Evaluation of the association between glutathione S-transferase polymorphisms and susceptibility to cutaneous melanoma: a systematic review and meta-analysis.

Introduction: Glutathione S-transferase (GST) enzymes play a crucial role in detoxification by catalysing the conjugation of many hydrophobic and electrophilic compounds with reduced glutathione. Polymorphisms in GST genes may influence the susceptibility to various cancers, including melanoma. Aim: We reported a systematic review and meta-analysis to evaluate the association between GST polymorphisms and susceptibility to cutaneous melanoma. Material and methods: A comprehensive search of four databases, namely PubMed, Scopus, Cochrane Library, and Web of Science, was conducted to gather pertinent studies up until 24 August 2023. No restrictions were imposed during the search. The analysis included 32 studies and was broken down into subgroups based on ethnicity, control source, control matching, quality score, and sample size. Results: The forest plot analyses on GSTM1, GSTT1, combined GSTM1/GSTT1, and GSTP1 polymorphisms in relation to melanoma risk showed no statistically significant differences between the case and control groups, except for the recessive model of GSTP1 polymorphism. The analysis revealed significant associations between GSTM1 polymorphisms and melanoma risk in Asians and in studies with a sample size of less than 200. For the combined GSTM1/GSTT1 polymorphisms, a significant association was found in hospital-based controls. Conclusions: While this study enhances our understanding of the genetic factors influencing melanoma risk, it also highlights the need for further research. The current evidence is not sufficient to confirm or reject the intervention effect. Future research should consider gene-gene and gene-environment interactions, which could offer a more comprehensive understanding of the complex biology of melanoma.

Advancements in tissue engineering for articular cartilage regeneration.

Articular cartilage injury is a prevalent clinical condition resulting from trauma, tumors, infection, osteoarthritis, and other factors. The intrinsic lack of blood vessels, nerves, and lymphatic vessels within cartilage tissue severely limits its self-regenerative capacity after injury. Current treatment options, such as conservative drug therapy and joint replacement, have inherent limitations. Achieving perfect regeneration and repair of articular cartilage remains an ongoing challenge in the field of regenerative medicine. Tissue engineering has emerged as a key focus in articular cartilage injury research, aiming to utilize cultured and expanded tissue cells combined with suitable scaffold materials to create viable, functional tissues. This review article encompasses the latest advancements in seed cells, scaffolds, and cytokines. Additionally, the role of stimulatory factors including cytokines and growth factors, genetic engineering techniques, biophysical stimulation, and bioreactor systems, as well as the role of scaffolding materials including natural scaffolds, synthetic scaffolds, and nanostructured scaffolds in the regeneration of cartilage tissues are discussed. Finally, we also outline the signaling pathways involved in cartilage regeneration. Our review provides valuable insights for scholars to address the complex problem of cartilage regeneration and repair.

[Effects of Atorvastatin Calcium on the Survival of Ultra-long Dorsal Random Skin Flaps in Rats].

OBJECTIVE: To investigate the effects of atorvastatin calcium (ATR) on the survival of ultra-long dorsal random skin flaps in rats. METHODS: Thirty SD rats were divided into five groups ( n=6) according to the random number table: normal saline control group (CON group), ATR 10 mg/kg group (P10 group), ATR 20 mg/kg group (P20 group), ATR 30 mg/kg group (P30 group), and ATR 40 mg/kg group (P40 group). After pretreatment with ATR or 0.9% saline for 3 days, an ultra-long dorsal random skin flaps with size of 8 cm×2 cm was made on the back of each rat and replanted in situ. After the operation, the ATR or saline treatment lasted for 3 d. Seven days after operation, the appearance of skin flaps was observed with naked eyes, the survival rate of skin flaps was calculated. The pathological changes in the surviving areas of skin flaps were observed by HE staining, the number of microvessels in skin flaps was observed by immunohistochemistry staining, the mRNA expressions of vascular endothelial growth factor ( VEGF) and basic fibroblast growth factor ( bFGF) were tested by quantitative real-time PCR, and the contents of superoxide dismutase, nitrogen monoxide and malonaldehyde were tested by enzyme linked immunosorbent assays (ELISA). RESULTS: On the 7 thday after operation, the skin flap of the CON group showed a large area of necrosis, and the necrotic part formed crusts. Crusts were hard and inelastic, and a large amount of tissue fluid exudated. The fascial layer showed dark purple. No exudation of tissue fluid was observed in the flaps of P10, P20, P30 and P40 groups. The scab shell fell off naturally and the fur grew normally. HE staining of CON group showed that a large number of inflammatory cell infiltration, epidermal loss and necrosis in skin flaps, but the pathological changes in skin flaps were significantly improved after treatment with ATR. Compared with the CON group, the survival rate of skin flaps, the number of microvessels in skin flaps and the levels of VEGF mRNA, bFGF mRNA, SOD, NO in skin flaps also increased with the dose of ATR, which reached a peak at 30 mg/kg ATR ( P<0.05). However, the level of MDA in skin flaps decreased with the dose of ATR, which reached the lowest at 30 mg/kg ATR ( P<0.05). CONCLUSION: ATR can enhance the survival of ultra-long dorsal random skin flaps in rats, which may be related to promoting microangiogenesis and inhibiting inflammatory and oxidative stress.

[Clinical application of autologous costal cartilage transplantation in repair of upper lip depression in secondary repair of cleft lip].

OBJECTIVE: To discuss the clinical application and effectiveness of autologous costal cartilage transplantation in the repair of upper lip depression in the secondary repair of cleft lip. METHODS: The clinical data of 10 patients of secondary repair of upper lip depression with cleft lip by autologous costal cartilage transplantation between January 2017 and January 2019 were retrospectively analysed. There were 7 males and 3 females with an average age of 24 years (range, 18-33 years). There were 8 cases of bilateral lip fissure and 2 cases of unilateral lip fissure. All of them underwent early lip repair at the age of 2-3 years old. The change of the profile of the soft tissue profile of the upper lip of the patient was quantitatively analyzed before operation and at immediate after operation, including the soft tissue facial angle (G-Sn-Pg'), the nasolabial angle (Cm-Sn-UL), the mentolabial angle (UL-LL-Pg'), the distance between the most salient point of the upper lip to the aesthetic plane (UL-E), the highest point of the frontal part, the projection distance of the most salient point of the upper lip on the plane of the orbital ear (G-UL), and the upper lip protrusion (ULP). RESULTS: One case had incision infection and healed after dressing change, and in the other 9 patients, the incisions healed by first intention, and no acute infection and other complications occurred. The appearance of the lateral morphology of the upper lip at immediate after operation was significantly improved when compared with that before operation. The value of UL-LL-Pg', UL-E, G-UL, and ULP were significantly increased and G-Sn-Pg' was significantly decreased when compared with preoperative ones ( P<0.05). There was no significant difference in Cm-Sn-UL between pre- and post-operation ( t=0.821, P=0.433). All the 10 patients were followed up 6-24 months, with an average of 15 months. During the follow-up, the soft tissue morphology of the upper lip was good. No long-term complications such as cartilage absorption and cartilage displacement were found. CONCLUSION: Autologous costal cartilage transplantation is a safe and effective treatment for upper lip depression in the secondary repair of cleft lip.

[Auricular cartilage multi-point suspension fixed to craniofacial deep fascia in correcting mild to moderate cupped ear malformation].

OBJECTIVE: To explore the feasibility and effectiveness of using auricular cartilage multi-point suspension fixed on deep craniofacial fascia in correcting mild to moderate cupped ear malformation. METHODS: Between January 2014 and March 2016, 22 patients (12 males and 10 females) with mild to moderate cupped ear malformation were admitted, aged from 6 to 28 years, with an average age of 15 years. Sixteen cases were unilateral and 6 cases were bilateral. According to Tanzer classification, there were 18 sides of type Ⅰ and 10 sides of type Ⅱ. The otocranial groove incision was selected to expose and release the posterior auricular muscles and ligaments. The abnormal structure of auricle subunits was remolded. The auricle cartilage was suspended and fixed on the deep craniofacial fascia with non absorbable line to remodel the shape and position of auricle. RESULTS: The incision healed by first intention, without hematoma, infection, and skin necrosis. All the patients were followed up 3-48 months, with an average of 12 months. In addition to 1 case of slippage of the fixed line knot, the effect was good after being suspended and fixed again, the auricles of the other patients were not drooping and tilted forward, the shape of the outer ear was good, the ear boat was obvious, the shape of the upper and lower feet of the ear wheel and the pair of ears was natural, the bilateral symmetry was good, and the patients and their families were satisfied. CONCLUSION: Auricular cartilage multi-point suspension fixed on deep craniofacial fascia is effective in the treatment of mild to moderate cupped ear malformation.

[Effectiveness of autologous costal cartilage transplantation in repair of Binder's syndrome].

Objective: To investigate the technical points and effectiveness of autogenous costal cartilage transplantation in repair of Binder's syndrome. Methods: Between June 2012 and June 2017, 8 cases of Binder's syndrome were admitted. There were 3 males and 5 females, aged 16-31 years (mean, 22 years). All patients were conformed to the typical manifestations of Binder's syndrome. The autogenous costal cartilage was harvested and carved into the nasal dorsum graft, nasal column graft, and nasal basement graft. Before and after operation, standard pictures of the anterior view, lateral view, and base view were taken to measure facial related parameters of nasal dorsum length, nasal columella-lobule ratio, nasofrontal angle, nasal columella-upper lip angle, nasal tip projection rate, and nasion projection. Then the effectiveness of this surgical procedure for Binder's syndrome was evaluated. Results: All incisions healed by first intention without acute infections. All patients were followed up 6-36 months, with an average of 18 months. The foreign body sensation in upper lip and scar hyperplasia in thoracic incision occurred in 1 case, respectively. The nasal morphology improved significantly and the coordinated relationships of the nose with the upper lip and face were restored postoperatively. Postoperative parameter measurements were taken in 6 cases. The nasal dorsum length, nasal columella-lobule ratio, nasofrontal angle, nasal columella-upper lip angle, nasal tip projection rate, and nasion projection at preoperation were significantly improved when compared with the values at 6 months after operation ( P<0.05). The difference in nasal dorsum length, nasal tip projection rate, and nasion projection between actual values at 6 months after operation and normal values was no significant ( P<0.05). There was significant difference in nasal columella-lobule ratio between actual value at 6 months after operation and normal value ( P>0.05). Conclusion: Autogenous costal cartilage transplantation in repair of Binder's syndrome can obviously improve patients' appearance of the external nose and middle face, and obtain the persistent effectiveness.

[Application of local skin flaps in adjustment of reconstructed nasal alars at second stage].

Objective: To investigate the effectiveness of local skin flaps such as V-Y advancement flap (V-Y plasty) and transposition flap (Z plasty) in the adjustment of reconstructed nasal alars at second stage. Methods: Between June 2012 and January 2017, 14 cases of reconstructed nasal alars by nasolabial flap or expanded forehead flap were recruited. There were 9 males and 5 females with an average age of 34.8 years (range, 18-52 years). The interval time between one- and two-stage operations was 1-12 months (mean, 3 months). The type of local skin flap was decided according to the flaws of reconstructed nasal alars. V-Y plasty was used in 5 cases, Z plasty in 2 cases, and V-Y plasty combined with Z plasty in 7 cases. Results: All operations were successfully completed. The flaps in 3 cases suffered from epidermal necrosis at the far end and healed by dressing change. The other wounds healed by first intention. All 14 cases were followed up 6-40 months (mean, 12 months). The nasal alars had verisimilar shape and symmetrical appearance. The color and texture of reconstructed nasal alar were closed to peripheral tissues. Conclusion: Applying local skin flaps such as V-Y plasty and Z plasty can acquire a better shape in the adjustment of reconstructed nasal alars.

[EFFECTIVENESS OF DEEP INFERIOR EPIGASTRIC ARTERY PERFORATOR FLAP FOR REPAIR OF PERINEAL AND PERIANAL CICATRICIAL CONTRACTURE].

OBJECTIVE: To discuss the effectiveness of deep inferior epigastric artery perforator flap to repair perineal and perianal cicatricial contracture. METHODS: Between March 2007 and December 2013, 23 patients with perineal and perianal cicatricial contracture were treated with deep inferior epigastric artery perforator flap. There were 15 males and 8 females, aged from 21 to 62 years (mean, 42 years). Burn depth was III degree. The burning scars involved in the fascia, even deeper, which was rated as peripheral type (mild stenosis of the anal region and perianal cicatricial contracture) in 13 cases and as central type (severe stenosis of the anal region and anal canal with shift or defect of external genitalia) in 10 cases. All patients had limited hip abduction and squatting. Repair operation was performed at 3 months to 2 years (mean, 6 months) after wound healing. The size of soft tissue defects ranged from 10 cmx6 cm to 28 cm x 13 cm after scar excision and release. The size of flaps ranged from 12 cmx7 cm to 30 cmx15 cm. The donor site was sutured directly in 16 cases and repaired by autograft of skin in 7 cases. RESULTS: The flap had distal necrosis, distal cyanosis, and spotted necrosis in 1 case, 2 cases, and 1 case respectively, which were cured after symptomatic treatment; the other flaps survived and wound healed primarily. Twenty-one patients were followed up 6 months to 2 years (mean, 1 year). Nineteen patients had good appearance of the perinea and position of external genitalia, normal function of defecation function; stenosis of the anal region was relived, and the flaps had good texture and elasticity. Linear scar contracture was observed at the edge of flap in 2 cases, and the appearance of the perineum was restored after Z plasty. The hip abduction reached 30-40°. No abdominal hernia was found at donor site. CONCLUSION: Deep inferior epigastric artery perforator flap has stable blood supply and flexible design, which is similar to the perianal and perineal tissues. The good effectiveness can be obtained to use this flap for repair of perineal and perianal cicatricial contracture.

[Chondrogenesis of adipose derived stem cells induced by misshapen auricular chondrocytes from microtia in vitro].

OBJECTIVE: To investigate the effects of the misshapen auricular chondrocytes from microtia in inducing. METHODS: Human ADSCs at passage 3 and misshapen chondrogenesis of human adipose derived stem cells (ADSCs) in vitro. auricular chondrocytes at passage 2 were harvested and mixed at a ratio of 7:3 as experimental group (group A, 1.0 x 10(6) mixed cells). Misshapen auricular chondrocytes or ADSCs at the same cell number served as control groups (groups B and C, respectively). All samples were incubated in the centrifuge tubes. At 28 days after incubation, the morphological examination was done and the wet weight was measured; the content of glycosaminoglycan (GAG) was detected by Alcian blue colorimetry; the expressions of collagen type II and Aggrecan were determined with RT-PCR; and HE staining, toluidine blue staining, Safranin O staining of GAG, and collagen type II immunohistochemical staining were used for histological and immunohistochemical observations. RESULTS: At 28 days after incubation, all specimens formed disc tissue that was translucent and white with smooth surface and good elasticity in groups A and B; the specimens shrank into yellow spherical tissue without elasticity in group C. The wet weight and GAG content of specimens in groups A and B were significantly higher than those in group C (P < 0.05), but no significant difference was found between groups A and B in the wet weight (t = 1.8203, P = 0.0687) and in GAG content (t = 1.8614, P = 0.0627). In groups A and B, obvious expressions of collagen type II and Aggrecan mRNA could be detected by RT-PCR, but no obvious expressions were observed in group C; the expressions in groups A and B were significantly higher than those in group C (P < 0.05), but no significant difference was found between groups A and B in collagen type II mRNA expression (t = 1.4576, P = 0.1449) and Aggrecan mRNA expression (t = 1.5195, P = 0.1286). Mature cartilage lacunas and different degrees of dyeing for the extracellular matrix could be observed in groups A and B; no mature cartilage lacunas or collagen type II could be observed in group C. The expression of collagen type II around cartilage lacuna was observed in groups A and B, but no expression in group C; the gray values of groups A and B were significantly lower than that of group C (P < 0.01), but no significant difference was found between groups A and B (t = 1.6615, P = 0.0970). CONCLUSION: Misshapen auricular chondrocytes from microtia can induce chondrogenic differentiation of human ADSCs in vitro.

[Effectiveness of modified method for cup ear deformity].

OBJECTIVE: To introduce a modified method to correct type I and type II cup ear and to evaluate the effectiveness. METHODS: Between May 2006 and November 2011, 23 patients with type I or type II cup ear (27 ears, type I in 6 ears and type II in 21 ears according to Tanzer's criteria) were treated. There were 14 males and 9 females with an average age of 10 years (range, 7-16 years). The unilateral ear was involved in 19 cases and bilateral ears in 4 cases. The main clinical manifestations included the flat helix and scapha and ptosis of upper 1/3 auricle. The arc incision was adopted in the auriculocephalic angle, elevation of the dis-clothing-like flap in the front and rear of the auricular cartilage, relocation of the craniofacial initiation site of the scapha and the cavity of auricular concha, correction of deformational auricular cartilage and reconstruction of smooth helix, antihelix, superior and inferior antihelix crus. RESULTS: All the incisions healed by first intention without any hematoma, postoperative infection, or flap necrosis. All patients were followed up 9 months-6 years (median, 36 months). No auricle ptosis, deformity contour, or atrophy was observed. The structure of the helix, scapha, and antihelix were clear, natural, and excellent. The scars at the local site were limited and unconspicuous. CONCLUSION: Modified method can almost correct all the anatomic defects of cup ear. It is an ideal method to treat type I and type II cup ear.

[Effectiveness of perforator flaps for elderly patients with ischia-sacral ulcers].

OBJECTIVE: To investigate the operative technique and the effectiveness of perforator flaps for the treatment of elderly patients with ischia-sacral ulcers. METHODS: Between January 2005 and June 2010, 29 elderly patients with ischia-sacral ulcers were treated. There were 16 males and 13 females, aged from 61 to 75 years (mean, 68 years), including 11 cases of degree III and 18 cases of degree IV according to the standard of the National Pressure Ulcer Advisory Panel (NPUAP). The disease duration was from 5 months to 10 years (median, 5.5 years). The size of ulcers ranged from 7 cm x 6 cm to 12 cm x 10 cm. Of them, 8 cases were companied by cerebral vascular disorders, 6 cases by Alzheimer disease, 11 cases by paraplegia, and 4 cases by others. The flap size ranged from 8 cm x 6 cm to 14 cm x 12 cm. The donor sites were sutured directly. RESULTS: Distal flap necrosis occurred in 3 cases (10.3%) 2 days after operation and healed after symptomatic treatment, and the remaining flaps survived and wound healed by first intention with first intention rate of 89.7%. The incisions of donor sites healed primarily. Two cases (6.9%) had infection 1 week after operation and 1 case (3.4%) had wound dehiscence 10 days after operation. Twenty-seven patients were followed up 6 months to 5 years (mean, 3 years). Two cases recurred at 1 and 3 years after operation, respectively. One died of infection, and the other healed by debridement and suture. The flaps of other patients had good texture, color, and elasticity. CONCLUSION: As long as the indications are controlled strictly, good effectiveness can be achieved in the treatment of elderly patients with ischia-sacral ulcers by using perforator flaps.