OBJECTIVETo introduce the application of pedicled anterolateral thigh (ALT) flap for total penile reconstruction and to investigate its feasibility and effect.

METHODSFrom May 2011 to May 2015, 12 male patients presented with absence of the penis or congenital malformation received phalloplasty with the pedicled ALT flap. Of them, the median age was 35 years old (range, 20-57 years). The size of the flaps ranged from 11 cm x 11 cm to 12 cm x 15 cm. 8 patients underwent urethra reconstruction with tube-in-tube flaps and other 4 patients with scrotal septal flaps. In this series, we performed one-stage urethral anastomosis in 4 cases and second-stage urethral anastomosis 6 months after the phalloplasty in 8 cases.

RESULTSAn acceptable reconstructed phallus was achieved in 10 patients. These flaps were primarily healed with satisfactory functional and cosmetic results. The reconstructed penis was completely necrosis because of the flap failure in one case. The distal half of the phallus was lost due to infection in one case. Both of them were treated with pedicled ALT flap from the other side. Reliable results were achieved. At a median follow-up of 1.5 year (range 1 to 4 years), 9 patients (90%) were fully satisfied with phallic cosmesis and size, and 4 patients who was married had successful sexual intercourse. 8 patients had normal urinate function. Fistula was developed in 2 patients (20%) which was treated with delayed repair at 6-12 months with local scrotal flaps.

CONCLUSIONSThe pedicled ALT flap can be simply used to reconstruct an entire penis as well as a urethra. It has several advantages including a less conspicuous donor site, greater bulk, better color match and no necessary for microsurgery.

Adult ; Anastomosis, Surgical ; methods ; Coitus ; Feasibility Studies ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Necrosis ; etiology ; Penis ; abnormalities ; surgery ; Reconstructive Surgical Procedures ; methods ; Scrotum ; Surgical Flaps ; pathology ; transplantation ; Thigh ; Time Factors ; Urethra ; surgery ; Young Adult

Objective To investigate the effects of c?myc promoter binding protein 1(MBP?1)gene on the proliferation of human Saos?2 osteo?sarcoma cells in vitro. Methods Saos?2 cells were divided into three groups:blank control group(untransfected cells),negative group(cells transfected with missense sequence)and experimental group(cells transfected with MBP?1 shRNA). Two MBP?1 shRNA sequences and one neg?ative control shRNA sequence were designed ,synthesized and cloned into pSIREN?retroQ plasma. Then the recombinant plasmids were construct?ed and transfected into human Saos?2 osteosarcoma cells by Lipofectamine 2000. The expressions of MBP?1 mRNA and protein in Saos?2 cells were detected by real?time PCR and Western blot ,respectively. The effects of altered expression of MBP?1 on cell proliferation were measured by CCK?8 cell proliferation assay. The expressions of cyclin D1 and cyclin E in Saos?2 were determined by Western blot. Results PCR and sequenc?ing results indicated that the recombinant plasmids pSIREN?retroQ was constructed. The relative expression level of MBP?1 mRNA in the MBP?1 siRNA transfection group was significantly decreased than that in blank control group(P<0.05). Compared with the blank control group,the ex?pression levels of MBP?1 protein in the experimental group also significantly decreased. The proliferation abilities of Saos?2 cells at 48,72,and 96 hours after MBP?1 siRNA transfection were significantly increased than those in the blank control group(P<0.05). Compared with the blank con?trol group,the expression levels of cyclin D1 and cyclin E protein in the experimental group also significantly increased(P<0.05). Conclusion Knockdown of the expression of MBP?1 gene promotes the proliferation of human Saos?2 osteosarcoma cells. MBP?1 gene may become the new tar?get of gene therapy for osteosarcoma.

OBJECTIVETo discuss the methods for urethral external meatus and glanuloplasty after correction of hypospadias.

METHODSThe V shape flap on the dorsal side of glan, combined with the bilateral glan flaps were moved to the ventral side. The flap at the ventral side of urethral external meatus was turned over. Then the urethral external meatus was repositioned to the top end of glan with the ventral defects covered by the dorsal flaps. Then the coniform glan was reconstructed.

RESULTSFrom January 2008 to December 2013, 28 cases were treated, including glandular hypospadias, postoperative retraction of external urethral meatus and meatal stenosis. 21 patients were followed up for 1 -12 months (average, 1 month) with marked improvement of glan appearance and retraction of external meatus. No meatal stenosis happened.

CONCLUSIONSPostoperative retraction of urethral external meatus and meatal stenosis can be corrected by V shape flap on the dorsal side of glan combined with the bilateral glan flaps. The flat appearance of glan can be improved. It is an ideal method for glandular hypospadias.

Humans ; Hypospadias ; surgery ; Male ; Penis ; surgery ; Postoperative Complications ; surgery ; Postoperative Period ; Surgical Flaps ; Urethra ; surgery ; Urethral Stricture ; etiology ; surgery

OBJECTIVETo compare differences between Crowe IV developmental dysplasia of the hip (DDH) with secondary acetabulum and Crowe IV DDH without secondary acetabulum,and determine whether it is necessary to divide Crowe IV DDH into two subtypes.

METHODSFrom June 2007 to May 2015,145 hips of 112 Crowe N patients who underwent total hip arthroplasty (THA) using S-ROM stem were divided into two groups: secondary acetabulum formaton group (group A) and no secondary acetabulum formaton group (group B). In group A,there were 12 females, 96 males,with an average age of (39.38 ± 11.19) years old. In group B, there were 2 females, 35 males, with an average age of (38.19 ± 10.92) years old. All the patients were evaluated by using Harris Hip Score. Radiographic evaluations were made preoperatively and during follow up. The differences between two groups were compared on dislocation height, canal flare index (CFI), subtrochanteric shortening osteotomy (SSTO) usage, pre- and post-operation Harris scores, complications.

RESULTSThe dislocation height for group A was (4.74 ± 1.57) cm, while the dislocation height for group B was (3.12 ± 1.15) cm. Significantly difference was detected between two groups. The CFI for group A was 2.69 ± 0.68, while the CFI for group B was 3.42 ± 0.79, and the significantly difference was detected between two groups. Harris scores were totally improved from 58.18 ± 15.67 preoperatively to 91.20 ± 3.79 post-operatively and the difference was significant. Pre-operative Harris scores was 58.1 ± 15.3 in group A, 58.3 ± 16.9 in group B. Post-operative Harris scores was 91.0 ± 4.1 in group A, 91.0 ± 5.1 in group B. No significant difference was found on Harris scores between A and B preoperatively and post-operatively. Complications of 4 cases peri-prosthesis fracture, 4 cases dislocation and 4 cases nerve injury occur in group A; While only one case dislocation and one case nerve injury occur in group B. No statistical significance was detected.

CONCLUSIONCrowe IV DDH with secondary acetabulum is significantly different from Crowe IV DDH without secondary acetabulum on dislocation height and femoral morphology, which causes the different selections of surgical techniques (SSTO usage or not). These important differences in fundamental parameters indicate the necessity to further divide Crowe IV DDH into IVA and IVB two subtypes.

Adolescent ; Adult ; Aged ; Female ; Hip Dislocation, Congenital ; classification ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; therapy

OBJECTIVETo observe the expression of P-selectin (Ps), intercellular adhesion molecule-1 (ICAM-1) and nuclear factor-kappa B (NF-kappaB) in lung tissues of acute lung injury (ALI) rat model induced by oleic acid (OA) and to explore the protective effects of melatonin (MT) in lung tissues in rats.

METHODSAll rats were randomly divided into four groups: control group, OA group, MT + OA group and SB203580 + OA group. Rat model of ALI was established by intravenous injection of oleic acid (OA). Lung coefficient was measured, lung tissues were imbedded by paraffin to observe morphological changes and the expression of Ps, ICAM-1 and NF-kappaB in lung tissues by means of immunohistochemistry staining.

RESULTSCompared with control group, the lung coefficient increased significantly in OA group (P < 0.05). Alveolar septum thickened significantly in OA group, there had many infiltrated inflammatory cells and collapsed alveoli of lung; positive expression of Ps, ICAM-1 and NF-kappaB were very obvious (P < 0.05); the administration of MT and SB203580 mitigated above changes significantly (P < 0.05).

CONCLUSIONMT possesses obviously protective effect on lung tissues during ALI, its protective mechanism might be related to the inhibition of the expression of Ps, ICAM-1 and NF-kappaB.

Acute Lung Injury ; chemically induced ; physiopathology ; prevention & control ; Animals ; Down-Regulation ; drug effects ; Intercellular Adhesion Molecule-1 ; metabolism ; Male ; Melatonin ; pharmacology ; therapeutic use ; NF-kappa B ; metabolism ; Oleic Acid ; adverse effects ; P-Selectin ; metabolism ; Protective Agents ; pharmacology ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo review our experience in surgical management of proximal anterior cerebral artery (A1) aneurysms in 23 patients.

METHODSBetween January, 2004 and December, 2014, 23 patients (1.6%) with A1 aneurysms diagnosed by CTA or DSA were treated surgically. The "3H" therapy was adopted for postoperative prevention of cerebrovascular spasm. All the patients were followed up and examined with cerebrovascular CTA at 6, 12, 48 and 60 months after the operation with their Glasgow Outcome Scale score recorded.

RESULTSThe patients consisted of 15 men and 8 women with an age range of 16 to 72 years (mean 51.3 years). The average diameter of the aneurysms was 5.8 mm, ranging from 3.2 to 9.7 mm. Twenty-two saccular aneurysms were found in these patients; 21 patients presented with SAH and two had vascular malformation. All the A1 aneurysms were managed through the pterional approach, and the mean postoperative Glasgow Outcome Scale score was 4.8.

CONCLUSIONThorough analysis of the angiographic data is essential for the diagnosis and treatment of A1 aneurysms. Preservation of the perforators and prevention of aneurysm rupture are critical during the surgery. Full exposure of the Sylvian fissure and temporary occlusion of the parent artery ensures safe and effective dissection of A1 aneurysms.

OBJECTIVETo evaluate the effect of micronutrients on the immune status of human immunodeficiency virus (HIV)-positive individuals.

METHODSTotally 102 HIV-positive individuals were randomly divided into supplementation group (received micronutrients supplement) and control group (received placebo). Physical examinations were performed at baseline and at the end of the trial. Immune status were determined in both two groups.

RESULTSAge, height, weight, and sex ratio were not significantly different between two groups (all P>0.05). Baseline CD3+, CD4+, and CD8+ T lymphocytes and IgA, IgG, IgM, C3 levels were not significantly different between two groups (all P>0.05), while the levels of CD3+, CD4+, and CD8+ T lymphocytes and IgA, IgG, IgM, C3 were significantly higher in supplementation group than in control group(all P0.05).

CONCLUSIONSupplementation of micronutrients can improve the immune status of HIV-positives individuals.

Adult ; Dietary Supplements ; HIV Infections ; drug therapy ; immunology ; Humans ; Micronutrients ; therapeutic use ; Middle Aged

OBJECTIVETo investigate the application of pedicled expanded flaps for the reconstruction of facial soft tissue defects.

METHODSThe expanded skin flaps, pedicled with orbicularis oculi muscle, submental artery, the branch of facial artery, superficial temporal artery, interior upper arm artery, had similar texture and color as facial soft tissue. The pedicled expanded flaps have repaired the facial soft tissue defects.

RESULTSBetween Jan. 2003 to Dec. 2013, 157 cases with facial soft tissue defects were reconstructed by pedicled expanded flaps. Epidermal necrosis happened at the distal end of 8 expanded flaps, pedicled with interior upper arm artery(4 cases), orbicularis oculi muscle(3 cases) and submental artery(1 case), which healed spontaneously after dressing. All the other flaps survived completely with similar color and inconspicuous scar. 112 cases were followed up for 8 months to 8 years. Satisfactory results were achieved in 75 cases. 37 cases with hypertrophic scar at incisions need secondary operation.

CONCLUSIONSIsland pedicled expanded flap with similar texture and color as facial soft tissue is suitable for facial soft tissue defects. The facial extra-incision and large dog-ear deformity could be avoided.

Cicatrix, Hypertrophic ; surgery ; Eyelids ; Face ; surgery ; Facial Muscles ; Humans ; Reconstructive Surgical Procedures ; Skin Pigmentation ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply

OBJECTIVETo compare the effect of three methods for penile reconstruction.

METHODSFrom Sept. 2000 to Dec. 2012, penile reconstruction was performed in 48 cases with free scapular flap transplantation, or pedicled superficial circumflex iliac artery skin flap, or anterolateral thigh skin flap pedicled with lateral circumflex femoral artery. The flaps were 12.0-14.5 cm in length, 10-12 cm in width and the urethra perimeter was about 2-3 cm.

RESULTSFree scapular flaps were used in 21 cases, with flap failure in 3 cases due to insufficient blood supply. Malleable penile prosthesis was implanted in 11 cases, which was exposed in 3 cases. Groin skin flaps were used in 21 cases, with flap failure in 8 cases due to insufficient blood supply. Malleable penile prostheses were implanted in 7 cases, which was exposed in 3 cases. Anterolateral thigh skin flaps were used in 6 cases, with flap failure in 2 cases due to necrosis and infection. No prosthesis was implanted in this group. All the failure cases underwent secondary reconstruction with successful results. 37 cases were followed up for 1-6 years, avevage 2.5 years. 26 cases were satisfied with the results of appearance and function.

CONCLUSIONSAmong these three methods, the free scapular flap is most recommended for its high survival rate, low complication rate and high patient satisfaction.

Adolescent ; Adult ; Humans ; Male ; Middle Aged ; Penis ; surgery ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Surgical Flaps ; Treatment Outcome ; Young Adult

BACKGROUND AND OBJECTIVENasopharyngeal carcinoma (NPC) is known for its propensity for distant metastases. Lung metastasis is one of the most important causes of death for patients with NPC. Solitary metastatic lung tumor from NPC is a distinctive group associated with a better survival. This study was to find a more effective treatment modality and prognostic factors for the group.

METHODSClinical data of 105 cases of solitary metastatic lung tumor from NPC were retrospectively analyzed. Survival rate was calculated by the Kaplan-Meier method. The difference of survival between the patients treated by different modalities was evaluated by the log-rank test. The Cox univariate and multivariate analyses of gender, age, pathologic type, stage, adjuvant chemotherapy, evaluation of treatment for NPC, disease-free interval, size of metastatic tumor, pulmonary hilar and/or mediastinal lymph node metastasis, treatment modalities, recurrent distant metastases and/or relapse of NPC were conducted.

RESULTSThe local control rate was 53.8% in chemotherapy group, 88.0% in radiotherapy ± chemotherapy group, and 96.4% in operation ± chemotherapy group (P < 0.01). The most promising progression-free survival (PFS) and overall survival (OS) were obtained with operation ± chemotherapy and followed by radiotherapy ± chemotherapy. Both of them showed much better efficacy than chemotherapy (P < 0.001). The Cox multivariate analysis showed that recurrent distant metastases and/or relapse of NPC affected the survival (OR = 2.087, 95% CI = 1.277-3.410, P = 0.003). The T stage of NPC, size of metastatic tumor, hilar and/or mediastinal lymph node metastasis, and the treatment modality were independent prognostic factors.

CONCLUSIONSOperation ± chemotherapy and radiotherapy ± chemotherapy are better treatment of solitary metastatic lung tumor from NPC, which could improve the local control and prolong the PFS and OS. Chemotherapy is recommended for patients with higher T stage of NPC, size of metastatic tumor ≥ 3 cm, pulmonary hilar and/or mediastinal lymph node metastasis.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Squamous Cell ; secondary ; therapy ; Combined Modality Therapy ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Lung Neoplasms ; secondary ; therapy ; Lymphatic Metastasis ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; pathology ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Pneumonectomy ; methods ; Radiotherapy, High-Energy ; Remission Induction ; Retrospective Studies ; Survival Rate ; Young Adult