【Abstract】 Objective To discuss the aesthetic effect and appl ication of refined incisions in breast reconstructionfor breast cancer patients by the transverse rectus abdominis myocutaneous (TRAM) flap. Methods From January 2001 toOctober 2006, 77 cases with breast cancer were treated with TRAM flap to immediate breast recontruction. The patients were all femals, with an average age of 45 years (ranging from 26 years to 53 years). There were 39 cases of left breast and 38 cases of right breast. The disease course was from 1 day to 180 days. There were 11 cases of stage I , 60 cases of stage II and 6 cases of stage III, among which 34 cases were located in the upper outer quadrant, 15 in the lower outer quadrant, 22 in the upper inner quadrant and 6 in the lower inner quadrant. The size of tumors varied from 1 cm to 4 cm. As to the pathologic type, 60 cases were invasive ductal cancers, 12 ductal cancers in situ, 5 invasive lobular cancers; positive lymph node (number: 1-7) happened in 29 cases, while negative lymph node happened in 48 cases. Among the 77 cases, regular shuttle incisions were performed in 35 cases, and refined circle incisions were performed in 42 cases, which were 2 cm away from the breast tumor border. Axillary incision was necessary for the breast tumors located in upper inner, lower inner and upper outer quadrants in order to perform axillary mastectomy. Ten cases were ni pple-areola sparing. The shape, symmetry and incision scar of the reconstructed breast were evaluated and graded. Results There were 6 cases out of 77 cases of breast reconstruction in which partial necrosis happened and the necrosis rate was 7.79%. The time of follow-up was from 13 months to72 months, with an average of 39 months. No recurrence or matastasis happened in 76 cases, and distant metastasis happened only in 1 case. There were 40 cases out of 42 cases with refined incisions which were scored more than 3, and the satisfaction rate was 95.24%. There were 31 cases out of 35 cases with regular incisions which were scored more than 3, and the satisfaction rate was 88.57%. Conclusion The reasonable refined incision based on the location of the tumor is effective to improve the satisfaction rate for the shape of the reconstructed breast.
ObjectiveTo investigate the mechanism of G protein coupled receptor kinase interacting protein 1 (GIT1) affecting angiogenesis by comparing the differentiation of bone marrow mesenchymal stem cells (BMSCs) differentiated into endothelial cells between GIT1 wild type mice and GIT1 gene knockout mice.MethodsMale and female GIT1 heterozygous mice were paired breeding, and the genotypic identification of newborn mice were detected by PCR. The 2nd generation BMSCs isolated from GIT1 wild type mice or GIT1 gene knockout mice were divided into 4 groups, including wild type control group (group A), wild type experimental group (group A1), GIT1 knockout control group (group B), and GIT1 knockout experimental group (group B1). The cells of groups A1 and B1 were cultured with the endothelial induction medium and the cells of groups A and B with normal cluture medium. The expressions of vascular endothelial growth factor receptor 2 (VEGFR-2), VEGFR-3, and phospho-VEGFR-2 (pVEGFR-2), and pVEGFR-3 proteins were detected by Western blot. The endothelial cell markers [von Willebrand factor (vWF), platelet-endothelial cell adhesion molecule 1 (PECAM-1), and vascular endothelial cadherin (VE-Cadherin)] were detected by flow cytometry. The 2nd generation BMSCs of GIT1 wild type mice were divided into 4 groups according to the different culture media: group Ⅰ, primary cell culture medium; group Ⅱ, cell culture medium containing SAR131675 (VEGFR-3 blocker); group Ⅲ, endothelial induction medium; group Ⅳ, endothelial induction medium containing SAR131675. The endothelial cell markers (vWF, PECAM-1, and VE-Cadherin) in 4 groups were also detected by flow cytometry.ResultsWestern blot results showed that there was no obviously difference in protein expressions of VEGFR-2 and pVEGFR-2 between groups; and the expressions of VEGFR-3 and pVEGFR-3 proteins in group A1 were obviously higher than those in groups A, B, and B1. The flow cytometry results showed that the expressions of vWF, PECAM-1, and VE-Cadherin were significantly higher in group A1 than in groups A, B, and B1 (P<0.05), and in group B1 than in groups A and B (P<0.05); but no significant difference was found between groups A and B (P>0.05). In the VEGFR-3 blocked experiment, the flow cytometry results showed that the expressions of vWF, PECAM-1, and VE-Cadherin were significantly higher in group Ⅲ than in groupsⅠ, Ⅱ, and Ⅳ, and in group Ⅳ than in groups Ⅰ and Ⅱ (P<0.05); but no significant difference was found between groups Ⅰ and Ⅱ (P>0.05).ConclusionGIT1 mediates BMSCs of mice differentiation into endothelial cells via VEGFR-3, thereby affecting the angiogenesis.
ObjectiveTo investigate the mechanism of early vascularization of the tissue engineered bone in the treatment of rabbit radial bone defect by local injection of angiopoietin 2 (Ang-2).MethodsForty-eight New Zealand white rabbits were established unilateral 1.5 cm long radius defect models. After implantation of hydroxyapatite/collagen scaffolds in bone defects, the rabbits were randomly divided into 2 groups: control group (group A) and Ang-2 group (group B) were daily injected with 1 mL normal saline and 1 mL saline-soluble 400 ng/mL Ang-2 at the bone defect within 2 weeks after operation, respectively. Western blot was used to detect the expressions of autophagy related protein [microtubule associated protein 1 light chain 3 (LC3), Beclin-1], angiogenesis related protein [vascular endothelial growth factor (VEGF)], and autophagy degradable substrate protein (SQSTMl/p62) in callus. X-ray films examination and Lane-Sandhu X-ray scoring were performed to evaluate the bone defect repair at 4, 8, and 12 weeks after operation. The rabbits were sacrificed at 12 weeks after operation for gross observation, and the angiogenesis of bone defect area was observed by HE staining.ResultsWestern blot assay showed that the relative expressions of LC3-Ⅱ/LC3-Ⅰ, Beclin-1, and VEGF in group B were significantly higher than those in group A, and the relative expression of SQSTMl/p62 was significantly lower than that in group A (P<0.05). Radiographic and gross observation of specimens showed that only a few callus were formed in group A, the bone defect was not repaired; more callus were formed and complete repair of bone defect was observed in group B. The Lane-Sandhu scores in group B were significantly higher than those in group A at 4, 8, and 12 weeks after operation (P<0.05). HE staining showed that the Harvard tubes in group B were well arranged and the number of new vessels was significantly higher than that in group A (t=–11.879, P=0.000).ConclusionLocal injection of appropriate concentration of Ang-2 may promote early vascularization and bone defect repair of tissue engineered bone in rabbits by enhancing autophagy.