Subcutaneous Fat Tissue Research Articles

Effect of combined compression-vibration therapy using non-invasive Beautylizer Therapy Cosmospheres V on the subcutaneous tissue morphology in women with gynoid lipodystrophy (pilot study).

Gynoid lipodystrophy is one of the most common cosmetical problems in women. The study aims to examine the pathomorphology and histology of subcutaneous tissue in women with gynoid lipodystrophy exposed to local compression/vibration therapy using a non-invasive Beautylizer Therapy Cosmospheres V medical device. The study enrolled 25 virtually healthy women aged 25-45years with gynoid lipodystrophy grades I and II. The women included in the study completed a 10-session month-long therapeutic course with a non-invasive Beautylizer Therapy Cosmospheres V medical device. Bioptic punch-size samples were taken from the gluteal region prior to and following the 10-session therapy course with the device. After completing a 10-session treatment course, a decrease in the mean adipocyte area from 123.08±13.60μm to 67.14±4.20μm was observed in punch bioptic samples of subcutaneous fat tissues of women with gynoid lipodystrophy as compared with the pre-treatment indices. Thus, local application of 10-session therapy with a non-invasive Beautylizer Therapy Cosmospheres V medical device in women with gynoid lipodystrophy demonstrated a positive effect on the histological structure of the hypodermis.

Identifying Key Genes and Functionally Enriched Pathways of Diverse Adipose Tissue Types in Cattle.

Background: Fat is a tissue that not just stores energy and plays a protective role; it is also a vital endocrine organ that generates and integrates signals to influence metabolism. Meanwhile, the excessive accumulation of lipids in adipose tissue can lead to metabolic disturbance and diseases. To date, the complicated molecular mechanisms of bovine adipose tissue are still unknown. This study aimed to identify key genes and functionally enriched pathways in various adipose tissue types. Results: The RNAseq data of 264 samples were downloaded from Gene Expression Omnibus (GEO) and analyzed by weighted gene co-expression network analysis (WGCNA). We identified 19 modules that significantly associated with at least one adipose tissue type. The brown module from GSE39618 was most closely associated with intramuscular fat tissue, which contained 550 genes. These genes were significantly enriched in pathways that related to inflammation and disease, such as TNF signaling pathway, IL-17 signaling pathway, and NF-kappa B signaling pathway. The pink module (GSE39618) that contained 58 genes was most closely associated with omental fat tissue. The turquoise (GSE39618), blue (GSE116775), and yellow (GSE65125) module were most closely associated with subcutaneous fat tissue. Genes in these modules were significantly enriched in pathways related to fat metabolism, such as the PPAR signaling pathway, fatty acid metabolism and PI3K-Akt signaling pathway. At last, key genes for intramuscular fat (PTGS2 and IL6), omental fat (ARHGEF5 and WT1), and subcutaneous fat (KIT, QR6Q1, PKD2L1, etc.) were obtained and verified. In addition, it was found that IL10 and VCAM1 might be potential genes to distinguish adipose and muscle. Conclusion: The study applied WGCNA to generate a landscape of adipose tissue and provide a basis for identifying potential pathways and hub genes of different adipose tissue types.

A Multi-Gene Panel to Identify Lipedema-Predisposing Genetic Variants by a Next-Generation Sequencing Strategy.

Lipedema is a disabling disease characterized by symmetric enlargement of the lower and/or upper limbs due to deposits of subcutaneous fat, that is easily misdiagnosed. Lipedema can be primary or syndromic, and can be the main feature of phenotypically overlapping disorders. The aim of this study was to design a next-generation sequencing (NGS) panel to help in the diagnosis of lipedema by identifying genes specific for lipedema but also genes for overlapping diseases, and targets for tailored treatments. We developed an NGS gene panel consisting of 305 genes potentially associated with lipedema and putative overlapping diseases relevant to lipedema. The genomes of 162 Italian and American patients with lipedema were sequenced. Twenty-one deleterious variants, according to 3 out of 5 predictors, were detected in PLIN1, LIPE, ALDH18A1, PPARG, GHR, INSR, RYR1, NPC1, POMC, NR0B2, GCKR, PPARA in 17 patients. This extended NGS-based approach has identified a number of gene variants that may be important in the diagnosis of lipedema, that may affect the phenotypic presentation of lipedema or that may cause disorders that could be confused with lipedema. This tool may be important for the diagnosis and treatment of people with pathologic subcutaneous fat tissue accumulation.

Evaluation of the Association between Lumbar Spinal Stenosis and Lumbar Subcutaneous Fat Tissue Thickness by MRI: A Novel Perspective.

To evaluate whether lumbar subcutaneous fat tissue thickness (LSFTT) on midsagittal magnetic resonance imaging (MRI) is associated with lumbar spinal stenosis (LSS). Observational cross-sectional study. Department of Radiology and Neurosurgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey between January 2018 and December 2020. The study group included 79 patients, who had undergone surgery for lumbar spinal stenosis. The control group included MRI scans of 80 individuals without lumbar spinal stenosis. Association between LSFTT and LSS was analysed through a comparison of both the groups. The agreement between the two observers was found to be very good agreement with a two-way mixed intra-class correlation coefficient of 0.986 or higher (p <0.001). There was statistically significant differences between the LSS and non-LSS groups for both L5-S1 and L4-5 level measurements, p=0.001, and p=0.004, respectively. L5-S1 level measurements in the LSS group showed 29% increase in average with respect to the non-LSS group; and in L4-L5 level measurements, the increase was 40% in median. Females exhibited significantly higher values in both levels, (p <0.001 and p <0.001, respectively). Lumbar subcutaneous fat tissue thickness is significantly associated with lumbar spinal stenosis. Measuring LSFTT on mid-sagittal MRI is an easily applicable, reproducible alternative method for predicting LSS. Key Word: Lumbar, Spinal canal, Stenosis, Subcutaneous fat tissue, Magnetic resonance imaging.

Comparative Transcriptomic Profiles of Differentiated Adipocytes Provide Insights into Adipogenesis Mechanisms of Subcutaneous and Intramuscular Fat Tissues in Pigs.

Subcutaneous fat thickness and intramuscular fat content are closely related to meat production and quality in the pig industry. Adipogenesis in adipocytes from subcutaneous and intramuscular fat tissues involves different genes and regulatory mechanisms. Analyzing the data of mRNA and miRNA transcriptomes during the differentiation of adipocytes from these two sources will help identify the different mechanisms of subcutaneous and intramuscular fat deposition. In this study, RNA sequencing technology was used to analyze the differential expression of genes and miRNAs in subcutaneous and intramuscular adipocytes at days 0, 2, 4, and 8 of differentiation. We mainly attributed the difference between fat depositions of the two types of adipocytes to variations in the expression patterns of related genes. Through combined weighted gene co-expression network analysis and K-MEANS, we identified 30 and 22 genes that mainly regulated the differentiation of subcutaneous adipocytes and intramuscular adipocytes, respectively. A total of 17 important candidate miRNAs were identified. This study provides valuable reference for the study of different mechanisms of adipogenesis among subcutaneous and intramuscular fat and contributes to improving pig breeding.

Pressure sores-Amultilayered challenge

Pressure sores occur when soft tissue of the skin, subcutaneous fat tissue or musculature is exposed to pressure or friction over along period of time, which leads to local ischemia with subsequent necrosis. All areas of the skin lying over bones with only athin layer of soft tissue are predilection sites. In older patients the risk factors for the development of apressure sore must be systematically documented at admission and during the course of the disease. Accordingly, the necessary prophylactic procedures must be initiated. The classification of the European Pressure Ulcer Advisory Panel (EPUAP) is used to describe a pressure sore. For the differential diagnosis, incontinence-associated dermatitis and a manifest peripheral artery occlusive disease must be excluded. The treatment consists of positioning procedures and local and systemic supportive wound treatment. In cases of deep pressure sores, coverage by plastic surgery can effectively accelerate healing. The multiprofessional geriatric team has the appropriate prerequisites for comprehensive treatment of pressure sores.

VP6: Lipografting for Face Asymmetry Pearls and Pitfalls

INTRODUCTION: Facial asymmetries are a common finding among patients seeking help in plastic surgeons, especially in the elder people as atrophy of subcutaneous fat tissue is the one of the main manifestations of aging which results not only in loss of skin laxity but also in the asymmetry of the face. Therefore it is essential to provide a patient with the volume replacement therapy. While there are several methods which may resolve this issue, the most appropriate in our opinion is the use of autologous fat. Its transplantation has been used with different degree of success. However due to its non allergenic nature and the ability to harvest it form almost any patient makes it the perfect filler to combat the asymmetries. In this presentation we would like to share our experience and provide some tips and tricks regarding the fat grafting in the asymmetry of the face MATERIALS AND METHODS: We have gathered our experience in fat grafting, starting from harvesting, processing and grafting itself in order to provide the patients with the most appeasing appearance. RESULTS: With our approach we have been able to not only to restore the natural appearance but also provide long lasting results. The complications were minimal, with the only partial loss of volume. CONCLUSION: Our method of fat processing and grafting provides the patients with the long lasting results, with minimal complications and makes the fat the perfect filler for volume replacement therapy.

Quantitative Evaluation of Fat Composition in Lumbar Vertebral Body and Paraspinal Muscle by Proton Density Fat Fraction with MRI

Purpose: Bone marrow and muscle adiposity have been considered to correlate with osteoporosis and Sarcopenia. Proton Density Fat Fraction (PDFF) can be measured by Magnetic Resonance Imaging (MRI). The purpose of the present study was to measure PDFF in the lumbar spine, paraspinal muscle and subcutaneous fat tissue. Methods: Participants were comprised of 30 patients (18 males, 12 females; age range, 14 - 87 years) who underwent MRI due to low back symptoms. PDFFs for the body of the fourth lumbar vertebra (L4), paraspinal muscle, and subcutaneous fat were measured. Results: PDFFs of the vertebral body and subcutaneous fat were significantly higher than that of paraspinal muscle (p fat between females and males, PDFFs of the vertebral body and paraspinal muscle were significantly higher in older subjects (>63 years) than in younger subjects (Conclusions: PDFF of the vertebral body was significantly higher than that of paraspinal muscle. PDFFs of the vertebral body and paraspinal muscle were significantly lower in younger subjects than in older subjects.

Comparison of Simple Tools For Measurement Of Obesity With Anthropometric Examination As A Predictor Of Metabolic Syndrome

Visceral fat shows a stronger relationship with the incidence of metabolic syndrome and cardiovascular risk than subcutaneous fat tissue. Visceral fat inhibits the action of adiponectin, so the body produces more fat than what we need. This study aims to compare simple tools for measuring obesity and visceral fat as predictors of metabolic syndrome. This research was a cross-sectional study with a sample of 50 subjects, the type of research was comparative and correlational. The variables in this study were bioelectric impedance analysis (BIA), skinfold thickness (ST), body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR) results. Data were analyzed with paired t-test and Pearson correlation test. There was a significant difference in body fat examination using BIA with ST (p=0.000). Body fat examination using BIA correlates with BMI, WC, and WHR (p=0.000). On the other hand, body fat examination using ST correlates with BMI and WC (p=0.000) but not with WHR (p=0.151). In conclusion, BIA and ST measurements were different, however, there was a significant correlation between BIA and ST. Body fat examination results of both BIA and ST correlate with other anthropometric examinations, except between ST and WHR.

Prognostic Impact of Quality and Distribution of Adipose Tissue in Patients With Primary Central Nervous System Lymphoma.

Body composition assessment has shown promising results as a prognostic biomarker as depicted by cross-sectional imaging of several tumor entities including lymphomas. The present study sought to elucidate the prognostic relevance of subcutaneous and visceral fat tissue (SAT and VAT) in patients with primary central nervous system lymphoma (PCNSL). Overall, 74 patients (36 female patients, 46.7%) with a mean age of 64.2±12.8 years (range=23-81 years) were identified in the database with sufficient clinical and imaging data and included into this retrospective study. Fat area assessment was performed on one axial slide on L3-height derived from staging computed tomography (CT) images. Subcutaneous, visceral, and intramuscular adipose tissues (SAT, VAT, IMAT) were estimated. Also, density of SAT, VAT, and IMAT were estimated. Finally, the ratio VAT/SAT (VSR) was calculated. Overall and progression-free survival (OS and PFS) were used as study end points. In the observation period, overall, 47 patients (63.5%) died. Mean OS was 33.8±45.4 months and mean PFS was 26.6±42.7 months. The mean VAT value was 162±99.5 cm2, the mean SAT was 202.4±103.3 cm2, the mean VSR was 0.92±0.69. The hazard ratios (HRs) for overall survival were 0.87 for high VAT, 1.52 for SAT, and 0.73 for VSR in univariable analysis. For PFS it was 0.24 for VAT, 1.11 for SAT, and 1.07 for VSR. No values achieved statistical significance. Similar results were shown in Kaplan-Meier analysis for OS and PFS, respectively. Parameters of adipose tissue are not associated with OS and PFS in patients with PCNSL.

Adipose-Derived Stem Cells: Isolation and Utilization within Regenerative Medicine and Cosmetic Procedures

Adipose-derived stem cells are a promising tool for the future of reconstructive surgeries, regenerative therapies and cosmetic procedures. Their ability to be safely, efficiently and cost-effectively isolated from extracted subcutaneous fat tissue makes them a favorable option for plastic surgeons, who often routinely perform liposuction procedures that provide adequate samples for stromal vascular fraction isolation. The differentiation potential of adipose-derived stem cells is vast and limited only in a developmental potential when compared to embryonic stem cells. Their utilization within clinical trials can be seen in procedures ranging from soft tissue and bony reconstruction, wound and burn healing, peripheral nerve regeneration and cosmetic procedures like skin rejuvenation and breast augmentations. The results from these trials provide evidence that supports future use of these stem cells within these fields of medicine.

Effects of voluntary exercise on the expression of browning markers in visceral and subcutaneous fat tissue of normotensive and spontaneously hypertensive rats

High physical activity is important to optimize the function of adipose tissue. Dysfunctional adipose tissue contributes to the development of metabolic stress, chronic inflammation, and hypertension. To improve our current understanding of the interaction between physical exercise and adipose tissue, we analyzed the effect of 10 months voluntary running wheel activity of rats on uncoupling protein (UCP) 1 negative white adipose tissue (visceral and subcutaneous adipose tissue, VWAT and SWAT). Analysis was performed via RT-PCR and immunoblot from adipose tissues depicted from adult normotensive and spontaneously hypertensive female rats. UCP1 negative VWAT differed from UCP1 positive WAT and brown adipose tissue (BAT) from interscapular fat depots, by lacking the expression of UCP1 and low expression of Cidea, a transcriptional co-activator of UCP1. High physical activity affected the expression of five genes in SWAT (Visfatin (up), RBP5, adiponectin, Cidea, and Nrg4 (all down)) but only one gene (Visfatin, up) in VWAT. Furthermore, the expression of these genes is differentially regulated in VWAT and SWAT of normotensive and spontaneously hypertensive rats (SHR) under sedentary conditions (UCP2) and exercise (Visfatin, Cidea, Nrg4). Keeping the animals after 6 months of voluntary exercise under observation for an additional period of 4 months without running wheels, Visfatin, Cidea, and Nrg4 were stronger expressed in VWAT of SHRs than in sedentary control rats. In summary, our study shows that SWAT is more responsible to exercise than VWAT.

Differences in anthropometric variables and muscle strength in relation to competitive level in male handball players.

Somatic characteristics manifested in different body morphology have great importance for the selection of athletes in most sports. The aim of our study is to evaluate the differences in anthropometric variables and isometric strength of handball players presenting different levels of sports competence, and to study the discriminative power of selected morphological characteristics that do not change in the training process. The study included the results of anthropometric measurements routinely used to monitor athletes, and body proportion indices were calculated. Fat percentage was assessed using the BIA, whereas body build was assessed using the Heath-Carter method. Measurements of right and left hand grip strength and back strength were taken. The results of measurements and calculations were analyzed using statistical methods. It was shown that players presenting the highest level dominate by the overall size and massiveness of the body, characteristics ensuring an advantage in direct confrontation. The size of subcutaneous fat tissue and percentage of body fat varied poorly between athletes in each group. Muscle strength assessed under static conditions shows a gradient in magnitude across teams from higher to lower rank, but the differences are not statistically significant. The same somatotype (balanced mesomorph) was present in all groups. Athletes presenting high sports level are characterized by body proportions that determine biomechanical conditions conducive to optimizing the structure of movements important in handball. Stepwise discriminant analysis showed that throwing-related characteristics (hand length, upper arm length, upper limb span, lower limb length) account for 88% of the variance in team ranking and can be used to identify the morphological predisposition of adepts to play handball.

The Effects of Aerobic Training with Different Intensity on FoxO1 and STRA13 Genes Expression in Subcutaneous Fat Tissue of Male Wistar Rat

The Effects of Aerobic Training with Different Intensity on FoxO1 and STRA13 Genes Expression in Subcutaneous Fat Tissue of Male Wistar Rat

Increased Ratio of CD14++CD80+ Cells/CD14++CD163+ Cells in the Infrapatellar Fat Pad of End-Stage Arthropathy Patients.

ObjectivesThis study sought to identify the ratio of M1/M2 cells in the infrapatellar fat pads (IFP) and subcutaneous fat tissues (SC) of osteoarthritis (OA) and rheumatoid arthritis (RA) patients. The clinical features of OA and RA patients treated with or without biological disease-modifying anti-rheumatic drugs (bDMARDs) were also assessed.MethodsIFP and SC were collected from patients with OA and RA who are undergoing total knee arthroplasty (TKA). CD14-positive cells were then isolated from these samples. Flow cytometry was used to determine the number of CD14++CD80+ cells and CD14++CD163+ cells. The expression levels of lipid transcription factors, such as sterol regulatory element-binding protein 1 (SREBP1) and liver X receptor alpha (LXRA), and inflammatory cytokines were also evaluated.ResultsTwenty OA patients and 22 RA patients were enrolled in this study. Ten of the RA patients (45.4%) received bDAMRDs before TKA. On average, a fivefold increase in the number of CD14-positive cells and lower expression levels of SREBP1C and LXRA were observed in OA IFP relative to OA SC; however, these results were not obtained from the RA samples. The median ratio of CD14++CD80+ cells/CD14++CD163+ cells of OA IFP was 0.87 (0.76–1.09, interquartile range), which is higher to that of OA SC with a lower ratio (p = 0.05835).ConclusionsThe quantity and quality of CD14-positive cells differed between IFP and SC in arthropathy patients. To our knowledge, this is the first study to characterize the ratio of M1/M2 cells in the IFP and SC of end-stage OA and RA patients. The increased ratio of CD14++CD80+ cells/CD14++CD163+ cells in the IFP from patients with OA and RA treated with bDMARDs indicated that inflammation was localized in the IFP. As adipose tissue-derived innate immune cells were revealed as one of the targets for regulating inflammation, further analysis of these cells in the IFP may reveal new therapeutic strategies for inflammatory joint diseases.

Effect of 6-Month Feeding with a Diet Enriched in EPA + DHA from Fish Meat on the Blood Metabolomic Profile of Dogs with Myxomatous Mitral Valve Disease

Simple SummaryAnimal nutrition plays an important role in the therapy of many diseases, including heart failure. The aim of the research was to assess whether 6 months of feeding diet enriched in unsaturated fatty acids (from fish meat) in dogs suffering from heart failure due to mitral degeneration impacts the dogs’ metabolic profile and clinical status. Twenty small breed dogs in early stages of heart failure were randomly divided into two groups. One group receiving a standard diet, the second one a diet enriched in fish meat. All dogs continued to receive appropriate cardiac therapy throughout the study. Control examinations were performed at the start of the study, after 3 and 6 months of appropriate feeding. The results showed no differences in clinical, cardiological, haematological and biochemical parameters between the two study groups. The metabolomic changes was more pronounced with time. After 6 months of feeding the diete enriched in fish meat, there was a favorable reduction in glycerophosphocholine and xanthine levels, but an adverse increase in lactate and furvan and a decrease in alanine was not stopped.Animal nutrition plays an important role in the therapy of many diseases, including heart failure. The aim was to assess whether 6 months of feeding an AEP + ADH enriched diet (from fish meat) in dogs suffering from heart failure due to mitral degeneration impacts the dogs’ metabolic profile and clinical status. Twenty small breed dogs were included: 50% were in stage B2 of MMVD and 50%, in stage C according to ACVIM. Dogs were randomly divided into two groups. One group receiving a standard diet, the second one a diet enriched with EPA + DHA (from fish meat). All dogs continued to receive appropriate therapy throughout the study. Control examinations were performed at the start of the study, after 3 and 6 months of appropriate feeding. Examinations included ECG, ECHO, blood hemathology and biochemistry, morphometric measurements, body fat index and subcutaneous fat tissue thickness. Serum samples were analyzed with a high-performance liquid chromatography system. Data were analyzed using the Progenesis QI (PQI, Non-linear Dynamics). The results showed no differences in clinical, cardiological, haematological and biochemical parameters between the two study groups. An effect on the metabolomic profile following a continued diet enriched in DHA + EPA (from fish meat) was more pronounced with time. After 6 months of feeding the diete enriched with DHA + EPA (from fish meat), there was a favorable reduction in glycerophosphocholine and xanthine levels, but an adverse increase in lactate and furvan and a decrease in alanine was not stopped.

Epidural Fat Tissue Is More Effective for Scar Prevention Than Conventional Subcutaneous Fat Grafting After Laminectomy in a Mouse Model.

Basic science study. The aim of this study was to examine whether epidural fat tissue (EFT) transplantation can prevent epidural adhesion after laminectomy more efficiently than subcutaneous fat tissue (SFT) transplantation. Epidural adhesion is almost inevitable after laminectomy. Although many materials have been used to prevent adhesion, none has been widely accepted. As EFT is an ectopic fat tissue located on the dura mater and there is no adhesion between EFT and the dura mater, we focused on the efficacy of EFT for adhesion prevention. We examined the differences in histology and gene expression between EFT and SFT of mice. We performed laminectomy at the 10th thoracic level and immediately transplanted EFT or SFT to the dura mater in mice. At 6 weeks after transplantation, we performed histological and gene expression analyses and evaluated the adhesion tenacity. In addition, we examined the characteristic differences between human EFT and SFT. The adipocytes of EFT were significantly smaller than those of SFT in mice and humans. The gene expression of inflammatory cytokine and fibrosis-related factors was significantly higher in SFT than in EFT. At 6 weeks after transplantation, the percentage of the remaining fat area over the dura mater was significantly greater in the EFT group than in SFT group, and the adhesion tenacity score was significantly lower in the EFT group than that in the SFT group. An RNA sequencing analysis revealed 1921 differentially expressed genes (DEGs) between human EFT and SFT, and a Gene Ontology term associated with the inflammatory response was most highly enriched in SFT. EFT has different molecular and histological profiles from SFT and EFT grafting is more effective for epidural adhesion prevention than conventional SFT transplantation after laminectomy in a mouse model.Level of Evidence: N/A.

A new radiological index for the assessment of higher body fat status and lumbar spine degeneration.

Obesity has been proposed as a risk factor for low back pain (LBP) and intervertebral disc degeneration (IVDD). Even though body mass index (BMI) is used as a parameter for obesity, it could not represent percentage and distribution of the body fat. Subcutaneous fat tissue thickness (SFTT) was proposed as one of the magnetic resonance imaging (MRI) parameters to evaluate the percentage of the body fat. In this study, we aimed to find out whether SFTT at lower back correlated with LBP and spine degeneration. We retrospectively reviewed a database of the patients with LBP. Concomitantly, asymptomatic control subjects were retrieved. Patients and control subjects were evaluated in terms of IVDD and Modic changes at all lumbar levels on MRI. SFTT was measured both on MRI and computed tomography (CT) scans, where applicable. SFTT at the lumbar spine had moderate-to-strong correlations with BMI. SFTT at L1-L2 level was significantly associated with severe IVDD at L5-S1 level, and Modic changes at L4-L5 and L5-S1 levels. BMI had no significant association with severe IVDD and Modic changes at lumbar spine. BMI and mean SFTT of all lumbar levels had ORs of 0.735 (95% CI: 0.631-0.857, p < 0.001) and 1.389 (95% CI: 1.266-1.524, p < 0.001) in predicting symptomatic subjects with LBP. SFTT at upper lumbar levels could predict severe IVDD and Modic changes better than BMI, specifically in men. SFTT was better than BMI in predicting a symptomatic patient with LBP.

Primary cutaneous adenoid cystic carcinoma: a clinicopathologic, immunohistochemical, and fluorescence in-situ hybridisation study of 13 cases.

This study aimed to investigate the clinical, histological, immunohistochemical and chromosomal features of primary cutaneous adenoid cystic carcinoma (PCACC). We retrospectively analysed 13 cases identified on their clinicopathological features and performed fluorescence in-situ hybridisation (FISH) on six available cases. Head and neck (46.2%) were most commonly involved. The median age was 53 years, with a male predilection. Histologically, tumours were classified as grades 1 (eight), 2 (four) and 3 with high-grade transformation (HGT) (one). The HGT component was demonstrated as poorly differentiated carcinoma with multifocal necrosis and myoepithelial differentiation. Patients with one of the following factors: longest diameter of the lesion (≥ 1 cm), involvement of subcutaneous fat tissue and widely infiltrative border had a relatively higher rate of local recurrence, distant metastasis and death. Five of six cases were confirmed to have MYB translocation, while nuclear staining for MYB proto-oncogene, transcription factor (MYB) protein was found in four cases. During the follow-up (median = 64 months), two patients experienced local recurrences. One patient, who was classified as grade III PCACC with HGT, developed multiple metastases and died of disease. Another patient was alive with multiple metastases. This is the largest single-institution study, to our knowledge, of PCACC in an Asian population. We describe the first case of scalp PCACC with HGT, which is the only death case in our series. PCACC tends to recur locally and has metastatic potential. PCACC with HGT has a poor prognosis.

Association of serum and fat tissue antibiotic concentrations with surgical site infections in lower gastrointestinal surgery

BackgroundDuring surgery, the effectiveness of perioperative prophylactic antibiotic administration against surgical site infections is inferred from serum concentrations and not from tissues where local infections occur. This study aimed to measure the serum and tissue concentrations of cefmetazole in colorectal surgery cases to clarify whether there is an association between the incidence of surgical site infections and antibiotic concentrations. MethodsThis prospective cohort study was performed at a single tertiary care center. The data of 105 patients who underwent colorectal surgery between October 2017 and September 2019 were evaluated. The primary outcome was the incidence of surgical site infections. Univariate analysis was performed to investigate the association between surgical site infections, perioperative factors, and the serum and tissue concentrations of cefmetazole. ResultsThe incidence of surgical site infections was 13/105 (12.4%). Cefmetazole concentrations were measured at initial incision (serum; 101 vs 93.1 mg/L, P = .75, subcutaneous fat tissue; 2.8 vs 3.7 mg/g, P = .15), intestinal resection (serum; 35.1 vs 36.7 mg/L, P = .63, mesenteric adipose tissue; 1.3 vs 1.7 mg/g, P = .55), and at skin closure (serum; 34.5 vs 44.8 mg/L, P = .18, subcutaneous fat tissue; 1.0 vs 2.2 mg/g, P = .09). In univariate analysis with P ≤ .10, cefmetazole concentration in subcutaneous fat tissue at skin closure was found to be a significant risk factor for surgical site infections. Age, additional intraoperative administration of cefmetazole, and creatinine clearance were also significant risk factors for the occurrence of surgical site infections. ConclusionLow subcutaneous fat cefmetazole concentrations at skin closure during gastrointestinal operations may also be involved in the occurrence of surgical site infections.