A rare case of male Fournier's gangrene with mixed Actinomyces turicensis infection.

BACKGROUND: Fournier's gangrene (FG), a urological emergency with high mortality, is an infectious necrotizing fasciitis of the perineal and genital regions. The majority of FG is caused by polymicrobial organisms involving mixed aerobes and anaerobes but rarely reveals Actinomyces species. CASE PRESENTATION: We report a healthy 67-year-old Asian male who presented with rapidly progressive painful swelling of the scrotum. Clinically diagnosed with FG, the patient underwent an emergency radical debridement, followed by broad-spectrum antibiotics and negative pressure wound therapy. The identification of the causative microorganisms showed Actinomyces turicensis and the antibiotic treatment was adjusted accordingly. After wound bed preparation, we took split-thickness skin grafts to cover the scrotal wound. Active management to minimize faecal contamination was applied throughout the whole course of treatment and repair. The patient was satisfied with the outcome. This was an extremely rare case of A. turicensis as the main causative pathogen of FG. CONCLUSIONS: FG due to Actinomyces species is rarely reported, but we should still consider this pathogenic microorganism that has long been neglected.

A nomogram prediction model for sternal incision problems.

Presently, the incidence and mortality rates of sternal incision problems (SIPs) after thoracotomy remain high, and no effective preventive measures are available. The data on 23 182 patients at Xinqiao Hospital, Army Medical University treated with median sternotomy from 1 August 2009 to 31 July 2019 were retrospectively reviewed. A prediction model of SIPs after median thoracotomy was established using R software and then validated using the bootstrap method. Next, the validity and accuracy of the model were tested and evaluated. In total, 15 426 cases met the requirements of the present study, among which 309 cases were diagnosed with SIPs, with an incidence rate of 2%. The body mass index (BMI), intensive care unit (ICU) time, diabetes mellitus, and revision for bleeding were identified as independent risk factors for postoperative SIPs. The nomogram model achieved good discrimination (73.9%) and accuracy (70.2%) in predicting the risk of SIPs after median thoracotomy. Receiver operating characteristic curve analysis showed that the area under curve of the model was 0.705 (95% confidence interval [CI]: 0.746-0.803); the Hosmer-Lemeshow test showed that χ2  = 6.987 and P = 0.538, and the fitting degree of the calibration curve was good. Additionally, the clinical decision curve showed that the net benefit of the model was greater than 0, and the clinical application value was high. The nomogram based on BMI, ICU time, diabetes mellitus, and revision for bleeding can predict the individualised risk of SIPs after median sternotomy, showing good discrimination and accuracy, and has high clinical application value. It also provides significant guidance for screening high-risk populations and developing intervention strategies.

Resection and reconstruction of a giant primitive neuroectodermal tumour of the abdominal wall with an ultra-long lateral circumflex femoral artery musculocutaneous flap: a case report.

BACKGROUND: Primitive neuroectodermal tumours are clinically rare. Here, we report a case of a large peripheral primitive neuroectodermal tumour of the abdominal wall. The defect was reconstructed with the longest lateral circumflex femoral artery musculocutaneous flap reported to date. CASE PRESENTATION: A 15-year-old male suffered rupture and bleeding of an abdominal wall mass with a volume of approximately 23*18*10 cm3, involving the whole layer of the abdominal wall. Pathological examination revealed a peripheral primitive neuroectodermal tumour. The tumour was removed via oncologic resection, and the abdominal wall was reconstructed with a bilateral 44*8 cm2 lateral circumflex femoral artery musculocutaneous flap combined with a titanium polypropylene patch. The patient had smooth recovery postoperative, and the functions of the donor and recipient areas of the flap were not significantly affected. CONCLUSION: In this case report, we describe a rare primitive neuroectodermal tumour of the abdominal wall, which invaded almost the entire abdominal wall due to delay of treatment. After thoroughly removing the tumour, we immediately reconstructed the abdominal wall with an ultra-long lateral circumflex femoral artery musculocutaneous flap and achieved better appearance and function after the operation. This case suggests that we should adopt an integrated scheme of surgery combined with radiotherapy and chemotherapy in the treatment of peripheral primitive neuroectodermal tumours. Under the premise of determining the blood supply, the lateral circumflex femoral artery musculocutaneous flap can be cut to a sufficient length.

Our experience with retroperitoneal laparoendoscopic single-site ureterolithotomy.

AIM: To report our experience with retroperitoneal laparoendoscopic single-site (LESS) ureterolithotomy for the management of large proximal ureteral stones. PATIENTS AND METHODS: From July 2011 to April 2012, 20 patients underwent retroperitoneal LESS ureterolithotomy. The indications for the operation were impacted upper ureteral stones larger than 15 mm. A reusable elastic single-port device with 3 working channels was inserted through the 2.5-cm incision at the midpoint between the costal arch and iliac crest on the mid-axillary line. A rigid 10-mm 30° extra-long laparoscope was introduced for monitoring, and a combination of lengthened pre-bent and conventional laparoscopic instruments was used for handling. The surgical procedure was similar to conventional retroperitoneal laparoscopic ureterolithotomy. RESULTS: Retroperitoneal LESS ureterolithotomy was completed in all of the patients. The mean stone size was 18.8 mm (range 16-28). The mean operative time was 108 min (range 75-140). Significant bleeding was not observed, and no major intraoperative complications occurred in any of the patients. The mean hospital stay was 4.4 days (range 3-7). CONCLUSIONS: Retroperitoneal LESS ureterolithotomy, using a reusable elastic single-port device, is technically feasible and safe, and the combination of conventional and pre-bent laparoscopic instruments represents an attractive option for retroperitoneal LESS.

A high-performance long-wave infrared photodetector based on a WSe2/PdSe2 broken-gap heterodiode.

Layered narrow bandgap quasi-two-dimensional (2D) transition metal dichalcogenides (TMDs) demonstrated excellent performance in long-wave infrared (LWIR) detection. However, the low light on/off ratio and specific detectivity (D*) due to the high dark current of the device fabricated using a single narrow bandgap material hindered its wide application. Herein, we report a type-III broken-gap band-alignment WSe2/PdSe2 van der Waals (vdW) heterostructure. The heterodiode device has a prominently low dark current and exhibits a high photoresponsivity (R) of 55.3 A W-1 and a high light on/off ratio >105 in the visible range. Notably, the WSe2/PdSe2 heterodiode shows an excellent uncooled LWIR response, with an R of ∼0.3 A W-1, a low noise equivalence power (NEP) of 4.5 × 10-11 W Hz-1/2, and a high D* of 1.8 × 108 cm Hz1/2 W-1. This work provides a new approach for designing high-performance room-temperature operational LWIR photodetectors.

[Application of deep inferior epigastric perforator flap for repair of extreme defects around knee].

Objective: To investigate the effectiveness of the deep inferior epigastric perforator (DIEP) flap for extreme defects around the knee. Methods: Between June 2017 and December 2018, 15 patients with the extreme defects around the knee were admitted. There were 9 males and 6 females with a median age of 36 years (range, 23-51 years). The etiology was the traffic accident in 7 cases, tumor in 5 cases, and burn in 3 cases. The injured location was left knee in 8 cases and right knee in 7 cases. The size of soft tissue defects ranged from 15 cm×10 cm to 30 cm×20 cm, and all defects complicated with exposure of blood vessels, nerves, tendons, and other tissues. Transverse DIEP flaps with 1-2 vascular pedicles were prepared according to the size of the defect, including 6 cases of single-pedicle flaps and 9 cases of double-pedicle conjoined flaps. According to the depth of the defect, 10 cases of skin flaps were thinned under microscope. The size of the DIEP flaps ranged from 16 cm×10 cm to 32 cm×20 cm; the average thickness was 1.5 cm (range, 0.8-1.8 cm); the average pedicle length was 7.5 cm (range, 5.0-9.0 cm). The donor site was directly sutured. Results: One single-pedicle flap developed distal necrosis after operation, and healed after skin grafting; the other skin flaps survived, and the wounds at the donor and recipient sites healed by first intention. All patients were followed up 16-28 months (mean, 24 months). The shape and texture of the flap were satisfactory, and there was no abnormal hair growth or obvious pigmentation. There was only linear scar at the donor site and no complication such as abdominal hernia. The appearance and function of the knee were satisfactory. No recurred tumor was observed, and the scar contracture was released. At last follow-up, 13 cases were excellent and 2 cases were good, according to the Knee Society Score (KSS) criteria. Conclusion: The DIEP flap is an ideal alternative for repairing the extreme defects around knee, with a concealed donor site, easy dissection, flexible design, as well as less complication.

Fully Depleted Self-Aligned Heterosandwiched Van Der Waals Photodetectors.

Room-temperature-operating highly sensitive mid-wavelength infrared (MWIR) photodetectors are utilized in a large number of important applications, including night vision, communications, and optical radar. Many previous studies have demonstrated uncooled MWIR photodetectors using 2D narrow-bandgap semiconductors. To date, most of these works have utilized atomically thin flakes, simple van der Waals (vdW) heterostructures, or atomically thin p-n junctions as absorbers, which have difficulty in meeting the requirements for state-of-the-art MWIR photodetectors with a blackbody response. Here, a fully depleted self-aligned MoS2 -BP-MoS2 vdW heterostructure sandwiched between two electrodes is reported. This new type of photodetector exhibits competitive performance, including a high blackbody peak photoresponsivity up to 0.77 A W-1 and low noise-equivalent power of 2.0 × 10-14  W Hz-1/2 , in the MWIR region. A peak specific detectivity of 8.61 × 1010  cm Hz1/2  W-1 under blackbody radiation is achieved at room temperature in the MWIR region. Importantly, the effective detection range of the device is twice that of state-of-the-art MWIR photodetectors. Furthermore, the device presents an ultrafast response of ≈4 µs both in the visible and short-wavelength infrared bands. These results provide an ideal platform for realizing broadband and highly sensitive room-temperature MWIR photodetectors.

Oriented Proton-Conductive Nanochannels Boosting a Highly Conductive Proton-Exchange Membrane for a Vanadium Redox Flow Battery.

In this work, we propose a sulfonated poly (ether ether ketone) (SPEEK) composite proton-conductive membrane based on a 3-(1-hydro-imidazolium-3-yl)-propane-1-sulfonate (Him-pS) additive to break through the trade-off between conductivity and selectivity of a vanadium redox flow battery (VRFB). Specifically, Him-pS enables an oriented distribution of the SPEEK matrix to construct highly conductive proton nanochannels throughout the membrane arising from the noncovalent interaction. Moreover, the "acid-base pair" effect from an imidazolium group and a sulfonic group further facilitates the proton transport through the nanochannels. Meanwhile, the structure of the acid-base pair is further confirmed based on density functional theory calculations. Material and electrochemical characterizations indicate that the nanochannels with a size of 16.5 nm are vertically distributed across the membrane, which not only accelerate proton conductivity (31.54 mS cm-1) but also enhance the vanadium-ion selectivity (39.9 × 103 S min cm-3). Benefiting from such oriented proton-conductive nanochannels in the membrane, the cell delivers an excellent Coulombic efficiency (CE, ≈ 98.8%) and energy efficiency (EE, ≈ 78.5%) at 300 mA cm-2. More significantly, the cell maintains a stable energy efficiency over 600 charge-discharge cycles with only a 5.18% decay. Accordingly, this work provides a promising fabrication strategy for a high-performance membrane of VRFB.

[Synergic effect of marine obligate hydrocarbonoclastic bacteria in oil biodegradation].

OBJECTIVE: In order to study the synergic effect of two marine obligate hydrocarbonoclastic bacteria in the oil biodegradation process. METHODS: We combined the PAHs degrader Marinobacter sp. PY97S with the oil degrader Alcanivorax sp. 22CO-6 and Alcanivorax sp. JZ9B respectively to construct oil-degrading consortia. Multiple methods including weighting method, gas chromatography-flame ionization detection, gas chromatography-mass spectrometry and thin layer chromatography-flame ionization detection were used to analyze and compare the oil degradation rates as well as the chromatographic figures of degraded oil between the pure cultures of obligate hydrocarbonoclastic bacteria and defined consortia. RESULTS: The two consortia, 22CO-6 + PY97S and JZ9B + PY97S, exhibited synergic effects in the oil biodegradation process. The degradation rates of oil by the consortia were increased from 27.81% and 83.52% to 64.03% and 86.89% compared to the pure culture of oil degrader 22CO-6 and JZ9B, respectively. The consortia could degrade aliphatic and aromatic fraction at the same time, including high molecular weight PAHs chrysene and its alkyl derivatives. CONCLUSION: There are obvious synergic effect of Alcanivorax and Marinobacter strains in the oil biodegradation process, which accelerated the oil biodegradation and decomposed thoroughly the more ecotoxic high molecular weight compounds in crude oil.

Genetic Variability of Morphological, Flowering, and Biomass Quality Traits in Hemp (Cannabis sativa L.).

Hemp (Cannabis sativa L.) is a bast-fiber crop well-known for the great potential to produce sustainable fibers. Nevertheless, hemp fiber quality is a complex trait, and little is known about the phenotypic variability and heritability of fiber quality traits in hemp. The aim of this study is to gain insights into the variability in fiber quality within the hemp germplasm and to estimate the genetic components, environmental components, and genotype-by-environment (G×E) interactions on fiber quality traits in hemp. To investigate these parameters, a panel of 123 hemp accessions was phenotyped for 28 traits relevant to fiber quality at three locations in Europe, corresponding to climates of northern, central, and southern Europe. In general, hemp cultivated in northern latitudes showed a larger plant vigor while earlier flowering was characteristic of plants cultivated in southern latitudes. Extensive variability between accessions was observed for all traits. Most cell wall components (contents of monosaccharides derived from cellulose and hemicellulose; and lignin content), bast fiber content, and flowering traits revealed large genetic components with low G×E interactions and high broad-sense heritability values, making these traits suitable to maximize the genetic gains of fiber quality. In contrast, contents of pectin-related monosaccharides, most agronomic traits, and several fiber traits (fineness and decortication efficiency) showed low genetic components with large G×E interactions affecting the rankings across locations. These results suggest that pectin, agronomic traits, and fiber traits are unsuitable targets in breeding programs of hemp, as their large G×E interactions might lead to unexpected phenotypes in untested locations. Furthermore, all environmental effects on the 28 traits were statistically significant, suggesting a strong adaptive behavior of fiber quality in hemp to specific environments. The high variability in fiber quality observed in the hemp panel, the broad range in heritability, and adaptability among all traits prescribe positive prospects for the development of new hemp cultivars of excellent fiber quality.

Mechanical and biological evaluations of beta-tricalcium phosphate/silicone rubber composite as a novel soft-tissue implant.

BACKGROUND: Although silicone rubber (SR) implants are most commonly used and effective for soft-tissue augmentation, they still have been implicated in many adverse reactions. To overcome this problem, a novel composite beta-tricalcium phosphate/silicone rubber (beta-TCP/SR) was prepared by adding beta-TCP into a SR matrix. This study was to evaluate its application potential by investigating the mechanical properties and biocompatibility of beta-TCP/SR. METHODS: Mechanical properties, including Shore A hardness and tensile strength, were evaluated with 3-mm-thick samples and a universal testing machine. Cytocompatibility tests were conducted in vitro using 0.2-mm-thick beta-TCP/SR samples by seeding fibroblasts onto different samples. Soft-tissue response to beta-TCP/SR and pull-out measurements were investigated 4 weeks and 24 weeks after implantation. RESULTS: The main mechanical properties were all significantly changed after mixing beta-TCP into the SR matrix, except for tearing strength. The cytocompatibility test showed enhanced adhesion and proliferation of fibroblasts onto beta-TCP/SR. Fibrous tissue ingrowth after resorption of beta-TCP was observed by in vivo histologic analysis. The peri-implant capsules in the beta-TCP/SR group were thinner than in the SR group 24 weeks after implantation. In a 24-week test, the maximum force required to pull out the beta-TCP/SR sheet was about six times greater than that needed for SR. CONCLUSION: Although some mechanical properties were significantly changed, the results of the cytocompatibility test and in vivo animal study still suggest that beta-TCP/SR may be more suitable as a soft-tissue implant than SR and has the potential to be used in plastic surgery.

Effects of diffusion process on potential induced degradation of silicon solar cells.

BACKGROUND: Potential induced degradation (PID) has recently been identified as one of the most important degradation mechanisms for silicon solar cells. It is widely considered that PID is closely related with the manufacture and application period of solar modules. METHODS: In this study, the effects of diffusion sheet resistance on PID were verified and explained by testing the emitter doping profile, the minority carrier lifetime, the emitter saturation current, the electrical performance of different cells, and the PID process. RESULTS: With increasing sheet resistance of cells, the depth and saturation current density of the emitter both decreased, and the cell efficiency increased, whereas the PID phenomenon became serious. CONCLUSIONS: It was found that higher sheet resistance or thinner P-N junction could lead to higher PID sensitivity. Therefore, more attention should be paid to PID phenomenon as the photovoltaic industry develops in the direction of high sheet resistance.

The role of postmastectomy radiation therapy in patients with immediate prosthetic breast reconstruction: A meta-analysis.

OBJECTIVE: The controversy remains as to whether immediate prosthetic breast reconstruction with postmastectomy radiation therapy (PMRT) is associated with acceptable complications and aesthetic outcomes. The aim of this meta-analysis was to provide a pooled analysis of comparative clinical studies that evaluated breast cancer patients who were treated with a mastectomy and an immediate prosthetic breast reconstruction to compare the complications and satisfaction of those who underwent or did not undergo PMRT. METHODS: According to the recommendations of the Cochrane Collaboration, we established a rigorous study protocol. We performed a systematic electronic search of the PubMed and Embase databases to identify articles for inclusion in our meta-analysis. Reconstruction failure, overall complications, capsular contracture, and patient satisfaction were analyzed individually. RESULTS: Fifteen controlled trials were included, comprising 5314 patients (1069 PMRT vs 4245 non-PMRT). Primary outcomes revealed a statistically significant increase in overall complications [odds ratio (OR) 3.45; 95% confidence interval (95% CI) 2.62-4.54; P < .00001], reconstruction failure (OR: 2.59; 95% CI 1.46-4.62; P = .001), and capsular contracture (OR: 5.26, 95% CI: 2.73-10.13, P < .00001) after receiving PMRT. CONCLUSION: Our review found that PMRT for patients who underwent immediate implant-based breast reconstruction led to higher risks of reconstruction failure, overall complications, and capsular contracture. However, it is still the standard adjuvant therapy for mastectomy patients who have opted for immediate implant-based breast reconstruction.

The use of expanded polytetrafluoroethylene in depressed deformities of the face.

Expanded polytetrafluoroethylene (ePTFE) has been extensively used for facial soft tissue augmentation procedures, and is regarded as safe and reliable and suitable as a permanent implant. This implant is generally used in the lower third of the face for lips filling, nasal augmentation, nasolabial folds and chin augmentation, and rarely for congenital or acquired depressed deformities of the face. The aim of the present study was to assess the effects of ePTFE in congenital or acquired depressed deformities of the face. From September, 2008 to January, 2014, 26 patients were implanted with the material ePTFE to correct depressed deformities of the face. The average age at operation was 23.2 years, with a range of 17-45 years. The depressed deformities were lateralized. The follow-up period was 6-18 months (average 9 months). The etiologies of the depressed deformities included stable hemifacial atrophy (3 cases), craniofacial microsomia (13 cases), bony depression after trauma (8 cases), and other unclear reasons (2 cases). The operations were performed under local anesthesia. ePTFE was inserted in different tissue planes that varied among the different subanatomical areas in the face: beneath the superficial temporal fascia in the temporal area, and on the surface of the superficial musculoaponeurotic system in the zygomatic area, cheek and mandibular area. All of the patients were followed up. Most of the patients [25 of 26 patients (96.2%)] were satisfied with the results, while 1 patient (3.8%) was not satisfied for incomplete correction of the depressed deformity. In conclusion, aside from lipofilling and a free flap transfer, the results showed that ePTFE was an alternative treatment for facial depressed deformity.

Relationship between the single nucleotide polymorphisms of ß2-adrenergic receptor 5'-regulatory region and essential hypertension in Chinese Kazakh ethnic minority group.

OBJECTIVE: To study the correlation of ß2-AR gene 5'-regulatory region SNPs and essential hypertension (EH) in Chinese Kazakh ethnic minority group. METHODS: The Sequenom MassArray(®) SNP detection technology was used to detect ß2-AR gene 5'-regulatory region SNPs in 150 Xinjiang Kazakh EH patients and 150 controls. Biochemical analyzer was used to detect lipid and other related biochemical parameters. SHEsis and other software were used to analyze linkage disequilibrium and haplotype. RESULTS: Six loci rs205304 (-1023G/A), rs17108803 (-893T/G), rs12654778 (-654G/A), rs11168070 (-468C/G), rs11959427 (-367C/T) and rs2895795 (-1429T/A) polymorphisms of ß2-AR gene 5'-regulatory region were found in the Xinjiang Kazakh populations. While, there was no significant difference between EH group and NH in genotypes and allele frequency of rs2053044, rs12654778, rs2895795, rs17108803 and rs11959427 (P>0.05). However; significant differences were detected of rs11168070 genotypes and allele frequency in two groups (P<0.05). Analysis of the linkage disequilibrium and haplotype in Kazakh population, there is a strong linkage disequilibrium of rs11168070, rs2053044, rs2895795 gene polymorphism in the EH group, and rs11168070, rs12654778, rs17108803 gene polymorphism in controls. Frequency of haplotype GTCCAT, GACTGT and ATGCGT in EH group was higher (P<0.05), while frequency of ATCTGT, ATGTGT, GTCCGT, GTCTAT, GACCAT and GTCTGT in the EH group was significantly lower than the control (P<0.05). CONCLUSIONS: ß2-AR gene 5'-regulatory region of rs11168070, rs2053044, rs17108803, rs12654778, rs11959427 and rs2895795 genetic polymorphism exists in Kazakh. Among them, rs11168070 locus genotype and allele frequency distribution in the two groups are significant differences. In six polymorphic loci, there is a strong linkage disequilibrium, which haplotypes GTCCAT, GACTGT, ATGCGT are risk factors of EH, and the ATCTGT, ATGTGT, GTCCGT, GTCTAT, GACCAT, GTCTGT are protective factors.

Correlation between polymorphisms of the E-selectin gene, hepatitis B virus DNA copies, pre-S1 antigen and clinical outcomes during chronic hepatitis B.

The aim of this study was to investigate the relationships between E-selectin +G98T, +A561C polymorphisms and different progression in Hepatitis B virus (HBV) infection Xinjiang Han population, also to determine the HBV DNA copies and pre-S1 antigen (preS1Ag) in this population. Polymorphisms of the E-selectin gene in 200 chronic HBV infection (61 cases of chronic HBV carriers, chronic hepatitis B 75, liver cirrhosis 43, liver cancer 21) and 200 healthy controls were detected using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Real-time quantitative PCR was used to detect the levels of HBV DNA. preS1Ag and five items of hepatitis B were detected by enzyme-linked immunosorbent assay. Liver fibrosis using chemiluminescence, biochemical markers using Roche 7600 automatic biochemical analyzer. E-selectin +A561C polymorphism of A/C genotype and C allele frequency in chronic hepatitis B (CHB) and cirrhosis (LC) group were compared with the control group had significant difference (P < 0.05). The risk of CHB and LC, AC genotype were 2.09, 2.33 times of the AA genotype. In group of CHB, the levels of HBV DNA and preS1Ag in the AC genotype patients were higher than those in the AA genotype (P < 0.05). However, there were no significant differences in comparison of liver function and liver fibrosis index in different genotypes of CHB and LC group. +A561C and +G98T linkage disequilibrium analysis showed: D' = 0.632, r(2) = 0.202, haplotype analysis showed that the G-A haplotype OR = 0.507, G-C haplotype OR = 1.973. E-selectin +A561C polymorphism may have some correlation with the occurrence of CHB and LC, and allele C may be one of the predisposing factors. AC polymorphism may affect HBV replication in CHB, but may not play an important and direct effect on liver injury and liver fibrosis after HBV infection. There were some linkage of +A561C and +G98T, G-C haplotype may be a risk factor for chronic HBV infection.

Laparoendoscopic single-site retroperitoneoscopic nephrectomy for giant hydronephrosis.

PURPOSE: To report our experience and assess the feasibility and safety of laparoendoscopic single-site (LESS) retroperitoneoscopic nephrectomy for giant hydronephrosis. PATIENTS AND METHODS: Between July 2011 and April 2013, 22 patients underwent LESS retroperitoneoscopic nephrectomy for giant hydronephrosis with nonfunctioning kidneys. A reusable elastic single-port device was inserted through the 2.5-cm incision at the midpoint between the costal arch and iliac crest on the midaxillary line. A rigid, 10-mm, 30° extra-long laparoscope was introduced for monitoring, and a combination of lengthened prebent and conventional laparoscopic instruments was used for handling. The operation procedure was similar to the conventional retroperitoneal laparoscopic nephrectomy. RESULTS: LESS retroperitoneoscopic nephrectomy was completed in all patients without conversion to open surgery and the additional placement of ports. The mean operative time was 98 minutes (range 77-146), and estimated blood loss was 45 mL (range 20-120). No major intraoperative complications occurred. The postoperative period was uneventful in all patients and the mean hospital stay was 3.4 days (range 2-7). CONCLUSIONS: LESS retroperitoneoscopic nephrectomy for giant hydronephrosis is technically feasible and safe for selected patients. The combination of conventional and prebent laparoscopic instruments represents an attractive option for retroperitoneoscopic LESS.

Hydroxyapatite-coated sillicone rubber enhanced cell adhesion and it may be through the interaction of EF1ß and γ-actin.

Silicone rubber (SR) is a common soft tissue filler material used in plastic surgery. However, it presents a poor surface for cellular adhesion and suffers from poor biocompatibility. In contrast, hydroxyapatite (HA), a prominent component of animal bone and teeth, can promote improved cell compatibility, but HA is an unsuitable filler material because of the brittleness in mechanism. In this study, using a simple and economical method, two sizes of HA was applied to coat on SR to counteract the poor biocompatibility of SR. Surface and mechanical properties of SR and HA/SRs confirmed that coating with HA changes the surface topology and material properties. Analysis of cell proliferation and adhesion as well as measurement of the expression levels of adhesion related molecules indicated that HA-coated SR significantly increased cell compatibility. Furthermore, mass spectrometry proved that the biocompatibility improvement may be related to elongation factor 1-beta (EF1ß)/γ-actin adjusted cytoskeletal rearrangement.

Osteopontin (OPN) is an important protein to mediate improvements in the biocompatibility of C ion-implanted silicone rubber.

Medical device implants are drawing increasing amounts of interest from modern medical practitioners. However, this attention is not evenly spread across all such devices; most of these implantable devices can cause adverse reactions such as inflammation, fibrosis, thrombosis, and infection. In this work, the biocompatibility of silicone rubber (SR) was improved through carbon (C) ion implantation. Scanning electron microscopy (SEM), atomic force microscopy (AFM), X-ray photoelectron spectroscopy (XPS), and X-ray diffraction (XRD) results confirmed that these newly generated carbon-implanted silicone rubbers (C-SRs) had large, irregular peaks and deep valleys on their surfaces. The water contact angle of the SR surface decreased significantly after C ion implantation. C ion implantation also changed the surface charge distribution, silicone oxygen rate, and chemical-element distribution of SR to favor cell attachment. The dermal fibroblasts cultured on the surface C-SR grew faster and showed more typical fibroblastic shapes. The expression levels of major adhesion proteins, including talin-1, zyxin, and vinculin, were significantly higher in dermal fibroblasts cultured on C-SR coated plates than in dermal fibroblasts cultured on SR. Those same dermal fibroblasts on C-SRs showed more pronounced adhesion and migration abilities. Osteopontin (OPN), a critical extracellular matrix (ECM) protein, was up-regulated and secreted from dermal fibroblasts cultured on C-SR. Matrix metalloproteinase-9 (MMP-9) activity was also increased. These cells were highly mobile and were able to adhere to surfaces, but these abilities were inhibited by the monoclonal antibody against OPN, or by shRNA-mediated MMP-9 knockdown. Together, these results suggest that C ion implantation significantly improves SR biocompatibility, and that OPN is important to promote cell adhesion to the C-SR surface.

Role of serum amyloid P in skin graft survival and wound healing in burned patients receiving skin grafts.

BACKGROUND: Recent studies in animal models suggest that serum amyloid P (SAP) can affect burn wound healing. However, the role of SAP in a clinical setting remains unknown. METHODS: We enrolled 88 patients with third degree burn wounds. All the patients were candidates for auto-skin graft procedure using stamp skin graft. The complete graft healing time and the number of survived grafts were recorded. Serum SAP levels were assessed 1 day before operation. RESULTS: There was no significant difference in SAP level between controls and patients. There were no significant differences noted among the patients with different burn surface area. However, when the patients in each group were stratified by SAP levels, the mean complete healing time of grafted wound and the mean numbers of survived skin grafts were significantly different. Spearman's analyses showed that the serum SAP levels negatively correlated with the complete wound healing time and mean numbers of survived skin grafts. Logistic regression analysis showed that the serum SAP levels and mean numbers of survived skin grafts were potent independent factors contributing to wound healing. CONCLUSIONS: The results of this study suggest that the serum SAP levels may be an easy detected predictor for the healing of burn wounds.