Objective:To investigate the correlation between the expression of GLI1 and im-mune invasion and clinical prognosis in gastric cancer.To study the effect of GLI1 expression on drug resistance in gastric cancer.Methods:The expression difference of GLI1 in gastric cancer and normal tissues was analyzed by using TCGA database,and the effect of clinical features and GLI1 gene ex-pression level on prognosis of patients with gastric cancer was analyzed.The correlation between GLI1 gene expression and tumor immune cell infiltration in gastric cancer tissues was analyzed to explore its influence on drug resistance of chemotherapy drugs and targeted drugs.Clinical samples were collect-ed to analyze the difference of GLI1 expression in gastric cancer and paracancer tissues.Results:The expression of GLI1 in gastric cancer tissues was 1.7 times that in normal tissues,and the overall sur-vival and disease-free survival of patients with high expression are shorter than those with low ex-pression(P＜0.05).The interstitial score,immune score and abundance of immunoinfiltrating cells were higher in the high expression of GLI1 in gastric cancer tissues.High expression of GLI1 reduces drug sensitivity and is positively correlated with the expression of immune checkpoint markers PDCD1(P＜0.05).GLI1 expression was significantly increased in patients with subdifferentiated gastric cancer.Conclusions:GLI1 expression is associated with the prognosis and immune infiltration of patients with gastric cancer,and it may lead to poor prognosis of patients by regulating chemotherapy resis-tance,which may be a potential therapeutic target and molecular marker for gastric cancer.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

BACKGROUNDGigantomastia is the overdevelopment of the female mammary gland, and it causes great physiological and psychological burdens to patients. A better understanding of the molecular mechanisms involved in gigantomastia is needed to develop less invasive and more effective medical treatments. MicroRNA (miRNA) is a class of small noncoding RNAs that play an important regulatory role at the post-transcriptional level. These miRNAs are known to be involved in many diseases, including breast cancer; however, the relationship between miRNA and gigantomastia is largely unknown.

METHODSWhole genome-wide expression of miRNA and mRNA in gigantomastia was detected using microarray and functional annotation was performed based on the altered expression of miRNAs and mRNAs.

RESULTSWe found many miRNAs and mRNAs to be significantly differentially expressed in gigantomastia compared with normal breast tissues. Functional annotation analysis indicated that APK, Wnt, and Neurotrophin signaling pathways may participate in gigantomastia.

CONCLUSIONThis study addresses the need for better diagnosis and treatment of gigantomastia by providing new insight into the molecular mechanisms underlying this disease.

Adult ; Breast ; abnormalities ; Female ; Gene Expression Profiling ; methods ; Humans ; Hypertrophy ; genetics ; Male ; MicroRNAs ; genetics ; RNA, Messenger ; genetics

OBJECTIVETo establish a standard method for digital evaluation of breast symmetry with 3D scanning technique.

METHODSFrom January 2009 to July 2010, 167 patients received 3D scanning before breast augmentation. The coordinate system was established and the 3D reconstructed breast models were analyzed by software. The discrepancy of nipple level, the distance between nipple to midline, inferior mammary fold location, breast width, breast projection, breast volume and anterior chest wall projection were measured.

RESULTSThe mean discrepancy of nipple level, the distance between nipple to midline, IMF level, breast width, breast projection and anterior chest wall projection were (4. 8 +/- 3.9) mm, (4.5 +/- 3.4) mm, (4.6 +/- 3.7) mm, (4.8 +/- 2.9) mm, (5.4 +/- 3.9) mm and (4.8 +/- 3.3) mm, respectively. The mean difference of breast volume was (51 +/- 44) ml. The incidence of significant asymmetry was 73% (122/167)in nipple position, 95% (159/167)in breast shape, 38% (63/167)in anterior chest wall projection.

CONCLUSIONS3D scanning technique can provide an accurate 3D measurement of breast. A thorough and objective evaluation of breast symmetry can be achieved.

Adult ; Breast ; anatomy & histology ; Female ; Humans ; Imaging, Three-Dimensional ; Mammaplasty ; Middle Aged ; Software ; Young Adult

OBJECTIVETo investigate the significance of preoperative MDCT angiography for breast reconstruction with abdominal flap.

METHODSPreoperative MDCT angiography scans were performed on 34 patients who underwent breast reconstruction with abdominal flaps during December 2006 to June 2009. The operation was designed based on the MDCT results. Then the MDCT results were proved intraoperatively. Another 22 cases who underwent breast reconstruction with abdominal flap without preoperative MDCT were selected as controls. The rate of operative method change, the operation time and the flap necrosis were compared between the two groups.

RESULTSThe preoperative design changed in 23.53% of the patients, based on the MDCT results. No one had any method change intraoperatively in the group with MDCT. The operative method was changed intraoperatively in 13.64% of the patients in the control group. The mean time spending on flap harvesting was (2.51 +/- 0.64) h in the experimental group and (4.42 +/- 0.21) h in the controlled group (P < 0.05). The rate of complication was 6.12% in the experimental group and 12.5% in the control group (P = 0.017).

CONCLUSIONSPreoperative MDCT angiography is an easy and reliable method for breast reconstruction with abdominal flap. The preoperative design can be more reasonable. It helps to save the operation time and reduce the risk.

Adult ; Angiography ; methods ; Epigastric Arteries ; diagnostic imaging ; Female ; Humans ; Mammaplasty ; methods ; Preoperative Care ; Surgical Flaps ; blood supply ; Tomography, Spiral Computed

OBJECTIVETo introduce the clinical experience of nipple-areolar reconstruction with the modified arrow flap.

METHODSThe arrow flaps were modified for nipple-areolar reconstruction in 12 cases. Among them, 2 cases were treated with combined thin split-thickness skin graft; 4 cases with autologous rib implant and tattoo; 6 cases with tattoo.

RESULTSAll the reconstructed nipples were survived. The reconstructed nipples lost projection 1 month after operation in 2 cases. The other 10 cases retained 50% of the nipple projection 3 months after operation. The results were maintained with satisfactory symmetry during the follow-up period of 6 months to one year.

CONCLUSIONSThe modified flap is easily performed with reasonable design and no need of donor site. The nipple projection can be maintained with good long-term effect.

Adult ; Female ; Humans ; Mammaplasty ; methods ; Middle Aged ; Nipples ; surgery ; Skin Transplantation ; Surgical Flaps

OBJECTIVETo investigate the technique of repeated operation for removement of polyacrylamide hydrogel from breast.

METHODS17 cases after uncomplete removement of PHG were reoperated through inferior periareolar incision. The PHG and affected denatured muscle and gland tissue were removed.

RESULTSPreoperative MRI or CT showed PHG distributed diffusely in muscle and gland. There was only minimal residual PHG after operation. Histological examination showed PHG distributed in the denatured and proliferative fibrous tissue, including giant cells, many neutrophilic cells infiltration, and foreign body granuloma. The symptoms, such as intramammary pump or nodule, chest and back pain, infection, were relieved after operation.

CONCLUSIONSBlinded suction technique can not remove PHG completely and can also result in malposition of PHG and make the tissue denaturation worse. We suggest open approach to remove the PHG and denatured tissue completely through periareolar incision.

Acrylic Resins ; Adult ; Breast Implants ; Device Removal ; methods ; Female ; Humans ; Mammaplasty ; instrumentation ; Middle Aged ; Young Adult

OBJECTIVETo discuss the complications of breast augmentation with injected polyacrylamide hydrophilic gel (PAHG) in order to avoid further injury by taking treatment at the right moment.

METHODS90 patients with some side-effects after breast augmentation with injected polyacrylamide hydrophilic gel had been undergone the treatment in our hospital from 1999 to 2006. Their clinical data were analyzed.

RESULTSThe major complaints of the patients were feeling pain, multiple indurations, secondary deformity, PAHG displacement, low-grade fever of unknown reason, limitation of upper limb activity, spillage of milk and blood, ulceration and sinus tract of breast, inversion of nipple, infection. All patients were treated by surgical operations to remove the injected PAHG.

CONCLUSIONSThe complications are might not only related to the injected material but also caused by incorrect manipulation during operation. To do suction several times may cause the injected material distributed diffusely and the tissue was badly injured. Operation can remove the PAHG as completely as possible. It is a better treatment for the complications of PAHG injection for augmentation mammaplasty.

Acrylic Resins ; adverse effects ; Adolescent ; Adult ; Breast Implantation ; adverse effects ; Breast Implants ; adverse effects ; Female ; Humans ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Young Adult

OBJECTIVETo evaluate breast reconstruction with a combined skin flap of the deep inferior epigastric perforator (DIEP) and the transverse rectus abdominis musculocutaneous (TRAM).

METHODSThe DIEP and TRAM united flap was elevated with the vessel pedicle of the deep inferior epigastric perforator on the affected side and the rectus abdominis muscle pedicle on the intact side. The reconstructive breast was shaped after the deep inferior epigastric vessels were anastomosed to the internal mammary vessels or the thoracodorsal vessels ipsilaterally.

RESULTSWe have used the DIEP and TRAM united flaps for breast reconstruction in 17 cases. All of the flaps survived, and the reconstructed breasts were well-shaped with the follow-up of 6-18 months.

CONCLUSIONSThe DIEP and TRAM united flap possesses of advantages such as rich blood supply, abundant tissue volume and easy shaping. It is especially applicable to the cases who have large chest defect and need large volume tissue.

Adult ; Epigastric Arteries ; transplantation ; Female ; Humans ; Mammaplasty ; methods ; Middle Aged ; Rectus Abdominis ; transplantation ; Skin Transplantation ; Surgical Flaps ; blood supply

OBJECTIVETo find anatomic basis for clinically modifying technique of harvesting superior and inferior gluteal artery perforator flap, in order to avoid muscle lossing in conventional superior and inferior myocutaneous flaps, keep the advantage such as large rich supplied volume soft tissue.

METHODS5 cases 10 sides adult cadaver were used to study the numbers, position, Course of superior and inferior gluteal artery perforators. The position of perforators was located by ultrasound Doppler in 6 cases and 12 sides in patient's superior and inferior gluteal area.

RESULTSSuperior and inferior gluteal artery originated from internal iliac artery. Several main perforators of large caliber were found in the paraischia and central portions of the gluteal muscle, its number was 10 - 15. The length of the vessels varies from 3 to 8 cm and their diameter from 1 - 1.5 mm. These significant perforators pass through the muscle itself and the fascial portion of the muscle to the overlying skin on the gluteal region. The dorsal branches of nervorum lumbalium perforate the deep fascia just above the iliac crest, lateral to the posterior superior iliac spine. If a nerve branch with a substantial diameter crosses the incision line, the nerve can be harvested within the flap. This nerve can be anastomosed to the anterior ramus of the lateral branch of the 4th intercostals nerve. In adult female, 3 - 5 perforators were located by ultrasound Doppler. They distributed in the triangle area among posterior superior iliac crest, the great trochanter and the coccyx.

CONCLUSIONSThe area and diameter of perforators of superior gluteal artery were relatively confirmed. It's possible to harvest the perforator flap without any muscle. It has the advantage of conventional myocutaneous flap with out of its disadvantages. It's easy to detect those perforator by ultrasound Doppler clinically. The nerve can be harvested and anastomosed simultaneously. Because the inferior gluteal area is a weight loading area, we suggested to use superior gluteal artery perforator flap. This flap can be transferred pedicled to treat sacral pressure sores or to be transferred freely for the breast reconstruction.

Adult ; Arteries ; anatomy & histology ; Buttocks ; blood supply ; innervation ; Female ; Humans ; Male ; Skin Transplantation ; Surgical Flaps ; blood supply ; innervation