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Background: MicroRNAs can regulates tumor metastasis either as an oncomiR or suppressor miRNA. Here, we investigate the role of miR-224 in lymphatic metastasis of non-small-cell lung cancer (NSCLC). Methods: The expression of miR-224 was demonstrated by a validation cohort of 156 lung cancer patients (77 cases with lymphatic metastasis) by q-PCR. In vitro and in vivo experiments were performed to study the malignant phenotype after upregulation and inhibition of miR-224 expression. Furthermore, the direct target genes of miR-224 were determined by a luciferase reporter assay. Results: miR-224 was identified as a high expression miRNA in the tumor tissues with lymphatic metastasis) with an area under the receiver operating characteristic curve (AUC) of 0.57. Forced expression of miR-224 in H1299 cells promoted not only the cell viability, plate clone formation, migration and invasion in vitro, but also tumor growth and lung metastasis in vivo. Consistently, inhibition of miR-224 suppressed the malignant characters both in vitro and in vivo. Molecular mechanism research suggested that miR-422a targeted the ANGPTL1 as a novel tumor suppressor.Conclusions: The present study demonstrates that miR-224 is a potential marker for the prediction of lymphatic metastasis of NSCLC. And application of miR-224 may help for prophylactic intervention of NSCLC in clinical practice.

Objective. This meta-analysis was conducted to compare the therapeutic efficacy and clinical safety of the combination therapy of apatinib plus chemotherapy with that of chemotherapy alone in patients with refractory or recurrent ovarian carcinoma (OC). Methods. Relevant randomized controlled trials (RCT) or case-control studies (CCS) were identified by searching Chinese and English databases up to October 31, 2020. The risk of methodological bias tool and Newcastle–Ottawa scale (NOS) were used to assess trial quality. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated to evaluate the therapeutic effects and adverse drug reactions. Subgroup analyses of study type, study sample size, dosage of apatinib, and chemotherapy regimen between treatment group and control group were performed. Publication bias was assessed by funnel plot symmetry, Begg–Mazumdar test, and Egger test. The robustness of our results was presented by removing the trial one by one. Results. Fifteen eligible studies covering 1,020 patients were included in this review and meta-analysis. Among these studies, 8 were RCTs, and 7 were CCSs. Compared with chemotherapy alone, apatinib plus chemotherapy significantly increased objective response rate (OR = 3.55; 95% CI 2.31 to 5.47), disease control rate (OR = 3.04; 95% CI 2.12 to 4.36), and overall survival (OR = 5.03; 95% CI 3.16 to 6.90). Conclusions. The combination treatment of apatinib plus chemotherapy provides better clinical benefits for OC patients when compared to chemotherapy alone and should be recommended for suitable patients with OC after the failure of standard regimens. However, further investigation into future large-scale prospective randomized research is still needed.

Background Pneumoperitoneum during laparoscopic surgery has a systemic impact on the renal system and might contribute to acute kidney injury or postoperative renal dysfunction. However, effective preventive strategies are still lacking. We aimed to explore the effects of dexmedetomidine (DEX) on kidney and other organ function in patients undergoing elective laparoscopic surgery for colorectal cancer. Materials and methods Fifty-six patients were randomly enrolled into the Control or DEX group. The DEX group received 1 µg kg−1 DEX intravenously within 10 min followed by a maintenance dose of 0.5 µg kg−1 h−1 infused until 30 min before closing the peritoneum. In the Control group, 0.9% sodium chloride was administered as a placebo. The primary outcome was serum neutrophil gelatinase-associated lipocalin (NGAL) levels reflecting kidney injury. Secondary outcomes included variables reflecting the kidney, intestinal injury and systemic inflammatory response. Results NGAL levels were significantly lower in the DEX group than in the Control group at 1 d and 5 d postoperatively (107.5 ± 55.6 ng mL−1 versus 179.5 ± 78.2 ng mL−1; 70.3 ± 45.8 ng mL−1 versus 135.2 ± 59.6 ng mL−1, P Conclusions Perioperative DEX administration may potentially confer kidney and intestinal protection during laparoscopic surgery for colorectal cancer patients.

OBJECTIVE The authors conducted this meta-analysis to compare the efficacy of auricle reconstruction using tissue expanders with skin grafting and auricle reconstruction using tissue expanders without skin grafting by comparing the 6 major evaluation indicators. METHODS The databases such as PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP information databases were searched. RESULTS By comparison, the authors found that, the satisfaction rate, the incidence of postoperative hematoma, the incidence of postoperative incision infection, and the incidence of cartilage framework exposure of patients with auricle reconstruction using tissue expanders with skin grafting were all lower than those with auricle reconstruction using tissue expanders without skin grafting. However, the incidence of postoperative skin necrosis, the incidence of leakage or exposure of expanders in patients with auricle reconstruction using tissue expanders with skin grafting were all higher than those with auricle reconstruction using tissue expanders without skin grafting. CONCLUSIONS Auricle reconstruction using tissue expanders with skin grafting has advantages in reducing the incidence of postoperative hematoma, the incidence of postoperative incision infection, and the incidence of cartilage framework exposure. Auricle reconstruction using tissue expanders without skin grafting has advantages in improving the satisfaction rate, reducing the incidence of postoperative skin necrosis, and the incidence of leakage or exposure of expanders. From the comparison of specific data, there is no significant difference in the treatment effect between the 2 surgical methods.

High-precision manufactured thin-walled pure copper components are widely adopted in precision physics experiments, which require workpieces with extremely high machining accuracy. Double-sided lapping is an ultra-precision machining method for obtaining high-precision surfaces. However, during double-sided lapping, the residual stress of the components tends to cause deformation, which affects the machining accuracy of the workpiece. Therefore, a model to predict workpiece deformation derived from residual stress in actual manufacturing should be established. To improve the accuracy of the prediction model, a novel method for predicting workpiece deformation by amending the initial residual stress slightly based on the support vector regression (SVR) and genetic algorithm (GA) is proposed. Firstly, a finite element method model is established for double-sided lapping to understand the deformation process. Subsequently, the SVR model is utilized to construct the relationship between residual stress and deformation. Next, the GA is used to determine the best residual stress adjustment value based on the actual deformation of the workpiece. Finally, the method is validated via double-sided lapping experiments.

Objective The aim of this study was to confirm the pathogenic variants, explore the genotype–phenotype correlation and characteristics of Chinese patients with Treacher Collins syndrome (TCS). Design Clinical details of 3 TCS family cases and 2 sporadic cases were collected and analyzed. Whole-exome sequencing and Sanger sequencing were conducted to detect causative variants. Setting Tertiary clinical care. Patients This study included 8 patients clinically diagnosed with TCS who were from 3 familial cases and 2 sporadic cases. Main Outcome Measures When filtering the database, variants were saved as rare variants if their frequency were less than 0.005 in the 1000 Genomes Project Database, the Exome Aggregation Consortium (ExAC) browser, and the Novogene database, or they would be removed as common ones. The pathogenic variants identified were verified by polymerase chain reaction. The sequencing results were analyzed by Chromas 2.1 software. Results Two novel pathogenic variants (NM_000356.3: c.537del and NM_000356.3: c.1965_1966dupGG) and 2 known pathogenic variants (NM_000356.3: c.1535del, NM_000356.3: c.4131_4135del) were identified within TCOF1 which are predicted to lead to premature termination codons resulting in a truncated protein. There was a known missense SNP (NM_015972.3: c.139G>A) within POLR1D. No phenotype–genotype correlation was observed. Instead, these 8 patients demonstrated the high genotypic and phenotypic heterogeneity of TCS. Conclusions This study expands on the pathogenic gene pool of Chinese patients with TCS. Besides the great variation among patients which is similar to international reports, Chinese patients have their own characteristics in clinical phenotype and pathogenesis mutations.

Obtaining a grip force in robot-assisted minimally invasive surgery (RMIS) has always been a crucial research topic. A novel grip force cognition scheme is proposed in this article. We utilize the dynamic analysis of the cable-driven system to conduct feature engineering and add prior knowledge to the Gaussian process regression (GPR). Specifically, the feature and GPR model candidates are acquired by analyzing the dynamic characteristics first. After that, a wrapper searching method combined with exhaustive search (ES) and sequential backward selection (SBS) is proposed to determine the features and GPR model. The hyperparameters are optimized by differential evolution (DE) by minimizing the negative log marginal likelihood (NLML). Besides, the training set is extended by including several different objects to avoid the algorithm “learning” the object property. Our method is verified on a cable-driven platform to ensure the errors are all derived from the algorithm rather than the cable tension loss. Our method reduces the errors on our testing set by about 64% and outperforms several popular model-based and learning-based methods. This article illustrates the significance to integrate the system’s characteristics when introducing machine learning techniques into robot systems.

Congenital microtia is a severe physiological defect and is among the most common craniofacial defects. It is characterized by severe auricle dysplasia, external auditory canal atresia or stenosis, and middle ear malformation, though inner ear development is mostly normal with some hearing occurring through bone conduction. Auricular reconstruction is the only treatment for congenital microtia. In this study, the authors integrated messenger ribonucleic acid and mass spectrometry data of cartilage obtained from the affected and unaffected sides of 16 unilateral microtia patients who had undergone ear reconstruction surgery. The authors next performed functional analyses to investigate differences in the proteome of the affected and unaffected ears to elicit molecular pathways involved in microtia pathogenesis. The authors collected 16 pairs samples. Proteomic and transcriptomic analyses identified 47 genes that were differentially expressed in affected and unaffected cartilage. Integrated pathway analysis implicated the involvement of genes related to cell adhesion, extracellular matrix organization, and cell migration in disease progression. Through the integration of gene and protein expression data in human primary chondrocytes, the authors identified molecular markers of microtia progression that were replicated across independent datasets and that have translational potential.

Vision-based detection and tracking of surgical instrument is attractive because it relies purely on existing setup already in the operating scenario for Robot assisted minimally invasive surgery (RMIS). While significant advanced approaches have been made in recent years, how to effectively carry out the efficient algorithm in the abdominal environment for real-time surgical instrument semantic segmentation is still a fundamental challenging topic. For this purpose, this letter reports the development of a surgical instrument semantic segmentation method for RMIS scenario. We have demonstrated a novel lightweight deep neural network to exploit surgical instrument semantic segmentation that meets real-time, accuracy and robustness. Specifically, our model contains an innovative design of two stages lightweight network by integrating the Ghost modules with MobileNetV3. Given that reducing computation cost with holding high accuracy is crucial for the task, in the first stage, Ghost module is explored to model the bottleneck for extracting the semantic features. We also design the lightweight Segmentation head as the second stage to further reduce computation cost, the model outputs a pixel-by-pixel mask to represent the surgical instrument parts semantic segmentation results. Promising validation has been conducted to evaluate the proposed lightweight network, the results report that the method can exhibit the outstanding surgical instrument semantic segmentation and surpass existing algorithms in the real-time performance with holding the high accuracy. The letter demonstrates the feasibility to perform real-time surgical instrument detection by taking advantage of the components of surgical robot system, contributing to the reference for further surgical intelligence.

Reconstruction of auricular deformities and facial scars after burns is a challenging undertaking for surgeons. Excessive scar tissue, a poor blood supply and the paucity of available skin are all substantial difficulties that should be considered before the operation. Expanded neck flaps provide comparatively larger and thinner flaps for the simultaneous treatment of auricular deformities and facial scars in burn patients. In this article, the authors introduced the use of an expanded neck flap as coverage tissue for ear reconstruction and face resurfacing in 2 burn patients. The operation consisted of 3 stages. In the first stage, the expander was implanted subcutaneously under the skin of the neck to create adequate skin and soft tissue. In the second stage, the expander was removed, and the expanded flap was transferred to cover defects on the auricle and face. The third operation to repair the reconstructed ear and thick flap could be performed according the willingness of the patients and surgeons. Esthetically satisfactory results were achieved in both of the patients. The flaps survived completely, and the skin color, texture, and flexibility were well matched to those of the peripheral tissue. Six months postoperatively, the flaps did not shrink, and subsequent contractures did not recur. Both of the patients experienced high satisfaction, and no adverse effects were detected.

Introduction In collaboration with the Alberta Medical Association’s Physician Learning Program we developed individualized physician reports and held a group feedback session on rheumatoid arthritis (RA) performance measures (PM) to facilitate treat-to-target (T2T) strategies and evaluated physician experiences with this process. Methods 5 PMs addressing T2T concepts from an established Canadian quality framework were operationalized for physician practice reports at 2 university-affiliated rheumatology clinics. Rheum4U, a quality improvement and research platform, was the data source. The audit results were reviewed in a facilitated group feedback session. Rheumatologists provided experiential feedback on the process through survey and/or an interview. Transcripts from interviews were analyzed using a 6-step thematic analysis. Results 11 of 12 eligible rheumatologists consented to receive practice reports and provided feedback through surveys (n = 5) and interviews (n = 6). The practice reports from Rheum4U (n = 448 patients) revealed high rates of yearly follow-up (> 85%, PM1) and 100% performance on documentation of disease activity at ≥ 50% of visits (PM2). Only 34% of patients were seen within 3 months if not in remission (PM3) with 62% (2017) and 69% (2018) of those with active RA achieving a LDA state within 6 months (PM4). Approximately 70% of patients were in remission at any time point (PM5). All survey respondents agreed or strongly agreed comparison to peers was valuable and helped them reflect on their practice. Several strategies for improvement were identified, including but not limited to, leveraging of electronic records for future audit and feedback reports, providing additional granularity of results, additional stratification of results, and using high-performing peers as the comparator rather than the group mean. Conclusions Audit and feedback was perceived by clinicians as a useful strategy for evaluating T2T efforts in RA. Future work will focus on longitudinal evaluation of the clinical impact of this quality improvement initiative. Electronic Supplementary Material The online version of this article (10.1007/s40744-020-00237-0) contains supplementary material, which is available to authorized users.

Purpose Existing robot-assisted minimally invasive surgery (RMIS) system lacks of force feedback, and it cannot provide the surgeon with interaction forces between the surgical instruments and patient’s tissues. This paper aims to restore force sensation for the RMIS system and evaluate effect of force sensing in a master-slave manner. Design/methodology/approach This paper presents a four-DOF surgical instrument with modular joints and six-axis force sensing capability and proposes an incremental position mode master–slave control strategy based on separated position and orientation to reflect motion of the end of master manipulator to the end of surgical instrument. Ex-vivo experiments including tissue palpation and blunt dissection are conducted to verify the effect of force sensing for the surgical instrument. An experiment of trajectory tracking is carried out to test precision of the control strategy. Findings Results of trajectory tracking experiment show that this control strategy can precisely reflect the hand motion of the operator, and the results of the ex-vivo experiments including tissue palpation and blunt dissection illustrate that this surgical instrument can measure the six-axis interaction forces successfully for the RMIS. Originality/value This paper addresses the important role of force sensing and force feedback in RMIS, clarifies the feasibility to apply this instrument prototype in RMIS for force sensing and provides technical support of force feedback for further clinical application.

Objectives: Ear deformity caused by burns is one of the most difficult types of deformity to treat with plastic surgery, and the reconstruction of burned ears undoubtedly remains a substantial challenge. This study aims to report the therapeutic regime of using a superficial temporal fascial flap to cover the framework in burned ear reconstruction. Methods: Autologous costal cartilage was used to form the ear framework in all of the reconstruction cases. A superficial temporal fascial flap was used as soft tissue to cover the ear scaffold. Results: Five patients with 6 ears were included in our study. The external ear healed well and the location, size, and shape of both ears were generally symmetrical. No complication was observed in any of the patients. Conclusions: The superficial temporal fascial flap is a good choice for covering the autogenous cartilage framework when treating ear deformities after burns.

Background Neuropsychiatric symptoms (NPS) such as depression, anxiety, apathy, and irritability occur in prodromal phases of clinical Alzheimer’s disease (AD), which might be an increased risk for later developing AD. Here we treated young APP/PS1 AD model mice prophylactically with serotonin-selective re-uptake inhibitor (SSRI) paroxetine and investigated the protective role of anti-depressant agent in emotional abnormalities and cognitive defects during disease progress. Methods To investigate the protective role of paroxetine in emotional abnormalities and cognitive defects during disease progress, we performed emotional behaviors of 3 months old APP/PS1 mouse following oral administration of paroxetine prophylactically starting at 1 month of age. Next, we tested the cognitive, biochemical and pathological, effects of long term administration of paroxetine at 6 months old. Results Our results showed that AD mice displayed emotional dysfunction in the early stage. Prophylactic administration of paroxetine ameliorated the initial emotional abnormalities and preserved the eventual memory function in AD mice. Conclusion Our data indicate that prophylactic administration of paroxetine ameliorates the emotional dysfunction and memory deficit in AD mice. These neuroprotective effects are attributable to functional restoration of glutamate receptor (GluN2A) in AD mice.

Background This study presents the results of complete excision of giant congenital melanocytic nevi (GCMN) on the auricle, forehead, or periorbital area combined with tissue expansion, and skin graft transplantation performed in two stages based on 10 years of experience. Aims To solve the giant congenital melanocytic nevi on the auricle, forehead, or periorbital area with two-stage operation. Patients/methods A total of 21 patients with GCMN were included in this study. The operation combined tissue expander and skin graft transplantation. Result All GCMNs were successfully and completely excised. No patient in the study group had experienced skin contraction or auricular deformation at 3 years after treatment. Conclusion Two-stage operation is effective for removing GCMN on the auricle or face and can achieve good oncological and cosmetic results.

Background The chest wall deformity is a well-known complication following costal cartilage harvest with the biomechanical factor considered to be a cause of this donor-site morbidity. Kawanabe-Nagata method is a widely-accepted approach to prevent the deformity. However, knowledge about the biomechanical properties of regenerated costal cartilage is limited, and the value of reimplantation of autologous costal cartilage blocks is not clear. Methods The fifth costal cartilage on both sides of six male, 8 weeks of age, New Zealand white rabbits were harvested with the perichondrium preserved intact in situ. The perichondrium was sutured to form a perichondrial pocket and part of the excised costal cartilage was cut into 0.5 mm cartilage blocks and returned to the perichondrial pocket of left side. The animals were sacrificed 16 weeks postoperatively and the regenerated and a piece native costal cartilage was harvested for morphological and three point bending test. Results There was no remarkable chest wall deformity in all animals, and there were no apparent differences in the appearance of the regenerated cartilage with and without reimplantation autologous cartilage blocks. The elastic modulus of native cartilage was significantly higher than the regenerated cartilage. The stiffness of regenerated cartilage without reimplantation was higher than that of with reimplantation, but this difference was not significant. Conclusions The stiffness of regenerated cartilage was significantly lower than the native cartilage. Reimplantation of autologous cartilage blocks was not superior to that without reimplantation in regard to restoring the volume defect and strengthening the regenerated cartilage.

Keloid is a common and frequently-occurring disease in plastic surgery, and its ugly appearance and itching symptoms bring mental and life pain to patients. However, the clinical treatment of keloid, such as drug injection treatment, surgical resection, cryotherapy, laser treatment and other therapeutic effects are poor. Since the discovery of tumor necrosis factor related apoptosis inducing ligand (TRAIL) in 1995, its selective apoptosis on tumor cells makes it have a great prospect in the targeted treatment of tumor. In recent years, it has been found that the formation of keloid is related to the imbalance of apoptosis of fibroblasts in scar and the binding of TRAI to its receptor mediates the apoptosis of fibroblasts. Therefore, the use of TRAIL and TRAIL-R2/death receptor 5 (DR5) in the treatment of keloid has become a hot research topic. In this paper, the present situation, mechanism and development prospect of TRAIL and TRAIL-R2/DR5 targeted treatment of keloid were reviewed, which provided a reference for promoting the development of keloid treatment.

Flexible wearable electronics, including monitors, supercapacitors, sensors and batteries, especially stress or strain sensors, have attracted extensive discussion and attention, due to their distinctive characteristics such as high sensitivity and ultra-flexibility, and their broad application prospects in artificial intelligence (AI), robot sensing interfaces, and also high precision medical instruments. However, a narrower deformation rate, higher latency, and even counterfeit sensitivity severely limit their sensing performance and popularity in practical applications. Herein, a new bifunctional sensor based on excellent conductive and biocompatible porous copper nanowire (CuNW)/IonGel (PCI) composite films introducing a polystyrene (PS) microsphere template is developed. The sensor exhibits unparalleled mechanical properties (the maximum extension rate is 8000%), as well as omnidirectional, arbitrary angle/dimension extension, distortion and bending. This piezo-resistive sensor also features a convincing ultra-high sensitivity (S, 72.1 kPa−1) and gauge factor (Gf, 28.5) with negligible hysteresis under repeated cycle tests. Furthermore, compared to the same type of sensor, the limit of detection (LOD) is drastically reduced (merely 0.14 Pa). Undoubtedly, it is promising for high-resolution strain/stress-sensing electronic skin (e-skin) and green super-stretched electrodes.

Disposable temperature sensors have great advantages in public health security and infectious disease control. However, complicated fabrication processes and poor performances persistently restrict their practical applications. In this paper, a flexible temperature sensor is firstly developed by directly writing or mask spraying commonly-used paper with a highly thermo-sensitive graphene nanoribbon (GNR) ink. The inexpensive, green materials and process endow the GNR sensors with the properties of being low cost, degradable and pollution free. The band gap and the local traps of GNRs, caused by the nanoscale effect and oxygen doping, make the sensor highly thermo-sensitive. The sensor also shows fast response, precise resolution and good bendable properties. As demonstrated, the sensor achieves monitoring of respiratory rate, measurement of body temperature, identification of human touch and constituting a 5 × 5 array for temperature mapping. These results demonstrate that the GNRs sensor is highly promising as an economical disposable device for personal healthcare and disease monitoring.

This article presents the development of a new medical robot system comprising a spherical remote center motion (RCM) mechanism with modular design and two mechanical decoupling methods for Minimally Invasive Surgery (MIS). We achieved excellent comprehensive performance indices through a novel multi-objective optimization model comprising four optimization objective functions, three constrained conditions and two optimization variables. In order to enhance the manipulability, remove the coupling between motors, and reduce the control difficulty, two new decoupling mechanism means were proposed to remove coupling motion between the wrist and pincers, coupling motion between the translational joint of mobile platform and four interface disks of surgical instrument as a results of rear drive motor, respectively. The control system architecture is designed to include intuitive motion control, incremental motion control, and proportional motion control. Master-slave attitude registration and surgical instrument replacement strategies improve the master-slave control efficiency. We tested the spherical RCM mechanism performance indices and developed two mechanical decoupling methods and a master-slave control algorithm. Our experimental test results validated that fixing point accuracy, the coupling motions, the positioning and repeated positioning accuracy of the MIS robot, and master-slave control algorithm meet the requirements of MIS. Successful animal experiments confirmed effectiveness of the novel MIS robot system.

Chronic psychological stress is closely correlated with breast cancer growth and metastasis. Sini San (SNS) formula is a classical prescription for relieving depression-related symptoms in traditional Chinese medicine (TCM). Current researches have suggested that chronic psychological stress is closely correlated with cancer stem cells (CSCs) and endoplasmic reticulum (ER) stress. This study aimed to investigate the effects of chronic psychological stress on ER stress-mediated breast cancer stemness and the therapeutic implication of SNS. Chronic psychological stress promoted lung metastasis in 4T1 breast tumor-bearing mice and increased the stem cell-like populations and stemness-related gene expression. Meanwhile, GRP78, a marker of ER stress, was significantly increased in the breast tumors and lung metastases under chronic psychological stress. As a biochemical hallmark of chronic psychological stress, cortisol dramatically enhanced the stem cell-like populations and mammospheres formation by activating GRP78 transcriptionally. However, GRP78 inhibitors or shRNA attenuated the stemness enhancement mediated by cortisol. Similarly, SNS inhibited chronic psychological stress-induced lung metastasis and stemness of breast cancer cells, as well as reversed cortisol-induced stem cell-like populations and mammospheres formation by attenuating GRP78 expression. Co-localization and co-immunoprecipitation experiments showed that SNS interrupted the interaction between GRP78 and LRP5 on the cell surface, thus inhibiting the Wnt/β-catenin signaling of breast CSCs. Altogether, this study not only uncovers the biological influence and molecular mechanism of chronic psychological stress on breast CSCs but also highlights SNS as a promising strategy for relieving GRP78-induced breast cancer stemness via inhibiting GRP78 activation.

Pengfei Sun, Meng Lu, Changchen Wang, Bo Pan Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, People’s Republic of ChinaCorrespondence: Bo PanDepartment of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, People’s Republic of ChinaTel +8613810855912Email zbzbzhc@163.comPurpose: This study evaluated the utility of a ruler for reconstructed article positioning.Methods: Forty-seven patients with unilateral microtia were selected from August 2020 to September 2021.Results: The linear distance from the highest point of the reconstructed auricle to the central axis of the nose was not significantly different from the distance from the highest point of the normal contralateral auricle to the central axis of the nose (P> 0.05). The distance from the lowest point of the reconstructed auricle to the central axis of the nose was not significantly different from the distance from the lowest point of the normal auricle to the central axis of the nose (P> 0.05). The linear distance from the highest to the lowest point of the reconstructed auricle was not significantly different from the distance from the highest to the lowest point of the normal auricle (P> 0.05). These results indicate that the reconstructed auricle was symmetrical to the contralateral ear.Conclusion: The positioning ruler evaluated in this study is simple, easy to use, accurate, and non-invasive.Keywords: microtia, reconstructed auricle, ruler, ear

Objective We conducted this meta-analysis to compare the efficacy of these two surgical methods by comparing the incidence of major evaluation indicators. Methods The databases such as PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP information databases were searched. Results The satisfaction rate of patients with auricle reconstruction using expanded flaps was 86.5%, and the satisfaction rate of patients with auricle reconstruction using non-expanded flaps was 87.9%. The incidence of postoperative hematoma was 2.5% in patients with auricle reconstruction using expanded flaps and 18.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative skin necrosis was 1.2% in patients with auricle reconstruction using expanded flaps and 4.1% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative incision infection was 2.4% in patients with auricle reconstruction using expanded flaps and 0.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of cartilage framework exposure was 2.2% in patients with auricle reconstruction using expanded flaps and 1.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative scar hyperplasia was 3.8% in patients with auricle reconstruction using expanded flaps and 3% in patients with auricle reconstruction using non-expanded flaps. The publication bias of included literature was evaluated by Egger test. There was no publication bias in this Meta-analysis ( P > .05). Conclusion The auricle reconstruction using non-expanded flaps is dominant in four of the six evaluation indexes. Therefore, we believe that the auricle reconstruction using non-expanded flaps has better therapeutic effect in patients with microtia. Due to the limitations of this meta-analysis, the conclusions of this meta-analysis still need to be further verified.

This study aimed to compare the therapeutic effects of biplane skin dilator implantation with those of conventional skin dilator implantation in auricular reconstruction. A total of 137 patients with microtia who met the inclusion criteria from January 2020 to April 2021 were retrospectively selected. Sixty-three patients comprised the control group and were implanted with a skin expander using the conventional method. Seventy-four patients comprised the experimental group and were implanted with a skin expander using the biplane method. Non-parametric tests were used to compare the down-moving distance of the skin dilator between the experimental group and the control group. There was a statistically significant difference in the down-moving distance of the skin dilator between the experimental group and the control group (P P > 0.05). Moreover, there was no significant difference in the satisfaction rate of patients and their families between the experimental group and the control group (P > 0.05). In this study, the treatment effect of biplane skin dilator implantation was better than that of conventional skin dilator implantation.

Crouzon syndrome is considered as one of the most common craniosynostosis syndromes with a prevalence of 1 in 65,000 individuals, and has a close relationship with variants in fibroblast growth factor receptor 2. Here the authors described a Crouzon syndrome case, which was asked for surgery treatment for the symptom of multisuture craniosynostosis. Mild midfacial retrusion, larger head circumference, proptosis, pseudo-prognathism, and dental malposition could also be found obviously. Then fronto-orbital advancement and cranial cavity expansion were performed to the child. After whole-exome sequencing (WES) and Sanger sequencing, gene variants in the exons 2 and 3 of FGFR2 were detected. And protein tyrosine 105 replaced by cysteine in the extracellular region of FGFR2 was also detected. After operation, she presented a satisfactory anterior plagiocephaly and scaphocephaly correction, and the result was satisfied by surgeons and her parents. Variants detected using WES have further research prospect.

Background Metastasis represents the leading cause of death in patients with breast cancer. Traditional Chinese medicine is particularly appreciated for metastatic diseases in Asian countries due to its benefits for survival period prolongation and immune balance modulation. However, the underlying molecular mechanisms remain largely unknown. This study aimed to explore the antimetastatic effect and immunomodulatory function of a clinical formula Aiduqing (ADQ). Methods Naive CD4+ T cells, regulatory T cells (Tregs), and CD8+ T cells were sorted by flow cytometry. Then, breast cancer cells and these immune cells were co-cultured in vitro or co-injected into mice in vivo to simulate their coexistence. Flow cytometry, ELISA, qPCR, double luciferase reporter gene assay, and chromatin immunoprecipitation assay were conducted to investigate the immunomodulatory and antimetastatic mechanisms of ADQ. Results ADQ treatment by oral gavage significantly suppressed 4T1-Luc xenograft growth and lung metastasis in the orthotopic breast cancer mouse model, without noticeable hepatotoxicity, nephrotoxicity, or hematotoxicity. Meanwhile, ADQ remodeled the immunosuppressive tumor microenvironment (TME) by increasing the infiltration of tumor-infiltrating lymphocytes (TILs) and cytotoxic CD8+ T cells, and decreasing the infiltration of Tregs, naive CD4+ T cells, and tumor-associated macrophages (TAMs). Molecular mechanism studies revealed that ADQ remarkably inhibited CXCL1 expression and secretion from TAMs and thus suppressed the chemotaxis and differentiation of naive CD4+ T cells into Tregs, leading to the enhanced cytotoxic effects of CD8+ T cells. Mechanistically, TAM-derived CXCL1 promoted the differentiation of naive CD4+ T cells into Tregs by transcriptionally activating the NF-κB/FOXP3 signaling. Lastly, mouse 4T1-Luc xenograft experiments validated that ADQ formula inhibited breast cancer immune escape and lung metastasis by suppressing the TAM/CXCL1/Treg pathway. Conclusions This study not only provides preclinical evidence supporting the application of ADQ in inhibiting breast cancer metastasis but also sheds novel insights into TAM/CXCL1/NF-κB/FOXP3 signaling as a promising therapeutic target for Treg modulation and breast cancer immunotherapy.

OBJECTIVES The symptoms associated with microtia are ever-changing and not to stick to 1 pattern. The symptoms associated with microtia are constantly changing and are not set in stone. The aim of this article was to describe the various phenotypes from multiple systems found in microtitis patients included in the DatabasE of genomiC varIation and Phenotype in Humans using Ensembl Resources database, and to analyze possible pathogenic mutations. METHODS DatabasE of genomiC varIation and Phenotype in Humans using Ensembl Resources is an interactive web-based database, which incorporates a suite of tools designed to aid the interpretation of genomic variants. The term "microtia" was used as the search term, and the data extracted from the DatabasE of genomiC varIation and Phenotype in Humans using Ensembl Resources for this study was updated until October 2020. Pearson chi-squared test was used to test associations between types of genomic variants and the pathogenicity of variants. RESULTS Of the 386 cases enrolled in the study, 99% (n = 382) had 1 or more associated abnormalities. The most frequently detected abnormalities were those of the face and neck (n = 362 [93.8% of all cases]); musculoskeletal system (n = 337 [87.3%]); and nervous system (n = 334 [86.5%]), followed by abnormalities of limbs (n = 252 [65.3%]); the eye (n = 212 [54.9%]); and the integument (n = 200 [51.8%]). Besides, a total of 479 genomic variants were determined, including sequence variants and copy number variants (loss and gain). The pathogenicity of loss-type variants was significantly higher among other types (P

Black carbon (BC) emissions, derived primarily from incomplete fuel combustion, significantly affect the global and regional climate. Mass absorption efficiency (MAE) is one important parameter in evaluating the climate impacts of BC. Here, values and variabilities in the MAE of BC (MAEBC) from real-world residential emissions were investigated from a field campaign covering 163 burning events for different fuel-stove combinations. MAEBC (average: 12 ± 5 m2/g) was normally distributed and varied greatly by 2 orders of magnitude. Statistically significant differences in MAEBC were found for various fuels, while no significant differences were observed among different stoves. The fuel difference explained 72 ± 7% of the MAEBC variation. MAEBC did not correlate with the modified combustion efficiency but positively correlated with the ratio of organic carbon (OC) to elemental carbon (EC) and negatively correlated with char-EC. The OC/EC ratio was not always lower in coal emissions in comparison to biomass burning emissions. Coal- and biomass-burning emissions had different profiles of carbon fractions. Char-EC, OC, OC/EC, and char-EC/soot-EC can explain 68.7% of the MAEBC variation, providing the potential for predicting MAEBC from the carbon fractions, since they are more commonly measured and available.

With the fast development of consumer electronic and artificial intelligence equipment, flexible pressure sensors (FPSs) have become a momentous component in the application of wearable electronic, electronic skin, and human-machine interfacing. The capacitive FPS possesses the merits of low energy consumption, high resolution, and fast dynamic response, so it is ideal for mobile and wearable electronics. However, capacitive FPS is vulnerable to electromagnetic interference and parasitic capacitance due to its low sensitivity. Microstructure or porous dielectric materials have been applied to improve the sensitivity of the capacitive FPS, but the high sensitivity is just limited to a narrow region. In this work, we propose a different strategy that incorporates a high-permittivity MXene nanocomposite dielectric with a 3D network electrode (3DNE) to improve the sensing performance of the capacitive FPS. Thanks to the high permittivity of the dielectric layer and hierarchical deformation of the electrode, the fabricated capacitive FPS exhibits a high sensitivity of 10.2 kPa-1 in the low pressure range (0-8.6 kPa) and still maintains a relatively high sensitivity of 3.65 kPa-1 with a near-linear response in a wide pressure range (8.6-100 kPa). In addition, the capacitive FPS can withstand over 20,000 times pressure loads without significant signal damping. Furthermore, the working mechanism of the capacitive FPS is illustrated by the finite element analysis (FEA) method and theoretical calculation. The application potential of the sensor in wearable electronics was demonstrated by human pulse wave monitoring and pressure mapping tests with a 4 × 6 sensor microarray.

Objective measurement is important for diagnosing congenital or acquired auricular abnormalities and the evaluation of therapeutic efficacy. However, methods applied in the past were mostly inaccurate and unreliable. The present study aimed to introduce five standardized indices for auricle measurement and present a highly precise and reliable methodology combining three-dimensional (3D) scanning techniques and the Materialise Mimics software for the evaluation of auricle sizes. A total of 20 normal ears were measured independently by four surgeons using the standardized digital method with 3D scanning technique and the traditional manual method. Parameters of the auricle, including the length and width, arc length, cranioauricular height and angle were measured using the Mimics software. Paired t-test, Wilcoxon signed rank test and intra-class correlation coefficients (ICC) were performed on the data to assess the precision, uniformity and observer independence of the method. Pearson's product moment correlation was calculated to assess the correlation between auricle length and width in addition to the correlation between cranioauricular height and angle. No significant differences were indicated between measurements of five auricular parameters made by two surgeons using the digital method. However, significant differences were found using the manual method (P0.05). Taken together, data from the present study suggested that measurements of the length and width, arch length, and cranioauricular height and angle of auricles using the standardized digital method combining 3D scanning with the Mimics software were comprehensive, precise, convenient, repeatable and reliable.

Compliant bridge-type mechanisms have been extensively utilized as displacement amplifiers, but most of the existing mathematical models were developed based on linear assumptions, incapable of revealing nonlinear characteristics. In this paper, an arm is regarded as a variable thickness beam that covers both lumped and distributed configurations, and thus a nonlinear closed-form model of compliant bridge-type mechanisms is developed through considering load effect. Then, application limitations, displacement amplification ratio, input compliance, and influence of actuator are discussed to quantitatively evaluate the influences of design parameters and capture the nonlinear characteristics of compliant bridge-type mechanisms. Finally, the analytical model is verified by finite element analysis (FEA) and experiments, and the results show that the proposed model can accurately predict the deformation of compliant bridge-type mechanisms.

BACKGROUND In previous studies, higher expression of PREX1 (PtdIns (3,4,5)P3-dependent Rac exchanger 1) has been detected in some subsets of breast cancer, and activation of PREX1 has been associated with tumor progression in vivo. However, an association between PREX1 and breast cancer prognosis has not been examined. MATERIAL AND METHODS In this study, we investigated the expression and correlation of PREX1 with important clinical factors and prognosis of patients with breast cancer. Immunohistochemical staining was performed for 121 tumor tissue specimens obtained from primary breast cancer lesions. RESULTS We found that 55 tissues exhibited positive staining for PREX1. Moreover, tumors positive for PREX1 were found to have significant association with recurrence rate (P=0.000) and metastasis rate (P=0.001). Univariate and multivariate regression analyses also identified PREX1 expression as an independent variable of disease-free survival. Our analyses indicate that high levels of PREX1 expression were related to longer disease-free survival in patients with breast cancer (P=0.013). CONCLUSIONS PREX1 is a favorable variable of prognosis for breast cancer patients, these study results need to be confirmed in larger research studies.

The morphology and structure of sensing materials are extremely important to performances of gas sensor. Zinc oxide (ZnO) is a promising gas-sensing material, due to its morphology controllable fabrication. In this work, flower-like ZnO (FZnO) was synthesized on GaN by electrodeposition as sensing materials of ethanol gas sensor. FZnO consisting of ZnO nanosheets with thickness of 55 nm is in situ grown on GaN. When FZnO/GaN heterojunction is used as sensing materials for detection of ethanol, this material possesses a higher response than ZnO or ZnO composite at room temperature. In detail, the FZnO/GaN based gas sensor displays remarkable sensitivity (Ra/Rg = 26.9), when the sensor is exposed to ethanol at the concentration of 50 ppm at room temperature. Importantly, rapid response and recovery time is 12 and 9 s, respectively. Meanwhile, this sensor presents excellent selectivity and stability. In addition, detection limit of the sensor is 100 ppb. Enhancement of the sensing response is mainly attributed to the FZnO and conductivity of the GaN. These results indicate the potential applications of the as-prepared metal oxide semiconductor based GaN in the sensing field.

Chronic graft-versus-host disease (cGVHD) and late acute graft-versus-host disease (L-aGVHD) are understudied complications of allogeneic hematopoietic stem cell transplantation in children. The National Institutes of Health Consensus Criteria (NIH-CC) were designed to improve the diagnostic accuracy of cGVHD and to better classify graft-versus-host disease (GVHD) syndromes but have not been validated in patients

Zinc oxide nanorods (ZnO NRs) were grown on gallium nitride (GaN) substrates by electrodeposition. HRTEM and XRD analyses were performed to determine crystalline structure. Single crystal ZnO NRs with an average size of 240 nm were grown along the c-axis direction. The resulting H2S sensors based on ZnO NRs/GaN displayed excellent selectivity and response, particularly in the concentration range of 1–50 ppm of H2S. In the concentration of 50 ppm H2S, a sensing response time of 82 s and a recovery time as low as 48 s can be achieved at 240 °C. In addition to ZnO NRs forming porous network channels for gas diffusion in and out, the H2S-sensing performance of ZnO NRs/GaN heterojunctions could be attributed to the enhanced electron transport and the favorable charge transfer resulting from the excellent transport capability of GaN. The in-situ fabrication of sensing materials makes our sensors extremely attractive in the field of H2S detection.

Background The incidence of bilateral breast cancer (BBC) is increasing nowadays comprising 2%‐11% of all breast cancer (BC). According to the interval time between the first and second cancer, BBC could be divided into synchronous (SBBC) and metachronous (MBBC). However, this interval time is quite different across studies. It remains controversial whether the survival of BBC, SBBC, and MBBC is similar or worse compared to that of unilateral breast cancer (UBC), and whether the survival of SBBC is similar or worse compared to MBBC. To better understand the survival of UBC, BBC, SBBC, and MBBC and how the interval time would influence the prognosis of SBBC and MBBC, we performed this meta‐analysis on studies from recent 10 years (2008‐2018). Methods Databases of PubMed, Embase, and Web of Science were searched for relevant studies within recent 10 years. Hazard ratio (HR) was adopted to evaluate the difference of overall survival (OS) of UBC, BBC, SBBC, and MBBC. HR of OS comparisons were performed between BBC vs UBC, SBBC vs UBC, MBBC vs UBC, and SBBC vs MBBC with 3, 6, 12 months as the interval time, respectively. Results There were 15 studies of 72 302 UBC and 2912 BBC included in the meta‐analysis. The summary HR of OS comparison between BBC vs UBC was 1.68 (95% CI: 1.28‐2.20), SBBC vs UBC was 2.01 (95% CI: 1.14‐3.55), MBBC vs UBC was 3.22 (95% CI: 0.75‐13.78). When 3, 6, 12 months were used as the interval time, the summary HR of the OS comparison between of SBBC vs MBBC were 0.64 (95% CI: 0.44‐0.94), 1.17 (95% CI: 0.84‐1.63) and 1.45 (95% CI: 1.10‐1.92), respectively. Conclusion BBC and SBBC showed worse prognosis in terms of OS compared to UBC while MBBC manifested similar or non‐superior survival as UBC. The OS comparison between SBBC and MBBC changed with different interval time used. The longer the interval time used, the worse the survival of SBBC. SBBC with interval of 3‐12 months between the two cancers had the worst prognosis. When 6 months was used to differentiate SBBC from MBBC, these two clinical entities showed similar OS.

The e-skin based on lead zirconate titanate (PZT) exhibits excellent electrical sensing performance, and it is widely used in clinical trials owing to its prominent piezoelectric, ferroelectric and pyroelectric performance. However, the complicated fabrication procedure and fatigue during long-term use still limit its application. In this study, a flexible e-skin withstanding fatigue over extended periods of use (more than 10 000 cycles) was facilely constructed by combining polydimethylsiloxane (PDMS) with a highly crystalline PZT thin film. Note that the sensor was first fabricated using the micro-structured PZT thin film via a low-temperature pulsed laser deposition system (PLD) method, which could be easily combined with other processes. The sensor highlighted an ultra-high detection sensitivity (S, ∼5.82 kPa−1) and almost negligible hysteresis rate or degree of hysteresis (DH, ∼0.45%) in the pressure-sensing test. Moreover, the obtained sensor exhibited the lower limit of detection (LOD) of 30 Pa as well as a faster response (∼0.38 s) and release time (∼0.79 s). Importantly, due to the excellent performance of this sensor, various dynamic and static signals of the human body could be detected within the maximum range allowed under the septal fracture effect.

Autogenous rib cartilage graft procedure for microtia reconstruction has been adopted as the most standardized current method. But calcification would make it difficult for cartilage harvesting and ear framework sculpting. The objective of this study was to explore the rate, degree, and pattern of rib cartilage calcification in microtia and to guide rib cartilage harvesting and the optimal timing of auricular reconstruction. A retrospective study was performed with the imaging data from 320 consecutive patients who received a preoperative 3-dimensional chest computed tomography (CT). Overall, calcification rate of cartilages in female patients was higher than male's (P 0.05). In 6 to 15 years group, calcification rates of male and female had a similar rate, while female's were higher than male's in other 3 groups. Furthermore, the moderate-to-severe calcification rate was higher in female than in male patients (P 0.001). Therefore, girls who are over 15 years should be paid more attention regarding the possibility of moderate-to-severe calcification; these patients should take CT examinations if necessary. Calcification rate of the youngest group (6-15 years) was the lowest of all groups, while other 3 groups showed no statistical significance (P 0.05). So merely the age increasing is not the contradiction for cartilage harvesting, as long as the authors effectively evaluate the condition of rib cartilage before operation. Rib cartilages serve as the key material in auricular framework sculpting and determine the feasibility and outcomes of the surgery. So CT examinations for preoperative evaluation of rib cartilage could be a useful method for planning microtia reconstruction.

Background Microtia is a congenital anomaly of the external ear that can appear in isolation or in association with other congenital anomalies. In this study, the authors identify the prevalence and phenotypes of associated congenital malformations in patients with microtia in a Chinese specialty clinic population. Methods Data were collected from 672 patients seen between December of 2014 and February of 2016 in the Department of Auricular Reconstruction at the Plastic Surgery Hospital of Peking Union Medical College. All patients were examined by trained clinicians and classified into one of three grades of microtia. Co-occurring congenital anomalies were detected and recorded. Results The majority of study participants were male patients (72 percent), and most participants had unilateral microtia (93 percent, 68 percent of whom had right-side microtia). Two hundred ninety-three patients (44 percent) had one or more associated anomalies. The most commonly occurring comorbid malformations were those of the ear, face, and neck (40 percent of all associated malformations); musculoskeletal system (35 percent); and cardiovascular system (11 percent). Conclusions These data represent the first detailed and thematic study of microtia and associated congenital anomalies in a Chinese clinical population. Substantial clinical heterogeneity was observed, and the prevalence of comorbid congenital malformations was high. Future studies investigating congenital anomalies associated with microtia are needed to improve understanding of its cause.

Objectives: To analyze the impact of the reversal penetrating technique (RPT) for intrathoracic gastroesophageal mechanical anastomosis on the development of anastomotic complications in Ivor Lewis minimally invasive esophagectomy (ILMIE) and further identify the risk factors for the development of anastomotic leakage and stricture.Methods: A retrospective observational study was conducted using clinical data of 316 patients with esophageal carcinoma (EC) who underwent ILMIE from January 2012 to December 2019. The participants were divided into three groups of RPT, transoral Orvil technique (TOT), or purse-string technique (PST) according to the different stapler placenent methods for intrathoracic mechanistic circular stapling. Multivariable analysis was performed to investigate the association of risk factors with anastomotic leakage and stricture.Results: There were 154 patients with RPT, 78 with TOT and 84 with PST intrathoracic gastroesophageal circular stapling in ILMIE. There was no differences in intraoperative anastomosis related conditions inclouding conversion of open operations, ways of esophageal reconstruction, lymph nodes harvested between the three groups. Whereas, The mean total operative time, and gastroesophageal anastomosis time in the RPT group were significantly shorter than those in other groups (both p