异种（牛）脱细胞真皮基质修复膜对预防腮腺肿瘤切除术后味觉性出汗综合征的效果

 目的　评价应用异种（牛）脱细胞真皮基质修复膜对防止腮腺切除术后味觉性出汗综合征的治疗效果。方法　选择57例腮腺切除的患者随机分成两组，试验组在腮腺床与皮瓣之间植入异种（牛）脱细胞真皮基质修复膜，对缺损的腮腺筋膜修复重建；对照组不植入任何间隔材料。术后追踪随访，进行效果评价。结果　术后随访6～24个月，肿瘤未见复发，试验组味觉性出汗综合征发生率为10.3 %（3／29），对照组为53.6 %（15／28）。两组比较差异有统计学意义（P＜0.001）。结论　异种（牛）脱细胞真皮基质修复膜为防止腮腺切除术后味觉性出汗综合征提供了一种新的治疗方法，对神经末梢的迷走再生起到间隔屏障的作用，减少味觉性出汗综合征的发生，手术操作简便，效果良好，值得推广。     

细胞外基质补片的临床应用

细胞外基质补片(accellular dermal matrix,ADM or EMC)为近年来临床应用越来越多的医用修补材料,该补片在烧伤整形、口腔科、耳鼻喉头颈外科、神经外科、普外科、泌尿外科等多个学科领域广泛应用,并取得了较好的临床效果.本文就细胞外基质补片在临床应用做一综述.     

细胞外基质补片的临床应用

细胞外基质补片（accellular dermal matrix，ADM or EMC）为近年来临床应用越来越多的医用修补材料，该补片在烧伤整形、口腔科、耳鼻喉头颈外科、神经外科、普外科、泌尿外科等多个学科领域广泛应用，并取得了较好的临床效果。本文就细胞外基质补片在临床应用做一综述。     

细胞外基质重构对肿瘤浸润转移的影响

肿瘤转移是一个复杂的过程,有多种调节机制,其中细胞外基质(ECM)重构与肿瘤浸润转移密切相关,重构后的ECM成分、物理学性质和空间结构均发生了明显的改变,在肿瘤侵袭转移的过程中起着重要的作用.因此细胞外基质重构的相关特征及分子可作为肿瘤临床分期、早期诊断及治疗、判断预后的重要指标.     

细胞外基质与肿瘤干细胞相互作用的研究进展

细胞外基质（extracellular matrix,ECM）是由蛋白质与糖类等生物大分子在细胞表面或细胞间构成的复杂网络结构。细胞外基质的过量沉积或结构形态异常是肿瘤微环境（tumor microenvironment,TME）的重要特征之一。肿瘤干细胞（cancer stem cells,CSC）指肿瘤内部一类具有无限增殖、自我更新及多向分化潜能的细胞亚群,参与肿瘤的启动、扩散、转移和复发。研究表明,肿瘤的发生是一个由细胞外基质和肿瘤干细胞相互促进、共同演化的过程。本文就ECM的组成成分、特性及其对CSC的生物学行为影响展开讨论,以期为肿瘤的临床治疗寻求新方向。     

肿瘤及肿瘤基质细胞释放的外泌体对肿瘤耐药产生的影响

恶性肿瘤已成为当今严重威胁人类健康的疾病之一,存在早发现难、治愈率低和预后差等三大难点.虽然,化疗是癌症治疗的主要手段,但由此产生的耐药也是当今影响疗效的最棘手问题之一,从而使患者面对无药可用的尴尬境地.外泌体(exosomes)作为细胞间信息传递的重要通讯员,在肿瘤耐药传递方面发挥重要作用.研究发现,肿瘤细胞和肿瘤微环境(tumor microenvironment,TME)中的基质细胞均可分泌携带耐药相关分子(包括蛋白质和miRNAs等)的外泌体,并通过外泌体在TME中相互作用,传递耐药分子,从而增强肿瘤细胞对药物的耐受性;同时肿瘤细胞外泌体还可以介导药物外排,从而影响药效;基质细胞也可与肿瘤细胞相互作用影响肿瘤细胞对药物的敏感性.同时,这些机制的发现也为克服肿瘤耐药提供了新思路,研究表明通过去除或抑制含耐药分子的外泌体,或者通过改变外泌体的成分(减少耐药分子或增加抗耐药分子),可在一定程度上逆转耐药.本文就肿瘤及肿瘤基质细胞释放的外泌体在肿瘤耐药中的作用以及由此而来的耐药逆转的研究进展作一综述.     

腮腺肿瘤术后Frey综合征的发病机制和防治措施

Frey综合征又称味觉性出汗综合征，耳颞神经综合征，Le syndrome du nerfauriculo—temporal，Freyg syndrome，为腮腺肿瘤术后较为常见的-种并发症。华沙大学神经科医生LucjaFrey于1923首先报道。表现为进食或者受到食物相关信息刺激后术侧耳颞区皮肤潮红、出汗。发生率各家报道差异性很大，大概为5％-70％，-般出现在术后5周到1年。     

参与肿瘤侵袭和转移的细胞外基质降解酶

 肿瘤细胞在侵袭和转移过程中必需穿透一系列天然组织屏障—基底膜和细胞外基质。合成及分泌大量基质降解酶,降解细胞外基质是肿瘤细胞侵袭、转移的重要步骤［1］。     

动态变化的细胞外基质

细胞外基质是正常、受损伤及肿瘤性组织内的结缔组织成分,以前一直认为是一种被动的无活力的结构支架,然而最近的工作已改变了此概念。细胞外基质为多种生理、病理过程提供甚至控制着动态变化的环境。这种支架不仅参与维持组织修复、生长、发育过程中正常组织完整性的维持,而且是抵抗恶性肿瘤侵袭和转移的第一道防线。     

BROWSE: A multicentre comparison of nine year outcomes in acellular dermal matrix based and complete submuscular implant-based immediate breast reconstruction-aesthetics,capsular contracture and patient reported outcomes

Approximately 60% of implant-based breast reconstructions (IBBR) are performed with an acellular dermal matrix (ADM), for which, reliable, good quality long-term outcome data is limited. In a retrospective multicentre cohort study, we aimed to determine long-term aesthetic and quality of life outcomes of IBBR with ADM (Strattice?) compared to a submuscular technique.MethodsCapsular contracture (Baker III/IV capsule) was determined by clinical examination by an independent researcher. Quality of life was assessed using BREAST-Q and aesthetic outcome by photographic assessment from a breast surgeon, breast care nurse and lay person, blinded to reconstruction type.ResultsWe recruited 117 (51 bilateral) patients with ADM reconstructions, median follow-up 62 months (range 29–113) and 49 patients (16 bilateral) with submuscular reconstructions, median follow-up 76 months (range 38–111). 17 (10.1%) ADM reconstructions were Baker 3/4 compared to six (9.2%) submuscular (p = 0.85). Of the Baker 1/2 reconstructions six (3.6%) ADM and eight (13.6%) submuscular had previously undergone revision surgery to correct capsular contracture (p = 0.01). Combining both findings gave an estimated rate of capsular contracture of 13.6% in the ADM group and 21.2% in the submuscular (p = 0.14). A higher mean score for satisfaction with breasts was demonstrated when comparing ADM to submuscular (62 and 55, respectively; p = 0.01) but no significant difference in other BREAST-Q domains. The mean ‘general satisfaction’ score was higher in the ADM group for all three photograph assessors.ConclusionThis study provides evidence of improved aesthetic outcome and reduction in capsular contracture with ADM reconstruction when compared to submuscular, consistent over long-term follow-up.     

Cost minimisation analysis of using acellular dermal matrix (Strattice™) for breast reconstruction compared with standard techniques

Background

We performed a cost analysis (using UK 2011/12 NHS tariffs as a proxy for cost) comparing immediate breast reconstruction using the new one-stage technique of acellular dermal matrix (Strattice™) with implant versus the standard alternative techniques of tissue expander (TE)/implant as a two-stage procedure and latissimus dorsi (LD) flap reconstruction.

Methods

Clinical report data were collected for operative time, length of stay, outpatient procedures, and number of elective and emergency admissions in our first consecutive 24 patients undergoing one-stage Strattice reconstruction. Total cost to the NHS based on tariff, assuming top-up payments to cover Strattice acquisition costs, was assessed and compared to the two historical control groups matched on key variables.

Results

Eleven patients having unilateral Strattice reconstruction were compared to 10 having TE/implant reconstruction and 10 having LD flap and implant reconstruction. Thirteen patients having bilateral Strattice reconstruction were compared to 12 having bilateral TE/implant reconstruction. Total costs were: unilateral Strattice, £3685; unilateral TE, £4985; unilateral LD and implant, £6321; bilateral TE, £5478; and bilateral Strattice, £6771.

Conclusions

The cost analysis shows a financial advantage of using acellular dermal matrix (Strattice) in unilateral breast reconstruction versus alternative procedures. The reimbursement system in England (Payment by Results) is based on disease-related groups similar to that of many countries across Europe and tariffs are based on reported hospital costs, making this analysis of relevance in other countries.     

Acellular dermal matrix (ADM) assisted breast reconstruction procedures: Joint guidelines from the Association of Breast Surgery and the British Association of Plastic,Reconstructive and Aesthetic Surgeons

Tissue expansion with delayed insertion of a definitive prosthesis is the most common form of immediate breast reconstruction performed in the United Kingdom. However, achieving total muscle coverage of the implant and natural ptosis is a key technical challenge. The use of acellular dermal matrices (ADM) to supplement the pectoralis major muscle at the lower and lateral aspects of the breast has been widely adopted in the UK, potentially allowing for a single stage procedure. There is however little published data on the clinical and quality criteria for its use, and no long term follow-up.     

The effect of ionizing irradiation on the intraductal pressure of the human parotid gland

The intraductal pressure of the human parotid glands in patients who had received fractionated ionizing irradiation prior to operation for pleomorphic adenoma was studied after stimulation of the glands with a 3 % solution of acetic acid. The following observations of interest were made: 1) the stimulation raised the intraductal pressure within 1–2 seconds; 2) the mean intraductal pressure in 24 normal glands after the first stimulation reached 752 mm H2O; 3) irradiation with one single dose (5 Gy) reduced the intraductal pressure of diseased glands by about 80 % within 24 hours; and 4) after three doses of 5 Gy/day no intraductal pressure could be measured on the irradiated side.     

超声介导下细针穿刺活检在腮腺肿瘤术前诊断中的应用价值

目的分析超声介导下细针穿刺活检(USFNA)在腮腺肿瘤术前诊断中应用的价值。方法回顾性分析2011年10月至2013年10月间外科就诊的腮腺肿瘤患者120例,所有患者术前均行USFNA诊断,并与术后病理学诊断比较。结果 USFNA定性诊断总相符率为92.5%,与病理学诊断完全一致的总准确率为74.2%。其中良性肿瘤定性诊断相符率为92.9%,准确率为77.4%;恶性肿瘤定性诊断相符率为91.7%,准确率为66.7%。结论 USFNA鉴别良恶性腮腺肿瘤安全快速,准确率高,临床并发症少,是术前重要的常规检查之一。     

The role of postoperative radiation therapy in carcinoma ex pleomorphic adenoma of the parotid gland

PURPOSE: To evaluate the impact of postoperative radiation therapy on the clinical course of patients with carcinoma ex pleomorphic adenoma of the parotid gland. METHODS AND MATERIALS: Between 1960 and 2004, 63 patients were treated with definitive surgery for carcinoma ex pleomorphic adenoma of the parotid gland. Forty patients (63%) received postoperative radiation therapy to a median dose of 60 Gy (range, 45-71 Gy). Adenocarcinoma (29 patients), salivary duct carcinoma (16 patients), and adenoid cystic carcinoma (9 patients) were the most common malignant subtypes. Pathologic T -stage was: 16% T1, 33% T2, 32% T3, and 19% T4. Twenty-one patients (33%) had microscopically positive margins and 39 (62%) had perineural invasion. Median follow-up was 50 months (range, 2-96 months). RESULTS: The use of postoperative therapy significantly improved 5-year local control from 49% to 75% (p = 0.005) and was associated with an improvement in survival among patients without evidence of cervical lymph node metastasis (p = 0.01). A Cox proportional hazard model identified pathologic involvement of cervical lymph nodes as an independent predictor of overall survival. Overall survival was 16% for patients with pathologic N-positive disease compared with 67% for those whose lymph node status was negative or unknown (p = 0.001). CONCLUSION: Surgery followed by postoperative radiation should be considered the standard of care for patients with carcinoma ex pleomorphic adenoma.