"An abdominoplasty modification for post-pregnancy abdomen with rectus diastasis and midline hernia: the technique and results".

SUMMARY: Few women recover from pregnancy abnormally and end up having severe post-pregnancy rectus diastasis (RD) with body control dysfunction, midline hernia or other quality of life impairment. The purpose of this study was to describe the authors' experience using HELP modification of abdominoplasty (Hydrodissection and Epidural anesthesia for Lateral Plication) to restore abdominal wall firmness. 46 consecutive post-pregnancy RD patients were enrolled. The mean intraoperative inter rectus distance was 4.6 cm. RD is not always the only structure that has been elongated. Firmness of the abdominal wall depends also on lateral fascia structures. Our study reports the total plicated distance addressing the lateral laxity in the abdominal wall. In this series total plication was 7.8 cm. In this series 16 patients had a midline hernia. We did not see hernia recurrences, and the rectus bellies were <5mm apart from each other in all participants verified with ultrasound after two years of follow up. Patient perspective of care and surgical outcome were recorded: HRQoL domains were significantly higher postoperatively implicating better health. Lumbar back pain visual analogy scale score was 4.5±2.3 preoperatively and 0.5 ±0.9 postoperatively. The ability to perform sit-ups increased from 0 to 11 suggesting better motor control. Total complication rate was 10.9%. HELP modification seems to offer a reliable and effective treatment method for RD repair with and without a small midline hernia with low complication rate.

Preventing White Adipocyte Browning during Differentiation In Vitro: The Effect of Differentiation Protocols on Metabolic and Mitochondrial Phenotypes.

Mitochondrial dysfunction in white adipose tissue is strongly associated with obesity and its metabolic complications, which are important health challenges worldwide. Human adipose-derived stromal/stem cells (hASCs) are a promising tool to investigate the underlying mechanisms of such mitochondrial dysfunction and to subsequently provide knowledge for the development of treatments for obesity-related pathologies. A substantial obstacle in using hASCs is that the key compounds for adipogenic differentiation in vitro increase mitochondrial uncoupling, biogenesis, and activity, which are the signature features of brown adipocytes, thus altering the white adipocyte phenotype towards brown-like cells. Additionally, commonly used protocols for hASC adipogenic differentiation exhibit high variation in their composition of media, and a systematic comparison of their effect on mitochondria is missing. Here, we compared the five widely used adipogenic differentiation protocols for their effect on metabolic and mitochondrial phenotypes to identify a protocol that enables in vitro differentiation of white adipocytes and can more faithfully recapitulate the white adipocyte phenotype observed in human adipose tissue. We developed a workflow that included functional assays and morphological analysis of mitochondria and lipid droplets. We observed that triiodothyronine- or indomethacin-containing media and commercially available adipogenic media induced browning during in vitro differentiation of white adipocytes. However, the differentiation protocol containing 1 µM of the peroxisome proliferator-activated receptor gamma (PPARγ) agonist rosiglitazone prevented the browning effect and would be proposed for adipogenic differentiation protocol for hASCs to induce a white adipocyte phenotype. Preserving the white adipocyte phenotype in vitro is a crucial step for the study of obesity and associated metabolic diseases, adipose tissue pathologies, such as lipodystrophies, possible therapeutic compounds, and basic adipose tissue physiology.

Proangiogenic Hypoxia-Mimicking Agents Attenuate Osteogenic Potential of Adipose Stem/Stromal Cells.

BACKGROUND: Insufficient vascularization hampers bone tissue engineering strategies for reconstructing large bone defects. Delivery of prolyl-hydroxylase inhibitors (PHIs) is an interesting approach to upregulate vascular endothelial growth factor (VEGF) by mimicking hypoxic stabilization of hypoxia-inducible factor-1alpha (HIF-1α). This study assessed two PHIs: dimethyloxalylglycine (DMOG) and baicalein for their effects on human adipose tissue-derived mesenchymal stem/stromal cells (AT-MSCs). METHODS: Isolated AT-MSCs were characterized and treated with PHIs to assess the cellular proliferation response. Immunostaining and western-blots served to verify the HIF-1α stabilization response. The optimized concentrations for long-term treatment were tested for their effects on the cell cycle, apoptosis, cytokine secretion, and osteogenic differentiation of AT-MSCs. Gene expression levels were evaluated for alkaline phosphatase (ALPL), bone morphogenetic protein 2 (BMP2), runt-related transcription factor 2 (RUNX2), vascular endothelial growth factor A (VEGFA), secreted phosphoprotein 1 (SPP1), and collagen type I alpha 1 (COL1A1). In addition, stemness-related genes Kruppel-like factor 4 (KLF4), Nanog homeobox (NANOG), and octamer-binding transcription factor 4 (OCT4) were assessed. RESULTS: PHIs stabilized HIF-1α in a dose-dependent manner and showed evident dose- and time dependent antiproliferative effects. With doses maintaining proliferation, DMOG and baicalein diminished the effect of osteogenic induction on the expression of RUNX2, ALPL, and COL1A1, and suppressed the formation of mineralized matrix. Suppressed osteogenic response of AT-MSCs was accompanied by an upregulation of stemness-related genes. CONCLUSION: PHIs significantly reduced the osteogenic differentiation of AT-MSCs and rather upregulated stemness-related genes. PHIs proangiogenic potential should be weighed against their longterm direct inhibitory effects on the osteogenic differentiation of AT-MSCs.

Monocyte-derived extracellular vesicles stimulate cytokine secretion and gene expression of matrix metalloproteinases by mesenchymal stem/stromal cells.

Intercellular communication is essential in bone remodelling to ensure that new bone is formed with only temporary bone loss. Monocytes (MCs) and osteoclasts actively take part in controlling bone remodelling by providing signals that promote osteogenic differentiation of mesenchymal stem/stromal cells (MSCs). Extracellular vesicles (EVs) have attracted attention as regulators of bone remodelling. EVs facilitate intercellular communication by transferring a complex cargo of biologically active molecules to target cells. In the present study, we evaluated the potency of EVs from MCs and osteoclasts to induce a lineage-specific response in MSCs. We analysed gene expression and protein secretion by both adipose tissue-derived MSCs and bone marrow-derived MSCs after stimulation with EVs from lipopolysaccharide-activated primary human MCs and (mineral-resorbing) osteoclasts. Isolated EVs were enriched in exosomes (EVs of endosomal origin) and were free of cell debris. MC- and osteoclast-derived EVs were taken up by adipose tissue-derived MSCs. EVs from activated MCs promoted the secretion of cytokines by MSCs, which may represent an immunomodulatory mechanism. MC-derived EVs also upregulated the expression of genes encoding for matrix metalloproteinases. Therefore, we hypothesize that MCs facilitate tissue remodelling through EV-mediated signalling. We did not observe a significant effect of osteoclast-derived EVs on gene expression or protein secretion in MSCs. EV-mediated signalling might represent an additional mode of cell-cell signalling during the transition from injury and inflammation to bone regeneration and play an important role in the coupling between bone resorption and bone formation. DATABASE: Gene expression data are available in the GEO database under the accession number GSE102401.

Efficient ultrafiltration-based protocol to deplete extracellular vesicles from fetal bovine serum.

Fetal bovine serum (FBS) is the most commonly used supplement in studies involving cell-culture experiments. However, FBS contains large numbers of bovine extracellular vesicles (EVs), which hamper the analyses of secreted EVs from the cell type of preference and, thus, also the downstream analyses. Therefore, a prior elimination of EVs from FBS is crucial. However, the current methods of EV depletion by ultracentrifugation are cumbersome and the commercial alternatives expensive. In this study, our aim was to develop a protocol to completely deplete EVs from FBS, which may have wide applicability in cell-culture applications. We investigated different EV-depleted FBS prepared by our novel ultrafiltration-based protocol, by conventionally used overnight ultracentrifugation, or commercially available depleted FBS, and compared them with regular FBS. All sera were characterized by nanoparticle tracking analysis, electron microscopy, Western blotting and RNA quantification. Next, adipose-tissue mesenchymal stem cells (AT-MSCs) and cancer cells were grown in the media supplemented with the three different EV-depleted FBS and compared with cells grown in regular FBS media to assess the effects on cell proliferation, stress, differentiation and EV production. The novel ultrafiltration-based protocol depleted EVs from FBS clearly more efficiently than ultracentrifugation and commercial methods. Cell proliferation, stress, differentiation and EV production of AT-MSCs and cancer cell lines were similarly maintained in all three EV-depleted FBS media up to 96 h. In summary, our ultrafiltration protocol efficiently depletes EVs, is easy to use and maintains cell growth and metabolism. Since the method is also cost-effective and easy to standardize, it could be used in a wide range of cell-culture applications helping to increase comparability of EV research results between laboratories.

Does Liposuction Improve Body Image and Symptoms of Eating Disorders?

BACKGROUND: Unpleasant attention to unfavorable fat may have harmful psychological effects in terms of body dissatisfaction. As a consequence, this may cause abnormal eating regulation. It has been noted that women interested in liposuction self-report more eating problems. As far as we know, there are no prospective studies with standardized instruments providing sufficient data regarding the effects of aesthetic liposuction on various aspects of quality of life. Nevertheless, publications on the effects of eating habits are lacking. METHODS: Sixty-one consecutive women underwent aesthetic liposuction. Three outcome measures were applied at baseline and at follow-up: the eating disorder inventory, Raitasalo's modification of the Beck depression inventory, and the 15-dimensional general quality of life questionnaire. RESULTS: The mean age at baseline was 44 years, and the mean body mass index was 26.0. Thirty-six (59%) women completed all outcome measures with a mean follow-up time of 7 months. A significant improvement from baseline to follow-up was noted in women's body satisfaction, and their overall risk for developing an eating disorder decreased significantly. CONCLUSION: Aesthetic liposuction results in a significantly reduced overall risk for an eating disorder in combination with improved body satisfaction.

Abdominoplasty improves quality of life, psychological distress, and eating disorder symptoms: a prospective study.

Background. Only some studies provide sufficient data regarding the effects of nonpostbariatric (aesthetic) abdominoplasty on various aspects of quality of life. Nevertheless, when considering the effects on eating habits, publications are lacking. Therefore we decided to assess the effects of nonpostbariatric abdominoplasty on eating disorder symptoms, psychological distress, and quality of life. Materials and Methods. 64 consecutive women underwent nonpostbariatric abdominoplasty. Three outcome measures were completed: the Eating Disorder Inventory (EDI), Raitasalo's modification of the Beck Depression Inventory (RBDI), and the 15D general quality of life questionnaire. Results. The mean age at baseline was 42 years and the mean body mass index (BMI) 26.4. Fifty-three (83%) women completed all the outcome measures with a mean follow-up time of 5 months. A significant improvement from baseline to follow-up was noted in women's overall quality of life, body satisfaction, effectiveness, sexual functioning, and self-esteem. The women were significantly less depressive and had significantly less drive for thinness as well as bulimia, and their overall risk of developing an eating disorder also decreased significantly. Conclusions. Abdominoplasty results in significantly improved quality of life, body satisfaction, effectiveness, sexual functioning, self-esteem, and mental health. The risk of developing an eating disorder is decreased significantly. This trial is registered with Clinicaltrials.gov NCT02151799.

Stem cell enrichment does not warrant a higher graft survival in lipofilling of the breast: a prospective comparative study.

BACKGROUND: Stem cell enrichment is generally believed to be of crucial importance for success in lipofilling for cosmetic breast augmentation. No comparative clinical studies have been reported to support this. METHODS: A total of 18 women underwent breast augmentation with water-assisted lipotransfer (WAL). In 10 of the cases, transferred lipoaspirate was enriched with stromal stem cells using the Celution(®) system (Cytori Therapeutics Inc., San Diego, Ca, USA). Magnetic resonance imaging (MRI)-based volumetric analysis was done preoperatively and 6 months after the procedure. To verify scientifically that stem cells were transplanted, samples of the transplanted tissues were processed in the laboratory to isolate the adipose stem cells (ASCs). RESULTS: MRI volumetry revealed a volume survival of the whole (watery) graft of mean 54% (SD 7) in the WAL only and of 50% (SD 10) in the WAL with stem cell-enrichment patients. As centrifugation of the WAL grafts demonstrated an average adipose tissue of 68%, the average volume survival of adipose tissue itself was 79% (SD 13) in the WAL only and 74% (SD 14) in the WAL with stem cell-enrichment patients. This difference (4.5%) was not statistically significant (independent samples t test, p = 0.330, 95% confidence interval of difference, 4.8, 13.9%). CONCLUSIONS: Breast augmentation by lipofilling using WAL alone is faster, cheaper, has a lower risk of contamination and offers at least an equal take rate. We do not see any advantage in stem cell enrichment by the Celution(®) system in cosmetic fat transplantation to the breast.

Povidone-iodine combined with antibiotic topical irrigation to reduce capsular contracture in cosmetic breast augmentation: a comparative study.

BACKGROUND: Antibacterial lavage with topical antibiotics may reduce the occurrence of capsular contracture (CC) in breast augmentation. OBJECTIVES: The authors investigate the efficacy of povidone-iodine combined with antibiotic irrigation in reducing the CC rate. METHODS: The charts of 330 consecutive women who underwent cosmetic breast augmentation during 2 different periods (group A: 2004-2009, n = 165; group B: 2009-2010, n = 165) were retrospectively reviewed. All patients in the series underwent augmentation with the same surgeon (A.S.) via the inframammary approach and dual-plane pocket. In group A, patients received a single perioperative dose of 1.5 g of intravenous cephalothin and 750 mg of oral cephalexin twice a day for 7 days after discharge. In group B, patients perioperatively received 750 mg of intravenous cefuroxime, and each implant and pocket were irrigated with 25 mL of a 10% povidone-iodine solution mixed with 750 mg of cefuroxime and 80 mg of gentamicin diluted in 15 mL of 0.9% sodium chloride solution. After discharge, patients received 500 mg of oral levofloxacin once a day for 5 days. Postoperative complications included occurrence of infection, hematoma, seroma, and CC. RESULTS: Mean (SD) postoperative follow-up in groups A and B was 24 (+/- 13) months and 22 (+/- 3) months, respectively. The postoperative superficial wound infection rate was 1.8% and 1.2%, the seroma rate was 1.8% and 1.2%, and the hematoma rate was 0.6% and 1.2% in groups A and B, respectively. Ten CC cases (Baker grade 3 or 4) in group A and 1 in group B were reported (6% vs 0.6%; P = .006). CONCLUSIONS: Povidone-iodine and antibiotic irrigation in cosmetic breast augmentation yielded a lower CC rate than standard perioperative antibiotics in this series of patients.

Breast reconstruction de novo by water-jet assisted autologous fat grafting--a retrospective study.

BACKGROUND: Autologous fat grafting has become a frequent, simple, reproducible and low-risk technique for revisional or partial breast reconstruction. The presented European multicenter study describes an optimized treatment and follow-up protocol for the de novo breast reconstruction after total mastectomy by lipotransfer alone. METHODS: A retrospective European multicenter trial included 135 procedures on 28 (35 breasts) postmastectomy patients (mean 52.4 years). All women were treated with the water-jet assisted fat grafting method (BEAULI™) combined with additional procedures (NAC reconstruction, contralateral mastoplasty) and evaluated with at least 6 months follow-up (mean 2.6 years). Sonography or mammography, clinical examination, patient questionnaire (10-point Likert scale) and digital photographs were carried out. RESULTS: On average the patients received 4 to 6 procedures each with a single volume of 159 ml (±61 ml) over 21 months (range 9 months to 2.5 years). In total 1,020 ml (±515 ml) fat were grafted till a complete breast reconstruction was achieved. Irradiated patients needed a significantly higher volume than non-irradiated (p<0.041). Main treatment complications were liponecrosis (2.59%), infection (0.74%) and granuloma (0.74%). Patient satisfaction was overall high to very high (96%) and confirmed the good aesthetic results (68%) and the natural softness, contour and shape of the reconstructed breast. CONCLUSIONS: A complete breast reconstruction with large volume fat grafting is alternatively possible to standard techniques in selected cases. It takes at least 4 to 6 lipotransfers in the course of 2 years. Patients with prior radiotherapy may require even up to 8 sessions over nearly 3 years of treatment.

[Free fat transfer--a versatile tool in reconstructive surgery]. / Rasvansiirto--korjaavan kirurgian yleistyvä työkalu.

Free fat transfer or lipofilling is a procedure quickly increasing in popularity. Free fat transfer offers treatment for soft tissue defects caused by trauma or cancer, congenital anomalies, painful scars, irradiation injuries and aesthetic indications. The advantages compared to, e.g., traditional flap reconstructions includes surgical easiness, minor donor-site morbidity, easy access, hardly no scars, quick recovery and avoidance of foreign bodies such as implants. The regenerative potential of free fat transfer is due to abundant adipose derived mesenchymal stem cells (ADSC). These cells are under extremely active investigation and have rapidly led to clinical trials and treatment modalities in combination with tissue engineering. Free fat transfer nowadays offers hope to patients that formerly could not be helped with surgical intervention.

The effects of aesthetic breast augmentation on quality of life, psychological distress, and eating disorder symptoms: a prospective study.

BACKGROUND: There are only a few studies that provide sufficient data regarding the effects of aesthetic breast augmentation on various aspects of quality of life. Significant improvement in body image, satisfaction with appearance, sexual attractiveness, and self-esteem has been observed in these studies. In contrast, however, a somewhat impaired general health-related quality of life has been reported at follow-up. Nevertheless, when considering the effects of aesthetic breast augmentation on eating habits, publications are lacking. We therefore decided to assess the effects of aesthetic breast augmentation on quality of life, psychological distress, and eating disorder symptoms. METHODS: This study included 79 consecutive women who underwent bilateral aesthetic augmentation mammaplasty. The women completed three outcome measures at baseline and at follow-up: the Eating Disorder Inventory, Raitasalo's modification of the Beck Depression Inventory, and the 15D general quality-of-life questionnaire. RESULTS: The mean age at baseline was 35 years (range = 18-52). The mean body mass index was 21.3 (range = 17.5-27.3). Sixty-five (82 %) women completed the outcome measures with a mean follow-up time of 7 months (range = 4-13). A significant improvement was observed in self-esteem and depression scores as well as body satisfaction from baseline to follow-up. Interpersonal trust also improved, and after the operation the women were more able to tolerate and understand their own feelings and sensations. A significant decrease in the overall risk for an eating disorder was also noted. CONCLUSIONS: Aesthetic breast augmentation results in significant improvement in women's body satisfaction and self-esteem. The level of risk for an eating disorder is also significantly reduced. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article.

The use of bioabsorbable osteofixation devices in craniomaxillofacial surgery.

Because of problems associated with the conventional osteofixation devices used in craniomaxillofacial surgery, bioabsorbable devices have presented an appealing alternative. Devices made of the polymers polyglycolide (PGA) and polylactide (PLA) and their copolymers (PLGA and PLDLA) are currently the most commonly used. Strong implants can be manufactured from these polymers with a self-reinforcing technique and used in the treatment of fractures and osteotomies. Self-reinforced devices have been studied for nearly 2 decades by our multidisciplinary research group for internal fixation of the bone in both experimental and clinical settings. In craniomaxillofacial fractures and osteotomies they have been used for as long as 10 years with no significant clinical problems. Because of more favored degradation characteristics, currently the copolymer devices (PLDLA and PLGA) represent the advancing front in the application of absorbable devices in craniomaxillofacial surgery. By using bioabsorbable devices, several problems associated with conventional biostable devices can be avoided, especially in children. New techniques that are not possible with biostable devices can be developed by using bioabsorbable devices, too. Our experience with and research on self-reinforced devices are shared here.