Construction of a 5-gene prognostic signature based on oxidative stress related genes for predicting prognosis in osteosarcoma.

BACKGROUND: The understanding of the complex biological scenario of osteosarcoma will open the way to identifying new strategies for its treatment. Oxidative stress is a cancer-related biological scenario. At present, it is not clear the oxidative stress genes in affecting the prognosis and progression of osteosarcoma, the underlying mechanism as well as their impact on the classification of osteosarcoma subtypes. METHODS: We selected samples and sequencing data from TARGET data set and GSE21257 data set, and downloaded oxidative stress related-genes (OSRGs) from MsigDB. Univariate Cox analysis of OSRG was conducted using TARGET data, and the prognostic OSRG was screened to conduct unsupervised clustering analysis to identify the molecular subtypes of osteosarcoma. Through least absolute shrinkage and selection operator (LASSO) regression analysis and COX regression analysis of differentially expressed genes (DEGs) between subgroups, a risk assessment system for osteosarcoma was developed. RESULTS: 45 prognosis-related OSRGs genes were acquired, and two molecular subtypes of osteosarcoma were clustered. C2 cluster displayed prolonged overall survival (OS) accompanied with high degree of immune infiltration and enriched immune pathways. While cell cycle related pathways were enriched in C2 cluster. Based on DEGs between subgroups and Lasso analysis, 5 hub genes (ZYX, GJA5, GAL, GRAMD1B, and CKMT2) were screened to establish a robust prognostic risk model independent of clinicopathological features. High-risk group had more patients with cancer metastasis and death as well as C1 subtype with poor prognosis. Low-risk group exhibited favorable OS and high immune infiltration status. Additionally, the risk assessment system was optimized by building decision tree and nomogram. CONCLUSIONS: This study defined two molecular subtypes of osteosarcoma with different prognosis and tumor immune microenvironment status based on the expression of OSRGs, and provided a new risk assessment system for the prognosis of osteosarcoma.

Discovery of New Therapeutic Targets for Osteosarcoma Treatment Based on Immune-Related lncRNAs in the Tumor Microenvironment.

Background: Long noncoding RNAs (lncRNAs) play an important role in osteosarcoma development, but their role in the tumor microenvironment (TME) is not fully understood. This study associated lncRNAs with immune-related genes and explored the mechanism of lncRNAs in osteosarcoma progression. Methods: Unsupervised consensus clustering was applied to construct immune subtypes based on immune-related lncRNAs identified by Pearson's correlation analysis. A series of functional analysis was performed to reveal the links among lncRNAs, immune subtypes, TME, and osteosarcoma prognosis. Results: We identified two immune subtypes C1 and C2 showing distinct overall survival. ECM-receptor interaction pathway was more activated in C2 subtype, while immune response pathways were more enriched in C2 subtype. Differential TME and response to chemotherapeutic drugs were observed between the two subtypes. Four metagenes of costimulation, cytolytic activity (CYT), immune score, and STAT1 were differentially enriched in the two subtypes. Based on 26-paired lncRNAs, we constructed a 4-paired lncRNA prognostic signature for predicting prognosis of osteosarcoma prognosis. Conclusions: This study focused on immune-related lncRNAs and TME, showing the possible role and mechanisms of lncRNAs in tumor growth and metastasis. ECM may be the new therapeutic target for treating osteosarcoma, and 26-paired lncRNAs could serve as a basis for further studying the mechanisms of CYT and STAT1 in immune response, cancer cell proliferation, and migration. The two subtypes and prognostic signature could promote the design of personalized osteosarcoma treatment.

Clinical effects of different etching modes for universal adhesives: a systematic review and meta-analysis.

BACKGROUND: To evaluate the clinical performance of universal adhesives in etch-and-rinse or self-etch application modes through meta-analysis. METHODS: A literature search was performed by two reviewers in the PubMed, Cochrane Library, and Embase databases (from January 2000 to March 2020). A total of 2,516 non-replicated records were identified and filtered. Studies that evaluated the clinical performance of universal adhesives using etch-and-rinse or self-etch mode were included. RevMan 5.3.5 (Cochrane, London, UK) was used to perform the meta-analysis. RESULTS: A total of 13 studies were included in the meta-analysis. The retention rates were higher in etch-and-rinse groups compared with self-etch groups [odds ratio (OR) =0.35, 95% confidence interval (CI): 0.18-0.71, P=0.003]. The etch-and-rinse approach also had better performance in marginal adaptation (OR =0.49, 95% CI: 0.36-0.67, P<0.001) and marginal staining (OR =0.49, 95% CI: 0.36-0.66, P<0.001). The current data showed a very low incidence rate of secondary caries or postoperative sensitivity, and there were no significant differences in the incidence rates between the etch-and-rinse groups and self-etch groups. DISCUSSION: The current evidence shows that, compared with self-etch approach, the etch-and-rinse approach for universal adhesives provides improved clinical outcomes in terms of retention rates, marginal adaptation, and marginal staining.

Preparation and biological characterization of the mixture of poly(lactic-co-glycolic acid)/chitosan/Ag nanoparticles for periodontal tissue engineering.

OBJECTIVE: This study aims to produce nanoparticles of chitosan (CS), poly(lactic-co-glycolic acid) (PLGA), and silver and investigate the optimal composite ratio of these three materials for periodontal tissue regeneration. METHODS: PLGA nanoparticles (nPLGA), CS nanoparticles (nCS), and silver nanoparticles (nAg) were prepared. The antibacterial properties of single nanoparticles and their effects on the proliferation and mineralization of periodontal membrane cells were investigated. Different ratios of nPLGA and nCS were combined, the proliferation and mineralization of periodontal membrane cells were investigated, and based on the results, the optimal ratio was determined. Finally, nPLGA and nCS in optimal ratio were combined with nAg, and the effects of the complex of these three materials on the proliferation and mineralization of periodontal membrane cells were investigated and tested in animals. RESULTS: The single nanoparticles were found to have no cytotoxicity and were able to promote cell mineralization. nCS and nAg in low concentrations showed antibacterial activity; however, nAg inhibited cell proliferation. The nPLGA and nCS complex in 3:7 ratio contributed to cell mineralization and had no cytotoxicity. nPLGA/nCS/nAg complex, which had the optimal proportion of the three materials, showed no cytotoxicity and contributed to cell mineralization. CONCLUSION: nPLGA/nCS/nAg complex had no cytotoxicity and contributed to cell mineralization. The 3:7 ratio of nPLGA/nCS and 50 µg/mL nAg were found as the optimal proportion of the three materials.

[Influence of immediate breast reconstruction after mastectomy on postoperative survival].

Objective: To compare over survival(OS),recurrence free survival(RFS) of 5 years and survival quality between patients with immediate breast reconstruction and patients without breast reconstruction after mastectomy. Methods: From January 2009 to December 2010,156 patients were diagnosed as breast cancer. Among them,56 patients, aged 30-55 years old, were treated with mastectomy and immediate breast reconstruction as rec onstruction group.100 patients, aged 30-55 years old, were treated with mastectomy without breast reconstruction as control group. The last follow-up time was June 2015.Patients' age, pathological type, clinical stage, lymph node metastasis were analyzed retrospectively. RFS and OS of 5 years and survival was compared by Kaplan Meier method. Survival quality of 1 year and 2 years after operation was compared between them. Results: Pathologic classification, clinical staging, sentinel lymph node positive rate, axillary lymph node positive rate and triple negative breast cancer had no difference between two groups(P ＞0.05).The median follow-up time was 56.3±13.7 (23-78) and 57.9 ± 14.1(27-78) months in the reconstruction group and control group respectively at end of the June of 2015.RFS 5 years was 75.2％ and 63.3％ respectively in the reconstruction group and control group, showing significant difference between them (P < 0.05).OS 5 years was 81.7％ and 83.3％ respectively in the reconstruction group and control group, with no statistical difference (P ＞ 0.05).Five aspects of physiological status, social/family status, emotion, functional status,additional focus in the reconstruction group 1 year postoperative were higher than those in control group (P ＜ 0.05).Physiology, social/family situation, emotion, functional status of the reconstruction group 2 years after operation were higher than that in control group (P ＜ 0.05).Scores of physiologic al status, social/family status, emotion, functional status and addition of 2 years in the reconstruction group were higher than those in 1 year after operation, with significant difference (P ＜ 0.05).The score improvement in control group was not obvious. Conclusions: Immediate breast reconstruction after mastectomy of breast improve the survival quality and postoperative RFS, but has no obvious effect on overall survival.

Reconstruction of Digital Skin Defects with the Free Wrist Crease Flap.

BACKGROUND: Soft-tissue digital defects frequently need to be covered by a flap rather than a skin graft. In hand surgery, functional preservation and aesthetic appearance are often as important as procedural efficacy. OBJECTIVE: We present our clinical experience with reconstruction of digital skin defects with the free wrist crease flap. METHODS: From January 2012 to September 2013, 14 digits of 14 patients (10 males, 4 females) were included for evaluation. The procedure was performed with brachial plexus block anesthesia. The superficial palmar branch of the radial artery, a subcutaneous superficial vein, and the palmar cutaneous branch of the median nerve were included in the free wrist crease flap. The flaps were used to reconstruct the skin defect of injured digits through microvascular anastomosis, and donor sites were closed primarily. RESULTS: Postoperative follow-up time ranged from 3 to 25 months. All digital deformities were corrected, all flaps survived completely without ischemia, and none were aesthetically bulky. The area of free wrist crease flaps ranged from 2.5 to 5.0 cm by 2.0 to 3.1 cm. Slight wound infections appeared in two cases. Venous crisis occurred in one case, but it was successfully addressed after vascular exploration and reanastomosis. Sensation determined by static two-point discrimination measured in these flaps 2 months postsurgery was "good" at a mean 9.7 ± 2.1 mm (range, 6-14 mm). The mean motion range of the distal interphalangeal joint and proximal interphalangeal joint was 23.4 ± 6.9 degrees (0-42 degrees) and 75.8 ± 22.1 degrees (0-98 degrees) preoperatively. The mean motion range of the distal interphalangeal joint recovered to 40.3 ± 5.7 degrees (36-42 degrees), and that of the proximal interphalangeal joint was 90.3 ± 15.3 degrees (85-98 degrees) postoperatively. Both joints reached normal motion angle and difference was statistically significant preoperatively and postoperatively (p < 0.05). The mean disabilities of arm and shoulder (DASH) score was 6.8 ± 3.4 (0-15), and there was statistically significant difference when compared with the preoperative score of 13.5 ± 4.3 (3-19) (p < 0.05). CONCLUSION: We found the free wrist crease flap to be an ideal solution for reconstruction of skin defects of digits.

T-shaped excision of the orbicularis oris muscle: an innovative technique for upper lip lift procedures.

BACKGROUND: The lips are a prominent part of the face and they age along with the face. Microsurgery for upper lip lifts is becoming popular because of its association with minimal trauma and rapid recovery. OBJECTIVES: The authors introduced an innovative method of lifting the upper lip. METHODS: From January 2009 to March 2013, a cohort of 30 women underwent an upper lip lift surgical procedure. Patients received local anesthesia for a regional block of the infraorbital nerve. A T-shaped orbicularis oris and a strip of skin were excised. The superior edge of the orbicularis oris muscle was sutured to the base of the nose, and the incision was closed with a continuous intradermal suture. Postoperative follow-up time ranged from 1 to 5 years. RESULTS: At the time of follow-up, the incisional scar was not visible on the patient. The nasolabial angle was 96.20° ± 1.86° before operation and 88.23° ± 2.58° after operation. The difference was statistically significant (P = 0.000 and P < 0.001). The upper lip angle was 65.56° ± 8.60° before operation and 51.90° ± 3.93° after operation. The difference was statistically significant (P = 0.000) and P < 0.001). After operation, the upper lip appeared to be clearly thickened. CONCLUSIONS: This innovative surgical technique is a simple and effective way to lift the upper lip.

A comparison of skin expansion and contraction between one expander and two expanders: a preliminary study.

BACKGROUND: This study aimed to compare the difference between the skin expansion and contraction rates for an expanded flap with one versus two expanders. METHODS: The study cohort comprised 24 cases of two overlapping expanders and 15 cases of a single implanted expander involving 22 patients. The method of "wet-cloth sampling" was applied to measure the expanded flap area and the initial unexpanded area and to calculate the skin expansion rate. Two points 5 cm apart in the center of the expanded flap were selected before the second surgical stage. After removal of the expander, the distance between the two fixed points was measured and recorded. The contraction rate of the expanded flap then was calculated. RESULTS: During the same period of expansion in the two groups (p = 0.06, >0.01), the skin expansion rate was 3.5 ± 0.9 % in the group with two overlapping expanders and 2.6 ± 0.6 % in the control group. The difference between the two groups was statistically significant (p = 0.002, <0.05). The instantly expanded flap contraction rates were 30.3 ± 0.8 and 32.3 ± 0.9 %, respectively for the two groups, and the difference was not statistically significant (p = 0.47, >0.05). We fitted a linear regression model that was Y = 0.533 − 0.003X, where Y was the contraction rate of the expanded flap and X was the period of expansion. The contraction rate of the expanded flap was negatively correlated with the period of expansion. CONCLUSIONS: Compared with the traditional method of implanting a single expander, the new method of overlapping two expanders in a single cavity increased the skin expansion rate. The instantly expanded flap contraction rate did not differ significantly between the two groups, so the amount of expanded skin area absolutely increased. The clinical application of the new method is worth promoting. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.