[Repair of severe flexion contracture deformity of adjacent fingers with trifoliated flap from toe web in six patients]

From May 2014 to January 2018, 6 patients with severe flexion contracture deformity caused by palmar cicatricial hyperplasia of adjacent 2 or 3 fingers were admitted to the Yidu Central Hospital of Weifang. There were 4 males (8 fingers) and 2 females (5 fingers), aged 13-51 years.The degrees of flexion of proximal interphalangeal joint of affected fingers and metacarpophalangeal joint were respectively 60-90°and 60-80°, and the total degree of passive extension of metacarpophalangeal joint, proximal interphalangeal joint, and distal interphalangeal joint was from -180 to -120°. After scar resection, tendon release, and extension of affected fingers, bone and/or tendon were exposed, and the wound area was 4.0 cm×2.0 cm-8.5 cm×4.0 cm.The wound was repaired with trifoliated flap composed of fibular flap of great toe, abdominal flap of the second toe, and plantar metatarsal flap, with flap area of 4.5 cm×2.5 cm-9.0 cm×4.5 cm.The plantar metatarsal wound of the donor site was sutured directly, and the remaining wound was repaired with full-thickness skin graft from the outside of the thigh. All the wounds of patients were healed. All flaps survived and had good blood circulation without vascular crisis after operation.During follow-up of 6 months to 2 years, the flaps were with good appearance, no swelling, similar in color to the surrounding skin, soft in texture, good in sensations of touch and pain, and the distance of discrimination of 6-8 mm. The active and passive flexion and extension of the affected fingers were good, and there was no dysfunction in the donor site of foot, only with slight scar. The article showed that trifoliated flap from toe web is one of the best methods to repair the severe contracture flexion deformity of fingers caused by severe cicatricial hyperplasia of palmar side, especially the soft-tissue defect of the skin after the cicatricial hyperplasia of adjacent 2 or 3 fingers is removed.

[Clinicopathological features of dedifferentiated liposarcomas with meningothelial-like whorls: report of six cases]

Objective: To investigate the histopathologic, immunohistochemical, molecular genetic characteristics of dedifferentiated liposarcomas with meningothelial-like whorls(DDLMW). Methods: Six cases of DDLMW diagnosed at Jiangsu Province Hospital(the First Affiliated Hospital of Nanjing Medical University) from March 2012 to August 2018 were enrolled. The cases were analyzed by routine HE staining, immunohistochemistry(MDM2, CDK4 and p16) and fluorescent in-situ hybridization(FISH) on MDM2 gene. Related literatures were also reviewed. Results: Three of the 6 patients were male.The patient ages ranged from 40 to 77 years (mean, 58 years). Four tumors occurred in the retroperitoneum and two in the mediastinum. Histologically, the tumors showed, in addition to foci of well-differentied liposarcoma, characteristic, scattered meningothelial-like concentrical whorls. The whorls were composed of tightly, concentrically arranged, spindle to ovoid cells with mild to mederate cytological atypia. Metaplastic bone was present within or in their immediate vicinity in four case. The tumors cell also showed strong and diffuse immunoreactivity to MDM2, CDK4 and p16, but no immunoreactivity to S-100 protein, SMA, SOX10, EMA, CD21, CD23 or CD35. The Ki-67 labeling indexes were low, while FISH showed high levels of MDM2 amplification in all cases. Conclusions: DDLMW is a rare morphologic variant of dedifferentiated liposarcoma. The whorls in DDLMW do not represent perineurial or follicular dendritic differentiation. Recognition and familiarity with its existence, as well as combined application of immunohistochemical staining and MDM FISH, are important to avoid confusion with other lesions.

P4647Next generation sequencing in 83 fetal left-sided CHDs reveals the entire genetic architecture of left-sided CHDs in fetal population

Background

No data is available for the contribution of single gene disorders (SGDs) to left-sided congenital heart defects (LSCHDs) in the fetal population.

Purpose

The aim of this study was to explore the entire genetic architecture of LSCHDs, especially the contribution of SGDs in a cohort of fetal LSCHDs.

Methods

Low-pass whole genome sequencing (WGS) and whole exome sequencing (WES) were performed on specimens from 83 deceased fetuses with lSCHDs, including 48 HLHS, 22 CoA, 5 AS, 3 AAH, 2 AS+CoA and 1 case of AA, AS+MS, MA. Sequencing was predominantly performed in fetus-parent trios (n=63, 75.9%), or in fetus only (n=20, 24.1%).

Results

34.9% (n=29) of the 83 fetal left-sided CHDs were identified with related genetic abnormalities. WGS analysis identified 14 (16.9%) with chromosomal abnormalities, including 6 (7.2%) aneuploidies and 8 (9.6%) pathogenic copy number variants (CNVs). WES analysis of the remaining 69 cases without chromosomal abnormalities identified 15 (15/69, 21.7%) with pathogenic/likely pathogenic variants. Of these 15 cases, KMT2D was the most frequently mutated gene (7/69, 10.1%), followed by NOTCH1 (4/69, 2.5%). Compound heterozygosity was identified in 3 genes (DNAH11, POFUT1, CRB2) that are not yet well established as CHD genes. Finally, we also observed a LOF variant in NONO (X-linked) that was maternally transmitted to an affected male case.

The genetic results of this cohort Aneuploidies Trisomy 18 4 Turner syndrome 2 CNVs 11q terminal deletion 3 1p36 deletion 1 15q terminal deletion 1 7q11.23 deletion 1 4p terminal deletion 1 12q complex internal duplication 1 SGDs AD (KMT2D = 7; NOTCH1 = 4) 11 AR (DNAH11, POFUT1, CRB2) 3 X-recessive (NONO) 1 AD: autosomal dominant; AR: autosomal recessive.

Conclusions

Our experience supports that SGDs contribute a significant part to the pathogenesis of fetal CHDs, WES has the potential to provide molecular diagnoses in fetal left-sided CHDs without chromosomal abnormalities. KMT2D mutations accounted for a large fraction of left-sided CHDs in fetal population. If the KMT2D mutation is detected, further diagnosis of Kabuki syndrome should be considered.

The morphological characteristics and germination of grassland forb species after simulated digestion by sheep in the Tianshan Mountains, China

Viable seeds from dry-fruited forbs growing in the Tianshan Mountains of China are often found in livestock dung. However, the effect of ingestion on their morphological characteristics and germination remains unclear. This research assessed the germination of 15 forbs after simulated ingestion (insertion through a rumen fistula) by Kazakh sheep. Seed accessory structures (such as wings, trichomes and mucilage) were digested. Seed length, width and thickness were negatively correlated with digestion time, and 100-seed mass was negatively (but not significantly) correlated with digestion time. The means of seed morphological traits (except for the seed shape index) and germination generally decreased. Germination was negatively correlated with digestion time. Germination of Rumex acetosa, Leontice incerta and Lonicera hispida initially increased and then decreased with increased digestion time, while germination of the other 12 seeds all significantly decreased with increased digestion time. Germination of Plantago depressa, Alyssum desertorum, Lachnoloma lehmannii, Tulipa gesneriana, Tauscheria lasiocarpa and Calligonum rubicundum decreased to zero after 24h digestion, whereas the other nine seeds still had some level of vigour. Seeds of several forbs survived rumen digestion, indicating the potential for endozoochorous seed dispersal, a dispersal mechanism known to enhance survival in dynamic and harsh desert habitats.

Investigation of a series of synthetic cationic porphyrins using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOFMS) was used to study a series of synthetic cationic porphyrins as the perchlorate and bromide salts. This work presents the analytical results for the porphyrins obtained using 2, 5-dihydroxybenzoic acid (DHB) and 1,8,9-anthratriol as matrices. The selective use of matrix affects ion formation from these porphyrins. By using DHB as the matrix, we not only observed [M - nClO(4)](+) (n = 1-4) ions, but also obtained [2M - nClO(4)](+) (n = 2-7) ions from the synthetic cationic porphyrins. The space volume of the side chains (R groups) and the nature of the anions (Br(-) or ClO(4)(-)) affected the relative importance of monomeric and dimeric ions of the porphyrin. The possible mechanisms of desorption and ionization of these cationic porphyrins were also considered in this study. MALDI-TOFMS proved to be a very useful method for obtaining structural information on these synthetic cationic porphyrins. Copyright 1999 John Wiley & Sons, Ltd.