Research progress of bile biomarkers and their immunoregulatory role in biliary tract cancers

Biliary tract cancers (BTCs), including cholangiocarcinoma and gallbladder carcinoma, originate from the biliary epithelium and have a poor prognosis. Surgery is the only choice for cure in the early stage of disease. However, most patients are diagnosed in the advanced stage and lose the chance for surgery. Early diagnosis could significantly improve the prognosis of patients. Bile has complex components and is in direct contact with biliary tract tumors. Bile components are closely related to the occurrence and development of biliary tract tumors and may be applied as biomarkers for BTCs. Meanwhile, arising evidence has confirmed the immunoregulatory role of bile components. In this review, we aim to summarize and discuss the relationship between bile components and biliary tract cancers and their ability as biomarkers for BTCs, highlighting the role of bile components in regulating immune response, and their promising application prospects.

Anatomy and tensile strength of the abdominal head of the pectoralis major muscle in relation to transaxillary breast augmentation

BACKGROUND

This study aimed to elucidate the anatomy of the abdominal head of the pectoralis major (AHPM) in relation to transaxillary breast augmentation (TBA).

METHODS

In 20 hemithoraxes of fresh Korean cadavers, the width, thickness, and location of the origin of the AHPM were measured in relation to the seventh rib-costal cartilage junction. A force gauge was used to measure the force needed to detach the AHPM from its origin. In another four breasts, an implant pocket was made first, followed by observation of the AHPM. In 92 patients who underwent surgery, the AHPM was observed at its origin during performance of endoscopic TBA.

RESULTS

The AHPM was observed in 23 (96%) of 24 hemithoraxes dissected. The AHPM was observed in 170 (92.4%) of 184 breasts subjected to surgery. The AHPM originated from the rectus fascia at the sixth (60%) and seventh (35%) costochondral junctions. The width of the AHPM was 23.5±5.2 mm at its origin, 15.2±3.9 mm at midbelly, and 7.3±4.3 mm at insertion. The thickness of the AHPM at its origin was 1.6±0.5 mm. The force needed to detach AHPM from its origin was 23.5±12.0 N. In two cadavers of mock surgery, the AHPM could limit the boundary of the implant pocket after division of the costal origins. After division of the AHPM, the free inferior space was obtained.

CONCLUSION

In submuscular or dual-plane breast augmentation, the AHPM should be cut to place the implant in the correct desired position.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Factors influencing the acceptance of toenail-to-fingernail transfer

The aim of this study is to determine the factors influencing the acceptance of toenail-to-fingernail transfer. A total of 240 patients were divided into four groups according to severity of nail injury. Half (expensed informed [EI] group) were informed about the expenses (about $9,000) before the interview; the other half were not informed (the expense not-informed [ENI] group). The participants were asked to answer yes or no to the question "If you lose your fingernail and it can be reconstructed by transferring your toenail like this figure, will you undergo surgery? If you want it or not, please choose the reason for your choice." In the EI group, 68.3% accepted the surgery. In the ENI group, 85.0% accepted the surgery. There was a significant difference between the EI and ENI groups (p = 0.002). In the EI group, the age of the surgery acceptance group (36.9 ± 11.8) was significantly lower (p = 0.004) than that of the surgery rejection group (44.5 ± 15.5). The young age group wished to accept the surgery irrespective of the expenses, yet the old age group hesitated to have surgery when informed about the expenses. We think the risk acceptance for toenail-to-fingernail transfer mostly depends upon the expense.

Myofibroblasts and capsular tissue tension in breast capsular contracture

BACKGROUND

This study aimed to observe the relationship between the number of myofibroblasts, the tensile strength of the breast implant capsule, and the degree of breast capsular contracture.

METHODS

The study enrolled 21 women with 31 capsular contractures after aesthetic breast augmentation. The capsular tissue specimens were obtained during capsulectomy, open capsulotomy, and other revisional procedures. The tensile strength of capsular tissues (1 × 3 cm) was measured by tensiometer. The capsular tissues were immunostained by alpha smooth muscle actin, and the immunostained myofibroblasts all were counted on a 2.5-mm length of the capsule.

RESULTS

Myofibroblasts were detected in 22 (71%) of 31 specimens. The myofibroblasts were on the outer layer of the capsule and made up 7.3% to 50% (average, 26.9% ± 12.7%) of the capsule thickness. The number of myofibroblasts varied according to the degree of capsular contracture, but grades 2, 3, and 4 contracture did not differ significantly (p = 0.102). The average tensile strength of the capsule was 44 ± 38 N. Tensile strength was the lowest for grade 2 (27.0 ± 22.2 N), increased for grade 3 (38.0 ± 22.6 N), and was highest for grade 4 (66.5 ± 55.4 N; p = 0.044) contracture. The tensile strength of the capsule correlated positively with the degree of capsular contracture (p = 0.029).

CONCLUSION

The tensile strength of breast capsules correlated with the degree of capsular contracture. The authors think myofibroblasts appear during an active phase of wound contraction and diminish when the wound has matured.

[The basic study of noninvasive detecting the ischemic/hypoxic cerebral injury]

The cerebrovacular diseases are important causes of mortality and disability in the world, and with the development of science and technology, many mission-oriented basic researches are aimed at the ischemic/hypoxic brain injury. This paper introduces some progress made in our research in this field, which includes: the animal experiment model of brain injury; the technique to efficiently extract evoked potentials from electroencephalogram; and the identification of the characteristic information of brain injury.