Preadsorption of Serum Proteins Regulates Bacterial Infections and Subsequent Macrophage Phagocytosis on Biomaterial Surfaces.

Bacterial infection has been one of the main obstacles for extensive biomedical applications of biomaterial films. Understanding the interactions among macromolecules, cells, and bacteria in the microenvironment located on the film surface at the molecular level is essential for developing antibacterial films. Here we report the distinct influence of several key serum proteins adsorbed on diamond-like carbon (DLC) and traditional Ti films on initial bacterial adhesion, biofilm formation, and corresponding immune responses. Type I collagen, Fn, and IgG were selected as the typical serum proteins. Gram-positive bacterium Staphylococcus epidermidis and Gram-negative bacterium Escherichia coli were used as the model bacteria. Macrophage phagocytosis tests were carried out to examine the impact of adsorbed proteins on the ability of macrophages to clear the adhered pathogens. Results show that it was the specific molecular recognition between adsorbed proteins and bacteria, not the surface physiochemical properties such as surface wettability, surface roughness, and surfaces charge, that decisively affected bacterial adhesion and following biofilm formation. Collagen resisted bacterial adhesion on both DLC and Ti films, even though the molecules exhibited distinct conformations on the two surfaces, whereas for Fn and IgG, the specific molecular recognition was closely related to protein conformations. Fn molecules formed globular aggregates on Ti surfaces that greatly enhanced bacterial adhesion but exhibited a fibril conformation on DLC surfaces that inhibited bacterial adhesion. IgG showed an end-on orientation with free F(ab)2 domains on Ti surfaces, facilitating bacterial adhesion and biofilm formation, while the flattened orientation on DLC films showed little effect on bacterial behaviors. Furthermore, preadsorption of Fn and IgG significantly promoted the phagocytosis ability of macrophages against S. epidermidis and affected the corresponding secretion of inflammatory cytokine. These results would give insights into understanding protein-surface interactions for developing appropriate surface modification techniques for biomaterials with desired anti-inflammatory functions.

Proper Choice of Donor Site Veins for Patients Undergoing Free Radial Forearm Flap Reconstruction for the Defects of Head and Neck.

PURPOSE: The purpose of this study was to analyze the reliability of the deep venous drainage system of the free radial forearm flap. MATERIALS AND METHODS: The authors implemented a retrospective cohort study and enrolled patients admitted for the evaluation and management of head and neck tumors with radial forearm flap reconstruction. The primary predictor variables were the donor site veins, including the deep, dual, and superficial venous drainage systems. The primary outcome measurement was the incidence of venous compromise. Potential confounders included patient demographics, history of chemotherapy with or without radiotherapy, defect sites, and the recipient artery and vein. The χ2 test and logistic regression analysis were used for statistical analysis. RESULTS: The final study population consisted of 520 patients (mean age, 54 years) who underwent head and neck soft tissue reconstruction using the free radial forearm flap. Patients with the deep system (odds ratio [OR] = 0.251; 95% confidence interval [CI], 0.108-0.581) or dual system (OR = 0.197; 95% CI, 0.064-0.605) had a markedly lower risk of venous compromise than those with the superficial system. The overall incidence of inadequate outflow was 2.5% (5 of 204) when the deep system was used alone and 8.9% (19 of 212) when the superficial system was used alone (P = .004). CONCLUSIONS: Patients with the deep venous drainage system had a statistically lower risk of venous compromise. This study recommends using the deep system as a drainage vein for the free radial forearm flap.

Fisetin suppresses malignant proliferation in human oral squamous cell carcinoma through inhibition of Met/Src signaling pathways.

Fisetin (3,7,3',4'-tetrahydroxyflavone) is a dietary flavonoid and has been indicated as a novel anti-cancer agent in several types of cancer cells. However, the mechanisms underlying the effect of fisetin in human oral squamous cell carcinoma (OSCC) remain unclear. Here, we report that fisetin significantly inhibits tumor cell proliferation and induces apoptosis in OSCC (UM-SCC-23 and Tca-8113) cancer cell lines. Further analysis demonstrates that fisetin also inhibits Met/Src signaling pathways using the PathScan® receptor tyrosine kinases (RTK) Signaling Antibody Array Kit. Fisetin resulted in decreased basal expression of Met and Src protein in UM-SCC-23 cancer cell lines, which validated by western blot. A student's t-test (two-tailed) was used to compare differences between groups. Furthermore, fisetin significantly inhibited the expression of a disintegrin and metalloproteinase 9 (ADAM9) protein in OSCC cells. Taken together, these results provide novel insights into the mechanism of fisetin and suggest potential therapeutic strategies for human OSCC by blocking the Met/Src signaling pathways.

Management strategy in patient with familial gigantiform cementoma: A case report and analysis of the literature.

RATIONALE: Familial gigantiform cementoma (FGC) is a rare benign autosomal dominant fibrocemento-osseous lesion generally limited to the facial bones, typically in the anterior portion of the mandible; it is often associated with abnormalities of the long bones and prepubertal pathologic fractures. Owing to the small number of such patients, a uniform treatment criterion has not been established. This paper presents a patient with FGC who was treated in our department, and offers a systematic review of the patients reported in the literature. Our aim was to explore the treatment strategy for patients with FGC. PATIENT CONCERNS: Our patient, a 13-year-old boy, presented with a painless enlargement of the mandible first noted 2 years earlier. It had grown rapidly over the preceding 8 months, affecting both his appearance and ability to chew. DIAGNOSIS: Based on the pathologic, clinical, and radiographic features, FGC was diagnosed. INTERVENTIONS: Mandibuloectomy was performed. The mandibular defect was immediately reconstructed with his right vascularized iliac crest flap. At the same time, a PubMed search was conducted to identify studies reporting on other patients with FGC. OUTCOMES: A 3-dimensional computed tomography (3D-CT) scan demonstrated appropriate height of the new alveolar bone. Follow-up results showed recovery of the patient's appearance and mandibular function. He was free of recurrence at 4-year follow-up. LESSONS: FGC is a rare benign fibrocemento-osseous lesion of the jaws that can cause severe facial deformity. Incomplete removal leads to more rapid growth of the residual lesion. Therefore, extensive resection is a suitable strategy to avoid recurrence. Defects of the facial bones found intraoperatively should be repaired with resort to an appropriate donor site. However, it is important to be aware that patients with FGC always have concomitant abnormalities of skeletal metabolism and structure, as well as a vulnerability to fractures of the long bones of the lower extremity. Therefore, the optimal management strategy should include a review of treatment options for other patients as reported in the literature. An optimal protocol can not only provide sufficient high-quality bone suitable for the reconstruction of bone defects, but also minimize complications and maximize quality of life.

A modified technique for reconstruction of a total maxillary defect.

Total maxillary defects with orbital retention (Brown class 2b) are a challenge to reconstructive surgeons because of the variety of anatomical structures involved. Traditional techniques to reconstruct the orbital floor, zygoma, and maxilla using only a vascularised fibular flap are complicated, as the osteotomy and orientation of bone are difficult. Reconstruction of the orbital floor with titanium mesh may also cause palpable discomfort and increase the risk of secondary infection. We describe a modified technique using a vascularised fibular flap, together with a coronoid temporalis pedicle flap, which we used in two patients in whom we achieved satisfactory aesthetic and functional results. Our technique provides adequate tissue for infraorbital skin defects, provides pedicles of sufficient length, and requires only one fibular osteotomy. To our knowledge this is the first report of this technique.

Alveolar soft part sarcoma of the oral and maxillofacial region: clinical analysis in a series of 18 patients.

OBJECTIVES: To summarize the clinical features, diagnosis, treatment strategies, and prognosis of alveolar soft part sarcoma (ASPS) of the oral and maxillofacial region. STUDY DESIGN: We performed a retrospective study in a consecutive series of 18 patients with ASPS of the oral and maxillofacial region between 1995 and 2013. Demographic characteristics, tumor sizes, sites, tumor metastasis, diagnosis, treatments, and overall follow-ups were documented. RESULTS: The 18 patients were diagnosed pathologically with primary tumor developed on the tongue (10), the cheek (5), the pharynx (1), and the gingiva (2) with an average tumor size of 4 cm. At the latest follow-up, 1 patient with lung metastases survived for 23 months; 1 died 3 months after the confirmation of local recurrence and multiple pulmonary metastases; the rest of the patients were disease free and remained in good health. CONCLUSIONS: ASPS of the oral and maxillofacial region appears to have special clinical characteristics.

A new clinical manifestation for cheek alveolar soft-part sarcoma: a case report and review of the literature.

Alveolar soft part sarcoma (ASPS) is a rare, histologically distinct, soft tissue malignancy with nonspecific clinical features usually described as a nonulcerated, painless, expanding mass. It has a pseudoalveolar appearance with clustered polygonal cells lacking central cohesion. It accounts for approximately 0.5 to 1% of all soft tissue sarcomas. It has a strong predilection for adolescents and young adults 15 to 35 years old, with a female predominance. In general, ASPS grows slowly, with a predilection for the trunk and extremities and rarely in the head and neck region. A literature review found only 11 cases of cheek ASPS that have been reported since 1952. This report describes the case of an unusually rapidly growing mass in the cheek of a 36-year-old woman. The superficial location of the mass led to early detection and treatment.

[Expression and significance of Runx3 in salivary adenoid cystic carcinoma].

PURPOSE: To investigate the association between Runx3 expression and progression of salivary adenoid cystic carcinoma(SACC). METHODS: The expression of Runx3 was examined in 4 pairs of primary SACC and adjacent salivary gland tissues from the same patient, using real-time PCR and Western blot. Furthermore, the Runx3 protein expression was analyzed in 65 clinicopathologically characterized SACC cases by immunohistochemistry. SPSS 17.0 software package was applied to complete data processing.Chi-square test was performed to determine the prognostic and diagnostic associations. RESULTS: Runx3 expression was found to be remarkably downregulated in SACC tissues than that in the normal salivary gland tissues, at both mRNA and protein levels. Statistical analysis revealed a significant correlation of Runx3 expression with Lymph node metastasis. CONCLUSIONS: The results suggest that Runx3 expression is associated with SACC progression, and might represent as a novel and valuable biomarker for clinical therapy of SACC patients.

[Perforator-based chimeric anterolateral thigh flap for head and neck reconstruction after en bloc resection].

PURPOSE: To discuss and report the operative techniques for harvesting perforator-based chimeric flap in anterolateral thigh region and the advantages for head and neck reconstruction after en bloc resection. METHODS: A retrospective review was performed of perforator-based chimeric anterolateral thigh (ALT) flap for head and neck reconstruction since December of 2007 to March of 2011. 66 perforator-based chimeric flaps were harvested including a skin paddle and a muscular flap supplied by one mother pedicle-descending branch of lateral circumflex femoral artery(d-LCFA). 32 flaps were used for the mobile tongue and floor of mouth reconstruction, 30 flaps for base of the tongue and parapharyngeal walls, two for the buccal skin, one for hemimandible and one for parotid. The muscular flap were used to eliminate the dead space of submandibular area. Flaps size ranged from 7cm±4cm to 16cm±7cm and muscular flap was 3cm±4cm approximately. The complications and functions of both donor and recipient sites were recorded and the operative techniques of perforator-based chimeric flap elevation were generalized. RESULTS: All 65 flaps survived completely and the total survival percentage was 98.5%. Only one flap failed and was removed 5 days postoperatively. No complications(fistula, infection, hematoma, seroma et al) were observed in recipient and donor sites. Two anteromedial thigh flaps (AMT) were used for reconstruction due to no sizable perforators in the ALT region. All cases were followed up for 0.5-3 years. The flaps didn't atrophy after six months and the contour was satisfactory. The functions of speech and swallow were recovered well. All the donor sites were closed primarily and the scar was not obvious. The leg's function recovered well. CONCLUSIONS: Using a combination of retrograde and antegrade dissection is a safe and versatile method for harvesting a perforator-based chimeric flap. A chimeric flap including multiple components can meet the requirements of three-dimensional reconstruction. Perforator-based chimeric anterolateral thigh flap is one of the best choices for complex head and neck reconstruction after en bloc resection.

[Rehabilitation by hollow obturator prosthesis immediately after total maxillectomy for malignant tumor].

OBJECTIVE: The feasibility and clinical effects of hollow obturator prosthesis for the repair of maxillofacial defect immediately after maxillectomy for cancer were assessed. METHODS: Thirteen patients with T3-4aN0M0 maxillary neoplasm were treated by the prostheses immediately after maxillectomy. According to the 3D-CT reconstruction of nasal sinus, the 3D stereoscopic prototype was constructed before the surgery. Simulating surgery with Surgicare 5.0 software and then the prosthesis 3D stereoscopic model was shaped. The prosthesis was made quickly and precisely with methacrylate resins according to the model and the print mold before surgery, with supplementary tooth at the bottom of prosthesis. In the surgery, the prosthesis was installed instantly after maxillectomy. The patients were followed up at 1, 3 and 6 month after the surgery, respectively. The facial features and the pronunciation clarity were examined and the questionnaires were carried out in the patients, with comparation by paired t-test. The hollow obturator prosthesis would be replaced by permanent prosthesis made of methacrylate resins at 6 month after the surgery. RESULTS: The hollow obturator prostheses were installed accurately and maxillofacial defects were repaired immediately after maxillectomy in the 13 patients. Postoperative follow-up showed there were significant differences in eyeball sagging (t = 4.67, P < 0.05), mid-facial region collapse (t = 5.67, P < 0.05), and pronunciation clarity (t = 16.38, P < 0.05) between patients with and without prostheses. Questionnaires showed that all the patients were satisfied with the retention of prostheses, the improvement of appearance, the improvement of the symptom of water choking and speech definition. Six months after the surgery, the hollow obturator prostheses were replaced smoothly by permanent prostheses in 11 of the 13 patients. CONCLUSION: The precise and instant repair of maxillofacial defect by prosthesis after maxillectomy can improve survival quality of patient.

Effect of electrochemical treatment on high-flow vascular malformations in the maxillofacial region.

We explored the effect of electrochemical therapy for the treatment of high-flow venous malformations in the maxillofacial region in 32 patients. We used a method of anaesthesia that was suitable to the site and size of the lesion, and then inserted platinum needles into the lesion in a sterile environment. We protected the normal skin by inserting the cannulas into plastic sheaths, and connected the needles to an electrochemical machine. The common voltage, electric current, and amount of electricity were 6-8 V, 80-100 mA, and 10-20 C/cm(2), respectively. During a follow up period of two months to three years, 18 (56%) patients had a complete response, and 14 a partial response (44%). Electrochemical treatment is a simple, relatively atraumatic method of dealing with high-flow venous malformations that leaves no scars.

Application of problem-based learning in a large class in stomatology course.

PURPOSE: To determine the feasibility of implementing problem-based learning (PBL) in a large class and whether previous PBL experience is necessary. MATERIALS AND METHODS: A total of 236 students from 2 large classes at China Medical University were enrolled. One class (118 students) had had a previous small-group PBL experience and another class (113 students) had not. Each class was subdivided into 15 groups (7 to 8 students/group) and took 2 separate 100-minute PBL sessions per week with the same teaching faculty. Each PBL class had 2 facilitators, 1 content expert facilitator, and 1 nonexpert facilitator. The results of the theoretical examination and case analysis examinations were analyzed using the t test. Questionnaires were used to evaluate both student and facilitator perceptions. RESULTS: The feedback from both students and facilitators was positive. According to the questionnaires, both experienced and non-experienced students acknowledged that the teaching method was enjoyable and functional. The test results showed students had achieved the learning objectives. The results of the theoretical and case analysis examinations showed no significant difference between the PBL experienced class and the non-experienced class. The mean study hours spent weekly by the students after class on the course were about 6.3 +/- 1.1 hours for the non-experienced students and 4.7 +/- 0.981 hours for the experienced students (t = 11.94, P < .001). The non-experienced students showed more preference for the content expert tutor. CONCLUSION: Implementing PBL in a large class is feasible without extracting great demand on limited educational resources. Previous PBL experience is helpful but not necessary.

[Expression and correlation of mast cell, Clusterin/apoJ and transforming growth factor-beta in the different stages of human dermal hemangioma].

OBJECTIVE: To investigate the expression and correlation of mast cell, Clusterin/apoJ and transforming growth factor-beta (TGF-beta) in the different stages of human dermal hemangioma. METHODS: Immunohistochemical stain technique (SABC) and toluidine blue (TB) stain technique were respectively used to detect the expression level of Clusterin/apoJ and TGF-beta and the number of mast cells in the different stages of human dermal hemangioma. RESULTS: There was remarkable statistical difference between the advanced stage of proliferative hemangioma and the other stages of proliferative hemangioma in the number of mast cell(P<0.01). There was also remarkable statistical difference between the early stage of involutional hemangioma and the other stages of involutional hemangioma in the number of mast cell (P<0.01). The expression of Clusterin/apoJ and TGF-beta in the advanced stage of proliferative hemangioma was significantly higher than the other stages in proliferative hemangioma (P<0.01). The expression of Clusterin/apoJ and TGF-beta in the early stage of involutional hemangioma was significantly higher than the other stages in involutional hemangioma (P<0.01). There was a significantly positive correlation between Clusterin/apoJ and TGF-beta in the different stages of human dermal hemangioma (P<0.01). The expression level of Clusterin/apoJ and TGF-beta was positively correlated with the number of mast cell in the different stages of human dermal hemangioma (P<0.01). CONCLUSION: Mast cell may play a promotive role of apoptosis during the spontaneous regulate the expression of Clusterin/apoJ and promote the spontaneous involution of human dermal hemangioma.

[Expression of bcl-2 and survivin gene products in different stages of vessel differentiation in hemangiomas].

PURPOSE: To investigate the relationship between cell apoptosis and regression process of hemangiomas. METHODS: Fourty four hemangiomas and 19 vascular malformations, confirmed by pathology without any previous treatments were involved. Hemangiomas were classified into two groups by histological characters, among which 23 were in proliferating phase and 21 cases were in involuting phase. SABC immunohistochemistry was used to determine the expression of bcl-2 and survivin genes in vascular and endothelial cells,and 8 normal skin tissues were obtained from infants and children for control. The data was analyzed using Chi-square test with SPSS 11.0 software package. RESULTS: Significant difference of bcl-2 expression in endothelial cells was detected between the proliferation and involuting phase of hemangiomas (P<0.01). There was no significant difference of survivin expression in endothelial cells between the proliferating and involuting phases of hemangiomas. CONCLUSION: This study confirms high level of bcl-2 expression in vascular endothelial cells in proliferating phase of infantile hemangiomas in contrast to that in the involuting phase of hemangiomas, which indicates that bcl-2 might play a role in the later stage of angiogenesis. While high level of survivin expression in vascular endothelial cells in the proliferating phase and involuting phase without significant difference indicates that survivin might not play a role in the apoptosis of infantile hemangiomas.

[Expression of cellular adhesion molecules and HLA-DR antigen on vascular endothelial cells in hemangiomas.].

PURPOSE: To investigate the expression and function of the adhesion molecules ICAM-3, CD34 and HLA-DR antigen on endothelial cells of hemangiomas in different stages. METHODS: SABC immunohistochemical technique was used to examine the expression of ICAM-3, CD34 and HLA-DR on vascular endothelial cells. Seventy-six specimens including 28 proliferating hemangiomas, 22 involuting hemangiomas, 18 vascular deformity and 8 normal skin tissue were obtained from infants and children for the experiment. RESULTS: The results showed: (1) both ICAM-3 and CD34 had high expression in proliferating hemangiomas, but poor or even no expression in involuting hemangiomas. There was a significant difference (P<0.001) between the two phases. Both ICAM-3 and CD34 had almost no expression in vascular deformity and normal skin tissue, significantly different from hemangiomas (P<0.001).(2) HLA-DR expression was closely related to the high differentiation phase of vascular epithelial cells. In the proliferating phase, HLA-DR didn't express, while it expressed highly as endothelial cells were in well-matured involuting phase. These differences were significant (P<0.001). CONCLUSION: ICAM-3 and CD34 might play a role in the early stage of angiogenesis and take part in the pathological genesis and regression process of hemangiomas by regulating endothelial cells adhesion; HLA-DR might be related either to acquisition of a mature phenotype or to an activated state of the endothelial cells.