Evaluation of Oral Mucosal Lesions Using the IllumiScan® Fluorescence Visualisation Device: Distinguishing Squamous Cell Carcinoma.

We evaluated whether fluorescence intensity (FI) and its coefficient of variation (CV) can be used to diagnose squamous cell carcinoma (SCC) through IllumiScan®, an oral mucosa fluorescence visualisation (FV) device. Overall, 190 patients with oral mucosal lesions (OMLs; SCC, 59; non-SCC OMLs, 131) and 49 patients with normal oral mucosa (NOM) were enrolled between January 2019 and March 2021. The FI of the images was analysed using image analysis software. After establishing regions of interest for SCC, non-SCC, and NOM, the average FI, standard deviation (SD), and CV were compared. There was a significant difference in the average FI for all pairs of comparisons. The SD was not significantly different between the SCC and NOM groups (p = 0.07). The CV differed significantly for NOM (p < 0.001) and non-SCC groups (p < 0.001) relative to the SCC group but was not different between NOM and non-SCC groups (p = 0.15). Univariate analysis of SCC and non-SCC groups showed significant differences for all factors, except age. However, multivariate analysis showed a significant intergroup difference only in the CV (p = 0.038). Therefore, analysing the CV in FV images of OML may be useful for the diagnosis of oral cancer.

Extracellular transglutaminase 2 induces myotube hypertrophy through G protein-coupled receptor 56.

Skeletal muscle secretes biologically active proteins that contribute to muscle hypertrophy in response to either exercise or dietary intake. The identification of skeletal muscle-secreted proteins that induces hypertrophy can provide critical information regarding skeletal muscle health. Dietary provitamin A, ß-carotene, induces hypertrophy of the soleus muscle in mice. Here, we hypothesized that skeletal muscle produces hypertrophy-inducible secretory proteins via dietary ß-carotene. Knockdown of retinoic acid receptor (RAR) γ inhibited the ß-carotene-induced increase soleus muscle mass in mice. Using RNA sequencing, bioinformatic analyses, and literature searching, we predicted transglutaminase 2 (TG2) to be an all-trans retinoic acid (ATRA)-induced secretory protein in cultured C2C12 myotubes. Tg2 mRNA expression increased in ATRA- or ß-carotene-stimulated myotubes and in the soleus muscle of ß-carotene-treated mice. Knockdown of RARγ inhibited ß-carotene-increased mRNA expression of Tg2 in the soleus muscle. ATRA increased endogenous TG2 levels in conditioned medium from myotubes. Extracellular TG2 promoted the phosphorylation of Akt, mechanistic target of rapamycin (mTOR), and ribosomal p70 S6 kinase (p70S6K), and inhibitors of mTOR, phosphatidylinositol 3-kinase, and Src (rapamycin, LY294002, and Src I1, respectively) inhibited TG2-increased phosphorylation of mTOR and p70S6K. Furthermore, extracellular TG2 promoted protein synthesis and hypertrophy in myotubes. TG2 mutant lacking transglutaminase activity exerted the same effects as wild-type TG2. Knockdown of G protein-coupled receptor 56 (GPR56) inhibited the effects of TG2 on mTOR signaling, protein synthesis, and hypertrophy. These results indicated that TG2 expression was upregulated through ATRA-mediated RARγ and that extracellular TG2 induced myotube hypertrophy by activating mTOR signaling-mediated protein synthesis through GPR56, independent of transglutaminase activity.

Skin ligation and argon beam coagulation for giant pachydermatocele resection.

Resection of giant neurofibroma in neurofibromatosis type 1 has a high risk of perioperative bleeding because the tumors are enriched in blood vessels, which are weakened due to the loss and thinning of vascular smooth muscle. Therefore, we combined skin ligation around the tumor and use of an argon beam coagulator (ABC) for hemostasis during resecting the giant neurofibroma. The ABC is a non-contact-type hemostasis device employing argon gas as a medium. We examined the usefulness of our method by retrospectively comparing the outcomes of the ABC-use group with those of the non-use group (7 patients, 9 tumors). Although there was no difference in resected tumor weight between the two groups, the operation time was slightly shorter and the volume of blood loss was smaller in ABC-use group than in the non-use group. Our method for hemostasis is easy and safe and is considered to be a useful method.

Gcorn Plant: A Database for Retrieving Functional and Evolutionary Traits of Plant Genes.

Gene homology helps us understand gene function and speciation. The number of plant genes and species registered in public databanks is continuously increasing. It is useful to associate homologous genes of various plants to better understand plant speciation. We designed the Gcorn plant database for the retrieval of information on homology and evolution of a plant gene of interest. Amino acid sequences of 73 species (62 land plants and 11 green algae), containing 2,682,261 sequences, were obtained from the National Center for Biotechnology Information (NCBI) Reference Sequence database. Based on NCBI BLAST searches between these sequences, homologous genes were grouped at various thresholds of homology indices devised by the authors. To show functional and evolutionary traits of a gene of interest, a phylogenetic tree, connecting genes with high homology indices, and line charts of the numbers of genes with various homology indices, are depicted. In addition, such indices are projected on a network graph in which species studied are connected based on the ratios of homologous genes, and on a phylogenetic tree for species based on NCBI Taxonomy. Gcorn plant provides information on homologous genes at various virtual time points along with speciation in plants.

ConfeitoGUI: A toolkit for size-sensitive community detection from a correlation network.

Analysis of the large amounts of data accumulated in public databanks can facilitate a more comprehensive understanding of molecular biological processes. Community detection from molecular biological data is paramount in characterizing evolutionary and functional traits of organisms based on gene homology and co-expression, respectively. Although there are common tools to detect local communities from a large network, no toolkit exists for detecting communities that include an element of interest based on size sensitivity, i.e., functionality to obtain local communities with preferred sizes. Herein, we present the ConfeitoGUI toolkit for detecting local communities from a correlation network involving size sensitivity. We compared the toolkit with other common tools for detection in reconstructing communities of microarray experiments of mice. In the results, ConfeitoGUI was observed to be preferable for detecting communities whose sizes are similar to those of original communities compared to other common tools. By changing simple parameters representing sizes for the toolkit, a user can obtain local communities with preferred sizes, which is beneficial for further analysis of members belonging to the communities.

Orbital floor reconstruction with ethyl-2-cyanoacrylate.

The orbital floor is one of the most frequently broken bones in maxillofacial fracture, and orbital reconstruction is needed in many cases. Various materials are used for orbital floor reconstruction. We report here orbital reconstruction using autologous orbital bone with cyanoacrylate. Entrapped soft tissues were freed and repositioned intraorbitally and bone fragments were gathered with a microscope simultaneously. The bone fragments were fixed to a board of bone with ethyl-2-cyanoacrylate and returned to the orbital fracture site. Of 96 fresh orbital floor fractures, this method was used for 31 (32.3%) patients. Simple reduction was performed in 48 patients. Bone graft with iliac crest was performed in the other 12 patients. Reconstruction with alloplastic materials was performed in 5 patients. Diplopia was corrected in 26 patients on whom this method was performed. The reconstructed bone collapsed into the maxillary sinus in 1 patient who underwent iliac bone graft on reoperation. Another 4 patients did not show diplopia preoperatively. None of the patients showed enophthalmos, foreign body reaction, or infection postoperatively. We were able to perform orbital bone reconstruction with autologous orbital bone without another donor site in 30 (62.5%) of 48 cases that required grafting. The indications for this method are that a sufficient quantity of bone fragments can be obtained and returned on a board of bone which can be stabilized in the orbit without collapsing into the maxillary sinus. Good results were obtained, and we consider this to be a safe and useful method.

Myositis ossificans traumatica of the masticatory muscles.

Myositis ossificans traumatica (MOT) is a disease in which muscular ossification develops following trauma. Almost all cases of MOT are found in skeletal muscle. The authors report in a 39-year-old man MOT involving several muscles in the head and neck, namely, bilateral masseter muscles, the left temporal muscle, the left lateral pterygoid muscle, and the left frontal muscle. Involvement of the lateral pterygoid muscle is especially rare.

Application of low-pressure negative pressure wound therapy to ischaemic wounds.

Negative pressure wound therapy (NPWT) is a useful wound dressing that can be applied to a wide variety of wounds. Patients with ischaemic wounds, however, may experience further necrosis with NPWT at the commonly recommended pressure of -125 mm Hg. We hypothesized that with a suction pressure of -125 mm Hg, tissue pressure will likely occlude most of the capillaries adjacent to the wound edge. Therefore, we treated three patients with ischaemic wounds using low-pressure NPWT at -50 mm Hg. All wounds healed successfully without further necrosis at the wound edge.

Classification of recipient veins in microsurgical flap reconstructions of the lower extremities.

It is difficult to cure severe open fractures of the lower extremities due to the frequent occurrence of severe damage to soft tissues or blood vessels, as well as bone defects, and concomitant infection, such as osteomyelitis. If appropriate treatment is not performed, long-term complications, such as nonunion of the bone, intractable ulcers, or other disorders, may arise. Between 1993 and 2010, we reviewed the records of 27 patients, and 28 limbs were treated. A total of 31 free-tissue transfers were performed on these 28 limbs. In this study, we classified the degree of damage based on the operative appearance of the condition of the recipient vein. A state that was normal or near-normal was described as type I-normal. A vein that was buried under a scar, but was comparatively easy to detach and retained a moderate adventitia was classified as type II-moderate. A vein with close adhesion between the wall and the scar that was not easy to detach was described as type III-severe. We also examined the relationships between recipient vein type and each of the following: (1) concomitant injury, (2) bone reconstruction, (3) preoperative infection, (4) length of time from injury to reconstruction, (5) eventual reoperation, and (6) flap necrosis. The results showed that there was a statistically significant relationship between recipient vein type and each of the following: bone reconstruction, preoperative infection, eventual reoperation, and flap necrosis. The selection of recipient vein is a factor that greatly affects the outcome of reconstruction of open fractures of the lower extremities. It is important to preoperatively estimate the condition of recipient vein even though it is difficult to preoperatively assess the condition. In some cases, only recipient veins in poor condition can be found intraoperatively on the affected leg. Under such circumstances, a cross-leg flap or a vein graft should be performed without hesitation to use recipient veins in a better condition.

Growth factor-defined culture medium for human mesenchymal stem cells.

Human bone marrow-derived mesenchymal stem cells (hMSCs) are potential cellular sources of therapeutic stem cells as they have the ability to proliferate and differentiate into a wide array of mesenchymal cell types such as osteoblasts, chondroblasts and adipocytes. hMSCs have been used clinically to treat patients with graft vs. host disease, osteogenesis imperfect, or alveolar cleft, suggesting that transplantation of hMSCs is comparatively safe as a stem cell-based therapy. However, conventional culture medium for hMSCs contains fetal bovine serum (FBS). In the present study, we developed a growth factor-defined, serum-free medium for culturing hMSCs. Under these conditions, TGF-beta1 promoted proliferation of hMSCs. The expanded hMSC population expressed the human pluripotency markers SSEA-3, -4, NANOG, OCT3/4 and SOX2. Furthermore, double positive cells for SSEA-3 and a mesenchymal cell marker, CD105, were detected in the population. The potential to differentiate into osteoblasts and adipocytes was confirmed. This work provides a useful tool to understand the basic biological properties of hMSCs in culture.

Concept and anatomical basis of microdissected tailoring method for free flap transfer.

BACKGROUND: For a refined microsurgical reconstruction, it is desirable to adjust the flap to fit the three-dimensional details of the defect. Essentially, each vessel arborized in the subcutaneous adipose tissue supplies axial blood flow to an individual small area surrounding the vessel. Therefore, free alteration of the flap would be possible if the anatomy of these branches could be identified during surgery. METHODS: The microdissected tailoring method is a new procedure for alteration of the flap, observing the branches of the perforator directly after microdissection. By means of this procedure, three flaps were transferred to complex tissue defects. In addition, among intraadipose branches of 59 perforators, 90 cases of three types of microdissected thin perforator flap transfer were measured to classify the anatomical variations relating to microdissected tailoring of the flap. RESULTS: All flap transfers were uneventful and no circulatory failure of the flaps was observed. Statistical analyses reveal that the intermuscular septum perforator branches at the deeper layer of the adipose tissue and then spreads more widely in the adipose layer than that of muscle perforator, regardless of the type of flap and the length of the intraadipose vessel. CONCLUSIONS: Microdissected tailoring of the flap provides the best solution for flap alteration in the reconstruction of a complex-shaped tissue defect. It represents a change in the concept of free flap transfer, because the flap is prepared according to the individual anatomy of the intraadipose vessel.

Clinical application and refinement of the microdissected thin groin flap transfer operation.

A microdissected thin groin flap is a uniform thin flap with a long vascular pedicle prepared by microdissection of the deep branch of the superficial circumflex femoral system (SCIS). However, the safe dimensions of the flap are not known, and anatomical variations of the SCIS sometimes impede elevation of the flap based on the deep branch. Therefore, modifications of the operation and accumulation of empirical knowledge are required for safe preparation of the flap. Thirty cases of various types of tissue defects were reconstructed using microdissected thin groin flaps. Among these, large flaps exceeding 20 cm on the long axis were investigated to estimate the maximum dimensions of the flap. Additionally, new operative procedures were developed to overcome anatomical variations of the SCIS and to assist preparation of a thin flap. One flap was lost due to a venous thrombosis. A small distal area of three large flaps became necrotic. The perforators from the deep branches were absent in five cases, and three of these flaps were successfully elevated based on the superficial branch using the new method. The clinically deduced safe dimensions of the flap ranged from 5 x 2 cm to 25 x 12 cm. The microdissected thin groin flap was found to be useful for coverage of various types and sizes of skin defects. Through improved operative procedures, a large and extremely thin flap can be prepared safely even if the perforator from the SCIS is absent.

Versatility of a second toe plantar flap.

A second toe plantar flap was first reported about ten years ago as a useful small neurocutaneous flap for reconstruction of fingertip defects. Since that time, a satisfactory follow-up report on this noteworthy procedure has not yet appeared. In this article, the advantages and potentialities of the flap are discussed along with the pitfalls of clinical application. Two types of reconstruction have been performed using this flap during the past eight years. One type, which has been used in 12 cases, involves combination with an onychocutaneous flap. The other type, which has been used in 15 cases, involves sole transfers to distal digital defects or secondary defects of the palmer side of the digits after releasing the contracture, which is assessed functionally and esthetically. Thirteen of these 27 reconstructions were conducted uneventfully; however, two cases of arterial insufficiency at the donor toe were experienced. Functional and esthetic evaluations of these thirteen cases were almost acceptable, and the donor toe complication was also considered to be a minimum adverse effect. This flap is suitable for not only a distal palmer defect, but also variously shaped skin defects of the digits with minimum donor site morbidity; however, the possibility of arterial insufficiency of the pedicle should be borne in mind.

Reconstruction of hand skin defects by microdissected mini anterolataral thigh perforator flaps.

SUMMARY: Three cases of traumatic skin defect and two cases of secondary skin defect after releasing scar contractures on the dorsum or palm of the hand, except for the fingers and thumb, were successfully reconstructed with the use of microdissected thin anterolateral thigh perforator flaps. This particular type of reconstruction needs thin, small flap coverage with a reliable blood supply from a long vascular pedicle. Microdissection of the perforator enables the distribution of vessels towards the thin layer of adipose tissue to be identified and the vessel in the deep adipose layer to be used as an additional pedicle vessel. Therefore, a small and thin flap can be elevated accurately with a longer vascular pedicle than is possible with the conventional method of flap elevation.

Analysis method of noise power spectrum for medical monochrome liquid crystal displays.

We investigated methods of analyzing the noise power spectrum (NPS) measurement for medical liquid crystal displays (LCDs). Uniform images displayed on the LCDs were imaged with a high-performance digital camera equipped with a close-up lens, and then the NPSs were calculated from the image data by means of several analysis methods. In a method using the 2D fast Fourier transform (FFT) with a 256 x 256 pixels data segment (basic method), we examined the efficacy of a background trend correction (BTC) and a Hanning windowing process used for reducing the spectral estimation errors in the Fourier analysis. To improve the frequency resolution of the basic method, we examined two 2D FFT methods by using 512 x 512 and 1024 x 1024 pixel segments. In addition, we studied a 1D FFT method with 1024-point 1D noise profiles (1D method). In these three methods, the BTC by a second-order polynomial fit and Hanning windowing were commonly applied. A 3-mega-pixel (MP) and a 5-MP monochrome LCD were employed for evaluating the respective methods. Also, a prototype 5-MP LCD equipped with a new anti-reflection surface-coated panel was compared with the conventional 5-MP LCD. The Hanning windowing process was indispensable for avoiding the spectral leakage errors caused by the pixel structures of the LCD. Sufficient frequency resolution was obtained by the 2D FFT method with the 1024 x 1024 pixels segments and the 1D method. The method which provided the most reliable NPSs was the 1D method, with which the BTC was achieved successfully.

Free microdissected thin groin flap design with an extended vascular pedicle.

BACKGROUND: The senior author has developed a method of microdissection whereby a thin perforator flap can be elevated accurately in a single-stage procedure. Recently, the authors also applied the microdissection technique to the inguinal area and elevated microdissected thin groin flap. METHODS: In preparation of the flap, the perforator penetrating the fascia of the sartorius muscle is initially detected suprafascially, and then the deep adipose and subfascial layer of the inguinal area is dissected using an operating microscope. After confirming the distribution of the blood vessels in this area, the flap is elevated while dissection is performed between the deep and superficial adipose layers. RESULTS: Six cases of scar contracture or skin defect by general burn, three cases of other types of traumatic tissue defects, and one case of skin loss at the donor site of an extended wraparound flap were successfully reconstructed with these new flaps. CONCLUSIONS: The uniform thinness and long vascular pedicle are distinctive characteristics of this flap compared with the traditional groin flap. Moreover, the buried vessels in the deep adipose layer and fascia can be confirmed by microdissection; this enables prediction of the safe area of the flap.

Recovery of disused replanted digits by second toe hemipulp flap transfer.

BACKGROUND: Amputation of the distal phalanx is the most common among all mutilation injuries. Generally, it has been believed that the prognosis of this type of amputation is satisfactory; however, disuse of digits because of severe atrophy and sensory disturbances is frequently observed in the follow-up period. METHODS: The authors intended to use the second toe hemipulp flap for recovery of these disused digits and transferred the flaps to eight severely atrophic postreplanted digits. Objective sensory recovery was assessed along with estimation of the "usefulness" of the reconstructed fingers. RESULTS: No complications were observed postoperatively, and estimations of the functional results were almost satisfactory. CONCLUSION: This procedure significantly improved the prognosis of the replantation of severely crushed digits.