Comparative Study of Three-Dimensional Volume Measurement for Facial Fat Grafting.

ABSTRACT: The three-dimensional (3D) volume measurement after facial fat grafting is of great significance to plastic surgeons. It has been ascertained that reliable results rely on the accurate measurement of 3D softwares. Some 3D softwares in literatures have proposed various ways to optimize each step of the procedure, including the pre- and post-operative image acquisition, alignment, calculation, and analysis. Good image alignment between pre- and post-scan is essential to quantify the volumetric change. Once the pre- and post-operative image alignment has slightly bias or deviation, the subsequent volume measurement would also be affected. To our knowledge, 2 types of 3D software have been widely applied in clinic, primarily based on the image-automatically alignment and image-manually alignment. This study aimed to compare the accuracy, repeatability, and reproducibility of the Geomagic Qualify 12.0 software and the 3-Matic 7.0 software in a relatively ideal model of virtual facial fat grafting. A simulated facial fat grafting was first performed for 10 preoperative patients diagnosed with progressive hemifacial atrophy, and the known volumetric change was named as the true value (T value). Then, the facial volumetric change of every case was remeasured 10 times with above 2 kinds of software separately. The mean volumetric change was calculated as Q value and M value. The paired t test, intraclass correlation coefficient, and Bland-Altman analysis showed that the Geomagic Qualify 12.0 software demonstrated a statistically higher accuracy, repeatability, and reproducibility in comparison with the 3-Matic 7.0 software.

Autologous Fat Grafting With Combined Three-Dimensional and Mirror-Image Analyses for Progressive Hemifacial Atrophy.

BACKGROUND: Autologous fat grafting (AFG) has been widely used to treat progressive hemifacial atrophy (PHA). However, objective and quantitative analyses in patients with PHA are complicated because of multidimensional atrophy and fat absorption. This study aimed to introduce a new method to predict volumetric deficiency of soft tissues and objectively evaluate the survival of grafted fat with 3-dimensional (3D) and mirror-image analysis (MIA). METHODS: Thirty-one patients with PHA were classified into 2 groups based on the location of the facial midsagittal plane (FMP), which was established through our proposed method using nasion (point a), anterior nasal spine (point b), and pogonion (point c). The included cases with centered FMP were treated using serial AFG and followed up for 12 to 15 months. Images were obtained preoperatively (pre-OP) and postoperatively at 2 time points (3 months and 12 months). Three-dimensional computed tomography (CT) was performed before the first surgery to locate the FMP and predict the volumetric deficiency of soft tissues with MIA. Three months after the first surgery, 3D laser scanning was conducted to evaluate the volume of surviving fat. Patient characteristics, satisfaction, and soft tissue augmentation results were analyzed. RESULTS: Twenty-seven cases (9 men and 18 women) with PHA were included and treated using serial AFG (mean number of operation, 3.1 times). The mean age was 22.1 years. With 3D CT or 3D laser-scanning camera and MIA, we obtained the mean deficient volume of the affected area (30.48 mm) and the mean volume of the total fat injection (133.61 mm). The mean fat absorption ratio was 47.92%. The mean satisfaction score immediately obtained at first postoperative (score = 4.3) was higher than that at 3 months postoperatively (score = 4.1) and 12 months postoperatively (score = 4.0). No complications and donor-site morbidity were noted. CONCLUSION: The facial symmetry of patients with centered FMP can be successfully restored using serial AFG alone. The combined 3D and MIA can be used to predict the volumetric deficiency of soft tissues and objectively evaluate the survival of grafted fat.

Adverse Events of Botulinum Toxin Type A in Facial Rejuvenation: A Systematic Review and Meta-Analysis.

BACKGROUND: Botulinum toxin A (BTX-A) is a medical product that is used widely in cosmetics, and concern over the safety profile has increased among injectors and patients. OBJECTIVE: The purpose was to enhance the statistical effect size using a meta-analysis to detect the incidence rate of adverse events (AEs) in the treatment of facial wrinkles. METHODS: A systematic search was performed for randomized, double-blind, placebo-controlled trials published through July 2015. RESULTS: We searched 16 trials, including 42,405 individual participants, and found that in all enrolled facial rejuvenation studies, patients in the BTX-A group had significantly more AEs than those patients in the placebo group (RR = 1.24; 95 % CI 1.07-1.43; p = 0.003). For crow's feet lines injection analysis, the BTX-A group did not exhibit any significant increase in AEs compared with the control group (RR = 1.19; 95 % CI 0.96-1.48; p = 0.12), except in injection site hematoma (RR = 2.14; 95 % CI 1.13-4.07; p = 0.02) in the treatment group. For frown wrinkle injection analysis, AEs were significantly observed in the BTX-A group (RR = 1.47; 95 % CI 1.23-1.77; p < 0.0001), particularly headaches (RR = 1.53; 95 % CI 1.15-2.03; p = 0.003), eyelid ptosis (RR = 5.56; 95 % CI 1.68-18.38; p = 0.005), and heavy eyelids (RR = 6.94; 95 % CI 1.27-37.93; p = 0.03). CONCLUSION: This meta-analysis confirmed the safety profile of BTX-A for glabellar and crow's feet lines, and BTX-A usage for the removal of upper facial wrinkles, which have some significant mild-to-moderate adverse profiles, including headache, eye disorder, eyelid ptosis, and heavy eyelids. Facial injectors should abide by the technical standards of neurotoxic drugs and be familiar with the local pharmacological effects to lessen the severe side effects. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the A5 online Instructions to Authors www.springer.com/00266 .

Migration choices of China's older adults and spatial patterns emerging therefrom (1995-2015).

The steady increase in China's ageing population and an upswing in migration among the country's population, on the whole, has caused a continuous expansion of the scale of older migrants. The migration of older adults not only directly affects the well-being of individual families but also significantly impacts the population structure and economic development of the places of origin and destination. Despite this, in China, the various relevant aspects concerning this age group and, in particular, its migration choices and the patterns thereof have only rarely been the subject of sound research. The study presented in this paper seeks to fill this gap; the present study makes use of the microdata obtained from the national population censuses of 2000 and 2010 and the 1% population sample surveys conducted nationally in 2005 and 2015. The findings of the present study were the following: ① During 1995-2015, the efficiency of older adults' migration was significantly higher in the eastern region than in the central and western regions. ② Older individuals migrating to urban areas are increasingly choosing, for their relocation, economically developed, urban areas such as the Yangtze River Delta, Pearl River Delta and Beijing-Tianjin-Hebei region. ③ Relocation of older adults to urban areas was much more than to rural areas. The latter group has a more diverse choice of destination, and the larger migration flow is primarily from developed provinces to relatively underdeveloped provinces. ④ The results of binary logit regression indicated that the factors that significantly and consistently influence the migration decisions of older adults were found to be the following: age, education level, health status, the primary financial resource, children aged ≤ 6 years being members of the household that would receive the migrants, and the average wage of employees. As for the geographical characteristics of the province to which the older adults migrate, a substantial difference was observed between the preferences of older adults migrating to urban regions and those of older adults relocating to rural areas. The findings of the present study provide further insight into the decision-making of older adults regarding migration. Further, these findings constitute an empirical basis for the local governments concerned to devise and implement policies to better cope with an ageing population.

Physiological and biochemical differences in diapause and non-diapause pupae of Sericinus montelus (Lepidoptera: Papilionidae).

The swallowtail butterfly, Sericinus montelus Gray, is endemic to East Asia, has high ornamental value but faces an increased risk of extinction. To understand the overwintering strategies of this species, the dynamic changes in supercooling point (SCP) and water and biochemical contents of diapause-destined and non-diapause S. montelus pupae were investigated. The SCP of laboratory-reared diapause pupae was as low as -26°C compared to -24°C in diapause pupae in the field. Although there was no significant difference in total water content between diapause-destined and non-diapause pupae, the free water of diapause-destined pupae was significantly lower, and the bound water was significantly higher, than that of non-diapause pupae. Lipid, glycogen, and protein contents of diapause-destined pupae showed a downward trend, whereas the total sugar content showed the opposite trend after pupation. The glycogen content decreased rapidly during the initial stage of pupation, whereas the lipid content decreased significantly after 30 days of pupation, suggesting that diapause-destined pupae deplete glycogen stores during the pre-diapause period and then switch to using lipids during the diapause maintenance phase. Trehalose levels in diapause-destined pupae increased significantly and remained high after pupation. Meanwhile, the trehalose content of overwintering pupae during the diapause maintenance period was significantly higher than that of diapause termination pupae in the field. These results suggest that trehalose is the main cryoprotectant for overwintering pupae. Thus, diapausing S. montelus pupae appear to be freeze avoidant, accumulate trehalose as a cryoprotectant, and reduce the free water content to decrease the SCP, enhancing their cold tolerance.

Organic matter and ammonia removal by a novel integrated process of constructed wetland and microbial fuel cells.

A novel approach, combining a microbial fuel cell (MFC) with an integrated vertical flow constructed wetland (IVCW), was developed, and its ability to simultaneously produce electrical energy while treating swine wastewater was verified. The system combined the singular water flow path of a traditional vertical flow constructed wetland (upflow and downflow)-microbial fuel cell (CW-MFC), which demonstrates better characteristics in the aerobic, anoxic, and anaerobic regions. It not only enhanced the anti-pollution load ability and the organic compound removal effect, but also improved the gradient difference in the redox potential of the system. The results showed that the structure and substrate distribution in the device could both improve swine wastewater treatment and increase bioelectricity generation capabilities. The average chemical oxygen demand (COD) and ammonia nitrogen (NH4 +-N) removal efficiencies were as high as 79.65% and 77.5%, respectively. Long-term and stable bioelectricity generation was achieved under continuous flow conditions. The peak values of the output voltage and power density were 713 mV and 456 mW m-3. The activated carbon layer at the bottom of this system provided a larger surface for the growth of microbes. It showed significant promotion of the relative abundance of electrochemically active bacteria, which might result in the increase of bioelectricity generation in integrated vertical flow constructed wetland-microbial fuel cells (IVCW-MFCs). The electrochemically active bacteria, Geobacter and Desulfuromonas, were detected in the anodic biofilm by high-throughput sequencing analysis.

Correction: Urban networks among Chinese cities along "the Belt and Road": A case of web search activity in cyberspace.

[This corrects the article DOI: 10.1371/journal.pone.0188868.].

Three-dimensional Volumetric Analysis of 3 Fat-Processing Techniques for Facial Fat Grafting: A Randomized Clinical Trial.

IMPORTANCE: Autologous fat grafting has revolutionized the field of facial soft-tissue augmentation, despite a lack of standardization. Objective data are needed to arrive at consensus regarding the best technique for optimal volume retention. OBJECTIVE: To compare 3 fat-processing techniques with 3-dimensional (3-D) technology to explore the optimal fat-processing technique for improving the volume retention of grafted fat. DESIGN, SETTING, AND PARTICIPANTS: From September 2015 to December 2016, patients with facial asymmetry were treated by initial facial fat grafting at the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Sixty-three patients (21 per group) were randomized to 1 of 3 fat-processing techniques: sedimentation, centrifugation, and cotton pad filtration. Patients underwent 3-D scanning preoperatively and at 1, 3, 6, and 12 months postoperatively. Patients who did not complete preoperative or postoperative follow-up and 3-D imaging were excluded from the analysis. INTERVENTION: Autologous fat grafting to correct facial asymmetry. MAIN OUTCOMES AND MEASURES: The percentage volume maintenance of each fat-processing technique was measured with 3-D software and analyzed with variance analysis. RESULTS: Of the 63 randomized patients, 30 (7 men, 23 women; mean [SD] age at surgery, 22.2 [8.0] years) completed follow-up. The mean (SD) percentage volume maintenance of the 3 groups at 1, 3, 6, and 12 months postoperatively was, respectively, 49% (4%), 45% (3%), 43% (3%), and 41% (3%) for the cotton pad filtration group; 41% (3%), 38% (4%), 36% (4%), and 34% (3%) for the centrifugation group; and 37% (4%), 34% (4%), 31% (3%), and 31% (3%) for sedimentation group. The variance analysis showed that the cotton pad filtration group demonstrated a statistically significant higher percentage volume maintenance in comparison with the centrifugation and sedimentation groups. CONCLUSIONS AND RELEVANCE: The use of 3-D technology provides an objective and accurate way to evaluate different fat-processing techniques. Autologous fat processed by cotton pad filtration had a significant higher volume retention than did that processed by centrifugation and sedimentation technique. TRIAL REGISTRATION: chictr.org.cn Identifier: ChiCTR-IOR-14005599. LEVEL OF EVIDENCE: 1.

Microtia in a Chinese Specialty Clinic Population: Clinical Heterogeneity and Associated Congenital Anomalies.

BACKGROUND: Microtia is a congenital anomaly of the external ear that can appear in isolation or in association with other congenital anomalies. In this study, the authors identify the prevalence and phenotypes of associated congenital malformations in patients with microtia in a Chinese specialty clinic population. METHODS: Data were collected from 672 patients seen between December of 2014 and February of 2016 in the Department of Auricular Reconstruction at the Plastic Surgery Hospital of Peking Union Medical College. All patients were examined by trained clinicians and classified into one of three grades of microtia. Co-occurring congenital anomalies were detected and recorded. RESULTS: The majority of study participants were male patients (72 percent), and most participants had unilateral microtia (93 percent, 68 percent of whom had right-side microtia). Two hundred ninety-three patients (44 percent) had one or more associated anomalies. The most commonly occurring comorbid malformations were those of the ear, face, and neck (40 percent of all associated malformations); musculoskeletal system (35 percent); and cardiovascular system (11 percent). CONCLUSIONS: These data represent the first detailed and thematic study of microtia and associated congenital anomalies in a Chinese clinical population. Substantial clinical heterogeneity was observed, and the prevalence of comorbid congenital malformations was high. Future studies investigating congenital anomalies associated with microtia are needed to improve understanding of its cause.

Urban networks among Chinese cities along "the Belt and Road": A case of web search activity in cyberspace.

"The Belt and Road" initiative has been expected to facilitate interactions among numerous city centers. This initiative would generate a number of centers, both economic and political, which would facilitate greater interaction. To explore how information flows are merged and the specific opportunities that may be offered, Chinese cities along "the Belt and Road" are selected for a case study. Furthermore, urban networks in cyberspace have been characterized by their infrastructure orientation, which implies that there is a relative dearth of studies focusing on the investigation of urban hierarchies by capturing information flows between Chinese cities along "the Belt and Road". This paper employs Baidu, the main web search engine in China, to examine urban hierarchies. The results show that urban networks become more balanced, shifting from a polycentric to a homogenized pattern. Furthermore, cities in networks tend to have both a hierarchical system and a spatial concentration primarily in regions such as Beijing-Tianjin-Hebei, Yangtze River Delta and the Pearl River Delta region. Urban hierarchy based on web search activity does not follow the existing hierarchical system based on geospatial and economic development in all cases. Moreover, urban networks, under the framework of "the Belt and Road", show several significant corridors and more opportunities for more cities, particularly western cities. Furthermore, factors that may influence web search activity are explored. The results show that web search activity is significantly influenced by the economic gap, geographical proximity and administrative rank of the city.

Evaluation of tracheobronchial branching abnormalities in patients with microtia using chest computed tomography.

BACKGROUND: The objective of this study was to identify the characteristics and incidence of Tracheobronchial branching abnormalities in patients with microtia and to evaluate the risk of anesthesia. METHODS: A total of 204 consecutive microtia patients and 465 nose cosmetic patients without microtia received a preoperative chest computed tomography. A retrospective study was performed with the clinical and imaging data from July 2016 to April 2017. RESULTS: With the chest computed tomography images, a total of 7 cases were documented with Tracheobronchial branching abnormalities, including 6 cases among the microtia patients and 1 case among the cosmetic patients without microtia. The incidence of Tracheobronchial branching abnormalities was higher in microtia patients than the cosmetic patients without microtia (2.94% versus 0.22%, P < 0.01). CONCLUSIONS: The incidence of Tracheobronchial branching abnormalities was high in patients with microtia. Preoperative diagnosis of tracheal bronchus can help anesthesiologists avoid complications. Microtia with Tracheobronchial branching abnormalities may involve a new syndrome previously undiscovered or just another extension with the very wide spectrum of microtia.

A new strategy for total auricular reconstruction using prelamination of an extended retroauricular flap with tissue expansion.

BACKGROUND AND AIM: To accomplish total ear reconstruction with aesthetic appearance is a great challenge for plastic surgeons worldwide due to insufficient skin coverage. A retroauricular fascial flap and skin graft technique are commonly used, but the results obtained are not satisfactory due to color mismatch, severe edema, and donor-site morbidity. Here, we describe a novel strategy for total ear reconstruction, utilizing an extended retroauricular flap prelaminated with tissue expansion to obtain enough skin for ear reconstruction. METHODS: About 2 months before ear reconstruction, a kidney-shaped tissue expander was inserted at the mastoid region subcutaneously. The retroauricular skin became enlarged and thinner in 2 months after expansion. Next, the expander was removed and the retroauricular flap was extended by dissecting the surrounding scalp subcutaneously. By mobilizing the scalp-extended retroauricular flap, we could encapsulate the entire framework with thin and non-hair-bearing skin. RESULTS: From August 2014 to September 2015, 36 microtia patients had undergone ear reconstruction using the novel strategy. Satisfactory aesthetics along with fine structure, symmetry, and maintenance of the auriculocephalic angle was achieved in all patients. CONCLUSIONS: Using our novel strategy, we can obtain satisfactory aesthetic outcomes by fully mobilizing the expanded skin without additional morbidities of the donor sites. Patients are satisfied with the vivid ear contour and lack of groin scar.

Three-dimensional chest computed tomography analysis of thoracic deformities in patients with microtia.

OBJECTIVE: The objective of this study was to identify the incidence and characteristics of congenital thoracic deformities in patients with microtia and to investigate the interaction between microtia and thoracic deformities. METHODS: A total of 239 consecutive patients received a preoperative three-dimensional chest computed tomography (3-D chest CT). A retrospective study was performed with the clinical and imaging data from March 2013 to December 2013. Pearson χ(2) test and Spearman analysis were used to analyze the interaction between microtia and thoracic deformities. RESULTS: With the 3-D chest CT images, a total of 68 cases (28.5%) were documented with thoracic deformities including 60 cases (25.1%) with rib anomalies, 20 cases (8.4%) with spinal deformities, and 12 cases (5.0%) with both rib anomalies and spinal deformities. The incidence of rib anomalies (P = 0.049) and spinal deformities (P = 0.000) varied with grades of microtia. The incidence of rib anomalies was slightly positively correlated with the incidence of spinal deformities in patients with microtia (r = 0.243). CONCLUSIONS: The incidence of congenital thoracic deformities was high in patients with microtia. We observed a higher incidence of thoracic deformities in patients with a more serious grade of microtia. Microtia with thoracic deformities may involve a new syndrome previously undiscovered or just another extension with the very wide spectrum of microtia.

[Effect of vacuum drainage on the blood circulation of expanded flap in ear reconstruction].

OBJECTIVE: To investigate the effect of vacuum drainage on blood circulation of expanded skin flap, so as to confirm suitable negative pressure for ear reconstruction. METHODS: 21 patients (Auricular Reconstructive Center of Plastic Surgery Hospital, PUMC) were randomly divided into A, B, C 3 groups to receive vacuum drainage of: -20, -40 and -60 kPa, respectively. The length and width of reconstructed ears,which represented the swelling degree, were measured instantly and 5, 10 days postoperatively. The changes were calculated and reflected venous drainage of flaps. The temperature of proximal (concha) and distal (helix) part of the expanded flaps, which represented the arterial blood supply of flaps, was detected by infrared thermography after operation. RESULTS: Five days after operation [(1.48 +/- 0.47) mm, (0.36 +/- 0.06) mm] and immediately [(1.67 +/- 0.69) mm, (0.40 +/- 0.16) mm)] , the changes of the length and width of reconstructed ear in group B was significantly low, while there was no statistically difference between group A and C (P > 0.05). The data between 10 days and 5 days after operation showed the same result. Along with the increase of the negative pressure, the swelling degree of reconstructed ears decreased firstly and then increased reversely ( P < 0.01 ). The flap temperature of reconstructed ears increased (P < 0.01), especially in proximal (concha) part (P < 0.01) , when the negative pressure increased (0 to -60 kPa). CONCLUSIONS: Vacuum drainage has effect on both the venous drainage and blood supply. Negative pressure of -40 kPa can improve both the blood supply and venous drainage. It should be as reference for clinical application.

[Correction of cryptotia using crescent flap with skin-grafting].

OBJECTIVE: To investigate the therapeutic effect of crescent flap with skin-grafting for the correction of cryptotia. METHODS: Between the helix and scalp, we designed a crescent flap with the pedicle above the helix. Another affiliated triangular flap was formed below the crescent flap. Skin-grafting was performed after the transposition of two flaps. RESULTS: From Jan. 2008 to Mar. 2013, 16 cases with cryptotia (19 ears) were treated by this method. The ears were re-positioned to normal location with auriculocephalic sulcus. No vascular crisis was happened. The patients were followed-up for 3 months to 2 years with satisfactory result and no recurrence. CONCLUSIONS: This method of crescent flap with skin-grafting is suitable for cryptotia at any grade. It is designed brilliantly with no inconspicuous scar.

Preliminary clinical research with thoracic deformities in microtia / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the characteristics and incidence of the thoracic deformities in patients with microtia.</p><p><b>METHODS</b>In Plastic Surgery Hospital, we conducted a retrospective study of the clinical and radiographical data of 300 patients with microtia from March 2013 to October 2014. Pearson χ2 test was used to analyze the relationship among deformities of ribs and spine, as well as microtia.</p><p><b>RESULTS</b>A total of 78 (26.0%) patients were documented with rib deformities, 26 patients (8.7%) had spinal deformities, and 17 patients (5.7% )had both. The incidence of rib deformities in microtia I, II, and III was 7.1% (2/28), 26.7% (62/232) and 35.0% (14/40) respectively. The incidence of spinal deformities in microtia I, II, and III was 3.6% (1/28), 6.5% (15/232) and 25.0% (10/40 respectively. The patients with microtia III were found to have a higher incidence of ribs and spinal deformities than those with microtia II, patients with microtia II were found to have a higher incidence of ribs and spinal deformities than those with microtia I (P < 0.05).</p><p><b>CONCLUSIONS</b>The incidence of ribs and spinal deformities is high in patients with microtia. The poorer one auricle developed, the higher the incidence of thoracic deformities.</p>