Persistent Lipid Accumulation Leads to Persistent Exacerbation of Endoplasmic Reticulum Stress and Inflammation in Progressive NASH via the IRE1α/TRAF2 Complex.

Non-alcoholic steatohepatitis (NASH) is a metabolic disorder that often leads to other severe liver diseases, yet treatment options are limited. Endoplasmic reticulum (ER) stress is an important pathogenetic mechanism of NASH and plays a key role in tandem steatosis as well as liver inflammation. This study aims to develop a progressive NASH model through sustained lipid accumulation and to elucidate its molecular mechanism through IRE1α/TRAF2 complex. Male SD rats were fed a high-fat diet (HFD) for 4, 8, and 12 weeks to induce progressive NASH. MRNA sequencing and PPI analysis were used to screen core genes. Transmission electron microscopy, immunofluorescence staining, ELISA, qRT-PCR, and Western blotting were used at each time point to compare differences between each index of progressive NASH at 4, 8, and 12 weeks. Sustained lipid accumulation led to structural disruption of the ER, a reduction in ER number, and an increase of lipid droplet aggregation in hepatocytes. Persistent lipid accumulation led to a persistent increase in mRNA and protein expression of the IRE1α/TRAF2 complex, IKK/IκB/NF-κB signaling pathway and ASK1/JNK1 signaling pathway, and TNF-α, IL-1ß, and IL-6 also continued to increase. Persistent lipid accumulation led to a persistent exacerbation of ER stress and inflammation in progressive NASH via the IRE1α/TRAF2 complex.

Improved Eyelid Muscle Tension Balance With Refined Frontalis Muscle Flap Suspension in the Treatment of Severe Ptosis.

BACKGROUND: The tension balance of the upper eyelid following ptosis repair is crucial to a successful postoperative outcome. To improve on existing surgical techniques, the authors developed a new refined frontalis muscle flap suspension (FMFS) for severe ptosis repair and explored the balancing effect between the orbicularis muscle and frontalis muscle following surgery. METHODS: Forty-three patients (47 eyes) with a mean age of 6.07 ± 2.55 years old were diagnosed with severe congenital ptosis and underwent refined FMFS with complete orbicularis preservation between January 1, 2010 and December 31, 2017 in the Wenzhou Eye Hospital, Wenzhou, China. The outcomes measured include upper eyelid margin reflex distance (MRD1), degree of lagophthalmos, and cosmetic outcome (lash angle, eyelid contour, and crease). Surgical complications were also recorded. RESULTS: The preoperative mean MRD1 was -1.29 ± 0.88 mm and preoperative levator function was 1.87 ± 0.82 mm (ranged from 0 to 3.0 mm). Following surgery, lagophthalmos was observed in all cases in the first week with a mean palpebral fissure height of 1.68 ± 0.40 mm and diminished over 3 months. The MRD1 improved to +3.04 ± 0.68 mm at 6 months following surgery. All cases showed excellent cosmetic outcomes. There were no significant complications. CONCLUSION: The refined FMFS is a safe and reliable surgery in treating severe ptosis. The eye-closing power of the intact orbicularis muscle is sufficient at countering the lifting power of the frontalis muscle suspension, achieving a balanced blink mechanism and eyelid closure.

A New Preoperative Upright Design for Dermatochalasis Correction.

BACKGROUND: Conventional assessment of the height of upper eyelid skin excision in dermatochalasis correction is performed with patient's eyes closed in supine position. It is not able to consider the effects of gravity on the upper eyelid, thus may lead to asymmetric postoperative appearance. The authors herein report a novel preoperative upright design (PUD) that can accurately determine the amount of skin excision with patients' eyes open in dermatochalasis correction. METHODS: Patients with dermatochalasis underwent PUD during blepharoplasty were enrolled and were followed-up for 9 to 15 months. RESULTS: A total of 116 patients (mean age 55.1 ±â€Š6.1 years, range 46-78 years) successfully underwent the surgery. Using the PUD, the vertical height of skin excision was 8.2 ±â€Š2.4 mm (6-19 mm), the preoperative margin fold distance was -0.5 ±â€Š1.0 mm (-4 - 1 mm), which improved to 2.1 ±â€Š0.6 mm (1-3 mm, P < 0.05) at the last follow-up visit. A total of 107 of 116 patients (92.2%) were judged as "good" (natural double eyelid folds with symmetric margin fold distance), 9 patients (7.8%) were judged as "fair" (natural double eyelid folds with the differences of margin fold distance between fellow eyelids within 2 mm), and no one was judged as "poor" (unsmooth double eyelid folds or the differences of margin fold distance between fellow eyelids is more than 2 mm). CONCLUSION: Preoperative upright design is a simple and effective method to accurately determine the amount of skin excision in blepharoplasty, and help to achieve symmetric double eyelids.

Tumescent Liposuction Combined with Power-Assisted Dermal Curettage Through Small Incisions for Axillary Osmidrosis.

BACKGROUND: Osmidrosis is a troublesome disease characterized by excessive bodily malodor. Invasive surgical treatments have proven effective and permanent in treating this disease. This study sets out to evaluate the effect of tumescent liposuction with power-assisted dermal curettage for the treatment of axillary osmidrosis. METHODS: Twenty-eight patients with axillary osmidrosis (56 axillae) were treated with tumescent liposuction and power-assisted dermal curettage between January 2016 and May 2019. Patients were followed up and evaluated using survey questionnaire at least 3 months after the procedure. RESULTS: Twenty-four (85.7%) patients responded excellent for malodor elimination, 4 (14.3%) patients evaluated it as good and no patients evaluated it as fair or poor. One patient reported mild pigmentation in the axilla after the procedure. No recurrence and no serious side effects were reported. CONCLUSION: Tumescent liposuction with power-assisted dermal curettage is a safe and effective surgical treatment of axillary osmidrosis with high patient satisfaction, rapid recovery time and minimal complications or recurrences. LEVEL OF EVIDENCE IV: 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.

Integrated and Stepwise Epicanthoplasty Combined with Blepharoplasty (ISEB) in an Ethnic Chinese Population.

PURPOSE: To evaluate the efficacy of the integrated and stepwise epicanthoplasty combined with blepharoplasty (ISEB) technique in an ethnic Asian population. METHOD: The medical records of patients who underwent ISEB at the Eye Hospital of Wenzhou Medical University over a period of 36 months were retrospectively reviewed. RESULTS: A total of 104 patients (208 eyelids) were included in this study with ages ranging from 16 to 36 years old (mean 21.2 ± 2.8 years) and follow-up duration ranging from 6 months to 26 months (mean 9.7 ± 4.1 months). All patients achieved cosmetically desirable and natural appearances with adequate lacrimal caruncle exposure and horizontal lengthening of palpebral fissure. At the 6-month follow-up, there was no or minimal visible scarring in the medial canthal region. Postoperative evaluation at least 6 months following surgery showed that 98.1% (102/104) of patients felt that their surgical results were good or excellent. No recurrences of the epicanthal fold or disturbances of lacrimal function occurred throughout the follow-up period. CONCLUSION: The ISEB is a novel surgical technique that is effective in dealing with vector forces during epicanthoplasty in combination with blepharoplasty and has been shown to be a practical and reliable method with good aesthetic outcomes. LEVEL OF EVIDENCE V: 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 .

[Network Meta-analysis of 3 kinds of Chinese medicine injections in treatment of acute exacerbations of chronic obstructive pulmonary disease].

To evaluate the efficacy and safety of traditional Chinese medicine injections( CMI) in the treatment of acute exacerbation of chronic obstructive pulmonary disease( AECOPD). PubMed,Cochrane Library,CNKI,CBM,Wan Fang and VIP database( since the date of database establishment to July 2018) were retrieved through computer for controlled randomized trials( CRTs) of 3 kinds of traditional Chinese medicine injections( Chuankezhi Injection,Tanreqing Injection,Xuebijing Injection) for AECOPD. After the methodological quality of included researches were evaluated,and the valid data were extracted,statistical analysis was performed with Stata 14,RevMan 5.3 is used for risk bias map. There were including 4 RCTs and 20 quasi-RCTs,which involving 579 patients.The results of network Meta-analysis showed that: ①there were significant differences in the forced expiratory volume in the first second between the 3 CMI and control groups,and there was no significant difference between CMI; ②3 kinds of CMI adjuvant therapy AECOPD,According to the forced expiratory volume in the first second of the probability ranking results,Tanreqing Injection is more effective,followed by Xuebijing Injection and Chuankezhi Injection. Based on the present evidence,3 kinds of CMI can improve the forced expiratory volume in the first second on the basis of Western medicine routine treatment of AECOPD,having better safty. In addition,the conclusion of this study still needs a large number of RCTs with reasonable design and proper method to confirm it.

Eriodictyol Attenuates ß-Amyloid 25-35 Peptide-Induced Oxidative Cell Death in Primary Cultured Neurons by Activation of Nrf2.

Oxidative stress plays an important role in the pathogenesis of neurodegenerative diseases, including Alzheimer's disease (AD). Eriodictyol, a flavonoid isolated from the Chinese herb Dracocephalum rupestre, has long been established as an antioxidant. The present study was designed to investigate the effect of eriodictyol on ß-amyloid 25-35 peptide (Aß25-35)-induced oxidative cell death in primary neurons and to explore the role of the nuclear factor erythroid-2-related factor 2/antioxidant response element (Nrf2/ARE) pathway in this process. For this purpose, primary cultures of cortical neurons were exposed to 15 µM Aß25-35 in the absence or presence of eriodictyol (20, 40 and 80 µM). The results revealed that Aß25-35-induced cytotoxicity and apoptotic characteristics such as activation of JNK/p38 apoptotic signaling pathway were effectively attenuated by eriodictyol pretreatment. Eriodictyol treatment also resulted in an increase in Nrf2 protein levels and subsequent activation of ARE pathway genes in primary cultured neurons. The protective effects of eriodictyol were attenuated by RNA interference-mediated knockdown of Nrf2 expression. Taken together, these results clearly demonstrate that eriodictyol protects neurons against Aß25-35-induced cell death partially through Nrf2/ARE signaling pathway, which further supports that eriodictyol might be a promising novel therapeutic agent for AD.

MicroRNA-195 protects against dementia induced by chronic brain hypoperfusion via its anti-amyloidogenic effect in rats.

Previous studies have demonstrated that chronic brain hypoperfusion (CBH) causes Aß aggregation by upregulating expression of amyloid precursor protein (APP) and ß-site APP cleaving enzyme 1 (BACE1) protein, which is accompanied by cognitive impairment, but the mechanisms are not fully understood. In this study, we evaluated the effect of microRNA on memory impairment in rats induced by CBH. We show here that CBH generated by bilateral common carotid artery occlusion (2VO) significantly decreased the learning and memory ability in rats, as assessed by Morris water maze, and upregulated expression of APP and BACE1 proteins in the hippocampus and cortex of rats, as evaluated by Western blot and immunofluorescence. In reciprocal, qRT-PCR analysis showed that microRNA-195 (miR-195) was downregulated in both the hippocampus and cortex of rats following CBH, and in the plasma of dementia patients. APP and BACE1 proteins were downregulated by miR-195 overexpression, upregulated by miR-195 inhibition, and unchanged by binding-site mutation or miR-masks, indicating that APP and BACE1 are two potential targets for miR-195. Knockdown of endogenous miR-195 by lentiviral vector-mediated overexpression of its antisense molecule (lenti-pre-AMO-miR-195) elicited dementia in rats, whereas overexpression of miR-195 using lenti-pre-miR-195 reduced dementia vulnerability triggered by 2VO. Additionally, chromatin immunoprecipitation analysis showed that NFκB was bound to the promoter region of miR-195 and inhibited its expression. We conclude that miR-195 may play a key role in determining dementia susceptibility in 2VO rats by regulating APP and BACE1 expression at the post-transcriptional level, and exogenous complement of miR-195 may be a potentially valuable anti-dementia approach.

Deciphering Müller cell heterogeneity signatures in diabetic retinopathy across species: an integrative single-cell analysis.

Diabetic retinopathy (DR), a leading cause of visual impairment, demands a profound comprehension of its cellular mechanisms to formulate effective therapeutic strategies. Our study presentes a comprehensive single-cell analysis elucidating the intricate landscape of Müller cells within DR, emphasizing their nuanced involvement. Utilizing scRNA-seq data from both Sprague-Dawley rat models and human patients, we delineated distinct Müller cell clusters and their corresponding gene expression profiles. These findings were further validated through differential gene expression analysis utilizing human transcriptomic data. Notably, certain Müller cell clusters displayed upregulation of the Rho gene, implying a phagocytic response to damaged photoreceptors within the DR microenvironment. This phenomenon was consistently observed across species. Additionally, the co-expression patterns of RHO and PDE6G within Müller cell clusters provided compelling evidence supporting their potential role in maintaining retinal integrity during DR. Our results offer novel insights into the cellular dynamics of DR and underscore Müller cells as promising therapeutic targets for preserving vision in retinal disorders induced by diabetes.

The effectiveness and safety of Chinese patent medicines plus calcium dobesilate for the treatment of diabetic retinopathy: A network meta-analysis.

Chinese patent medicines (CPMs) are commonly prescribed by clinicians in China as adjuvant therapy for diabetic retinopathy (DR). The study of network meta-analysis (NMA) aims to compare the effectiveness and safety of three CPMs plus calcium dobesilate (CD) for DR, and to explore optimal CPM for treatment of DR. Methods. Bayesian network meta-analyses were designed to evaluate the safety and effectiveness of different CPMs for the treatment of DR. Systematic Review Registration CRD42022323996. Results. A total of 23 eligible RCTs involving 1824 patients were enrolled. Compared with CD alone, Cmpound Danshen Dripping Pills (DS) + CD or Qiming Granule (QM) + CD considerably enhanced best corrected visual acuity (BCVA); DS + CD or Compound Xueshuantong Capsule (XST) + CD significantly reduced macular thickness; CPMs + CD significantly reduced the level of VEGF. In addition, DS + CD or XST + CD over QM + CD in reducing macular thickness. As for the adverse events, the differences across different CPMs were not statistically significant, and no statistically significant difference between the CPMs and CD. Conclusion. DS plus CD or QM plus CD may be better effective in improving BCVA; DS plus CD or XST plus CD may be better effective in reducing macular thickness; The combination therapy all may be better effective in reducing the level of VEGF. As for safety profile that CPMs plus CD did not increase the incidence of adverse events. The results of this study might support DS as a relatively prior adjuvant therapy option for patients with DR.

Metal-organic frameworks decorated wood aerogels for efficient particulate matter removal.

The severe indoor/outdoor air contamination caused by hazardous particulate matters (PMs) has a devastating impact on the environment and human health. Herein, air filters fabricated from delignified wood aerogels and metal-organic frameworks (MOFs) were used for PM removal. Two specially designed MOFs (i.e. Zn-based ZIF-L and Zr-based UiO-66-NH2) were deposited into a highly porous wood matrix through in situ growth approach. The MOF crystals are attached tightly to the highly available cellulose surface groups and distributed uniformly. The integration of MOFs can regulate the aerogel morphology and surface property, leading to enhanced PM removal performance. Bare wood aerogels beard removal efficiencies of 70.7% and 75.0% for PM2.5 and PM10, with a low-pressure drop of 15 Pa. By contrast, ZIF-L decorated wood aerogels exhibited PM2.5 and PM10 removal efficiencies of 97.6% and 99.5%, respectively, which are ascribed to the increased interception/impaction of PMs with the positively charged ZIF-L layer. While UiO-66-NH2 functionalized wood aerogels demonstrated PM2.5 and PM10 removal efficiencies of 96.4% and 98.9% because of the hierarchical filter matrix and the presence of polar -NH2 groups. Moreover, MOF modified wood aerogels can be easily regenerated and superior reusability can be achieved. This work provides an effective and economic strategy for the preparation of air filters from renewable materials.

Efficacy and safety of proton pump inhibitors and H2 receptor antagonists in the initial non­eradication treatment of duodenal ulcer: A network meta­analysis.

The present network meta-analysis aimed to enhance the corresponding evidence with respect to the efficacy and safety of pharmaceuticals treatments. Frequentist network meta-analysis was used. Medical literature up to November 2022 was searched for randomized clinical trials assessing the efficacy and safety of these pharmaceuticals, either compared with each other or compared with placebo. With the exception of ranitidine (300 mg four times daily) and vonoprazan (20 mg once daily) having lower safety than placebo, the efficacy and safety of the remaining treatments were superior to placebo. Cimetidine (400 mg four times daily) and pantoprazole (40 mg once daily) were ranked first in terms of efficacy. The frequentist network meta-analysis shows that for cimetidine (except 400 mg once daily), famotidine, rabeprazole, ilaprazole, lansoprazole (except 7.5 mg once daily) and omeprazole (except 10 mg once daily or 30 mg once daily), the efficacy comparison between the different doses of each of the aforementioned pharmaceuticals did not indicate statistically significant differences. In conclusion, pantoprazole (40 mg once daily) was the best choice for the initial non-eradication treatment of patients with duodenal ulcer, and cimetidine (400 mg twice daily), omeprazole (20 mg once daily), lansoprazole (15 mg once daily), ilaprazole (5 mg once daily) and rabeprazole (10 mg once daily) could be used as the first choice. If the aforementioned pharmaceuticals cannot be prescribed, famotidine (40 mg twice daily) is recommended.

Chinese herbal injections plus Western Medicine on inflammatory factors for patients with acute exacerbation of chronic obstructive pulmonary disease: a systematic review and network meta-analysis.

Background: Chinese herbal injections (CHIs) are commonly prescribed in China as adjuvant therapy for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, evidence supporting the effect of CHIs on inflammatory factors for patients with AECOPD is insufficient, posing a challenge for clinicians to choose the optimal CHIs for AECOPD. This network meta-analysis (NMA) aimed to compare the effectiveness of several CHIs combined with Western Medicine (WM) and WM alone on the inflammatory factors in AECOPD. Methods: Randomized controlled trials (RCTs) on different CHIs for treating AECOPD were thoroughly searched from several electronic databases up to August 2022. The quality assessment of the included RCTs was conducted according to the Cochrane risk of bias tool. Bayesian network meta-analyses were designed to assess the effectiveness of different CHIs. Systematic Review Registration CRD42022323996. Results: A total of 94 eligible RCTs involving 7,948 patients were enrolled in this study. The NMA results showed that using Xuebijing (XBJ), Reduning (RDN), Tanreqing (TRQ), and Xiyanping (XYP) injections combined with WM significantly improved treatment effects compared to using WM alone. XBJ + WM and TRQ + WM significantly changed the level of C-reactive protein (CRP), white blood cells, percentage of neutrophils, interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). TRQ + WM showed the most significant effect in reducing the level of procalcitonin. XYP + WM and RDN + WM could reduce the level of white blood cells and the percentage of neutrophils. A total of 12 studies reported adverse reactions in detail, and 19 studies demonstrated no significant adverse reactions. Conclusions: This NMA showed that using CHIs combined with WM could significantly reduce the level of inflammatory factors in AECOPD. A combination of TRQ and WM may be a relatively prior adjuvant therapy option for AECOPD treatment considering its effects in reducing the levels of the anti-inflammatory mediators.

Separation of Three Phenanthrenes and Two Bibenzyls from Chloroform Fractions of Pholidota Articulata Lindl. Using HPLC.

BACKGROUND: Pholidota articulata Lindl has been used as a traditional medicine and Yi-nationality herbal medicine for the treatment of various diseases. Phenanthrenes and bibenzyls commonly found in the genus Pholidota are one of their most important natural ingredients, due to their various biological activities. OBJECTIVE: This study aimed to establish an HPLC method for determination of the levels of three phenenthrenes (flavidin, lusianthridin, coelonin) and two bibenzyls (batatasin III, cirrhopetalidin) in rhizomes of P. articulata Lindl. METHOD: The separated and elucidated compounds from chloroform fractions of P. articulata Lindl were used as standards and analyzed by gradient elution HPLC with a variable wavelength detector at 274 nm. RESULTS: The calibration curves exhibited good linearity (R2 = 0.9999), ranging from 20 to 960 ng/mL, the average recoveries were between 91.5 and 102.9%, and the RSD values of precision, stability, and repeatability were <2.34%. There were significant differences in the content of phenenthrenes and bibenzyls from the plants of genus Pholidota, Dendrobium, and Bulbophyllum. Furthermore, this is the first report on the validation of a method for the quantitative analysis of flavidin and cirrhopetalidin. CONCLUSIONS: The present study provides an alternative method for the rapid separation of phenanthrenes and bibenzyls from natural products and lays a foundation for the study of biological activity. HIGHLIGHTS: When using developed method in this study for separation of phenanthrenes and bibenzyls in genus Pholidota, chemicalin formation was more abundant from chloroform fractions.

"An integrated clip-shaped costal cartilage carving approach for rhinoplasty".

BACKGROUND: Nasal tip management is considered to be one of the most complicated and challenging parts of rhinoplasty in East Asian patients. Within current rhinoplasty surgical practice, costal cartilage serves as an ideal source for grafting due to its ability to provide strong support to the nasal tip. METHODS: From March 2013 to December 2021, integrated clip-shaped costal cartilage grafts were applied to patients with primary (n = 12) or secondary (n = 3) short nose deformities. The costal cartilage was carved into an monobloc clip-shaped cartilage graft and then placed on the nasal septum and fixed with sutures. The nasal length index, projection index, and nasolabial angles were measured preoperatively and postoperatively. Postoperative evaluation at 8 months was performed using a grading scale. RESULTS: A total of 15 patients were included in this study with an average age of 23.7 ± 3.6 years. The mean follow-up period was 14.3 ± 5.3 months and ranged from 8 to 26 months. There were statistically significant differences between the preoperative and postoperative values in nose length index and projection index. Also, the nasolabial angle was significantly reduced. Postoperative evaluation, conducted at a minimum of 8 months following surgery, showed that 86.6% (13/15) of patients felt that their surgical results were good or excellent. No patients rated the results as "poor". CONCLUSION: The integrated clip-shaped costal cartilage carving approach has been shown to be a practical method of obtaining satisfactory esthetic outcomes in patients with nasal deformities.

Increased mean platelet volume is associated with arterial stiffness.

The brachial-ankle pulse wave velocity (baPWV) is a useful index of arterial stiffness. Mean platelet volume (MPV), an indicator of platelet activation, is associated with hypertension, stroke, and coronary artery disease, all of which may be caused by arteriosclerosis. However, little research has been conducted to investigate the relationship between MPV and arterial stiffness. In this cross-sectional study, we investigated the relationship between platelet count, MPV, and baPWV in 2645 apparently healthy Chinese participants (1676 men, 969 women) in a general health examination. Different metabolic parameters were compared across MPV quintiles (Q1: ≤8.1 fl, Q2: 8.2-8.5 fl, Q3: 8.6-9.6 fl, Q4: 9.7-10.7 fl, and Q5: ≥10.8 fl). Age-adjusted mean values of baPWV gradually increased with MPV quintiles (Q1 = 1124, Q2 = 1134, Q3 = 1199, Q4 = 1207, and Q5 = 1270 cm/s). Univariate analysis showed that age, sex, smoking status, body mass index (BMI), systolic blood pressure (SBP), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG), total platelet count, and MPV were significantly associated with baPWV. In addition, age, sex, BMI, MPV, SBP, and FPG were significant factors in the multivariate model with baPWV. Notably, MPV was found to be a significant determinant for baPWV (ß = 0.198; P < 0.001). The findings show that elevated MPV is positively correlated to arterial stiffness.

Auricular cartilage versus donor sclera as a wrapping of hydroxyapatite orbital implants.

AIM: To retrospectively compare postoperative outcomes after primary enucleation and placement of a hydroxyapatite (HA) implant without wrapping, wrapped with auricular cartilage or donor sclera. METHODS: Medical records of patients presented as intraocular tumor or severe ocular injury were identified from the electronic medical record system. Cases underwent enucleation and HA orbital implantation were enrolled in this study and were divided into 3 groups according to the wrapping material of HA implant. Cases with autogenous cartilage caps were enrolled in group A (n=11), with donor sclera caps in group B (n=12), and without any wrapping material in group C (n=9). Follow-ups were set at 1, 2wk, 1, 3, 6, and 12mo after surgery. RESULTS: Altogether 32 cases finished the follow-up and were enrolled in this study. Three cases (27.27%) in group A, 4 cases (33.33%) in group B, and 4 cases (44.44%) in group C developed one complication each after surgery. In group A, no HA exposure occurred, but conjunctival inclusion cyst occurred in one and severe conjunctive chemosis in two cases. In group B, one HA exposure occurred, conjunctive inclusion cysts occurred in one, severe conjunctive chemosis occurred in one, and conjunctival granuloma occurred in one case. In group C, one HA exposure occurred, severe conjunctive chemosis occurred in two cases, and conjunctival granuloma occurred in one case. The case of exposure of none-wrapped implant was noted in the first 6mo after placement of the orbital implant. The case of exposure of donor sclera-wrapped implant was noted at the 12mo after placement of the orbital implant. Both exposure cases were treated successfully with conservative treatment. CONCLUSION: With low incidence of implant exposure and mild complications, auricular cartilage can be a good choice of alternative wrapping material of orbit implant with satisfied outcome.

Conjunctival flap with auricular cartilage grafting: a modified Hughes procedure for large full thickness upper and lower eyelid defect reconstruction.

AIM: To investigate the suitability of a modified Hughes procedure, which consists of conjunctival flap with auricular cartilage grafting in reconstructing large full thickness upper and lower eyelid defect. METHODS: Patients with full thickness eyelid carcinoma involving more than 50% margin length who underwent surgical resection were retrospectively reviewed in the study. The defects were reconstructed using conjunctival flap with auricular cartilage grafting, covered with myocutaneous flap above. Followed-up time ranged from 12 to 24mo. Outcomes were classified as "good", "fair", and "poor" by evaluating the margin appearance, eyelid appearance, and complications. RESULTS: A total of 42 patients were enrolled in the study (26 males, 16 females, mean age, 68.6±7.7y, range: 53 to 82y). The mean defect widths measured 23.2±2.9 mm (range, 17 to 28 mm). The mean posterior lamellar defect height was 5.5±1.3 mm (4 to 8 mm). Thirty-seven patients had a "good" outcome (88.1%), 5 patients had a "fair" outcome (11.9%), and no one had a "poor" outcome. CONCLUSION: Conjunctival flap with auricular cartilage grafting and myocutaneous flap grafting is an effective procedure in reconstructing large full thickness upper and lower eyelid defect. It can not only achieve satisfied reconstruction, but also preserve intact tarsal plate of the opposite eyelid, avoiding retraction or entropion.

Peroxisome proliferator-activated receptor gamma promotes neuroprotection by modulating cyclin D1 expression after focal cerebral ischemia.

Peroxisome proliferator-activated receptor gamma (PPARgamma) has been shown to protect against stroke and improve neurological outcome after cerebral ischemia. This study investigated whether activation of cerebral PPARgamma improves recovery from focal cerebral ischemia by reducing expression of cyclin D1, which is associated with programmed neuron death. Focal cerebral ischemia was induced by 90 min of middle cerebral artery occlusion (MCAO), followed by reperfusion. Intracerebroventricular (i.c.v.) infusion of the PPARgamma agonist ciglitazone, beginning 5 days before and continuing through 1 day after MCAO, reduced infarct size and cyclin D1 expression in the peri-infarct cortical region. Furthermore, primary cortical neurons treated with ciglitazone showed suppressed expression of cyclin D1 in response to hypoxia-reoxygenation. This protective effect was reversed after cotreatment with the selective PPAR-gamma antagonist GW 9662 (2-chloro-5-nitrobenzanilide), clearly demonstrating the involvement of a PPARgamma-dependent mechanism. Our data provide evidence that activation of neuronal PPARgamma makes a substantial contribution to neuroprotection by preventing cyclin D1 up-regulation in vitro and in vivo.

Orbicularis Oculi Muscle Flap Rotation for Correction of Sunken Eyelid in Cosmetic Blepharoplasty.

BACKGROUND: Attempting traditional cosmetic blepharoplasty in a sunken eyelid may cause complications such as multiple folds, irregular or high placement of fold. Additional surgical procedures, such as orbital fat repositioning or free fat grafting, are introduced to correct the sunken appearance. The study sought to introduce a novel orbicularis oculi muscle flap (OOMF) rotation procedure for the correction of the sunken eyelid during blepharoplasty. METHODS: Retrospective chart review was performed on patients who presented with sunken eyelid(s) and underwent cosmetic blepharoplasty. All patients underwent OOMF rotation to fill the sunken area during blepharoplasty. Postoperative follow-up ranged from 12 to 15 months - the esthetic outcome and complication rates were recorded at each visit. RESULTS: The sunken appearances of eyelids were improved, and smooth double eyelid folds were achieved in all 62 patients (62 females, mean age 24.1±5.2 years, range: 19-34 years). The mean sunken depths were measured as 6.5 ± 1.0 mm (range: 5-9 mm) preoperatively, and were improved to 4.2 ± 0.9 mm (range: 3-6 mm) at the last follow-up visit (P<0.05). At the last follow-up visit, patients rated the surgical result as good in 88.7% (satisfied with the appearance improvement, n=55), fair in 11.3% (mild complaints about the surgical outcome, n=7), and poor in 0 of cases (unsatisfied with the surgical outcome, n=0). CONCLUSIONS: In selected patients with sunken eyelid who seek cosmetic blepharoplasty, the OOMF rotation offers a simple and effective way to fill the sunken area and help to form beautiful double eyelids.