Objective Noninvasive Measurement of the Volumizing Effect of a Dermal Filler: An In Vivo Study.

BACKGROUND: Information about the volumizing effects of dermal fillers is critical for physicians' understanding of product features and prudent decision-making in clinical practice. It is important for material engineers to develop and optimize new dermal fillers, especially when comparing the physiochemical properties of a new product with those of existing fillers that are used worldwide. OBJECTIVE: This study aimed to establish a reliable, noninvasive method for in vivo quantitative evaluation of the filling effect in order to predict possible effectiveness after filler injection and to evaluate the degradation trend over time. METHODS: A rabbit model of ear injection with dermal fillers was established. Hyaluronic acid (HA) filler was injected into the subcutaneous layer of rabbit ears, resulting in a stable skin bulge. Ultrasonography was used to noninvasively measure the skin bulge for volume calculation; the volume change was analyzed periodically until 38 weeks. Pathological examination, the gold standard, was performed to confirm degradation. RESULTS: The immediate volumizing effect of HA filler injection was macroscopically observed as a local skin bulge. Ultrasound was able to precisely detect the shape of the filler and calculate the length, width, and height of the skin bulge at each time point. The degree of uplift and amount of residual samples in the pathological evaluation were consistent with the results of morphological observation using ultrasound. CONCLUSION: Evaluation of the volume impact of dermal filler through the rabbit ear injection model evaluation enables material science evaluation in the early stage of material development, and has certain clinical reference value. 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 .

Promotion of adipose stem cell transplantation using GelMA hydrogel reinforced by PLCL/ADM short nanofibers.

Adipose-derived mesenchymal stem cells (ADSCs) show poor survival after transplantation, limiting their clinical application. In this study, a series of poly(l-lactide-co-ϵ-caprolactone) (PLCL)/acellular dermal matrix (ADM) nanofiber scaffolds with different proportions were prepared by electrospinning. By studying their morphology, hydrophilicity, tensile mechanics, and biocompatibility, PLCL/ADM nanofiber scaffolds with the best composition ratio (PLCL:ADM = 7:3) were selected to prepare short nanofibers. And based on this, injectable gelatin methacryloyl (GelMA) hydrogel loaded with PLCL/ADM short nanofibers (GelMA-Fibers) was constructed as a transplantation vector of ADSCs. ADSCs and GelMA-Fibers were co-cultured, and the optimal loading concentration of PLCL/ADM nanofibers was investigated by cell proliferation assay, live/dead cell staining, and cytoskeleton stainingin vitro. In vivoinvestigations were also performed by H&E staining, Oil red O staining, and TUNEL staining, and the survival and apoptosis rates of ADSCs transplantedin vivowere analyzed. It was demonstrated that GelMA-Fibers could effectively promote the proliferation of ADSCsin vitro. Most importantly, GelMA-Fibers increased the survival rate of ADSCs transplantation and decreased their apoptosis rate within 14 d. In conclusion, the constructed GelMA-Fibers would provide new ideas and options for stem cell tissue engineering and stem cell-based clinical therapies.

The Role of Interchain Force and/or Chain Entanglement in the Melt Strength and Ductility of PLA-Based Materials.

As an eco-friendly material, PLA was a desirable alternative to polyethylene and polypropylene films due to its biodegradability. The preferable melt strength of PLA-based materials was a key factor in ensuring its processing using extrusion blow. This paper focuses on the influence of interchain force and/or chain entanglement on the melt strength and ductility of PLA-based materials in recent years. In addition, the preparation of PLA-based materials via physical blending or reactive processing was also summarized. The blending of PLA with a flexible heteropolymer, driven by the interchain force and/or chain entanglements, were characterized as a practicable method for toughening PLA-based materials. Also, the restructuring of PLA chains, by branching based on chain entanglement, was suitable for increasing chain entanglements in PLA matrix, yielding satisfactory melt strength and ductility. This review aims to elucidate the relationship between interchain forces and/or entanglement with the melt strength and ductility of PLA-based materials. An essential and systematic understanding of the tailoring melt strength and rheological properties of PLA by interchain forces and/or entanglement was apt to improve and perfect the processing technology of the extrusion blow, and consequently improve the tensile strength and toughness of PLA films.

Role of macrophage polarisation in skin wound healing.

Skin wound healing is a complex pathophysiological change that is driven by macrophages and their secreted related factors. Depending on the stimuli, macrophages can be polarised into two subtypes of macrophages with completely different phenotypes and functions, namely M1 and M2. The aim of this study was to explore the role of M1 and M2 macrophages in skin healing in order to develop new drugs for the treatment of refractory wounds. Primary bone marrow-derived macrophages (BMDMs) were isolated from rats and expanded in vitro using macrophage colony stimulating factor. In addition, the BMDMs were polarised into the M1 and M2 subtypes using lipopolysaccharides (LPS) and interleukin-4 (IL-4), respectively. Cytokine levels in the culture supernatants were measured by an enzyme linked immunosorbent assay. Epidermal wounds were made on the dorsal surface of rats, and treated with M1 or M2 cell suspensions or phosphate buffered saline. Wound healing was recorded on days 1, 3, 7, 10, and 14 after stamping, and the wound healing rate was measured by haematoxylin-eosin and Masson staining. A total of 3 to 4 × 107 bone marrow cells were extracted from each rat femur. The BMDM culture had 87.1% CD45+ cells, 89.2% CD68+ cells, and 86.5% CD45+ CD68+ cells. Furthermore, IL-12 (P < .05) and IL-10 (P ≥ .05) levels, respectively, increased and decreased in the culture supernatants of the M1 cells after LPS stimulation compared with those in the M0 (unstimulated) group. Likewise, IL-4 stimulation led to a significant increase in IL-10 levels (P < .01) in the conditioned media of M2 cells, while that of IL-12 decreased slightly (P ≥ .05). In the rat model, the infusion of M2 cells accelerated wound healing and tissue regeneration, whereas the M1 cells delayed the recruitment of inflammatory cells, granulation growth, and collagen deposition, which impaired wound healing. Macrophage polarisation and activation are critical for skin wound healing. While exogenous M1 cell infusion delayed wound healing, the M2 cells promoted wound healing in a rat model.

Methylene Blue Combined with Ropivacaine for Intercostal Nerve Block After Autologous Costal Cartilage Removal in Juvenile Patients.

OBJECTIVES: Autologous costal cartilage is commonly used as a graft material in plastic surgery. However, after autologous costal cartilage removal, the pain at the surgical site is particularly strong. We conducted this controlled clinical study to verify the efficacy of methylene blue (MB) in intercostal nerve block after autologous costal cartilage removal and to provide a reference for the application of MB in postoperative analgesia after autologous costal cartilage removal. METHODS: In this study, 90 adolescent patients with congenital microtia who underwent autologous rib cartilage graft for auricular reconstruction were randomly allocated to one of three groups (Group A: intercostal nerve block was performed with 0.75% ropivacaine; Group B: intercostal nerve block was performed with 1% MB; and Group C: intercostal nerve block was performed with 1% MB and 0.75% ropivacaine mixture). Two trained researchers observed and recorded the pain status of the children at 6 hours (T1), 24 hours (T2), 48 hours (T3), and 72 hours (T4) after surgery, respectively. Numerical rating pain scale (NRS) was used for scoring. And adverse reactions such as nausea, vomiting, and skin itching were recorded. RESULTS: In this study, there was no statistical difference in age and gender of patients in Groups A, B, and C (P >0.05). In terms of NRS comparison, 6 hours after operation (T1), Group B > Group A > Group C (P< 0.05); 24 hours after operation (T2), Group B > Group A > Group C (P< 0.05); 48 hours after operation (T3), Group B > Group A > Group C (P< 0.05); 72 hours after operation (T4), Group A > Group B > Group C (P< 0.05). There were no statistically significant differences in postoperative nausea, vomiting, and skin itching among the three groups (P>0.05). CONCLUSION: The analgesic effect of IV self-controlled analgesia combined with ropivacaine is quick, but the maintenance time is short. The analgesic effect of IV self-controlled analgesia combined with MB is slow to onset but long to maintain. The analgesic effect of IV self-controlled analgesia combined with MB and ropivacaine mixture is quick and maintained for a long time. Therefore, in patients after removal of costal cartilage, we recommend the analgesic treatment method of IV self-controlled analgesia combined with MB and ropivacaine mixture. 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 . Special Topic.

Comparison of 2940 nm Er: YAG laser treatment in the microlaser peel, fractional ablative laser, or combined modes for the treatment of concave acne scars.

OBJECTIVE: To compare and analyze the effects of Er:YAG laser treatment in the microlaser peeling, fractional ablative laser, or combined modes for the treatment of concave acne scars. METHOD: Ninety patients of concavity acne scar were randomly assigned to three different groups:microlaserpeeling mode group (MM group), fractional ablative mode group (FM group) and combined mode group (CM group). MM group received microlaserpeeling mode with depth of 60 µm and a repetition rate of 20%, FM group received fractional ablative mode with depth of 300 µm and a fractional density of 8%, and CM group received a fractional depth of 200 µm, density of 8%, and a peeling depth of 30 µm, repetition rate of 20%. All patients were evaluated for their treatment effects and side effects 30 days after treatment, including the treatment satisfaction, the ECCA grading scale, pain score and pigmentation level. RESULTS: According to the effect satisfaction of patients' self-assessment, the difference among the three groups was statistically significant (P < .05), the CM group was better than the other two groups, but there was no significant difference between the FM group and the MM group (P > .05). About the ECCA grading scale 30 days after treatment, the statistical result among the three groups was significant (P < .05), the CM group is much lower than the FM group which is approximately equal to the MM group. There was statistical difference in pain score among the three groups and every two groups (P < .05), the CM group had the highest pain score, while FM group had the lowest. About the pigmentation level, there was statistical difference among the three groups (P < .05), FM group had the lightest pigmentation, while the CM group had the heaviest. CONCLUSIONS: Three treatment modes are all effective in treating the concavity acne scar. Among the three modes, CM group is best effective, also accompanied with the most severe side effect; FM group achieves the best balance between treatment effect and side effect. The treatment practices indicate that when the Er:YAG laser with a wavelength of 2940 nm is used to treat concavity acne scars, the right treatment mode should be subject to the severity of the scar.

Construction and validation of a nomogram for patients with skin cancer.

ABSTRACT: Skin cancer is a common malignant tumor in human beings. At present, the construction of clinical prediction models mainly focuses on malignant melanoma and no researchers have constructed clinical prediction models for all kind of skin cancer to predict the prognosis of skin cancer. We used patient data collected from the surveillance, epidemiology, and end results program database to construct and validate our model for clinical prediction of skin cancer, hoping to provide a reference for clinical treatment of skin cancer.R software was used for univariate and multivariate Cox regression analysis of variables to screen out factors that have an impact on the survival of skin cancer patients. Then the prognostic model of skin cancer patients was constructed and the nomogram was drawn. Concordance Index (C-index), receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the clinical prediction model.A total of 3180 skin cancer patients were included in this study. We constructed nomogram, a 3-year and 5-year clinical prediction model for skin cancer patients. We used C-index to evaluate the accuracy of nomogram model, and the result of C-index was 0.728, 95%CI (0.703-0.753). The nomogram model was evaluated by ROC curve. The area under the curve values of the ROC curve for 3-year survival rate and 5-year survival rate were 0.732 and 0.768 respectively. The model calibration diagram of the modeling group also shows that the model exhibits high accuracy.The nomogram model of postoperative survival of patients with skin cancer, based on the surveillance, epidemiology, and end results program database of patients with skin cancer, has shown good stability and accuracy in multi-method validation.

miR-942-5p promotes the proliferation and invasion of human melanoma cells by targeting DKK3.

OBJECTIVE: The purpose of this study was to figure out the dysregulation of miR-942-5p in melanoma and its role in melanoma pathogenesis. METHODS: Quantitative real-time PCR (qRT-PCR) assay was used to determine the change of RNA expression. Protein expression was examined by Western blotting. miRNA target was validated through TargetScan and luciferase assay. Cell migration and invasion were detected by wound healing and transwell assay, respectively. RESULTS: Results of qRT-PCR manifested miR-942-5p were upregulated in melanoma cell. High expression of miR-942-5p in melanoma patients presented a poor prognosis. Upregulation of miR-942-5p accelerated cell proliferation, migration, and invasion in melanoma cells. Cell apoptosis was inhibited by miR-942-5p mimics. Suppression of miR-942-5p by its inhibitor showed the opposite effects in melanoma cells. TargetScan and luciferase assay showed that miR-942-5p directly targeted to the 3'-untranslated region (3'-UTR) of DKK3. Overexpression of DKK3 inhibited GSK-3ß phosphorylation and reduced the expression of ß-catenin in both cytoplasm and nucleus, which were induced by miR-942-5p mimics leading to the activation of Wnt/ß-catenin pathway. CONCLUSION: Upregulation of miR-942-5p was observed in melanoma cells and tissues and significantly associated with a poor prognosis. Though targeting 3'-UTR of DKK3, miR-942-5p could activate Wnt/ß-catenin pathway, resulting in melanoma cell proliferation, migration, and invasion, which promoted the development of melanoma. These results showed that miR-942-5p might be a diagnosis and prognosis biomarker in melanoma.

Foam sclerotherapy compared with liquid sclerotherapy for the treatment of lower extremity varicose veins: A protocol for systematic review and meta analysis.

BACKGROUND: There is a continued discussion on which is the best sclerosant to treat lower extremity varicose veins. Therefore, we did this meta-analysis to determine that foam sclerotherapy versus liquid sclerotherapy, which could perform better in the treatment of lower extremity varicose veins. MATERIALS AND METHODS: We independently searched 5 databases from inception to February 1, 2019, for randomized controlled trials and prospective controlled trials for comparing foam sclerotherapy and liquid sclerotherapy for the treatment of lower extremity varicose veins. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of studies. The primary outcome and secondary outcomes were analyzed using stata 15.0. This meta-analysis was performed according to Cochrane Handbook. RESULTS: There were significant differences in effective rate (P < .001, odd ratios = 5.64, 95% confidence interval = 3.93-8.10) and incidence rate of pain (P = .030, odd ratios = 1.52, 95% confidence interval = 1.04-2.21) between foam sclerotherapy and liquid sclerotherapy. And there were no significant differences among local inflammation (P = .896, rate difference = 0.00, 95% confidence interval = -0.03 to 0.03), thrombophlebitis (P = .90, rate difference = 0.00, 95% confidence interval = -0.02 to 0.02) and hyperpigmentation (P = .336, rate difference = 0.05, 95% confidence interval = -0.05 to 0.14). CONCLUSIONS: Although foam sclerotherapy has a higher incidence rate of complications, it could achieve a more stable clinical efficacy in the treatment of lower extremity varicose veins than liquid sclerotherapy.

Clinical characteristics of hospitalized patients with SARS-CoV-2 infection: A single arm meta-analysis.

OBJECTIVE: We aim to summarize reliable evidence of evidence-based medicine for the treatment and prevention of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) by analyzing all the published studies on the clinical characteristics of patients with SARS-CoV-2. METHODS: PubMed, Cochrane Library, Embase, and other databases were searched. Several studies on the clinical characteristics of SARS-CoV-2 infection were collected for meta-analysis. RESULTS: Ten studies were included in Meta-analysis, including a total number of 50466 patients with SARS-CoV-2 infection. Meta-analysis shows that, among these patients, the incidence of fever was 0.891 (95% CI: 0.818, 0.945), the incidence of cough was 0.722 (95% CI: 0.657, 0.782), and the incidence of muscle soreness or fatigue was 0.425 (95% CI: 0.213, 0.652). The incidence of acute respiratory distress syndrome (ARDS) was 0.148 (95% CI: 0.046, 0.296), the incidence of abnormal chest computer tomography (CT) was 0.966 (95% CI: 0.921, 0.993), the percentage of severe cases in all infected cases was 0.181 (95% CI: 0.127, 0.243), and the case fatality rate of patients with SARS-CoV-2 infection was 0.043 (95% CI: 0.027, 0.061). CONCLUSION: Fever and cough are the most common symptoms in patients with SARS-CoV-2 infection, and most of these patients have abnormal chest CT examination. Several people have muscle soreness or fatigue as well as ARDS. Diarrhea, hemoptysis, headache, sore throat, shock, and other symptoms are rare. The case fatality rate of patients with SARS-CoV-2 infection is lower than that of Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). This meta-analysis also has limitations, so the conclusions of this Meta-analysis still need to be verified by more relevant studies with more careful design, more rigorous execution, and larger sample size.

A thermosensitive RGD-modified hydroxybutyl chitosan hydrogel as a 3D scaffold for BMSCs culture on keloid treatment.

Cell therapy with bone marrow-derived mesenchymal stem cells (BMSCs) is a potential method for many disease treatments, including keloid. In the present study, an Arg-Gly-Asp (RGD) modified hydroxybutyl chitosan (HBC) hydrogel (HBC-RGD) was developed to enhance the adhesion and proliferation of BMSCs within the hydrogel. The successful synthesis of HBC-RGD was confirmed by FTIR and 1H NMR. Both HBC and HBC-RGD hydrogel had desired thermosensitivity, biocompatibility and enzymatic degradability in vitro. Compared with HBC hydrogel, HBC-RGD hydrogel was more beneficial for the adhesion and proliferation of BMSCs. Furthermore, the BMSCs incorporated HBC-RGD (BMSCs/HBC-RGD) hydrogel could inhibit the proliferation of keloid fibroblasts (Kfs) and suppress the nodular collagenous fibers of keloid tissue. These results suggested that the HBC-RGD hydrogel could be applied as a potential 3D hydrogel scaffold for cell culture, and BMSCs/HBC-RGD hydrogel was potential to be applied for keloid therapy with subcutaneous in-situ injection in the future.

The Time Course Pathological Changes After Burn Injury.

In the present study, we aimed to explore the time course pathological changes after burn injury. The time course microarray data of burn injury from the Gene Expression Omnibus (GEO) was further analyzed through bioinformatics analysis. The differential expression genes (DEGs) were identified in the early-stage vs. control groups, middle-stage vs. control groups, and early-stage vs. middle-stage groups after burn injury, followed by pathway enrichment analysis. Gene modules associated with burn injury progression were identified through weighted gene co-expression network analysis (WGCNA), and hub genes were identified via network topology analysis. There were a total of 745 DEGs in the early vs. control group, 1104 DEGs in mid vs. control, and 61 DEGs in early vs. mid group. The significant pathways enriched by DEGs in the middle stage were also enriched by DEGs in the early stage. Immunodeficiency was a significant pathway specific for the DEGs in the early stage. There were 19 overlapped genes, such as myeloperoxidase, transcobalamin, and interferon-induced protein with tetratricopeptide repeats 1, among DEGs in early vs. control, middle vs. control, and early vs. middle groups. WGCNA identified three gene modules that were significantly associated with burn injury progression. Furthermore, we identified several gene modules and biological processes that might be associated with burn injury progression, and such results may be beneficial in understanding the underlying mechanisms and developing novel drugs.

Effect of hyperbaric oxygen on the process of hypertrophic scar formation in rabbit ears.

OBJECTIVE: To explore the influence of hyperbaric oxygen on scar formation in rabbit ears. METHODS: A total of 20 New Zealand rabbits were selected to establish the hypertrophic scar model on the ears. The rabbits were randomly divided into control group and experimental group (7d, 14d, 21d, and 28d group according to different HBO treatment days),each experimental group received hyperbaric oxygen treatment after the operation at the same time everyday for 1 hour. After the day 29, the scars were collected. Histomorphological change in scars was observed by hematoxylin-eosin staining, Masson staining, and transmission electrical microscope. The expression of bax, bcl-2, and the cell apoptosis rate was detected by immunohistochemical method. RESULTS: (i) Both number of fibroblast and amount of collagen fibrils in experimental group were significantly reduced compared with those in control group. In Masson staining, arrangement of collagen fibrils in experimental group was much more irregular and coarse than control groups. (ii) HI value can be found much smaller in the experimental groups than the control (P < .05). Among the four experimental groups, there is significant difference among 7d, 14d, and 21d groups (P < .05), while there is no difference between 21d and 28d groups (P > .05). (iii) Expression of Bax could be detected up-regulated in experimental group (P < .05). While the expression of Bcl-2 is detected significantly down-regulated in experimental group than that in control group (P < .05). Compared with the 7d group, the expression of Bax and Bcl-2 has significant difference in 14d group (P < .05), and the expression of this two factors in 21d group has significant difference comparing with 14d group(P < .05),but there is no significant difference between 28d group and 21d group(P > .05). (iv) Significant difference of cell apoptosis rate can be detected between the experimental groups and the control group (P < .05). Among the four experimental groups, there is significant difference among 7d, 14d, and 21d groups (P < .05), while there is no difference between 21d and 28d groups (P > .05). CONCLUSION: The hyperbaric oxygen can up-regulate bax/bcl-2 value, increase the cell apoptosis rate, and inhibit the early hypertrophic scar in rabbit ears.

Exceedingly expanded retroauricular flaps for microtia reconstruction.

BACKGROUND: The authors propose here a new strategy to obtain exceedingly expanded retroauricular mastoid skin for sufficient coverage of the three-dimensional autogenous costal cartilage framework generally used in auricular reconstruction surgery. From February 2000 to September 2009, 42 microtia reconstructions were performed using this new strategy. METHODS: Auricular reconstruction was performed in three surgical stages. In the first stage, a 50-ml kidney-shaped expander was inserted subcutaneously in the retroauricular mastoid region. From 5 to 8 ml saline was then injected into the expander every 4 days until the final volume of the expander reached 100-120 ml. In the second stage, we divided the expanded mastoid skin into a superior two-third region (flap A) and an inferior one-third region (flap B, rotation flap). Autogenous costal cartilage framework was then enveloped by these expanded flaps. Tragus construction and conchal excavation was performed in the third stage. RESULTS: All patients were followed up from 6 months to 4 years after reconstruction. A total of 36 cases reported to be satisfied with the appearance of good shape, accurate size, right orientation, and duplication of well-detailed structures. Further revision was requested by six of the total. Complications in this series includes one case of haematoma, two cases of partial evection of the expanded skin and two cases of partial skin necrosis of the helix. All the complications were treated appropriately. CONCLUSION: Exceeding expansion can provide sufficient retroauricular non-hair-bearing skin tissues for draping the auricular cartilage framework. Skin grafts and retroauricular fascial flap are not needed any more. Patients are usually satisfied with their reconstructive auricles as regards the size, location, projection, convolution, skin-colour matching, etc. Exceedingly expanded retroauricular flaps are the appropriate envelope for the auricular cartilage framework.