Exosomes from MicroRNA-125b-Modified Adipose-Derived Stem Cells Promote Wound Healing of Diabetic Foot Ulcers.

INTRODUCTION: Exosomes derived from Adipose-Derived Stem Cells (ADSCs-Exo) have been implicated in the enhancement of wound repair in Diabetic Foot Ulcers (DFU). OBJECTIVE: The current research was designed to explore the therapeutic potential and underlying mechanisms of ADSCs-Exo modified with microRNA-125b (miR-125b) in the context of DFU. METHODS: Rat models with DFU and human umbilical vein endothelial cells (HUVECs) subjected to high glucose (HG) conditions served as experimental systems and were administered miR-125b-engineered ADSCs-Exo. Then, the expressions of CD34, Ki-67, angiogenesis-related factors (VEGF and TGFß-1), angiogenesis inhibitor DLL-4, and inflammation-related proteins (TLR-4 and IL-6) were detected. RESULTS: MiR-125b was upregulated in ADSCs-Exo. MiR-125b-mimics transfection in ADSCs- Exo reduced inflammatory infiltration and promoted granulation formation and wound healing in wound tissues. MiR-125b-mimics-modified ADSCs-Exo injection increased the expression of CD34, Ki-67, VEGF, and TGFß-1, whereas decreased the expression of DLL-4, TLR-4, and IL-6 in wound tissues of DFU rats. In addition, miR-125b-mimics-ADSCs-Exo injection reversed the negative effects of HG on the proliferation, migration, and angiogenesis of HUVECs, as well as the positive effects of cell apoptosis. Moreover, miR-125b-inhibitor-ADSCs-Exo injection had the opposite effects to miR-125b-mimics-ADSCs-Exo. CONCLUSION: ADSCs-Exo promoted wound healing of DFU rats, especially when overexpressing miR-125b.

A rare and highly malignant Stwart-Treves syndrome case after breast cancer surgery: a case report.

Background: Stewart-Treves syndrome (STS) is a lymphatic sarcoma secondary to chronic lymphedema of the extremities. Most STS patients have a history of breast cancer and have undergone radical mastectomy and postoperative radiation and chemotherapy. It usually occurs 11 to 12 years after surgery, and about 0.45% of patients are estimated to have the disease. The characteristics of STS include that it is clinically relatively rare, has a high degree of malignancy, can spread easily in the absence of timely treatment, and has low survival rate. Herein, we report a case of STS which developed 13 years after breast cancer-related lymphoedema (BCRL). It allows doctors to recognize and detect the disease earlier. Case Description: A 74-year-old woman had undergone modified radical mastectomy 13 years ago for invasive ductal breast cancer in her left breast. After multiple rounds of postoperative chemoradiotherapy, multiple purple lesions were found in the left upper limb during physical examination in April 2021. The lesions spread rapidly and were varied in size. An immediate skin biopsy reported the lesions as STS. The patient was diagnosed with lymphangiosarcoma with metastasis (STS). The surgical method was shoulder joint amputation, chest wall resection, and local flap transfer. After surgery, the patient underwent 6 rounds of paclitaxel 300 mg + carboplatin 300 mg chemotherapy. After chemotherapy, the patient's wound healed and the suspected metastasis disappeared. At the time of writing, she has survived for more than 13 months, and her quality of life has improved significantly, to the satisfaction of the patient and her family. The patient is able to eat normally and lead a normal life with some assistance, without significant weight loss. Conclusions: Although rare, STS is a serious invasive complication of breast cancer surgery. To increase their relative survival time, patients with BCRL need to identify and thoroughly investigate rapidly progressing skin lesions, and undergo timely surgery.

Tumor-like disorder of the brachial plexus region in a patient with hemophilia: A case report.

BACKGROUND: Various tumors and tumor-like disorders, originating from the neural sheath, as well as other types, may affect the brachial plexus region. Due to the infrequent presentation, brachial plexus palsy caused by spontaneous hematoma in patients with hemophilia might miss the treatment by early surgical decompression and progress to permanent nerve damage. CASE SUMMARY: The case reported here was a 30-year-old man with hemophilia, as well as both sensory and motor dysfunction of the left upper extremity. A presumptive diagnosis of brachial plexus tumor was initially made, which was subsequently confirmed to be an organized chronic hematoma rather than a neoplasm. The hemophilia-induced expanding hematoma compressing the brachial plexus was considered to be the main reason for the patient's complaints. The clinical symptoms were alleviated and the involved nerves partially recovered at a follow-up of 1 year. CONCLUSION: Early surgical intervention is crucial and it seems to be an essential precondition for recovery of nerve function in brachial plexus lesions.

Tissue-engineered bones with adipose-derived stem cells - composite polymer for repair of bone defects.

Background: Development of alternative bone tissue graft materials based on tissue engineering technology has gradually become a research focus. Engineered bone composed of biodegradable, biosafe and bioactive materials is attractive, but also challenging. Materials & methods: An adipose-derived stem cell/poly(L-glutamic acid)/chitosan composite scaffold was further developed for construction of biodegradable and bone-promoting tissue-engineered bone. A series of composite scaffold materials with different physical properties such as structure, pore size, porosity and pore diameter was developed. Results: The composite scaffold showed good biodegradability and water absorption, and exhibited an excellent ability to promote bone differentiation. Conclusion: This type of biodegradable scaffold is expected to be applied to the field of bone repair or bone tissue engineering.

In recent years, the application of bone graft materials in bone defect repair has become a research hotspot. Engineered bone composed of biodegradable, biosafe and bioactive materials is attractive but also challenging. A composite scaffold composed of adipose-derived stem cells and two polymers was developed for construction of biodegradable and bone-promoting tissue-engineered bone. A series of composite scaffold materials with different physical properties was prepared and studied. The composite scaffold showed good biodegradability and water absorption, and exhibited excellent ability to promote bone differentiation ­ that is, bone defect repair function. This kind of biodegradable scaffold is expected to be applied to the field of bone repair or bone tissue engineering.

Laparoscopy-assisted Chimeric Peritoneal-deep Inferior Epigastric Perforator Flap for Reconstruction of Hand and Foot.

Management of hand and foot defects with exposed tendons is a big challenge for plastic surgeons. Thin vascularized tissue offers an ideal surface for tendon excursion. OBJECTIVE: This study examines the reconstructive benefits of a laparoscopy-assisted chimeric peritoneal-deep inferior epigastric artery perforator (DIEP) flap in the treatment of hand and foot injury defects. MATERIALS AND METHODS: A retrospective review was performed on 8 patients (6 men, 2 women) that received hand or foot reconstruction with laparoscopy-assisted chimeric peritoneal-DIEP flap. Soft tissue defects of the hand or foot ranged from 16 cm x 10 cm to 22 cm x 14 cm. The peritoneum supplied by the peritoneal branches of the deep inferior epigastric artery was retrieved by laparoscopy to cover exposed extensor tendons, while the DIEP flap consisted of the cutaneous component part of this chimeric flap. RESULTS: The flaps survived in 7 of 8 patients. Partial necrosis of the chimeric flap was observed in 1 patient due to venous thrombosis. A split-thickness skin graft then was performed to achieve wound closure on that patient. Motor and sensory functions of these 8 patients improved gradually within the first-year follow-up. CONCLUSIONS: The laparoscopy-assisted chimeric peritoneal-DIEP flap is useful for reconstructing defects of the hand and foot with exposed tendons.

A totally laparoscopic peritoneal free flap for reconstruction of hand.

Management of defects on the hand and foot with exposed tendons remains a major challenge for plastic surgeons. Here, we present a case of hand reconstruction with a totally laparoscopic peritoneal flap. The anterior rectus sheath was preserved in situ. The peritoneal free flap supplied by peritoneal branches of the deep inferior epigastric artery was retrieved by laparoscopy to cover the soft tissue defect of the hand. The defect of the dorsal hand was 17 cm ×12 cm. The peritoneal flap measuring 22 cm × 15 cm survived completely without any complications. A following split-thickness skin graft offered the suc- cessful wound closure. Motor and sensory function improved gradually within the first year follow-up. The totally laparoscopic peritoneal free flap is a good choice for reconstruction of the soft tissue de- fects accompanied by exposed tendons on the hand and foot.

Elevated levels of plasma fibrinogen in patients with pancreatic cancer: possible role of a distant metastasis predictor.

OBJECTIVES: Although changes of plasma fibrinogen have been documented in limited pancreatic malignant tumors, a relationship between plasma fibrinogen and pancreatic cancer in a large-scale clinical study has not been shown. METHODS: Preoperative plasma levels of fibrinogen were retrospectively analyzed in 133 pancreatic cancer and 38 pancreatic benign tumor patients. RESULTS: Plasma fibrinogen in pancreatic cancer patients were significantly higher than those with benign pancreatic tumor (3.99 +/- 1.01 vs 2.62 +/- 0.65; P < 0.001). The percentage of hyperfibrinogenemia (>4.20 g/L) in pancreatic cancer was 41.1%, and no positive results were obtained in benign pancreatic disease. Plasma fibrinogen levels were increased in pancreatic cancer with advanced tumor stage. Accompanied with the progression of tumor stage, there was an increase in the percentage of positivity of hyperfibrinogenemia in pancreatic cancer. There were markedly higher levels of plasma fibrinogen in the distant-metastasis group than in the no-distant-metastasis group (4.41 +/- 0.84 vs 3.76 +/- 1.04; P < 0.01). Univariate and multivariate analysis revealed that high plasma fibrinogen levels (>4.20 g/L) were positively associated with distant metastasis of pancreatic cancer. CONCLUSIONS: Plasma fibrinogen levels had a positive relationship with tumor stage of pancreatic cancer. Increased preoperative plasma fibrinogen levels might be a useful predictor for distant metastasis in human pancreatic cancer.

High DcR3 expression predicts stage pN2-3 in gastric cancer.

BACKGROUND: A soluble decoy receptor 3 (DcR3), also known as TR6 or M68, is a member of the TNF receptor family. It has been reported that high DcR3 expression occurs in many tumors. METHODS: This prospective study evaluated the DcR3 tissue status by RT-PCR and its correlation with the lymph node (N) stages in 62 primary gastric cancers. RESULTS: DcR3 expression levels in patients with pN2-3 disease were much higher than those in patients with pN0-1 disease (median values 1.31 vs. 0, P < 0.01). Using ROC analysis, a cutoff level of DcR3 expression at 1.20 was found to be associated with optimal sensitivity and specificity of 62.5% (15 of 24) and 92.1% (35 of 38) respectively, in the prediction of stage pN2-3. According to the cutoff value, patients were divided into 2 groups with relatively high and low levels of DcR3 expression. Among the 18 patients with high DcR3 expression, 83.3% (15 of 18) were staged as pN2-3. In the other 44 patients with low DcR3 expression, only 20.5% (9 of 44) were identified as pN2-3. Logistic regression analysis for stage pN2-3 revealed that high DcR3 expression was an independent risk factor. CONCLUSION: Gastric cancer patients with high DcR3 expression presented more advanced pN2-3 disease than those with low DcR3 expression. Preoperative checking DcR3 expression might be an additional approach to imaging modalities for evaluating N stages in gastric cancer to guide the operative procedures.

Serum HDL-C as a potential biomarker for nodal stages in gastric cancer.

BACKGROUND: Although changes in lipid profile have been documented in gastrointestinal cancers, the specific relationship between serum lipid levels and lymph node (N) stages in gastric cancer remains uncertain. METHODS: Preoperative serum lipid concentrations were retrospectively examined in 501 patients who underwent curative resection for primary gastric cancer. Univariate and multivariate analyses were carried out to investigate the association of serum lipid levels with nodal stages. RESULTS: The serum high-density lipoprotein cholesterol (HDL-C) levels in gastric cancer patients correlated well with N stages. Cases with low HDL-C (< 40 mg/dl) presented more advanced pN(2-3) disease (57.6%, 83/144) than those with normal HDL-C (36.4%, 130/357; P < 0.05). The observed elevation of the TC/HDL-C ratio for patients with pN(2-3) disease was statistically significant when compared with that for patients with pN(0-1 )disease (mean values 3.57 vs. 3.31, P < 0.05). By receiver operating characteristic analysis, the combination of serum HDL-C concentration and TC/HDL-C ratio led to a sensitivity of 70.0% and a specificity of 51.0% in predicting stage pN(2-3). A logistic regression model revealed that both low HDL-C (< 40 mg/dl) and high TC/HDL-C ratio (> or =3.32) had an independent association with advanced pN(2-3 )stages. When patients' lipid levels were stratified by means of histological differentiation, the significant correlation of serum HDL-C levels with nodal stages was only detected in differentiated gastric cancer. CONCLUSIONS: For gastric cancer patients, preoperative low serum HDL-C concentration or high TC/HDL-C ratio might be a potential biomarker of advanced pN(2-3) stages, especially for those with the histologically differentiated type.

Risk factors for infectious morbidity in gallbladder cancer patients treated surgically.

BACKGROUND/AIMS: To explore risk factors associated with postoperative infectious morbidity in gallbladder cancer patients. METHODOLOGY: We investigated 58 consecutive patients undergoing surgery for primary gallbladder cancer between January 2000 and June 2005 in our hospital. Records of all patients were retrospectively reviewed. Twenty-two independent tumor-, patient-, and treatment-related variables were analyzed. The dependent variable was clinical infectious complications. A binary logistic regression analysis was used to assess the independent association of variables with the dependent variable. RESULTS: Overall surgical morbidity was 33% (19/58), and 14 (24%) of the 58 patients developed infectious complications postoperatively. On univariate analysis, presence of jaundice, hypoalbuminemia and intraoperative blood transfusion were found to be significantly associated with infectious morbidity. The multivariate analysis of logistic regression disclosed that presence of jaundice and intraoperative blood transfusion of 4 units or more only showed marginally significant impacts on infectious complications (odds ratio, 8.004, 7.782; 95% confidence interval, 0.886-72.278, 0.914-66.283, respectively), while weight loss and hypoalbuminemia were significantly associated with infectious complications postoperatively (odds ratio, 9.609, 40.257; 95% confidence interval, 1.269-72.253, 3.901-415.438, respectively). CONCLUSIONS: Hypoalbuminemia and weight loss are significantly associated with postoperative infectious morbidity independently. While presence of jaundice and intraoperative blood transfusion of 4 units or more appear to be marginally significant factors, modality of operation or liver resection, blood loss, and additional gastrointestinal operation are not risk factors.

High DcR3 expression predicts stage pN2 in gastric cancer.

BACKGROUND/AIMS: A soluble decoy receptor 3 (DcR3), also known as TR6 or M68, is a member of the TNF receptor family. It has been reported that high DcR3 expression occurs in many tumors. METHODOLOGY: This prospective study evaluated the DcR3 tissue status by RT-PCR and its correlation with the lymph node (N) stages in 62 primary gastric cancers. RESULTS: DcR3 expression levels in patients with pN2 disease were much higher than those in patients with pN0-1 disease (Median values 1.31 vs. 0, P< 0.01). Using ROC analysis, a cut-off level of DcR3 expression at 1.20 was found to be associated with optimal sensitivity and specificity of 62.5% (15/24) and 92.1% (35/38) respectively, in the prediction of stage pN2. According to the cut-off value, patients were divided into two groups with relatively high and low levels of DcR3 expression. Among the 18 patients with high DcR3 expression, 83.3% (15/18) showed metastases to the second level lymph nodes. In the other 44 patients with low DcR3 expression, only 20.5% (9/44) had secondary nodal involvement. Logistic regression analysis for stage pN2 revealed that high DcR3 expression was an independent risk factor. CONCLUSIONS: Gastric cancer patients with high DcR3 expression presented more advanced pN2 disease than those with low DcR3 expression. Preoperative checking DcR3 expression might be an additional approach to imaging modalities for evaluating N stages in gastric cancer to guide the operative procedures.