M2 Macrophage Polarization and Tissue Remodeling in Autologous Fat Grafting for Diabetic Skin Defects.

Autologous adipose tissue was recognized as a promising therapeutic option for soft tissue defects owing to its regenerative potential and ability to facilitate tissue reconstruction. However, the mechanisms by which autologous fat grafting (AFG) promotes healing remain unclear, hindering its potential applications. This study aimed to investigate the distribution and phenotypic transition of infiltrating macrophages in transplanted adipose tissue, as well as their correlation with diabetic skin defect remodeling. Streptozotocin-induced diabetic rats with full-thickness dorsal skin defects were included in this study. The transplanted adipose tissue at the skin defects was collected and analyzed using flow cytometry to determine macrophage proportion and phenotype. The healing of skin defects was evaluated, and treatment was continued until day 14 as the designated endpoint of healing, followed by histopathologic examinations. Immunostaining with CD31 and lymphatic vessel endothelial receptor-1 was performed on wound tissues to analyze angiogenesis and lymphangiogenesis, respectively. Western blot and quantitative polymerase chain reaction analyses were used to assess the expression of the representative genes involved in the healing process. The results showed early polarization of M2 macrophages in the transplanted adipose tissue, concomitant with the upregulation of growth factors and downregulation of inflammatory factors. In vivo experiments revealed that AFG significantly promoted macrophage infiltration and M2 transformation in diabetic skin defects compared to the control groups, thereby promoting tissue extracellular matrix remodeling and lymphatic and vascular regeneration. However, the beneficial effects of AFG were inhibited by macrophage depletion. This study further demonstrated the potential of AFG for treating diabetic skin defects.

Effect of nonpharmacological interventions on nutrition status, complications and quality of life in head and neck cancer patients undergoing radiotherapy: A systematic review and meta-analysis.

PURPOSE: To evaluate the effect of nonpharmacological therapies on nutrition status, complications and quality of life in head and neck cancer patients and to provide a basis for clinical practice. METHODS: This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Ten databases were systematically searched for all available articles from construction to November 2023. Two researchers independently conducted literature screening, data extraction and quality evaluation. Cochrane Review Manager 5.3 was used for meta-analysis. RESULTS: Finally, 27 RCT studies including 2814 patients with head and neck cancer were included. Five categories of interventions were used: nutritional support, exercise, swallowing function training, psychological intervention and low-level laser therapy. Nonpharmacological interventions can improve body weight loss in patients with HNC at the end of treatment (MD: 1.66 kg; 95% CI: 0.80 to 2.51), and subgroup analysis showed that nutritional support, psychological intervention and low-level laser therapy were effective. Nonpharmacological interventions can also ameliorate decreases in BMI (MD: 0.71; 95% CI: 0.16 to 1.26) and reduce the incidence of malnutrition (RR: 0.76; 95% CI: 0.67 to 0.86), oral mucositis (RR: 0.54; 95% CI: 0.37 to 0.80) and gastrointestinal complications (RR: 0.61; 95% CI: 0.38 to 0.96) during radiotherapy; however, no significant differences were found in other complications and quality of life. CONCLUSION: Nonpharmacological interventions can improve the nutrition status of patients with head and neck cancer and reduce the incidence of severe oral mucositis and gastrointestinal complications during radiotherapy but have no significant impact on quality of life.

A Prospective Investigation of Patient Satisfaction and Psychosocial Status Following Facial Bone Contouring Surgery using the Face-Q.

OBJECTIVE: The objective of this study was to assess satisfaction and psychosocial status before and after facial bone contouring surgery using the Face-Q. METHODS: The Face-Q, a multimodular patient-reported outcome (PRO) instrument, comprises independently functioning scales and checklists designed to assess outcomes in facial aesthetic patients. A prospective cohort study was conducted from November 2020 to May 2022. Participants undergoing facial bone contouring surgery (reduction mandibuloplasty and/or malarplasty) were asked to complete the Face-Q preoperatively and 12 months postoperatively. Comparative analyses were conducted using normative Face-Q data from 534 matched normal individuals. Face-Q scores were evaluated for each domain on a scale of 0 to 100, with higher scores indicating greater satisfaction with appearance or a superior quality of life. RESULTS: A total of 284 patients (274 female and 10 male) completed the Face-Q preoperatively and 12 months postoperatively. Of these, 146 underwent reduction mandibuloplasty, 18 underwent malarplasty, and 120 underwent both procedures. Post-surgery, patients experienced significant improvements in overall appearance, features altered by surgery, and quality of life, excluding the patient-perceived age. Preoperatively, patients demonstrated significantly lower scores compared to normative data, with scores significantly increasing postoperatively to levels representative of the general population. Satisfaction with outcome was significantly correlated with postoperative Face-Q measurements but not preoperatively. CONCLUSION: Facial bone contouring surgery significantly improves the satisfaction and quality of life in patients with square faces, reaching a level at least equivalent to the normative population. The use of Face-Q should be highlighted in the clinic practice. 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.

Construction of a Lentiviral Vector for Fgfr2 Overexpression and its Impact on the Biological Behavior of Cranial Suture Mesenchymal Stem Cells.

OBJECTIVE: Suture mesenchymal stem cells (SuSCs), possessing self-renewal and multilineage differentiation abilities, play a crucial role in cranial bone growth. However, the impact of the disease-causing fibroblast growth factor receptor 2 (FGFR2) mutation on SuSCs in Crouzon syndrome has not been explored. This study aims to employ a lentivirus to overexpress Fgfr2 and investigate its role in the pathogenesis of Crouzon syndrome. METHODS: Starting with the prevalent FGFR2 mutation site in patients with Crouzon syndrome, a lentiviral vector carrying the Fgfr2.C361Y mutation was developed and transfected into SuSCs, with a determined multiplicity of infection values. The experimental group, SuSCs+Fgfr2.C361Y, was compared with the empty vector and normal SuSC groups. Cell proliferation, cycle, apoptosis, and osteogenic functionality were assessed using CCK-8 assays, flow cytometry, ALP activity assays, and real-time quantitative polymerase chain reaction. RESULTS: The lentiviral vector effectively infected SuSCs, leading to heightened Fgfr2 expression, with optimal multiplicity of infection values of 80. The experimental group demonstrated decreased proliferation activity and a higher apoptosis rate compared with controls (P < 0.05). After osteogenic induction, the experimental group showed significantly higher ALP activity than controls (P < 0.05). Real-time quantitative polymerase chain reaction indicated lower mRNA expression levels of Gli1, Axin2, Pcna, Cdk2, and Bcl-2 in the experimental group than controls, whereas Bax, Runx2, and Bmp-2 showed higher expression (P < 0.05). CONCLUSION: This study constructed a lentivirus vector to upregulate Fgfr2 expression in SuSCs, suppressing stem cell stemness by inhibiting proliferation, promoting apoptosis, and accelerating premature osteogenic differentiation, resulting in premature suture closure. These findings establish the groundwork for further understanding the pathogenesis of Crouzon syndrome.

Double Chin Concerns after En Bloc Mandibular U-Shaped Osteotomy: Submental-Cervical Soft Tissue Changes and Anterior Belly of Digastric Muscle Assessment.

OBJECTIVE: To assess submental-cervical soft tissue changes after en bloc mandibular U-shaped osteotomy and examine alterations in the anterior belly of digastric muscle (ABDM). METHODS: A retrospective study analyzed 20 patients who underwent en bloc mandibular U-shaped osteotomy from 2018 to 2023. Preoperative (Tp) and long-term follow-up (Tf) CT data were collected for analysis, measuring mandibular volume, soft tissue thickness at menton (Mes) and cervicale (C), and ABDM parameters (length, cross-sectional area (CSA), volume, distance from centroid point to the mandibular margin). Correlation analyses were performed to investigate the connection between soft tissue thickness changes, ABDM changes, and mandibular osteotomy volume. RESULTS: Long-term follow-up revealed a significant increase in soft tissue thickness at the Mes and C points after U-shaped mandibular osteotomy, especially at the C point. The adaptive length of ABDM decreased, CSA increased, and volume decreased, but the ABDM centroid point shifted downward relative to the mandibular margin, indicating drooping protrusion. The increment of soft tissue thickness was moderately positively correlated with the amount of osteotomy, and the decrement of ABDM length and volume were slightly positively correlated with the amount of osteotomy. CONCLUSION: The degree of soft tissue relaxation after U-shaped osteotomy is related to the extent of osteotomy. Notably, the protrusion of ABDM relative to the mandibular margin affects submental-cervical contour aesthetics. Prior to U-shaped osteotomy, it is crucial to assess the soft tissue condition of the patient's lower face, and the individualized design of the osteotomy volume should be carried out cautiously and safely. 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 .

Mentalis Muscle Reconstruction: An Innovative Technique.

BACKGROUND: The mentalis muscle is a significant component of the lower lip; its injury could impair appearance and function. This study presents a surgical strategy for treating mentalis muscle rupture to restore muscle tension and improve function. METHODS: Medical records and photographs of 2 patients with mentalis muscle rupture were reviewed. After physical examinations, 3-dimensional computed topographies were conducted to evaluate chin appearance further. The surgical strategy was designed according to individual malformations and requests. RESULTS: Both patients injured their mentalis muscles in childhood and presented to our clinic with a concave deformity at the center of the chin and impaired mentalis muscle function. The surgical procedure involved the reconstruction of the mentalis muscle by reassembling the muscle flaps and releasing the scarred soft tissue. Both patients were satisfied with the outcome. CONCLUSIONS: Mentalis muscle rupture requires surgical correction. The study proposes an innovative approach that enables patients to achieve a more harmonious appearance and improve function.

Would hyaluronic acid-induced mental bone resorption be a concern? A prospective controlled cohort study and an updated retrospective cohort study.

BACKGROUND: Hyaluronic acid (HA) is a widely used filler for face contouring and is generally believed to be safe and effective. However, there have been reports of HA-related bone erosion in the chin area without clear scientific data regarding its existence, incidence, and severity. This exploratory study was to evaluate HA-related mental bone resorption through a prospective, controlled, observer-blind, nonrandomized clinical trial and a retrospective cohort study. METHODS: On the one hand, a prospective, controlled, nonrandomized, single-shot HA-injection clinical trial was conducted. Computed tomographic scans were collected at baseline and at 6-12 months of follow-up for both HA-injection and control groups. On the other hand, an updated retrospective cohort study compared the HA-injection with a blank control group. The primary outcomes composed of three quantitative parameters [bone resorption index (BRI M and BRI N ), bone resorption thickness ratio] and one subjective evaluation index (severity ranking). Information about demographics, complications, and injection volume were also recorded. RESULTS: From June 2021 to March 2023, 78 patients were prospectively recruited for the study. There was a significant association between HA-injection and bone resorption [BRI M : pre (84.24±8.10%) vs post (79.21±8.70%), P <0.001; BRI N : pre 92.50% (73, 144%) vs 87.99% (63, 132%), P <0.001; bone thickness ratio: HA 24.08% (0, 48%) vs control 0 (0, 17%), P <0.001]. However, there was no difference in large-volume (>1 ml) and small-volume (≦1 ml) injection subgroups [bone resorption thickness ratio: (21.50±10.91%) vs (24.51±11.92%), P =0.350]. The imaging manifestation revealed discernible bone resorption in 35.90% of the patients, with an median bone resorption thickness ratio of 24.08%. Between October of 2019 and March 2023, 95 HA-injection patients (190 semimandibular cases), 95 normal controls were enrolled. The BRI M was significantly lower in the HA-injection group compared to the controls ( P <0.001). CONCLUSIONS: HA may induce bone resorption in the mentum. Large-scale randomized controlled clinical trial is warranted for further confirmation. Patients should be informed of this potential complication.

Optimal time to initiate early oral feeding in postoperative patients with upper gastrointestinal malignancy: A network meta-analysis.

BACKGROUND: With the development of enhanced recovery after surgery, early oral feeding is likely to become the preferred mode of nutrition after surgery for upper gastrointestinal tract malignancies. However, the optimal time to initiate early oral feeding remains unknown. OBJECTIVE: We aimed to compare the effects of different introduction times of early oral feeding in patients with upper gastrointestinal malignancies in terms of safety, tolerance, and effectiveness and to identify the optimal time for early oral feeding after surgery. METHODS: A random-effects meta-analysis was performed to identify evidence from relevant randomized controlled trials. Ten electronic databases were searched for randomized controlled trials from their earliest records to May 2023. Data were analyzed using the Stata 16.0 software. RESULTS: A total of 22 randomized controlled trials including 2510 patients and seven time points for oral feeding after surgery were considered. Regarding safety, oral feeding initiated on postoperative day 3 may be the safest (high-quality evidence) compared with other times. Regarding tolerance, oral feeding initiated on postoperative day 5 may be the most well-tolerated (moderate-quality evidence) compared with other times. Regarding effectiveness, oral feeding initiated on postoperative day 3 may be the most effective (moderate-quality evidence) compared with other times. CONCLUSIONS: Early oral feeding is safe, tolerable, and effective in postoperative patients with upper gastrointestinal malignancies. The optimal time to initiate early oral feeding after surgery was most likely postoperative day 3. The results of this meta-analysis provide evidence-based guidelines for clinical decision-making.

RCAN family member 3 deficiency contributes to noncompaction of the ventricular myocardium.

Noncompaction of the ventricular myocardium (NVM), the third most diagnosed cardiomyopathy, is characterized by prominent trabeculae and intratrabecular recesses. However, the genetic etiology of 40-60% of NVM cases remains unknown. We identified two infants with NVM, in a nonconsanguineous family, with a typical clinical presentation of persistent bradycardia since the prenatal period. A homozygous missense variant (R223L) of RCAN family member 3 (RCAN3) was detected in both infants using whole-exome sequencing. In the zebrafish model, marked cardiac dysfunction was detected in rcan3 deficiency (MO-rcan3ATG-injected) and rcan-/- embryos. Developmental dysplasia of both endocardial and myocardial layers was also detected in rcan3-deficient embryos. RCAN3 R223L variant mRNAs did not rescue heart defects caused by rcan3 knockdown or knockout; however, hRCAN3 mRNA rescued these phenotypes. RNA-seq experiments showed that several genes involved in cardiomyopathies were significantly regulated through multiple signaling pathways in the rcan3-knockdown zebrafish model. In human cardiomyocytes, RCAN3 deficiency resulted in reduced proliferation and increased apoptosis, together with an abnormal mitochondrial ultrastructure. Thus, we suggest that RCAN3 is a susceptibility gene for cardiomyopathies, especially NVM and that the R223L mutation is a potential loss-of-function variant.

A novel chin-reductive drawer-genioplasty using subapical and mandibular contouring ostectomy.

SUMMARY: As the most prominent feature of the lower face, the chin is crucial to human facial morphology and it plays a large role in contributing to facial attractiveness and harmony. Although an increasing number of genioplasty procedures are being introduced for chin augmentation, chin reduction procedures are rarely performed. Due to the inevitable cervicomental angle (CA) widening and relaxation of the floor-of-mouth muscles caused by chin shortening and the elevation of the lower edge of the mandible, chin reduction remains a challenging procedure. Our novel drawer-genioplasty approach involves a flexible chin-reducing procedure using subapical and mandibular contouring ostectomy. This technique can effectively shorten various long chins for improved facial proportions and maximize the floor-of-mouth muscle protection during surgery, thereby avoiding postoperative submental sagging. Several parameters, including the ratio between the lower (the subnasale to menton distance) and middle facial heights (the glabella to subnasale distance) (R1), the ratio between the anterior midline bone heights of the mandible (the stomion-to-menton distance) and maxilla (the subnasale-to-stomion distance) (R2), and the CA, were used to evaluate the outcome of the procedure. Comparing the preoperative and postoperative parameters revealed that there was a significant decrease in both R1 (1.25±0.15 versus 1.09±0.12) and R2 (1.94±0.24 versus 1.58±0.11). Although CA increased from 107.3±8.2° preoperatively to 112.4±7.0° postoperatively, this value was still within the normal range. In addition to providing effective and significant aesthetic improvements, the drawer-genioplasty is safe and involves no complications.

High-Quality Genome Assembly and Genome-Wide Association Study of Male Sterility Provide Resources for Flax Improvement.

Flax is an economic crop with a long history. It is grown worldwide and is mainly used for edible oil, industry, and textiles. Here, we reported a high-quality genome assembly for "Neiya No. 9", a popular variety widely grown in China. Combining PacBio long reads, Hi-C sequencing, and a genetic map reported previously, a genome assembly of 473.55 Mb was constructed, which covers ~94.7% of the flax genome. These sequences were anchored onto 15 chromosomes. The N50 lengths of the contig and scaffold were 0.91 Mb and 31.72 Mb, respectively. A total of 32,786 protein-coding genes were annotated, and 95.9% of complete BUSCOs were found. Through morphological and cytological observation, the male sterility of flax was considered dominant nuclear sterility. Through GWAS analysis, the gene LUSG00017705 (cysteine synthase gene) was found to be closest to the most significant SNP, and the expression level of this gene was significantly lower in male sterile plants than in fertile plants. Among the significant SNPs identified in the GWAS analysis, only two were located in the coding region, and these two SNPs caused changes in the protein encoded by LUSG00017565 (cysteine protease gene). It was speculated that these two genes may be related to male sterility in flax. This is the first time the molecular mechanism of male sterility in flax has been reported. The high-quality genome assembly and the male sterility genes revealed, provided a solid foundation for flax breeding.

Successful Treatment and Long-term Follow-up of Parry-Romberg Syndrome with Anterolateral Thigh Adipofascial Flap.

BACKGROUND: Anterolateral thigh (ALT) adipofascial free flap transfer is a frequently used method to reconstruct the facial symmetry and restore facial soft-tissue contour in PRS patients. While its long-term prognosis and patient outcomes assessment are still lack of understanding. METHOD: The authors report their treatment experience in 42 patients between 2001 and 2017 using microsurgical free anterolateral thigh adipofascial flap transfer. The long-term follow-up results and final reconstructive outcomes were evaluated. RESULTS: A total of 42 patients were included. The follow-up ranged from 5 to 21 years. All patients were satisfied with the surgery. Photographic evaluation revealed significant enhancement of postoperative appearance. Numbness or hypesthesia of the local area was the most common symptom in the long-term follow up. CONCLUSION: This study has evaluated the long-term treatment results of Parry-Romberg disease with microsurgery using ALT free flap in our department. Over 20 years' experience and the significant enhancement of the overall appearance indicate a long-lasting, excellent outcome.

The Effect of Various Temperatures on the Inflammatory Profile of Fat Graft Storage: An Experimental Study.

Fat tissue has been widely used as a filler material during plastic surgery, but unpredictable fat retention remains a significant concern. Fat tissue is vulnerable to ischemia and hypoxia, but it always has waiting time before injection in the operation theater. Apart from transferring fat tissue as quickly as possible after harvesting, washing the aspirate with cool normal saline is often used. However, the mechanisms of cool temperature acting on adipose tissue have yet to be fully elucidated. Herein, this study aims to explore the effect of preservation at different temperatures on the inflammatory profile of adipose tissue. Inguinal adipose tissue of rats was collected and cultured in vitro under 4°C, 10°C, and room temperature for 2 hours. The proportion of damaged adipocytes and an array of cytokines were determined. We observed that the damage rate of the adipocyte membrane was slightly higher at room temperature, but there was no significant difference, while we noticed increased IL-6 and MCP-1 levels in adipose tissue at room temperature ( P ＜0.01). The 4°C and 10°C cool temperatures may offer protection against proinflammatory states during the adipose tissue preserved in vitro.

Astaxanthin Promotes the Survival of Adipose-Derived Stem Cells by Alleviating Oxidative Stress via Activating the Nrf2 Signaling Pathway.

The survival of free fat grafts is dependent primarily on adipose-derived stem cells (ADSCs); however, ADSCs are susceptible to oxidative stress in the recipient area. Astaxanthin (Axt) is a natural xanthophyll carotenoid with potent antioxidant properties and numerous clinical applications. To date, the therapeutic potential of Axt in fat grafting has not been explored. The purpose of this study is to investigate the effects of Axt on oxidatively stressed ADSCs. An oxidative model of ADSCs was developed to simulate the host's microenvironment. Oxidative insult decreased the protein levels of Cyclin D1, type I collagen alpha 1 (COL1A1), and type II collagen alpha 1 (COL2A1), while increasing the expression of cleaved Caspase 3 and secretion of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in ADSCs. Axt pre-treatment significantly reduced oxidative stress, increased the synthesis of an adipose extracellular matrix, alleviated inflammation, and restored the impaired adipogenic potential in the present model. Furthermore, Axt immensely activated the NF-E2-related factor 2 (Nrf2) pathway, and ML385, an inhibitor of Nrf2, could negate Axt's protective effects. Additionally, Axt alleviated apoptosis by inhibiting bcl-2-associated X protein (BAX)/Caspase 3 signaling and improving the mitochondrial membrane potential (MMP), which could also be abolished by ML385. Our results suggest that Axt may exert its cytoprotective effect on ADSCs through the Nrf2 signaling pathway and could be therapeutic in fat grafting.

Redefining Mandibular Sub-units: The "ABC" Classification and Surgical Strategies for Lower Face Contouring.

BACKGROUND: In east Asia, lower face contouring surgeries including reduction mandibuloplasty and genioplasty are the most popular aesthetic craniofacial surgeries. Conventional selection of surgical strategies mainly relied on the visual judgment of the mandibular angle, without overall assessment of the mandibular sub-units. Furthermore, only a few studies offered quantitative assessment of the mandibular shape. METHODS: From 2010 to 2021, 1241 patients diagnosed with square faces and received customized lower face contouring surgeries by the senior author were reviewed and analyzed to propose an "ABC" classification system for facilitating surgical planning. RESULTS: Among them, 998 (80.42%) received bilateral mandible reshaping, 155 (12.49%) underwent bilateral mandible reshaping combined with genioplasty, and 88 (7.09%) received asymmetric mandible reshaping. A modified classification system composed of three critical parameters (height, morphology/thickness, divergence) in three aesthetic zones (mandibular angle, mandibular body, chin) was proposed based on quantitative summarization of the CT database and the senior author's 12-year experience. The way to facilitate surgical planning with this classification was demonstrated. CONCLUSIONS: This modified classification system ushered a decision-making process that prioritized several critical measurements and proposed an operative planning form. Meanwhile, it can also be cooperated into the three-dimensional virtual surgical plan. 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 http://www.springer.com/00266 .

Soft and Hard Tissue Changes and Facial Rejuvenation of Anterior Maxillary Segmental Osteotomy: A Three-Dimensional Cephalometric Study.

OBJECTIVE: To explore the efficacy of anterior maxillary segmental osteotomy (AMSO) in reliving maxillary protrusion and better analyze the three-dimensional (3D) morphological changes of the postoperative nasolabial region using computed tomography (CT) and evaluate the trend of facial rejuvenation. MATERIALS AND METHODS: Forty-five patients who underwent AMSO from January 2017 to December 2021 were retrospectively included. CT and oriented photography were performed before and 10 months after the treatment. The mimics17.0 software was used to reconstruct the 3D CT scan results before and after the operation, measure the data of each anatomical index, and systematically evaluate the soft tissue changes in the nasolabial region. The patients themselves, the plastic surgeons, family members, or friends of patients use the Face-Q Age Appraisal Visual Analogue Scale (VAS) to evaluate the changes in patients' visual age before and after the operation. RESULTS: Forty-five cases of maxillary protrusion were alleviated. Seen from the side, the protruding degree of the upper lip is obviously reduced. In the front view, âˆ Cont-Sbal-F, the width of alar base, and alae nasi all increased significantly. Contrary to traditional perceptions, the protrusion and height of the nose tip actually increased rather than decreased after AMSO. The visual age score improved positively, and patients obtained facial rejuvenation. No serious complications occurred; after 10-month follow-up, we achieved a high degree of satisfaction. CONCLUSION: AMSO can significantly improve the maxillary protrusion, and it can increase the protrusion and height of the nose tip. Also, patients can get a younger appearance. Comprehensive preoperative evaluation and postoperative nasolabial morphology with maxillary protrusion patients are helpful for correct clinical decision-making. At the same time, the operation suggests a new choice of facial rejuvenation for patients with maxillary protrusion. 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.

Optimal timing of postmastectomy radiotherapy in two-stage prosthetic breast reconstruction: An updated meta-analysis.

BACKGROUND: There is no consensus on the timing of postmastectomy radiotherapy (PMRT) in relation to the exchange procedure in breast cancer patients undergoing the immediate two-stage prosthetic breast reconstruction. This meta-analysis investigated the reconstruction failure, complications, and cosmesis between PMRT to the tissue expander (TE) and PMRT to the permanent implant (PI). METHODS: A literature search was conducted in PubMed and Embase databases until February 2022. Studies presenting at least one aspect relating to reconstruction failure, complications, and cosmesis between two cohorts were included. Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias in included studies. RESULTS: Eleven studies presenting 1447 patients were enrolled. Three studies were prospective controlled research. The risk for implant loss was higher in PMRT to TE cohort (RR 1.75; 95% CI, 1.03 to 2.98; p = 0.04); meanwhile, the PMRT to TE cohort had a significantly lower risk of capsular contracture (RR 0.47; 95% CI, 0.29 to 0.78; p = 0.003). However, the synthesized result should be interpreted sensibly due to heterogeneity in statistical methods and definitions. CONCLUSION: Delivering PMRT to PI may reduce the risk of implant loss, while delivering PMRT to TE can reduce the risk of severe capsular contracture. More high-quality studies are warranted for the refinement of clinical practice.

The Effect of Yes-Associated Protein on the Interaction Between the MEK/Extracellular Signal-Regulated Kinase and Hippo Pathways in Osteoblasts Co-Cultured With Fibroblast Growth Factor Receptor 2-Mutated Dura Cells.

BACKGROUND: C342Y (Cys342Tyr) point mutation of FGFR2 (fibroblast growth factor receptor 2) is closely associated with the pathogenesis of Crouzon syndrome. The dura mater plays an important role in mediating the closure of cranial sutures. However, the underlying mechanisms of these pathological processes have been rarely investigated. in this study, the authors analyzed the effects of dura cells with FGFR2 mutations on the biological function of osteoblasts. METHODS: Dura cells and cranial osteoblasts from C57BL/6 mice were extracted and cultured. C342Y-FGFR2 mutant constructs were established via lentivirus and applied to infect dura cells. A co-cultured trans-well system with dura cells and osteoblasts was established. Three experimental groups were set up: oste group, Oste + Dura-vector group, and Oste + Dura-C342Y group. The expression levels of key factors in MEK (Mitogen-activated protein kinase kinase, MAPKK)/extracellular signal-regulated kinase (ERK) and Hippo pathway were detected by western blot and RT-qPCR (Real Time Quantitative PCR). Finally, a rescue experiment was carried out with small interference RUA. RESULTS: The proliferation level of osteoblasts in Oste + Dura- C342Y group was significantly up-regulated. Our studies indicated that the activation of MEK/ERK pathway in Oste + Dura-C342Y group could inhibit the Hippo pathway, lead to down-regulation of large tumor suppressor 1 and promote the activation and nuclear localization of yes-associated protein, and the results of rescue experiments showed a reverse expression trend, further confirming the effects of C342Y-FGFR2 mutation in dura cells on osteoblasts and its potential mechanism. CONCLUSIONS: This study suggested that the C342Y-FGFR2 mutation in dura cells could promote osteoblastic proliferation, and shown the crosstalk between MEK/ERK and Hippo pathways. As the regulatory machinery center, yes-associated protein might play a bridging role in these pathways, and might influence the pathogenesis of craniosynostosis by activating downstream transcriptional factors.

Global and Chinese publications in plastic surgery journals between 2010 and 2020: a bibliometric analysis.

Background: Plastic surgery has evolved rapidly in recent years. We performed a bibliometric analysis of plastic surgery publications from 2010 to 2020 to evaluate global developments in plastic surgery and the Chinese contribution to this field. Methods: The 2020 Journal Citation Reports (JCR) was used to identify all plastic surgery journals; those that were available on the Web of Science database were retrieved and analyzed according to their number of published articles, citation rates, impact factors (IFs), research funding, and article references. We also determined the most popular journals for research from the 8 top-ranking countries in terms of contributed articles, including China. Results: From 2010 to 2020, 55,554 articles were published in the 35 selected plastic surgery journals. China, which contributed 9.48% of these articles, was the country with the second-highest number of articles published, a number which has been increasing annually. The average IF of Chinese articles was 1.74, with an average citation count of 6.68. These figures were significantly lower than those for articles from developed countries. China contributed 1,641 articles to the 10 highest impact plastic surgery journals. The Journal of Craniofacial Surgery was the most popular in terms of contributions by China. China had the highest rate of articles supported by funding (45.30%). The top 12 research-topic clusters were obtained by analyzing the references in the articles. Emerging research-topic trends worldwide and in China included fat grafting and blindness after filler injection. Conclusions: From 2010 to 2020, research into plastic surgery increased continuously, both worldwide and in China. However, the quality of the Chinese articles was lower than that of other top-ranked countries. Researchers who have elected to conduct research might consider emerging trends when designing future studies.

In Vitro Study on the Biological Characteristics of Adipose-Derived Stem Cells from Liposuction Area in Patients with Progressive Hemifacial Atrophy.

OBJECTIVE: In this study, we investigate the biological characteristics of ADSCs from the liposuction area in patients with hemifacial atrophy in vitro. METHODS: ADSCs were respectively extracted from the donor site of patients with hemifacial atrophy and healthy ones. ADSCs of two groups were respectively tested for proliferation ability, phenotype, multipotency, migration ability, self-repair ability, apoptosis, and autophagy. Exosomes extracted from the supernatant of two groups were detected by NTA particle size, electron microscopy (TEM), and WB for CD63 and TSG10, respectively. RESULTS: CCK-8 showed a statistically less increase in cell proliferation in PHA-ADSCs after the sixth day. ADSCs in both groups had typical phenotypes and multidirectional abilities. PHA-ADSCs exhibited weaker droplet formation. The cell migration ability in PHA-ADSCs was weaker tested by Transwell assay. The live/dead proportion calculated by ImageJ following calcein-AM/PI double staining revealed live cells in PHA-ADSCs was 46.11% compared with 54.21% in NORM-ADSCs after OGD treatment. A significant down-regulation of ATG7 and ATG12 and a higher percentage of apoptosis were found in PHA-ADSCs. A significant up-regulation of BAX occurred in PHA-ADSCs.ARPC5 expression in the PHA group was extremely distinct down-regulated.CDKN1A and CDKN2A expression in the PHA group was significantly up-regulated.WB analyses confirmed that both groups' ADSCs-Exosomes surface markers CD63 and TSG101 were positively expressed but varied significantly. CONCLUSIONS: PHA-ADSCs exhibited a poorer proliferation ability, higher apoptosis percentage, weaker lipid droplets formation, weaker cell migration, poorer intolerance to OGD, aging earlier, and weaker self-renewal and repairability.PHA-ADSCs-Exosomes showed low expressions of CD63 and TSG101.This study provides strong evidence that the addition of exosomes with specific cytokines can improve the fat survival rate after fat filling in patients with hemifacial atrophy. NO LEVEL ASSIGNED: This journal requires that authors 42 assign a level of evidence to each submission to which 43 Evidence-Based Medicine rankings are applicable. This 44 excludes Review Articles, Book Reviews, and manuscripts 45 that concern Basic Science, Animal Studies, Cadaver 46 Studies, and Experimental Studies. For a full description of 47 these Evidence-Based Medicine ratings, please refer to the 48 Table of Contents or the online Instructions to Authors 49 https://www.springer.com/00266 .