Dominant activities of fear engram cells in the dorsal dentate gyrus underlie fear generalization in mice.

Over-generalized fear is a maladaptive response to harmless stimuli or situations characteristic of posttraumatic stress disorder (PTSD) and other anxiety disorders. The dorsal dentate gyrus (dDG) contains engram cells that play a crucial role in accurate memory retrieval. However, the coordination mechanism of neuronal subpopulations within the dDG network during fear generalization is not well understood. Here, with the Tet-off system combined with immunostaining and two-photon calcium imaging, we report that dDG fear engram cells labeled in the conditioned context constitutes a significantly higher proportion of dDG neurons activated in a similar context where mice show generalized fear. The activation of these dDG fear engram cells encoding the conditioned context is both sufficient and necessary for inducing fear generalization in the similar context. Activities of mossy cells in the ventral dentate gyrus (vMCs) are significantly suppressed in mice showing fear generalization in a similar context, and activating the vMCs-dDG pathway suppresses generalized but not conditioned fear. Finally, modifying fear memory engrams in the dDG with "safety" signals effectively rescues fear generalization. These findings reveal that the competitive advantage of dDG engram cells underlies fear generalization, which can be rescued by activating the vMCs-dDG pathway or modifying fear memory engrams, and provide novel insights into the dDG network as the neuronal basis of fear generalization.

Effects of nanographene oxide on adipose-derived stem cell cryopreservation.

Cryoinjury mitigation is key in cell cryopreservation. Here, we aimed to assess the effectiveness of nanographene oxide (nano-GO) for improving cryoprotectant agents (CPAs) in human adipose stem cell (hADSC) cryopreservation. For in vitro experiments, nano-GO (5 µg/mL) was added to the CPAs in the control, and passage (P) 2 hADSCs were collected and cryopreserved for around two weeks. We compared cytotoxicity, cell viability, immunophenotypes, proliferation, cell apoptosis, and tri-lineage differentiation. In vivo, studies used lipoaspirate to create non-enriched or hADSC-enriched fat tissues by combining it with PBS or hADSCs cryopreserved with the aforementioned CPAs. Each nude mouse received a 0.3 mL subcutaneous injection of the graft. At 12 weeks, the grafts were harvested. Histology, adipocyte-associated genes and protein, vascular density and angiogenic cytokines, macrophage infiltration, and inflammatory cytokines were analyzed. Nano-GO CPA contributed to increased cell viability, improved cell recovery, and lowered levels of early apoptosis. Nano GO at concentrations of 0.01-100 µg/mL caused no cytotoxicity to hADSCs. The absence of nano GOs in the intracellular compartments of the cells was confirmed by transmission electron microscopy. The fat grafts from the CPA-GO group showed more viable adipocytes and significantly increased angiogenesis compared to the PBS and CPA-C groups. Adding hADSCs from the CPA-GO group to the graft reduced macrophage infiltration and MCP-1 expression. Nano-GO plays an anti-apoptotic role in the cryopreservation of hADSCs, which could improve the survival of transplanted fat tissues, possibly via improved angiogenesis and lower inflammatory response in the transplanted adipose tissue.

Effectiveness of a New Enzyme-Free Method for the Preparation of a Decellularized Adipose-Derived Matrix.

BACKGROUND: Decellularized adipose-derived matrix (DAM) represents a new alternative to tissue fillers. The function of DAM is closely associated with the decellularization technique used for its preparation. However, most techniques are time-consuming and expensive, and this might reduce the popularity of DAM. OBJECTIVES: The study aimed to investigate an enzyme-free adipose decellularization method and generate a DAM capable of adipose tissue regeneration. METHODS: DAMs prepared by the enzyme-free and Flynn's methods were compared and co-cultured with human adipose-derived stem cells (hADSCs) to investigate cytocompatibility. Adipose tissue formation was evaluated by injecting the DAMs into the backs of nude mice over 4 weeks. Samples were harvested for gross and perilipin immunohistochemistry analysis at 1 and 4 weeks. RESULTS: The enzyme-free method is effective for adipose decellularization because it removes adipocytes and preserves the microstructure. In vitro, the DAM made by the enzyme-free method could support the attachment, growth, proliferation, and differentiation of hADSCs, and promote the enhanced secretion of vascular endothelial growth factor by hADSCs; this DAM also induced the formation and maturity of adipocytes in vivo. CONCLUSIONS: This study describes a highly effective enzyme-free method for adipose tissue decellularization that also promotes adipocyte formation and adipose tissue volume stability in vitro and in vivo, resulting in a new alternative tissue filler.

Interrater agreement between children's self-reported and their mothers' proxy-reported dental anxiety: a Chinese cross-sectional study.

BACKGROUND: Children's dental anxiety is common in dental clinics. This study aimed to determine the interrater agreement between children's self-reported and their mothers' proxy-reported dental anxiety and its affecting factors. METHODS: In this cross-sectional study performed in a dental clinic, primary school students and their mothers were assessed for enrollment eligibility. The Modified Dental Anxiety Scale plus Facial Image Scale (MDAS-FIS) was employed to test both the children's self-reported and their mothers' proxy-reported dental anxiety independently. The interrater agreement was analyzed using percentage agreement and the linear weighted kappa (k) coefficient. Factors affecting children's dental anxiety were analyzed using univariate and multivariate logistic regression models. RESULTS: One hundred children and their mothers were enrolled. The median ages of the children and mothers were 8.5 and 40.0 years old, respectively, and 38.0% (38/100) of the children were female. The scores of children's self-reported dental anxiety were significantly higher than their mothers' proxy-reported dental anxiety (MDAS-Questions 1-5, all p < 0.05); moreover, there was no agreement between the two groups in terms of all anxiety hierarchies (kappa coefficient = 0.028, p = 0.593). In the univariate model, a total of seven factors (age, gender, maternal anxiety, number of dental visits, mother's presence or absence, oral health status, and having siblings or not) were involved for analysis, and age [every 1-year increase, odds ratio (OR) = 0.661, 95% confidence interval (CI) = 0.514-0.850, p = 0.001], several dental visits (every 1 visit increase, OR = 0.409, 95% CI = 0.190-0.880, p = 0.022), and mother presence (OR = 0.286, 95% CI = 0.114-0.714, p = 0.007) were affecting factors. In the multivariate model, only age (every 1 year increase) and maternal presence were associated with 0.697-fold (95% CI = 0.535-0.908, p = 0.007) and 0.362-fold (95% CI = 0.135-0.967, p = 0.043) decreases in the risk of children's dental anxiety during dental visits and treatment, respectively. CONCLUSION: There was no significant agreement between elementary school students' self-reported dental anxiety and mothers' proxy ratings of children's dental anxiety, which suggests that self-reported dental anxiety by children should be encouraged and adopted, and the mother's presence during dental visits is strongly recommended.

Helmet Wearing State Detection Based on Improved Yolov5s.

At many construction sites, whether to wear a helmet is directly related to the safety of the workers. Therefore, the detection of helmet use has become a crucial monitoring tool for construction safety. However, most of the current helmet wearing detection algorithms are only dedicated to distinguishing pedestrians who wear helmets from those who do not. In order to further enrich the detection in construction scenes, this paper builds a dataset with six cases: not wearing a helmet, wearing a helmet, just wearing a hat, having a helmet, but not wearing it, wearing a helmet correctly, and wearing a helmet without wearing the chin strap. On this basis, this paper proposes a practical algorithm for detecting helmet wearing states based on the improved YOLOv5s algorithm. Firstly, according to the characteristics of the label of the dataset constructed by us, the K-means method is used to redesign the size of the prior box and match it to the corresponding feature layer to increase the accuracy of the feature extraction of the model; secondly, an additional layer is added to the algorithm to improve the ability of the model to recognize small targets; finally, the attention mechanism is introduced in the algorithm, and the CIOU_Loss function in the YOLOv5 method is replaced by the EIOU_Loss function. The experimental results indicate that the improved algorithm is more accurate than the original YOLOv5s algorithm. In addition, the finer classification also significantly enhances the detection performance of the model.

A Two-Step Technique for Correction of Severe Inverted Nipples with Minimally Invasive Procedures.

BACKGROUND: Congenital inverted nipple is not uncommon in Asian females, which impairs the patient's psychology and breastfeeding function. Although various methods have been reported in references, no consensus has been reached on an ideal treatment for severe inverted nipples. OBJECTIVES: This study aimed to propose a minimally invasive and reliable method that could correct severe inverted nipples, reduce their recurrence rate, and create a definite nipple neck for a natural shape. METHODS: We designed a two-step technique to correct severe inverted nipples, including congenital grade III inversion and recurrent grade III inversion with or without scar adhesion after correction with different methods from other hospitals. A retrospective study was performed on 38 patients (68 nipples) who underwent the new two-step technique in our department. The follow-up time was at least 6 months. Patient demographics, operation details, and complication rate were documented. RESULTS: A total of 68 nipples in 38 patients (bilateral: 30 patients; unilateral: 8 patients) received correction, among which there were four recurrent cases from other hospitals treated with different methods. In this study, the total recurrence rate was 7.89%. In these cases, the nipple exhibited the appearance of Grade I inversion, but not back to the preoperative state of Grade III. There was one case that suffered exposure of thread knot. CONCLUSIONS: The two-step technique is a minimally invasive method to successfully correct severe inverted nipples with a low recurrence rate and achieve a natural shape with a definite nipple neck. 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 .

Nursing allocation in isolation wards of COVID-19 designated hospitals: a nationwide study in China.

BACKGROUND: Appropriate allocation of nursing staff is key to ensuring efficient nursing in hospitals, and is significantly correlated with patient safety, nursing quality, and nurse job satisfaction. However, there are few studies on nursing workforce allocation in the isolation wards of COVID-19 designated hospitals globally. This study aims to better understand the nursing workforce allocation in the isolation wards of COVID-19 designated hospitals in China, and provide a theoretical basis for efficiently deploying first-line nurses in China and across the world in the future. METHODS: An online survey was conducted among the head nurses (n = 229) and nurses (n = 1378) in the isolation wards of 117 hospitals (selected by stratified sampling), using a self-reported human resource allocation questionnaire. RESULTS: The average bed-to-nurse ratios of different isolation wards were different (Z = 36.742, P = 0.000). The bed-to-nurse ratios of the ICU, suspected COVID-19 cases ward, and confirmed COVID-19 cases ward, were 1:1.88, 1:0.56, and 1:0.45, respectively. The nurse work hours per shift in different isolation wards were also different (Z = 8.468, P = 0.014), with the specific values of the ICU, suspected COVID-19 cases ward, and confirmed COVID-19 cases ward, being 5, 6, and 6 h, respectively. A correlation analysis showed that the average work hours per shift was proportional to the overtime work of nurses (rs = 0.146), the proportion of nurse practitioners was proportional to the overall utilization rate of nursing human resources in the wards (rs = 0.136), and the proportion of nurses with college degrees was proportional to teamwork (rs = 0.142). The proportion of nurses above grade 10 was inversely proportional to teamwork and psychological problems (rs = 0.135, rs = 0.203). The results of multiple stepwise regression analyses showed that the work hours of nurses per shift was the main factor affecting nurse satisfaction and that the proportion of nurses and the work hours of nurses per shift were both independent factors affecting the length of stay (LOS) of patients. CONCLUSION: Hospitals in China have made good nursing workforce allocations during the COVID-19 pandemic, but there are certain shortcomings. Therefore, scientific and efficient nursing workforce allocation practice plans should be established to improve the ability of hospitals to deal with public health emergencies and are urgent problems that need to be addressed soon.

Sub-toxic levels of cobalt ions impair chondrocyte mechanostranduction via HDAC6-dependent primary cilia shortening.

Cobalt ions are the main wear particles associated with orthopaedic implants, causing adverse complications due to cytotoxicity and inflammatory mediators. Recent studies have shown that sub-toxic levels of cobalt ions regulate matrix synthesis and inflammation, but the influence of cobalt ions on mechanotransduction remains unclear. Previously, we reported that sub-toxic levels of cobalt ions modulated primary cilia, which are crucial for mechanotransduction. This study therefore aimed to investigate the effect of cobalt ions on chondrocyte mechanosensation in response to cyclic tensile strain and the association with primary cilia. Sub-toxic levels of cobalt ions impaired chondrocyte mechanosensation and affected the gene expression of aggrecan, collagen II and MMP-13. Moreover, cobalt ions induced HDAC6-dependent primary cilia disassembly, which was associated with either cytoplasmic or ciliary α-tubulin deacetylation. Pharmaceutical HDAC6 inhibition with tubacin restored primary cilia length and mechanotransduction, whereas chemical depletion of primary cilia by chloral hydrate prevented mechanosignalling. Thus, sub-toxic levels of cobalt ions impaired chondrocyte mechanotransduction via HDAC6 activation, which was associated with tubulin deacetylation and primary cilia shortening.

Active compound identification by screening 33 essential oil monomers against Botryosphaeria dothidea from postharvest kiwifruit and its potential action mode.

The antifungal activity of postharvest kiwifruit against the pathogen Botryosphaeria dothidea was evaluated for 33 essential oil monomers. The possible mechanism for the known active compounds were further assessed in this study. The results show all the EO components exhibit inhibitory effects on the pathogen to different degrees except for Farnesol. Carbon chain length and C2-C3 double bonds had a great effect on the antifungal activities of aldehydes. Of all of these, carvacrol had the strongest antifungal activity with EC50 of 12.58 µL/L and EC90 of 22.08 µL/L. Carvacrol also exhibits significant inhibitory effects on the pathogen, both in vivo and in vitro. Carvacrol evidently alters the hyphal morphology of B. dothidea and severely damages cell membrane and inhibits the formation of lipid components on the membrane. As cell membrane permeability increases, intracellular homeostasis including ion and biomacromolecules were destroyed by carvacrol. Furthermore, carvacrol appears to significantly inhibit mitochondrial activity and respiration rates, resulting in cell death of B. dothidea. Our results provide evidence that carvacrol could be a very useful compound for controlling postharvest rot soft in kiwifruit.

Does Water-Jet Force Affect Cryopreserved Adipose-Derived Stem Cells? Evidence of Improved Cell Viability and Fat Graft Survival.

BACKGROUND: Adipose tissue harvested by liposuctions is an available source of adipose-derived stem cells (ASCs). Water-jet-assisted liposuction is a favorable method for fat collection with little mechanical damage. This study aimed to investigate whether or not the water-jet-assisted liposuction made a difference in the biological characteristics of cryopreserved ASCs and fat graft survival in cell-assisted lipotransfer. METHODS: Human lipoaspirates were obtained from the abdomen or thighs of 20 female participants for body contouring. A single surgeon randomly harvested 50 mL of adipose tissue by the water-jet-assisted liposuction and the conventional liposuction, respectively. Adipose-derived stem cells were isolated from lipoaspirates and then cryopreserved for 4 weeks. Cryopreserved ASCs were used to examine the surface markers, cell proliferation, migration, and adipogenic differentiation in vitro. The fat survival of ASCs-enriched grafts from different liposuctions was measured in animal models. RESULTS: The cryopreserved ASCs with the water-jet assistance had better capacities of cell proliferation, migration, and adipogenic differentiation and achieved a better survival result of ASCs-enriched fat grafting. CONCLUSIONS: Cryopreservation of ASCs with the water-jet force showed more excellent biological characteristics. The water-jet-assisted liposuction was superior to the conventional liposuction in obtaining ASCs and fat survival of coimplantation with grafts.

Browning of White Adipocytes in Fat Grafts Associated With Higher Level of Necrosis and Type 2 Macrophage Recruitment.

BACKGROUND: Induced browning adipocytes were assumed less viable and more prone to necrosis for their hypermetabolic property. A previous study showed that browning of adipocytes was more evident in fat grafts with necrosis in humans. OBJECTIVES: The authors aimed to estimate whether fat transfer-induced browning biogenesis was associated with necrosis and its potential inflammation mechanisms in murine models. METHODS: Human subcutaneous adipose from thigh or abdomen of 5 patients via liposuction was injected in 100 µL or 500 µL (n = 20 per group) into the dorsal flank of 6- to 8-week-old female nude mice fed with normal chow diet and harvested after 2, 4, 8, and 12 weeks. Control groups did not receive any grafting procedures (sham operation), where lipoaspirates were analyzed immediately after harvest. Histology and electronic microscopy, immunological analyses of browning markers, necrosis marker, and type I/II macrophages markers in mice were performed. RESULTS: Histology and electronic microscopy showed browning adipocytes in fat grafts with a higher level of necrosis (0.435 ±â€…0.017 pg/mL for cleaved caspase-3, **P < 0.01), IL-6 (749.0 ±â€…134.1 pg/mL,***P < 0.001) and infiltration of type 2 macrophage profiles in mice (twofold increase, *P < 0.05). CONCLUSIONS: Browning of adipocytes induced by fat transfer in mice is in parallel with post-grafting necrotic levels associated with elevated interleukin-6 and activated type 2 macrophage profiles, which promote browning development.

Evidence of Browning of White Adipocytes in Poorly Survived Fat Grafts in Patients.

BACKGROUND: Browning adipocytes induced by burn and cancer were assumed less viable and more prone to necrosis for their hypermetabolic properties. Recent studies have shown browning of white adipose after fat engraftment in mice. OBJECTIVES: The authors sought to evaluate whether fat transfer could induce browning biogenesis in fat grafts in humans and if it is associated with graft necrosis. METHODS: Necrotic adipose grafts were excised from 11 patients diagnosed with fat necrosis after fat grafting or flap transfer. Non-necrotic fat grafts were from 5 patients who underwent revisionary surgeries after flap transfer. Histology and electronic microscopy as well as protein and gene expression of browning-related marker analyses were performed. RESULTS: Fat grafts with necrosis demonstrated a higher gene expression level of uncoupling protein-1 (greater than fivefold increase, **P < 0.01), a master beige adipocyte marker, than non-necrotic fat grafts. Electronic microscopy and histology showed that browning adipocytes were presented in necrotic adipose in patients. CONCLUSIONS: Fat transfer induced browning adipocytes in patients and was evident in patients with postgrafting necrosis.

LncRNA TTN-AS1 promotes the progression of oral squamous cell carcinoma via miR-411-3p/NFAT5 axis.

BACKGROUND: Oral squamous cell carcinoma (OSCC) is a common kind of squamous cell carcinoma of the head and neck, which is a threat to public health. Long noncoding RNAs (lncRNAs) are associated with the development of various diseases, including cancers. LncRNA titin antisense RNA 1 (TTN-AS1) is known as a crucial regulatory factor in several cancers. Nevertheless, the specific functions of TTN-AS1 in OSCC remains obscure. METHODS: The expression of TTN-AS1 in OSCC samples or cells was analyzed through qRT-PCR. Colony formation assay, EdU assay, flow cytometry assay, TUNEL assay and wound healing assay were conducted to estimate the functions of TTN-AS1 in OSCC cells. RIP and luciferase reporter assays were utilized to detect the interaction between TTN-AS1 and miR-411-3p as well as between miR-411-3p and NFAT5. RESULTS: TTN-AS1 expression was stronger in OSCC cells. Knockdown of TTN-AS1 effectively restrained cell proliferation and migration but had inductive role in apoptosis. Moreover, TTN-AS1 could function as the miR-411-3p sponge in OSCC and miR-411-3p exerted the inhibitory functions on OSCC cell growth. In addition, NFAT5 was proven as the target of miR-411-3p. Rescue assay indicated that overexpressing NFAT5 could reverse the inhibitory function of TTN-AS1 depletion on cell growth. CONCLUSION: lncRNA TTN-AS1 contributed to the progression of OSCC via miR-411-3p/NFAT5 axis.

Effects of Harvest Sites on Cryopreserved Adipose-Derived Stem Cells and ASC-Enriched Fat Grafts.

BACKGROUND: Enrichment of adipose-derived stem cells (ASCs) with fat grafts has demonstrated benefit for graft retention and histologic appearance. There is no consensus on the optimal harvest site for adipose-derived stem cells. This study aimed to investigate the effects of harvest sites on the characteristics of cryopreserved adipose-derived stem cells and the graft retention of cell-assisted lipotransfer. METHODS: Lipoaspirates were harvested from 18 healthy volunteers who underwent liposuctions for body contouring. Twenty milliliters of lipoaspirates was, respectively, obtained from four sites, including the upper limb, abdomen, waist, and thighs, by the Coleman technique. Adipose-derived stem cells were ex vivo cultured and cryopreserved for four weeks. The biological characteristics of ASCs from four harvest sites were analyzed: MSC surface markers, cell proliferation, migration ability, and multipotential differentiation. The fat grafts were co-implanted with ASCs from four harvest sites and injected subcutaneously in mice. The ASC-enriched fat grafts were analyzed three months after transplantation. RESULTS: Cryopreserved ASCs from the abdomen and thighs maintained more significant cell proliferation, migration ability, and differentiation potential, compared with cells from the upper limb and waist. Moreover, we achieved better graft retention of cell-assisted fat grafts with cryopreserved ASC from the abdomen and thighs. CONCLUSIONS: The harvest site of adipose tissue affects the cellular activity and differentiation potential of cryopreserved ASCs. Improved understanding of harvest sites for ASCs can optimize the outcomes of cell-assisted fat grafts. Fat grafts enriched with cryopreserved ASCs from the abdomen or thighs are the optimal choices. 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 .

The Effect of Thymosin beta4 on the Survival of Autologous Fat Grafting: A Preliminary Study.

BACKGROUND: Autologous fat grafting is a common procedure to improve tissue deficiencies. However, the survival rate of fat grafting is unpredictable. Thymosin beta 4 (Tß4), a multifunctional peptide containing 43 amino acids, is effective in angiogenesis, inhibiting apoptosis and inflammation. OBJECTIVES: The authors initially investigated the potential effect of Tß4 in fat grafting. METHODS: Adipose tissue premixed exogenous Tß4 were transplanted into rabbit ears. Rabbits were randomly assigned to 3 groups: group A, 5 µg/mL Tß4; group B, 10 µg/mL Tß4; and group C, phosphate-buffered saline buffer as a blank control. The fat grafts were subjected to magnetic resonance imaging at 2, 4, and 12 weeks in vivo. Each harvested graft was analyzed at 3 time points after transplantation. RESULTS: The fat grafts in the Tß4-treated groups showed better volume and weight retention, greater adipose tissue integrity, adipocyte viability, and angiogenesis. The results of dynamic contrast-enhanced magnetic resonance imaging also showed that the experimental groups increased microcirculation perfusion of the grafts. CONCLUSIONS: The study proved that Tß4 could improve adipose tissue survival and neovascularization. It may be useful for fat grafting as a potential protective reagent.

Which Fat Processing Can Achieve Optimal Transplantation in Patients With Insufficient Fat Resource?

BACKGROUND: Autologous fat transfer has been widely used in breast augment surgery. The breast fat graft is different form facial, it needs megavolume grafts. However, most Asian women are thin, who often encounter the fat resource insufficiency during breast augmentation. In fact, some processing methods do contribute to great loss of potential fat that could have been grafted. How to choose a best processing method to achieve optimal transfer in patients with insufficient fat resources is fairly important. METHODS: Lipoaspirate was obtained from 10 healthy female patients who underwent liposuction from abdomen. According to the processing methods, 10-mL initial fat grafts divided into 4 groups: decantation (group A), centrifugation (group B), cotton pad (group C), and cell-assisted lipotransfer (CAL) (group D). Lipoaspirate from each group was compared in the vitro and vivo experiments. The content and function of stromal vascular fraction (SVF) were compared as well as lipoaspirate survival after grafting in nude mice. RESULTS: The SVFs were counted in decantation group 4.32 ± 0.75 × 10/mL, centrifuge group 3.48 ± 0.78 × 10/mL, cotton pad group 1.64 ± 0.84 × 10/mL, CAL group 4.08 ± 0.73 × 10/mL. The decantation group was higher than the cotton pad group (P < 0.05). All the groups' SVFs had capability of multilineage differentiation. The fat graft weight in decantation group: 0.3908 ± 0.023 g, centrifuge group 0.3073 ± 0.015 g, cotton pad group 0.1726 ± 0.019 g, and CAL group 0.2396 ± 0.021 g. The weight of the fat graft in the decantation group was greater than that of the centrifugation group, cotton pad group and CAL group (P < 0.05). There was no significant difference in cell integrity, necrotic cysts and fibrosis between the groups. The vascularization degree in the cotton pad group was lower than that in the decantation group (P < 0.05). CONCLUSIONS: Decantation processing can achieve optimal transplantation in patients who have insufficient fat resources.

M1/M2 Macrophages Play Different Roles in Adipogenic Differentiation of PDGFRα+ Preadipocytes In Vitro.

BACKGROUND: PGGFRα+ preadipocytes are the major subpopulations that can regenerate into adipocytes. Two different types of macrophages exist in the fat tissue: the classically activated macrophage (M1) and the alternatively activated macrophage (M2). In this study, we investigated whether M1/M2 macrophages play distinct roles in adipogenic differentiation of PDGFRα+ preadipocytes. METHODS: Mouse preadipocytes and macrophages were isolated from C57BL/6 male mice of 6-8 weeks. The culture supernate of M1 and M2 macrophages was collected and co-cultured with the PDGFRα+ preadipocytes. After 3 days, Oil Red O staining was used to evaluate to adipogenic differentiation of PDGFRα+ preadipocytes and the expression of adipogenic-related transcription factors (C/EBP-α, PPARγ) were also tested. RESULTS: The results showed that when cultured in vitro, M1 macrophages could significantly suppress the adipogenesis of PDGFRα+ preadipocytes as well as the C/EBP-α and PPARγ expression, but M2 macrophages did not have significant influence on the adipogenesis of PDGFRα+ preadipocytes nor on C/EBP-α and PPARγ expression compared with the control group. CONCLUSIONS: M1 macrophages significantly suppress PDGFRα+ preadipocyte adipogenesis which provides a possible way to improve adipogenesis and fat retention after fat-free grafting by mitigating acute inflammation and manipulating M1 macrophage levels. NO LEVEL ASSIGNED: 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 .

Breast Reconstruction in Poland Syndrome Patients with Latissimus Dorsi Myo Flap and Implant: An Efficient Endoscopic Approach Using Single Transverse Axillary Incision.

BACKGROUND: Breast hypoplasia or amastia with pectoralis major muscle defect in female Poland syndrome patients always necessitates surgical intervention. This study aims to introduce an efficient endoscopic technique to perform breast reconstruction in Poland syndrome patients with a latissimus dorsi myo flap and an implant using a single transverse axillary incision (ELDM + IMPLANT) and to evaluate its safety and effectiveness. METHODS: A prospective study was designed to recruit Poland syndrome candidates for ELDM + IMPLANT breast reconstruction. Only one transaxillary incision was made to harvest the LDM flap and create the anterior chest wall pocket. The LDM flap was transposed to the front to reconstruct the breast with a silicone implant. Patient demographics, LDM area, implant size, contralateral symmetry surgery, operative time and post-operative complications were collected. The BREAST-Q reconstruction module was used to evaluate patient quality of life. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire was used to evaluate patient upper extremity disabilities. RESULTS: Sixteen eligible patients were recruited and received ELDM + IMPLANT-BR. Mean endoscopic time for LDM flap harvesting was 61.6 min. All of the 16 patients recovered uneventfully without any significant complications. The post-operative scores of satisfaction with breast and psychosocial well-being were significantly higher than the pre-operative ones. The score of DASH was 7.1 pre-operatively and 8.3 post-operatively with no significant difference either. The score of satisfaction with outcome was 80.0. CONCLUSIONS: Our proposed ELDM + IMPLANT technique provides a safe and efficient way to reconstruct breasts in Poland syndrome patients with a high satisfaction rate, optimized aesthetic outcome and minimized donor site morbidity. 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 .

Complications Following Subpectoral Versus Prepectoral Breast Augmentation: A Meta-analysis.

BACKGROUND: Subpectoral and prepectoral planes have commonly been used in implant-based breast augmentation. The effect of implant plane on complication rate was still unclear. This meta-analysis demonstrated current evidence with regard to comparison of complication rates between subpectoral and prepectoral breast augmentation. METHODS: Pubmed, EMBASE and Cochrane library were searched to December 2018. The results of selected studies were meta-analyzed to obtain a pooled odds ratio of the effect of subpectoral versus prepectoral breast augmentation on rates of complications. RESULTS: There were significantly lower rates of capsular contracture and hematoma but higher rates of implant displacement and animation deformity in the subpectoral group compared with the prepectoral group. There was no significant difference with regard to rates of reoperation, seroma, rippling, infection and implant rupture between these two groups. CONCLUSIONS: Subpectoral and subglandular breast augmentations both have their merits and demerits with regard to complications. The pros and cons of each procedure should be fully explained to patients and selection of implant plane should be considered more comprehensively. 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 .

The Comparison of Scars in Breast Implantation Surgery with Inframammary Fold Incision Versus Axillary Incision: A Prospective Cohort Study in Chinese Patients.

BACKGROUND: A prospective cohort study was developed to compare the surgical scars in the axilla and the inframammary fold at short-, medium- and long-term time periods after surgery. METHODS: Patients who underwent primary breast augmentation with implants in our department were divided into two groups based on the incision location they chose and were followed up for scar assessment at 1 month, 6 months and 12 months post-surgery from June 2012 to March 2016. Each scar was evaluated by the Vancouver Scar Scale (VSS) and patient satisfaction score. The data were analyzed with Wilcoxon rank-sum tests, Cochran-Armitage trend tests and Fisher's exact probability tests based on the data type. RESULTS: One hundred and sixty-three patients were completely investigated three times. Ninety-four patients underwent breast augmentation surgeries with implants through axillary approaches and 69 patients through IMF approaches. At 1 month after surgery, the median total VSS score was 6 in the axillary incision group and 4 in the IMF group, with statistically significant differences (P < 0.05). Larger proportions of high scores in terms of vascularity and height were found in the axillary incision group (P < 0.05). At 6 months after surgery, the median total VSS score was 4 in the axillary incision group and 3 in the IMF group, with statistical significance (P < 0.05). The axillary group still had a larger proportion of high scores in terms of vascularity and height than that of the IMF group (P < 0.05). At 12 months after surgery, the median total VSS score was 2 in both groups. The median patient satisfaction score was 9 in both groups. No significant differences were noted in the total VSS and patient satisfaction scores between the two groups. However, the axillary group had a larger proportion of high scores in terms of vascularity and low scores in terms of pliability. CONCLUSIONS: The total VSS score for the axillary incision group was significantly higher than that for the IMF incision group one and 6 months after surgery, mainly on the subscales of vascularity and height. At 12 months after surgery, the total VSS scores were not different between the two groups, and patients with both kinds of incisions were highly satisfied with scar appearance. The research confirmed that the scars at two locations can achieve comparable appearance in the long term after surgery. 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 .