MyoD control of SKIP expression during pig skeletal muscle development

Skeletal muscle and kidney enriched inositol phosphatase (SKIP) was identified as a 5'-inositol phosphatase that hydrolyzes PI(3,4,5)P3 to PI(3,4)P2 that negatively regulates insulin-induced phosphatidylinositol 3-kinase signaling in skeletal muscle. In this study, we obtained a 1575-bp mRNA sequence of porcine SKIP that included the full coding region encoding a protein of 450 amino acids. With the use of comparative mapping, we mapped this gene to SSC12 q1.3, where many QTLs affect Backfat thickness at 10th rib, carcass yield, the number of muscle fibers, and ham weight traits. As a candidate gene for growth and carcass traits, a novel single nucleotide polymorphism in exon 12 (G>A) was detected by PCR-RFLP. The results showed that the GG genotype had higher skin percentage (SP), carcass length to first spondyle (CL1), carcass length to first rib (CL2), but lower intramuscular fat (IMF) as compared with genotype AG (P<0.05), and allele G seemed to be associated with an increase in the growth trait. Porcine SKIP was expressed abundantly in skeletal muscle tissue and was transcriptionally upregulated during skeletal muscle differentiation. Analysis of the porcine SKIP promoter sequence demonstrated that MyoD was involved in regulating SKIP mRNA expression in myotubes, partly via the cis-acting elements in SKIP promoter. In summary, we suggested that SKIP might play a role in the regulation of skeletal muscle development in pigs.

Evidence for a new allele at the SERCA1 locus affecting pork meat quality in part through the imbalance of Ca2+ homeostasis

Sarcoendoplasmic reticulum Ca2+-ATPase 1 (SERCA1) as a Ca2+ release channel plays a key role in the relaxation of skeletal muscle through pumping cytosolic Ca2+ into the SR (sarcoplasmic reticulum). In this study, a novel single nucleotide polymorphism (SNP) in exon 8 (C > T) was detected by tetra-primer ARMS-PCR and the tissue expression pattern of SERCA1 was analyzed in eleven tissues. A model of primary skeletal muscle cells in vitro exposed to dexamethasone (DEX, a synthetic corticosteroid) was also employed to determine whether stress hormones cause an increase in intracellular Ca2+ concentration that is associated with alteration in SERCA1 and in turn subsequently affect meat quality. The results showed that the CC genotype has lower content intramuscular fat and higher water than pig carrying the genotype CT and CC. In addition, the additive effects were both significantly (P < 0.05) and allele T seemed to be associate with increase in intramuscular fat, while decrease in water content. Accompanied with previous studies, the high abundance of porcine SERCA1 was found in skeletal muscle tissue. DEX markedly down-regulated the expression of SERCA1, leading to Ca2+ overload. Furthermore, the imbalance of Ca2+ homeostasis up-regulated the transcription level of Calpain1. Taken together, we demonstrated a novel mechanism that the changes in expression of SERCA1 potential disturb the normal Ca2+ channel as well as the balance of Ca2+ homeostasis and which in turn finally activated Ca2+-dependent proteases such as Calpain1 which could affect meat quality.

Cutaneous large B-cell lymphoma of the leg: presenting initially as mononeuritis multiplex

We report a rare case of primary B-cell lymphoma of the leg presenting with mononeuropathy multiplex. A 79-year-old Chinese woman who was being investigated for mononeuritis multiplex had an incidental finding of indurated erythematous plaques on the breast and left leg. A skin biopsy from the nodular area on the right breast showed a dense and diffuse infiltrate of atypical cells with large, round, hyperchromatic nuclei with prominent nucleoli. These atypical lymphocytes were CD20+, Bcl-2+ and Mum-1+. A diagnosis of diffuse large B-cell lymphoma, leg type involving the breast and leg with extracutaneous involvement, was made. This case highlights the importance of a full systemic and cutaneous examination in patients presenting with progressive, painful peripheral neuropathy.

Four and a half LIM domains 1 (FHL1) and receptor interacting protein of 140kDa (RIP140) interact and cooperate in estrogen signaling

Four and a half LIM domains 1 (FHL1) belongs to a family of LIM-only proteins that regulate gene transcription, cell proliferation, differentiation and apoptosis. However, the biological function of FHL1 remains largely unknown. We used a yeast two-hybrid system and identified receptor interacting protein of 140kDa (RIP140) as a novel FHL1-binding protein. RIP140 interacted with FHL1 both in vitro and in mammalian cells and estrogen enhanced this interaction. All domains of FHL1 are required to interact with RIP140. Overexpression of FHL1 enhanced RIP140 repression of estrogen signaling in breast cancer cells in a reporter assay, whereas reduction of endogenous FHL1 with FHL1 small interfering RNA abolished this effect. Furthermore, overexpression of the FHL1 deletion mutant that lacks the RIP140-binding sites had no effect on RIP140 repression of estrogen signaling. Consistent with the results of the reporter assays, FHL1 and RIP140 synergistically inhibited the transcription of the estrogen-responsive gene pS2. The results presented here suggested the cooperative transcriptional regulation of estrogen signaling by FHL1 and RIP140, and might provide a new regulation mechanism by which estrogen signaling-related diseases such as breast cancer develop.

Prevalence of malnutrition and its risk factors in stroke patients residing in an infirmary

INTRODUCTION

The aim of this study was to investigate the prevalence of malnutrition, and its associated risk factors, in stroke patients residing in an infirmary in Hong Kong.

METHODS

A cross-sectional retrospective study of 61 stroke patients residing in an infirmary was conducted. Baseline demographic data, including age, gender, smoking habit, and alcohol consumption, were obtained on admission. Nutritional status was assessed according to anthropometric parameters. Malnutrition was defined as having a body mass index (BMI) of below 18.5 kg per square metres for both gender and a serum albumin level of less than 35 g/L. 12 risk factors associated with malnutrition were evaluated according to established protocols.

RESULTS

61 of the 93 patients assessed had a history of cardiovascular accident and gave consent to participate in the study. Among them were 28 (46 percent) women and 33 (54 percent) men. The mean length of stay of these patients was 850 days (or 28 months). The mean age of these patients was 76 (standard deviation 12.8) years. Among the patients, five (8.2 percent) were malnourished and 56 (91.8 percent) were adequately nourished. There were no significant differences in the distribution of eight risk factors between the malnourished and nourished groups. These risk factors were a previous history of alcohol consumption, comorbidities (five or more), polypharmacy (five or more), diabetes mellitus, impaired functional status of daily living, impaired mobility (wheelchair- or bed-bound), tube-feeding, and edentulism. Insufficient data was available to assess the effects of two risk factors: depressed mood and impaired cognitive function. The distribution of another two risks factors (previous history of smoking and dysphagia) was significantly different between the malnourished and nourished groups. Odds ratios of smoking and dysphagia associated with malnourishment were approximately 3.3 and 2.6, respectively.

CONCLUSION

Five of 61 (8.2 percent) stroke patients residing in an infirmary were malnourished. Two risk factors significantly associated with malnutrition were previous history of smoking and dysphagia. It is recommended that smoking history be elicited during routine history-taking of all stroke patients and particular nutritional attention be given to these at-risk patients. It is also emphasised that the management of dysphagia should follow a standardised protocol and form an integral element of patient care.

[Repair of immedicable ulcer in skull cap with expanded bipedical axial flap in senile patients]

OBJECTIVE

To investigate the method to repair immedicable ulcer in skull cap in senile patient and the clinical effect of expanded bipedical axial flap in skull cap.

METHODS

From September 2002 to June 2006, 5 patients with immedicable and chronic ulcer in skull cap were treated. All patients were males, aging 55-76 years. Among them, the causes of disease were trauma in 1 case, infection in 1 case, squamous cell carcinoma in 2 cases, and basal cell carcinoma in 1 case. The disease course was 6-25 months. All patients had been treated by 1-4 operations. The area of ulcer ranged from 5 cm x 3 cm to 10 cm x 9 cm. At first stage, soft tissue expander was implanted under the frontal branch of superficial temporal artery and the musculus frontalis according to preoperative design. Then periodic saline injection was carried out after operation. At second stage, the soft tissue expander was taken out. The immedicable ulcer in skull cap was removed, then expanded bipedical axial flap in forehead was designed and transferred to the wound according to the size of the wound. And the donor site was covered with odd expanded flap or split-thickness skin graft. The defect size was 6.0 cm x 3.5 cm to 12.0 cm x 10.5 cm. The size of the flap was from 26 cm x 10 cm to 34 cm x 17 cm.

RESULTS

All the expanded bipedical axial flap survived after operation. The wound had a primary healing. The donor sites healed well. No complications occurred at donor site. All patients were followed up from 3 to 24 months (mean 10 months). No ulcer recurrence and no incompetence in papebral fissure was found. The patients were satisfied with the operation results.

CONCLUSION

The satisfactory clinical results are obtained in repairing immedical ulcer in skull cap in old patients by using expanded bipedical axial flap in skull cap. This operation design can be used as a new method to repair immedical ulcer in skull cap in senile patients.

Mesalazine downregulates c-Myc in human colon cancer cells. A key to its chemopreventive action?

BACKGROUND

Dysplasia and malignant transformation of colonocytes in ulcerative colitis are associated with overexpression of c-Myc and genes regulating cell survival. 5-Aminosalicylates such as mesalazine may reduce the development of colorectal cancer in ulcerative colitis, but the mechanisms of its chemopreventive action are not clear.

AIMS

To examine whether mesalazine affects the expression of c-Myc in human colon cancer cell lines.

METHODS

Human colon cancer cells were treated with vehicle or mesalazine (4 mm or 40 mm). We examined: (i) mRNA expression by gene array, (ii) protein expression by Western blotting and immunohistochemistry and (iii) apoptosis by Annexin V labelling.

RESULTS

Mesalazine significantly reduced expression of c-Myc mRNA and protein.

CONCLUSIONS

Mesalazine downregulates gene and protein expression of c-Myc. The apoptotic and growth inhibitory effects of mesalazine are dose-dependent. Expression of c-Myc is significantly reduced by mesalazine 40 mm.

[Expanded clavipectoral skin flap combined with reverse axis skin flap in repairing cervical scar contracture deformity after burn]

OBJECTIVE

To evaluate the effect of a combined cervical expanded skin flap in repairing cervical scar contracture deformity after burn injury.

METHODS

From April 2001 to May 2003, 16 cases (10 males and 6 females) of scar contracture deformity in the cervix were treated with expanded clavipectoral axis skin flap combined with reverse axis skin flap. The tissue expanders were embedded under the part containing cutaneous branches of transverse cervical artery in cervical segments and the second and/or the third perforating branch of internal thoracic artery for the first operation. Normal saline was injected regularly. The expanded clavipectoral skin flap and reverse axis skin flap with perforating branch of internal thoracic artery were designed, the scar in the cervix was loosed or dissected according to the size of the skin flaps, the skin flaps were transferred to cover the wound, and the contracture deformity in the cervix was corrected. The size of the flaps were 9 cm x 5 cm-15 cm x 7 cm.

RESULTS

All skin flap survived. The function and appearance of the cervix was improved significantly after 6-30 months follow-up. However, venous return dysfunction in reverse perforating branch of internal thoracic artery occurred in 1 case, and blood circulation was improved after treatment.

CONCLUSION

Expanded clavipectoral axis skin flap combined with reverse axis skin flap can be used to repair scar contracture deformity in cervix, which lessen scar and abate the chance to contract again.

[Influence of lipopolysaccharide on the biological characteristics of skin fibroblasts and its potential role in wound healing]

OBJECTIVE

To investigate the influence of lipopolysaccharide (LPS) on the proliferation and collagen synthesis of normal human skin fibroblasts so as to elucidate its relation with skin wound healing.

METHODS

Fibroblasts were isolated and cultured in vitro, and then exposed to different doses of LPS(0.005, 0.010, 0.050, 0.100, 0.500, and 1.000 microg/ml) from E. coli055:B5 respectively. Then the absorbance (A) value of fibroblasts was determined with the colorirneteric thiazolyl blue (MTT) assay, and the cell number was counted under inverted phase contrast microscope from the 1st day to the 9th day after LPS administration, and collagen synthesis of fibroblasts in culture medium was measured with the method of pepsin digestion after incorporation of 3H-proline into stable, single-layered, confluent fibroblasts at 7 days after LPS administration.

RESULTS

Compared with control group, A value increased with the increasing concentration of LPS (0.005 microg/ml-0.500 microg/ml) and LPS of 0.100 microg/ml group had the strongest effect. The difference was remarkable from the 5th day to the 9th day(P<0.05). A value decreased when challenged with the LPS of 1.000 microg/ml and the difference was remarkable from the 3rd day to the 9th day(P<0.05). Cell number increased with the administration of LPS of different concentrations (0.005 microg/ml-0.500 microg/ml) and LPS of 0.100 microg/ml group had the strongest effect. The difference was remarkable from the 1st day to the 6th day(P<0.05). Cell number decreased remarkably when challenged with LPS of 1.000 microg/ml and the difference was remarkable from the 2nd day to the 9th day (P < 0.05). Collagen synthesis increased when challenged with LPS of different concentrations (0.005 microg/ml-0.500 microg/ml) and the 0.100 microg/ml group had the strongest effect. However, when the dose of LPS reached 1.000 microg/ml, it inhibited collagen synthesis.

CONCLUSION

LPS could promote the proliferation and collagen synthesis of fibroblasts within a certain range of low doses, but over-high dose of LPS might inhibit the proliferation and collagen synthesis of fibroblasts, suggesting that LPS of certain concentrations might contribute to wound healing, while excessive LPS has negative effect on wound healing.

A Comparative Study on the Predictive Value of Digital Subtraction Angiography and B-Mode Ultrasonography in Evaluating Arterial Injury in High-Voltage Electrical Burn of the Forearm

To compare the predictive value of digital subtraction angiography (DSA) with B-mode ultrasonography in evaluating the arterial injury in high-voltage electrical burn of the forearm, 19 forearms sustaining high-voltage electric burn were examined with DSA and B-mode ultrasonography. During surgery, the involved arteries were examined closely to compare their gross pathology with the results of DSA and B-mode ultrasonography. The thrombotic or necrotic arteries found during surgery were excised and examined pathologically. Among 19 ulnar and radial arteries examined by DSA and B-mode ultrasonography, the abnormal signs were found in 14 ulnar and 11 radial arteries in DSA, including narrowing of lumen, beading of the wall, thrombosis, and slowing of blood flow, whereas abnormal signs were shown by B-mode ultrasonography in 19 ulnar and 16 radial arteries, including roughening, edema or exfoliation of the endothelium, thickening of vessel wall, narrowing of lumen, beading of the wall, and decrease in the blood flow. The vessels with severe injuries showed thrombosis or necrosis of the vessel wall. The aforementioned changes were confirmed during surgery and pathologic examination. B-mode ultrasonography is a more efficient tool than DSA in evaluating vascular injuries of the forearm sustaining high-voltage electrical burn.

Retrospective survival analysis of 3-unit fixed-fixed and 2-unit cantilevered fixed partial dentures

To evaluate the cumulative survival (CS) rates of fixed partial dentures (FPDs) retained by full-veneer retainers, and those of resin-bonded FPDs provided by graduating dental students for the replacement of a single missing tooth. In 168 patients, 61 3-unit fixed-fixed FPDs and 25 2-unit cantilevered FPDs retained by full-veneer retainers, and 77 3-unit fixed-fixed resin-bonded FPDs and 47 2-unit cantilevered resin-bonded FPDs, were examined for their retention and integrity. The periodontal health, endodontic status and coronal tissues of all abutment teeth were also evaluated. The survival rates of these various designs were analysed with the Kaplan-Meier method. The mean age of all FPDs was 31 months. At 48 months after their insertion, 3-unit FPDs retained by full-veneer retainers had a CS rate of 82%, followed by 2-unit resin-bonded FPDs at 81%, 2-unit FPDs retained by full-veneer retainers at 77%, and 3-unit resin-bonded FPDs at 63%. No significant difference was found between the four designs (P>0.05). Up to both 48 and 60 months, the most common causes of failure were endodontic for FPDs retained by full-veneer retainers, and dislodgement for resin-bonded FPDs. The 3-unit fixed-fixed FPDs retained by full-veneer retainers had the most favourable prognosis after 48 months for replacing a single missing tooth, but the difference between designs was not statistically significant.

Painful small-fiber neuropathy in Sjogren syndrome

Of 20 consecutive patients with Sjögren neuropathy, 16 (80%) presented with burning feet and 12 (60%) with non-length-dependent sensory symptoms. Leg and thigh skin biopsies, performed in 13 patients, including 7 with normal electrophysiology, showed either reduced epidermal nerve fiber (ENF) density or abnormal morphology. ENF loss was frequently non length dependent, suggesting that patients with this disorder commonly have a small-fiber sensory neuronopathy rather than a "dying-back" axonopathy.

Rebamipide inhibits gastric cancer growth by targeting survivin and Aurora-B

Rebamipide accelerates healing of gastric ulcers and gastritis but its actions on gastric cancer are not known. Survivin, an anti-apoptosis protein, is overexpressed in stem, progenitor, and cancer cells. In gastric cancer, increased and sustained survivin expression provides survival advantage and facilitates tumor progression and resistance to anti-cancer drugs. Aurora-B kinase is essential for chromosome alignment and mitosis progression but surprisingly its role in gastric cancer has not been explored. We examined in human gastric cancer AGS cells: (1) survivin expression, (2) localization of survivin and Aurora-B, (3) cell proliferation, and (4) effects of specific survivin siRNA and/or rebamipide (free radical scavenging drug) on survivin and Aurora-B expression and cell proliferation. Survivin and Aurora-B are strongly expressed in human AGS gastric cancer cells and co-localize during mitosis. Survivin siRNA significantly reduces AGS cell viability. Rebamipide significantly downregulates in AGS cell survivin expression, its association with Aurora-B and cell proliferation. Rebamipide-induced downregulation of survivin is at the transcription level and does not involve ubiquitin-proteasome pathway.

A 5-year prospective study on small diameter screw-shaped oral implants

Alveloar ridges of limited dimensions could preclude the placement of dental implants of the regular dimension. Smaller diameter implants - narrow platform (NP) implants were commercially available to address this issue. The aim of the study was to determine the 5-year clinical performance of 3.3 mm diameter NP implants. Twenty-three machined screw-shaped NP implants were placed in nine patients (six males; three females) between 18 and 70 years of age. Clinical and radiographic examinations were performed annually for 5 years. Recognized implant success criteria was used. The criteria were based on the mean marginal alveolar bone loss, the placement of prosthesis of satisfactory appearance, and the absence of implant mobility, peri-implant radiolucency, pain, discomfort or infection. One implant failed at abutment connection. The remaining 22 implants were restored and functioned successfully according to the criteria. The mean marginal alveolar bone loss during the first year was 0.41 +/- 0.17 mm. The mean marginal alveolar bone loss between the second and fifth year was 0.03 +/- 0.06 mm. The success rate of NP implants according to a well-established set of criteria was 96%.

Prevalence of malnutrition and risk factors in geriatric patients of a convalescent and rehabilitation hospital

OBJECTIVES

To investigate the prevalence and risk factors of malnutrition in geriatric patients admitted to a convalescent and rehabilitation hospital.

DESIGN

Cross-sectional study.

SETTING

Regional hospital, Hong Kong.

PATIENTS

A total of 120 patients (aged 60 years or older) referred to Tung Wah Eastern Hospital.

MAIN OUTCOME MEASURES

Anthropometric, biochemical, and haematological parameters were measured for nutritional assessment. Malnutrition was defined as a body mass index of lower than 18.5 kg/m(2) and serum albumin level of lower than 35 g/L. The clinical outcomes of patients were also recorded. The predictive value of the Chinese Mini Nutritional Assessment as a nutritional screening tool was assessed. Potential risk factors associated with malnutrition were evaluated according to established protocols.

RESULTS

The mean age of patients was 80.3 years (standard deviation, 7.4 years), and the mean body mass index was 21.9 kg/m(2) (standard deviation, 4.4 kg/m(2)). The prevalence of malnutrition was 16.7%. The age distribution of malnourished patients (mean, 86.2 years; standard deviation, 7.0 years; n=20) was significantly different to those nourished (mean, 79.1 years; standard deviation, 6.9 years; n=100) [P=0.0001]. Mortality was also higher in malnourished patients (25%) than nourished patients (4%) [P=0.001]. Based on the Chinese Mini Nutritional Assessment, 16.9% of patients were classified as malnourished (cut-off value, 18.5). The Chinese Mini Nutritional Assessment was useful as a screening tool to exclude patients who were not malnourished, ie it had a high negative predictive value (95%). Being totally dependent for the performance of activities of daily living, living in a home for the elderly, and being chair- or bed-bound posed a significantly increased risk of malnutrition. The presence of mental depression (geriatric depression scale score of 8 or higher), moderately or severely impaired cognitive function (abbreviated mental test score of lower than 7), or polypharmacy (five medications or more) did not significantly affect risk of malnutrition.

CONCLUSIONS

Malnutrition was common in the geriatric patients studied and was associated with an increased mortality. The Chinese Mini Nutritional Assessment was a useful screening tool to exclude malnutrition. Significant risk factors of malnutrition were total dependence, living in a home for the elderly, and being chair- or bed-bound.

Characterization of SSU and LSU rRNA genes of three Trypanosoma (Herpetosoma) grosi isolates maintained in Mongolian jirds

Trypanosoma (Herpetosoma) grosi, which naturally parasitizes Apodemus spp., can experimentally infect Mongolian jirds (Meriones unguiculatus). Three isolates from A. agrarius, A. peninsulae, and A. speciosus (named SESUJI, HANTO, and AKHA isolates, respectively) of different geographical origin (AKHA from Japan, and the others from Vladivostok), exhibited different durations of parasitaemia in laboratory jirds (2 weeks for HANTO, and 3 weeks for the others). To assess the genetic background of these T. grosi isolates, their small (SSU) and large subunit (LSU) ribosomal RNA genes (rDNA) were sequenced along with those of 2 other Herpetosoma species from squirrels. The SSU rDNA sequences of these 3 species along with available sequences of 3 other Herpetosoma trypanosomes (T. lewisi, T. musculi and T. microti) seemed to reflect well the phylogenetic relationship of their hosts. Three isolates of T. grosi exhibited base changes at 2-6 positions of 2019-base 18S rDNA, at 5-29 positions of 1817/1818-base 28Salpha rDNA, or 1-5 positions of 1557-1559-base 28Sbeta rDNA, and none was separated from the other 2 isolates by rDNA nucleotide sequences. Since base changes of Herpetosoma trypanosomes at the level of inter- and intra-species might occur frequently in specified rDNA regions, the molecular analysis on these regions of rodent trypanosomes could help species/strain differentiation and systematic revision of Herpetosoma trypanosome species, which must be more abundant than presently known.

Reduced expression of epidermal growth factor receptor related protein in gastric cancer

OBJECTIVES

The recently cloned epidermal growth factor receptor related protein (ERRP) has been proposed to be a negative regulator of the epidermal growth factor receptor (EGFR). Because of the causal involvement of EGFR and its ligands in gastric cancer growth, we investigated expression of ERRP and cell proliferation in human gastric cancer.

METHODS

We examined ERRP expression and localisation in surgical specimens of gastric cancers from 47 patients versus non-malignant gastric mucosa and determined their relationship to cell proliferation and differentiation. We also examined expression of ERRP by western blotting in three different gastric cancer cell lines. To further determine the functional properties of ERRP, we examined the effect of ERRP on epidermal growth factor (EGF) induced EGFR phosphorylation essential for its activation in MKN-28 gastric cancer cells.

RESULTS

ERRP expression was dramatically reduced in gastric cancers (34% of all specimens positive) compared with non-malignant gastric mucosa (66% of specimens positive). Expression of ERRP in cancer cells inversely correlated with cell proliferation and grade of malignancy. Cell lines derived from metastatic gastric cancers had reduced ERRP expression compared with cell lines derived from a non-metastatic cancer. Exogenous ERRP protein markedly inhibited EGF induced EGFR phosphorylation in gastric cancer cells providing a novel molecular mechanism of its action.

CONCLUSIONS

Our data indicate that downregulation of ERRP could play an important role in gastric cancer differentiation and progression. ERRP is a negative regulator of tumour cell proliferation and may exert its inhibitory effect, in part, by attenuating EGFR activation.

Incidence of deep vein thrombosis after varicose vein surgery

BACKGROUND

Varicose vein surgery is generally considered to have little risk of postoperative deep vein thrombosis (DVT). This prospective study examined the incidence of DVT in patients undergoing varicose vein surgery.

METHODS

Lower leg veins were assessed before operation by duplex ultrasonography in 377 patients, and reassessed 2-4 weeks after surgery, and again at 6 and 12 months. Patients were instructed to contact a physician if symptoms consistent with DVT occurred before the scheduled follow-up appointment. Preoperative prophylaxis (a single dose of subcutaneous heparin) was left to the discretion of the vascular surgeon.

RESULTS

DVT was detected in 20 (5.3 per cent) of the 377 patients. Of these, only eight were symptomatic and no patient developed symptoms consistent with pulmonary embolus. Eighteen of the 20 DVTs were confined to the calf veins. Subcutaneous heparin did not alter the outcome. No propagation of thrombus was observed and half of the DVTs had resolved without deep venous reflux at 1 year.

CONCLUSION

The incidence of DVT following varicose vein surgery was higher than previously thought, but these DVTs had minimal short- or long-term clinical significance.

[Development of selective acellular porcine skin and its preliminary clinical application on burn wounds]

OBJECTIVE

To develop a new kind of skin substitute, selective acellular porcine skin, to cover excised wounds in treatment of extensive deep burns on the basis of controlled de-cell technique.

METHODS

Partial thickness porcine skin was treated with 0.25% trypsin for 2 hours at 37 degrees C after crosslinked with glutaraldehyde, and then it was glued to a container with the edge embedded with glue. The skin was shaken in 0.5% SDS for 24 hours, and then washed before use. The selective acellular skin was used with micro-autografts on the dermal side to cover 2 surgically excised burn wounds in a patient. The recoveries of function and appearance were observed.

RESULTS

Morphological observation showed that the treated porcine skin had an intact epithelial layer and an acellular dermis. After being used to cover burn wounds, its acellular dermis could serve as host dermal matrix, and its devitalized epithelial layer could prevent the dermis from drying. The devitalized epithelium was finally replaced by host epithelial cells, and the healed wounds could achieve good cosmetic and functional results.

CONCLUSION

Selective acellular porcine skin can be used as promising skin substitute to cover excised wounds.

Rebamipide activates genes encoding angiogenic growth factors and Cox2 and stimulates angiogenesis: a key to its ulcer healing action?

Clinical and experimental data indicate that rebamipide accelerates ulcer healing, improves scar quality, and prevents ulcer recurrence. However, the mechanisms responsible for these rebamipides' actions are not fully elucidated. We studied, using gene expression microarray analysis, which of the ulcer healing genes are activated by rebamipide treatment. Normal rat gastric epithelial cells (RGM1) were treated with either vehicle or rebamipide. Gene expression was determined using Affymetrix rat genome U34A gene chip arrays and data were analyzed using the GeneSpring program. Activation of some of the genes and protein translation were also examined by RT/PCR and Western blotting. Rebamipide significantly upregulated the proangiogenic genes encoding vascular endothelial growth factor (VEGF), by 7.5-fold, heparin binding epidermal growth-like factor (HB-EGF), by approximately 5-fold, fibroblast growth factor receptor-2 (FGFR2), by 4.4-fold, and cyclooxygenase-2 (Cox2), by 9.3-fold, as well as growth promoting genes, e.g., insulin growth factor-1 (IGF-1), by 5-fold. RT/PCR and Western blotting demonstrated that Cox2 mRNA and protein were upregulated; the latter, approximately 6-fold. Treatment of rat gastric mucosal endothelial cells with rebamipide stimulated in vitro angiogenesis by approximately 240% (vs. controls, P < 0.001). Conclusions are as follows. (1) Rebamipide activates in gastric epithelial RGM-1 cells a genetic program that promotes angiogenesis and signals cell growth and tissue regeneration. (2) In addition, rebamipide treatment directly stimulates angiogenesis in gastric microvascular endothelial cells. Thus rebamipide has two separate and distinct mechanisms of proangiogenic action: one through activation in gastric epithelial cells of proangiogenic growth factor genes and the second a direct angiogenic action on microvascular endothelial cells.

Repair and reconstruction of massively damaged burn wounds

OBJECTIVE

To report repair and reconstruction of massively damaged burn wounds under unusual condition.

METHODS

One hundred forty-eight patients with deep burn tissue defects admitted from January 1993 through December 2000 were analyzed, among them 96 patients suffered from electrical injury which constituted 65.3% of all cases, 18 patients with hot press injury, 18 cases with deep burns as a result of CO poisoning or epileptic seizure, accounting for 12.2 and 12.2%, respectively, 6 cases with radiation injury, comprising 4.0% of all cases, 2 cases with explosive injury, 2 cases with chemical burn and 6 cases caused by erosive chemicals and wound infection. One hundred seventy-six flaps were transferred with mostly local flaps to repair deep burn wounds in 148 patients with tissue defects, in which necrotic tendons were replaced by acellular allogeneic tendons simultaneously in seven cases. Sixty-one iliolumbar arterial axial skin flaps for coverage of soft-tissue defects in hands or wrists were transplanted. Technical innovations to repair large soft-tissue defects of temporal region and ear, chin and lip, and dorso-lateral aspect of foot due to deep burn were explored. New technics to define necrotic tissue and vascular damage as a result of electrical injury were developed.

RESULTS

The biggest dimension of flaps in this group was 22cmx30cm. The survival rate of flap was 96.5%, while necrosis of the tip of flap occurred in 3.5%. The function and configuration were satisfactory after 4 months to 8 years follow-up. The technique of 99Tcm-methylene di-phosphonate (99Tcm-MDP) scintigraphy helped identify necrotic tissue before operation, and with the help of digital subtraction arteriogram (DSA) arterial injury could be identified. B-mode ultrasound was helpful to show the extent of endothelial injury, and Colour Doppler was useful to show luminal blood flow signal and filling defect in the injured artery.

CONCLUSIONS

Repair and reconstruction of massively damaged burn wound at early stage could be achieved. Techniques which helped define the extent of damage to the soft tissues, including arteries and tendons were essential preoperatively for successful reconstruction. Functional and aesthetic reconstruction, as well as the general condition of the patients, could thus be significantly improved early after the devastating injuries. Further innovations of operative technics would benefit more patients with such injuries.