Activation of moderate autophagy promotes survival of fat graft.

Clinically unpredictable retention following fat grafting remains outstanding problems because of the unrevealed mechanism of grafted fat survival. The role of autophagy, a process to maintain cellular homeostasis through recycling cellular debris, has yet been to be reported in fat grafting. This study aims to improve the survival of fat grafting through the autophagy. First, the relationship between cell death and autophagy in the early stage of fat grafting was evaluated through immunostaining, RNA sequencing, and western blot. Next, rapamycin, an autophagic agonist, was used for the culturing of adipose-derived stem cells and adipocytes during ischemia. Cell death, autophagy, and reactive oxygen species (ROS) were assayed. Finally, rapamycin was used to assist fat grafting in nude mice. The results demonstrated that the peak of cell death at the early stage of fat grafting was accompanied by a decrease in autophagy. In vitro, during ischemia, 25 nM was confirmed as the optimal dose of rapamycin that reduces cell death with enhanced autophagy and mitophagy, improved mitochondrial quality as well as decreased ROS accumulation. In vivo, promoted mitophagy, alleviated oxidative stress, and decreased cell apoptosis of rapamycin-treated fat grafts were observed in the early stage. In addition, rapamycin increased the survival of fat grafts with increased neovascularization and reduced fibrosis. We suggested that moderate autophagy induced by rapamycin contribute to enhanced ischemic tolerance and long term survival of fat grafts through mitochondrial quality control.

The Anatomic Features of Müller's Muscle: A Histology Study in Chinese.

The purpose of this article is to clarify the character of Müller's muscle in Chinese specimens. METHODS: Ten upper eyelids of 10 formalin-fixed Chinese cadavers (9 elderly people, from 68 to 86 years of age; 1 male child, 10 years old) were examined. Full-thickness sagittal sections of the central part of the upper eyelids were microscopically examined using hematoxylin-eosin, Masson trichrome, and anti-smooth muscle actin antibodies staining. RESULT: In 9 elderly specimens, Müller's muscle inserted onto tarsus via fibers, and the smooth muscle components decreased gradually and even faded away from the originated inferior branch of levator palpebrae superioris muscle to the upper margin of tarsus, although, in 1 child specimen, Müller's muscle inserted directly onto tarsus rather than connective fibrous structure, and smooth muscle components did not decrease obviously. Both in elderly and young specimens, the aponeurotic structure that originated from Müller's muscle extended to the tarsal plate. CONCLUSION: This study suggests that Müller's muscle inserts onto the tarsus via fibrous tissue or smooth muscle, and also indicates that the smooth components of Müller's muscle may decrease gradually in elderly people.

A Novel Repair Idea on Nasal Sidewall Defect in Asians: Local Tissue Regeneration.

BACKGROUND: The traditional ways indicate using different types of flap to repair the nasal sidewall defect, but the scar in the donor area or bloated flap is a problem that cannot be ignored. This study propose the clinical application of the principle of tissue regeneration priority in small defects (defect diameter <1.0 cm) of nasal sidewall. METHODS: A retrospective study of 3 patients experienced the tumor excision and tissue regeneration healing in situ from January 2019 to January 2020. In this group, the nasal sidewall defect was treated with wound moist theory, preventing infection, to promote the wound regeneration and repair. RESULT: The longest follow-up time was 8 month, all patient undergone half a year follow-up at least. One of them were left small sunken scars but all of them healed up well and satisfied with the results. CONCLUSION: When dealing with the small defect of the skin and soft tissue on the nasal sidewall (defect diameter <1.0 cm), this article provided a new idea that is application of the priority principle for tissue regeneration repair rather than traditional flap used for 1-stage repair. For the small defects of the skin and soft tissue on the nasal sidewall, the tissue regeneration and natural repair in situ can achieve satisfactory effects. More importantly, it has the advantages of simplicity, ease of operation, and fewer complications.

Decreased smooth muscle component in Müller's muscle may induce or aggravate blepharoptosis in elderly Asians.

Previous studies have suggested that the senile ptosis is mostly aponeurotic ptosis. Aponeurotic ptosis, the most common cause of acquired ptosis in elderly adults, results from disinsertion or dehiscence of the levator aponeurosis from the tarsal plate. Müller's Muscle is located below the levator aponeurosis, and its main function is to contribute to a few millimeter in upper eyelid elevation. In recent years, studies have shown that Müller's Muscle plays a more important role in the eye-opening process than previously reported. There are few reports on the changes of smooth muscle component with age in Müller's Muscle. As far as we know, it has not been written up previously. Through histological study on Müller's Muscle of Chinese cadaver specimens, we found that Müller's Muscle contained obvious smooth muscle components above the upper edge of the tarsus in the specimen of a child. However, in elderly specimens, we observed that the smooth muscle components decreased gradually even faded away from originated inferior branch of levator superioris muscle to upper margin of tarsus. We hypothesized that the number of smooth muscle components in Müller's Muscle gradually decreases, with the increase of age, which further affects the function of Müller's Muscle in assisting levator muscle, and further causes or aggravates ptosis. Our hypothesis needs to be further verified by more autopsy histological studies of different ages and genders, so as to provide a new idea for the clinical diagnosis and treatment of ptosis.

COVID-19 and diabetes cutaneous comorbidity.

Diabetes patients have a higher risk in morbidity and mortality with COVID-19.It should be considered as a risk factor for a rapid progression and bad prognosis of COVID-19.Additional, the research in the cutaneous complication of diabetes with COVID-19 need to be considered. Therefore, particular concern should be given to diabetes, and its cutaneous complications and SARS-CoV-2.

A New Anatomy Finding of Levator Aponeurosis and Müller Muscle at Pretarsal Plate in Asian Males.

PURPOSE: To examine the fine anatomic structures between levator aponeurosis and Müller muscle in front of the tarsus. MATERIALS AND METHODS: Postmortem specimens of 6 Chinese males (5 elderly men, aging from 68 to 86 years; 1 child, 10 years old) were used. A 3-µm thickness sagittal section of the central part of the upper eyelid was prepared, and the samples were examined microscopically by using hematoxylin-eosin, Masson trichrome, and anti-smooth muscle actin antibodies staining. RESULTS: There are 2 new findings in this study, one is the posterior layer of the levator aponeurosis and the other is the extensions of Müller muscle. The posterior levator aponeurosis had different insertion patterns that approximately paralleled the extension line of the levator aponeurosis at the confluence of attachment site of the orbital septum on the levator superioris. Below the confluence, it took the form of a layered insertion, and then extended to the orbicularis oculi muscle and subcutaneous tissue rather than inserting directly into tarsus. The Müller muscle was a multilayered structure at the upper border of tarsus. The superior Müller muscle extended above the peripheral arcade, and the inferior Müller muscle tendon was attached to the surface of tarsus with an Umbrella-shaped fiber. CONCLUSIONS: The authors discovered that the levator aponeurosis had different insertion patterns of the posterior layers. The Müller muscle gave branches at the peripheral arcade: the anterior one crossed the peripheral arcade and extended to the tarsus, and the posterior one attached and extended to the tarsus.