Architecting V2O5 with a Triune Crystal Water-Amorphous-Crystalline Feature for Robust Zinc-Ion Batteries.

The notorious collapse of the electrode structure and strong electrostatic interactions in aqueous zinc-ion batteries (AZIBs) limit the achievement of a long cycle life. Herein, by designing an ordered/disordered hybrid structure, we have effectively preserved the integrity of the V2O5·1.6H2O (VOH) electrode. Moreover, our approach facilitates the release of stress concentration contributed to by the amorphous component, alleviating the strong electrostatic interaction merited by crystal water and promoting the diffusion kinetics of Zn2+ assisted by the crystalline component. Noteworthy, the crystal water serves as an interlayer pillar significantly enhancing the structural stability of the electrode. As a result, our VOH electrode exhibits high electrochemical performance. It delivered 227.8 mAh g-1 at a higher current density of 2 A g-1, and a high cycle life of 1000 cycles with 95% capacity retention was achieved at a current density of 1 A g-1.

Filter Membrane-Based Colorimetric Approach for Point-of-Care Detection of Biomarkers Using CRISPR-Cas12a.

CRISPR-Cas-based point-of-care testing (POCT) strategies have been widely explored for the detection of diverse biomarkers. However, these methods often require complicated operations, such as careful solution transfer steps, to achieve high sensitivity and accuracy. In this study, we combine a filter membrane-based POCT method with CRISPR-Cas12a for colorimetric detection of biomarkers. For the nucleic acid target, the trans-cleavage activity of CRISPR-Cas12a is directly triggered, cutting the single-stranded DNA linkers on glucose oxidase (GOx)-modified polymer nanoparticles. Due to the size difference between GOx and the polymer nanoparticles, GOx can be separated using a filter membrane. The filtrate containing GOx reacts with the substrate to generate a colorimetric signal. For the non-nucleic acid target, the non-nucleic acid signal is converted into a nucleic acid signal that activates CRISPR-Cas12a, resulting in a colorimetric signal. The entire operation is easy to perform, and the signal can be directly observed via the naked eye, which circumvents the use of costly instruments. The developed strategy holds great promise for accurate and accessible POCT detection of disease biomarkers in resource-limited settings.

Association of semaglutide treatment with coronary artery inflammation in type 2 diabetes mellitus patients: a retrospective study based on pericoronary adipose tissue attenuation.

BACKGROUND: The pericoronary fat attenuation index (FAI) has emerged as a novel and sensitive biomarker reflecting the degree of coronary artery inflammation. Semaglutide has been demonstrated to exert a cardiovascular protective effect independent of hypoglycemia; however, its impact on coronary artery inflammation remains elusive. This study aimed to investigate the association between semaglutide treatment and coronary artery inflammation based on FAI in patients with type 2 diabetes mellitus (T2DM). METHODS: This study enrolled 497 T2DM patients who underwent coronary computed tomography angiography (CCTA) at Hebei General Hospital, of whom 93 treated with semaglutide (Sema+) and 404 did not (Sema-). Clinical data, laboratory indicators, and CCTA parameters were collected and compared between the two groups at baseline. Propensity score matching (PSM) was used to adjust for confounders, and pericoronary FAI was compared. Multivariate linear regression models were used to analyze the association between semaglutide treatment and pericoronary FAI. RESULTS: Before PSM, pericoronary FAI of the LAD and LCX was lower in patients treated with semaglutide than those without semaglutide treatment. The results of the PSM analysis revealed a lower FAI in all three major coronary arteries in the Sema + group compared to the Sema- group. Multivariate linear regression analyses revealed an independent association between semaglutide treatment and reduced FAI in all three major coronary arteries. This association varied across T2DM patients of differing profiles. CONCLUSION: Semaglutide treatment may be associated with lower coronary artery inflammation in patients with T2DM, which might partially explain its cardiovascular protective mechanism.

CRISPR-Cas12a-based ultrasensitive assay for visual detection of SARS-CoV-2 RNA.

The development of ultrasensitive and visual methods is of great significance for molecular diagnosis at the point-of-care. In this study, we have integrated recombinase polymerase amplification (RPA) with the CRISPR-Cas12a system to design an ultrasensitive strategy for visual nucleic acid testing. RPA is utilized to amplify the target nucleic acid, producing amplicons that activate the single-stranded DNase property of CRISPR-Cas12a. The activated CRISPR-Cas12a then degrades the single-stranded DNA on magnetic nanoparticles (MNPs), releasing immobilized GOx from the MNPs which catalyses the chromogenic substrate. The developed method exhibits remarkable sensitivity, successfully detecting as low as 10 aM (∼6 copies per µL) of the target nucleic acid by visual colour changes in solution. The instrumental limit of detection is calculated to be 2.86 aM (∼2 copies per µL), comparable to the sensitivity of polymerase chain reaction (PCR). Importantly, this approach only requires isothermal incubation operation and does not involve costly instruments. The method has been validated by visually detecting the SARS-CoV-2 RNA gene fragment within 50 minutes. With its ultrasensitivity, simplicity of operation, and potential for integration into a point-of-care detection kit, this strategy holds great promise for nucleic acid testing in various settings.

Ultrafast Nucleation Reverses Dissolution of Transition Metal Ions for Robust Aqueous Batteries.

The dissolution of transition metal ions causes the notorious peeling of active substances and attenuates electrochemical capacity. Frustrated by the ceaseless task of pushing a boulder up a mountain, Sisyphus of the Greek myth yearned for a treasure to be unearthed that could bolster his efforts. Inspirationally, by using ferricyanide ions (Fe(CN)63-) in an electrolyte as a driving force and taking advantage of the fast nucleation rate of copper hexacyanoferrate (CuHCF), we successfully reversed the dissolution of Fe and Cu ions that typically occurs during cycling. The capacity retention increased from 5.7% to 99.4% at 0.5 A g-1 after 10,000 cycles, and extreme stability of 99.8% at 1 A g-1 after 40,000 cycles was achieved. Fe(CN)63- enables atom-by-atom substitution during the electrochemical process, enhancing conductivity and reducing volume change. Moreover, we demonstrate that this approach is applicable to various aqueous batteries (i.e., NH4+, Li+, Na+, K+, Mg2+, Ca2+, and Al3+).

Ostwald-Ripening Induced Interfacial Protection Layer Boosts 1,000,000-Cycled Hydronium-Ion Battery.

Collapsing and degradation of active materials caused by the electrode/electrolyte interface instability in aqueous batteries are one of the main obstacles that mitigate the capacity. Herein by reversing the notorious side reactions include the loss and dissolution of electrode materials, as we applied Ostwald ripening (OR) in the electrochemical cycling of a copper hexacyanoferrate electrode in a hydronium-ion batteries, the dissolved Cu and Fe ions undergo a crystallization process that creates a stable interface layer of cross-linked cubes on the electrode surface. The layer exposed the low-index crystal planes (100) and (110) through OR-induced electrode particle growth, supplemented by vacancy-ordered (100) superlattices that facilitated ion migration. Our design stabilized the electrode-electrolyte interface considerably, achieving a cycle life of one million cycles with capacity retention of 91.6 %, and a capacity retention of 91.7 % after 3000 cycles for a full battery.

Oxygen Vacancies Boosted Hydronium Intercalation: A Paradigm Shift in Aluminum-Based Batteries.

In aqueous aluminum-ion batteries (AAIBs), the insertion/extraction chemistry of Al3+ often leads to poor kinetics, whereas the rapid diffusion kinetics of hydronium ions (H3O+) may offer the solution. However, the presence of considerable Al3+ in the electrolyte hinders the insertion reaction of H3O+. Herein, we report how oxygen-deficient α-MoO3 nanosheets unlock selective H3O+ insertion in a mild aluminum-ion electrolyte. The abundant oxygen defects impede the insertion of Al3+ due to excessively strong adsorption, while allowing H3O+ to be inserted/diffused through the Grotthuss proton conduction mechanism. This research advances our understanding of the mechanism behind selective H3O+ insertion in mild electrolytes.

Association between Malnutrition and Coronary Plaque Characteristics in Patients with Acute Coronary Syndrome: An Optical Coherence Tomography Study.

Background: Malnutrition has a negative impact on patients with arteriosclerotic cardiovascular disease (ASCVD); however, only a few studies have confirmed the effect of malnutrition on atherosclerosis. We aimed to investigate the association between malnutrition and vulnerable plaques via optical coherence tomography (OCT). Methods: Overall, 142 acute coronary syndrome (ACS) patients were included in this study. Malnutrition was assessed using the Controlled Nutritional Status Score (CONUT), and plaque vulnerability was measured using OCT. Finally, patients were divided into four groups according to their CONUT scores and body mass index (BMI) ≥ 25.0 or not, to further compare the effects of both factors on plaque characteristics in patients. Results: OCT results showed that there were significant differences in plaque rupture, thin cap fibroatheroma (TCFA), minimal fiber cap thickness (FCT), thrombus, and macrophage infiltration between different nutritional states [Absent (0-1) vs Mild (2-4) vs Moderate (5-8), plaque rupture: 34.8% vs 52.5% vs 66.7%, p = 0.038; TCFA: 10.1% vs 24.6% vs 33.3%, p = 0.039; minimal FCT: 125.0 vs 110.4 vs 96.9, p = 0.022; thrombus: 50.7% vs 70.5% vs 83.3%, p = 0.019]. Multivariate logistic regression showed that malnutrition was a significant predictor of plaque vulnerability. Plaque rupture: CONUT score (odds ratio [OR]: 1.448, 95% confidence interval [CI]: 1.136-1.845, p = 0.003), Mild (OR: 1.981, 95% CI: 0.932-4.210, p = 0.075), and Moderate (OR: 4.375, 95% CI: 1.048-18.255, p = 0.043); TCFA: CONUT score (OR: 1.334, 95% CI: 1.029-1.730, p = 0.030), Mild (OR: 3.518, 95% CI: 1.251-9.897, p = 0.017), and Moderate (OR: 4.863, 95% CI: 1.019-23.208, p = 0.047); and macrophage: CONUT score (OR: 1.343, 95% CI: 1.060-1.700, p = 0.015), Mild (OR: 3.016, 95% CI: 1.305-6.974, p = 0.010), and Moderate (OR: 4.637, 95% CI: 1.159-18.552, p = 0.030). Combined CONUT score and BMI showed an independent association with macrophages in the malnourished and overweight group (OR: 4.010, 95% CI: 1.188-13.537, p = 0.025). Conclusions: Malnutrition is a predictor of vulnerable plaques and is associated with inflammatory progression.

A Nomogram with the Keloid Activity Assessment Scale for Predicting the Recurrence of Chest Keloid after Surgery and Radiotherapy.

BACKGROUND: Patients with chest keloids undergoing surgery and adjuvant radiotherapy still have a high recurrence rate, which is a critical problem. The level of keloid activity has not been studied, and a nomogram model for predicting keloid recurrence has not been established in previous studies. METHODS: A total of 145 patients with chest keloids who underwent surgery and radiotherapy between January 2015 and January 2019 at Peking Union Medical College Hospital were included in our study. Demographic and clinical features and the score of KAAS were analyzed. We compared the area under the curve (AUC) and decision curve analysis (DCA) between KAAS and the Vancouver scar scale (VSS) and established a nomogram model for predicting the risk of recurrence. We used bootstrap and calibration plots to evaluate the performance of the nomogram. RESULTS: The KAAS can predict recurrence in patients with chest keloids after surgery and radiotherapy. Areas under the curve (AUCs) of KAAS and VSS were 0.858 and 0.711, respectively (p < 0.001). Decision curve analysis (DCA) demonstrated that the KAAS was better than the VSS. Complications after treatment may be risk factors for keloid recurrence. We created a nomogram by using complications and KAAS. The AUC was 0.871 (95% CI 0.812-0.930). The ROC of the model's bootstrap was 0.865 and was well calibrated. CONCLUSIONS: The KAAS can be used to predict the recurrence and we developed a nomogram for predicting the recurrence of chest keloids after surgery and adjuvant radiotherapy. 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 .

Glutamate-aspartate transporter 1 attenuates oxygen-glucose deprivation-induced injury by promoting glutamate metabolism in primary cortical neurons.

Ischemic stroke is a common cerebral disease. However, the treatment for the disease is limited. Daurian ground squirrel (GS; Spermophilus dauricus), a hibernating mammalian species, is highly tolerant to ischemia. In the present study, GS neurons in a non-hibernating state were found to be more resistant to oxygen-glucose deprivation (OGD), an ischemic model in vitro. We leveraged the differences in the endurance capacity of GS and rats to investigate the mechanisms of resistance to ischemia in GS neurons. We first identified glutamate-aspartate transporter 1 (GLAST) as a cytoprotective factor that contributed to tolerance against OGD injury of GS neurons. The expression of GLAST in GS neurons was much higher than that in rat neurons. Overexpression of GLAST rescued viability in rat neurons, and GS neurons exhibited decreased viability following GLAST knockdown under OGD conditions. Mechanistically, more glutamate was transported into neurons after GLAST overexpression and served as substrates for ATP production. Furthermore, eukaryotic transcription initiation factor 4E binding protein 1 was downregulated by GLAST to rescue neuronal viability. Our findings not only revealed an important molecular mechanism underlying the survival of hibernating mammals but also suggested that neuronal GLAST may be a potential target for ischemic stroke therapy.

Histology and Vascular Architecture Study of Keloid Tissue to Outline the Possible Terminology of Keloid Skin Flaps.

BACKGROUND: Using the keloid "epidermis" to cover a wound is widely used during treatment for keloids. Many flap terminologies have been used in literature. However, the definition of the flap is not well established. Here, we refined the definition of the flap and associated terminology and explored the survival mechanism of the 'flap' through histological analysis and blood supply studying. METHODS: Histology and vascular study of keloid was carried out with keloid and its surrounding normal skin tissue which were collected from keloid patients following keloid resection operations. The histological structures and thicknesses of epidermal and subepidermal of the keloids were analyzed and measured using hematoxylin & eosin (H&E) staining. Vascular density and blood perfusion in the subepidermal layer of keloids (KDS) were analyzed using CD31 immunohistochemical staining and a laser speckle contrast imaging system (LSCI), respectively. The vascular network in KDS was visualized by CD31 immunofluorescence staining and three-dimensional reconstruction. RESULTS: 29 pieces of keloid and its surrounding normal skin tissue sample from ten patients were collected. Keloid samples were about 2 cm wide and 5 cm long. The normal skin samples were about 2 to 3 mm in width. The thickness of epidermal layer of keloids was (136.4 ± 35.3) µm, and the thickness of epidermal layer of surrounding normal skin was (78.8 ± 13.9) µm. There was statistical thickness difference between the two layers, t(20) = 7.469, P < 0.001. The total thickness of keloid epidermal and subepidermal layers was 391.4 ± 2.3 µm. The vascular density (13.9 ± 3.4/field) and blood flow perfusion (132.7 ± 31.3) PU in KDS were greater than that of surrounding normal skin (7.8 ± 2.3/field, 73.9 ± 17.9 PU), P < 0.001. Horizontally distributed vessels with several vertical branches were observed in 3D vascular network reconstruction. CONCLUSION: The epidermal layer of keloid is thicker than that of surrounding normal skin. There is a vascular network structure under it. The vessels mainly locate at a depth of about 150 to 400 µm from the surface of keloid epidermis, randomly distribute and run parallel to the epidermis. Based on these characteristics which may ensure an adequate blood supply, we propose the concept of a "keloid subepidermal vascular network flap." 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 .

Clinical Observation of Subepidermal Vascular Network Flaps in Keloid Patients.

BACKGROUND: There are many different keloid treatment modalities. One surgical technique is to keep the "shell" of the keloid to cover the defect. We named this "shell" keloid subepidermal vascular network flap (KSVNF), and we outlined the characteristics of this flap by observing 35 flaps in keloid patients. METHODS: A total of 35 KSVNFs were designed in 15 patients during 2020-2021. All patients underwent the operation and adjuvant radiotherapy as well as hyperbaric oxygen therapy. All flap lengths and widths were recorded, and the blood perfusion of the flaps was measured on the first day postoperation and the day of stitch removal. Flap survival and the quality of flaps were evaluated on the day of stitch removal. All harvested data were analyzed using the R (version 4.0.1) package. RESULTS: The mean blood perfusion on the first day postoperation (pod1) and the day of stitch removal was 120.4013 and 168.6900, respectively (p = 0.02249); 2 flaps had partial necrosis (5.714%). Receiver operating characteristic (ROC) curve analysis showed that when the length/width ratio was less than 1.05, the quality of the flap was good (AUC = 0.724), which suggests that the effective safe length/width ratio was 1.05. CONCLUSION: KSVNF is an applicable method for covering the remaining wound after keloid mass removal with sufficient blood perfusion and adequate skin quality. We recommend that the length/width ratio of the flap design not exceed 1. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

The Role of CD28 and CD8+ T Cells in Keloid Development.

Background: A keloid is a benign skin tumor that extends beyond the initial injury area, and its pathologic mechanism remains unclear. Method: High-throughput sequencing data were obtained from normal skin tissue of patients with keloids (Group N) and healthy controls (Group C). Important genes were mined by bioinformatics analysis and identified by RT−qPCR, Western blotting, immunohistochemistry and immunofluorescence assays. The CIBERSORT algorithm was used to convert gene expression information into immune cell information. Flow cytometry was used to verify the key immune cells. Fluorescence-activated cell sorting coculture and CCK8 experiments were used to explore the effect of CD8+ T cells on keloid-associated fibroblasts. Neural network models were used to construct associations among CD28, CD8+ T cells and the severity of keloids and to identify high-risk values. Result: The expression levels of costimulatory molecules (CD28, CD80, CD86 and CD40L) in the skin tissue of patients with keloids were higher than the levels in healthy people (p < 0.05). The number of CD8+ T cells was significantly higher in Group N than in Group C (p < 0.05). The fluorescence intensities of CD28 and CD8+ T cells in Group N were significantly higher than those in Group C (p = 0.0051). The number and viability of fibroblasts cocultured with CD8+ T cells were significantly reduced compared with those of the control (p < 0.05). The expression of CD28 and CD8+ T cells as the input layer may be predictors of the severity of keloids with mVSS as the output layer. The high-risk early warning indicator for CD28 is 10−34, and the high-risk predictive indicator for CD8+ T cells is 13−28. Conclusions: The abnormal expression of costimulatory molecules may lead to the abnormal activation of CD8+ T cells. CD8+ T cells may drive keloid-associated immunosuppression. The expression of CD28 and CD8+ T cells as an input layer may be a predictor of keloid severity. CD28 and CD8+ T cells play an important role in the development of keloids.

Effectively removing tetracycline from water by nanoarchitectured carbons derived from CO2: Structure and surface chemistry influence.

Understanding of the correlation between physico-chemical property of adsorbent and the adsorption performance of contaminant is very significant for developing high-efficient materials to remove antibiotic contamination from water. In this work, a novel kind of carbon adsorbent (EC) derived from CO2 and activated ECs with modified structure via a facile chemical method using H2 and KOH were prepared. The synthetic carbon materials (EC, EC-H2, and EC-KOH) were then applied to remove tetracycline (TC). The kinetics of adsorption for these three carbon materials all well fitted the pseudo-second-order kinetic model. The experimental data of adsorption isotherm had good compatibility with Langmuir and Freundlich models (R2 > 0.90), but the Temkin model was the most applicable for all adsorbents (R2 > 0.98). A super-high adsorption capacity of EC-KOH obtained from Langmuir fitting was 933.56 mg g-1, which was much higher than that of EC-H2 (538.91 mg g-1) and EC (423.30 mg g-1), possibly due to its larger specific surface area (SBET), pore volume, and specific surface chemical structure. Moreover, it was found that surface functional groups and large aperture of adsorbents had a positive effect on adsorption rate. More adsorption sites and surface functional groups of adsorbents were beneficial to enhance the adsorption affinity. These results are of great benefit to the directional control of carbon structure to increase the adsorption performance in rate, capacity, and affinity of antibiotics.

Large chest keloids treatment with expanded parasternal intercostal perforator flap.

BACKGROUND: Chest keloids often converged into a large lesion on the chest in some patients. Such keloids often lead to obstacle to excision and reconstruction. We describe a surgical method for large chest keloids with expanded parasternal intercostal perforator flap (EPIPF). METHODS: Fifteen patients with chest keloid were treated with EPIPF in our department between August 2017 and Dec 2019. The surgical treatment was divided into two different phases. In the first phase, we implanted skin expanders into the layer under the deep fascia beside the keloids. The expander was expanded every week for about 3-4 months. In the second phase, the expander was removed, the keloid tissue was removed and an expanded perforator flap was then designed to cover the wound. Patients were followed-up after surgery. Complications after surgery were analyzed. Recurrence and the patients, satisfactory rate was recorded. RESULTS: Of the 15 patients, one patient complicated with undesirable small area wound healing. 11 were cured without scar hypertrophy or recurrence and four were partially cured with a small portion of scar hypertrophy. Eleven patients thought that the esthetic result was good (73.7%), and 4 patients thought the result was acceptable (26.7%). None patient was dissatisfied. CONCLUSION: EPIPF are effective surgical method for managing large chest keloids. It can offer enough skin flap coverage for keloid wound resurfacing with stable blood supply to assure satisfactory results. LEVEL OF EVIDENCE: Level IV, case series.

Comparative and phylogenetic analyses of Swertia L. (Gentianaceae) medicinal plants (from Qinghai, China) based on complete chloroplast genomes.

Swertia L. is a large genus in Swertiinae (Gentianaceae). In China, many Swertia species are used as traditional Tibetan medicines, known as "Zangyinchen" or "Dida". However, the phylogenetic relationships among Swertia medicinal plants and their wild relatives have remained unclear. In this study, we sequenced and assembled 16 complete chloroplast (cp) genomes of 10 Swertia species, mainly distributed in Qinghai Province, China. The results showed that these species have typical structures and characteristics of plant cp genomes. The sizes of Swertia cp genomes are ranging from 149,488 bp to 154,097 bp. Most Swertia cp genomes presented 134 genes, including 85 protein coding genes, eight rRNA genes, 37 tRNA genes, and four pseudogenes. Furthermore, the GC contents and boundaries of cp genomes are similar among Swertia species. The phylogenetic analyses indicated that Swertia is a complex polyphyletic group. In addition, positive selection was found in psaI and petL genes, indicating the possible adaptation of Qinghai Swertia species to the light environment of the Qinghai-Tibet plateau. These new cp genome data could be further investigated to develop DNA barcodes for Swertia medicinal plants and for additional systematic studies of Swertia and Swertiinae species.

lncRNA-H19/miR-29a axis affected the viability and apoptosis of keloid fibroblasts through acting upon COL1A1 signaling.

This study was intended to clarify the potential of applying the long-chain noncoding RNA H19/miR-29a axis in keloid treatment by elucidating its correlation with the activity of fibroblasts. In this study, 80 keloid tissues, 63 normal fibrous tissues, and 91 normal skin tissues were collected in advance, and concurrently, fibroblasts separated from the tissues were cultured. Besides this, the si-H19, pcDNA3.1-H19, miR-29a mimic, and miR-29a inhibitor were transfected to keloid fibroblasts, whose proliferation, apoptosis, and metastasis were appraised by employing the colony formation assay, flow cytometry, and transwell assay. In addition, the luciferase reporter gene assay was carried out to determine whether targeted regulation was present between H19 and miR-29a, as well as between miR-29a and COL1A1. The study results demonstrated that keloid tissues and fibroblasts exhibited observably upregulated H19 expression and downregulated miR-29a expression, relative to normal skin tissues and fibroblasts (P < .05). Also observed was a negative correlation between H19 expression and miR-29a expression among the gathered keloid tissues (rs = -.267, P = .017). Furthermore, in vitro transfection of pcDNA3.1-H19 or miR-29a inhibitor could intensify viability, proliferation, migration, and invasion of the fibroblasts (P < .05), while silencing of H19 and overexpression of miR-29a hindered both metastasis and multiplication of the fibroblasts significantly (P < .05). In addition, H19 was capable of altering miR-29a expression within fibroblasts by directly sponging it, and overexpression of COL1A1 could deter the impact of miR-29a on viability, proliferation, migration, and invasion of fibroblasts (P < .05). In conclusion, H19 might facilitate proliferation and metastasis of fibroblasts by modifying downstream miR-29a and COL1A1, which was expected to allow for development of keloid-targeted treatments.

Keloid Skin Flap Retention and Resurfacing in Facial Keloid Treatment.

OBJECTIVE: Facial keloids commonly occur in young patients. Multiple keloid masses often converge into a large lesion on the face, representing a significant obstacle to keloid mass excision and reconstruction. We describe a new surgical method that excises the keloid mass and resurfaces the wound by saving the keloid skin as a skin flap during facial keloid treatment. METHODS: Forty-five patients with facial keloids were treated in our department between January 2013 and January 2016. Multiple incisions were made along the facial esthetic line on the keloid mass. The keloid skin was dissected and elevated as a skin flap with one or two pedicles. The scar tissue in the keloid was then removed through the incision. The wound was covered with the preserved keloid skin flap and closed without tension. Radiotherapy and hyperbaric oxygen were applied after surgery. Patients underwent follow-up examinations 6 and 12 months after surgery. RESULTS: Of the 45 total patients, 32 patients were cured and seven patients were partially cured. The efficacy rate was 88.9%, and 38 patients (84.4%) were satisfied with the esthetic result. CONCLUSION: We describe an efficacious and esthetically satisfactory surgical method for managing facial keloids by preserving the keloid skin as a skin flap. 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 .

The "Sandwich Therapy": A Microsurgical Integrated Approach for Presternal Keloid Treatment.

BACKGROUND: Keloid therapy remains a great challenge for plastic surgeons, especially when the defect cannot be closed primarily, necessitating tissue transplantation. Here, we introduce a new treatment modality, called the sandwich therapy, for presternal keloids; the sandwich therapy incorporates preradiotherapy, superficial circumflex iliac artery perforator (SCIP) flap transplantation, and postradiotherapy. METHODS: From December 2012 to October 2013, 12 patients received the "sandwich therapy." For the protocol, all patients went through 5 days of specific events: the precut procedure, preradiotherapy, resection and SCIP flap transplantation, donor site radiotherapy, and final presternal radiotherapy. RESULTS: All the flaps survived completely. No complication was observed during the perioperative period. With a mean follow-up of 12 months, only 1 case was reported with an incisional hypertrophic scar. In all patients, the main discomfort complaints were resolved postoperatively. CONCLUSIONS: A low-tension or without-tension closure could be achieved with SCIP flap transplantation. The perioperative radiotherapy could further lower the risk of keloid recurrence. The sandwich therapy provides a new surgical approach to presternal keloid treatment.