Microvascular Replantation for partial auricle Amputation: Only Arterial anastomoses and Acupuncture Bloodletting.

BACKGROUND: There have been many reports on replantation of complete auricle amputation, but few reports on successful replantation of partial auricle amputation. The main reason is that the diameter of blood vessels at the end of auricle is only 0.3 mm, and it is difficult to find suitable blood vessels, especially venous vessels. The purpose of this study was to investigate the method of revascularization after partial auricle amputation. METHODS: Microvascular repairs were performed in an amputated segment with only identified artery vessels for anastomosis, and vein was unavailable for anastomosis. Postoperative acupuncture bloodletting and heparin compress treatments were planned. RESULTS: Two patients with partial ear amputation were treated at our center between 2019 and 2021. All the amputated ear were replanted successfully. No blood transfusions and no infections were observed. A week later the replanted auricles were seen, blood flow established. CONCLUSION: Microvascular repair should be considered as the best options in cases of auricular avulsion segment replantation. When no vein was available for anastomosis, only one artery repaired was feasible. Acupuncture bloodletting and heparin compress are the effective methods to treat vein congestion. 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 .

Influence of different region of interest sizes on CT-based radiomics model for microvascular invasion prediction in hepatocellular carcinoma. / æ„Ÿå ´è¶£åŒºèŒƒå›´å¯¹CT影像组学模型预测肝细胞癌微血管侵犯的影响.

OBJECTIVES: Microvascular invasion (MVI) is an important predictor of postoperative recurrence or poor outcomes of hepatocellular carcinoma (HCC). Radiomics is able to predict MVI in HCC preoperatively. This study aims to investigate the influence of different region of interest (ROI) sizes on CT-based radiomics model for MVI prediction in HCC. METHODS: Patients with HCC with or without MVI confirmed by pathology and those who underwent preoperative plain or enhanced abdominal CT scans in the Third Xiangya Hospital of Central South University from January 2010 to December 2020 were retrospectively and consecutively included. According to the ratio of 7 to 3, the patients were randomly assigned into a training set and a validation set. Clinical data were collected from medical records, and radiomics features were extracted from the arterial phase (AP) and portal venous phase (PVP) of preoperatively acquired CT in all patients. Six different ROI sizes were employed. The original ROI (OROI) was manually delineated along the visible borders of the tumor layer-by-layer. The OROI was expanded out by 1-5 mm. The OROI was combined with 5 different peritumoral regions to generate the other 5 ROIs, named Plus1-Plus5. Feature extraction, dimension reduction, and model development were conducted in 6 different ROIs separately. Supporter vector machine (SVM) was used for model construction. Model performance was assessed via receiver operating characteristic (ROC) curve. RESULTS: A total of 172 HCC patients were included, in which 83 (48.3%) were MVI positive, and 89 (51.7%) were MVI negative. Three hundred and ninety-six features based on AP or PVP images were extracted from each ROI. After feature selection and dimension reduction, 4, 5, 15, 11, 6, and 3 features of OROI, Plus1, Plus2, Plus 3, Plus4, and Plus5 were selected for model construction, respectively. In the training set, the sensitivity, specificity, and area under the curve (AUC) of OROI were 0.759, 0.806, and 0.855, respectively. The AUC values of Plus2 (0.979) and Plus3 (0.954) were higher than that of OROI. The AUC values of Plus1 (0.802), Plus4 (0.792), and Plus5 (0.774) were not significantly different from those of OROI. In the validation set, the sensitivity, specificity, and AUC value of OROI were 0.640, 0.630, and 0.664, respectively. The AUC value of Plus3 was 0.903, which was higher than that of OROI. The AUC values of Plus1 (0.679), Plus2 (0.536), Plus4 (0.708), and Plus5 (0.757) were not significantly different from that of OROI (P>0.05). CONCLUSIONS: The size of ROI significantly inflluences on the performance of CT-based radiomics model for MVI prediction in HCC. Including appropriate area around the tumor into ROI could improve the predictive performance of the model, and 3 mm might be appropriate distance.

LncRNA MIAT promotes the proliferation, migration, and invasion of melanoma cells through recruiting TCF12 and activating NFAT5.

The present study aimed to explore the biological functions and mechanism of long non-coding RNA myocardial infarction-associated transcript (MIAT) in melanoma progression. MIAT expression in melanoma tissue samples and cells was detected by quantitative real-time PCR. After gain-of-function and loss-of-function models were constructed, cell counting kit-8, EdU, and Transwell assays were employed to detect the proliferation, migration, and invasion of melanoma cells. catRAPID database was employed and RNA pull-down assay and RNA immunoprecipitation assay were utilized to verify, the binding relationship between MIAT and transcription factor 12 (TCF12). The binding of TCF12 to the promoter region of the gene of nuclear factor of activated T cells 5 (NFAT5) was verified by chromatin immunoprecipitation-quantitative PCR assay and dual-luciferase reporter gene assay. The regulatory effects of MIAT and TCF12 on NFAT5 expression were detected via Western blot. The results showed that MIAT expression was increased in melanoma tissues and cells, and was significantly associated with the AJCC stage and the differentiation of melanoma tissues. MIAT overexpression markedly facilitated melanoma cells' multiplication, migration, and invasion, while MIAT knockdown inhibited the multiplication, migration, and invasion. MIAT showed direct interaction with TCF12. MIAT promoted the binding of TCF12 to NFAT5 promoter region, thereby promoting NFAT5 transcription. In conclusion, MIAT promotes melanoma progression through recruiting TCF12 and its interaction with NFAT5.

Preoperative CT for Characterization of Aggressive Macrotrabecular-Massive Subtype and Vessels That Encapsulate Tumor Clusters Pattern in Hepatocellular Carcinoma.

Background Macrotrabecular-massive (MTM) subtype and vessels encapsulating tumor clusters (VETC) pattern of hepatocellular carcinoma (HCC) are associated with unfavorable prognosis. Purpose To estimate the potential of preoperative CT in the prediction of MTM subtype and VETC pattern. Materials and Methods Patients who underwent surgical resection or liver transplant and preoperative CT for HCC between January 2015 and June 2018 were retrospectively included in the primary cohort. CT imaging features were evaluated by two radiologists. Predictors associated with the MTM subtype or VETC pattern were determined by using logistic regression analyses and the performance was tested in a validation cohort. Prognostic factors associated with early recurrence after surgical resection were identified by using Cox regression analyses. Results The primary cohort included 170 patients (median age, 55 years; interquartile range, 48-63 years; 152 men). Serum α-fetoprotein level higher than 100 ng/mL (odds ratio [OR], 4.3; 95% CI: 2.1, 9.2; P < .001), intratumor necrosis (OR, 5.2; 95% CI: 2.5, 11.0; P < .001), and intratumor hemorrhage (OR, 5.4; 95% CI: 1.3, 23.3; P = .02) were independent predictors for MTM subtype, whereas tumor size greater than 5 cm (OR, 3.8; 95% CI: 1.7, 8.1; P = .001) and intratumor necrosis (OR, 2.1; 95% CI: 1.0, 4.4; P = .045) were independent predictors for VETC pattern. These features were used for the construction of ANH and SN scores (where A is α-fetoprotein level, N is necrosis, H is hemorrhage, and S is size), respectively, which showed comparable prediction performance in the primary and validation cohorts. Preoperative high ANH and high SN phenotype (hazard ratio, 1.9; 95% CI: 1.2, 3.0; P = .01) was independently associated with early recurrence after surgical resection. Conclusion Preoperative CT features could be used for the characterization of macrotrabecular-massive subtype and vessels that encapsulate tumor clusters pattern and were of prognostic significance for early recurrence in patients with hepatocellular carcinoma. Online supplemental material is available for this article. See also the editorial by Yoon and Kim in this issue. Published under a CC BY 4.0 license.

Diagnostic performance of MRI using extracellular contrast agents versus gadoxetic acid for hepatocellular carcinoma: A systematic review and meta-analysis.

BACKGROUND & AIMS: Magnetic resonance imaging (MRI) is the first-line tool for the noninvasive diagnosis of hepatocellular carcinoma (HCC) in patients with chronic liver diseases. We performed a meta-analysis to compare the performance of MRI using extracellular contrast agents (ECA-MRI) with that using gadoxetic acid (EOB-MRI) for diagnosing HCC. METHODS: We searched multiple databases for studies comparing the diagnostic performance of ECA-MRI with that of EOB-MRI in patients with suspected HCC until 31 May 2020. The bivariate random-effects model was used to pool the performance and further subgroup analysis was performed. RESULTS: Eight studies were included evaluating a total of 1002 patients. ECA-MRI revealed significantly higher per-lesion sensitivity in the diagnosis of HCC than EOB-MRI did (0.76 vs 0.63, P = .002). For modified EOB-MRI (mEOB-MRI) using extended washout to the transitional phase (TP) or hepatobiliary phase (HBP), the sensitivity increased compared with that of EOB-MRI using restrictive washout in the portal venous phase (PVP) (0.74 vs 0.63, P = .07). No significant difference among the specificities of ECA-MRI, EOB-MRI, and mEOB-MRI (0.96, 0.98, and 0.93, respectively) was found. The sensitivity for lesions < 20 mm was significantly lower than that for lesions ≥ 20mm (0.66 vs 0.87, P = .01) only for ECA-MRI, which achieved higher sensitivity in Asian patients or with a 3.0 T scanner. CONCLUSIONS: ECA-MRI outperforms EOB-MRI in per-lesion sensitivity for diagnosing HCC, whereas mEOB-MRI shows a trend towards improved sensitivity compared with EOB-MRI with slightly decreased specificity. Registration: Prospero CRD42020189680.

Sarcopenia associates with increased risk of hepatocellular carcinoma among male patients with cirrhosis.

BACKGROUND & AIMS: Sarcopenia is associated with a higher rate of complications and is an independent predictor of poor outcomes in cirrhosis. The aim of this study was to investigate the association between sarcopenia and the risk of hepatocellular carcinoma (HCC) among patients with cirrhosis. METHODS: Four hundred and ninety-two patients with cirrhosis and no evidence of HCC from 2008 to 2017 were enrolled, who had baseline abdominal computed tomography (CT) analyzed for identification of sarcopenia according to the previously established sex-specific cutoffs. The main endpoint of follow-up was the occurrence of HCC. RESULTS: The majority of patients were male (365/492, 74.2%), and sarcopenia were present in 238 (48.4%) patients at baseline. During a median follow-up of 3.6 years, 54 (11.0%) patients developed HCC. The cumulative incidence of HCC was significantly higher in male patients with sarcopenia than those without sarcopenia (P = 0.001), but not in female patients (P = 0.26). Multivariate Cox regression analysis showed that sarcopenia (hazard ratio [HR], 2.27; 95% confidence interval [CI], 1.09-4.74) was a significant independent factor for HCC development in male patients with cirrhosis, which was consistently identified through competing-risk analysis (subdistribution HR, 2.20; 95% CI, 1.02-4.72). After propensity score matching, male cirrhotic patients with sarcopenia still had a higher risk of HCC than those without sarcopenia (P = 0.02). CONCLUSION: Sarcopenia is associated with an increased risk of developing HCC among male patients with cirrhosis. Therefore, nutritional assessment and necessary interventions in specific cirrhotic patients need to be valued.

Benzyl butyl phthalate (BBP) triggers the migration and invasion of hemangioma cells via upregulation of Zeb1.

Hemangioma (HA) are tumors formed by hyper-proliferation of vascular endothelial cells. As a potential endocrine disrupting chemical (EDC), benzyl butyl phthalate (BBP) can mimic estrogen to disturb the estrogenic signals. Our present study investigated the potential roles of phthalates on the progression of HA and found that 100 nM BBP can significantly trigger the migration and invasion of HA cells, which was evidenced by the results that BBP can induce the expression of matrix metalloproteinase (MMPs) and vimentin. Further, BBP can increase the expression of Zeb1, one powerful transcription factor for cell migration and invasion. Targeted inhibition of Zeb1 blocked BBP induced cell migration. Mechanistically, BBP can increase the mRNA stability of Zeb1 via suppression of miR-655. Further, BBP can enhance the protein stability of Zeb1 via upregulation of ataxia telangiectasia mutated (ATM). Collectively, our present study revealed that BBP can trigger the migration and invasion of HA cells via upregulation of Zeb1.

Protective effects of alogliptin against TNF-α-induced degradation of extracellular matrix in human chondrocytes.

Osteoarthritis (OA) is a common debilitating disease most prevalent among the elderly population worldwide. Excessive degradation of the articular extracellular matrix is a pivotal event in the development of OA. Preventative treatments against the destruction of type II collagen and aggrecan, the two main components of the articular extracellular matrix, may serve as a novel therapy against the progression of OA. In the current study, we investigated whether the DPP-4 inhibitor alogliptin could prevent degradation of the articular extracellular matrix in human primary chondrocytes. Pretreatment with alogliptin successfully prevented degradation of type II collagen and aggrecan in a dose-dependent manner by reducing increased expression of MMP-1, -3, and -13 as well as ADAMTS-4 and -5 induced by treatment with TNF-α. Furthermore, pretreatment with alogliptin also reduced TNF-α-induced expression of IKKα/ß, IκBα and NF-κB in human primary chondrocytes. This suggests that DPP-4 inhibitors such as alogliptin may be used as an effective preventative therapy against continued destruction of the articular extracellular matrix in OA.

TMEM88 inhibits extracellular matrix expression in keloid fibroblasts.

Keloid is characterized by hyper-proliferation of fibroblasts and excess extracellular matrix (ECM) deposition. Transmembrane protein 88 (TMEM88), belonging to the TMEM family, was involved in the regulation of tumorigenesis and fibrogenesis. However, the role of TMEM88 in keloid formation remains unclear. This study aimed to investigate the effects of TMEM88 on keloid-derived fibroblasts (KFs) proliferation and ECM expression, and explore the underlying mechanism. Our results demonstrated that TMEM88 was lowly expressed in human keloid tissues and TGF-ß1-stimulated KFs. TMEM88 overexpression significantly inhibited the proliferation and migration of KFs, as well as suppressed ECM expression in TGF-ß1-stimulated KFs. Furthermore, TMEM88 overexpression greatly inhibited the protein levels of ß-catenin, cyclin D1 and c-myc in TGF-ß1-stimulated KFs. In conclusion, our data indicate that TMEM88 inhibits the TGF-ß1-stimulated cell proliferation, migration and ECM expression in KFs through the inactivation of Wnt/ß-catenin signaling pathway. Therefore, TMEM88 may be a potential therapeutic target for treating keloids.