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Transcriptomic and machine learning analyses identify hub genes of metabolism and host immune response that are associated with the progression of breast capsular contracture

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Genes & Diseases 2024年第3期11卷 427-437页

作者： Yukun Mao Xueying Hou Su Fu Jie Luan Breast plastic and Reconstructive surgery Center Plastic Surgery HospitalChinese Academy of Medical SciencesPeking Union Medical CollegeBeijing 100144China

Capsular contracture is a prevalent and severe complication that affects the post-operative outcomes of patients who receive silicone breast implants.At present,prosthesis replacement is the major treatment for capsular contracture after both breast augmentation procedures and breast reconstruction following breast cancer surgery.However,the mecha-nism(s)underlying breast capsular contracture remains unclear.This study aimed to identify the biological features of breast capsular contracture and reveal the potential underlying mechanism using RNA sequencing.Sample tissues from 12 female patients(15 breast capsules)were divided into low capsular contracture(LCC)and high capsular contracture(HCC)groups based on the Baker grades.Subsequently,41 lipid metabolism-related genes were identified through enrichment analysis,and three of these genes were identified as candidate genes by SVM-RFE and LASSO algorithms.We then compared the proportions of the 22 types of im-mune cells between the LCC and HCC groups using a CIBERSORT analysis and explored the Cor-relation between the candidate hub features and immune cells.Notably,PRKAR2B was positively correlated with the differentially clustered immune cells,which were M1 macro-phages and follicular helper T cells(area under the ROC=0.786).In addition,the expression of PRKAR2B at the mRNA or protein level was lower in the HCC group than in the LCC group.Potential molecular mechanisms were identified based on the expression levels in the high and low PRKAR2B groups.Our findings indicate that PRKAR2B is a novel diagnostic biomarker for breast capsular contracture and might also influence the grade and progression of capsularcontracture.

关键词： Biomarker Breastcapsular contracture Immune infiltration Machinelearning algorithms PRKAR2B

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Reconstructive surgery for phantom and residual limb pain in post-conflict settings

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Chinese Journal of plastic and Reconstructive surgery 2024年第1期6卷 54-55页

作者： Damián Palafox plastic and Reconstructive surgery Department, Hospital Angeles Puebla Hospital Angeles Puebla plastic and Reconstructive surgery Department

Traumatic amputations remain one of the most frequent and disturbing wounds of armed conflict. In this scenario,most amputees develop residual and phantom limb pain, impacting their quality of life. There are several elective surgical procedures available for both conditions, such as neuroma excision followed by nerve reconstruction,nerve relocation, e.g., surgically implanting a transected nerve into a muscle, nerve transfers in cases of associated paralysis, and most recently, regenerative peripheral nerve interface surgery. Whenever possible in the postconflict phase, a coordinated effort between traveling humanitarian surgeons specializing in reconstructive microsurgery and local healthcare providers is essential for successfully treating phantom and chronic residual limb pain in post-conflict amputees. While providing a detailed logistical framework for global humanitarian missions is beyond the scope of this article, we provide a brief perspective on a topic of utmost importance for reconstructive surgeons worldwide: the high-quality care and treatment of refugees and those whose lives have been impacted by conflict, disaster, or displacement.

关键词： Residual limb pain Phantom limb pain Refugees Reconstructive surgery Microsurgery Amputees

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A long-term histological research on human frontalis muscle flap specimens from recurrent blepharoptosis patients

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International Journal of Ophthalmology(English edition) 2024年第6期17卷 1161-1163页

作者： Lu Zhou Yu-Cheng Yan Jin-Cai Fan Department of plastic and Reconstructive surgery Plastic Surgery HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100144China

Dear Editor,We present two patients with recurrent severe blepharoptosis after frontalis muscle(FM)flap suspension.Here we describe long-term histological changes of the FM flaps observed in revision surgeries.FM flap suspension is widely applied in treating severe ptosis with poor levator function(surgery flaps which could reflect trends of morphological changes within the functioning FM flaps to some extent.

关键词： patients histological surgery

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Effects of microenvironment and biological behavior on the paracrine function of stem cells

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Genes & Diseases 2024年第1期11卷 135-147页

作者： Zhixin Xue Yunjun Liao Ye Li The Department of plastic and Cosmetic surgery Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdong 510515China

Mesenchymal stem cells(MSCs),the most well-studied cell type in the field of stem cell therapy,have multi-lineage differentiation and self-renewal potential.MsC-based thera-pies have been used to treat diverse diseases because of their ability to potently repair tissue and locally restore function.An increasing body of evidence demonstrates that paracrine func-tion is central to the effects of MsC-based therapy.Growth factors,cytokines,chemokines,extracellular matrix components,and extracellular vehicles all contribute to the beneficial ef-fects of MSCs on tissue regeneration and repair.The paracrine substances secreted by MSCs change depending on the tissue microenvironment and biological behavior.In this review,we discuss the bioactive substances secreted by MsCs depending on the microenvironment and biological behavior and their regulatory mechanisms,which explain their potential to treat human diseases,to provide new ideas for further research and clinical cell-free therapy.

关键词： Bioactive behavior Mesenchymal stem cells Microenvironment Paracrine Secretome

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Malignant triton tumor in the abdominal wall:A case report

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World Journal of Clinical Cases 2024年第8期12卷 1467-1473页

作者： Ho Jik Yang Donghyun Kim Won Suk Lee Sang-Ha Oh Department of plastic and Reconstructive surgery Chungnam National University Sejong HospitalSejong 30099South Korea Department of plastic and Reconstructive surgery Chungnam National University HospitalDaejeon 35015South Korea Department of Emergency Eulji University HospitalDaejeon 35233South Korea Department of plastic and Reconstructive surgery Chungnam National University College of MedicineDaejeon 35015South Korea

BACKGROUND Malignant triton tumors(MTTs)comprise a subgroup of malignant peripheral nerve sheath tumors(MPNSTs)that exhibits rhabdomyosarcomatous differen-tiation and follow an aggressive course.MTTs are primarily located along peripheral nerves.Cases of MTTs in the abdominal wall have not been reported.MTT has a poorer prognosis than classic MPNSTs,and accurate diagnosis necessitates a keen understanding of the clinical history and knowledge of its differential diagnosis intricacies.Treatment for MTTs mirrors that for MPNSTs and is predominantly surgical.CASE SUMMARY A 49-year-old woman presented with a subcutaneous mass in her lower abdo-minal wall and a pre-existing surgical scar that had grown slowly over 3-4 months before the consultation.She had previously undergone radical hysterectomy and concurrent chemo-radiotherapy for cervical cancer approximately 5 years prior to the consultation.Abdominal computed tomography(CT)showed a 1.3 cm midline mass in the lower abdomen with infiltration into the rectus abdominis muscle.There was no sign of metastasis(T1N0M0).An incisional biopsy identified sporadic MTT of the lower abdomen.A comprehensive surgical excision with a 3 cm margin inclusive of the peritoneum was executed.Subse-quently,the general surgeon utilized an approach akin to the open peritoneal onlay mesh technique.The patient underwent additional treatment with an excision shaped as a mini-abdominoplasty for the skin defect.No complications arose,and annual follow-up CTs did not show signs of recurrence or metastasis.CONCLUSION An abdominal MTT was efficaciously treated with extensive excision and abdominal wall reconstruction,eliminating the need for postoperative radiotherapy.

关键词： Malignant triton tumor Abdominal wall Surgical excision Reconstruction Case report

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Adaptability of bipedicled scalp advancement flap for coverage of huge scalp defects after tumor resection

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Chinese Journal of plastic and Reconstructive surgery 2024年第1期6卷 16-21页

作者： Waleed Aldabaany Department of plastic surgery, Faculty of Medicine, Fayoum University Faculty of Medicine Department of plastic surgery Fayoum University

Background: Several reconstructive techniques have been used to reconstruct scalp defects. Numerous researchers have studied the utilization of bipedicled scalp advancement flaps for scalp defect coverage. In this study, we will assess the adaptability of a bipedicled scalp advancement flap for coverage of huge scalp defects after tumor resection.Methods: This study was performed at the plastic surgery Department, Fayoum University Hospital, on 20 patients with huge scalp tumors treated by adequate excision and reconstructed using a bipedicled scalp advancement flap from December 2021 to July 2023.Results: The study was conducted on 20 patients: 16(80%) were men and 4(20%) were women presenting with large scalp tumors. The mean age was 57.4 years(33–68 years). The sites of the tumors were 10(50%) occipital,6(30%) parietal, and 4(20%) parieto-occipital. No major complications occurred postoperatively, and the bipedicled flaps survived well in all cases, with no necrosis.Conclusion: Huge scalp defects after tumor resection can be safely reconstructed with a large versatile bipedicled advancement scalp flap, either transversely or longitudinally oriented, with favorable functional results and accepted aesthetic results, apart from the alopecic area over the grafted donor site, which can be treated by tissue expansion if desired later.

关键词： Bipedicled advancement flap Huge scalp defects Tumor resection

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Reconstruction of cervical necrotizing fasciitis defect with the modified keystone flap technique:Two case reports

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World Journal of Clinical Cases 2024年第7期12卷 1305-1312页

作者： Wonseok Cho Eun A Jang Kyu Nam Kim Department of plastic and Reconstructive surgery Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoul 03181South Korea

BACKGROUND Cervical necrotizing fasciitis(CNF)is a rare,aggressive form of deep neck space infection with significant morbidity and mortality rates.Serial surgical debridement acts as the cornerstone of CNF treatment;however,it often results in defects requiring complex reconstructions.CASE SUMMARY We report two cases in which the keystone flap(KF)was used for CNF defect coverage:Case 1,an 85-year-old patient with CNF in the anterior neck,and Case 2,a 54-year-old patient with CNF in the posterior neck.Both patients received empirical intravenous antibiotic therapy and underwent serial debridement,enabling adequate wound preparation and stabilization.The final defect size measured 5.5 cm×12 cm in Case 1 and 6 cm×11 cm in Case 2.For defect coverage,we employed an 8 cm×19 cm type II KF based on perforators from the superior thyroid artery in Case 1 and a 9 cm×18 cm type II KF based on perforators from the transverse cervical artery in Case 2.Both flaps showed complete survival.No postoperative complications occurred in both cases,and favorable outcomes were observed at 7-and 6-month follow-ups in case 1 and 2,respectively.CONCLUSION We effectively treated CNF-associated defects using the KF technique;KF is viable for covering CNF defects in carefully selected cases.

关键词： Fasciitis Necrotizing Debridement plastic surgery Dermatologic surgical procedures Case report

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Pedicled abdominal flap using deep inferior epigastric artery perforators for forearm reconstruction: A case report

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World Journal of Clinical Cases 2024年第4期12卷 828-834页

作者： Jae Hyung Jeon Kyung Wook Kim Hong Bae Jeon Department of plastic and Reconstructive surgery Dankook University HospitalCheonan 31116ChungnamSouth Korea Department of Orthopaedic surgery Dankook University HospitalDankook University College of MedicineCheonan 31116ChungnamSouth Korea Department of plastic and Reconstructive surgery Dankook University HospitalDankook University College of MedicineCheonan 31116ChungnamSouth Korea

BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects.However,some drawbacks include restricted flap size,partial flap loss,and donor-site morbidity.To address these concerns,we present a case of a pedicled abdominal flap using the deep inferior epigastric artery perforators(DIEP)for forearm reconstruction in a patient with a large soft tissue defect.CASE SUMMARY A 46-year-old male patient was admitted to our hospital with forearm injury caused by a pressing machine.A 15 cm×10 cm soft tissue defect with complete rupture of the ulnar side structures of the forearm was found.One week after orthopedic management of the neurovascular injury and fractures using the first stage of Masquelet technique,the patient was referred to the plastic and recon-structive surgery department for wound coverage.Surgical debridement and negative-pressure wound therapy revealed a 20 cm×15 cm soft tissue defect.A pedicle abdominal flap with the DIEP was used to cover the defect.Three weeks later,the flap was detached from the abdomen,and the abdominal defect was directly closed.Subsequently,the second stage of Masquelet technique was performed at the fracture site at week 10.Finally,all donor and recipient sites healed without complications,such as flap dehiscence,infection,hematoma,or necrosis.Fracture site osteosynthesis was achieved without complications.CONCLUSION Pedicled abdominal flap using the DIEP provides a reliable option for forearm reconstruction in patients with large soft tissue defects.

关键词： Forearm injury Open fracture reduction Perforator flap Deep inferior epigastric artery perforators Case report

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The clinical characteristics and risk factors for necrotizing soft tissue infection in children

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儿科学研究(英文) 2024年第1期8卷 21-26页

作者： Liu Jing Chen Jigang Wang Yanni Qi Hongyan Yu Jing Department of Burn and plastic surgery Beijing Children’s Hospital Capital Medical University National Center for Children’s Health Beijing China

Importance: Necrotizing soft tissue infection (NSTI) is a serious infectious disease. However, the early clinical manifestations and indicators of NSTI in children are still unclear.Objective: The purpose of this study was to analyze the clinical characteristics and risk factors of NSTI in pediatric patients.Methods: A total of 127 children with skin and soft tissue infection (SSTI) were treated at our hospital and divided into two groups: the NSTI group and the non-NSTI group, based on their discharge diagnosis from January 2011 to December 2022. Then, we collected and analyzed the clinical characteristics and risk factors of all patients, including sex and age, disease inducement, admission temperature, local skin manifestations, infection site, the presence of sepsis, bacterial culture, and laboratory indicators.Results: In our study, there was a statistical difference in the age distribution and disease inducement between NSTI and non-NSTI groups. The occurrence of local skin manifestations (blisters/bullae and ecchymosis) and the presence of sepsis significantly increased in the NSTI group compared to the non-NSTI group. Additionally, only the platelet count on laboratory tests was statistically different between the NSTI and non-NSTI groups. Finally, the logistic regression analysis suggested that local skin manifestations such as blisters/bullae, and ecchymosis, as well as the presence of sepsis, were identified as risk factors for NSTI.Interpretation: Children with SSTI and skin manifestations such as blisters/bullae, ecchymosis, and the presence of sepsis are at a higher risk of developing NSTI. These symptoms serve as useful indicators for early detection of NSTI.

关键词： Clinical characteristics Risk factors Necrotizing soft tissue infection Skin and soft tissue infection

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Complicated calcified alloplastic implants in the nasal dorsum:A clinical analysis

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World Journal of Clinical Cases 2024年第18期12卷 3351-3359页

作者： Yong-Seon Hwang Taek-Kyun Kim Dong-Jun Yang Si-Hyong Jang Da-Woon Lee Department of plastic and Reconstructive surgery College of MedicineSoonchunhyang UniversityCheonan-Si 31151South Korea Department of plastic surgery The PLUS Plastic Surgery ClinicSeoul 06035South Korea Department of plastic surgery CDU Plastic Surgery ClinicSeoul 06067South Korea Department of Pathology College of MedicineSoonchunhyang UniversityCheonan 31151Chungcheongnam-doSouth Korea

BACKGROUND In rhinoplasty,calcification around silicone implants is frequently observed in the tip dorsum(TD)area.Additionally,based on a review of various literature,it is presumed that calcification in silicone implants occurs due to both inflammatory chemical reactions and physical friction against the tissue.The calcification of nasal silicone implants not only results in the functional loss of the implants,but also leads to material deformation.However,there is a lack of research on calcification of nasal silicone implants in the current literature.AIM To elucidate various clinical characteristics of calcification around nasal silicone implants,using histological and radiological analysis.METHODS This study analyzed data from 16 patients of calcified nasal implants,who underwent revision rhinoplasty for various reasons after undergoing augmentation rhinoplasty with silicone implants.The collected data included information on implant duration,implant types,location of calcification,presence of inflammatory reactions,and computed tomography(CT)scans.RESULTS The most common location of calcification,as visually analyzed,was in the TD area,accounting for 56%.Additionally,the analysis of CT scans revealed a trend of increasing Hounsfield Unit values for calcification with the duration of implantation,although this trend was not statistically significant(P=0.139).CONCLUSION Our study shows that reducing the frequency of calcification may be achievable by using softer silicone implants and by minimizing the damage to perioperative tissues.

关键词： Silicone implants Rhinoplasty Calcification Complication Hounsfield unit

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