Comparison of the Incidence of Capsular Formation in Two-Stage, Implant-Based Breast Reconstruction Using an Insertion Funnel and Sizer

Purpose. Capsular formation around breast implants can produce various complications, including erythema, tenderness, discomfort, and breast deformation. Moreover, the capsule is thought to be correlated with breast implant-associated anaplastic large cell lymphoma. The proposed technique of capsule reduction can prevent some of these complications. Thus, the authors suggest a no-touch technique in two-stage, implant-based breast reconstruction. Patients and Methods. This single-center retrospective study evaluated the medical records and digitalized pathological slides of patients who underwent two-stage, implant-based breast reconstruction between February 2018 and May 2019. The selected patients were divided into group A and group B. Group A underwent a no-touch technique that included the following two steps: (1) using a sizer as the frame to create the submuscular and acellular dermal matrix (ADM) pocket for expander insertion and (2) inserting the expander through the funnel. After the second stage of implant insertion, the capsule was harvested for biopsy of the ADM, chest wall, and muscle. Results. This study included 33 breasts (31 patients): 18 in group A and 15 in group B. The capsular thicknesses of the ADM, the chest wall, and the muscle of group A were significantly thinner than those in group B. Pearson’s correlation coefficient indicated negative correlations between capsular thickness and age; underlying disease; lesion side; interval of two-stage implant insertion; size of the expander; and radiotherapy, chemotherapy, or hormone therapy. Conclusion. To reduce the incidence of capsular formation following breast reconstruction using prostheses, a no-touch technique that uses a funnel and sizer to avoid implant contact is both efficient and beneficial.

Effect of CAP10 gene on immune response in mice infected with Cryptococcus neoformans

ABSTRACT Background Capsule is an vital virulence factor in Cryptococcus neoformans infection. Recent studies show CAP10 is a key gene in capsular formation. However, the role of CAP10 in the pathophysiology of cryptococcosis is still not well understood. This study aims to investigate the association of CAP10 expression with the immune responses to infected mice. Methods The shRNA expression plasmid was designed to interfere with the synthesis of CAP10. The animal model was established with C. neoformans wt strain H99, cap10-shRNA C. neoformans and PBS control in the respiratory tract. On the 7 days and 21 days after infection, mice lung histopathological examination and homogenate culture were performed, and cytokines expression level in the serum of mice were quantitatively detected. Results The lower degree of edema and infiltration of inflammatory cells were observed in cap10-shRNA group. The growth rate of cap10-shRNA strain was significantly reduced. In addition, interference with CAP10 altered the expression profile of Th1, Th2, Th17 and Treg type cytokine. Down-regulation of CAP10 was beneficial to the balance of Th1/Th2, Th17/Treg ratio. Conclusions Taken together, our results indicated the expression of the CAP10 was associated with an antifungal immune response to mice infected with C. neoformans. CAP10 might play an important role in regulating the inflammatory response, and could expected to be a new molecular therapeutic target in cryptococcosis.

Persistent Hypotony Associated with Immunosuppressive Therapy in Glaucoma Drainage Implant Surgery

Purpose: To describe the histopathology of non-valved implant capsules in three cases of persistent postoperative hypotony after the restrictive tube ligature was released in patients receiving immunosuppressive therapy. Observations: The macroscopic appearance of the capsules 3 and 4 months postoperatively was immature and loose. Microscopic examination disclosed extremely irregular thin tissue, with thicknesses ranging from 0.02 to 0.6 mm, depending on the capsular location studied. Withdrawal of immunosuppressive therapy did not facilitate rebuilding of new capsules. Replacement with a valved implant device was necessary in two cases; the third case recovered with tapering of prednisone. Conclusions and Importance: The use of chronic systemic immunosuppressive therapy might interfere with capsular formation around the plates of drainage devices inducing persistent hypotony. In these cases, the use of valved implants might be safer.