Constricted posterior fourchette deformities: Definition, classification and surgical treatment.

BACKGROUND: Labiaplasty is one of the top cosmetic procedures patients are seeking in the past two years. However, treatment of disease in posterior fourchette caused by various etiological factors was less investigated and neglected. METHODS: Three types of posterior fourchette deformity were proposed: (1) Redundant posterior fourchette, (2) Relaxed posterior fourchette, and (3) Constricted posterior fourchette. Local flap transfer technique was applied. Y-V-plasty and 5-Z-Flap-plasty were used to treat web type and tight type of the constricted posterior fourchette, respectively. Follow-ups were arranged on the Internet or at the outpatient clinic. Visual analogue scale (VAS) was utilized to evaluate sexual discomfort in the satisfaction questionnaires during follow-up. RESULTS: A total of 48 patients with constricted posterior fourchette deformity from May 2022 to May 2023 were reviewed in the study. Y-V-plasty could decrease VAS in patients with web-type deformity by 4.13 ± 1.46 (p＜0.001). 5-Z-Flap-plasty could decrease VAS in patients with tight-type deformity by 3.76 ± 1.53 (p＜0.05). Satisfaction rates of the web type and tight type were 93.1% (27/29) and 86.7% (13/15) respectively. Complications include two cases of hematoma, one case of persistent pain and two cases of dehiscence. CONCLUSION: Constricted posterior fourchette seriously affects the quality of life. Y-V-plasty and 5-Z-Flap-plasty can be utilized to treat the two subtypes of constricted posterior fourchette, which can effectively reduce the pain score of patients with high satisfaction and few long-term complications.

Comprehensive aesthetic corrections of gynecomastia using the reproducible safe and minimally invasive surgical strategy.

BACKGROUND: Minimally invasive access and fast recovery are trends of gynecomastia surgery. We placed great importance on liposuction and modified original pull-through technique. The purpose of this study was to present a refined surgical strategy for gynecomastia in grade I and II. METHODS: The refined strategy embraced enhanced liposuction to remove the intraglandular fat sufficiently, followed by open resection of gland using the pull-through and bottom-up technique with adjuvant liposuction in the end. Surgical data were recorded and satisfactory questionnaires with 5-point scales were administered during follow-up. RESULTS: Between January 2017 and May 2022, 165 patients underwent enhanced liposuction combined with the pull-through and bottom-up technique for gland excision. Age ranged from 12 to 56 years. The median length of surgery was 100 min. A median of 300 ml of fat was aspirated and a median of 20.8 g of gland was excised. Seventy-seven patients (46.7%) responded the questionnaires at least 6 months postoperatively, and the average overall satisfaction was 4.68 ± 0.52 points. Thirteen sides of breasts developed complications with a rate of 4.0%. CONCLUSION: Enhanced liposuction combined with pull-through and bottom-up technique proved effective to treat grade I and II gynecomastia with minimal scarring and high satisfaction. The refined strategy was simple and safe, and would obtain optimal outcomes even for inexperienced surgeons.

Nicotine in Complex Samples: Recent Updates on the Pretreatment and Analysis Method.

Nicotine is a significant evaluation index of tobacco and its related products' quality, but nicotine overdose can pose serious health hazards and cause addiction and dependence, thus it can be seen that it is necessary to find suitable and efficient detection methods to precisely detect nicotine in diverse samples and complex matrices. In this review, an updated summary of the latest trends in pretreatment and analytical techniques for nicotine is provided. We reviewed various sample pretreatment methods, such as solid phase extraction, solid phase microextraction, liquid phase microextraction, QuEChERS, etc., and diverse nicotine assay methods including liquid chromatography, gas chromatography, electrochemical sensors, etc., focusing on the developments since 2015. Furthermore, the recent progress in the applications and applicability of these techniques as well as our prospects for future developments are discussed.HighlightsUpdated pretreatment and analysis methods of nicotine were systematically summarized.Microextraction and automation were main development trends of nicotine pretreatment.The introduction of novel materials added luster to nicotine pretreatment.The evolutions of ion source and mass analyzer were emphasized.

Unsymmetrical dimethylhydrazine and related compounds in the environment: Recent updates on pretreatment, analysis, and removal techniques.

Unsymmetrical dimethylhydrazine (1,1-Dimethylhydrazine, UDMH) has been widely used as aerospace fuel in many countries. The launch of space vehicles can cause the release and leakage of UDMH into the environment, posing serious threats to ecology system and human population. Even worse, the health risks are also pertinent to its numerous classes of transformation products including N-Nitrosodimethylamine (NDMA), because most of them display carcinogenic and mutagenic properties. Recently, there has been an intense ongoing development of simple, fast, green, and effective techniques for determining and removing these hazardous substances. This review summarizes the latest research progress regarding the sources, fates, pretreatment, analysis, and removal techniques of UDMH and related products in the environment. Sample preparation methods mainly include pressurized liquid extraction, liquid-phase microextraction techniques, solid-phase extraction, headspace-solid-phase microextraction, and supercritical fluid extraction. Detection and identification methods mainly include high-performance liquid chromatography coupled with tandem mass spectrometry (HPLC-MS/MS), gas chromatography coupled with tandem mass spectrometry (GC-MS/MS), and sensors. Removal methods mainly include advanced oxidation processes, adsorption, biodegradation techniques. The advantages/disadvantages, applications, and trends of the proposed approaches are thoroughly discussed to provide a valuable reference for further studies.

Adipose-Derived Stromal Cells Attenuate Adipose Inflammation in Obesity through Adipocyte Browning and Polarization of M2 Macrophages.

Obesity is a metabolic condition associated with multiple health problems such as endocrine and metabolic dysfunction and chronic inflammation in adipose tissues. In this study, the ADSCs could be stimulated to differentiate into brown adipocyte with rosiglitazone treatment based on the Oil-Red-O staining trial. Furthermore, the multilocular lipid droplets located in the center was increased in differentiated brown adipocytes, and brown fat-associated proteins, UCP1, PPAR-γ, and LPL were highly expressed in brown adipocytes differentiated from ADSCs. Additionally, the results of animal experiments showed that both weight and amount of VLDL and LDL were decreased in the serum of obese mice after transplantation of rosiglitazone-induced brown adipocytes, while the level of HDL increased. Moreover, the proteins associated with lipid metabolism, LPA and UCP1, were downregulated, and the inflammatory response was suppressed through inhibition of the ITGAM/NF-κB-mediated proinflammatory responses and polarization of M2 macrophages. Similarly, the amounts of proinflammatory cytokines, TNF-α, IL-6, and IL-1ß were decreased after rosiglitazone-induced brown adipocyte transplantation. On the contrary, anti-inflammatory cytokine IL-10 was significantly increased in both groups of obese mice, with or without brown adipocyte transplantation. Therefore, the adipose-derived stromal cells with induced browning could promote lipid consumption and alternative polarization of M2 macrophages to attenuate adipose inflammation in obesity mouse models, which thus provides a potential therapy for obesity.

Sensitization of keloid fibroblasts by quercetin through the PI3K/Akt pathway is dependent on regulation of HIF-1α.

Keloids are raised, red, hard and irregular tumors that are prone to extend beyond the wound borders. Surgical excision is not sufficient to eradicate a keloid. Adjuvant therapy with radiation is a recommended treatment that reportedly achieves improved efficacy. However, radiation does not only kill cells in the keloid tissue but also stimulates their resistance, and intractable cases can display continuous recurrence. Quercetin was initially extracted from natural products and is used as a dietary supplement. The role of quercetin as an oxidant scavenger has been highlighted in many studies and has drawn interest to the application of ionizing radiation (IR) sensitization. In this study, we first demonstrate that keloid fibroblasts acquire resistance after IR treatment, and this can be relieved by treatment with quercetin. Further, we showed that hypoxia-inducible factor 1 (HIF-1), a prognostic marker used in clinical practice after radiation therapy, was associated with stronger radioresistance in keloid fibroblasts, which was downregulated after quercetin treatment. The inhibition of HIF-1 expression by quercetin was found to be dependent on the phosphatidylinositol-3-kinase (PI3K)/Akt pathway. Quercetin has been reported to reduce the phosphorylation of Akt. Taken together, we revealed one mechanism underlying the suppression of radioresistance by quercetin, which involved the regulation of HIF-1α by the PI3K/Akt pathway. Our study provides a molecular basis for the application of quercetin in radiation sensitization in the treatment of keloids.

Coordination of Bactericidal and Iron Regulatory Functions of Hepcidin in Innate Antimicrobial Immunity in a Zebrafish Model.

Hepcidin acts as both an antimicrobial peptide and a hormonal regulator of iron homeostasis; however, the biological significance of this dual-function in immune reactions remains elusive. In this study, we provide experimental evidence regarding the coordination of this dual-function in the innate antimicrobial immunity using a zebrafish model. The transcription of hepcidin gene was significantly upregulated in liver by Aeromonas hydrophila (A.h) DNA stimulation, which was accompanied by an increase of hepcidin protein and a decrease of iron concentration in serum. Thus, an enhanced bactericidal activity against A.h and Escherichia coli and inhibitory effects on A.h growth and OmpA expression were observed in A.h cells, the latter of which made the bacterium more susceptible to complement attack. The enhanced bacteriostatic activities in serum following the stimulation were dramatically impaired by neutralizing hepcidin or restoring iron to the samples. Immuno-protection assay showed that zebrafish administrated with A.h DNA or designed CpG-ODNs had a significantly enhanced defence against A.h and Vibrio alginolyticus infections, which was also eliminated by the neutralization of hepcidin. Results indicate that the induction of hepcidin leads to the decrease of iron in circulation, which eventually limits iron availability to invading microorganisms, thus contributing to host defence.

Perinipple Broken Line Incision: a Novel Approach for Breast Augmentation.

OBJECTIVE: To investigate reliability of the infra-nipple broken line incision for breast augmentation. METHODS: From January 2012 to January 2013, 15 patients underwent primary bilateral retromuscular breast augmentation with round textured silicone-gel implants and a novel infra-nipple broken line incision. Preoperatively, a semicircular incision was marked along the inferior base of the nipple. It was then extended bilaterally using two transverse right-angled geometric broken lines within the pigmented areolar skin. Follow-up was performed to evaluate the sensation of nipple-areolar complex, the scar, and the shape and texture of the breasts. RESULTS: The average follow-up was 6.7 months. Most of the patients complained of paresthesia of the nipple or breast skin, but transient decreased sensation improved within 3 months. No patients showed permanent sensory changes of the nipple areolar complex at a minimum follow-up of 4 months. The scars were imperceptible in all patients. CONCLUSION: We believe that for selected patients, the infra-nipple broken line incision is a practical and reliable method to achieve aesthetic result.

A young man with primary prostatic extra-gastrointestinal stromal tumor: a rare case report and review of the literature.

Mounting evidence demonstrates the presence of extragastrointestinal stromal tumor (EGIST) which originates from tissues outside the gastrointestinal (GI) tract and shares overlapping immunohistological features with gastrointestinal stromal tumor (GIST). GIST emanating from prostate is extremely rare. To our knowledge, there are only 3 definitely reported cases of primary prostatic EGIST. Herein, we report a case of prostatic EGIST in 31-year-old man with low urinary tract symptoms who was initially misdiagnosed as sarcoma of prostate. Imaging studies assist in determining the origin and location of EGIST. Immunohistochemical assessment (DOG-1, CD117, and CD34) helps in differentiating such lesion from other stromal tumors and in addressing an appropriate and optimal therapeutic strategy.

[Diagnosis and treatment of xanthogranulomatous prostatitis: a case report and review of the literature].

OBJECTIVE: To explore the diagnosis and treatment of xanthogranulomatous prostatitis. METHODS: A 75-year-old man presented with a 3-month history of difficult urination and frequent micturition, which was exacerbated for 2 days. Digital rectal examination indicated an enlarged prostate size of II degrees with hard texture but no tenderness. Serum total PSA was 172.5 microg/L. TRUS revealed 200 ml of post-micturition residual urine, thickened bladder wall, prostate size of 4.3 cm x 3.8 cm x 5.0 cm and no isochrones. MRI showed an enlarged prostate gland, with marked enlargement of the central zones and low-signal intensity of the peripheral gland, part of the prostate gland protruding to the bladder with no clear dividing line. It was diagnosed as prostate cancer initially, and confirmed by needle biopsy. RESULTS: Histopathological examination revealed large numbers of "foamy macrophages" in the lesion, with a few multinucleated giant cells, leukocytes, mononuclear, plasmocytes and fibroplasia. Immunohistochemistry showed CD68 (+) and PSA (-). The patient was treated with oral Tamsulosin and glucocorticoid and by temporary catheterization, and followed up for 20 months. Urination symptoms began to alleviate and serum PSA to decrease at 4 months. The PSA level was 9.2 microg/L at 13 months and 3.6 microg/L at 17 months. CONCLUSION: Xanthogranulomatous prostatitis is a rare clinically, which can be confirmed by histopathological examination. It is treated mainly by supportive therapy and, for the cases with severe lower urinary tract obstruction, TURP can be employed. Follow-up must be performed by possible examination of PSA and necessary needle biopsy of the prostate.

[Experimental research of the relationship between the safety of expanded flap and expansion volume].

OBJECTIVE: To investigate the relationship between the survival rate of expanded flap and expansion volume. METHODS: The minipigs were used and divided into 5 groups according to different expansion volume of the tissue expanders: injection to full content, 50% over content, 100% over content, 0% content and normal control. In each animal, 4 expanders (100 ml) were designed to be implanted at the bilateral side of back. Normal skin control was also designed at the back. The skin histologic change and flap survival rate were detected and analyzed when the expansion volume changed. RESULTS: The flap survival rate increased along with the increase of expansion volume. While the survival rate decreased when the expansion volume was exceeded to 100% over content. CONCLUSIONS: In soft tissue and skin expansion, the flap survival rate and the flap size increased as the expansion is over the standard volume, while over-expansion to 100% over content may cause decreased survival rate of expanded flap.

[Acellular cadaveric dermis-assisted immediate breast reconstruction: the preliminary experience].

OBJECTIVE: To investigate the feasibility and therapeutic effect of acellular cadaveric dermis (ACD)-assisted immediate breast reconstruction. METHODS: From Sep. 2009 to May 2010, 10 cases received ACD-assisted immediate breast reconstruction. During the operation, the ACD was used to cover inferior and lateral portion of the implants in 2 cases and expanders in 8 cases. RESULTS: The patients were followed up for an average period of 4 months with satisfactory breast appearance. The complications included infection in 2 cases and dehiscence in 2 cases. But no implant or expander was taken out. CONCLUSIONS: The ACD-assisted immediate breast reconstruction is a technically simple procedure with minimal morbidity. Satisfactory clinical outcome can be achieved with appropriate candidates.

[Application of melanocytes and bone marrow mesenchymal stem cells in tissue engineered skin construction].

OBJECTIVE: To explore the method of constructing tissue-engineered skin using melanocytes and bone marrow mesenchymal stem cells (BMSCs) in vivo. METHODS: Melanocytes were isolated from human foreskin. BMSCs were isolated from human bone marrow. Both of them were co-cultured at a ratio of 1:10, and then were implanted into the collagen membrane to construct the tissue-engineered skin, which was applied for wound repair in nude mice. The effectiveness of wound repair and the distribution of melanocytes were evaluated by morphological observation, in vivo 4,6-diamidino-2-phenylindole, dihydrochloride (DAPI) fluorescent staining tracing, HE staining, S-100 immunohistochemistry, and transmission electron microscopy. RESULTS: The wounds were satisfactorily repaired among the nude mice. The melanocytes were distributed in the skin with normal structure, as confirmed by DAPI fluorescent staining tracing, HE staining, S-100 immunohistochemistry, and transmission electron microscopy. CONCLUSION: Melanocytes and BMSCs, after proper in vitro culture at an appropriate ratio, can construct the tissue-engineered skin with I type collagen membrane.

[The technique of periorbital defects reconstruction with island orbicularis oculi myocutaneous flap in orbital zone].

OBJECTIVE: To investigate the technique of periorbital defects reconstruction with island orbicularis oculi myocutaneous flap in orbital zone. METHODS: The upper or lower eyelid island orbicularis oculi myocutaneous flap,medially based,were used for the defects of the periorbital area, according to the position,shape and size of the defects. The donor site was closed directly. RESULTS: From July 2003 to October 2009, 24 patients were treated in this method, the flaps survived totally. The flap proved to be flexible, safe, relatively simple, and provided good functional and aesthetic results with follow up 6 to 24 months. Complications were minimal. CONCLUSIONS: The upper eyelid or lower eyelid island orbicularis oculi myocutaneous flap, medially based, is a satisfied method in repairing periorbital defects in one stage with good blood supply, excellent color texture matching and inconspicuous donor scar and deformity.

[Comparison study on the efficacy of three methods for the treatment of osmidrosis].

OBJECTIVE: To compare the efficacy of decollement, combined tumescent liposuction and curettage, Botox injection in the treatment of osmidrosis. METHODS: From September 2006 to April 2009, 350 patients with osmidrosis were treated by decollement method in 180 cases, curettage in 120 cases,and Botox injection in 50 cases. The therapeutic effect and complications were retrospectively analyzed. RESULTS: The patients were followed up for 3-24 months. The cure rate was 90.6%, 84.8% and 84.2% in decollement, curettage and Botox groups, respectively. The effective rate was 100% in all groups. CONCLUSIONS: All the three methods are effective for the treatment of osmidrosis. The odor symptom can be improved a lot with decollement method. Considering the complication, downtime and cosmetic results, Botox injection is suitable for patients with minor or median odor, while combined liposuction and curettage is selected for patients with median to severe odor.

[The design and technique of one stage treatment of eyelid divided nevus with island skin flap].

OBJECTIVE: To investigate the design and technique of the one stage treatment of eyelid divided nevus with adjacent and distant island skin flap. METHODS: Under local or general anesthesia, the divided nevus on the upper and lower eyelid were excised totally or partially. According to the location, shape and size of the defect, orbicularis oculi musculocutaneous flap, postauricular SMAS-pedicled flap or reversal superficial temporal artery flap was chosen to repair the defect in one stage. The donor site was closed directly. RESULTS: Since 2003, 16 patients were treated in this group, with 10 orbicularis oculi musculocutaneous flaps, 3 postauricular SMAS-pedicled flaps, and 3 reversal superficial temporal artery flaps. The largest size of the nevus on the upper and lower eyelid were 2.5 cm x 2.0 cm and 4.0 cm x 3.0 cm, respectively. One postauricular SMAS-pedicled flap and 1 reversal superficial temporal artery flap showed distal venous refluence obstruction and epidermal necrosis in early postoperative stage, which healed through dressing. The other flaps survived completely. CONCLUSIONS: Treating eyelid divided defects with adjacent or distant island skin flap is a suitable method with satisfactory result and less morbidity in donor sites.

[Correction of secondary breast deformities after removement of injected polyacrylamide hydrophilic gel].

OBJECTIVE: To investigate the correction of secondary breast deformities after removement of injected polyacrylamide hydrophilic gel (PAHG). METHODS: From March 2003 to March 2008, 100 patients with bilateral breast augmentation with injected PAHG underwent operation to remove the PAHG. The age of patients ranged from 35 to 50 years. Ultrasound and MRI were performed before operation to show the distribution of PAHG and the muscle infiltration around the PAHG. According to the PAHG distribution, muscle infiltration, skin elasticity, infection and PAHG residue, the patients were treated respectively with breast implants at the same stage or at the second stage, or without implants. RESULTS: The patients were followed up for 3 months to 3 years. The percentage of satisfactory, median satisfactory and dissatisfactory was 90%, 9%, and 1%. In the median satisfactory group, 3 breasts in 3 cases showed slight capsular contracture (Baker II), 8 implants in 6 cases were palpable on the lower pole of the breasts. The middle-aged patient in dissatisfactory group was not satisfied with the high-projected implants shape which were chosen by herself and placed at the second stage. Then implants were removed. There was no complication of implant hernia, infection, wound disruption, or asymmetry. CONCLUSIONS: The secondary breast deformities could be corrected by breast augmentation with implants. Both breast appearance and the psychological affection can be improved.

[Atrial myocytes KChIP2 mRNA expression in rheumatic heart disease patients with atrial fibrillation].

OBJECTIVE: To detect the KChIP2 mRNA level in rheumatic heart disease patients with or without atrial fibrillation (AF) by real-time PCR. METHODS: Right atrial appendage samples from rheumatic heart disease patients with (n = 17) or without AF (n = 13) were obtained during cardiac surgery. Total RNA was extracted from the atrial tissues, and the KChIP2 and Kv4.3 mRNA were detected by SYBR Green I real-time PCR with the GAPDH as the house keeping gene. RESULT: The ratio of KChIP2/GAPDH (0.1468 +/- 0.0452 vs. 0.2200 +/- 0.0388, P<0.01) and the ratio of Kv4.3/GAPDH (0.3946 +/- 0.1826 vs. 0.5257 +/- 0.1427, P<0.05) were significantly lower in AF patients compared to non-AF patients. CONCLUSION: Down-regulated atrial KChIP2 and Kv4.3 mRNA expressions in rheumatic heart disease patients with chronic AF might be one of the molecular bases responsible for the down-regulation of the I(to) current density of AF.

[The clinical application of parotid fascia-SMAS-platysma flap in the lifting of lower face and neck].

OBJECTIVE: To investigate the technique of lower face and neck lifting with parotid fascia-SMAS-platysma flap. METHODS: To improve the lifting strength of SMAS and the cosmetic result, the traditional SMAS-platysma flap was modified as parotid fascia-SMAS-platysma flap. The modified flap was folded and suspended step by step to lift the lower face and neck. RESULTS: From Oct. 2004 to Oct. 2008, 78 patients were treated with this method. The patients' age ranged from 40 to 65 years old. There were 2 cases of male and 76 cases of female. All the patients were followed up for 6 months to 4 year with satisfactory results. CONCLUSIONS: Folding and suspension of the parotid fascia-SMAS-platysma flap step by step can effectively lift the saggy tissue of lower face and neck.

Determination of residual acrylamide in medical polyacrylamide hydrogel by high performance liquid chromatography tandem mass spectroscopy.

OBJECTIVE: To determine residual acrylamide in medical polyacrylamide hydrogel by high performance liquid chromatography tandem mass spectroscopy (HPLC-MS). METHODS: After (13)C3 labeled acrylamide was added, the sample was extracted with water and then cleaned up with Extrelut 20. The polyacrylamide hydrogel sample and 20 clinical cases were analyzed by HPLC-MS/MS and isotope dilution quantifying technique in selected reaction monitoring (SRM) mode. RESULTS: Acrylamide was separated from polyacrylamide hydrogel. The concentration of acrylamide in polyacrylamide hydrogel ranged from 3.9 x 10(-9) to 3.1 x 10(-8) g/L in the 20 clinical cases. The peak area was favorable linear and the range was up to 3000 microg/L. The recovery rate was 103.1% with a relative standard deviation (RSD) of 6.20%, when the mark level was 50 microg/L. CONCLUSION: HPLC-MS is a rapid, accurate, and sensitive method for the determination of residual acrylamide in medical polyacrylamide hydrogel.