Human albumin aggravates cerebral edema by disrupting the blood­brain barrier in a rat model of ischemic stroke.

Cerebral edema and elevated intracranial pressure (ICP) are common complications observed following ischemic stroke. Osmotherapy has been used as a foundation to manage ICP induced by cerebral edema, and albumin is one of the most commonly used osmotic agents. The present study aimed to explore whether albumin lowered ICP by reducing cerebral edema when albumin elevated the colloid osmotic pressure (COP) of plasma. Sprague­Dawley rats that underwent middle cerebral artery occlusion were used to assess COP and ICP. Magnetic resonance imaging measurements were performed to evaluate cerebral edema and infarct size. Evans blue was used to assess the blood­brain barrier (BBB) permeability. Western blotting was used to determine the expression levels of the tight junction proteins in cerebral vascular endothelial cells. The results showed that 25% albumin treatment (1.25 g/kg) by intravenous injection elevated the COP of plasma but did not reduce the ICP in rats that had undergone ischemic stroke. Additionally, albumin did not reduce the infarct size and instead aggravated cerebral edema. Furthermore, the BBB permeability was increased by albumin. Concomitantly, albumin treatment significantly downregulated the expression of tight junction proteins (ZO­1, occludin, and claudin­5) in cerebral vascular endothelial cells. Tight junction protein expression was significantly upregulated when the cells were treated with an MMP­9 inhibitor (GM6001). These results suggest that albumin aggravates cerebral edema in rats with ischemic stroke by increasing BBB permeability.

High DND1 Level Indicates a Poor Prognostic Factor in Prostate Cancer.

BACKGROUND: Dead end 1 (DND1) plays a vital role during oncogenesis and cancer progression by regulating the mRNA content via competitive combination with miRNA, but what function it exerts in prostate cancer has been unclear. The purpose of this paper is to explore the correlation between DND1 expression levels and clinical characteristics in prostate cancer (PCa) patients. MATERIALS AND METHODS: To assess the expression of DND1 in tumor specimens compared with paired paracancerous tissues, the sample from 83 patients was analyzed by immunohistochemistry. The Cancer Genome Atlas (TCGA) database was used to verify our results. Subsequently, we statistically analyzed the relationship between DND1 expression and the clinical prognosis of PCa patients. RESULTS: Compared with paracancerous tissues, DND1 has a higher expression level in prostate cancer. The overexpression of DND1 in protein level was significantly associated with the higher clinical stage (P = 0.006), ISUP grading group (P < 0.001), seminal vesicle invasion (P = 0.006), and PSA density (P = 0.002). Furthermore, the overexpression of DND1 indicates a poor clinical prognosis in prostate cancer patients. CONCLUSION: High-level expression of DND1 was associated with tumor progression and poor clinical prognosis. Hence, DND1 may become a potential prognostic biomarker for PCa.

Hypoxia-Regulated miR-146a Targets Cell Adhesion Molecule 2 to Promote Proliferation, Migration, and Invasion of Clear Cell Renal Cell Carcinoma.

BACKGROUND/AIMS: miR-146a has recently been shown to promote cell proliferation, migration, and invasion in many cancers, but the role of miR-146a in clear cell renal cell carcinoma (ccRCC) remains unclear. METHODS: Reverse transcription quantitative PCR (RT-qPCR) was performed to investigate the mRNA expression of miR-146a and CADM2 in ccRCC tissues. The luciferase reporter assay, Western blotting, and ChIP assay were carried out to explore the promoter and the transcription factor of miR-146a. Moreover, the effect of miR-146a and CADM2 on ccRCC cells was explored using methyl thiazolyl tetrazolium, colony formation, and migration and invasion assays. The luciferase reporter assay, RT-qPCR, western blotting, and immunofluorescence assay were carried out to investigate whether CADM2 is directly regulated by miR-146a. A tumor xenograft model and immunohistochemical staining were used to examine the carcinogenic effect of miR-146a and CADM2 in vivo. RESULTS: miR-146a has been shown to promote cell proliferation, migration, and invasion. Here, we found that miR-146a is highly expressed in ccRCC tissues, whereas CADM2 is down-regulated. Hypoxia can induce the expression of miR-146a by stimulating its promoter. In addition, we demonstrated that miR-146a promoted and CADM2 inhibited proliferation, migration, and invasion of ccRCC cells. The 3' untranslated region (UTR) luciferase reporter assay identified that miR-146a targeted the 3' UTR of CADM2 and negatively regulated its expression. Ectopic expression of CADM2 counteracted the promoting effect of miR-146a on cell proliferation, migration, invasion, and the epithelial-mesenchymal transition process. CONCLUSION: Together, the finding of down-regulation of CADM2 by miR-146a can provide new insights into ccRCC pathogenesis and might contribute to the development of novel therapeutic strategies.

Non-sticky and antimicrobial zwitterionic nanocomposite dressings for infected chronic wounds.

Zwitterionic poly(sulfobetaine acrylamide) (pSBAA)-based nanocomposite hydrogels impregnated with germicidal silver nanoparticles (AgNPs) were synthesized and implemented for the treatment of infected chronic wounds. The zwitterionic hydrogels exhibited excellent non-sticky properties and had reinforced mechanical properties by the addition of hectorite nanoclay and poly(ethylene glycol)dimethacrylate as physical and chemical crosslinkers, respectively. In addition, AgNPs were grown within the intercalated clay/polymer structure by in situ free radical reduction, as confirmed by UV-vis spectroscopy and transmission electron microscopy (TEM). The silver-containing pSBAA nanocomposite hydrogels (pSBAA/Ag) exhibited germicidal properties against Gram-positive S. epidermidis and Gram-negative P. aeruginosa. The zwitterionic hydrogels show higher water content than 2-hydroxyethyl methacrylate (pHEMA) hydrogels, owing to the strong hydration via ionic solvation. The negligible cytotoxicity of pSBAA/Ag hydrogels was assessed with human fibroblasts by the MTT assay. Moreover, the zwitterionic hydrogels demonstrated excellent resistance to the adsorption of bovine serum albumin (BSA). To evaluate the feasibility of the hydrogels for clinical application as wound dressings, we created infected diabetic rat models and compared with commercial wound dressings. The results show that pSBAA/Ag hydrogels did not adhere to the newly formed tissue, and were readily removed from the wounds after treatment for 3 days. Moreover, the healing recovery was evaluated by visual observation of infected dorsal wounds on rats with induction of diabetes by streptozotocin. The finding indicates complete healing with the pSBAA/Ag hydrogels after 15 days, faster than other dressings. A histological examination also proved that the zwitterionic hydrogels facilitated epithelialization and collagen distribution in the infected diabetic wounds. Consequently, these novel non-sticky and antimicrobial zwitterionic nanocomposite hydrogels can have high potential for the treatment of infected chronic wounds.

500-Gray γ-Irradiation May Increase Adhesion Strength of Lyophilized Cadaveric Split-Thickness Skin Graft to Wound Bed.

BACKGROUND: Human cadaveric skin grafts are considered as the "gold standard" for temporary wound coverage because they provide a more conductive environment for natural wound healing. Lyophilization, packing, and terminal sterilization with gamma-ray can facilitate the application of cadaveric split-thickness skin grafts, but may alter the adhesion properties of the grafts. In a pilot study, we found that 500 Gy γ-irradiation seemed not to reduce the adherence between the grafts and wound beds. AIM AND OBJECTIVES: We conducted this experiment to compare the adherences of lyophilized, 500-Gy γ-irradiated skin grafts to that of lyophilized, nonirradiated grafts. MATERIALS AND METHODS: Pairs of wounds were created over the backs of Sprague- Dawley rats. Pairs of "lyophilized, 500-Gy γ-irradiated" and "lyophilized, nonirradiated" cadaveric split-thickness skin grafts were fixed to the wound beds. Adhesion strength between the grafts and the wound beds was measured and compared. RESULTS: On post-skin-graft day 7 and day 10, the adhesion strength of γ-irradiated grafts was greater than that of the nonirradiated grafts. CONCLUSIONS: Because lyophilized cadaveric skin grafts can be vascularized and the collagen of its dermal component can be remodeled after grafting, the superior adhesion strength of 500-Gy γ-irradiated grafts can be explained by the collagen changes from irradiation.

A New Form of Artificial Skin to Promote Permanent Wound Coverage: A Preliminary Report.

BACKGROUND: Although tendon-exposed or bone-exposed wounds can be resurfaced with flaps, such surgeries may not be feasible in patients with poor general or local conditions. Biosynthetic artificial skin is an alternative for critical wound coverage. We designed a new artificial skin bilayer to close difficult wounds permanently. AIM AND OBJECTIVES: This study compares incorporation and wound contraction between silicone acellular porcine dermis (SAPD) and the Integra graft (Integra Life Sciences Corp., Billerica, Mass) in a rat model. MATERIALS AND METHODS: The SAPD was manufactured according to our previously described standard procedures. Integra grafts were obtained commercially. We included 24 male adult Sprague-Dawley rats and divided them into 2 groups. After creating a 3 × 4-cm full-thickness wound on the back, we transplanted the same-sized SAPD and Integra grafts onto the rat wounds. Autologous full-thickness skin (FTS) was grafted onto the acellular porcine dermal matrix (APDM) of the SAPD and the Integra dermal matrix (IDM) 2 weeks later. We measured the wound size and contraction rate of recipient wounds, studied the incorporation of FTS on the dermal matrix, and did pathological examination. Generalized estimating equations were used to assess the data from repeated wound and scar contraction measurements using SAS v9.2. RESULTS: The sizes of wounds of both groups decreased over time. No difference in wound contraction was observed between the SAPD and Integra groups at weeks 2, 4, or 6 after grafting. However, the contraction rates in both groups increased significantly. The pathological examination showed that the FTS was well incorporated in the APDM and IDM. The recipient wounds showed new vessels and cell infiltration in the new matrix, but no severe inflammation. Skin appendages were regenerating in the FTS. There was no rejection sign. CONCLUSIONS: Both SAPD and Integra are double-layered artificial skin products. Our results demonstrate that APDM and IDM are good templates and show excellent incorporation with autologous FTS graft. The results also demonstrated gradual wound contraction over time, but the contraction rate was not different between SAPD and Integra 6 weeks after grafting in a rat model.

Safe Finger Tourniquet--Ideas.

Tourniquets are often needed for optimized phalangeal surgeries. However, few surgeons forget to remove them and caused ischemic injuries. We have a modified method to create a safe finger tourniquet for short duration finger surgeries, which can avoid such tragedy. It is done by donning a glove, cutting the tip of the glove over the finger of interest, and rolling the glove finger to the base. From 2010 to 2013, approximately 54 patients underwent digital surgical procedures with our safe finger tourniquet. Because the glove cannot be forgotten to be removed, the tourniquet must be released and removed. This is a simple and efficient way to apply a safe finger tourniquet by using hand rubber glove for a short-term bloodless finger surgery and can achieve an excellent surgical result.

Zwitterionic nanocomposite hydrogels as effective wound dressings.

In this study, zwitterionic poly(sulfobetaine acrylamide) (pSBAA) nanocomposite hydrogels were synthesized and implemented as effective chronic wound dressings. The hydrogels exhibited reinforced mechanical properties from added hectorite nanoclay as a physical crosslinker in the polymer chains. Due to the strong interaction with water molecules via ionic solvation, the hydration of the zwitterionic nanocomposite hydrogels was superior to the non-ionic 2-hydroxyethyl methacrylate (pHEMA) hydrogels, which interacts with water molecules via hydrogen bonding. The pSBAA nanocomposite hydrogels cytotoxicity was accessed with NIH-3T3 fibroblast by the MTT assay, the results indicated negligible cytotoxicity after incubation for three days. In addition, the zwitterionic hydrogels displayed evident resistance to adsorption of bovine serum albumin (BSA), NIH-3T3 fibroblast, and bacteria of gram positive S. epidermidis and gram negative P. aeruginosa. The need for antifouling properties in a wound dressing is because commercial dressings removal typically damaging newly formed tissues and colonization of microorganisms occurs on the dressings. For clinical applications as wound dressings, we created normal and diabetic wounds on mice and compared newly developed pSBAA nanocomposite hydrogels with commercial available products. We demonstrated that non-adhesive pSBAA nanocomposite hydrogels enabled ready wound surface removal. Moreover, the wound recovery was conducted with normal and diabetic wounds on rat dorsal by visual observation and showed a complete heal after 10 and 12 days, respectively. Moreover, the histological examination of mice skin confirmed that the zwitterionic hydrogels exhibited thorough re-epithelialization and total formation of new connective tissues in the normal and diabetic wounds after 10 and 12 days, respectively, which was faster than commercial dressings. Consequently, we demonstrated that the pSBAA nanocomposite can serve as an effective dressing for wound management.

Outcome of microscopic excision of a subungual glomus tumor: a 12-year evaluation.

BACKGROUND: Glomus tumors are rare benign neurovascular tumors, up to 75% of which occur in the hand, mainly the subungual area. Local recurrence and nail deformity are commonly seen if tumor excision is not performed completely or properly. OBJECTIVE: This study was designed to assess the long-term efficacy of microscopic excision of subungual glomus tumors. MATERIALS AND METHODS: This retrospective analysis reviewed a total of 22 patients diagnosed with glomus tumors who underwent microscopic surgical excision at a single medical center over a 12-year period (2002-2014). Outcomes were analyzed based on symptom relief, recurrence rate, finger function, nail esthetics, and patient satisfaction. RESULTS: With a mean follow-up period of 48.4 months, neither recurrence nor postexcision nail deformity developed in any patient. Patient satisfaction was rated as "good" in 86.3% of patients (19/22). CONCLUSION: Microscopic surgical excision enables the surgeon to completely remove a glomus tumor while minimizing damage to the nail unit, thereby resulting in significantly decreased recurrence and nail deformity. In this study, an incision made according to the anatomic location provided an easy approach and the best visualization. Patients' finger function was successfully restored, nail esthetic outcome was good, and patient satisfaction was high.

Comparison of hatchet-shaped tensor fascia lata flap and pedicle anterior lateral thigh flap for treatment of trochanteric sores: a retrospective analysis of 48 patients.

PURPOSE: Surgical reconstruction of trochanteric sores remains a formidable task for plastic surgeons. Diverse types of flaps have been proposed for use in this situation, each with particular advantages and limitations. This study aimed to compare the surgical outcomes between the hatchet-shaped tensor fascia lata (TFL) flap and the pedicle anterior lateral thigh (ALT) flap in treatment of trochanteric sores. METHODS: Forty-eight patients with trochanteric sores were operated on under spinal or general anesthesia using TFL or ALT flaps between August 2007 and November 2010. In the TFL group, 26 hatchet-shaped TFL musculocutaneous flaps were performed on 24 patients. In the ALT group, 25 pedicle ALT musculocutaneous flaps were performed on 24 patients. Surgical outcomes were retrospectively analyzed. RESULTS: No significant difference was detected between the TFL and ALT groups in terms of age, preoperative disease period, obesity (body mass index), American Society of Anesthesiologists score, comorbidity, the defect size, follow-up time, and complication rate. The recurrence rate and the flap size were significantly higher in the TFL group than in the ALT group (P = 0.022; P < 0.001). The operation time was longer in the ALT group (P < 0.001). CONCLUSIONS: The pedicle ALT flap is a more effective treatment than the TFL flap for the surgical management of trochanteric sores. The hatchet-shaped TFL flap should be reserved for the reconstruction of recurrent trochanteric sores or for use in the critically ill patient who cannot tolerate longer anesthesia and operation time.

Bilateral breast reconstruction with a pedicled transverse rectus abdominis myocutaneous flap after subcutaneous mastectomy for symptomatic injected breasts.

Breast deformities after augmentation with injectable materials carried out by uncertified medical personnel present challenging problems. Materials include liquid silicone, paraffin, polyacrylamide hydrogels, and unknown gels. They usually cause granulomatous reactions, erythema, pain, and even skin necrosis. Tender masses that cannot be differentiated from breast cancers are the major concern. This retrospective study presents the authors' experience in managing 10 symptomatic injected breasts in five patients during the past 8 years. Subcutaneous mastectomies were carried out using periareolar, inverted "T", or inframammary approaches combined with breast reconstruction using bilateral pedicled transverse rectus abdominis myocutaneous (TRAM) flaps. All flaps survived well and gave a satisfactory cosmetic appearance. There was no major complication or late occurrence of breast cancers over the following 8 years. Injectable materials used for breast augmentation should be prohibited until more scientific data are available about the long-term effect of these materials in breast tissues. Once the injected breasts become symptomatic, subcutaneous mastectomy and reconstruction with bilateral pedicled TRAM flaps is a reasonable option for the patient.

Surgical treatment of gynecomastia: complications and outcomes.

Gynecomastia is defined as the benign enlargement of the male breast. Multiple surgical options have been used to improve outcomes. The aim of this study was to analyze the surgical approaches to the treatment of gynecomastia and their outcomes over a 10-year period. All patients undergoing surgical correction of gynecomastia in our department between 2000 and 2010 were included for retrospective evaluation. The data were analyzed for etiology, stage of gynecomastia, surgical technique, complications, risk factors, and revision rate. The surgical result was evaluated with self-assessment questionnaires. A total of 41 patients with 75 operations were included. Techniques included subcutaneous mastectomy alone or with additional ultrasound-assisted liposuction (UAL) and isolated UAL. The surgical revision rate for all patients was 4.8%. The skin-sparing procedure gave good surgical results in grade IIb and grade III gynecomastia with low revision and complication rates. The self-assessment report revealed a good level of overall satisfaction and improvement in self-confidence (average scores 9.4 and 9.2, respectively, on a 10-point scale). The treatment of gynecomastia requires an individualized approach. Subcutaneous mastectomy combined with UAL could be used as the first choice for surgical treatment of grade II and III gynecomastia.

Cystic seminoma with elevated value of carbohydrate antigen 19-9 in tumor fluid mimicking cystic teratoma.

The incidence of cystic lesions of anterior mediastinum is low, which is responsible for approximately 10% of anterior mediastinal tumors. We presented a special case of primary anterior mediastinal tumor with both prominent cystic change and extreme high carbohydrate antigen 19-9 level of cystic fluid here. From the finding of this case report, we suggested that the diagnosis of cystic anterior mediastinal tumors should include both cystic seminoma and mature cystic teratoma.

[The feasibility study of using the dual stylet method as a bedside measure in facilitating insertion of the spiral distal end nasal-enteral feeding tube in critically ill patients].

OBJECTIVE: To evaluate the feasibility of using the dual stylet method as a bedside measure after unsuccessful of the spiral distal end nasal-enteral feeding tubes into the duodenum in critically ill patients. METHODS: Spiral distal end nasal-enteral feeding tubes were introduced into the stomach of 50 critically ill patients but unable to pass through the pylorus from July 2005 to March 2007. Under electrocardiographic monitoring, the dual stylet method was used as a bedside measure to facilitate the passage. The duration, successful ratio, and complication of the procedure were recorded. RESULTS: This procedure took an average time of (24.5+/-4.9) minutes. The success rate of passing through the pylorus was 82.0% (41/50). The success rate of the latter 25 cases treated from July 2006 to March 2007 was significantly higher than that of the former 25 cases treated from July 2005 to July 2006 [96.0% (24/25) vs. 68.0% (17/25), P<0.05]. The average insertion distance of the 41 successful cases was (85.3+/-2.9)cm. Heart rate(HR) during the procedure was (116.7+/-18.5) beats per minute, that before insertion was (107.6+/-14.2) beats per minute (P<0.01), respiratory rate (RR) was (22.4+/-4.6)breaths per minute during the procedure and (21.3+/-3.9)breaths per minute (P<0.01) before the procedure and mean arterial pressure (MAP) (86.7+/-10.7) mm Hg during and (82.0+/-7.7)mm Hg (1 mm Hg=0.133 kPa, P<0.01) before the procedure. But there was no change in arterial oxygen saturation (SaO(2)). No severe complication was noted. CONCLUSION: The dual stylet method can be used effectively and safely in critically ill patients as a bedside measure after placement of the spiral distal end nasal-enteral feeding tubes.