Buccal Fat Pad Augmentation for Midfacial Rejuvenation: Modified Fat Grafting Technique and Ogee Line Remodeling.

BACKGROUND: The volume and position of the buccal fat pad (BFP) change with age, which manifests as a hollow midface. Previous studies showed that autologous fat grafting for BFP augmentation could effectively ameliorate midfacial hollowing. OBJECTIVES: The aim of this study was to introduce a modified fat grafting technique for female patients with midfacial hollowing to restore the volume of BFP, and to evaluate the safety and effectiveness of this approach. METHODS: Two cadavers were used for the dissection of the BFP and to demonstrate the surgical procedures. Forty-eight patients were treated for midfacial hollowing with the modified grafting strategy. The BFP was filled through a percutaneous zygomatic incision and an immediate amelioration in the hollow area was observed. Improvements were evaluated from measurements of the ogee line and ogee angle, FACE-Q questionnaires, and 3-party satisfaction ratings. Clinical profiles were reviewed and statistically analysed. RESULTS: The mean [standard deviation] ogee angle was 6.6° [1.9°] preoperatively and 3.9° [1.4°] postoperatively (average reduction, 2.7°). Patients' ogee lines were smoother postoperatively, with marked improvements in overall appearance, psychological well-being, and social confidence. Patients reported high satisfaction with decision-making and postoperative outcomes and felt 6.61 [2.21] years younger. Overall, 88%, 76%, and 83% of the cases were graded as good or excellent in improvement by surgeon, patient, and the third party, respectively. CONCLUSIONS: For age-dependent midfacial hollowing in female patients, the modified percutaneous grafting technique described here was safe and efficacious in restoring BFP volume. This technique produced a smoother ogee line and a natural, younger midfacial contour.

Aesthetic Improvement of Body Proportion Through Trunk Liposculpture: A Waistline-based Strategy.

BACKGROUND: Abdominal contouring through liposuction has been practiced for decades. However, few studies have focused on describing the definition and enhancement of the waistline in torso contouring procedures. OBJECTIVES: In the present study, the authors proposed a waistline-based strategy for abdominal liposculpture to achieve a better aesthetic outcome and emphasize high overall patient satisfaction. METHODS: The data of patients who underwent the waistline-based liposculpture procedure from 2020 to 2023 were retrospectively reviewed. Aesthetic improvement of the central trunk contour was evaluated and analyzed by comparing preoperative and postoperative photogrammetric measurements. Satisfaction with the outcome was assessed with a patient satisfaction questionnaire. RESULTS: A total of 70 patients were enrolled in this study. During 6 months of postoperative evaluation, the shape of the central trunk contour improved significantly (both waist concavity and hip convexity increased quantitatively, P < .05), while the position of the waist did not differ significantly postoperatively (P > .05). All patients were satisfied with their postoperative outcomes, including their overall aesthetic appearance, waistline position, and waist-to-hip ratio. There were no intraoperative complications or rare postoperative complications. CONCLUSIONS: Waistline-based liposculpture is a simple and effective procedure to improve the aesthetic outcomes of trunk contouring and has highly satisfactory results after long-term follow-up.

Lower Gluteal Liposuction Combined With Upper Gluteal and Infragluteal Region Fat Grafting: A Novel Concept to Improve Gluteal Ptosis.

BACKGROUND: Gluteal ptosis results in a severe disturbance of gluteal aesthetics. Currently, satisfactory procedures for improving gluteal ptosis are lacking. OBJECTIVES: To improve gluteal ptosis, the authors propose a novel concept of combined liposuction of the lower gluteal region and fat grafting to the upper gluteal and infragluteal regions, and verify its efficacy and safety. METHODS: Patients who underwent liposuction of the lower gluteal region combined with fat grafting to the upper gluteal and infragluteal regions between January 2020 and July 2023 were retrospectively reviewed. Postoperative changes in the gluteal ptosis grade, complications, and patient satisfaction were evaluated. RESULTS: A total of 28 patients were enrolled in this study; 21 (75.0%) patients had gluteal ptosis grade 4 and 7 (25.0%) patients had gluteal ptosis grade 5. The median fat removal volume was 210 mL, and the median fat graft injected volume was 355 mL in the gluteal region and 180 mL in the infragluteal region. All patients showed improvement in gluteal ptosis; 16 (57.1%) patients improved by 1 grade and 12 (42.9%) patients showed a 2-grade improvement. All patients were satisfied with their posttreatment outcomes. Only 1 patient showed lateral translocation of the fat graft. No other complications were observed. CONCLUSIONS: Liposuction of the lower gluteal region combined with fat grafting to the upper gluteal and infragluteal regions is effective in improving gluteal ptosis, with a low risk of complications and high patient satisfaction.

Efficacy and safety of platelet-rich plasma in the treatment of venous ulcers: A systematic review and meta-analysis of randomized controlled trials.

Considering the substantial impact of venous ulcers on quality of life and healthcare systems, this study evaluated the efficacy and safety of platelet-rich plasma (PRP) in comparison to conventional therapy. A systematic review of four databases identified 16 randomized clinical trials, including 20 study groups. PRP significantly enhanced complete ulcer healing, exhibiting an odds ratio (OR) of 5.06 (95% confidence interval [CI]: 2.35-10.89), and increased the percentage of healed ulcer area by a mean difference of 47% (95% CI: 32%-62%). Additionally, PRP shortened the time required for complete healing by an average of 3.25 months (95% CI: -4.06 to -2.43). Although pain reduction was similar in both groups, PRP considerably decreased ulcer recurrence rates (OR = 0.16, 95% CI: 0.05-0.50) without increasing the risks of infection or irritative dermatitis. These results suggest PRP as a viable, safe alternative for venous ulcer treatment, providing significant improvements in healing outcomes.

Efficient Atmospheric Water Harvesting of Superhydrophilic Photothermic Nanocapsule.

Drought and water scarcity are two of the world's major problems. Solar-powered sorption-based atmospheric water harvesting technology is a promising solution in this category. The main challenge is to design materials with high water harvesting performance while achieving fast water vapor adsorption/desorption rates. Here, a superhydrophilic photothermic hollow nanocapsule (SPHN) is represented that achieves efficient atmospheric water harvesting in outdoor climates. In SPHN, the hollow mesoporous silica (HMS) is grafted with polypyrrole (PPy) and also loaded with lithium chloride (LiCl). The hollow structure is used to store water while preventing leakage. The hydrophilic spherical nanocapsule and the trapped water produce more free and weakly adsorbed water. Significantly lower the heat of desorption compared to pure LiCl solution. Such SPHN significantly improves the adsorption/desorption kinetics, e.g., absorbs 0.78-2.01 g of water per gram of SPHN at 25 °C, relative humidity (RH) 30-80% within 3 h. In particular, SPHN has excellent photothermal properties to achieve rapid water release under natural sunlight conditions, i.e., 80-90% of water is released in 1 h at 0.7-1.0 kW m-2 solar irradiation, and 50% of water is released even at solar irradiation as low as 0.4 kW m-2 . The water collection capacity can reach 1.2 g g-1 per cycle by using the self-made atmospheric water harvesting (AWH) device. This finding provides a way to design novel materials for efficient water harvesting tasks, e.g., water engineering, freshwater generator, etc.

Comparison of Microfat, Nanofat, and Extracellular Matrix/Stromal Vascular Fraction Gel for Skin Rejuvenation: Basic Animal Research.

BACKGROUND: Although stromal vascular fraction (SVF) cells and adipose-derived stem cells have well-defined antiaging effects on skin, certain disadvantages have limited their clinical application. OBJECTIVES: The aim of this study was to evaluate the effects of microfat, nanofat, and SVF-gel in improving ultraviolet (UV)-induced photoaged skin injury in nude mice. METHODS: After successfully establishing a photoaging model by UVA and UVB irradiation in nude mice, the back of each mouse was divided into 2 regions and randomly injected under the dermis with 0.5 mL of microfat, nanofat, SVF-gel, and phosphate-buffered saline. Inflammatory infiltration, dermis thickness, hydroxyproline content, Type I/Type III collagen ratio, elastic fiber morphology, skin cell proliferation, and adipocyte viability were measured. The overall structure of the skin was also observed by scanning electron microscopy. RESULTS: In the microfat group, the grafts survived well, with intact structure and viable adipocytes and little infiltration of inflammatory cells. Microfat promoted skin cell proliferation, collagen content increased, the ratio of Type I and III collagen reversed, and new oxytalan fibers formed, which to some extent improved the photoaging skin. In the nanofat and SVF-gel groups, a large amount of inflammatory cell infiltration and foam cell deposition in the grafts and dermis led to fibrosis and proliferation of skin tissue. Although the skin thickness and collagen content were also increased, these factors did not improve the photoaging skin. CONCLUSIONS: Microfat survives well, and improves photoaged skin injury in nude mice by promoting skin tissue regeneration and supplementing the capacity of subcutaneous adipose tissue.

Efficacy and Safety of Perioral Mound Region Liposuction-A Novel Concept to Improve Perioral Mound Fullness.

BACKGROUND: Fullness of the perioral mound is considered a dissatisfying aspect of premature aging and has become a common complaint of patients seeking facial rejuvenation. OBJECTIVES: The authors propose a novel concept of improving perioral mound fullness by liposuction and verify its safety and efficacy through cadaver and clinical studies. METHODS: A cadaver study was conducted to discover the soft tissue structure of the perioral mound region and identify a vital use for liposuction. For clinical evaluation, 37 patients with perioral mound fullness who underwent liposuction were retrospectively reviewed. RESULTS: The cadaver study results showed moderate fatty tissue in the subcutaneous layer of the perioral mound region. The liposuction manipulation was limited to the subcutaneous fat layer. Among the 37 patients (including 74 perioral mound regions), the median fat removal volume per perioral mound region was 2.0 (1.2, 2.3) mL. After liposuction, the subcutaneous fat thickness significantly decreased (median 5.0 [3.9, 6.6] mm vs 0.7 [0.4, 1.0] mm per perioral mound region, P < .001). All patients were satisfied with their posttreatment outcomes. Two patients (5.4%) had slight skin hyperpigmentation in the liposuction area after treatment and recovered naturally in 3 months without any intervention. No other complications were noted. CONCLUSIONS: Liposuction is effective in improving perioral mound fullness with a low risk of complications.

Use of LetibotulinumtoxinA for Aesthetic Treatment of Asians: A Consensus.

Treatment of wrinkles and dynamic lines with botulinum toxin has been a routine practice for years in aesthetic clinical settings. The effective treatment of wrinkles requires a comprehensive understanding of facial expression muscles and their interactions, the mechanism of action of botulinum toxin, and individual patient preferences. The dose adjustment practice and injection technique of physicians are affected by cultural differences; most Asian patients prefer natural-looking results. This article aims to present an expert consensus on the injection sites, doses, and levels of botulinum toxin for various indications in Asians, with the hope of providing guidance to some clinicians. This consensus paper reviews LetibotulinumtoxinA for patient evaluation, dosage, and delivery techniques in Asians from the time LetibotulinumtoxinA was approved up to December 2022. Panelists proposed individualized treatment plans for botulinum toxin type A (BTxA) treatments in 3 areas-wrinkle removal, contour adjustment, and face lifting-for Asians based on their extensive experience and knowledge of facial anatomy. When using a different BTxA, clinicians should start with a conservative dose and carefully individualize the treatment for each patient, and adjust it according to feedback to obtain a higher satisfaction level.

Narrow linewidth parity-time symmetric Brillouin fiber laser based on a dual-polarization cavity with a single micro-ring resonator.

A narrow linewidth parity-time (PT) symmetric Brillouin fiber laser (BFL) based on dual-polarization cavity (DPC) with single micro-ring resonator (MRR) is proposed and experimentally investigated. A 10 km single-mode fiber provides SBS gain, while a DPC consisting of optical coupler, polarization beam combiner and a MRR, is used to achieve PT symmetry. Due to the reciprocity of light propagation in the MRR, the PT symmetry BFL based on DPC implements two identical feedback loops that are connected to one another, one with a Brillouin gain coefficient and the other with a loss coefficient of the same magnitude, to break a PT symmetric. Compared with existing BFL studies, this design does not call for frequency matching of compound cavities structures or without ultra-narrow bandwidth bandpass filters. In the experiment, the 3-dB linewidth of PT symmetry BFL based on DPC with single MRR is 11.95 Hz with the threshold input power of 2.5 mW, according to the measured linewidth of 239 Hz at the -20 dB power point. And a 40 dB maximum mode suppression ratio are measured. Furthermore, the PT symmetry BFL's wavelength is tuned between 1549.60 and 1550.73 nm. This design with single longitudinal mode output can be applied to high coherent communication systems.

Oncological Safety of Autologous Fat Grafting in Breast Reconstruction: A Meta-analysis Based on Matched Cohort Studies.

BACKGROUND: Autologous fat grafting has become a commonly used procedure for breast reconstruction after breast cancer surgical treatment. Nevertheless, oncological considerations remain concerning autologous fat grafting after breast cancer surgery. OBJECTIVE: This meta-analysis aimed to summarize the current matched cohort studies and provide high-quality evidence-based conclusions on the oncological safety of fat grafting in breast reconstruction. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed. A literature search was performed on August 1, 2021, using PubMed. All relevant matched cohort studies of patients undergoing autologous fat grafting after breast cancer surgery were included. After independently screening the studies and extracting the data, pooled estimates for local and regional recurrence as well as distant metastases were conducted using Review Manager software (RevMan, version 5.3). Outcomes were expressed as odds ratios and 95% confidence intervals. RESULTS: Seventeen studies involving 7494 patients were included. The observed outcomes indicated that no significant differences existed in the risks of local and regional recurrence or distant metastases between autologous fat grafting and control groups. Also, there was no significant heterogeneity among the studies. CONCLUSION: This study provided evidence-based conclusions that support the use of autologous fat grafting in breast reconstruction. LEVEL OF EVIDENCE III: 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 .

Washing Lipoaspirate Improves Fat Graft Survival in Nude Mice.

BACKGROUND: The optimal fat processing technique of fat grafting has not been determined. We have proved the importance of washing lipoaspirate to remove blood, but the necessity of washing when there is no obvious bleeding during liposuction is not clear. OBJECTIVES: The purpose of this study is to further investigate the effect of washing on fat graft survival and the underlying mechanisms, from the perspective of inflammation, oxidative stress and apoptosis. METHODS: To exclude the influence of blood, de-erythrocyte infranatant (dEI) isolated from lipoaspirate was obtained. Purified fat processed by cotton pad filtration mixed with dEIs after sedimentation (sedimentation group), washing (washing group) or phosphate buffer solution (control group) was transplanted to nude mice subcutaneously. Samples were harvested at 1 day and 1, 3, 8 weeks after transplantation. Volume and weight retention, histologic examination, immunostaining of perilipin-1, CD31, CD45 and Ly6g, mRNA expression of PPAR-γ, C/EBPα, VEGF, bFGF, IL-6, IL10, TNF-α, TGF-ß, Bax and Bcl-2, and protein contents of 8-iso-PGF2α, IL-6, IL10, TNF-α and TGF-ß were all compared among groups. RESULTS: After transplantation, volume and weight retention, histologic scores, viable adipocytes and vascularization were all improved in the washing group, with increased expression of adipogenic and angiogenic genes. Compared with the sedimentation group, the washing group had milder inflammation, lower levels of oxidative stress and apoptosis. CONCLUSIONS: Washing lipoaspirate to eliminate mixed components can improve fat graft survival and promote adipogenesis and angiogenesis, possibly by relieving inflammation, reducing oxidative stress injury and inhibiting apoptosis. NO LEVEL ASSIGNED: 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 47 these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Liposuction of the Zygomatic Arch Area: A Novel Concept to Improve the Midface Contour.

BACKGROUND: An ovoid, slender face with a smooth contour is preferred in oriental esthetics. We developed a novel concept to achieve a slimmer and harmonious midface contour by liposuction of the projection area of the zygomatic arch. METHODS: A cadaver study including anatomical dissection and histologic examination were conducted to better understand the soft tissue structure of the projection area of the zygomatic arch and the vital technique for liposuction. For the clinical evaluation, 49 patients with midface hypertrophy who underwent liposuction of the zygomatic arch area from January 2016 to June 2021 were retrospectively reviewed. RESULTS: Cadaver study showed that abundant fatty tissue existed in the subcutaneous layer of the zygomatic arch area. The liposuction manipulation was precisely limited to the subcutaneous fat layer, and nerve branches were observed in the deeper loose areolar tissue plane. Of the 49 patients enrolled in this study (including 98 zygomatic arch areas), the median fat removal volume per zygomatic arch area was 3.0 (2.0, 5.0) mL. The subcutaneous fat thickness was significantly decreased postoperatively [median 9 (6, 10) mm vs. 1 (1, 2) mm per zygomatic arch area, P < 0.001]. All patients were satisfied with their postoperative outcomes. Only three patients underwent slight depression of the liposuction area during making facial expression after surgery and subsequently recovered. CONCLUSIONS: Liposuction of the zygomatic arch area is effective in improving midface hypertrophy and achieving a harmonious facial contour with a low risk of complications. 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 .

Low Negative Pressure Combined With Supertumescence Microliposuction as a New Method for Repairing Facial Fat Overfilling: A Case Series of 32 Patients.

BACKGROUND: Face fat overfilling sometimes occurs and is unfortunately very difficult to repair. OBJECTIVES: The aim of this study was to report initial experience of microliposuction with low negative pressure combined with supertumescence (LNPST) in a case series of 32 patients. METHODS: The LNPST microliposuction was performed in 32 patients aged 22 to 41 years (mean [standard deviation] age, 29.6 [4.9] years) with facial overfilling. Discomfort and bleeding were monitored intraoperatively by 2 independent plastic surgeons, who used a grading system to record the results. All patients were followed-up for hematoma within 1 week postoperatively and for skin numbness and muscle paralysis at 1 week and 3 months postoperatively. In addition, at 6 months postoperatively, patient satisfaction with the postoperative aesthetic effects was analyzed by FACE-Q questionnaire. RESULTS: All patients successfully completed the operation under local anesthesia. The mean intraoperative discomfort and blood-loss scores were 1.69 [0.62] and 1.22 [0.41], respectively. The hematoma score was 1.13 [0.34] within 1 week. Other scores included postoperative skin numbness (1 week, 1.96 [0.62]; 3 months, 1.13 [0.33]) and postoperative muscle paralysis (1 week, 1.22 [0.51]; 3 months, 1.0 [0]). Overall, neither skin necrosis nor serious complications requiring revision surgery occurred. Seventy-two percent of the patients (n = 23) answered the FACE-Q questionnaire and the score was 21.8 (1.7), covering satisfaction with the outcome score into a standard score (81.7 [15.1], from 0 to 100), which verified the high satisfaction rate. CONCLUSIONS: LNPST technology is a safe and effective method for repair of facial fat overfilling, with less bleeding, less nerve injury, fewer complications, and high patient satisfaction.

Dedifferentiation of Human Adipocytes After Fat Transplantation.

BACKGROUND: Fat transplantation is a common method employed to treat soft-tissue defects. The dedifferentiation of mature adipocytes has been well documented, but whether it occurs after fat transplantation remains unclear. OBJECTIVES: The major purpose of this project was to investigate the dedifferentiation of mature adipocytes after fat transplantation. METHODS: Human lipoaspirate tissue was obtained from 6 female patients who underwent esthetic liposuction. Mature adipocytes were extracted and labeled with PKH26, mixed with lipoaspirate, and injected into nude mice. In addition, PKH26+ adipocytes were subjected to a ceiling culture. Grafted fat was harvested from nude mice, and stromal vascular fragment cells were isolated. The immunophenotype of PKH26+ cells was detected by flow cytometry analysis at 2 days and 1 week. The PKH26+ cells were sorted and counted at 2 and 4 weeks to verify their proliferation and multilineage differentiation abilities. RESULTS: Two days after transplantation, almost no PKH26+ cells were found in the stromal vascular fragment cells. The PKH26+ cells found 1 week after transplantation showed a positive expression of cluster of differentiation (CD) 90 (CD90) and CD105 and a negative expression of CD45. This indicates that the labeled adipocytes were dedifferentiated. Its pluripotency was further demonstrated by fluorescent cell sorting and differentiation culture in vitro. In addition, the number of live PKH26+ cells at week 4 [(6.83 ± 1.67) × 104] was similar with that at week 2 [(7.11 ± 1.82) × 104]. CONCLUSIONS: Human mature adipocytes can dedifferentiate into stem cell-like cells in vivo after fat transplantation.

Enteromorpha prolifera Diet Drives Intestinal Microbiome Composition in Siganus oramin.

Enteromorpha prolifera (E. prolifera) contains complex sulfated polysaccharides that are resistant to biological degradation. Most organisms cannot digest biomass of E. prolifera, except Siganus oramin (S. oramin). This study was conducted to identify the bacteria in the intestine of S. oramin facilitating the digestion of E. prolifera polysaccharides (EPP). Metagenomic sequencing analysis of the S. oramin intestinal microbiota revealed that E. prolifera diet increased the number of Firmicutes, replacing Proteobacteria to be the dominant bacteria. The proportion of Firmicutes increased from 38.8 to 58.6%, with Bacteroidetes increasing nearly fivefold from 5 to 23.7%. 16S rDNA high-throughput sequencing showed that EPP-induced Bacteroidetes increased significantly in the intestinal flora of S. oramin cultivated in vitro. Metatranscriptome analysis showed that EPP induced more transferase, polysaccharide hydrolase, glycoside hydrolase, and esterases expressed in vitro, and most of them were taxonomically annotated to Bacteroidetes. Compared with the aggregation of GH family genes in metagenomic sequencing analysis in vivo, EPP induced more CBM32, GH2, GT2, GT30, and GH30 families gene expression in vitro. In general, We found that the bacteria in intestinal tract of S. oramin responsible for digestion of E. prolifera were Firmicutes and Bacteroidetes, while Bacteroidetes was the dominant bacteria involved in EPP degradation in vitro cultures. Compared with in vivo experiments, only GH family genes were mostly involved, we detected a more complete and complex EPP degradation pathway in vitro. The results may benefit the further study of biodegradation of E. prolifera and has potential implications for the utilization of E. prolifera for biotechnology.

A model of seven immune checkpoint-related genes predicting overall survival for head and neck squamous cell carcinoma.

BACKGROUND: Head and neck squamous cell carcinoma (HNSCC) is a heterogeneous disease characterized by different molecular subtypes with different prognosis and response to treatment. Therefore, the aim of this study was to construct reliable gene signatures based on immune checkpoint-related genes to distinguish between subgroups of patients with different risks. METHODS: We obtained the HNSCC data from The Cancer Genome Atlas (TCGA) database and Gene Expression Omnibus (GEO) as a training set and the external validation set, respectively. First, differentially expressed immune checkpoint-related genes in tumor tissues and normal tissues were determined, and the potential functions of differential genes were explored through GO function annotation and KEGG pathway enrichment analysis. Using univariate Cox regression analysis, 20 immune checkpoint-related genes in HNSCC patients were significantly associated with overall survival (OS). Subsequently, seven genes were selected by multivariate Cox regression analysis to create a gene signature. Next, the stability of gene signatures was assessed using Kaplan-Meier curve, Time-dependent receiver operating characteristic (ROC) curve. Finally, we constructed a nomogram visualization modelled to facilitate subsequent clinical applications. RESULTS: A total of 80 differentially expressed genes (DEGs) were obtained, the GO analysis of these DEGs indicated that they were significantly enriched in positive regulation of cell activation, T cell activation; the KEGG analysis results performed and showed that the DEGs were enriched in the MAPK signaling pathway, PI3K - Akt signaling pathway. 7 genes (PPP2R1B, MYD88, CD86, CD80, MAP2K1, TRIB3 and ICOS) were screened by univariate and multivariate Cox regression, and they were used to construct a prognostic model. In the TCGA and GEO datasets, Kaplan-Meier analysis indicated that patients in the high-risk group have a poor prognosis. The sensitivity and specificity evaluation of prognostic model for 1-, 3-, 5-year OS in TCGA were 0.644, 0.661 and 0.625, respectively; and in GSE41613 were 0.748, 0.719, and 0.727, respectively. The calibration chart curve showed that the nomogram has strong clinical performance in the prognosis prediction of HNSCC patients. CONCLUSIONS: A novel immune checkpoint-related gene signature can effectively predict and stratify OS in HNSCC patients.

The Effects of Lipoaspirate-Derived Fibrous Tissue on Survival Quality and Mechanical Property of Fat Grafts.

BACKGROUND: Fibrous connective tissue (referred to as fiber) in lipoaspirates would be discarded before lipotransfer in case of cannula blockage. However, the fiber contains extracellular matrix which provide structure support and is rich in stromal vascular fractions (SVFs). Removal of the fiber might theoretically affect the survival quality and mechanical properties of fat grafts. But there is few evidence in vivo and vitro about how the fiber affects the fat grafts. OBJECTIVE: To assess the effect of fibers on the survival quality and mechanical property of fat grafts. METHODS: The SVFs in both fat and fiber were obtained by collagenase digestion for cells counting and comparison. Three groups were designed according to the different proportions of fat and fiber: the fat group (100% fat), the mixed group (50% fat, 50% fiber in volume ratio), and the fiber group (100% fiber). Three groups of grafts were transplanted in vivo to evaluate the differences in volume retention rate, histological characteristics and mechanical properties. RESULTS: The amount of SVF cells in fibers (3.47 ±â€Š1.49 × 104 cells/mL) was significantly lower than that in fat (12.3 ±â€Š4.95 × 104 cells/mL) (P < 0.05). Grafts in the mixed group and the fiber group showed an increase of volume retention at week 4, but the fiber content showed no significant effects on the volume retention of grafts in three groups at week 12. Elasticity modulus of grafts in the fat group was higher than that in the fiber group and the mixed group at week 4 and 8, the fiber content showed no significant effects on the elasticity modulus of grafts in three groups at week 12. The addition of the fiber reduced the inflammation, cysts, fibrosis, and capillaries density of the grafts. CONCLUSIONS: There were few SVF cells in the fiber. When it was mixed with fat in different proportions and transplanted in vivo, the content of fiber showed no significantly different effects on the long-term volume retention and mechanical property of fat grafts. Due to the risk of blockage, it is recommended to discard the fiber in lipoaspirates.

Blood Impairs Viability of Fat Grafts and Adipose Stem Cells: Importance of Washing in Fat Processing.

BACKGROUND: Fat processing plays a pivotal role in graft survival. Each component of the blood in lipoaspirate affects fat survival in different ways, but the mechanisms are not clear. OBJECTIVES: The aim of this study was to investigate, by various experimental methods, the effect of blood on the viability of fat grafts and adipose stem cells (ASCs). METHODS: Blood and fat samples were obtained from 6 female patients undergoing aesthetic liposuction. For the in vivo experiment, we compared fat mixed with normal saline or various ratios of blood in nude mice. The samples were explanted at 2 and 8 weeks to evaluate the gross volume retention and histologic and immunohistochemical characteristics. For in vitro experiments, ASCs were pretreated with hemoglobin at different concentrations and for different times. We then assessed the proliferation, migration, adipogenesis, and reactive oxygen species production of ASCs. RESULTS: Blood in the graft led to a decrease in graft viability, as evaluated by general observation and histologic and immunohistochemical morphology in vivo. In vitro experiments showed inhibited proliferation, migration, and adipogenesis, and increased reactive oxygen species production in ACSs, after hemoglobin treatment, suggesting impaired ASC viability. CONCLUSIONS: This study suggests that blood impairs the viability of fat grafts and ASCs and provides evidence that washing to remove blood is important in fat processing.

Comparison of Microfat, Nanofat, and Extracellular Matrix/Stromal Vascular Fraction Gel for Skin Rejuvenation: Basic Research and Clinical Applications.

BACKGROUND: Over the past 2 decades, fat grafting has been extensively applied in the field of tissue regeneration. OBJECTIVES: The aim of this study was to investigate the therapeutic potential of microfat, nanofat, and extracellular matrix/stromal vascular fraction gel (SVF-gel) in skin rejuvenation. METHODS: Microfat was harvested by a cannula with multiple 0.8-mm smooth side holes and processed with a fat stirrer to remove fibers. Nanofat and SVF-gel were prepared according to previously reported methods, and their structure and viability were evaluated. Then, SVF cells from the 3 types of samples were isolated and characterized, and the cell viability was compared. RESULTS: The microstructure of the 3 samples showed distinct differences. The microfat group showed a diameter of 100 to 120.0 µm under the microscope and presented a botryoid shape under calcein acetoxymethyl (calcein-AM)/propidium iodide staining. Scanning electron microscopy analysis showed that the microfat maintained an integral histologic structure. In the nanofat group, no viable adipocytes and no normal histologic structure were observed, but high levels of free lipids were noted. The SVF-gel group showed uniform dispersion of cells with different sizes and parts of the adipose histologic structure. Cell count and culture revealed that the number of viable SVF cells decreased distinctly in the nanofat group compared with the microfat group. In contrast, the number of viable SVF cells in the SVF-gel group increased moderately. Clinical applications with microfat showed marked improvements in skin wrinkles. CONCLUSIONS: Microfat can preserve the integrity of the histologic structure and presents the advantages of subcutaneous volumetric restoration and improvement of skin quality in skin rejuvenation compared with the nanofat and SVF-gel.

Individual Factors of Botulinum Type A in Treatment of Gummy Smile: A Prospective Study.

BACKGROUND: Botulinum type A (BTX-A) injection is a promising treatment for gummy smile (GS), although its effects are varied and inconsistent. OBJECTIVES: The aim of this study was to explore the effect of individual factors on BTX-A treatment for GS, and to establish treatment expectations. METHODS: In this prospective clinical study, a standardized technique comprising bilateral single-point injections of 2 U BTX-A (total, 4 U) was administered to all GS patients. Data were collected at baseline and after 4, 12, and 32 weeks of follow-up. Twenty-nine potential individual factors were analyzed by correlation and regression analysis to exclude confounding bias. RESULTS: Ninety-four patients completed the BTX-A treatment. After adjusting for potential confounding factors, the correlation and regression analysis confirmed the following formula: anterior gingival exposure (GE) at 4 weeks = 1.44 + (0.94 × baseline anterior GE) - (1.88 × sex) (where male = 1 and female = 2). The confidence interval (CI) of the prediction showed that for all female participants with baseline anterior GE <5.3 mm, the 95% CI of anterior GE was 0.3 to 3.0 mm after 4 weeks of treatment, and 3.0 to 8.9 mm with baseline anterior GE ≥6 mm. For male patients with baseline anterior GEs of 3 and ≥4.6 mm, the 95% CIs were 1.5 to 3.3 mm and 3.2 to 8.9 mm, respectively. CONCLUSIONS: The effect of average-dose BTX-A treatment for GS depended on GS severity and patient's sex, rather than GS etiology and other factors. Female participants with baseline anterior GE <5.3 mm were more likely to show complete improvement after 4 weeks of treatment. However, female participants with baseline anterior GE ≥6.0 mm or male participants were less likely to show complete improvement at 4 weeks.