To investigate the therapeutic effects of recombinant humanized anti-HER2 antibody (Herceptin) on Her-2/neu-overexpressing metastatic human breast cancer, 7 patients with Her-2/neu-overexpressing metastatic human breast cancer were involved in this study. The results indicated that the therapeutic effective rate was 71. 4%. CR. PR, SD. PI) were seen in 2. 3, 1, 1 cases, respectively. No side reactions were observed. The results revealed that the therapeutic effect of Herceptin is intimately linked to Her-2/neu expression of breast cancer.

OBJECTIVETo investigate the distribution of the internal mammary artery and its branches by the multi-slice spiral CT angiography, and to explore the feasibility of transferring pedicled transverse rectus abdomials myocataneous (TRAM) flap for breast reconstruction through resection of inferior costicartilages.

METHODS30 female patients received abdominal CT angiography. (1) The distance between internal mammary artery and the sternum midline were recorded; (2) The position and the numbers of branches from bilateral internal mammary arteries at the level of 5th, 6th, 7th rib was observed; (3) The points where the superior epigastric artery gets through the rectus abdominis muscle were located.

RESULTS( The average distance between left internal mammary artery to the sternum midline is from 1. 66 cm (0. 62-2. 39 cm ) to 2.34 cm (0.69-3.36 cm) at the level from 4th to 6th intercostal space. The average distance between right internal mammary artery to the sternum midline is from 1.55 cm(0. 66-2. 29 cm) to 2.29 cm(0. 73-3. 67 cm) at the level from 4th to 6th intercostal space; ) The number of branches is the most at the level of 6th intercostal space; (3) There are 235 branches in the superior epigastric artery.

CONCLUSIONSThis imaging study of internal mammary artery explores the feasibility of transferring pedicled transverse rectus abdominals myocataneous flap for breast reconstruction. It has important significance in the breast reconstruction using TRAM flap with lengthened pedicle.

Abdominal Muscles ; blood supply ; Epigastric Arteries ; anatomy & histology ; diagnostic imaging ; Female ; Humans ; Mammaplasty ; Mammary Arteries ; anatomy & histology ; diagnostic imaging ; Multidetector Computed Tomography ; Rectus Abdominis ; anatomy & histology ; diagnostic imaging ; Sternum ; anatomy & histology ; diagnostic imaging ; Surgical Flaps

BACKGROUND: Bone marrow mesenchymal stem cells (BMSCs) have a remarkable differentiation potential and superiority as a type of seed cells,but their application is limited in the presence of certain diseases,such as aplastic anemia and myelogenous neoplasm.The present studies have found that seed cells called muscle-derived stem cells (MDSCs) have brought more and more attention,because of their capability of stir-renewal and multi-diffcrentiation like B MSCs.OBJECTIVE: To explore the biological characterization of the muscle-derived stem cells (MDSCs) from rabbits,and analyze the phenotype.DESIGN,TIME AND SETTING: Cell in vitro observation experiment was performed at the Medical Research Center of Second Affiliated Hospital of Sun Yat-sen University from August 2005 to March 2006.MATERIALS: A New Zealand rabbit (1.5 months old,clean grade) was enrolled for the preparation of Muscle-derived stem cells.Growth medium was DMED-LG added with 10% fetal bovine serum and 10% horse serum and fusion medium was DMEM-LG added with 2% fetal bovine serum.METHODS: The muscle mass was removed from the anesthetized rabbit to isolate MDSCs.These cells were dissociated using three enzymes (collagenase XI,dispase and trypsin) respectively.Sediment was resuspended.Then preplate technique was used.The muscle cell extract was plated on a collagen-coated culture flask with growth medium.The flask was called PP1.PPI was kept overnight in a 37 ℃ incubator containing 5% CO2,After that,the suspension was transferred to another collagen-coated culture flask,which was called PP2.PP3,PP4,PP5 and PP6 were constructed later following the same procedures.The cells adhered in PP6 were collected,plated in 6-well plates,and divided into 2 groups.Growth medium was used in one group,in which the cells were kept growing at a degree of confluence beyond 50%,and fusion medium was used in the other one,in which the cells were passaged with a degree up to 30%.MAIN OUTCOME MEASURES: The cells from PP1 to PP6 were collected,and the characterization was identified preliminary by Flow cytomctry,Immunocytochemistry and Western Blotting.The fusion of cells in PP6 was detected at different confluence degrees and concentration of medium.RESULTS: The cells in PP6 showed ＞ 80% desmin+,＞ 70% Bcl-2+,＞ 95% CD45,which indicated that MDSCs were in a high concentration.The expressions of α-SMA in the cells were decreasing with the Preplate technique used and the cells in PP6 almost had no α -SMA expression.When passaged at a high confluence (＞ 50%) or cultured with low concentrations of serum (2% serum),the cells in PP6 had a strong tendency of fusing into myotubes or cell chains and were skeletal myosin+.CONCLUSION: MDSCs,which are capable of multi-differentiation under a high fusion or low serum conditions,express dcsmin and Bcl-2 highly,but extreruelv little CD45 and no α -SMA.

Objective To measure the leakage rate in the process of expansion in vivo and in normal saline and the over-expansion property of the expander.Methods We chose 17 cases that were treated with the skin expansion.We recorded total injected saline volume intentionally in these cases before the second surgery,and recorded the remainder of the volume of saline postoperatively.We injected normal saline into 8 expanders,respectively,exceeding 50％ of the volume-rating;and subsequently put these expanders into plastic bucket filled with saline.30 days after,we measured the remaining volume of the normal saline.We injected 100 ml normal saline into 4 expanders,respectively,of which nominal volume was 100 ml,and then left these expanders in saline and measured the remainder volume of the saline 30 days later.In the second time,we injected 150 ml and repeated the abovementioned process.It was repeated 7 times until the injection volume reached 400 ml.We processed the data and depicted a curve of effective expansion.Results The results showed that the leakage rate reached (29.0+12.5) ％ in vivo.Experiments in vitro confirmed that 85.0％ (8.0/9.4) of the saline leaked through the injection port and 14.8％ (1.4/9.4) leaked through the membrane of the expander.In addition,over-expansion performance index test confirmed that the over-expansion property of an expander was about twice the nominal volume.Conclusions The expander is not completely sealed structure.Normal saline can leak through the injection part and the membrane of the expander.The over-expansion property of an expander is limited.When the volume injected into the expander exceeds a certain value,the effective expansion performance is not increased with it.

Objective To analyze the complications of breast reconstruction with pedicled transverse rectus abdominis myocutaneous flap (TRAM flap) and latissimus dorsi flap (LDF).Methods From databases such as CNKI,SinoMed,PubMed,VIP and Cochrane Library and manual search of articles on breast reconstruction with pedicled TRAM and LDF from 1992 to 2002 for the language of both Chinese and English,1493 cases were collected.47 cases were selected after they all were inspected by the excluded and included standards.RevMan 5.0 software was used to perform the Mantele-Haenszel fixed effect model.Results Ten studies reporting outcomes of pedicled TRAM and LDF were used to estimate relative risk (RR) and 95 ％ confidence interval (CI) for complications.There was a 1.7 times increase in the risk of partial flap necrosis (relative risk,1.72; 95 ％ CI,1.02to 2.88) in pedicled TRAM flap patients compared with LDF patients.There was no difference in the risk for fat necrosis (relative risk,1.01; 95 ％ CI,0.60 to 1.72) and total flap loss (relative risk,2.13; 95 ％ CI,0.82 to 5.54) between pedicled TRAM flap and LDF patients (P＞0.05).Conclusions Compared with the pedicled TRAM flap,partial flap loss risk of breast reconstruction with LDF is lower,and the risk of fat necrosis and total flap loss have no statistical difference (P＞0.05).

Objective To locate the points where the superior epigastric artery perforates the rectus abdominis muscle by using the spiral CT,in order to evaluate its control on abdominal complications after breast reconstruction.Methods Fifty cases had received abdominal spiral CT angiography,respectively.Then the coordinate system was established,with the umbilicus as the origin,the umbilicus horizontal line as X axis,vertical umbilical level line as Y axis.The point where superior epigastric artery perforates the rectus abdominis muscle in the coordinate system was located as described above.Results There were 392 perforating points in the rectus abdominis muscle in all 50 cases,with a mean of 7.84 perforators per patient.In the first quadrant,the points where superior epigastric artery perforate the rectus abdominis muscle were located in the range from 1.45 cm to 5.47 cm on the X axis,and in the range from 2.52 cm to 16.38 cm on the Y axis,respectively.In the second quadrant,the points where superior epigastric artery perforates the rectus abdominis muscle were located in the range from 2.02 cm to 6.80 cm on the X axis,and in the range from 2.30 cm to 14.46 cm on the Y axis,respectively.Conclusions The spiral CT angiography has high sensitivity and specificity,it can locate the point where the superior epigastric artery perforates the rectus abdominis muscle,which can avoid to cut extra rectus abdominis muscle.It is significant to reach best postoperative effect with the lowest donor site complications.

Objective To investigate the effect of tissue expansion in facial congenital giant nevus.Methods From October 2014 to October 2016,7 cases of facial congenital giant nevus patients were treated with expanded skin flaps,including single expansion and secondary expansion.Partial excision and skin tissue expansion were used to drastically remove giant pigmented nevi on body or extremities of infants.There were some points for attention during the surgery:the size and location of the partial excision and expander should be designed reasonably;no tumor-manipulation and non-tension principle should be taken great notice,and expanders should be linked up with one another when several expanders were used at the same time,so as to reduce the possibility of forming the envelop,which was favorable for the second surgery of transfer of a skin flap.Results All cases of giant pigmented nevi excision were on the face,which were completely removed from the patients.The areas of the nevi were from 7 cm × 5 cm to 15 cm × 13 cm.All patients were followed up for 3-12 months (mean 6 months).All flaps survived well.Expander exposure was happened in 2 cases with no bad results.One case of scar received late repair due to surgical scars and all got satisfactory results.Conclusions Tissue expansion is an ideal method in the treatment of facial congenital giant nevus.

Objective To evaluate the clinical effect of clitoroplasty with preservation of the glans clitoris and the dorsal neurovascular pedicle in patients with clitoral hypertrophy. Methods From July 2003 to June 2009, cunnus feminization operations with preservation of the glans clitoris and the dorsal neurovascular pedicle and labioplasty were performed on 8 patients with female pseudohermaphroditism. Results All 8 cases were primary healing. The shaping glans of clitoris was completely viable with satisfactory size, location, contour and touching sensitivity, and the cunnuses presented the appearances of female external genital organs. Conclusions Clitoroplasty with preservation of the glans clitoris and the dorsal neurovascular can improve the appearance of clitoris and labia, preserving the functions of sensation and erection, reconstruting a new clitoris which is aesthetically appealing and functional, and it is suitable for various kinds of cunnus feminization operations.

Objective To investigate the correlation of the type of hypospadias and external genital system malformations. Methods From Jan 2000 to Oct 2009, the data of 632 patients diagnosed with hypospadias was analyzed retrospectively. The proportion of all types of hypospadias and the frequency of external genital system malformations were statistically analyzed. Results Among all cases, 12.6% exhibited mild hypospadias, 22. 8% moderate, 43. 2% severe and 21.4% had extremely severe hypospadias. One hundred and eighty-four cases with external genital system malformations were classified into penoscrotal transposition, cryptorchidism, hydrocele of tunica vaginalis,concealed penis and pseudovagina. The probability was about 24.8% (157 cases) of 632 patients with hypospadias. There was significant difference and a positive correlation among the type of hypospadias with total malformations, penoscrotal transposition, cryptorchidism. Conclusions In this patient cohort, moderate and severe hypospadias accounted for the majority of hypospadias. Penoscrotal transposition was the most frequent external genital system malformation in hypospadias, followed by cryptorchidism and hydrocele of tunics vaginalis. More severe hypospadias is accompanied with a higher probability of the external genital system malformations, penoscrotal transposition and cryptorchidism.

Objective:To compare the differences in distribution and prognosis of cervical cancer patients in the 2009 and 2018 editions of International Federation of Gynecology and Obstetrics (FIGO) staging, and to analyze the prognostic factors of cervical cancer patients.Methods:The clinical data of 524 cervical cancer patients admitted to the First Affiliated Hospital of Soochow University from January 2010 to December 2018 were retrospectively analyzed. The cases were staged according to the 2009 and 2018 FIGO staging, and the Kendall τb coefficient was calculated to compare the consistency of the distribution of the two stages. Kaplan-Meier was used for survival analysis, and log-rank test was used to test the difference of prognosis in each stage. Cox-regression was used to analyze the prognostic factors of cervical cancer patients.Results:In the 2009 FIGO edition of staging, 1 case of stage ⅠB1 was reduced to stage ⅠA1 due to the microscopic infiltration depth <5 mm, 51 cases of stage ⅠB1 were raised to stage ⅠB2 due to 2 cm4 cm. A total of 119 cases raised to stage ⅢC1 due to pelvic lymph node metastasis, and 11 cases raised to stage ⅢC2 due to para-aortic lymph node metastasis. The distribution of cases in the two stages was consistent (τb=0.61, P<0.001). There were statistically significant differences in overall survival (OS) ( χ2=107.13, P<0.001; χ2=93.02, P<0.001; χ2=92.74, P<0.001) and progression-free survival (PFS) ( χ2=91.95, P<0.001; χ2=77.69, P<0.001; χ2=73.27, P<0.001) among patients with different stages of FIGO in 2018 (ⅠA, ⅠB, Ⅱ, ⅢA, ⅢB, ⅢC1, ⅢC2, Ⅳ) and 2009 (ⅠA, ⅠB, Ⅱ, ⅢA, ⅢB, Ⅳ) and patients with different T stages (T 1, T 2, T 3, T 4). There were statistically significant differences in OS ( χ2=20.71, P<0.001) and PFS ( χ2=24.25, P<0.001) in 2018 FIGOⅠB and ⅢC stages, and there was a statistically significant difference in OS between stage ⅢC1 and stage ⅠB2 ( χ2=6.18, P=0.013). Multivariate analysis showed that age ( HR=1.88, 95% CI: 1.08-3.28, P=0.026), pathological type ( HR=2.11, 95% CI: 1.04-4.27, P=0.038), lymph node metastasis ( HR=2.18, 95% CI: 1.34-3.56, P=0.002), parametrial spread ( HR=2.56, 95% CI: 1.52-4.29, P<0.001), maximum tumor diameter ( HR=1.98, 95% CI: 1.18-3.30, P=0.009), squamous cell carcinoma antigen (SCCA) positive after treatment ( HR=4.49, 95% CI: 2.09-9.68, P<0.001) and Hemoglobin (HB) level before treatment ( HR=0.58, 95% CI: 0.35-0.96, P=0.035) were independent risk factors for OS in patients with cervical cancer. According to the 2018 FIGO stage, the 5-year OS rates of patients with stage ⅠB1, ⅠB2, ⅠB3 were 100%, 97.1% and 87.9% respectively, with a statistically significant difference ( χ2=7.79, P=0.020), and there was a statistically significant difference between stage ⅠB1 and ⅠB3 ( χ2=5.55, P=0.019). According to the 2009 FIGO stage, the 5-year OS rates of patients with stage ⅠB1 and ⅠB2 were 95.7% and 84.3% respectively, with a statistically significant difference ( χ2=9.08, P=0.003). For patients with 2018 FIGO stage ⅠB, SCCA positive after treatment ( HR=1 172.50, 95% CI: 10.37-132 554.51, P=0.003) was an independent risk factor for OS, and differentiation degree ( HR=0.09, 95% CI: 0.01-0.81, P=0.032), treatment method ( HR=0.17, 95% CI: 0.04-0.71, P=0.015) and SCCA positive after treatment ( HR=190.68, 95% CI: 14.27-2 547.67, P<0.001) were independent risk factors for PFS. For patients with 2018 FIGO stage ⅠB, stage ( HR=9.56, 95% CI: 2.38-38.32, P=0.001), SCCA positive after treatment ( HR=126.32, 95% CI: 12.36-1 290.60, P<0.001) and lymph node metastasis ( HR=20.07, 95% CI: 3.63-111.11, P=0.001) were independent risk factors for OS, and differentiation degree ( HR=0.11, 95% CI: 0.02-0.63, P=0.013), treatment method ( HR=0.22, 95% CI: 0.06-0.75, P=0.015) and SCCA positive after treatment ( HR=43.83, 95% CI: 7.94-241.84, P<0.001) were independent risk factors for PFS. According to the 2018 FIGO stage, the 5-year OS rates of patients with stage ⅡA and ⅡB were 95.7% and 75.6% respectively, with a statistically significant difference ( χ2=13.96, P<0.001). The 5-year PFS rates of patients with stage ⅡA and ⅡB were 83.1% and 67.1% respectively, with a statistically significant difference ( χ2=7.61, P=0.006). According to the 2009 FIGO stage, the 5-year OS rates of patients with stage ⅡA and ⅡB were 90.9% and 75.0% respectively, with a statistically significant difference ( χ2=8.85, P=0.003). The 5-year PFS rates of patients with stage ⅡA and ⅡB were 75.7% and 66.7% respectively, with a statistically significant difference ( χ2=4.07, P=0.044). For patients with 2018 FIGO stage Ⅱ, pathological type ( HR=20.28, 95% CI: 2.93-140.32, P=0.002) and stage ( HR=4.35, 95% CI: 1.02-18.55, P=0.047) were independent risks factors for OS. For patients with 2009 FIGO stage Ⅱ, pathological type ( HR=5.82, 95% CI: 1.62-20.94, P=0.007) was an independent risk factor for OS, and pathological type ( HR=3.09, 95% CI: 1.22-7.85, P=0.017) and lymph node metastasis ( HR=2.07, 95% CI: 1.22-3.51, P=0.007) were independent risk factors for PFS. For patients with 2018 FIGO stage Ⅲ, maximum tumor diameter ( HR=3.31, 95% CI: 1.45-7.56, P=0.005) and SCCA positive after treatment ( HR=4.67, 95% CI: 1.22-17.86, P=0.024) were independent risk factors for OS, and pathological type ( HR=4.15, 95% CI: 1.47-11.77, P=0.007) and SCCA positive after treatment ( HR=3.96, 95% CI: 1.45-10.86, P=0.007) were independent risk factors for PFS. Conclusion:The 2018 and 2009 FIGO staging have a good distribution consistency in the cervical cancer patients, and the 2018 FIGO stage ⅠB has more advantages in judging the prognosis, but stage ⅢC cannot accurately judge the prognosis. Lymph node metastasis and maximum tumor diameter are more important prognostic factors.