Submucosal Trans-Septal Suturing Technique After a Septal Extension Graft with Porous High-Density Polyethylene: A Technical Report.

BACKGROUND: Porous high-density polyethylene (pHDPE) is an alternative material for a septal extension graft (SEG) in oriental rhinoplasty when autologous cartilage is limited. Although nasal packing (NP) and trans-septal suturing (TSS) techniques are routine procedures to obviate the dead space after septoplasty, they are associated with certain discomforts and complications. OBJECTIVE: To investigate the application of a submucosal trans-septal suturing (STSS) technique after SEG with pHDPE. METHODS: A prospective study was conducted on 60 female participants who underwent SEG with pHDPE. The participants were randomly divided into the NP group and STSS group. The extra surgical duration of NP and STSS, pain, nasal obstruction, and sleeping disturbance as well as postoperative complications were recorded and compared between groups. RESULTS: No significant difference was found between group NP and group STSS in terms of mean age. The mean extra surgical duration of group STSS was significantly longer than group NP. There were significant higher pains of group NP at 24 hours and 48 hours postoperatively, compared with group STSS. The NP group also experienced significantly more nasal obstruction and sleep disturbance within 48h postoperatively compared to the STSS group. There was one infection in each group, minor bleeding in two NP patients, and one STSS patient. There was no major bleeding, hematoma, graft exposure, or septal perforation in both groups. CONCLUSION: Although STSS needs a longer extra surgical duration than NP, it significantly improves the patient's postoperative comfort with a faster return to normal respiration compared to NP. LEVEL OF EVIDENCE I: 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 .

[Effectiveness of comprehensive rhinoplasty on secondary nasal deformity with saddle nasal deformity after cleft lip surgery].

Objective: To investigate the effectiveness of comprehensive rhinoplasty with autogenous costal cartilage grafting and prosthesis augmentation rhinoplasty in the treatment of secondary nasal deformity with saddle nasal deformity after cleft lip surgery. Methods: The clinical data of 96 patients with secondary nasal deformity with saddle nasal deformity after cleft lip surgery between September 2008 and January 2019 were retrospectively analyzed. There were 17 males and 79 females with an average age of 25.6 years (range, 17-38 years). Autogenous costal cartilage grafts were used to construct stable nasal tip framework and enhance the strength of alar cartilage. Nasal dorsum prostheses (39 cases of bulge, 45 cases of silicone prosthesis) or autogenous costal cartilage (12 cases) were used for comprehensive rhinoplasty. Visual analogue scale (VAS) score was used to evaluate the postoperative satisfaction subjectively, and nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle were calculated to evaluate objectively before and after operation. Results: All patients were followed up 6 months to 8 years, with an average of 13.4 months. Nasal septal hematoma occurred in 3 patients after operation, which was improved after local aspiration and nasal pressure packing. Two cases had mild deformation of the rib cartilage graft of the nasal dorsum, one of which had no obvious deviation of the nasal dorsum and was not given special treatment, and one case underwent the cartilage graft of the nasal dorsum removed and replaced with silicone prosthesis. The incisions of the other patients healed by first intention, and there was no complication such as postoperative infection and prosthesis displacement. The nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle significantly improved after operation when compared with preoperative ones ( P<0.05). Postoperative subjective satisfaction evaluation reached the level of basic satisfaction or above, and most of them were very satisfied. Conclusion: Comprehensive rhinoplasty using autologous rib cartilage grafting to construct a stable nasal tip support, combined with dorsal nasal prosthesis or autologous cartilage implantation, can achieve good effectiveness on secondary nasal deformity with saddle nasal deformity after cleft lip surgery.

Comparison of Clinical Results of Crescent-Shaped Expanded Polytetrafluoroethylene (e-PTFE) and Granulated Rib Cartilage for Filling The Nasal Base to correct Midface Depressions.

Objective: The center of the face plays an important role in the fullness of our facial contours, however, sunken center of the face is more common in Asians than in Europeans and Americans. Expanded polytetrafluoroethylene (PTFE) and rib cartilage are commonly used to fill the nasal base to improve the hollowing of the center of the face. This study aimed to compare the efficacy and safety of crescent-shaped expanded polytetrafluoroethylene (e-PTFE) with granulated rib cartilage for nasal base filling to treat midface depressions. Methods: Fifty-one patients with mild to moderate midface depression and normal occlusion admitted to our department from June 2017 to August 2020 were selected. Comprehensive rhinoplasty was performed, which included nasal base filling using crescentic e-PTFE or granulated rib cartilage. They are all women, with an average age of 27.4 years. The e-PTFE group (group A) had 27 cases, while the granulated rib cartilage group (group B) had 24. Changes in two face parameters, the wing ear line and facial convexity, were measured and recorded based on preoperative and postoperative photographs of the patients and using 3D imaging technology. Postoperative complications and satisfaction were assessed by questionnaires to compare the two surgical approaches' differences, advantages, and disadvantages. Results: Postoperative midface depression improved significantly in 51 patients. Most of the patients who underwent both procedures showed significant improvement in the wing ear line and facial convexity. The 3D imaging has also helped us to more objectively assess the changes in midface concavity. Some patients experienced acute discomfort, such as foreign body sensation and stiffness in the surgical area, for the first three months after nasal base filler surgery. Still, these symptoms resolved on their own within six months. Most patients (92.6% in group A and 91.6% in group B) felt that they had natural facial expressions and were satisfied with the filler results. Conclusion: The use of crescentic e-PTFE and granular rib cartilage to fill the nasal base is easy to operate and has a quick postoperative recovery, allowing for good postoperative results. However, after some of the granular rib cartilage filling treatments, the height of the nasal base was lowered, which may be connected to its limited structural support, ease of displacement, and resorption. Crescentic e-PTFE is superior to granular rib cartilage in terms of both morphology and mechanical support. The crescentic e-PTFE filling method provides rapid postoperative recovery and good shape maintenance, but local stiffness is more pronounced than in the granular rib cartilage group. This may help the plastic surgeon's choice of surgical procedure.

Application of a Single T-Shaped Porous High-Density Polyethylene in Oriental Nasal Tip-Plasty.

Porous high-density polyethylene (pHDPE) is an alternative material for septal extension grafts. This study investigated the clinical application of a single T-shaped pHDPE graft combined with auricular cartilage in oriental nasal tip-plasty. A retrospective analysis was conducted of 66 patients who underwent septal extension graft with a T-shaped pHDPE and auricular cartilage graft from December 2018 to November 2021. All patients were female from 19 to 51 years old (average: 28.9 years). Patients were followed up for 5 to 40 months with an average of 23.8 months. The postoperative nasal length (39.8±3.7 mm) was significantly improved (35.6±5.7 mm preoperatively, P <0.0001) with the tip projection increasing from 23.9±2.3 mm preoperatively to 25.3±2.4 mm postoperatively ( P =0.0005). There was a significant difference in the nasolabial angle (96.8±14.1 degrees preoperatively versus 101.8±7.2 degrees postoperatively, P =0.0105) but no significant change in the nasofrontal angle (143.3±9.5 degrees preoperatively versus 143.7±5.5 degrees postoperatively, P =0.7546), with an improved tip projection achieved in 93.9% of patients. One patient had an abscess in the nasal septum and a tip graft was performed using auricular cartilage in another patient because of an insufficient postoperative tip projection. There was a slight tip deviation in 2 patients, 1 case of a deviated nasal tip was corrected with a pHDPE sheet graft, while the other was left intact. Two patients had excess cartilaginous graft protruding to the nasal cavity that did not affect nasal ventilation and the shape of the nasal tip was relatively good, so the prominent cartilaginous graft was not addressed. In conclusion, this technique not only improved the bulbous nasal tip, lengthened the short nose, and increase the tip projection, but also prevented absorption of the existing septal cartilage and reduced infection or extrusion of the pHDPE.

Efficient delivery of VEGF-A mRNA for promoting diabetic wound healing via ionizable lipid nanoparticles.

Diabetes is often accompanied by chronic non-healing wounds, and vascularendothelial growth factor A (VEGF-A) is crucial in the treatment of chronic diabetic wounds. However, the application of VEGF-A protein in clinic is limited due to poor absorption and short half-life of protein macromolecule. Herein, we employed an emerging protein replacement therapy by delivering VEGF-A mRNA into the body to express the desired protein to accelerate diabetic wound healing. Primarily, VEGF-A mRNA was synthesized by an in vitro transcription (IVT) method and encapsulated with an ionizable lipid-mediated nanoparticles (LNP) delivery system via a microfluidic method. The resultant LNP/VEGF-A mRNA were characterized by using dynamic light scattering (DLS) and transmission electron microscope(TEM). The nanoparticles have regular spherical morphology with an average particle size of 101.17 nm, a narrow polydispersity (PDI) of 0.17 and negative Zeta potential of -3.05 mV. The bioactivities of the nanoparticles formulation were evaluated against HUVEC cells through cell proliferation, migration and tube formation assays. It was found that the LNP/VEGF-A mRNA nanoparticles could promote endothelial cell proliferation. In addition, they exhibited successful mRNA delivery and high VEGF-A protein expression in vitro and in vivo by means of Western Blot assay and in vivo imaging system (IVIS). Finally, C57BL/6 diabetic mice model was established and intradermally treated with the LNP/VEGF-A mRNA nanoparticles. It was found that the LNP/VEGF-A mRNA treated wounds were almost healed after 14 days with an average wound area of 2.4 %, compared with the PBS group of 21.4 %. Apparently, the nanoparticles formulation was able to significantly expedite diabetic wound healing. The histological analysis containing H&E, Masson's trichrome staining and CD31 further confirmed the healing efficacy and low toxicity of the formulation. Taken together, the LNP/VEGF-A mRNA nanoparticles can be taken up by cells to express protein effectively and improve diabetic wound healing, which might have potential application in the treatment of chronic diabetic wounds as a protein replacement therapy.

Efficient delivery of VEGFA mRNA for promoting wound healing via ionizable lipid nanoparticles.

Vascular endothelial growth factor A (VEGFA) plays an important role in the healing of skin wound. However, the application of VEGFA protein in clinic is limited because of its high cost manufacturing, complicated purification and poor pharmacokinetic profile. Herein, we developed nucleoside-modified mRNA encoding VEGFA encapsulated ionizable lipid nanoparticles (LNP) to improve angiogenesis and increase wound healing rate. First, VEGFA mRNA was synthesized by an in vitro transcription (IVT) method. After that, VEGFA mRNA-LNP was prepared by encapsulating mRNA in ionizable lipid based nanoparticles via a microfluidic mixer. The physicochemical properties of VEGFA mRNA-LNP were investigated via dynamic light scattering (DLS) and transmission electron microscopy (TEM). The results showed that the VEGFA mRNA-LNP possessed regular spherical morphology with an average size of 112.67 nm and a negative Zeta potential of -3.43 mV. The LNP delivery system had excellent lysosome escape capability and high transfection efficiency. ELISA and Western Blot analysis indicated that the mRNA-LNP could express VEGFA protein in Human umbilical vein endothelial cells (HUVECs). Besides, endothelial tube formation, cell proliferation and scratch assays were performed. The results revealed VEGFA mRNA-LNP boosted angiogenesis, cell proliferation and cell migration by expressing VEGFA protein. Finally, C57BL/6 mouse model of skin wound was established and intradermally treated with VEGFA mRNA-LNP. The VEGFA mRNA-LNP treated wounds were almost healed with an average wound size of 1.56 mm2 compared with the blank of 18.66 mm2 after 9 days. The results indicated that the VEGFA mRNA-LNP was able to significantly expedite wound healing. Histological analysis further demonstrated tissue epithelialization, collagen deposition and enhancement of vascular density after treatment. Taken together, VEGFA mRNA-LNP can be uptaken by cells to express protein effectively and promote wound healing, which may provide a promising strategy for clinical remedy.

Breast implant-associated squamous cell carcinoma in a male patient: A case report and review of the medical literature.

Background: Primary squamous cell carcinoma (SCC) of the breast is a rare tumor type. The diagnosis of this tumor type is more frequently made only after microscopy evaluation. Breast implant-associated SCC is rarer with medical literature review indicating only 18 cases reported in female individuals. Case presentation: We reported an unusual case that a man found a 3-cm sized mass on his left breast at first, who had a implant surgery 18 years previously to reconstruct the deformed left breast, as related to the Poland's syndrome. More than 1 year after the mass was detected, the size of the mass gradually increased to 20 cm with swelling and severe pain, and the patient was admitted to our hospital. The patient underwent surgical excision of the tumor, followed by removal of the implant, complete capsulectomy, and sentinel lymph node biopsy. The microscopy evaluation demonstrated the tumor as moderately and poorly differentiated invasive SCC. Follow-up at 12 months after showed multiple metastases, including the skin of the chest, axillary lymph nodes and pleura. Conclusion: Breast implant-associated SCC can occur in male patients. Therefore, it should be considered when the clinical manifestation or histopathological appearance is not typical of other breast neoplasms. Malignant transformation of normal epithelial cells takes about 18 years, after which rapid evolution follows leading to fast growth of the tumor.

[Clinical analysis of epicanthus correction with two methods: Z-plasty and Y-V plasty].

OBJECTIVE: To compare the clinical effects of different surgical methods for the epicanthus corrective surgery. METHODS: Canthoplasty with asymmetric Z-flap is applied in 46 cases, Y-V advancement procedure for epicanthoplasty is applied in 42 cases. The epicanthus aesthetic measurement were measured and calculated by software before and after surgery, the diameter of the iris was measured as a reference value,and the postoperative scar was assessed by VSS scale. At the same time, by measuring the lateral canthal distance, the accuracy of the measurement method can be verified. RESULTS: All patients were satisfied with the long-term results and there were no recurrences of the epicanthal fold. The shortening ratio of the ICD is 8.36% in the group with the Z-plasty, and 5.88% in Y-V plasty. the lateral canthal distance have no diffrence before and after surgery. CONCLUSIONS: Two surgical methods can get good results. The magnitude of correction in Z-plasty may larger than Y-V plasty, but postoperative retraction may existed in Z plasty.

Combating multidrug resistance in bacterial infection by targeting functional proteome with natural products.

Antibiotic resistance has become a major clinical and public health problem within the lifetime of most people living today. Development of new therapeutic approaches to prevent antimicrobial chemotherapy from bacterial multidrug resistance has thus been becoming a primary consideration in the medicinal community. In this study, we describe a protocol that is potential for combating multidrug resistance by rational screening of natural medicines to target the bacterial functional proteome. To achieve this, a pipeline of integrating virtual screening and susceptibility testing has been described to identify antibacterial agents from various natural products with diverse structures and high drug-likeness. A number of promising candidates with potent antibacterial activity were identified, from which six available compounds were assayed to determine their susceptibility to four multidrug-resistant strains. Consequently, while most tested candidates showed moderate (20 < MIC < 50 µg/mL) or low (MIC>50 µg/mL) antibacterial activities, two natural products, i.e. pseudopterosin A and ciprofloxacin, were measured to possess strong broad-spectrum potency combating different strains (MIC < 20 µg/mL).

[Study on hydroxyapatite porous scaffold bonded by phosphates and its biocompatibility].

The porous scaffolds for bone tissue engineering were prepared by foam impregnation. The magnesium and aluminum acid phosphates were used as bonder and the hydroxyapatite ((Ca10 (PO4)6(OH)2, HA) powder as raw materials. Scanning electron microscopy (SEM) examination indicated that the 3D interconnected porous structure of the organic foam was replicated well by the scaffolds calcined at high temperature and the structural requirement of tissue engineering was satisfied. XRD analysis showed that the scaffold was composed of HA and Ca7Mg2P6O24 while calcined at 1150 degrees C for shorter time and of (Ca, Mg)3(PO4)2 when the time prolonged to 2 h. There was no peak of CaO found in the scaffolds by XRD. According to the culture in vitro, the scaffold possesses good biocompatibility and certain degree of degradability.