Objective To study the inhibition of growth and induction of differentiation of mouse B16 melanoma by acitretin and their mechanism.Methods Animal models of B16 melanoma were established by subcutaneously inoculation of cultured B16 cells into the right axilla of mice.All mice were divided into 5 groups,negative control group treated with peanut oil,low-dose acitretin group treated with acitretin 10 mg per kilogram of body weight per day,high-dose acitretin group treated with 20 mg per kilogram body weight per day,cisplatin group treated with cisplatin 10 mg per kilogram body weight,combination group treated with acitretin 20 mg per kilogram body weight per day plus cisplatin 10 mg per kilogram body weight.Acitretin was given daily via intragastric administration.and cisplatin was given with an interval of 7 days,from day 2 till day 22 after the inoculation.The growth of transplanted tumor was measured with an interval of 3 days.After drug withdrawal,mice were killed,transplanted tumors were obtained for the measurement of tumor weight,pathological examination and immunohistochemical staining for survivin,Fas and vascular endothelial growth factor(VEGF).Results Acitretin could significantly inhibit the growth of B16 melanoma,the average weight and volume of transplanted tumor in the treated groups were significantly lower than those in the negative control group(all P＜0.01).Pathological examination revealed that in the control group,tumor cells showed typical heteromorphism,and closely arranged with an obscure boundary,whereas in the treated groups,a massive or focal necrosis at different levels was observed in the center and margin of tumor tissue.The relative expression levels of suvivin,VEGF and Fas protein were 3.600±0.966,4.600±0.966,4.300±0.949 respectively,in high-dose acitretin group,2.100±0.568,2.400±0.516,5.900±0.730 respectively,in combination group,5.900±1.370,6.100 ±1.1 97,2.1 00±0.568,respectively,in the negative control group,and a significant decrease was observed in the expression of suvivin and VEGF in the former two groups along with an increase in Fas expression compared with the negative control group(all P＜0.01).Additionally,in all the treated mice,the expression of survivin was negatively correlated to that of Fas(rs=-0.77,P＜0.01),but positively to that of VEGF (rs=0.72,P＜0.01).Conclusions Acitretin can obviously inhibit the growth and induce the differentiation of B16 melanoma,which may be associated with its downregulation of survivin and VEGF expression as well as the upregulation of Fas expression.

The incidence of inflammatory myofibroblastic sarcoma is low, and bladder origin is more rare. We reported a 58-year-old patient with painless gross hematuria for one week. Total abdominal CT examination showed soft tissue mass in the anterior wall of the bladder, which was considered as bladder cancer, and bladder tumor resection was performed. Postoperative pathology showed inflammatory myofibroblastic sarcoma. Therefore, radical cystectomy was performed because of the high degree of malignancy. There was no recurrence during 3 years follow-up.

Objective To investigate the clinical manifestations, genetic basis and related literatures of Boucher-Neuh(a)user syndrome(BNS), hoping to help physicians recognize this rare disease. Methods A 25-year-old BNS patient was reported.The clinical manifestations and the laboratory data including fundus examination, blood testing, brain MRI and genetic data were summarized.The related literatures were also reviewed.Results The patient presented with tremors, ataxia, secondary sexual characteristics dysplasia,epilepsy, and then got worse progressively.Brain MRI showed severe cerebellar atrophy.Two mutations of PNPLA6 gene were found: one is the heterozygous mutation c.1811C >T (p.A604V),which has not been reported;another is c.2990C>T(p.S997L),which has been reported as a pathogenic mutation related to BNS.Conclusion PNPLA6-related BNS may be considered for adolescent patients with tremor and ataxia,secondary sexual characteristics dysplasia and epilepsy.

Objective:To analyze the clinical effects of the pre-expanded internal mammary artery perforator flap in large chest keloids surgical treatment.Methods:Patients with large chest keloid were treated with the pre-expanded internal mammary artery perforator flap between January 2017 and September 2021. The surgical treatment was divided into two different phases. In the first phase, a tissue expander was implanted beneath the skin within the angiosome of the internal mammary artery perforator. The expander was injected with normal saline once a week. In the second phase, the expander and the keloid tissue were removed, and a pre-expanded internal mammary artery perforator flap was designed to cover the wound. Radiotherapy and hyperbaric oxygen therapy were performed in the postoperative period. The treatment effect was followed up. The postoperative complications were analyzed, and the recurrence and patient satisfaction rates were recorded.Results:A total of 41 patients were enrolled, including 20 male and 21 female patients. The patients’ age ranged from 24 to 64, with a mean disease history of 11.9 years. The mean size of the keloid was 9 cm × 8 cm. Some patients were treated with one expander, but four expanders were needed in some extensive cases. The volume of the expander ranged from 80 to 600 ml. The mean volume was 300 ml, with a mean expansion time of 3 months. The mean flap size was 9 cm × 8 cm. Two cases with distal necrosis were observed. Five cases suffered from partial incision scar hyperplasia. No recurrence occurred during the followed-up period. Thirty-six patients (87.8%) were satisfied with the operation effect, and five (12.2%) thought the effect was acceptable.Conclusions:The pre-expanded internal mammary artery perforator flap is an effective treatment for the large chest keloid. It can provide sufficient skin tissue for wound repair, with a stable blood supply and an excellent curative effect.

Objective:To analyze the clinical effects of the pre-expanded internal mammary artery perforator flap in large chest keloids surgical treatment.Methods:Patients with large chest keloid were treated with the pre-expanded internal mammary artery perforator flap between January 2017 and September 2021. The surgical treatment was divided into two different phases. In the first phase, a tissue expander was implanted beneath the skin within the angiosome of the internal mammary artery perforator. The expander was injected with normal saline once a week. In the second phase, the expander and the keloid tissue were removed, and a pre-expanded internal mammary artery perforator flap was designed to cover the wound. Radiotherapy and hyperbaric oxygen therapy were performed in the postoperative period. The treatment effect was followed up. The postoperative complications were analyzed, and the recurrence and patient satisfaction rates were recorded.Results:A total of 41 patients were enrolled, including 20 male and 21 female patients. The patients’ age ranged from 24 to 64, with a mean disease history of 11.9 years. The mean size of the keloid was 9 cm × 8 cm. Some patients were treated with one expander, but four expanders were needed in some extensive cases. The volume of the expander ranged from 80 to 600 ml. The mean volume was 300 ml, with a mean expansion time of 3 months. The mean flap size was 9 cm × 8 cm. Two cases with distal necrosis were observed. Five cases suffered from partial incision scar hyperplasia. No recurrence occurred during the followed-up period. Thirty-six patients (87.8%) were satisfied with the operation effect, and five (12.2%) thought the effect was acceptable.Conclusions:The pre-expanded internal mammary artery perforator flap is an effective treatment for the large chest keloid. It can provide sufficient skin tissue for wound repair, with a stable blood supply and an excellent curative effect.