Ghrelin ameliorates cardiac fibrosis after myocardial infarction by regulating the Nrf2/NADPH/ROS pathway.

To evaluate the role of ghrelin in cardiac fibrosis after myocardial infarction (MI) and to investigate the underlying mechanisms of ghrelin-regulated Nrf2/NADPH/ROS pathway-mediated cardioprotection, the profile of Nrf2, fibrosis markers, and oxidative stress markers were characterized in a rat model of MI and Angiotensin II (Ang II)-stimulated cardiac fibroblasts (CFs). The effects of ghrelin on cardiac function, fibrosis and oxidative stress were investigated after MI in vivo. The role of ghrelin in CF migration and proliferation was evaluated in Ang II-stimulated CFs in vitro. Inhibition of ghrelin receptors using the antagonist, d-Lys3-GHRP-6, in addition to ghrelin was employed in MI and CFs to investigate the direct effect of ghrelin on cardiac fibrosis. Loss function of Nrf2 in CFs was performed to investigate the effect of ghrelin-regulated Nrf2 on oxidative stress and cardiac fibrosis. Ghrelin improved the post-MI cardiac function and reduced cardiac fibrosis. This phenotype is associated with the upregulation of Nrf2 and downregulation of fibrotic proteins, NADPH oxidase and ROS production. In line with in vivo findings, ghrelin attenuated Ang II-stimulated CF migration, proliferation, and oxidative stress in vitro. Inhibition of the ghrelin receptor or knockdown of Nrf2 abolished the beneficial effects of ghrelin on MI or Ang II-stimulated cardiac fibroblasts. In conclusion, ghrelin ameliorates post-MI and Ang II-induced cardiac fibrosis by activating Nrf2, which in turn inhibits the NADPH/ROS pathway.

Giant barocaloric effect in hexagonal Ni2In-type Mn-Co-Ge-In compounds around room temperature.

The most widespread cooling techniques based on gas compression/expansion encounter environmental problems. Thus, tremendous effort has been dedicated to develop alternative cooling technique and search for solid state materials that show large caloric effects. An application of pressure to a material can cause a change in temperature, which is called the barocaloric effect. Here we report the giant barocaloric effect in a hexagonal Ni2In-type MnCoGe0.99In0.01 compound involving magnetostructural transformation, Tmstr, which is accompanied with a big difference in the internal energy due to a great negative lattice expansion(ΔV/V ~ 3.9%). High resolution neutron diffraction experiments reveal that the hydrostatic pressure can push the Tmstr to a lower temperature at a rate of 7.7 K/kbar, resulting in a giant barocaloric effect. The entropy change under a moderate pressure of 3 kbar reaches 52 J kg(-1) K(-1), which exceeds that of most materials, including the reported giant magnetocaloric effect driven by 5 T magnetic field that is available only by superconducting magnets.

[Repair of defects in lower extremities with peroneal perforator-based sural neurofasciocutaneous flaps].

OBJECTIVE: To explore the operative technique and clinical results of using peroneal perforator-based sural neurofasciocutaneous flaps to repair skin and soft tissue defects in lower extremities. METHODS: From January 2009 to March 2012, 26 patients with skin and soft tissue defects at distal region of leg and foot were hospitalized. Among them, 9 patients suffered from tendon or bone exposure at the distal region of leg after injury due to traffic accident; 4 patients suffered from skin defects in the ankle as a result of electric injury; 8 patients suffered from chronic ulcer at the distal part of leg and foot; 5 patients suffered from plantar pressure ulcer. After debridement, soft tissue defect sizes ranged from 11 cm×5 cm to 18 cm×13 cm. According to the position and size of the defects, peroneal perforator-based sural neurofasciocutaneous flaps were designed and procured to repair the skin and soft tissue defects. The size of flaps ranged from 12 cm×6 cm to 20 cm×15 cm. Flap donor sites were closed by direct suture or skin grafting. RESULTS: Twenty-five flaps survived completely. Only one flap suffered partial margin necrosis in the size of 2 cm×1 cm, which was healed after dressing change. Patients were followed up for 6 to 12 months. The appearance and sensation of flaps were satisfactory; no ulcer occurred; the movement of lower extremities was normal. CONCLUSIONS: It is suitable to repair the skin and soft tissue defects at distal region of leg and foot with the peroneal perforator-based sural neurofasciocutaneous flap, as it possesses reliable blood supply, long and non-bulky pedicle, and sufficient available size. The operation is also easy to perform.

Clinical application of the thoracodorsal artery perforator flaps.

BACKGROUND: Thoracodorsal artery perforator (TAP) flaps without latissimus dorsi muscle - have been used for reconstruction of the extremities, head and neck as free style flaps, and as pedicled flaps for reconstruction of the chest wall and axillary wounds. This retrospective study aimed to analyse the clinical applications and relevant anatomic findings of TAP flaps. METHODS: From April 2007 to August 2011, 67 free or pedicled TAP flaps were transferred in 67 patients for reconstruction of wounds of the extremities, chest wall and axilla. Eight were used as free flaps for reconstruction of extremities, and 59 used as pedicled flaps for reconstruction of axillary or chest wounds. Patient ages ranged from 7 to 55 years (26.04±12.83). Perforator arteries were detected and identified with a hand-held Doppler. The size of flaps ranged from 6 by 9 to 14 by 18 cm ((8.66±2.05) by (12.62±2.03)). Flaps were designed with the perforator artery included, with all flaps based on one or two perforator arteries. RESULTS: All of the flaps survived. There were no problems with vascular spasm or occlusion. Significant venous congestion was not observed in any of the cases. Two cases developed minor wound dehiscence but healed with conservative therapy. None of the donor sites developed seromas. CONCLUSIONS: The thoracodorsal artery flap without associated latissimus dorsi muscle can provide a thin, large and reliable flap with robust blood supply. The TAP flap can significantly reduce donor site morbidity.

Reconstruction of lower face defect or deformity with submental artery perforator flaps.

BACKGROUND: Reconstruction of lower face defects or deformity often presents as a challenge for plastic surgeons. Many methods, including skin graft, tissue expander, or free flap are introduced. Submental artery perforator flaps have been used in the reconstruction of defects or deformities of the lower face. METHODS: Between August 2006 and December 2008, 22 patients with lower face defects or deformity underwent reconstruction with pedicled submental artery perforator flaps. Their age ranged between 14 and 36 years. The perforator arteries were detected and labeled with a hand-held Doppler flowmeter. The size of flaps ranged from 4 × 6 to 6 × 7 cm, and the designed flaps included the perforator artery. RESULTS: All the flaps survived well, except 1 flap which resulted in partial necrosis in distal region and healed after conservative therapy. No other complication occurred with satisfactory aesthetic appearance of the donor site. CONCLUSIONS: The submental artery perforator flap is a thin and reliable flap with robust blood supply. This flap can reduce donor-site morbidity significantly and is a good choice for reconstructive surgery of lower face.

Pedicled thinned deep inferior epigastric artery perforator flap for perineal reconstruction: a preliminary report.

BACKGROUND: Deep inferior epigastric artery perforator (DIEP) flap has proved to be an effective method in perineal reconstruction. However, a few literatures have reported thinned DIEP flap which yields a better functional and cosmetic result. There are also no clear guidelines on the degree to which a DIEP flap may be debulked of excess tissue before flap viability becomes compromised. In this preliminary report, a series of patients are presented whereby perineal reconstruction was achieved using the pedicled, thinned DIEP flap, based on debulking parameters from our clinical findings. METHODS: Between September 2007 and August 2010, 12 pedicled, thinned DIEP island flaps for perineal reconstruction were performed on three patients with vulval or vaginal tumour, five patients with congenital vaginal agenesis and four patients with perineal Paget's disease. The flap was thinned in the plane inferior to the superficial inferior epigastric vein based on the subcutaneous vasculature of the abdominal wall, as depicted by preoperative computed tomography (CT) angiography (CTA) examination. RESULTS: Preoperative abdominal CTA can perfectly display the anatomy of DIEP flap. With a sensitivity of 100% and a specificity of 100% (Φ>0.5 mm), it helped in reducing the harvesting time for the flap and in guiding flap thinning. Partial necrosis of the distal flap occurred in a relatively large transverse flap measuring 24 cm×8.5 cm. One patient experienced dehiscence and a subsequent suture was successfully made. The other ten flaps were transplanted successfully without any complications. CONCLUSION: This series demonstrates that DIEP flap can be reliably debulked in the plane inferior to the superficial inferior epigastric vein with relatively no risk of necrosis and can be used safely in perineal reconstruction. The abdominal CTA can be employed as an assisting tool to plan the DIEP flap as well as guide flap thinning.

[Superior or inferior gluteal artery perforator flaps for the gluteal sores].

OBJECTIVE: To investigate the clinical application of superior or inferior gluteal artery perforator flaps for the gluteal sores. METHODS: Before operation, the perforator artery was detected by Doppler flowmeter and labeled. The perforator flap was designed, including the perforator artery, but not the gluteal maximum muscle. RESULTS: From Aug. 2006 to May 2009, 15 cases were treated. The flap size ranged from 6 cm x 8 cm to 7 cm x 15 cm. All the flaps survived completely without hematoma, seroma or other complication. CONCLUSIONS: The gluteal maximum muscle-reserved gluteal artery perforator flap is a good choice for gluteal sore with reliable blood supply and less morbidity in donor site.

[The submental artery perforator flap for lower face defect and deformity].

OBJECTIVE: To analyze the clinical application of submental artery perforator flap for lower face defect and deformity. METHODS: From Sep. 2006 to Mar. 2009, 22 cases with lower face defects and deformities were treated with the submental artery perforator flaps. The age of the patients ranged from 14 to 36. The perforator point was detected by Doppler flowmeter. The size of the flaps ranged from 4 cm x 5 cm to 6 cm x 7 cm. RESULTS: Distal partial necrosis happened in one flap, which healed through dressing. All the other flaps survived with satisfactory appearance and less morbidity in donor sites. CONCLUSIONS: Submental artery perforator flap is very suitable for lower face defect and deformity with reliable blood supply and less morbidity in donor site.

[Application of four-dimensional computed tomography angiography in the study of vascular structure of the deep inferior epigastric artery perforator].

OBJECTIVE: To explore the vascular structure of the deep inferior epigastric artery perforator with the four-dimensional computed tomography (CT) angiography. METHODS: 10 abdominal specimens harvested from fresh cadavers were cannulated with trocar and injected with contrast medium in the deep inferior epigastric artery at different levels, including the deep inferior epigastric artery, its bifurcations, the lateral or medial large perforators. During the perfusion of the contrast medium in the flap, the flap was scanned by three-dimensional CT (four-dimensional defined as three dimensional CT plus time). The CT data were sent to CT workstation and the images were processed and reformatted. RESULTS: The deep inferior epigastric artery perforator terminates in the subdermal vascular plexus, with bifurcating superior to the Scarpa fascia and under the skin. The anastomosis in the abdominal midline occurs in the subdermal vascular plexus. The blood flow distributes in two ways, one is the subdermal vascular plexus, the other is the existed vascular structure. The zone overlying the rectus muscle in the pedicle side has the best blood supply, the other adjacent zone on the ipsilateral side of the abdomen, the zone overlying the contralateral rectus muscle and the zone lateral to the contralateral rectus muscle has declining perfusion. CONCLUSIONS: The four-dimensional CT is a useful method to study the vascular structure of the deep inferior epigastric artery perforator in the superficial fascia.

[Clinical application of thoracodorsal artery perforator flaps].

OBJECTIVE: To analyses the clinical application of thoracodorsal artery perforator flaps (TAP). METHODS: We used free or pedicled TAP flaps in 7 patients from Aug 2006 to April 2007, The age ranged from 7 to 42 years old, the perforator arteries was detected and labeled with a hand held Doppler flowmeter, the size of flaps ranged from 6 cm x 9 cm - 12 cm x 16 cm, the flaps designed with perforator artery included, all the flaps are based on the first perforator artery. RESULTS: All the flaps survived well, no complication occurred with lowest donor site morbidity. CONCLUSIONS: The thoracodorsal artery flap with latissimus dorsal muscle saved is a thin and reliable flaps with robust of blood supply, the flap can reduce significantly donor site morbidity and is a good choice for reconstructive surgery.

Reversed anterolateral thigh adipofascial flap for knee and proximal calf defects.

BACKGROUND: Reconstruction of defects involving the knee and proximal one third of the lower leg presents a challenging problem in plastic surgery. AIM: To evaluate the reversed anterolateral thigh adipofascial flap for covering such defects. METHODS: Between September 2006 and May 2007, one man and four women with defects around the knee and upper calf underwent reconstruction with reversed anterolateral thigh adipofascial flaps. The patients' average age was 45 years (25-72 years). The size of the transferred flap ranged from 6 cm x 8 cm to 12 cm x 13 cm. RESULTS: Four flaps with overlying skin grafts healed uneventfully; one skin graft showed minor necrosis due to haematoma, but the adipofascial flap survived well. Postoperatively the appearance of the reconstructive flap was acceptable. CONCLUSIONS: The reversed anterolateral thigh adipofascial flap is an effective option for covering defects of the knee and proximal calf.

[Clinical breast reconstruction with various methods].

OBJECTIVE: To investigate and clarify the indications of breast reconstruction after mastectomy with various methods. METHODS: A clinical analysis was made, based on 44 patients with the 45 breasts who had received breast reconstruction after mastectomy in our hospital from 2003 to 2005. The methods of breast reconstruction included in tissue expander/implant (5 cases), implants covered by latissimus dorsi flap (13 cases), latissimus dorsi flap along (3 cases), DIEP flap (6 cases), TRAN flap (10 cases) and solid double-pedicle TRAM flap (8 cases). RESULTS: All of the flaps survived well in total 40 patients (40 breasts) who were used a flap for breast reconstruction. Superficial skin necrosis occurred in 1 case with the method of tissue expander/implant; rupture of breast prosthesis and infection occurred in 1 case with the technique of implant with a latissimus dorsi flap; subcutaneous seroma occurred in 1 case with the method of DIEP flap; partial flap necrosis occurred in 2 cases with the method of TRAM flap. By the follow-ups of 3 - 12 months, the reconstructed breasts were well-shaped and there were no complications such as abdominal hernia. CONCLUSIONS: These 6 methods for breast reconstruction achieved the satisfactory results for the requirement of breast reconstruction in Chinese women. With the development of plastic surgery technique, the indications of breast reconstruction were enlarged.

[Clinical study of preoperative analgesia for liposuction].

OBJECTIVE: To observe the effect of the preoperative analgesia with Oxycodone/Acetaminophen for liposuction. METHODS: In the double-blind, placebo-controlled clinical trial, 40 patients undergoing the liposuction were randomly assigned into two groups which were received a single oral dose of Oxycodone/Acetaminophen or calcium gluconate respectively before the operation. The degrees of pain were evaluated by visual analogue scale (VAS) at the beginning and the end of the operation. Adverse effects and the overall satisfaction on analgesic therapy were assessed when operation finished. RESULTS: The VAS scores of the experimental group were significantly lower than the control group at the beginning and the end of operation (P < 0.05). There were no significant differences between the two groups in side effects (P > 0.05). CONCLUSIONS: Oxycodone/Acetaminophen could produce preemptive effect. Preoperative oral administration of Oxycodone/ Acetaminophen may provide patients with good analgesia in plastic and cosmetic operation.

[Vulvar form reconstruction in extended radical vulvectomy of vulvar carcinoma].

OBJECTIVE: To evaluate the method of vulvar reconstruction after extended vulvectomy. METHODS: Retrospectively, fourteen cases of vulva carcinoma were treated by radical wide local excision, and the defects were repaired with anterolateral thigh flap and inferior pedicle rectus abdominal myocutaneous flap. After the flap was harvested, it was put on the defect through the tunnel between the donor and the recipient site and the vulvae was reconstructed. RESULTS: All the flaps were survived except 1 anterolateral thigh flap with partial necrosis. One patient was infected at the groin incision but the flap and the grafted skin were survived. The patients were treated with change of the dressing and recovered after skin grafting. All other incisions were healed with first intention. The partial necrosis area was about 4 cm x 6 cm, it healed at 36 postoperative days after free skin grafting. The reconstructed vulvae were plump and elastic. It appeared like the normal vulvae and there was no contraction of the vagina. CONCLUSIONS: Vulvar reconstruction with the anterolateral thigh flap and rectus abdominal flaps after the radical vulvectomy could make the patients recover easily. It produces almost normal appearance and function of the vulvae, reduces the time of wound healing. The patient could have the next therapy more quickly and the quality of life improves. It has wide application value in clinics.

[The application of pedicled anterolateral thigh fasciocutaneous flaps for reconstruction of perineal and inguinal defects].

OBJECTIVE: To evaluate a method for the reconstruction of defects of perineum and groin with pedicled anterolateral thigh fasciocutaneous flaps. METHODS: From July 2003 to February 2005, 12 pedicled anterolateral thigh fasciocutaneous flap based on the perforators of lateral circumflex femoral artery had been designed and transferred to the defects of perineum and groin. RESULTS: Anterolateral thigh fasciocutaneous island flaps were performed in twelve patients. The size of the transferred flap ranged from 8 cm x 11 cm to 18 cm x 20 cm. Only one patient developed superficial cutaneous necrosis in the posterior aspect of the flap because of fecal contamination and infection. The wounds healed secondarily. CONCLUSIONS: Despite variable vascular anatomy and technical difficulties in elevating the anterolateral thigh flap, the anterolateral thigh flap is a good choice for perineum and groin reconstruction.

[Microsurgical tissue transfer for the reconstruction of hemifacial atrophy (Parry-Romberg syndrome)].

OBJECTIVE: To reconstruct the soft tissue defect of the hemifacial with free anterolateral thigh fascioadipose flaps or scapular dermal-adiposal flap. METHODS: The free anterolateral thigh fascioadipose flaps based on the perforators of lateral circumflex femoral artery or scapular dermal-adiposal flap based on the circumflex scapular artery has been designed and reconstructed hemifacial atrophy with the donor artery and vein anastomosed to the facial artery and vein. RESULTS: Anterolateral thigh fascioadipose flaps were performed in 7 patients. Scapular dermal-adiposal flap was applied in 1 patient. All the flaps survived well and aesthetic appearance of reconstructed face achieved good result. CONCLUSIONS: The microsurgical tissue transfer, especially the free anterolateral thigh fascioadipose flap is a good and reliable choice for hemifacial reconstruction.

[The periareolar approach management of postoperative complications of breast augmentation by injected polyacrylamide hydrogel].

OBJECTIVE: To analysis various complications of 30 patients of breast augmentation by injected polyacrylamide hydrogel and discuss the treatment through periareolar incision. METHODS: All patients were classified according to the different complications. Open suction technique and partial mastectomies via periareolar incisions were performed in all patients, Only one patient had immediately breast reconstruction with prosthesis, five patients received secondarily breast prostheses implantation via a axillary incision. RESULT: All the symptoms were relieved after remove of polyacrylamide hydrogel. CONCLUSIONS: Polyacrylamide hydrogel should be prohibited for injected breast augmentation at present. A double-blinded randomized clinical study, controlled animal experiments and a large sample questionnaire survey for complications are necessary. The periareolar approach is valuable technique and can remove polyacrylamide hydrogel as completely as possible.

[The reverse first dorsal metatarsal artery flap for the defects of the distal foot].

OBJECTIVE: To explore a new method to reconstruct the defect of the distal foot. METHODS: A distally based dorsum pedis island flap pedicled with the first dorsal metatarsal artery was designed and transferred to the defect of the distal foot. RESULTS: Five patients were treated with this flap, which ranged from 2 cm x 4 cm to 6 cm x 7 cm in size. Four flaps survived completely, one flap had marginal necrosis and healed after conservative therapy. CONCLUSIONS: The reverse first dorsal metatarsal artery flap, with good blood circulation and easy manipulation, is a good option for the defects of the distal foot.