Saphenous Artery Perforator/Propeller Flap in the Reconstruction of Perigenual Soft Tissue Defects.

Introduction In this article, we investigate the saphenous artery perforator propeller flap for the reconstruction of perigenual defects. We describe the anatomy of the saphenous artery and the method of raising a perforator propeller flap based on our study and early clinical experience. Aim To assess the effectiveness of the saphenous artery perforator propeller flap in the reconstruction of perigenual defects. Materials and Methods A preliminary cadaver dissection and injection study was conducted to discern the anatomical details of the perforator system of the saphenous vessel in 35 cadaveric specimens in 18 fresh cadavers. From March 2016 to March 2018, 16 clinical cases (5 females and 11 males, in the average age group of 33.5 years) with perigenual defects were reconstructed with saphenous artery perforator propeller flap. They were followed up for an average period of 12.5 months. Results Cadaver study established anterior sartorial perforators as the dominant system of the saphenous vessel and brought to the forefront the type 2 blood supply of the saphenous nerve. All patients had well-settled flaps at the end of the follow-up period, with good return of knee function. Conclusion Saphenous artery perforator propeller flap is a viable option for the reconstruction of defects around the knee joint. Level of Evidence Type V, therapeutic study.

Evaluation of quantitative miRNA expression platforms in the microRNA quality control (miRQC) study.

MicroRNAs are important negative regulators of protein-coding gene expression and have been studied intensively over the past years. Several measurement platforms have been developed to determine relative miRNA abundance in biological samples using different technologies such as small RNA sequencing, reverse transcription-quantitative PCR (RT-qPCR) and (microarray) hybridization. In this study, we systematically compared 12 commercially available platforms for analysis of microRNA expression. We measured an identical set of 20 standardized positive and negative control samples, including human universal reference RNA, human brain RNA and titrations thereof, human serum samples and synthetic spikes from microRNA family members with varying homology. We developed robust quality metrics to objectively assess platform performance in terms of reproducibility, sensitivity, accuracy, specificity and concordance of differential expression. The results indicate that each method has its strengths and weaknesses, which help to guide informed selection of a quantitative microRNA gene expression platform for particular study goals.

Retrospective review of work-related injuries sustained by foreign workers: a single centre experience over 10 years.

OBJECTIVES: To investigate current patterns of work-related injuries sustained by foreign workers in Singapore and compare them to a decade ago. Secondary aim to analyse usefulness of selected trauma scores in this context. DESIGN: Retrospective review of trauma registry of a single centre, from 1 April to 30 June 2015. Data compared with those from similar study performed at same centre in 2004. SETTING: Emergency department (ED) of 1500-bedded acute urban public hospital in Singapore. PARTICIPANTS: 1094 foreign workers with work-related injuries were included. Tourists, foreign students, non-work-related injuries, re-attendances for the same condition were excluded. RESULTS: Mean age of participants was 32.8 years (SD 7.8), 90.0% were men. ED attendance was lowest on Sundays. Mechanism of injury: blunt (78.2%), penetrating (19.2%), burns (2.6%). Compared to 2004, 5% of foreign workers required admission (vs 19.6% in 2004, p≤0.0001), 8.0% underwent day or inpatient surgical procedures (vs 13.2% in 2004, p≤0.0001), 41.6% were referred to specialist outpatient clinics (vs 27.6% in 2004, p≤0.0001), 12.5% were referred to primary care follow-up (vs 29.9% in 2004, p≤0.0001). Mean duration of sick days was 4.3 (vs 5.1 in 2004, p≤0.0001). Of admitted patients, 49.1% had extremity injuries and 36.3% had head and neck injuries. Mean Injury Severity Score (ISS) for admitted patients was 3.64 (SD 3.1) (vs 4.3 (SD 5.5) in 2004, p=0.39). Mean Revised Trauma Score (RTS) for admitted patients was 7.74 (SD 0.39) (vs 7.8 (SD 0.2) in 2004, p=0.07). Of discharged patients, 48.9% had extremity injuries and 48.9% had external injuries. There was no death. CONCLUSION: Compared to 2004, there were fewer major/fatal work-related injuries and an increased proportion of minor injuries. ISS and RTSs were of limited use in this setting.

Defining an EPOR- regulated transcriptome for primary progenitors, including Tnfr-sf13c as a novel mediator of EPO- dependent erythroblast formation.

Certain concepts concerning EPO/EPOR action modes have been challenged by in vivo studies: Bcl-x levels are elevated in maturing erythroblasts, but not in their progenitors; truncated EPOR alleles that lack a major p85/PI3K recruitment site nonetheless promote polycythemia; and Erk1 disruption unexpectedly bolsters erythropoiesis. To discover novel EPO/EPOR action routes, global transcriptome analyses presently are applied to interrogate EPO/EPOR effects on primary bone marrow-derived CFUe-like progenitors. Overall, 160 EPO/EPOR target transcripts were significantly modulated 2-to 21.8-fold. A unique set of EPO-regulated survival factors included Lyl1, Gas5, Pim3, Pim1, Bim, Trib3 and Serpina 3g. EPO/EPOR-modulated cell cycle mediators included Cdc25a, Btg3, Cyclin-d2, p27-kip1, Cyclin-g2 and CyclinB1-IP-1. EPO regulation of signal transduction factors was also interestingly complex. For example, not only Socs3 plus Socs2 but also Spred2, Spred1 and Eaf1 were EPO-induced as negative-feedback components. Socs2, plus five additional targets, further proved to comprise new EPOR/Jak2/Stat5 response genes (which are important for erythropoiesis during anemia). Among receptors, an atypical TNF-receptor Tnfr-sf13c was up-modulated >5-fold by EPO. Functionally, Tnfr-sf13c ligation proved to both promote proerythroblast survival, and substantially enhance erythroblast formation. The EPOR therefore engages a sophisticated set of transcriptome response circuits, with Tnfr-sf13c deployed as one novel positive regulator of proerythroblast formation.