One Patient of Blepharoptosis Caused by Levator Palpebrae Superioris Aponeurosis Degeneration.

Ptosis is one of the common diseases of plastic surgery, which is caused by various causes of levator palpebrae superioris dysfunction or Müller muscle insufficiency, which is manifested by the upper eyelid margin being lower than normal when level viewed. Ptosis can be divided into congenital and acquired, and the main cause of congenital ptosis is due to congenital levator palpebrae superioris dysplasia or the motor nerve innervation that innervates it is caused by abnormal oculomotor neurodevelopment and dysfunction. Acquired ptosis can be divided into traumatic, neurogenic, myogenic, senile, mechanical, and false ptosis. At present, there are few reports of ptosis due to the degeneration of the aponeurosis of the upper eyelid muscle. We received a case of ptosis caused by degeneration of the levator palpebrae superioris aponeurotic membrane, we use the method of the levator palpebrae superioris high advancement. The levator palpebrae superioris-Miller muscle was folded to form a stable composite structure by the levator palpebrae superioris high advancement. During the operation, the levator palpebrae superioris was separated along the gap, and the surrounding tissues were less damaged. Therefore, postoperative adhesion was less, and the main complications of severe blepharoptosis after the operation, such as upper eyelid hysteresis and incomplete closure, almost did not occur, and after surgery, the results were good.

Lnc-H19 enhances anaerobic glycolysis of keloid fibroblasts by targeting the miR-214-5p/FGF2 axis.

Long non-coding RNA (lncRNA) H19 has been demonstrated as vital regulator in tumors. However, whether lnc-H19 mediated the development of keloid fibroblasts (KD) was unknown, this study was aimed to clarify the role and molecular mechanisms of lnc-H19 in KD. We have investigated the expression levels of lnc-H19, miR-214-5p and fibroblast growth factor 2 (FGF2) in KD skin samples and normal skin tissues as well as matched cells by real-time quantitative polymerase chain reaction (RT-qPCR) assay. The glycolysis ability of keloid fibroblasts was assessed by measuring glucose consumption, lactate production, and ATP level. The western blot assay was used to assay the expression levels of FGF2 and hexokinase 2 (HK2). Migration and invasion were analyzed by transwell in keloid fibroblasts. The bioinformatics database and dual-luciferase reporter assay were used to search and identify the target of miR-214-5p and lnc-H19. Lnc-H19 was overexpressed in KD tissues and keloid fibroblasts than normal skin tissues and normal fibroblasts, respectively. Small interfering RNA of lnc-H19 treatment markedly inhibited glycolysis, migration and invasion of keloid fibroblasts exposed to hypoxia, which was reserved by silencing of miR-214-5p or upregulation of FGF2. Mechanistically, lnc-H19 regulated KD development by regulation of miR-214-5p/FGF2 axis. In summary, lnc-H19 may exert regulatory functions in KD by targeting miR-214-5p/FGF2 axis, further regulated glycolysis, migration and invasion in keloid fibroblasts exposed to hypoxia, which might be a potential marker of KD diagnosis or progression.

Application of Local Flaps in Repairing Total and Near-Total Lower Lip Defects of Young Patients.

BACKGROUND: It has always been a great challenge for clinical doctors to reconstruct total and near-total lower lip defects. Compared with elderly patients, the repair operation in young patients is more difficult where free flaps are usually used for transfer. In order to obtain better postoperative results, the authors combined two kinds of local skin flaps for operation purpose, and evaluated their postoperative clinical effects. METHODS: From April 2011 to May 2019, a total of 5 young patients with lower lip tumor or trauma were included in this study, with an average age of 30.4 years old. The lesion was all resected and resulted in a defect of 87% to total area of the lower lip, accompanied by a partial defect of the chin each. To repair the defect of the lower lip, the authors firstly used the modified Bernard flap. Then the authors designed the double Abbe flap to perform the operation according to the recovery of the patient 3 months later than the first operation. Finally, the outcomes of either operation were compared upon slit width, mouth opening height, aesthetics, and function of the patients, and statistically analyzed the results. RESULTS: All patients underwent the repair of modified Bernard flaps and double Abbe flaps of with no hemodynamic disorder of the flaps and well-recovery. At 3 months after the operation, the average gap width of lip was 4.34 ±â€Š0.24 cm, the average opening height was 3.18 ±â€Š0.28 cm, the average aesthetic score was 7.98 ±â€Š0.51 (full score of 10), and the average functional score was 11.4 ±â€Š0.55 (full score of 12). The 5 patients showed no obvious scar but a good shape on the lower lip. The function of eating, pronunciation, expression of feelings and smiling change were close to normal. Three patients had mild numbness in the lower lip, while the other two had normal sensory function. CONCLUSION: Combined modified Bernard flap and double Abbe flaps can bring out promising reparative outcomes of near-total or total lower lip defects in lower lip in young patients with good aesthetic and functional recovery, which is recommended while considering surgical alternatives.

[The experimental study of the effect of ASCs on the skin expansion rate in rabbit].

Objective: To explore the effect of adipose-derived stem cells (ASCs) on the skin expansion rate in rabbit. Methods: The rabbit ASCs were isolated from fat tissue and cultured in vitro. The ADSCs were identified by cell immunofluorescence and marked by Edu staining.20 new Zealand rabbits were randomly divided into experimental(n =10) and control group(n =10).An area of 1.5 cm ×1.5 cm on the one side back of each rabbit was tattooed and one 30 ml round expander was implanted subcutaneously. ASCs suspension (1 ml) was injected subcutaneously in the experimental group, while serum free DMEM medium(1 ml) in control group. The expansion was proceeded regularly under constant pressure for 4 weeks.The expanded tattooed square area was measured on the 7th,14th,28th day and analyzed statistically. The expanded skin was harvested for histological study. Immunohistochemical staining was used to detect the expression of vascular endothelial cell marker CD31,and the microvessel density determination. The expression of epidermal growth factor (EGF) and vascular endothelial growth factor(VEGF)was detected by ELISA for skin tissue specificity. Western Blot was used for detection of CK19 in the epidermal cells. Results: The expanded skin thickness and expansion rate in experimental group were significant higher than those in control group (P ＜ 0.05). Compared with control group, the expression of CK19,CD31 and EGF, VEGF, as well as the microvessel density were all markedly increased in experimental group(P ＜0.05). Conclusions: ASCs can increase the expansion rate of skin tissue by promotion of angiogenesis and tissue regeneration.

[EFFECT OF ADIPOSE-DERIVED STEM CELLS COMBINED WITH CHITOSAN ON IMMEDIATE RETRACTION RATE OF EXPANDED SKIN IN RABBIT].

OBJECTIVE: To investigate the effect of adipose-derived stem cells (ADSCs) combined with chitosan on the immediate retraction rate of rabbit expanded skin. METHODS: ADSCs were isolated from rabbit fresh fat under sterile conditions and cultured to the 3rd generation by methods of enzymatic digestion; the specific surface markers and the differentiation into epidermal cells and cartilage cells were identified. Forty New Zealand white rabbits (aged, 2-3 months) were randomly divided into 4 groups (n = 10): control group (group A), ADSCs group (group B), chitosan group (group C), and ADSCs+chitosan group (group D). ADSCs cell suspension with the concentration of 5 x 106 cells/mL was prepared. The skin expansion model was made by embedding 30 mL dilator into the back of rabbit. Chitosan (2%, 5 mL) was coated on the surface of the dilator in groups C and D, and ADSCs cell suspension (1 mL) was injected into the skin in groups B and D. Conventional tissue expansion was performed to expected capacity at 4 weeks, and maintained for 1 week. The expanded skin was harvested to measure the immediate retraction rate, and the thickness of skin, epidermis, and fibrous capsule with HE staining. Masson staining was used to observe the characteristics of collagen in the fibrous capsule, and immunohistochemical staining for CD31 to determine the microvessel density (MVD). RESULTS: ADSCs were successfully isolated, and had multiple differentiation ability. All the animals survived to the end of the experiment. The immediare retraction rate of group D was significantly lower than that of the other groups (P < 0.05), groups B and C were significantly lower than group A (P < 0.05), and group B was significantly lower than group C (P < 0.05). The histological staining revealed that there were more mature fibroblasts and coarse collagen fibers with regular arrangement in groups A and B; there were more naive fibroblasts and tiny and sparse collagen fibers in groups C and D. The thickness of skin and epidermis, and MVD of groups B and D were significantly larger than those of groups A and C (P < 0.05); the thickness of fibrous capsule of groups C and D was significantly less than that of groups A and B (P < 0.05); but no significant difference was found in the above indexes between other groups (P > 0.05). CONCLUSION: ADSCs can promote angiogenesis and regeneration of the expanded skin, have no effect on the fibrous capsule. Chitosan can inhibit the proliferation of fibrous capsule, so a combination of ADSCs and chitosan can inhibit the immediate retraction of the expanded skin.

FOXL2 suppresses proliferation, invasion and promotes apoptosis of cervical cancer cells.

FOXL2 is a transcription factor that is essential for ovarian function and maintenance, the germline mutations of which give rise to the blepharophimosis ptosis epicanthus inversus syndrome (BPES), often associated with premature ovarian failure. Recently, its mutations have been found in ovarian granulosa cell tumors (OGCTs). In this study, we measured the expression of FOXL2 in cervical cancer by immunohistochemistry and its mRNA level in cervical cancer cell lines Hela and Siha by RT-PCR. Then we overexpressed FOXL2 in Hela cells and silenced it in Siha cells by plasmid transfection and verified using western blotting. When FOXL2 was overexpressed or silenced, cells proliferation and apoptosis were determined by Brdu assay and Annexin V/PI detection kit, respectively. In addition, we investigated the effects of FOXL2 on the adhesion and invasion of Hela and Siha cells. Finally, we analyzed the influences of FOXL2 on Ki67, PCNA and FasL by flow cytometry. The results showed that FOXL2 was highly expressed in cervical squamous cancer. Overexpressing FOXL2 suppressed Hela proliferation and facilitated its apoptosis. Silencing FOXL2 enhanced Siha proliferation and inhibited its apoptosis. Meanwhile, silencing FOXL2 promoted Siha invasion, but it had no effect on cells adhesion. In addition, overexpressing FOXL2 decreased the expression of Ki67 in Hela and Siha cells. Therefore, our results suggested that FOXL2 restrained cells proliferation and enhanced cells apoptosis mainly through decreasing Ki67 expression.

[Complex of auto-cartilage grafting and silicone implant for open nasal plasty].

OBJECTIVE: To investigate the surgical methods and outcome of reshaping the nose by using autologous cartilage grafting-silicone gel complex combined with trimming the lower lateral cartilages and thinning the superfluous tissue of the tip. METHODS: Between May 2006 and July 2008, 36 patients with ugly nose shape received open nasal plasty by thinning the superfluous tissue and trimming the lower lateral cartilages combined with implant of auto-cartilage and silicone gel complex. There were 3 males and 33 females with an average age of 23 years (range, 18-36 years), including 20 cases of hypertrophy and obtuse round of nasal tip, 10 cases of flat of nasal tip, 2 cases of slight nostril exposure, and 4 cases of small whole nose with hypertrophy of nasal tip. Among them, 8 cases received 2-time operations. RESULTS: All incisions achieved healing by first intention. No deformation and complication occurred at donor sites of cartilage. The appearance, contour, color, and touch sensation of the nose were satisfactory and no complications of prosthesis exposure and skin redness of the nasal tip occurred. At 3-5 months after operation, the appearance of the nasal tip was satisfactory when part of the soft tissue was absorbed. Thirty-two patients were followed up 3-12 months (6 months on average), who were satisfied with the appearance of nose with good correct rate. CONCLUSION: Nasal plasty by using auto-cartilage grafting and silicone implant combined with trimming the lower lateral cartilages and thinning the superfluous tissue of the tip is an effective method especially for round or bulbous nasal tip.

[Clinical results of primary and complex resection of levator palpebrae superioris musculus in treatment of blepharophimosis-ptosis-epicanthus inversus syndrome].

OBJECTIVE: To observe the clinical outcome of treating blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) by means of primary and complex resection of levator palpebrae superioris musculus. METHODS: From May 2001 to May 2007, 12 patients with BPES were treated, including 6 males and 6 females aged 4-15 years old (average 7 years old). All patients marked signs of BPES--typical ptosis of the upper eyelids, epicanthus inversus, palpebral fissure, and increased distance between inner canthus. The eye fissure width was (2.8 +/- 1.8) mm, the eye fissure length was (19.8 +/- 4.7) mm, and the inner canthi diameter was (41.6 +/- 6.5) mm. The muscular strength of levator palpebrae superioris was deficient in 4 cases, the muscular strength of levator palpebrae superioris was (2.0 +/- 0.6) mm in 8 cases. All patients were associated with visual function congenital defects of varying degrees. The surgical technique included shortening of the internal canthal ligaments, resection of the tarsus and levator muscle, and skin plasty. RESULTS: All the incisions healed by first intension. Twelve patients were followed up for 12-48 months (average 30 months). Amelioration of ptosis and epicanthus was achieved. At 18 months after operation, the eye fissure width of 10 patients was (9.0 +/- 2.1) mm, the eye fissure length was (26.5 +/- 3.5) mm, and inner canthi diameter was (30.2 +/- 2.7) mm, the muscular strength of levator palpebrae superioris increased to (5.6 +/- 1.9) mm, showing significant difference when compared with preoperation (P < 0.05). CONCLUSION: The primary and complex resection of levator palpebrae superioris musculus can provide relating good cosmetic and functional results for the correction of BPES. Patients with BPES should receive surgery as early as possible.

Effects of chondrogenic microenvironment on construction of cartilage tissues using marrow stromal cells in vitro.

OBJECTIVE: To investigate whether it is feasible to use the chondrogenic microenvironment provided by cartilage cells to construct cartilage tissues in vitro with bone marrow stromal cells (BMSC). MATERIALS AND METHODS: We isolated and cultured BMSC and cartilage cells from Sprague Dawley rats (SD rats). The supernatant of cartilage culture was used as inducing solution to cause differentiation of BMSC from the second generation of cells cultured in vitro. Cells were examined seven days later, using immunohistochemistry to determine the expression of collagen specific to type II cartilage. RT-PCR was used to detect the expression of type II collagen and aggrecan mRNA. BMSC and cartilage cells were isolated from SD rats and cultured in vitro. The BMSC and cartilage cells in culture were mixed evenly in an 8:2 ratio and inoculated into a polyglycolic acid/polylactic acid (PGA/PLA) scaffold to a final concentration of 5.0x10(7) cells/ml. PGA/PLA preparations with pure cartilage cells or pure BMSC served as the positive and negative controls, respectively. The control group of low-concentration cartilage cells consisted of PGA/PLA preparations containing cartilage cells at 20% of the above mentioned concentration (1.0x10(7) cells/ml). Samples were collected eight weeks later, at which time general observations, wet weight, and glycosaminoglycan (GAG) levels were determined, and histological and immunohistochemical examinations were performed. RESULTS: Immunohistochemistry showed the induction of BMSC type II collagen, and RT-PCR indicated the expression of type II collagen and aggrecan mRNA. In the mixed-cell group and the positive control group, pure mature cartilage cells were produced after eight weeks of culture in vitro, and the size and shape of the scaffold were maintained throughout the culture period. The two groups gave rise to newly generated cartilage cells essentially identical in appearance and histological properties. The immunohistochemical results showed that the cartilage cells of both groups expressed abundant cartilage-specific type II collagen. The average wet weight and GAG content were more than 70% of the values in the positive control group. Only an extremely small amount of immature cartilage tissue formed in local regions in the BMSC-only sample, and the scaffold was obviously shrunken and deformed. Although the wet weight of newly generated cartilage tissue in the low-concentration cartilage cell sample reached 30% of the value of the positive control group, the scaffold was obviously shrunken and deformed. Only regional and discontinuous cartilage tissues were formed, and the amount of newly generated cartilage was obviously less than in the co-culture and positive control groups. CONCLUSIONS: Cartilage cells can provide a microenvironment for cartilage formation to some extent, and also effectively induce BMSC to differentiate into cartilage cells and form tissue-engineered cartilage in vitro.

[Nasal septum cartilage-silica gel complex for repairing nasal deformities of unilateral cleft lip].

OBJECTIVE: To evaluate the operative methods and therapeutic effects of nasal septum cartilage-silica gel complex for two-stage repair of nasal deformities of unilateral cleft lip. METHODS: From June 2001 to June 2007, 38 cases of secondary nasal deformity and septum deviation of cleft lip were treated with transplanting nasal septum cartilage-silica gel complex. Among of them, there were 21 males and 17 females, aging 14-23 years with an average of 17.6 years. All cases were with nasal deformities of unilateral cleft lip, including 21 cases of complete cleft lip and 17 cases of incomplete cleft lip. The locations were left side in 26 cases and right side in 12 cases. Nasal deformities were columella nasi deflexion, flattened nasal tip, pteleorrhine and alanasi collapse. The patients received 1-4 times operations, and the interval of two operations was 3-10 years (mean 5.5 years). According to nasal deformity, the nasal septum cartilage of 1.8 cm x 1.2 cm was cut, and transplanted into the nose point phantom surface forming "the shield" to extend nose column and to raise the tip of the nose. At the same time the nasal tip fat-connective tissue flap graft with fat knot was given. After fixation, the nasal alar cartilage and soft tissues were reduced to normal position. RESULTS: Primary healing of the incisions was achieved in all cases. The nasal deformity was corrected. The postoperative follow-up period was 12-18 months with an average of 15.6 months. All the patients of regional cartilage scars had no complication. The figure of nose was slinky, the height of apex of nose and the shape of nose was natural, the apex of nose, nasal ala, nostrils and nasal columella were satisfactory [(the results were satisfactory in 30 cases (78.9%), general in 8 cases (21.1%)]. The nose department overall esthetics shape was improved in all the patients, no complications of the phantom sliding, shifting and exposure, hemorrhage and infection occurred. CONCLUSION: The nasal septum cartilage-silica gel complex to repair the nasal deformities of unilateral cleft lip is an ideal operation style.