Objective： To discuss the suitable immediate breast reconstruction modalities for Chinese patients by comparing the pedicled transverse rectus abdominis myocytaneous flap （TRAM） reconstruction with latissimus dorsi...Objective： To discuss the suitable immediate breast reconstruction modalities for Chinese patients by comparing the pedicled transverse rectus abdominis myocytaneous flap （TRAM） reconstruction with latissimus dorsi myocytaneous flap （LTD） reconstruction plus implants or not after mastectomy due to breast cancer. Methods： From Jan. 2000 to Jul. 2005, 74 staged 0-II patients （mean age 39） were performed immediate breast reconstruction with autologous tissue either using LTD flaps or pedicled TRAM flaps with supplemental implants when necessary after mastectomy due to breast cancer and the charts were reviewed. Results： The age, marriage and menses status did not affect the selection of modalities and the need of implants. In 74 patients, 62 cases （83.8%） were performed LTD reconstruction with 13 implants and 12 cases received TRAM with 1 implant. The difference in need of implants or not between the two modalities had no statistical significance （P=0.442, Fisher＇ exact test）. Aesthetic results judged as good or fair were in 88% patients and the cosmetic effects between LTD and TRAM groups or implant and non-implant groups had no differences. All reconstructions were successful, with 4.1% cumulative locoregional recurrence and 100% overall survival by following up to 66 months （median 9 months）. The DFS and RFS between the two modalities had no significant differences by log rank test. Conclusion： Immediate autologous tissue reconstruction makes it possible to regain the natural and symmetric contour of breast without increased local recurrence. The LTD flap reconstruction is a suitable option for most Chinese women as well as the pedicled TRAM flap.展开更多
Breast cancer(BC) in men represents between 0.5% and 1% of all BC diagnosed each year. We report a case of advanced BC in a 62-year-old male treated at our interdisciplinary Breast Cancer Center. The patient presented...Breast cancer(BC) in men represents between 0.5% and 1% of all BC diagnosed each year. We report a case of advanced BC in a 62-year-old male treated at our interdisciplinary Breast Cancer Center. The patient presented with a newly diagnosed large, symptomatic mass in his left breast. Clinical examination showed a not movable mass of 16 cm diameter, deforming the whole breast; the overlying skin was livid and hypervascularized. Enlarged lymph nodes were palpable in the axillary pit. He had no concomitant diseases at time of presentation. He denied any first- or second degree family medical history of cancer of any type and he never received radiotherapy. Ultrasound guided minimal-invasive 14-gauge core biopsy revealed a moderately differentiated encapsulated papillary carcinoma with high expression of estrogen and progesterone receptors(both > 80%, IRS 12) and HER2-negative. Because of the tumor size a mastectomy with axillary dissection and chest wall reconstruction using a latissimus dorsi flap was performed. Histological analysis showed invasive growth besides typical(non-invasive) papillary carcinoma and was classified as invasive solid papillary carcinoma; p T3(10 cm), p N0(0/15), M0,R0; Oncotype DX Recurrence Score indicated low risk(RS: 2). After discussion in the interdisciplinary tumor board meeting, radiation therapy and tamoxifen were recommended. The patient had an uneventful recovery and is disease-free after two years of follow-up. Male BC is typically diagnosed at an advanced stage, most likely due to a lack of awareness that men can develop BC. Therefore, in case of a large tumor, a flap-based thoracic reconstruction may be required.展开更多
Objective To investigate the utility of pre-expanded muscle-sparing latissimus dorsi flaps in the reconstruction of deformities secondary to severe scar contractures on the anterior chest.Methods The function of the l...Objective To investigate the utility of pre-expanded muscle-sparing latissimus dorsi flaps in the reconstruction of deformities secondary to severe scar contractures on the anterior chest.Methods The function of the latissimus dorsi was preserved with blood supply from the main or lateral branch of the thoracodorsal artery.The entire treatment period was divided into two stages,during which segmental latissimus dorsi flaps were pre-expanded in stage I and anterior chest scar deformities were reconstructed in stage II.During stage I,the musculocutaneous perforators arising from the lateral branch of the thoracodorsal artery were determined by ultrasound preoperatively;the flap design included the anterior segment of the latissimus dorsi supplied by the musculocutaneous perforators from the lateral branch;and a tissue expander was placed following flap dissection and then infused with saline intermittently for 4–6 months.In stage II,the chest scars were excised,and breast tissues were repositioned;the continuity of the medial branch of the thoracodorsal nerve to the muscle was preserved when reconstruction was performed using the segmental latissimus dorsi flaps supplied by the main or lateral branch of the thoracodorsal artery.Results From October 2010 to October 2019,21 patients(on 24 sides)underwent reconstructive procedures for extensive scar contractures on the anterior chest.All flaps survived,and their donor sites were sutured directly.During a follow-up of 3 months to 8 years,the flaps became soft and exhibited color similar to that of the adjacent tissues.The limited neck and shoulder movements improved,and postoperatively,all female patients were satisfied with the shape of their breasts.Additionally,neither apparent weakening on the adduction,internal rotation,or extension strength of the shoulder joint on the affected side nor marked depression deformity in the back was observed.Conclusion Pre-expanded muscle-sparing latissimus dorsi flaps with blood supply from the main or lateral branch of the thoracodorsal artery proved to be a desirable option for the reconstruction of extensive scar contractures on the anterior chest.展开更多
Objective: Bronchopleural fistula (BPF) is a life threatening complication after pneumonectomy. Extra thoracic skeletal muscle transposition especially latissimus dorsi muscle flap (LDMF) had been used to prevent this...Objective: Bronchopleural fistula (BPF) is a life threatening complication after pneumonectomy. Extra thoracic skeletal muscle transposition especially latissimus dorsi muscle flap (LDMF) had been used to prevent this complication. The aim of this study was to assess the effectiveness of LDMF in preventing BPF developing after extrapleural pneumonectomy (EPP) and external radiation therapy in malignant pleural mesothelioma (MPM). Methods: Between May 1999 and Dec. 2008, 37 patients with MPM were operated upon by EPP using LDMF prophylactically to reinforce the bronchial stump, and then received external radiation therapy with or without postoperative chemotherapy. Results: The mean age of all patients was 46.7 (range 26-57) years. Twenty five patients were males and 12 patients were females. Twenty three patients had MPM of the right side and 14 patients had MPM of the left side. The peri-operative mortality was 2.7% and only few flap related postoperative morbidity were reported in the form of minor seroma and subcutaneous surgical emphysema. The median follow up was 17 (range 9-43) months. All cases completed their postoperative external radiation therapy with no reported cases of early or late BPF. Conclusion: Intrathoracic pedicled LDMF transposition is proved to be effective in prevention of BPF developing after EPP and external radiation therapy in MPM and it is advised to be a routine step in EPP in these cases and to use more sophisticated technique of postoperative external beam radiotherapy (3D conformal or IMRT) to minimize this complication.展开更多
Background: The latissimus dorsi (LD) muscle flap plays an essential role in breast reconstruction after partial mastectomy for cancer because of its stability and versatility. We evaluated both oncologic and aestheti...Background: The latissimus dorsi (LD) muscle flap plays an essential role in breast reconstruction after partial mastectomy for cancer because of its stability and versatility. We evaluated both oncologic and aesthetic outcomes in addition to the related complications of this flap as an adjunct to breast conserving surgery in the management of breast cancer patients. Methods: All patients underwent a one-stage procedure with immediate reconstruction through two-steps operation;wider local excision utilizing oncoplastic principles and mini flap harvest & volume replacement. Results: The study included 34 cases with early breast cancer;30 patients had partial breast resection and defect refilling by LD mini-flap, three patients underwent mastectomy and one patient underwent extended LDF. The mean defect volume was (212.63 cm<sup>3</sup> ± 59.57) cm<sup>3</sup>, while the mean flap volume was (218.27 cm<sup>3</sup> ± 53.64 cm<sup>3</sup>). Patient self-evaluation of the cosmetic outcome was excellent in 20%, good in 60% and satisfactory in 20% of patients. Panel evaluation according to Harvard scale showed excellent in 36.7%, good in 36.7%, fair in 26.7% of patients. The median hospital stay was 4 days. The postoperative complications included wound gap in 4 patients (13.3%), postoperative donor site seroma in 16 patients (53.3%). No flap loss or necrosis, no affection on arm or shoulder mobility occurred. Lastly, no tumor recurrence till now. Conclusion: Latissimus dorsi mini-flap can achieve adequate cosmetic and oncologic outcomes with a low incidence of complications in patients with early stage (I/II) breast cancer and small to medium sized breasts.展开更多
为探究秦川牛宰后成熟期间基础免疫球蛋白(basigin,BSG)对丝裂原活化蛋白激酶(mitogen activated protein kinase,MAPK)信号通路及细胞凋亡的影响,利用4D-非标记定量组学技术分析BSG及其差异蛋白的变化情况。向宰后秦川牛肉的背最长肌...为探究秦川牛宰后成熟期间基础免疫球蛋白(basigin,BSG)对丝裂原活化蛋白激酶(mitogen activated protein kinase,MAPK)信号通路及细胞凋亡的影响,利用4D-非标记定量组学技术分析BSG及其差异蛋白的变化情况。向宰后秦川牛肉的背最长肌中注射BSG抑制剂衣霉素,通过蛋白质免疫印迹法测定秦川牛肉在4℃贮藏过程中MAPK通路关键蛋白质表达水平,并测定caspase-3的活力变化。研究表明:在秦川牛宰后贮藏期内,BSG的表达量总体呈先上升后下降趋势;利用京都基因与基因组百科全书通路分析发现BSG及其差异蛋白质显著注释于氧化磷酸化通路、钙信号通路、MAPK信号通路,说明BSG通过MAPK途径发挥作用。另外,衣霉素组MAPK通路关键蛋白质的相对表达量均显著下调,说明BSG抑制剂使得MAPK信号通路失活。这为研究BSG对MAPK信号通路影响奠定了很好的基础。在抑制BSG的表达后,衣霉素组caspase-3的活力明显上升,说明细胞凋亡是细胞损伤机制的重要环节,衣霉素作用于BSG的N端结构使蛋白质发生去糖基化作用。通过抑制细胞内蛋白质的折叠使其生物学活性受到抑制,从而诱导细胞凋亡。展开更多
为了筛选华西牛和雪龙黑牛背最长肌重量相关的遗传标记和候选基因,试验以1478头华西牛和452头雪龙黑牛为研究对象,对其背最长肌重量性状进行全基因组关联分析(genome-wide association study,GWAS),即测定其屠宰后背最长肌重量表型数据...为了筛选华西牛和雪龙黑牛背最长肌重量相关的遗传标记和候选基因,试验以1478头华西牛和452头雪龙黑牛为研究对象,对其背最长肌重量性状进行全基因组关联分析(genome-wide association study,GWAS),即测定其屠宰后背最长肌重量表型数据,利用Illumina Bovine-HD(770K)芯片对其基因组进行基因分型,采用FarmCPU模型和GEMMA模型对质控后的芯片数据进行GWAS,挖掘与华西牛和雪龙黑牛背最长肌重量显著相关的单核苷酸多态性(single nucleotide polymorphism,SNP)位点和候选基因。结果表明:华西牛与雪龙黑牛群体背最长肌重量表型性状均符合正态分布,且二者芯片数据经过质控后分别得到607198,511320个SNP位点,这些SNP位点在二者各个染色体上的分布比较均匀;利用FarmCPU模型在华西牛与雪龙黑牛群体分别检测到12个和9个与其背最长肌重量显著相关的SNP位点,且华西牛群体的显著SNP位点分别位于1,5,7,11,12,13,15,16,22,23号染色体上,鉴定到KCNAB1、PFN2、RNF13、TTLL1、MCAT、CREB3L3、ZBTB7A、MAP2K2、CAMKMT、ZC3H13、OPTN、MCM10、UCMA、OVOL2、PET117、KAT14、MAML2、HHAT、FHIT和LY86共20个候选基因;雪龙黑牛群体的SNP位点分别位于4,16,27号染色体上,鉴定到PCLO、DCTD、WWC2共3个候选基因;利用GEMMA模型在华西牛与雪龙黑牛群体中分别检测到6个与其背最长肌重量显著相关的SNP位点,其中华西牛群体的SNP位点位于13号染色体上,鉴定到GATA3、TAF3、ODAD2、SNX5、MGME1、OVOL2、KAT14、PET117共8个候选基因;雪龙黑牛群体的SNP位点位于1,4,5,25号染色体上,但未鉴定到有效的候选基因。说明在华西牛和雪龙黑牛群体中分别检测到的18个和15个SNP位点与注释到的25个和3个候选基因可作为改良牛背最长肌重量的新的分子标记和候选基因。展开更多
Background： The latissimus dorsi （LD） flap procedure remains a popular and useful breast reconstrtlction tool in China and Western countries, and donor site seroma formation is the main complication. This study was...Background： The latissimus dorsi （LD） flap procedure remains a popular and useful breast reconstrtlction tool in China and Western countries, and donor site seroma formation is the main complication. This study was conducted in Chinese patients to determine whether stable cases of seromas would resolve without treatment. Methods： A retrospective review of 45 consecutive cases of immediate breast reconstruction with LD flap from April 2012 to February 2017 was conducted. The scope of the seroma was demarcated with a marker pen, and cases that remained stable over time （i.e. the size of the seroma did not increase） were observed without treatment. The measured outcomes included the incidence ofseromas, the volume and duration of postoperative wound drainage, and other demographic characteristics. Results： Twenty-four patients （53.3%） developed a seroma at the donor site. Of these, 21 patients （87.5%） did not require treatment, and the seroma resolved over time. The mean duration of a sustained serol-na was 6.8 ± 1.4 weeks （range： 4-9 weeks）. Conclusions： This study observed the scope and progression of the seromas and found that seromas at the LD donor sites resolved over time without treatnlent.展开更多
文摘Objective： To discuss the suitable immediate breast reconstruction modalities for Chinese patients by comparing the pedicled transverse rectus abdominis myocytaneous flap （TRAM） reconstruction with latissimus dorsi myocytaneous flap （LTD） reconstruction plus implants or not after mastectomy due to breast cancer. Methods： From Jan. 2000 to Jul. 2005, 74 staged 0-II patients （mean age 39） were performed immediate breast reconstruction with autologous tissue either using LTD flaps or pedicled TRAM flaps with supplemental implants when necessary after mastectomy due to breast cancer and the charts were reviewed. Results： The age, marriage and menses status did not affect the selection of modalities and the need of implants. In 74 patients, 62 cases （83.8%） were performed LTD reconstruction with 13 implants and 12 cases received TRAM with 1 implant. The difference in need of implants or not between the two modalities had no statistical significance （P=0.442, Fisher＇ exact test）. Aesthetic results judged as good or fair were in 88% patients and the cosmetic effects between LTD and TRAM groups or implant and non-implant groups had no differences. All reconstructions were successful, with 4.1% cumulative locoregional recurrence and 100% overall survival by following up to 66 months （median 9 months）. The DFS and RFS between the two modalities had no significant differences by log rank test. Conclusion： Immediate autologous tissue reconstruction makes it possible to regain the natural and symmetric contour of breast without increased local recurrence. The LTD flap reconstruction is a suitable option for most Chinese women as well as the pedicled TRAM flap.
文摘Breast cancer(BC) in men represents between 0.5% and 1% of all BC diagnosed each year. We report a case of advanced BC in a 62-year-old male treated at our interdisciplinary Breast Cancer Center. The patient presented with a newly diagnosed large, symptomatic mass in his left breast. Clinical examination showed a not movable mass of 16 cm diameter, deforming the whole breast; the overlying skin was livid and hypervascularized. Enlarged lymph nodes were palpable in the axillary pit. He had no concomitant diseases at time of presentation. He denied any first- or second degree family medical history of cancer of any type and he never received radiotherapy. Ultrasound guided minimal-invasive 14-gauge core biopsy revealed a moderately differentiated encapsulated papillary carcinoma with high expression of estrogen and progesterone receptors(both > 80%, IRS 12) and HER2-negative. Because of the tumor size a mastectomy with axillary dissection and chest wall reconstruction using a latissimus dorsi flap was performed. Histological analysis showed invasive growth besides typical(non-invasive) papillary carcinoma and was classified as invasive solid papillary carcinoma; p T3(10 cm), p N0(0/15), M0,R0; Oncotype DX Recurrence Score indicated low risk(RS: 2). After discussion in the interdisciplinary tumor board meeting, radiation therapy and tamoxifen were recommended. The patient had an uneventful recovery and is disease-free after two years of follow-up. Male BC is typically diagnosed at an advanced stage, most likely due to a lack of awareness that men can develop BC. Therefore, in case of a large tumor, a flap-based thoracic reconstruction may be required.
文摘Objective To investigate the utility of pre-expanded muscle-sparing latissimus dorsi flaps in the reconstruction of deformities secondary to severe scar contractures on the anterior chest.Methods The function of the latissimus dorsi was preserved with blood supply from the main or lateral branch of the thoracodorsal artery.The entire treatment period was divided into two stages,during which segmental latissimus dorsi flaps were pre-expanded in stage I and anterior chest scar deformities were reconstructed in stage II.During stage I,the musculocutaneous perforators arising from the lateral branch of the thoracodorsal artery were determined by ultrasound preoperatively;the flap design included the anterior segment of the latissimus dorsi supplied by the musculocutaneous perforators from the lateral branch;and a tissue expander was placed following flap dissection and then infused with saline intermittently for 4–6 months.In stage II,the chest scars were excised,and breast tissues were repositioned;the continuity of the medial branch of the thoracodorsal nerve to the muscle was preserved when reconstruction was performed using the segmental latissimus dorsi flaps supplied by the main or lateral branch of the thoracodorsal artery.Results From October 2010 to October 2019,21 patients(on 24 sides)underwent reconstructive procedures for extensive scar contractures on the anterior chest.All flaps survived,and their donor sites were sutured directly.During a follow-up of 3 months to 8 years,the flaps became soft and exhibited color similar to that of the adjacent tissues.The limited neck and shoulder movements improved,and postoperatively,all female patients were satisfied with the shape of their breasts.Additionally,neither apparent weakening on the adduction,internal rotation,or extension strength of the shoulder joint on the affected side nor marked depression deformity in the back was observed.Conclusion Pre-expanded muscle-sparing latissimus dorsi flaps with blood supply from the main or lateral branch of the thoracodorsal artery proved to be a desirable option for the reconstruction of extensive scar contractures on the anterior chest.
文摘Objective: Bronchopleural fistula (BPF) is a life threatening complication after pneumonectomy. Extra thoracic skeletal muscle transposition especially latissimus dorsi muscle flap (LDMF) had been used to prevent this complication. The aim of this study was to assess the effectiveness of LDMF in preventing BPF developing after extrapleural pneumonectomy (EPP) and external radiation therapy in malignant pleural mesothelioma (MPM). Methods: Between May 1999 and Dec. 2008, 37 patients with MPM were operated upon by EPP using LDMF prophylactically to reinforce the bronchial stump, and then received external radiation therapy with or without postoperative chemotherapy. Results: The mean age of all patients was 46.7 (range 26-57) years. Twenty five patients were males and 12 patients were females. Twenty three patients had MPM of the right side and 14 patients had MPM of the left side. The peri-operative mortality was 2.7% and only few flap related postoperative morbidity were reported in the form of minor seroma and subcutaneous surgical emphysema. The median follow up was 17 (range 9-43) months. All cases completed their postoperative external radiation therapy with no reported cases of early or late BPF. Conclusion: Intrathoracic pedicled LDMF transposition is proved to be effective in prevention of BPF developing after EPP and external radiation therapy in MPM and it is advised to be a routine step in EPP in these cases and to use more sophisticated technique of postoperative external beam radiotherapy (3D conformal or IMRT) to minimize this complication.
文摘Background: The latissimus dorsi (LD) muscle flap plays an essential role in breast reconstruction after partial mastectomy for cancer because of its stability and versatility. We evaluated both oncologic and aesthetic outcomes in addition to the related complications of this flap as an adjunct to breast conserving surgery in the management of breast cancer patients. Methods: All patients underwent a one-stage procedure with immediate reconstruction through two-steps operation;wider local excision utilizing oncoplastic principles and mini flap harvest & volume replacement. Results: The study included 34 cases with early breast cancer;30 patients had partial breast resection and defect refilling by LD mini-flap, three patients underwent mastectomy and one patient underwent extended LDF. The mean defect volume was (212.63 cm<sup>3</sup> ± 59.57) cm<sup>3</sup>, while the mean flap volume was (218.27 cm<sup>3</sup> ± 53.64 cm<sup>3</sup>). Patient self-evaluation of the cosmetic outcome was excellent in 20%, good in 60% and satisfactory in 20% of patients. Panel evaluation according to Harvard scale showed excellent in 36.7%, good in 36.7%, fair in 26.7% of patients. The median hospital stay was 4 days. The postoperative complications included wound gap in 4 patients (13.3%), postoperative donor site seroma in 16 patients (53.3%). No flap loss or necrosis, no affection on arm or shoulder mobility occurred. Lastly, no tumor recurrence till now. Conclusion: Latissimus dorsi mini-flap can achieve adequate cosmetic and oncologic outcomes with a low incidence of complications in patients with early stage (I/II) breast cancer and small to medium sized breasts.
文摘为探究秦川牛宰后成熟期间基础免疫球蛋白(basigin,BSG)对丝裂原活化蛋白激酶(mitogen activated protein kinase,MAPK)信号通路及细胞凋亡的影响,利用4D-非标记定量组学技术分析BSG及其差异蛋白的变化情况。向宰后秦川牛肉的背最长肌中注射BSG抑制剂衣霉素,通过蛋白质免疫印迹法测定秦川牛肉在4℃贮藏过程中MAPK通路关键蛋白质表达水平,并测定caspase-3的活力变化。研究表明:在秦川牛宰后贮藏期内,BSG的表达量总体呈先上升后下降趋势;利用京都基因与基因组百科全书通路分析发现BSG及其差异蛋白质显著注释于氧化磷酸化通路、钙信号通路、MAPK信号通路,说明BSG通过MAPK途径发挥作用。另外,衣霉素组MAPK通路关键蛋白质的相对表达量均显著下调,说明BSG抑制剂使得MAPK信号通路失活。这为研究BSG对MAPK信号通路影响奠定了很好的基础。在抑制BSG的表达后,衣霉素组caspase-3的活力明显上升,说明细胞凋亡是细胞损伤机制的重要环节,衣霉素作用于BSG的N端结构使蛋白质发生去糖基化作用。通过抑制细胞内蛋白质的折叠使其生物学活性受到抑制,从而诱导细胞凋亡。
文摘Background： The latissimus dorsi （LD） flap procedure remains a popular and useful breast reconstrtlction tool in China and Western countries, and donor site seroma formation is the main complication. This study was conducted in Chinese patients to determine whether stable cases of seromas would resolve without treatment. Methods： A retrospective review of 45 consecutive cases of immediate breast reconstruction with LD flap from April 2012 to February 2017 was conducted. The scope of the seroma was demarcated with a marker pen, and cases that remained stable over time （i.e. the size of the seroma did not increase） were observed without treatment. The measured outcomes included the incidence ofseromas, the volume and duration of postoperative wound drainage, and other demographic characteristics. Results： Twenty-four patients （53.3%） developed a seroma at the donor site. Of these, 21 patients （87.5%） did not require treatment, and the seroma resolved over time. The mean duration of a sustained serol-na was 6.8 ± 1.4 weeks （range： 4-9 weeks）. Conclusions： This study observed the scope and progression of the seromas and found that seromas at the LD donor sites resolved over time without treatnlent.
