid models were decreased dramatically after transfection of the HSP47- shRNA plasmid, in comparison with the control group. Following the down-regulation of HSP47, we found that the volume of animal keloid models and the major collagen expression were reduced correspondingly. Combining the results of our previous in vitro experiment results, we suggest that overexpression of HSP47 in keloid fibroblast cells could induce excessive collagen accumulation by enhancing collagen synthesis, which not only presents a possible mechanism of keloid formation, but also offers a therapeutic potential of RNA interference to HSP47 for the treatment of keloids and other fibroproliferative disorders.

[Repair of chronic osteomyelitis of sternum after thoracotomy with greater pectoral muscle flap].

OBJECTIVE: To explore a surgical method for chronic osteomyelitis of sternum after thoracotomy. METHODS: From January 2006 to February 2009, 11 cases of chronic osteomyelitis after thoracotomy (2 cases of coronary bypass, 6 cases of mitral valve replacement, and 3 cases of ventricular defect repair) were admitted. Of them, there were 6 males and 5 females, aged from 6 to 62 years (median 34 years), including 6 cases of simple osteomyelitis of sternum, 2 cases of osteomyelitis of sternum with suppurative infection of mediastinum, and 3 cases osteomyelitis of sternum with costal chondritis. Necrotic sternum were excised and defect was from 4 cm x 3 cm to 7 cm x 4 cm. Greater pectoral muscle flap was designed from 8 cm x 5 cm to 10 cm x 6 cm on one side and was transferred to defect. Negative drainage and sensitive antibiotics were administered after operation. RESULTS: Healing by first intention was achieved in 10 patients except 1 patient who had a few discharge at the drainage outlet and whose incision healed 1 week later. The follow up was from 3 to 10 months with an average of 6 months. The formed scars were flat with soft texture in 8 patients and moderately hypertrophy in 3 patients. The wounds healed without pain, relapse or abnormal function of donor upper limb. CONCLUSION: Transplantation of greater pectoral muscle flap is an effective way to repair chronic osteomyelitis of sternum after thoracotomy.

Anti-inflammatory effect of the polysaccharides of golden needle mushroom in burned rats.

The present study was to investigate chemical components of polysaccharides isolated from Golden needle (GNP) mushroom using high performance liquid chromatography (HPLC) and nuclear magnetic resonance spectroscopy (NMR). Then, anti-inflammatory effect of the polysaccharides was also evaluated. Results indicated that GNP was composed of the three monosaccharides (glucose, mannose and xylose) with a molar ratio of 3.5:0.8:1.4. GNP could significantly decreased CD4+ CD8+, ICAM-1, and MPO in serum and colon of normal and burned rats. It could be concluded that GNP possessed strong anti-inflammatory activity in burned rats.

[Surgical treatment of hemangioma and vascular malformation in body surface].

OBJECTIVE: To investigate the surgical treatment and curative effect of hemangioma and vascular malformation in body surface. METHODS: From May 2003 to December 2006, 145 patients with hemangioma or vascular malformation (81 males and 64 females, aging from 2 months to 40 years with median of 17 years) were treated with surgical therapy. The course of disease was from 2 months to 40 years. The locations were head and face in 85 cases, extremities in 34 cases and trunk in 26 cases. The size ranged from 1 cm x 1 cm to 27 cm x 24 cm. Wounds were sutured directly after lesions excision in 40 cases, were repaired with 3 cm x 2 cm-18 cm x 11 cm local flap transferring in 21 cases (donor site sutured directly in 18 and free skin grafted in 3) and with 5 cm x 3 cm-27 cm x 18 cm middle-thick skin graft in 84 cases (abdominal skin donor site sutured directly in 61, thigh skin donor site thin-partial-thickness grafted in 5 and skin in-situ regrafted in 18). RESULTS: The pathological results showed 38 cases of capillary hemangioma, 23 cases of venular malformation, 67 cases of venous malformation, 15 cases of arteriovenous malformation and 2 cases of lymphatic malformation. Six of 84 cases receiving free skin graft had partial skin necrosis; one case complicating by skull exposure achieved healing after local fascial flap transferring and other 5 cases achieved healing by second intention after dressing changes. Other free skin graft survived. All the donor sites healed by first intention. All patients were followed up for 1-3 years. Recurrence occurred in 12 cases 6 months to 2 years after operation, including 4 cases of arteriovenous malformation, 7 cases of venous malformation and 1 case of venular malformation. They were cured after second operation. The others achieved good results with no recurrence. CONCLUSION: Extensive and thorough excision was the effective way to cure hemangioma and vascular malformation in body surface. All cases should be followed up closely to deal with recurrence promptly.

[Effects of connective tissue growth factor on angiogenesis of random skin flaps in rats].

OBJECTIVE: To investigate the effects of connective tissue growth factor (CTGF) on angiogenensis of random skin flaps in rats. METHODS: Thirty-two SD rats were randomly divided into three CTGF groups (rCTGF 120 ng, rCTGF 160 ng, rCTGF 200 ng) and one control group. Ischemic random dorsal skin flaps (2 cm x 8 cm) were constructed on the backs of the rats. In the CTGF groups, connective tissue growth factor (CTGF) was injected subcutaneously to the rats in the skin flaps at the time of surgery. The same volume of 0.9% NaCl solution was injected to the rats in the control group. Ten days later, the amount of viable tissues within the flaps were examined by planimetry. Specimens from the random skin flaps were harvested for immunohistological and HE staining to examine the microvascular growth. RESULTS: The immunohistochemical staining and HE staining revealed that the three CTGF groups had more vessels than the control group (21.00 +/- 3.423, 27.38 +/- 3.114 and 37.38 +/- 3.583 vs. 13.88 +/- 1.959, P < 0.05). Similar results were found in the middle parts of the skin flaps (15.50 +/- 2.777, 24.63 +/- 3.335 and 28.63 +/- 4.984 vs. 9.50 +/- 1.927, P < 0.05). CONCLUSION: CTGF may enhance the survival of skin flaps in a dose-dependent manner, which is associated with an increase in angiogenesis of skin flaps.

[Reconstruction of soft tissue defects in maxillofacial region using sternal head of sternocleidomastoid myocutaneous flap].

OBJECTIVE: To evaluate the preliminary etfect of using the sternal head of the sternocleidomastoid myocutaneous flap to reconstuct a defect in the maxillofacial region. METHODS: From May 2004 to September 2006, 5 male patients aged 23-34 underwent the reconstruction for the defect in the maxillofacial region by using the sternal head of the sternocleidomastoid myocutaneous flap. Their defects were caused by an infection of the face, an injection of medicine in the mother's uterus or a scar or depressed abnormality left by an electric injury. The defects ranged in size from 5 cm x 3 cm to 9 cm x 6 cm. RESULTS: All the 5 sternocleidomastoid myocutaneous flaps survived, with a little necrosis of the epidermis because of the venous return disturbance, but 2-3 weeks after operation the necrosis healed spontaneously with just a little scar formation around the flap. One patient had weakness in the left shoulder after operation, which almost recovered 6 months after operation. The postoperative follow-up for 1-6 months revealed that 1 patient had a little fat and clumsy appearance in the flap pedicle, 1 patient had an obvious scar at the operation site, but the 2 patients still felt satisfaction. The other 3 patients were satisfied with their good appearance at the operation sites. CONCLUSION: The sternal head of the sternocleidomastoid myocutaneous flap can be designed with more flexibility compared with the entire sternocleidomastoid myocutaneous flap. It can provide an enough tissue mass for restoring the defect. The sternal head of the sternocleidomastoid myocutaneous flap is an ideal tissue flap for restoring defects in the maxillofacial region.

[Inhibition of HPV16 E6 oncogene in cervical cancer by RNA interference].

OBJECTIVE: The efficiency of HPV16 E6 gene silenced by RNA interference in vitro and in vivo was assessed. METHODS: The specific siRNA of HPV16 E6 was designed and transfected into CaSki cells by liposome. Cell apoptotic rates and the changes in HPV16 E6 mRNA and protein before and after transfection were measured. Cervical cancer nude mice models were set up, siRNA was injected directly into subcutaneous tumor. The function of siRNA was evaluated by the changes in tumor volume, HPV16 E6 protein expression and apoptosis of tumor cells. RESULTS: In vitro research, the cell apoptotic rates were 7.7%, 11.8%, 37.4% and 12.6% respectively at 24 h, 48 h, 5th day and 9th day after transfection. The HPV16 E6 mRNA was reduced by 77%, 83%, 59% and 41% at 24 h, 48 h, 5th day and 9th day after transfection. The inhibition rates of E6 protein measured by Flow cytometry were 79.7%, 80.4%, 71.3% and 57.4% at 24 h, 48 h, 5th day and 9th day after transfection, which were confirmed by the results of Western blot. In vivo research, E6 siRNA administration groups had great power in inhibiting tumor growth, restraining E6 protein expression, increasing tumor necrosis and apoptosis. The result of repeated injections of siRNA was better than that of single injection. CONCLUSION: RNA interference with HPV16 E6 is specific and highly efficient in vitro and in vivo.

[Analysis of complications induced by polyacrylamide hydrogel injection for augmentation mammaplasty].

OBJECTIVE: To analyze the complications induced by polyacrylamide hydrogel injection for augmentation mammaplasty, explore the reason of the complication. METHODS: Twenty three patients with complications after polyacrylamide hydrogel injection were classified by signs and symptoms, ultrasound and pathologic examinations were made. RESULTS: The main complications were pain, hard nodule, asymmetry and breast deformation. The injected material was distributed diffusely behind gland, in gland, in muscles subcutaneous, even out of breast, caused some pathologic changes and it's hard to be cleaned completely from normal tissue. CONCLUSIONS: The complications were caused mainly by incorrect manipulation during operation, others might be relative to the injected material. The reliability of this injection method for augmentation should be cautiously observed.