Submucosal Trans-Septal Suturing Technique After a Septal Extension Graft with Porous High-Density Polyethylene: A Technical Report.

BACKGROUND: Porous high-density polyethylene (pHDPE) is an alternative material for a septal extension graft (SEG) in oriental rhinoplasty when autologous cartilage is limited. Although nasal packing (NP) and trans-septal suturing (TSS) techniques are routine procedures to obviate the dead space after septoplasty, they are associated with certain discomforts and complications. OBJECTIVE: To investigate the application of a submucosal trans-septal suturing (STSS) technique after SEG with pHDPE. METHODS: A prospective study was conducted on 60 female participants who underwent SEG with pHDPE. The participants were randomly divided into the NP group and STSS group. The extra surgical duration of NP and STSS, pain, nasal obstruction, and sleeping disturbance as well as postoperative complications were recorded and compared between groups. RESULTS: No significant difference was found between group NP and group STSS in terms of mean age. The mean extra surgical duration of group STSS was significantly longer than group NP. There were significant higher pains of group NP at 24 hours and 48 hours postoperatively, compared with group STSS. The NP group also experienced significantly more nasal obstruction and sleep disturbance within 48h postoperatively compared to the STSS group. There was one infection in each group, minor bleeding in two NP patients, and one STSS patient. There was no major bleeding, hematoma, graft exposure, or septal perforation in both groups. CONCLUSION: Although STSS needs a longer extra surgical duration than NP, it significantly improves the patient's postoperative comfort with a faster return to normal respiration compared to NP. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

SNX10 promoted liver IR injury by facilitating macrophage M1 polarization via NLRP3 inflammasome activation.

BACKGROUND: Liver ischemia reperfusion (IR) injury is a common cause of liver dysfunction in patients post liver partial resection and liver transplantation. However, the cellular defense mechanisms underlying IR are not well understood. Macrophage mediated sterile inflammation plays critical roles in liver IR injury. Sorting nexin (SNX) 10, a member of the SNX family which functions in regulation of endosomal sorting. This study aimed to explore the role of sorting nexin 10 (SNX10) during liver IR injury with a focus on regulating macrophage function. METHODS: Both the gene and protein expression levels of SNX10 were analyzed in human specimens from 10 patients undergoing liver partial resection with ischemic insult and in a mouse model of liver IR. The in vivo effects of SNX10 in liver IR injury and sterile inflammation in mice were investigated. Bone marrow derived macrophages (BMDMs) were used to determine the role of SNX10 in modulating macrophage function in vitro. RESULTS: Increased expression of SNX10 was observed both in human specimens and mice livers post IR. SNX10 knockdown alleviated IR induced sterile inflammation and liver damage in mice. SNX10 promoted M1 polarization of macrophage treated with LPS and facilitated inflammatory response by activating NLRP3 inflammasome. CONCLUSIONS: We report for the first time that SNX10 is upregulated in IR-stressed livers. SNX10 activation aggravates liver IR injury and sterile inflammation by facilitating macrophage M1 polarization and inflammatory response suggesting SNX10 as a potential therapeutic target for liver IR injury.

Application of a Single T-Shaped Porous High-Density Polyethylene in Oriental Nasal Tip-Plasty.

Porous high-density polyethylene (pHDPE) is an alternative material for septal extension grafts. This study investigated the clinical application of a single T-shaped pHDPE graft combined with auricular cartilage in oriental nasal tip-plasty. A retrospective analysis was conducted of 66 patients who underwent septal extension graft with a T-shaped pHDPE and auricular cartilage graft from December 2018 to November 2021. All patients were female from 19 to 51 years old (average: 28.9 years). Patients were followed up for 5 to 40 months with an average of 23.8 months. The postoperative nasal length (39.8±3.7 mm) was significantly improved (35.6±5.7 mm preoperatively, P <0.0001) with the tip projection increasing from 23.9±2.3 mm preoperatively to 25.3±2.4 mm postoperatively ( P =0.0005). There was a significant difference in the nasolabial angle (96.8±14.1 degrees preoperatively versus 101.8±7.2 degrees postoperatively, P =0.0105) but no significant change in the nasofrontal angle (143.3±9.5 degrees preoperatively versus 143.7±5.5 degrees postoperatively, P =0.7546), with an improved tip projection achieved in 93.9% of patients. One patient had an abscess in the nasal septum and a tip graft was performed using auricular cartilage in another patient because of an insufficient postoperative tip projection. There was a slight tip deviation in 2 patients, 1 case of a deviated nasal tip was corrected with a pHDPE sheet graft, while the other was left intact. Two patients had excess cartilaginous graft protruding to the nasal cavity that did not affect nasal ventilation and the shape of the nasal tip was relatively good, so the prominent cartilaginous graft was not addressed. In conclusion, this technique not only improved the bulbous nasal tip, lengthened the short nose, and increase the tip projection, but also prevented absorption of the existing septal cartilage and reduced infection or extrusion of the pHDPE.

p16INK4a Plays Critical Role in Exacerbating Inflammaging in High Fat Diet Induced Skin.

Background: Long term high fat diets (HFD) promote skin aging pathogenesis, but detailed mechanisms remain unclear especially for inflammaging, which has recently emerged as a pathway correlating aging and age-related disease with inflammation. p16INK4a (hereafter termed p16) inhibits the cell cycle, with p16 deletion significantly inhibiting inflammaging. We observed that HFD-induced p16 overexpression in the skin. Therefore, we investigated if p16 exacerbated inflammaging in HFD-induced skin and also if p16 deletion exerted protective effects against this process. Methods: Eight-week-old double knockout (KO) ApoE-/-p16-/- mice and ApoE-/- littermates were fed HFD for 12 weeks and their skin phenotypes were analyzed. We measured skin fibrosis, senescence-associated secretory phenotype (SASP) levels, and integrin-inflammasome pathway activation using histopathological, RNA-sequencing (RNA-seq), bioinformatics analysis, and molecular techniques. Results: We found that HFD contributed to inflammaging in the skin by activating the NLRP3 inflammasome pathway, increasing inflammatory infiltration, and promoting apoptosis by balancing expression between proapoptotic and antiapoptotic molecules. p16 knockout, when compared with the ApoE-/- phenotype, inhibited skin fibrosis by ameliorating inflammatory infiltration and proinflammatory factor expression (Interleukin-1ß (IL-1ß), Interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α)), and also alleviated inflammaging skin progress induced by HFD in the ApoE-/- mouse model. RNA-seq showed that p16 KO mice inhibited both integrin-inflammasome and NF-κB proinflammatory pathway activation. Conclusions: p16 deletion or p16 positive cell clearance could be a novel strategy preventing long term HFD-induced skin aging.

The Biosynthetic Pathway of Ergothioneine in Culinary-Medicinal Winter Mushroom, Flammulina velutipes (Agaricomycetes).

Ergothioneine is a natural 2-thiol-amidazole amino acid that plays an important role in inflammation, depression, and cardiovascular disease. Flammulina velutipes is a common basidiomycete mushroom rich in ergothioneine (EGT). However, the biosynthetic pathway of EGT in F. velutipes is still unclear. In this study, the F. velutipes ergothioneine biosynthetic gene 1 (Fvegtl), F. velutipes ergothioneine biosynthetic gene 2 (Fvegt2), and F. velutipes ergothioneine biosynthetic gene 3 (Fvegt3) were cloned and expressed, and the activities of the proteins encoded by these three genes (FvEgt1, F. velutipes ergothioneine biosynthase 1; FvEgt2, F. velutipes ergothioneine biosynthase 2; and FvEgt3, F. velutipes ergothioneine biosynthase 3) were identified. The results showed that FvEgtl not only has the function of methyltransferase, but also has the function of hercynlcysteineteine sulfoxide (Hersul) synthase, which can catalyze the production of Hersul from histidine and cysteine in F. velutipes. FvEgt2 and FvEgt3 are two functionally different cysteine desulfurase enzymes. Among them, FvEgt2 is a cysteine-cysteine desulfurase-which catalyzes the activation of the S-H bond on cysteine, while FvEgt3 is a pyridoxal phosphate (PLP)-dependent cysteine desulfurase responsible for catalyzing the production of ketimine complex. Our results show that FvEgt1/FvEgt2/FvEgt3 can simultaneously catalyze the production of EGT by histidine, cysteine, and pyridoxal phosphate. Collectively, the in vitro synthesis of EGT in the edible fungus F. velutipes was first achieved, which laid the foundation for the biological production of EGT.

Human amnion-derived mesenchymal stem cells protect against UVA irradiation-induced human dermal fibroblast senescence, in vitro.

The aim of the present study was to determine if human amnion­derived mesenchymal stem cells (HAMSCs) exert a protective effect on ultraviolet A (UVA) irradiation-induced human dermal fibroblast (HDF) senescence. A senescence model was constructed as follows: HDFs (104­106 cells/well) were cultured in a six­well plate in vitro and then exposed to UVA irradiation at 9 J/cm2 for 30 min. Following the irradiation period, HDFs were co­cultured with HAMSCs, which were seeded on transwells. A total of 72 h following the co­culturing, senescence­associated ß­galactosidase staining was performed and reactive oxygen species (ROS) content and mitochondrial membrane potential (Δψm) were detected in the HDFs via flow cytometric analysis. The results demonstrated that the percentage of HDFs, detected via staining with X­gal, were markedly decreased when co­cultured with human HAMSCs, compared with the group that were not co­cultured. The ROS content was decreased and the mitochondrial membrane potential (Δψm) recovered in cells treated with UVA and HAMSCs, compared with that of cells treated with UVA alone. Reverse transcription­quantitative polymerase chain reaction revealed the significant effects of HAMSCs on the HDF senescence marker genes p53 and matrix metalloproteinase­1 mRNA expression. In addition to this, western blot analysis verified the effects of HAMSCs on UVA induced senescence, providing a foundation for novel regenerative therapeutic methods. Furthermore, the results suggested that activation of the extracellular­signal regulated kinase 1/2 mitogen activated protein kinase signal transduction pathway, is essential for the HAMSC­mediated UVA protective effects. The decrease in ROS content additionally indicated that HAMSCs may exhibit the potential to treat oxidative stress­mediated UVA skin senescence in the future.

Protective effect of pyrroloquinoline quinine on ultraviolet A irradiation-induced human dermal fibroblast senescence in vitro proceeds via the anti-apoptotic sirtuin 1/nuclear factor-derived erythroid 2-related factor 2/heme oxygenase 1 pathway.

The aim of the present study was to determine whether pyrroloquinoline quinine (PQQ) exerts a protective effect on ultraviolet A (UVA) irradiation­induced senescence in human dermal fibroblasts (HDFs) and to elucidate its mechanism of action in vitro. A senescence model was constructed as follows: HDFs (1x10(4)­1x10(6)) were cultured in a six­well plate in vitro and then exposed to UVA irradiation at a dosage of 9 J/cm2. Various concentrations of PQQ (50, 100 and 200 ng/ml) were added to the culture medium 24 h prior to UVA exposure. Following 72 h of irradiation, senescence­associated ß­galactosidase staining was performed in order to evaluate the senescence state. Furthermore, mRNA expression of the senescence marker genes matrix­metalloprotease (MMP)1 and MMP3 was determined using reverse transcription quantitative polymerase chain reaction. Protein expression of sirtuin (SIRT)1, SIRT6, nuclear factor erythroid 2­related factor 2 (Nrf2) and heme oxygenase 1 (HO­1) were detected using western blot analysis. The results showed that the percentage of cells stained by X­gal following 9 J/cm2 UVA irradiation was markedly increased compared with that of the control group (53 and 8%, respectively), while 50 ng/ml PQQ attenuated the ratio of positive staining compared with that of the UVA­only cells (29 vs. 53%, respectively). Expression of fibroblast senescence marker genes MMP1 and MMP3 was decreased in cells treated with UVA and 50 ng/ml PQQ compared with that of cells in the UVA­only group. Western blot analysis revealed significant effects of PQQ on SIRT1 and SIRT6. Nrf2 and HO­1 exbibited mild changes with the same trend when treated with or without UVA and PQQ. In conclusion, the results of the present study showed that pyrroloquinoline quinine may have a protective effect on UVA irradiation­induced HDF aging, which may be associated with the anti­apoptotic SIRT1/Nrf2/HO­1 pathway as well as SIRT6 signaling.

[Value of X-ray combined with ultrasound in the diagnosis and treatment of solitary osteochondroma].

OBJECTIVE: To explore the most appropriate imaging examinations for solitary osteochondroma in primary hospitals. METHODS: A retrospective evaluation was performed to analyze the imaging examinations (including X-ray, CT, and ultrasound) of 62 patients undergoing surgeries for solitary osteochondroma in terms of the diagnostic results and preoperative expenditure of the patients. RESULTS: X-ray and CT have a high diagnostic value for solitary osteochondroma, but X-ray cannot display cartilage and lesions in surrounding soft tissues. Ultrasound is limited in diagnosis of solitary osteochondroma, but performed well as CT in displaying cartilage and lesions in surrounding soft tissues. There was no statistical difference between combined X-ray and ultrasound and CT in diagnosis of solitary osteochondroma (P>0.05), but the former had a lower cost (P<0.05). CONCLUSION: X-ray combined with ultrasound has almost comparable value with CT in the diagnosis of solitary osteochondroma and is more practical for application in primary hospitals.

A modified septal extension graft for the Asian nasal tip.

IMPORTANCE: Septal extension graft is an effective procedure in tip plasty because it can provide stable structural support for the nasal tip. However, in Asian patients septal cartilage is much weaker, thinner, and smaller than that of white people, causing the existing caudal septal cartilage and the septal extension graft to deviate to the opposite side of graft placement. OBJECTIVE: To introduce an effective and reliable modified septal extension graft in tip plasty. DESIGN, SETTING, AND PARTICIPANTS: Observational study of a total of 143 patients (84 undergoing primary rhinoplasty and 59 undergoing secondary rhinoplasty). INTERVENTION: A modified septal extension graft technique in combination with other procedures, including tip graft and implant augmentation. MAIN OUTCOME AND MEASURE: Subjective evaluation based on photographic analysis. RESULTS: This procedure was applied in 143 Asian patients, with substantial improvement seen in the nasal tip of all patients except for 3 (1 for the overprojected nasal tip and 2 for bending of existing caudal septum). Other complications included infection in 1 patient and implant deviation in 1 patient; the implant and grafts were removed 10 days after surgery in the patient with infection. The other patient underwent revision 3 months after surgery for the deviated implant. CONCLUSIONS AND RELEVANCE: This technique is an effective method to provide long-term, stable nasal tip support. It helps to set the existing caudal septum and the septal extension grafts exactly at the anterior midline and decrease the deviation of the nasal tip. LEVEL OF EVIDENCE: 4.

Modified technique of chin augmentation with MEDPOR for Asian patients.

BACKGROUND: Commonly used chin implants are made of silicone, expanded polytetrafluoroethylene (e-PTFE), or high-density porous polyethylene (MEDPOR). Although MEDPOR is an effective implant for chin augmentation, modification of the external aspect of the implant is recommended, particularly for Asian patients, to create an appropriate shape for the new chin. It is often difficult to contour the inner aspect of the implant to conform to the patient's mandible. Without modification, a gap may exist between the implant and mandible. To address this problem, a modified augmentation technique was developed. OBJECTIVES: The authors describe their modified technique for MEDPOR chin augmentation, which includes removal of the genial tubercles and, if necessary, the mental protuberance. METHODS: Ninety-five patients underwent the modified MEDPOR technique of chin augmentation. Before placement of the contoured implant, a drill was used to remove the patient's genial tubercles. If the mental protuberance was deemed too prominent, it was removed as well. The implant was inserted and fixed to the mandible with 2 titanium screws. RESULTS: Results were satisfactory in 90 cases. Chin shape was too "strong" in 4 patients, and another patient had poor transition between the implant and mandible. Complications were minimal. The most common complication in this modified technique was lower lip numbness, which was transient in all cases. CONCLUSIONS: The MEDPOR chin implant can be effectively contoured to the mandible by removing the genial tubercle and/or mental protuberance. This technique is less invasive than chin osteotomy. Successful results can be achieved with minimal risks.

Modification of square face in men.

BACKGROUND: Women with elliptical faces are considered to be aesthetically appealing in Asia. Some men prefer this shape for themselves and choose to have their square-shaped face altered to an elliptical shape. To accomplish this, we perform an ostectomy that includes resection of the mandibular angle, splitting of the lateral cortex, and reduction in the width of the chin. METHODS: Nineteen men with a square face (aged 22-30 years) underwent ostectomy, including resection of the mandibular angle, splitting of the lateral cortex around the mandibular angle, and reduction of the width of the chin by an intraoral approach. RESULTS: The results of the ostectomy were satisfactory 3 to 6 months postoperatively. The bigonial distance was effectively reduced and stable chin contours were achieved. The overall shape of the face was elliptical. There was no microgenia, facial asymmetry, hematoma, infection, or permanent mental nerve injury. CONCLUSION: Ostectomy that includes resection of the mandibular angle, splitting of the lateral cortex, and reduction in the width of the chin is a safe and effective method to modify a man's square-shaped face into a more elliptical appearance.

Temporal augmentation using a polytetrafluoroethylene implant with the assistance of an endoscope.

BACKGROUND: Expanded polytetrafluoroethylene (e-PTFE), invented by W. L. Gore in the late 1960s, has become a popular material in facial plastic and reconstructive surgery. The use of e-PTFE sheets in the temporal region is reported by some authors and achieving good results. Endoscopic techniques, characterized by small incisions, slight injury, and fewer complications, can be applied in many fields. With the assistance of an endoscope, temporal augmentation with e-PTFE is performed under direct sight, and complications can be reduced. This study aimed to investigate endoscopically assisted temporal augmentation using e-PTFE. METHODS: In this study, 16 patients with concave temporal regions underwent temporal augmentation using e-PTFE with the assistance of an endoscope. The implants were inserted in the plane overlying the deep temporal fascia. RESULTS: Most of the patients were satisfied with the result. One patient had mild temporal area asymmetry, which did not need revision. Another patient had paralysis of the temporal branch of the facial nerve and recovered 3 months after surgery. No infection, foreign body reaction, implant rejection or extrusion, hematoma, seroma, or curling of the edge of the implant occurred. CONCLUSION: Endoscopic procedures are characterized by small incisions, slight tissue injury, direct vision, and fewer complications. Such procedures are helpful in the reconstruction of concave temporal regions using e-PTFE.

Another use of the alar cartilaginous flap.

BACKGROUND: Resection of the cephalic or middle portion of lateral crura of alar cartilages is a method for correcting bulbous nose in which the resected cartilages usually are discarded, resulting in a waste of autologous tissues. A silastic implant usually is used to correct saddle nose in Asian countries, but implant extrusion, a severe complication, sometimes occurs. Cartilage flaps were first reported by José to increase the projection of the nasal tip. In this study, the authors used cartilaginous flaps of the lateral crura to wrap the tip of the nasal implant for patients with bulbous and saddle noses. This study aimed to investigate the application of cartilaginous flaps of lateral crura. METHODS: A flap was created from the cephalic portion of the lateral crus of the alar cartilage, leaving the caudal portion intact. The cartilage flap remained attached at the level of the original domal segment of the middle crura. It was rotated over to wrap the tip of the silastic implant, then sutured to the other side flap. RESULTS: From March 2003, 19 patients were treated with this technique. The results were satisfactory without implant extrusion or any other complications except for nonobvious scars. CONCLUSION: The cartilage flap can reduce the incidence of implant extrusion and help to reduce the size of the bulbous tip.

[Mask lift and facial aesthetic sculpturing].

OBJECTIVE: To improve the outcome of the face-lift with a craniofacial contouring procedure. METHODS: Thirty-seven patients aged 29-53 years (31 in female, 6 in male) were treated through a bicoronal incision. The facial tissue was lifted through a subperiosteal procedure and the facial skeleton was remodeled in three dimensions by osteotomies. RESULTS: The results were satisfactory after the 3-12 months of the follow-ups. CONCLUSIONS: The Face-lift combined with the facial aesthetic sculpturing may be more effective for the aging-face rejuvenating.

[Contour changing of forehead].

OBJECTIVE: To bring forward a method to improve the prominence of the forehead contour. METHODS: 16 patients(age 29-53 years, female 11, male 5) were treated through a bicoronal incision. Following the incision, the forehead soft tissues are reflected down to the level of the superior orbital rims with the protection to the supraorbital neurovascular bundles. To adjust the forehead contour, both superior orbital rims and frontal bossing was reduced by burring down the excess bone or removing the anterior wall of the forehead. RESULTS: The operative effect were satisfactory during 3-12 months of follow-up. No recurrence or osteogenesis were found in the cases. Nasofrontal angle and forehead angle were normal. The prominence of the supraorbital ridges disappeared and forehead became nature. CONCLUSION: Cranioplasty via an osteomy or burring of the outer line of forehead bone are safe, compact and effective way to improve the prominence of the superior orbital rims or frontal bossing.