Decellularized adipose-derived matrix from Superficial layers of abdominal adipose tissue exhibits superior capacity of adipogenesis compared to deep layers.

The adipogenic property of decellularized adipose-derived matrix (DAM) varies widely across reports, making it difficult to make a horizontal comparison between reports and posing challenges for the stable clinical translation of DAM. It is possibly due to differences in donor characteristics, but the exact relationship remains unclear. Despite extensive research on the differences between superficial and deep layers of abdominal subcutaneous fat, a main donor of DAM, little is known about their extracellular matrix (ECM) which is promising in regenerative medicine. In this study, we first confirmed the distinct compositional profiles and adipogenic potential between superficial and deep DAM (S-DAM and D-DAM). Both in vitro and in vivo assays confirmed superior adipogenic induction potential in S-DAM over D-DAM. Total amounts of ECM proteins like collagen and laminin were similar, however, the predominant types differed, with collagen I dominating S-DAM and collagen XIV prevailing in D-DAM. S-DAM was enriched with mitochondrial and immunological proteins, whereas D-DAM featured more neuronal, vascular, muscular, and endocrine-related proteins. More proteins involved in mRNA processing were found in D-DAM, with Protein-Protein Interaction (PPI) analysis revealing HNRNPA2B1, HNRNPA1, and HNRNPC as the most tightly interacting members. These findings not only deepen our comprehension of the structural and functional heterogeneity of adipose tissues but also become one of the reason for the large variability between batches of DAM products, providing guidance for constructing more efficient and stable bio-scaffolds.

Hydrophilic Components as Key Active Ingredients in Adipose-Derived Matrix Bioscaffolds for Inducing Fat Regeneration.

Decellularized adipose-derived matrix (DAM) has emerged as a promising biomaterial for soft tissue reconstruction. However, due to a lack of research on its complex composition, the understanding of the key components in DAM remains limited, leading to inconsistent adipogenic properties and challenges in optimizing preparation methods purposefully. In this study, it is proposed for the first time that DAM comprises two distinct components: hydrophilic (H-DAM) and lipophilic (L-DAM), each with markedly different effects on fat regeneration. It is confirmed that H-DAM is the key component for inducing fat regeneration due to its enhanced cell-cell and cell-scaffold interactions, primarily mediated by the Hedgehog signaling pathway. In contrast, L-DAM exhibits poor cell adhesion and contains more antigenic components, leading to a higher immunoinflammatory response and reduced adipogenesis. In addition, it is found that intracellular proteins, which are more abundant in H-DAM, can be retained as beneficial components due to their hydrophilicity, contrary to the conventional view that they shall be removed. Accordingly, a purified bioscaffold with unprecedented efficacy is proposed for fat regeneration and reduced immunogenicity. This finding provides insights for developing scaffolds for fat regeneration and promotes the realization of xenotransplantation.

"Autologous Breast Dermal Filler": A Novel Technique for Breast Reconstruction After Nipple- or Skin-Sparing Mastectomy in Pubertal Gigantomastia.

BACKGROUND: For females in puberty, mastectomy caused by pathological gigantomastia usually brings significant psychological problems. Appropriate immediate breast reconstruction method is necessary. OBJECTIVES: The aim of this study is to present a novel method of breast reconstruction that requires neither implants nor donor-site sacrifice. METHODS: All patients who were diagnosed with pathological gigantomastia and indicated for nipple-sparing or skin-sparing mastectomy (NSM or SSM) were selected. All extra skin was de-epithelialized, followed by NSM or SSM through a vertical incision on the lower pole of the breast. Then, a skin and dermal envelope in all directions was formed. Whether to preserve the nipple-areolar complex depended on its perfusion. The dermal flap was folded inward to serve as the "autologous dermal filler" and reconstruct the breast. A second surgery of inframammary fold elevation for larger projection was performed at least 6 months. Follow up for at least 1 year and record complications as well as pre- and postoperative BREAST-Q Scores. RESULTS: A total of 11 breasts were included. Four (36.4%) were NSM and seven (63.6%) were SSM. Nipple to sternal notch distance in NSM and SSM was 32.3±9.1cm and 35.1±4.4cm, respectively. No complications occurred, while one breast with NSM showed nipple upward displacement. The BREAST-Q indicated significant postoperative improvements in breast satisfaction (20.5 ± 11.3 vs 80.2 ± 10.4) and psychosocial well-being (23.4 ± 8.9 vs. 81.4 ± 11.3). CONCLUSIONS: Preliminary study demonstrated the efficacy and long-term safety of "autologous breast dermal filler." For adolescents, it is a less invasive autologous breast reconstruction method, or transitional plan for further adjustment in adulthood. 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 .

Preoperative Three-Dimensional Measurement-Based Periareolar Augmentation Mastopexy: Indication and Breast Crown Approach.

SUMMARY: At present, there is no uniform and quantitative indication standard for periareolar augmentation mastopexy. The authors proposed an indication algorithm and a matched approach to delineate the outer circle, to optimize the result of this operation. Five parameters, including both implant and breast characteristics, were incorporated to form an indication algorithm based on three-dimensional measurement. The indication follows the principle that the circumference of the outer circle should be no more than two times the inner circle. To delineate the outer circle, a "crown" was made on the breast. The above approaches were used on patients who came for periareolar augmentation mastopexy from October of 2015 to January of 2019. Data analyzed included BREAST-Q score, areola diameter, the distance of the sternal notch to the nipple preoperatively and 1 year postoperatively, the distance of nipple elevation 1 year postoperatively, and complication and revision rates. A total of 28 breasts (14 patients) were included in this study. BREAST-Q scores 1-year postoperatively showed significant increases in Satisfaction with Breasts, Psychosocial Well-Being, and Sexual Well-Being ( p = 0.000). The mean areolar diameter preoperatively and postoperatively was 6.7 ± 1.2 cm and 4.6 ± 0.4 cm, respectively ( p = 0.000), and the mean sternal notch-to-nipple distance preoperatively and postoperatively was 22.2 ± 1.9 cm and 18.6 ± 1.0 cm, respectively ( p = 0.000), with an average nipple elevation of 3.2 ± 1.1 cm. The overall complication rate was 7.1 percent ( n = 2); both cases were areolar spreading. The overall revision rate was 0 percent. This preliminary study demonstrated the safety and efficacy of the indication and breast crown approach in reducing complication and revision rates. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Retroperitoneal dermoid cyst mimicking a liposarcoma based on imaging assessment: case report and literature review.

Dermoid cyst is a kind of mature cystic teratoma that contains only one germ layer. It usually occurs in the head and neck, retroperitoneal dermoid cysts are uncommon. Teratomas are characterized by mixed density and features like calcification or air-fluid level. Here, we present a case of 40-year-old female with a 12.1 cm × 10.0 cm retroperitoneal fatty mass which showed no calcification and few other specific characteristics of teratoma. Thin and uniform separations were observed. On PET-CT, it was adherent to several retroperitoneal organs like left adrenal gland and left kidney, and had a close relationship with several retroperitoneal vessels like aorta, superior mesenteric arteriovenous, left superior renal artery and inferior vena cava. On PET-CT, mild 18F-FDG uptake was observed. Based on the above imaging findings, a clinical diagnosis of liposarcoma was considered. After laparotomy and open surgery transit through a left vertical incision, the histopathologic examination revealed a retroperitoneal dermoid cyst. During a 2-month follow-up, the patient recovered well without discomfort and recurrence. Comparison between dermoid cyst and liposarcoma in imaging findings was performed. In dermoid cysts, there can be thin and uniform separations, rather than linear, localized and irregular high density in liposarcoma. The difference between dermoid cyst and mature cystic teratoma is yet to be clarified. A review of clinical and histopathological features of retroperitoneal dermoid cyst was also performed to enhance the level of the diagnosis and management.

Multiple myeloma complicated by skull plasmacytoma discovered after head injury.

Plasmacytoma is a malignant tumor originating from the plasma cells of the bone marrow. Those discovered after a head injury is rare. We report a case of a 48-year-old female who complained of scalp mass without other symptoms after head injury. Meningioma was considered preoperatively based on imaging findings, and surgical resection was performed. Postoperatively, multiple myeloma complicated by skull plasmacytoma was diagnosed by histopathology and systematic examinations in succession. When evaluating a head mass that appeared after a head injury, plasmacytoma should be considered at times. Osteolytic changes and biconvex form on imaging are beneficial to differentiation.

Comorbidity Burden and Health Services Use in Community-Living Older Adults with Diabetes Mellitus: A Retrospective Cohort Study.

OBJECTIVES: Diabetes frequently coexists with other conditions, resulting in poorer diabetes self-management and quality of life, higher risk for diabetes-related complications and higher health service use compared to those with diabetes only. Few Canadian studies have undertaken a comprehensive, population-level analysis of comorbidity and health service utilization by older adults with diabetes. This study examined comorbidity and its association with a broad range of health services in a cohort of community-dwelling older adults with diabetes in Ontario, Canada. METHODS: We linked multiple administrative databases to create a cohort of 448,736 older adults with diabetes, described their comorbidities and obtained their 1-year use of health services (physician visits, emergency department visits, inpatient hospital admissions, home care use, nursing home admissions). We examined comorbidity patterns by age and gender and estimated the prevalence of 20 comorbid conditions and the most common condition clusters. The association between number of comorbidities and health service use was also examined. RESULTS: More than 90% of the cohort had at least 1 comorbid condition. The number of comorbidities increased with age for both genders, and hypertension was the most common, affecting 79.1% of the cohort. Other common conditions included other cardiovascular conditions, ischemic heart disease, arthritis and anxiety. Utilization of all health services increased with the number of comorbid conditions. CONCLUSIONS: Health service use was driven by the number of comorbid conditions, including diabetes and nondiabetes-related conditions, highlighting the importance of aligning diabetes care plans with patients' comorbidities.

Rates of prenatal screening across health care regions in Ontario, Canada: a retrospective cohort study.

BACKGROUND: It is recommended that all pregnant women be offered screening for Down syndrome and open neural tube defects, but emerging prenatal tests that are not publicly insured may compromise access. We evaluated screening rates for publicly insured screening tests across health care regions in the province of Ontario and determined whether maternal, provider or regional characteristics are associated with screening uptake. METHODS: We conducted a population-based retrospective cohort study involving pregnant women in Ontario who were at or beyond 16 weeks' gestation in 2007-2009. We ascertained prenatal screening rates using linked health administrative and prenatal screening datasets. We examined maternal, provider and regional characteristics associated with screening uptake. Rate ratios (RRs) were estimated. RESULTS: Of the 264 737 women included in the study, 62.2% received prenatal screening; uptake varied considerably by region (range 27.8%-80.3%). A greater proportion of women initiated screening in the first rather than the second trimester (50.0% v. 12.2%). Factors associated with lower screening rates included living in a rural area versus an urban area (adjusted rate ratio 0.64, 95% confidence interval [CI] 0.63-0.66), receiving first-trimester care from a family physician or midwife versus an obstetrician (adjusted rate ratio 0.91, 95% CI 0.90-0.92, and 0.40, 95% CI 0.38-0.43, respectively) and being in a lower income quintile (adjusted RR for lowest v. highest 0.95, 95% CI 0.94-0.96). Being an immigrant or a refugee was associated with higher screening rates. INTERPRETATION: There were significant maternal, provider and regional differences in the uptake of prenatal screening across the province. With discrepancies expected to increase with the emergence of noninvasive prenatal tests paid for out of pocket by many women, policy efforts to reduce barriers to prenatal screening and optimize its availability are warranted.