[Application of preoperative serum CYFRA 21-1 level in the prognosis of colorectal cancer].

To explore the predictive value of preoperative serum CYFRA 21-1 in colorectal cancer (CRC) resection patients. In this retrospective study, 456 patients with CRC who received surgical treatment in the Department of General Surgery, Affiliated Hospital of Nantong University from January 2016 to February 2018 were analyzed. Preoperative CYFRA 21-1, CEA, CA19-9 and pathological data of the study subjects were collected. Determine the cut-off value of CYFRA 21-1 based on the X-tile. Chi-square test or Fisher exact probability test were used to compare clinicopathological features in different CYFRA 21-1 level groups. Univariate and multivariate regression analysis of factors affecting 5-year overall survival (OS) and disease-free survival (DFS). Kaplan-Meier survival curves were used to analyze 5-year differences in OS and DFS in CRC patients with different levels of CYFRA 21-1, CEA and CA19-9. Receiver operating characteristic(ROC) was adopted. ROC curves were used to analyze the prognostic efficacy of CYFRA21-1 for CRC, and nomogram maps were used to predict 1, 3, and 5-year survival rates. The results showed that the optimal cut-off values of serum CYFRA 21-1, CEA and CA19-9 were 4.9 ng/ml, 29.2 ng/ml and 72.8 U/ml, respectively. Different gender, tumor size, location, degree of differentiation, depth of invasion, lymph node metastasis and tumor node metastasis (TNM) classification stage were significantly different between the two groups with high and low CYFRA 21-1, the P-values were 0.018,<0.001,<0.001,<0.001, 0.002, 0.001, 0.003, respectively. CYFRA 21-1 (≥4.9 ng/ml) was an independent risk factor for 5-year OS (HR: 4.008, 95%CI: 2.309-6.958, P<0.001) and DFS (HR: 3.75, 95%CI: 2.227-6.314, P<0.001) in CRC patients. CYFRA 21-1 predicts a 5-year AUC of 0.725 and 0.720 for OS and DFS, respectively, and 0.804 and 0.827 for the combination of CEA and CA19-9. Based on the results of multivariate Cox regression analysis, nomogram graphs of OS and DFS were established, the C-indexes were 0.799 and 0.803, respectively. In conclusion, preoperative serum CYFRA 21-1 level may be an independent risk factor affecting the prognosis of patients with colorectal cancer. The prognostic model established by CYFRA 21-1 combined with CEA, CA19-9 and TNM stages may provide references for the prevention of CRC recurrence and clinical decision-making.

[Advances in the research of the relationship between miRNA-29c and cancer].

miRNAs are a class of endogenous non coding, single stranded small RNAs, which regulate the expression of tumor suppressor genes and oncogenes and involve in almost all of the tumor-related processes. miRNA-29c, acting as a tumor suppressor of miRNA, has low expression in many solid malignancies such as nasopharyngeal carcinoma, glioma, gastric cancer, hepatocellular carcinoma, bladder cancer, esophageal cancer, breast cancer, colon cancer and so on. It relates with cancerous proliferation, apoptosis, invasion and metastasis. miRNA-29c directly inhibits the transcription of the target gene encoding protein and down regulates the expression of the target gene. miRNA-29c inhibits tumor cells infinite proliferation and promotes apoptosis by regulating the signal pathways, oncogene, and cell cycle. miRNA-29c can inhibit the invasion and metastasis of tumor cells by regulating different target genes, signal pathways and mediating epithelial-mesenchymal transition. In tumor tissues, the lower expression of miRNA-29c, the higher clinical stage,and the poorer prognosis, so it can be used as an indicator of early diagnosis and prognosis. miRNA-29c is also closely related to head and neck cancer. Therefore, enhancement of the expression of miRNA-29c in tumor cells is expected to be a potential therapeutic strategy for cancer. Selective COX2 inhibitors and demethylated drugs can significantly increase the expression of miRNA-29c. miRNA-29c can be a new tumor biomarker and drug or gene therapeutic target.

Deficient transforming growth factor beta and interleukin-10 responses contribute to the septic death of burned patients.

In order to understand the roles of pro-inflammatory and anti-inflammatory cytokines in burn injury and sepsis post-burn, serial changes in serum levels of transforming growth factor beta-1 (TGF-beta-1) were determined and compared to those of IL-6 and IL-10 in 15 burned patients. Among these 15 patients, 8 recovered without sepsis. The other seven, who were septic, expired. Our results showed that an initial peak serum TGF-beta-1 response was detected within 1 day post-burn. Peak serum IL-6 and IL-10 responses were also detected within 4 days after the burn injury of these patients. Significant differences in peak serum IL-6, IL-10 and TGF-beta-1 levels were not found between patients with total body surface area (TBSA) of greater or less than 50% and between patients who survived or expired from burn injury. Afterwards, levels of circulating IL-6 and IL-10 remained low in the survivors. However, a second peak response in serum TGF-beta-1 levels was observed in all burned patients analyzed. The second peak serum TGF-beta-1 levels post-burn of the eight survivors and the seven non-survivors were from 28,542 to 76,554 pg/ml (a mean value of 51,256+/-14,264 pg/ml) and from 8616 to 40,851 pg/ml (a mean value of 24,079+/-10,399 pg/ml), respectively. A significant difference (P<0.01) in mean values of the second peak TGF-beta-1 responses between groups of survivors and non-survivors was detected. Levels of circulating IL-6 in the septic non-surviving patients showed a tendency to increase 1-2 weeks post-burn and reached high levels before the expiration of these patients. After an initial peak response, the serum IL-10 level remained low in one of the seven non-survivors, while it increased in the other six non-survivors. However, marked increases in circulating IL-10 levels were observed only just before the death of these non-survivors. In conclusion, an initial increase in serum levels of IL-6, IL-10 and TGF-beta-1 was detected post-burn. A marked increase in serum levels of IL-6 before death suggests its role in the pathophysiology of sepsis in burned patients. In addition, a low secondary TGF-beta-1 response and a lack and/or delay in the increase of circulating IL-10 in the non-survivors may all contribute to the pathophysiology of septic death in burned patients.

Watch out for the K-wire: painful experiences in two cases.

According to reviews in the literature, only a few case reports have mentioned the unusual migration of K-wires during orthopaedic surgery since 1991. This report emphasises the potential migration of the K-wire during plastic surgery in order to avoid the possible catastrophic complications.

Necrotizing fasciitis of the head and neck: an analysis of 47 cases.

Necrotizing fasciitis is an overwhelming infection common to the perineum, abdominal wall, and extremities. It is a surgical emergency related to a high mortality rate that is more often seen in elderly and immunocompromised patients. Necrotizing fasciitis occurs uncommonly in the head and neck region. Over a 12-year period, 47 cases of necrotizing fasciitis of the head and neck region were collected at this hospital. The demographics, predisposing factors, clinical presentation and courses, management, complications, and outcomes were analyzed. The cases were divided into two groups: survivors and nonsurvivors. Statistical comparisons were made of the parameters age, gender, smoking or drinking habit, underlying medical problems, laboratory data, and treatments used. Forty-two patients (89.4 percent) had associated systemic disease; most of these patients had diabetes (72.3 percent). The clinical manifestations are nonspecific but are often typical for diagnosis. The necessity of computed tomographic scans is not conclusive in this study. Presentation of septic shock (p = 0.004) and association with underlying malignancy (p = 0.03) were the only statistically significant factors that led to a poor prognosis. The cornerstones of proper management include early diagnosis, aggressive surgical debridement, broad-spectrum antibiotics, and intensive supportive care.

Phalloplasty in female-to-male transsexuals using free radial osteocutaneous flap: a series of 22 cases.

From July 1994 to December 1996, 22 cases of primary female transsexualism received phalloplasty using free radial forearm osteocutaneous flaps in The Veterans General Hospital, Taipei, Taiwan. Follow-up period ranged from 6 months to 35 months. No complete flap loss and one partial loss (10% reduction) were noted after operation. The urethrocutaneous fistula rate was 40.9%, needing fistula repair surgery. Urethral stricture was noted in three cases (13.7%). Significant donor forearm morbidity was noted in two cases (9.1%) including one who suffered from radius bone fracture. All preserved 'clitorises' had intact erotic sensation and all neophalli gained protective sensation within 9 months. No 'penile fracture' was noted. In nine cases that have regular sexual activities, the sexual performance was rated as satisfactory. We share our experience and recommend that the free radial forearm osteocutaneous tubing flap is a promising choice for phalloplasty in female-to-male transsexuals.

Changes in circulating levels of interleukin 6 in burned patients.

Interleukin 6 (IL-6) levels in serial serum samples of 10 burned patients were analyzed. The total body surface areas (TBSA) of the burn injury varied from 30 to 85%. Among these 10 patients, five recovered and the other five, who were septic, expired. A significant difference in serum IL-6 values on admission (5-13 h postburn) was found (p < 0.05) between patients who survived or died from burn injury as analyzed by the Wilcoxon's rank sum test. In addition, a significant difference in serum IL-6 on admission was also found (p < 0.05) between patients with TBSA of greater or less than 50%. Afterwards, an initial peak serum IL-6 response was detected within 4 days postburn. Significant differences in the peak serum IL-6 levels were not found between patients with TBSA of greater or less than 50% and patients who survived or expired from burn injury. In the survivors, serum IL-6 remained low, while IL-6 increased markedly starting at about one to two weeks postburn in four of the five nonsurvivors with proven sepsis. Except for the patient who expired 42 days postburn, the maximum serum IL-6 values of the other four nonsurvivors were all greater than those of the five survivors from burn injury. Significant correlation (p < 0.05) relating the change in serum IL-6 and body temperature was observed in only two (one survivor and one nonsurvivor) of the ten patients. Changes in serum IL-6 were also compared with changes in circulating TNF-alpha and IL-8 determined previously. A similar pattern in the dynamic changes of circulating TNF-alpha, IL-8 and IL-6 was observed in the individual burned patient. An increase in serum levels of all three cytokines was detected postburn. Serum levels of three cytokines were significantly higher in the septic patients, who all died. It was considered that all three cytokines analyzed may play a significant role in the pathophysiology of sepsis in burned patients.

Epicanthoplasty with modified Y-V advancement procedure.

The presence of epicanthal folds and lack of supratarsal folds are unique features in most Asian eyelids. Although many surgical procedures are available to eliminate epicanthal folds, scarring on the medial canthus is still an obstacle for surgeons to overcome. From January of 1989 to November of 1997, we used modified Y-V advancement procedures in 148 cases to correct epicanthal folds in Asian eyelids. Five of those cases involved congenital palpebral anomalies, including congenital entropion, congenital ptosis, and Down syndrome. There were few complications in our series. We believe that the modified Y-V advancement procedure causes minimum scarring on medial canthus in correcting Oriental epicanthal folds and congenital palpebral anomalies. This procedure can also be simultaneously combined with blepharoplasties and corrective procedures of eyelids.

Glans sculpting in phalloplasty--experiences in female-to-male transsexuals.

An aesthetically appealing neophallus with an urethral meatus at its tip is one of the goals of phalloplasty in female-to-male transsexuals. From July 1993 to December 1996, 20 cases of female-to-male transsexuals who had received sculpting of glans in four different ways were enrolled. Their photographs were collected and were scored by independent surgical and non-surgical assessors. The Norfolk procedure creates a more normal neoglans assessed by patients themselves and by the assessors. Split-thickness skin graft (SSG) produces a more normal-looking coronal sulcus than full-thickness skin graft (FTSG) in the Norfolk procedure.

Changes in serum tumour necrosis factor-alpha in burned patients.

Dynamic tumour necrosis factor-alpha (TNF-alpha) changes in serial serum samples of 10 burned patients were analysed in this study. The total body surface areas (TBSA) of the burn injury were from 30 to 85 per cent. Among these 10 patients, five recovered and another five died with proved sepsis. On admission which was about 5-13 h postburn, eight of the 10 patients showed their serum TNF-alpha levels to be higher than the mean serum TNF-alpha value of five healthy laboratory personnel. Furthermore, an initial peak serum TNF-alpha response which could be detected within 2.5 days after burn injury has also been observed. However, significant differences in both the serum TNF-alpha values on admission, as well as the first peak serum TNF-alpha levels, were not found (P > 0.05) between patients with TBSA of greater or less than 50 per cent and patients who survived or died from burn injury. In the survivors, serum TNF-alpha stayed at low levels, while it increased markedly in four of the five non-survivors with proven sepsis starting at about 1 week postburn. A significant difference in the maximum serum TNF-alpha levels (P < 0.05) was detected between patients who recovered and died from the thermal injury. In conclusion, great increases in serum TNF-alpha levels have been detected in burned patients with the occurrence of bacterial infection postburn. It is suggested that strategies for the inhibition of TNF-alpha production or in the neutralization of TNF-alpha activity should also be considered in the better treatment of burned patients.

Changes in levels of serum IL-8 in burned patients.

Interleukin (i.l.)-8 levels in serial serum samples of 10 burned patients were analysed. The total body surface areas (TBSAs) of the burn injury ranged 30 to 85 per cent. Of these ten patients, five recovered and the other five, who were septic, died. On admission at about 5-13 h postburn, one of the five survivors and two of the non-survivors had serum IL-8 levels higher than 18.1 pg/ml, which is the detection limit of the IL-8 assay kit. The serum IL-8 values of six healthy laboratory personnel included in the present study were all less than 18.1 pg/ml. Afterwards, an initial peak serum IL-8 response was detected within 2-4.5 days postburn. Significant differences in the peak serum IL-8 levels were not found between patients with TBSAs of greater or less than 50 per cent and patients who survived or expired from burn injury. In the survivors, serum IL-8 remained low, whereas IL-8 increased markedly, starting at about one week postburn in four of the five non-survivors with confirmed sepsis. Significant differences in the maximum serum IL-8 levels were detected between patients who recovered vs. those who died from the thermal injury. In conclusion, the results showed that there was an increase in serum IL-8 postburn. Serum IL-8 was significantly higher in the septic patients, who all died. This cytokine may play a significant role in the pathophysiology of sepsis in burned patients.

Measurement of radiation-induced DNA double-strand breaks in human diploid fibroblasts from keloid and normal skin by single-cell gel electrophoresis.

Cell culture experiments recently have shown that different populations of fibroblasts may exist in keloid patients. Moreover, several studies have strongly suggested heterogeneity in cell response of skin fibroblasts in the same individual. The purpose of this study was to evaluate the radiation sensitivity of skin fibroblasts from keloid and normal skin. Single-cell gel electrophoresis was employed in detecting amounts of DNA double-strand breaks generated in individual fibroblasts primarily cultured from normal skin and from keloid tissue after various doses of gamma-irradiation (0, 25, 50, and 100 Gy aerobically) from a 137Cs radiation generator. For the repair study, cells were incubated at 37 degrees C for 0 and 15 minutes and 1 and 2 hours after irradiation. Following neutral lysis and electrophoresis, DNA double-strand breaks were then detected by propidium iodide staining and determined by fluorescence microscope and quantitative image analysis. No significant difference in the extent of DNA double strand breaks in fibroblasts from normal skin or keloid after various doses of irradiation was observed. However, the residual DNA double-strand breaks remaining after various periods of incubation were demonstrated to be significantly increased in fibroblasts from keloid (p < 0.01). In conclusion, different repair capacities were found in fibroblasts from normal skin and keloid scar; this finding may play a role in the treatment of the disease entity.

Multiple symmetrical lipomatosis (Madelung's disease): a case report.

Multiple symmetrical lipomatosis (Madelung's disease) is a rare disease of undetermined cause characterized by symmetrical deposits of non-encapsulated fat on the suboccipital area, cervical area, shoulders and trunk. The patients are usually middle-aged male alcoholics. The treatment is palliative surgical removal of excess fat from the neck and paracervical regions or any other lesion sites. Oriental report about multiple symmetrical lipomatosis (MSL) is very rare. Here a case of multiple symmetrical lipomatosis in a 43 year-old man is described. We describe his clinical course and review the literature.

Swelling and Ca2+-activated anion conductances in C127 epithelial cells expressing WT and delta F508-CFTR.

CFTR is a chloride channel that is required for fluid secretion and salt absorption in many exocrine epithelia. Mutations in CFTR cause cystic fibrosis. CFTR expression influences some ion channels, but the range of channels influenced, the mechanism of the interaction and the significance for cystic fibrosis are not known. Possible interactions between CFTR and other ion channels were studied in C127 mouse mammary epithelial cell lines stably transfected with CFTR, delta F508-CFTR, or vector. Cell lines were compared quantitatively using an 125I efflux assay and qualitatively using whole-cell patch-clamp recording. As expected, 125I efflux was significantly increased by forskolin only in the CFTR line, and forskolin-stimulated whole-cell currents were time- and voltage independent. All three lines responded to hypotonic challenge with large 125I efflux responses of equivalent magnitude, and whole-cell currents were outwardly rectified and inactivated at positive voltages. Unexpectedly, basal 125I efflux was significantly smaller in the delta F508-CFTR cell line than in either the CFTR or control cell lines (P < 0.0001), and the magnitude of the efflux response to ionomycin was largest in the vector cell line and smallest in the cell line expressing delta F508-CFTR (P < 0.01). Whole-cell responses to ionomycin had a linear instantaneous I-V relation and activated at depolarizing voltages. Forskolin responses showed simple summation with responses to ionomycin or hypotonic challenge. Thus, we found no evidence for interactions between CFTR and the channels responsible for swelling-mediated responses. Differences were found in basal and ionomycin-stimulated efflux, but these may arise from variations in the clonally selected cell lines that are unrelated to CFTR expression.

Heterogeneity in radiosensitivity of human diploid fibroblasts from keloids and normal skins.

Colony-forming ability was employed in evaluating the susceptibility to in vitro gamma ionizing radiation in human diploid skin fibroblasts (HDF). Twelve pairs of HDF, each composed of fibroblasts from excised keloid lesion and local normal skin tissue as its control, were studied in patients with clinically persistent keloids. Parameters of radiosensitivity, both D0 and D10, and growth kinetics were examined. The radiosensitivity in three of the 12 keloids (25%) were demonstrated significantly increased than their counterpart controls, even though no difference in growth kinetics in between. Moreover, a broad range in the radiosensitivity of fibroblast cells was demonstrated and it is suggested that there is a great heterogeneity of cellular response to radiation in HDF.

Coverage of chest wall defect with pectoralis-breast myocutaneous flap: a report of two cases.

Reconstruction of a chest wall defect remains a challenging problem, especially where such defects are radiation related. Two cases of modified breast flaps associated with pectoralis major muscle were performed to cover a huge mediastinal defect, with heart lung exposure and a post-mastectomy radiation-related chest wall defect with partial rib resection. Both modified breast flaps healed uneventfully. No respiratory distress was encountered post-operatively. The breast flap associated with pectoralis major muscle ensured flap reliability and minimized flap complication. It is easy to raise and its size is large enough to cover of large chest wall defect which is radiation related, or those internal mammary arteries and thoracodorsal arteries compromised in previous surgery where the transverse rectus abdominis myocutaneous (TRAM) flap and latissimus dorsi flap become unreliable. In such cases a contralateral modified breast flap associated with pectoralis major muscle is the better choice.

Enhanced amino acid uptake in both skeletal muscle and liver by burn plasma in rats.

The study was designed to test amino acid uptake in skeletal muscle after burn injury (up to 72 h). Also examined were the effects of plasma from burned rats over varying periods postburn (1-72 h), when plasma was added in vitro to incubated muscles and liver slices. Major burn injury (40 per cent total body surface area (TBSA)) was produced in male Sprague-Dawley rats weighing 60-80 g. Both soleus muscles were dissected intact at 1, 3, 6, 12, 24, 48 and 72 h postburn. Amino acid transport was measured by determining intracellular uptake of [3H] alpha-aminoisobutyric acid (AIB) during a 2 h incubation. In the second series of experiments, whole plasma from burned rats was added in vitro to incubated muscles and liver slices from healthy animals, and amino acid uptake was determined. AIB uptake in burned rat muscle was reduced by 24 per cent by 24 h postburn and 16 per cent by 48 h postburn. There was an increased effect from burn plasma on normal incubated muscles and liver slices, 72 per cent on muscles and 30 per cent on livers. Present results suggest an intrinsic decrease in amino acid uptake by muscle from burned rats. A factor or factors existed in plasma which increased both muscle and liver amino acid uptake postburn.

Endoscopic mandibular angle surgery: a swine model.

The improvement of endoscopic technology has revolutionized surgery, and endoscopy has become a trend in recent years. In plastic surgery, endoscopic release of the carpal tunnel and endoscopic face-lifting have been used clinically. However, no report has been noted that deals with the bone of the face. Using pigs as the animal model, endoscopic resection of the mandibular angles was undertaken. The result was satisfactory; it appears that it can also be effective in humans.

Surgical treatment of axillary osmidrosis: an analysis of 343 cases.

From July of 1986 to July of 1992, 343 patients have received surgery for axillary osmidrosis by partially removing skin and cellular tissue en bloc and removing the subcutaneous cellular tissue of the adjacent area. A total of 102 patients were followed for 4 months to 6 years, with an average of 32 months. The total satisfaction rate was 91 percent (93 of 102). The wound complication rate was 6.715 percent (46 of 685). There were no scar contractures or limitations of arm abduction. In this paper we emphasize three merits of our procedure. One is that partially removing the skin promises definite excision of more than half the eccrine glands which were located in the dermis of the operative field. The second merit is good exploration for undermining and defatting of the under-surface of the adjacent area. The third merit is a low wound complication rate because the width of the skin excision is less than 3 cm. Therefore, partial removal of skin and cellular tissue en bloc and the subcutaneous cellular tissue of the adjacent area is the choice for surgical treatment for axillary osmidrosis.

Dissociation of depolarization-activated and swelling-activated Cl- channels.

In many cells, patch excision and depolarization induce outwardly rectifying Cl- channels (ORDIC channels) whose function and normal mode of regulation are unknown. One possible function is the mediation of swelling-activated Cl- conductance, because in many cells rectifying Cl- currents are activated by cell swelling. However, swelling-activated Cl- channels in some epithelia have larger conductances than ORDIC channels and inactivate more rapidly, although both have similar anion selectivity and are blocked by stilbenes. Thus it has not been possible to determine whether the two types of channel current arise from distinct proteins or alternate states of a single protein. We studied 14 cell lines and found 2 lines, C127 mouse mammary epithelial cells and IEC-6 rat intestinal crypt cells, with very low levels of ORDIC channels. However, despite the near absence of ORDIC channels in these rodent cells, a large swelling-activated Cl-conductance was demonstrated by whole cell, efflux, and single-channel methods. Thus it is likely that ORDIC and swelling-activated channel currents arise from different channel proteins.