Additional venous anastomosis in free profunda artery perforator flap transfer using the posterior accessory saphenous vein

BackgroundThe profunda artery perforator (PAP) flap has recently been widely used for head and neck as well as breast reconstruction. Although this flap has various advantages, its vascular pedicle is relatively smaller and shorter than that of other workhorse flaps such as the anterolateral thigh flap. The posterior accessory saphenous vein (pASV) is a branch of the great saphenous vein, which runs in the posteromedial aspect of the thigh and can be included in the PAP flap. Here, we present the anatomical characteristics of the pASV and feasibility of its use in PAP flap transfers.Patients and methodsAn anatomical study of the pASV was conducted in nine lower extremities of five patients using ultrasonography. Several landmarks such as point A (the point where the pASV crosses the posterior border of the adductor longus muscle), point B (the point where the pASV merges with the great saphenous vein) and the inguinal crease, were marked. Distribution of the pASV was plotted, and several distances were measured. On the basis of the anatomical study, nine free PAP flap transfers were performed.ResultsIn the anatomical study, the mean diameter of the pASV was 3.4 and 4.9 mm at points A and B, respectively. The mean available length of the pASV was 9.4 cm. In clinical cases, all flaps completely survived. No flap-related complication was observed. The pASV was included in the PAP flap in eight cases. The mean length of the harvested pASV was 8.6 cm, and the mean diameter was 3.3 mm. Indocyanine green angiography showed effective drainage using the pASV alone.ConclusionsThe use of the pASV can be an effective option, particularly for head and neck reconstruction, and its application in various types of reconstructive surgery can be widened.     

Effect of sildenafil on neuroinflammation and synaptic plasticity pathways in experimental autoimmune encephalomyelitis

Multiple sclerosis (MS) is a chronic immuno-inflammatory disease of the central nervous system characterized by demyelination and axonal damage. Cognitive changes are common in individuals with MS since inflammatory molecules secreted by microglia interfere with the physiological mechanisms of synaptic plasticity. According to previous data, inhibition of PDE5 promotes the accumulation of cGMP, which inhibits neuroinflammation and seems to improve synaptic plasticity and memory. The present study aimed to evaluate the effect of sildenafil on the signaling pathways of neuroinflammation and synaptic plasticity in experimental autoimmune encephalomyelitis (EAE). C57BL/6 mice were divided into three experimental groups (n = 10/group): (a) Control; (b) EAE; (c) EAE + sild (25 mg/kg/21 days). Sildenafil was able to delay the onset and attenuate the severity of the clinical symptoms of EAE. The drug also reduced the infiltration of CD4+ T lymphocytes and their respective IL-17 and TNF-α cytokines. Moreover, sildenafil reduced neuroinflammation in the hippocampus (assessed by the reduction of inflammatory markers IL-1β, pIKBα and pNFkB and reactive gliosis, as well as elevating the inhibitory cytokines TGF-β and IL-10). Moreover, sildenafil induced increased levels of NeuN, BDNF and pCREB, protein kinases (PKA, PKG, and pERK) and synaptophysin, and modulated the expression of the glutamate receptors AMPA and NMDA. The present findings demonstrated that sildenafil has therapeutic potential for cognitive deficit associated with multiple sclerosis.     

Curcumin induces apoptosis involving bax/bcl-2 in human hepatoma SMMC-7721 cells

Curcumin is a major active component of Curcuma aromatica salisb, which has been shown to inhibit proliferation of a wide variety of tumor cells. In this study, the molecular mechanisms of curcumin inducing apoptosis in human hepatoma SMMC-7721 cells were examined. We find that curcumin inhibits the growth of SMMC-7721 cells significantly in a concentration-depenent manner, with typical apoptotic morphological changes of cellular nuclei. Annexin-V/PI double staining detected by flow cytometry and expression of the relative apoptotic proteins (Bax, Bcl-2 and caspase-3) revealed a strong apoptosis-inducing competent of curcumin in SMMC-7721 cells. Curcumin increased the expression of bax protein while decreasing that of bc1-2 protein significantly. The results suggest that curcumin induction of apoptosis involves modulation of bax/bcl-2 in SMMC-7721 cells and provide a molecular basis for the development of naturally compounds as novel anticancer agents for human hepatomas.     

Laparoscopic cholecystectomy as a ‘session’ surgery

Aims: To introduce laparoscopic cholecystectomy to our Day Surgery Unit and assess the implications of a 6 h postoperative stay in unselected patients. Methods: A retrospective analysis of data was performed in which the case notes of a series of 170 consecutive patients undergoing day case laparoscopic cholecystectomy were studied. All patients with symptomatic gallstones were considered for day case laparoscopic cholecystectomy. Patients were excluded if there was major medical co-morbidity but not solely on the basis of age or Body Mass Index (BMI). Surgery was performed in a dedicated Day Surgery Unit and cholangiography was performed selectively. All patients were assessed at 6 h postoperatively for discharge and followed up by telephone at 24, 48 h and 2 weeks postoperatively. Results: Of 170 patients 121 (71.1%) were discharged at 6 h, 116 reported no problems and were satisfied with day case treatment. Two (1.6%) patients required a GP visit at home within 24 h and three (2.5%) patients required readmission. Forty-nine (28.9%) patients required admission, the commonest cause for admission being postoperative pain and nausea (10.6%) in approximately equal proportions. Three were admitted as they had open surgery. One patient required further surgical intervention (laparoscopy). Conclusion: Laparoscopic cholecystectomy as a ‘session’ surgery, with planned discharge 6 h after operation, is successful in the majority of unselected patients even though a significant number of overnight admissions are to be anticipated.     

JWA T723G多态性与胃癌易感性

目的探讨JWAT723G多态性与胃癌易感性之间的关系。方法采用多聚酶链反应(polymerase chain reaction,PCR)和变性高效液相色谱法(denaturing high performance liquid chromatography,DHPLC)检测107例胃癌患者和200例同龄健康人群的JWAT723G多态性并进行分析。结果病例组和对照组JWAT723G基因分布频度无显著差异(χ2=2.290,P=0.318)。在调整了性别和年龄后,与T/T基因型相比,T/G基因型发生胃癌的危险性上升到1.21(95%CI:0.94～1.57),G/G基因型发生胃癌的危险性上升到1.49(95%CI:0.45～4.96)。合并T/G和G/G基因型分析显示G等位基因发生胃癌的危险性上升到1.21(95%CI:0.95～1.55),JWAT723G多态性与胃癌的易感性无相关性(P=0.1316)。结论 JWAT723G多态性与胃癌易感性不相关。