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The degradation of collagen in different body parts is a critical point for designing collagen-based biomedical products. Here, three kinds of collagens labeled by second near-infrared (NIR-II) quantum dots (QDs), including collagen with low crosslinking degree (LC), middle crosslinking degree (MC) and high crosslinking degree (HC), were injected into the subcutaneous tissue, muscle and joints of the mouse model, respectively, in order to investigate the in vivo degradation pattern of collagen by NIR-II live imaging. The results of NIR-II imaging indicated that all tested collagens could be fully degraded after 35 days in the subcutaneous tissue, muscle and joints of the mouse model. However, the average degradation rate of subcutaneous tissue (k = 0.13) and muscle (k = 0.23) was slower than that of the joints (shoulder: k = 0.42, knee: k = 0.55). Specifically, the degradation rate of HC (k = 0.13) was slower than LC (k = 0.30) in muscle, while HC showed the fastest degradation rate in the shoulder and knee joints. In summary, NIR-II imaging could precisely identify the in vivo degradation rate of collagen. Moreover, the degradation rate of collagen was more closely related to the implanted body parts rather than the crosslinking degree of collagen, which was slower in the subcutaneous tissue and muscle compared to the joints in the mouse model.

In this research, we designed and implemented a small, convenient, and non-invasive paper-based microfluidic sweat sensor that can simultaneously detect multiple key biomarkers in human sweat. The origami structure of the chip includes colorimetric and electrochemical sensing regions. Different colorimetric sensing regions are modified with specific chromogenic reagents to selectively identify glucose, lactate, uric acid, and magnesium ions in sweat, as well as its pH value. The regions of electrochemical sensing identify cortisol in sweat by molecular imprinting. The entire chip is composed of hydrophilic- and hydrophobically-treated filter paper, and 3D microfluidic channels are constructed by using folding paper. The thread-based channels formed after hydrophilic and hydrophobic modifications are used to control the rate of flow of sweat, which in turn can be used to control the sequence of reactions in the differently colored regions of development to ensure that signals of the best color can be captured simultaneously in the colorimetric sensing regions. Finally, the results of on-body experiments verified the reliability of the proposed sweat sensor and its potential for the non-invasive identification of a variety of sweat biomarkers.

Against the backdrop of hidden symptoms of diseases and limited medical resources of their investigation, in vitro diagnosis has become a popular mode of real-time healthcare monitoring. Electrochemical biosensors have considerable potential for use in wearable products since they can consistently monitor the physiological information of the patient. This review classifies and briefly compares commonly available electrochemical biosensors and the techniques of detection used. Following this, the authors focus on recent studies and applications of various types of sensors based on a variety of methods to detect common compounds and cancer biomarkers in humans. The primary gaps in research are discussed and strategies for improvement are proposed along the dimensions of hardware and software. The work here provides new guidelines for advanced research on and a wider scope of applications of electrochemical biosensors to in vitro diagnosis.

BACKGROUND AND OBJECTIVES There has been reports on fractional CO2 laser successfully improving contracture scars that impair the function of a joint. It seems that certain contracture problems could be solved by laser instead of surgery. However, the clinical application could be difficult when the efficacy of the method remains unknown. The purpose of this study is to report the releasing capacity of the fractional CO2 laser on contracture scars based on a defined treatment method. STUDY DESIGN/MATERIALS AND METHODS We conducted a retrospective study in patients with limited function in joints caused by contracture scars. Fractional CO2 laser and our "3D mesh releasing" protocol were applied. The primary outcome was the improvement measured in range of motion (ROM) of the relevant joint before all intervention and 6 months after the last treatment. RESULT From November 2016 to January 2018, 11 joints of 10 cases were treated by the fractional CO2 laser. Patients went through 2.27 (standard deviation [SD] 1.42, 1-5) sessions. The average progress of ROM before and 6 months after all treatments was 19.13° (SD 10.25, P

Background Preoperative localization of the perforators allows precise planning of the flap design and improves surgical efficiency. Recently, infrared thermography is introduced as a reliable alternative, where the perforator corresponds to the "hot spot" on the thermogram. This study aims to compare the application of color Doppler ultrasound (CDU) and infrared thermography in preoperative perforator mapping of the anterolateral thigh (ALT) perforator flap. Patients and Methods From September 2017 to January 2019, CDU and infrared thermography were both applied on 20 patients to locate the perforators originated from lateral circumflex femoral artery preoperatively. The perforators identified using each modality were marked on the anterolateral thigh region. The accuracy of both mapping methods was analyzed according to the intraoperative findings. The relation between location bias and the thickness of subcutaneous tissue was analyzed. Results A total of 20 ALT flaps were included. Fifty-three perforators were detected by CDU, and 51 "hot spots" were identified by infrared thermography, in which 50 "hot spots" corresponded to CDU, and the consistency test showed that the kappa index was 0.712 (P 0.05). Conclusions Compared with CDU, infrared thermography can be used to locate perforators, in this case, the ALT perforators, with a high degree of consistency. It is portable, economical, noninvasive, and easy to operate. It has higher accuracy in patients with thinner subcutaneous tissue. We believe that infrared thermography can be a useful technique for perforator mapping, especially in patients where the subcutaneous tissue is thinner.

Background Ischemic preconditioning of the forehead flap prior to pedicle division helps to improve angiogenesis. Clamping the pedicle by a clamped rubber band with vessel forceps is often clinically applied. However, the severe pain and unstable blocking effect influenced the preconditioning process. In this study, we described an innovative device designed for ischemic preconditioning and compared its efficacy with the clamped rubber band. Methods The device consists of a self-locking nylon cable tie with a buckle and a rubber tube. The rubber tube is fed over the cable tie to act as a soft outer lining and the cable tie is tightened across the pedicle to block the perfusion for ischemic preconditioning. This device and the standard clamped rubber band were applied respectively before division surgery. The constriction effect, reliability, reproducibility, and the patients' pain tolerance were compared. Results A total of 20 forehead flaps were included. The cable tie had less incidence of loosening (7.7% vs. 16.6%, p Conclusion Compared with the clamped rubber band, the cable tie produces a more reliable and reproducible ischemic preconditioning effect. It is also better tolerated by the patients. Therefore, we recommend using the nylon cable tie as the preferred device for ischemic preconditioning of the forehead flap.

Microfluidic paper-based analytical devices (μPADs) have been widely used in point-of-care testing owing to their simple operation, low volume of the sample required, and the lack of the need for an external force. To obtain accurate semi-quantitative or quantitative results, μPADs need to respond to the challenges posed by differences in reaction conditions. In this paper, multi-layer μPADs are fabricated by the imprinting method for the colorimetric detection of C-reactive protein (CRP). Different lighting conditions and shooting angles of scenes are simulated in image acquisition, and the detection-related performance of μPADs is improved by using a machine learning algorithm. The You Only Look Once (YOLO) model is used to identify the areas of reaction in μPADs. This model can observe an image only once to predict the objects present in it and their locations. The YOLO model trained in this study was able to identify all the reaction areas quickly without incurring any error. These reaction areas were categorized by classification algorithms to determine the risk level of CRP concentration. Multi-layer perceptron, convolutional neural network, and residual network algorithms were used for the classification tasks, where the latter yielded the highest accuracy of 96%. It has a promising application prospect in fast recognition and analysis of μPADs.

Background Coronary plaque progression is a major risk factor of adverse cardiac events in patients with coronary heart disease (CHD). Emerging evidence showed that attenuated high-density lipoprotein (HDL) function measured by cholesterol efflux capacity (CEC) was associated with development of atherosclerosis independent of HDL cholesterol level. In this study, we sought to investigate whether CEC is a predictor for coronary plaque progression in CHD patients. Methods We consecutively enrolled CHD patients from January 2017 to August 2019 in our Hospital who underwent elective percutaneous coronary intervention and had at least one non-target coronary lesion. Follow-up coronary angiography were performed at around 12 months. Fluorescence-labeled cholesterol and J774 macrophages were used to measure the CEC of ApoB-depleted serum sample from all patients. Quantitative coronary angiography (QCA) was performed both at baseline and follow-up to analyze the plaque progression. Results A total of 430 CHD patients with 586 non-target coronary lesions were included in the final analysis. During a mean follow-up time of 381.04±59.52 days, patients with decreased CEC presented more severe plaque progression (net luminal loss in highest to lowest CEC quartile: 0.22±0.42mm vs 0.20±0.41mm vs 0.13±0.36mm vs 0.11±0.34mm, p=0.035). In multivariate analysis, baseline CEC was independently associated with coronary plaque progression after adjustment for traditional risk factors including HDL cholesterol and ApoA-I, no matter treated as categorical variable (OR: 0.382 [95% CI 0.180–0.781] for highest to lowest quartile) or continuous variable (OR: 0.522 [95% CI 0.373–0.714] for per SD increase]. Furthermore, CEC demonstrated a better power in predicting coronary plaque progression compared with HDL cholesterol concentration (AUC=0.644 vs 0.514). Conclusions This study suggests that HDL function reflected by serum CEC is an independent predictor for coronary plaque progression in CHD patients. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China, Shanghai Municipal Commission of Health and Family Planning

Summary Background Pre-expanded pedicled flaps possess a more flexible transfer pattern and higher tissue utilization than random flaps, but the perfusion is fully dependent on the chosen axial vessels. A precise mapping of the vessels would assist the surgical design and increase the likelihood of success. The application of Infrared thermography (IRT) has been previously reported for perforator location. The aim of this study is to report the use of IRT in mapping the course and distribution of axial vessels in the pre-expanded flap to guide the designing and harvesting. Methods Patients who underwent head and neck reconstruction using pre-expanded flaps were included. After tissue expansion, IRT was used to mark the vessel distribution along the expanded flap. The results were compared with color Doppler ultrasound (CDU) and/or computed tomographic angiography (CTA). The flap was designed and raised based on the pre-operative marking by IRT. The mark was verified intraoperatively. Results A total of 26 expanded flaps were performed, including 20 pedicled flaps and 6 free flaps. IRT succeeded to map the vessel distribution in all cases. All marked results were verified by CDU, CTA, and intraoperative dissection (26/26, 100%). IRT showed more comprehensive distribution of vascular branches than CDU or CTA, and could be utilized intraoperatively to identify the arteries. Conclusion IRT provides accurate and comprehensive mapping of the axial vessel distribution in the pre-expanded flaps, assisting with flap design and harvest. It is easy to use and non-invasive as an important tool pre- or intraoperatively to ensure the safe elevation.

In this study, we developed a power-free, accurate, and portable diagnostic platform called Handing based on embedded technology, which can rapidly detect fluorescent signals from quantum dots (QDs) on lateral flow test strips (LFTSs). The Handing system has three components: a hand-held test terminal, LFTS cartridge, and data server. The hand-held test terminal is the primary system component and it is integrated with tiny components using printed circuit board packaging for image acquisition, processing, and data handling by a specific program. A black smooth shell and three-dimensional printed test cartridge are used to facilitate the portability of the detection terminal, which provides a closed detection process as well as enhancing the anti-interference capacity. The functions of the data server comprise pre-editing, storage, range querying, and sharing with an international network. Multiple hand-held terminal devices can be linked simultaneously to the same data server. In this study, we detected the tumor marker carcinoembryonic antigen (CEA) using the QD-LFTS system, which allowed quantitative analysis in the range of 1-100ng/mL with an ideal detection limit of 0.049ng/mL. Thus, the system is suitable for detecting CEA in the clinically accepted range. We also detected 70 positive and 30 negative serum samples using the Handing system, which exhibited good specificity and sensitivity. Thus, Handing has the capacity for rapid quantitative detection with high stability and repeatability, so it could be used for in vitro diagnostics in the laboratory and in other conditions for various applications, e.g., food evaluation, disease screening, environmental monitoring, and drug testing.

Summary Objective The popularity of the superficial circumflex iliac artery perforator (SCIP) flap has been limited by factors such as variable vascular anatomy and short arterial pedicle. This article aimed to delineate flap design and harvest strategies based around either the proximal or distal perforators of the superficial circumflex iliac artery (SCIA) and propose a set of strategies that can help deal with the limitations of the flap. Method From August 2011 to June 2015, the SCIP flap was used in 80 patients for soft tissue defects at our institution. We utilized vessel imaging navigation to get a detailed overview of the vascular anatomy preoperatively. Flaps were designed on the basis of either the proximal or distal perforators of the SCIA. Backup strategies and surgical maneuvers were suggested to solve the problems that emerged during surgery. Results In total, 51 flaps were raised on the basis of the proximal perforators of the superficial branch of the SCIA, whereas 25 cases were based on the distal perforators from the deep branch, and in four cases, the pedicle was switched to the superficial inferior epigastric artery. In eight cases, the arterial pedicle lengthen technique was applied with a maximum length of 10 cm. All donor sites were closed directly with inconspicuous scars. Conclusion These surgical strategies simplified the intraoperative decision-making and overcame the shortcomings of the SCIP flap. We believe that the SCIP flap has a great potential to become a new workhorse flap in the field of reconstructive surgery.

Nipple reconstruction is an important last step in the process of autologous or implant-based breast reconstruction. A multitude of techniques have been described, among others the S-flap. To prevent nipple retraction after surgery, we modified the originally described method by Cronin. By adding an S-shaped incision line, the flap can be transposed with less tension and sutured on top of the new nipple along a curved line. Furthermore, two small triangular flaps were inserted at the base for reinforcement and reduced linear contraction. Assessment was completed by measuring nipple diameter and projection with a caliper. A total of 16 patients underwent the technique, of whom 11 could be followed after 3 and 6 months. Overall patient satisfaction with the aesthetic result was high, and we observed no infection or necrosis. Nipples were stable in size and shape at 6 months. Although reduction of 68% in projection and 31% in diameter was observed, the nipples remained pleasantly similar to the contralateral non-operated side. The modified S-flap is a simple and reliable technique for moderate-sized nipple reconstruction. By providing more tissue at the base, size and projection remain stable and durable. Moreover, by a modified linear incision line at the base, tension and subsequent scar contraction is minimal. 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 .

BackgroundReconstruction of upper and lower lip subunits is a complicated and elusive challenge. For patients affected by defects involving upper and lower lip subunits, a technique able to reconstruct both aesthetic units with matched colour, sufficient contours and similar texture would be ideal. In this study, we present our experience with upper and lower lip reconstruction using the pre-expanded bipedicled visor flap.MethodsFrom January 2014 to January 2017, 12 male patients presenting with defects of the upper and lower lip subunits were treated using this surgical technique. After a period of expansion of the scalp flap of over 6 months, the bipedicled visor flap was raised from both the parietal regions and rotated to resurface the defect. Delay and section of the pedicle were then performed.ResultsTwelve male patients with postburn scars aged 22 to 48 years (mean: 34 years) were successfully treated with no major complications. The donor site was closed primarily in all cases. Subsequent flap debulking and minor revisions were performed under local anaesthesia between 6 and 12 months postoperatively.ConclusionsThe pre-expanded bipedicled visor flap provides an effective and reliable option for upper and lower lip reconstruction with excellent colour and texture. It is feasible to achieve these results simultaneously from a single donor site by using a pre-expanded bipedicled visor flap.

It has been reported that the injection of the hyaluronic acid (HA) into the lower lid area could improve lower eyelid retraction. However, the published studies offered few insights into the mechanism of this treatment. When the underlying mechanism is not clear, many surgeons will not trust the method enough to apply it in their clinical practice. The purpose of this article was to propose a possible explanation for the underlying mechanism of the treatment and further verify the method by a series of cases. The authors performed a mechanical analysis on the physical impact of HA on the lower eyelid. In the clinical cases, we injected the fillers under the orbicularis muscle to correct lower lid retraction. The results were evaluated by the standardized marginal reflex distance 2 (MRD2) immediately and 9 months later. From October 2013 to October 2015, the injections were carried out in 27 cases (14 post-blepharoplasty and 13 involuntary). In 26 cases (96.3%), the retraction was completely corrected and did not recur through the last follow-up. The average improvement of the standardized MRD2 was 0.84 mm immediately after the injection and 1.19 mm 9 months later. Complications were not reported. Lower eyelid retraction could be treated by the injection of HA under the orbicularis muscle. The filler in this situation acted as a lifter because the filler changed the balance of force of the lower lid, forcing it to shift upward to gain the new balance. The ‘lifter’ mechanism could be applicable to other facial injections that generate elevating effects. 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 .

Effective real-time and long-time in vivo imaging for flap perfusion requires bright and stable imaging agents whose emissions can effectively penetrate live tissues without photobleaching. Compared to the standard imaging agent today – intraoperative indocyanine green (ICG), quantum dots (QDs) is a more attractive alternative due to its excellent optical properties including broad emission spectrum and stability against photobleaching. Recent studies have confirmed that the shortwave infrared window (SWIR) between 1000 and 2300 nm is the most sensitive spectral range for in vivo imaging due to its extremely low tissue absorption and autofluorescence . Here, we, for the first time, report a novel approach of flap perfusion assessment that provides real-time and long-time in vivo imaging using lead sulfide (PbS) QDs. Our results show that PbS QDs, as an imaging agent, can improve the stability of in vivo high-resolution images in a sustained manner, thus facilitating the precise evaluation of flap perfusion. In summary, compared to current imaging reporters, SWIR QDs have high photostability and deep tissue penetration, which makes them as promising in vivo imaging agents for more precise evaluation of flap perfusion.

Owing to their high emission intensity and size-based tunability, lead sulfide (PbS) quantum dots (QDs) have been employed in a broad spectrum of biological applications especially for the second near-infrared (NIR-II) biological imaging. However, the toxicity of Pb2+ ions remains an unavoidable risk factor during both preparation and biological applications. Here, we have developed an economical and environmentally friendly synthetic route with a recycle setup to prepare whey-protein-capped PbS QDs. Furthermore, the final Pb2+ ions were allowed to react with excess S2– ions and produce nontoxic precipitate in the end, which helped to avoid polluting the environment. After surface modification with protein, both our prepared QDs and the final reaction wastes demonstrated low toxicity in following both in vitro and in vivo experiments. Notably, the conversion efficiency of Pb2+ ions into PbS QDs in this study was almost 3 times than that of a one-time reaction without recycle. In addition, each batch of as...

This investigation compared the application of color Doppler ultrasound and computed tomographic angiography in preoperative planning of lower extremity perforator flaps.This study was a prospective comparative analysis of 40 patients with lower extremity defects who underwent reconstruction with perforator flaps. The position, caliber, route, and quality of the perforator vessels were detected by computed tomographic angiography and color Doppler ultrasound preoperatively. The results of the preoperative navigation with both imaging techniques were verified during the operation.Color Doppler ultrasound had a higher accuracy in terms of identifying (95 percent versus 90 percent) and locating (95 percent versus 82.5 percent) the perforators in the lower extremity. Color Doppler ultrasound required approximately 25 minutes for examination, whereas computed tomographic angiography required 46 seconds for the scan and approximately 22 minutes for the image analysis. There was no significant difference between the two methods.Preoperative radiologic vessel navigation is capable of offering valuable information such as the perforator's location, diameter, and path; and information regarding the quality of the perforators, which can shorten the operative time and improve the surgical results. The authors recommend color Doppler ultrasound for preoperative planning when harvesting perforator flaps from the lower extremity. In cases where the patient has a metal implant, allergy to the contrast agent, or renal insufficiency, color Doppler ultrasound is the only option. In time, the use of color Doppler ultrasound and computed tomographic angiography in combination will be recommended to improve the accuracy of preoperative perforator navigation.Diagnostic, IV.

Tissue engineering provides a promising approach for auricle reconstruction of microtia. Although the first clinical trial of tissue-engineered ear reconstruction has been performed using in vitro engineered human-ear-shaped cartilage, this approach is not regarded as the clinically available treatment yet, due to individual differences in clinical efficacy. In the present study, the feasibility and in vivo long-term fate of elastic cartilage regenerated with an accurate human-ear shape were explored using polycaprolactone (PCL) inner support strengthened biodegradable scaffold and expanded microtia chondrocytes (MCs) to identify factors that may result in discrepant clinical outcomes. Polyglycolic acid/polylactic acid (PGA/PLA) scaffolds with or without PCL inner support were prepared into different shapes by three-dimensional (3D) printing, hot-compressing, and pre-molding technologies. The expanded MCs were seeded into the scaffolds to evaluate biocompatibility of PCL inner support and its influence on cartilage regeneration, tissue integration, mechanical strength, and shape maintenance. The results testified that all the cartilages generated by different patients’ cells were highly consistent in both qualitative and quantitative data, indicating high repeatability and stability of cartilage construction technology. PCL inner support manifested a satisfactory biocompatibility and it had no inhibitory effect on cartilage formation, maturation, and tissue integration. After in vivo implantation, the regenerated cartilage without PCL inner support showed the same level of mechanical strength and shape maintenance ability as the PCL strengthened cartilage. Mature and continuous elastic cartilage with an accurate ear shape could be successfully regenerated in vivo with a long-term shape maintenance. All the cells of regenerated cartilage were derived from the implanted MCs, which could survive and maintain their phenotype for a long time. The current study provides reliable evidence, key techniques, and optimized strategies for further clinical applications of in vitro regenerated cartilage with special shapes such as ear, nose, and trachea.

Following the conventional physicochemical treatment of electroless nickel (Ni) plating wastewater (ENPW) in electroplating wastewater treatment plants, highly stable and recalcitrant coordination complexes of Ni (CCN) still remain. This results in various technical problems, leading to the treatment difficulty, poor wastewater biochemistry, and failure to meet effluent standards. Therefore, an efficient decomplexation system involving heterogeneous catalytic ozonation assisted with heavy metal chelation (O3/SAO3II-MDCR) was proposed in this study for the advanced treatment of CCN. The catalyst SAO3II was characterized by various methods, which revealed the mechanism of catalytic ozonation. Hydroxyl radicals ( OH) and other reactive oxygen species (ROS) groups were detected, proving that catalytic ozonation was a complicated reaction process and also a foundation process of the entire system. These ROS are vital for decomplexation via heterogeneous catalytic ozonation of the system. During the catalytic decomplexation process via ozonation, CCN first underwent gradual decomposition from a highly stable macromolecular state to a volatile micromolecular state (or even completely mineralized state). Then Ni was chelated to form an insoluble and stable chelate via competitive coordination. The optimum conditions for the O3/SAO3II-MDCR system were determined by single factor static experiments. After treatment with the O3/SAO3II-MDCR system, the effluent concentration of total Ni was found to be

The repair and functional reconstruction of long-segment tracheal defects is always a great challenge in the clinic. Finding an ideal substitute for tracheal transplantation is the only way to solve this problem. The current study proposed a series of novel strategies for constructing a bionic living trachea substitute. For the issue of tubular cartilage support, cartilage sheet technique based on high-density culture of chondrocytes was adopted to avoid the inflammatory reaction triggered by the materials and thus formed mature cartilage-like tissue in autologous goat model. For the issue of epithelialization, the autologous transplantation of oral mucosal epithelium was used to realize mucosa coverage of the constructed trachea lumen. Finally, the flat trapezius fascia flap with double blood supply was separated by microsurgical techniques to achieve stable pre-vascularization of both the regenerated cartilage and the grafted epithelium simultaneously. By integrating the above strategies, the vascularized and epithelialized tracheal substitute with tubular cartilage support was successfully constructed in a goat model. The reconstructed trachea possessed a multiple layer structure of muscle-cartilage-fascia-mucosa comparable to the native trachea, and thus might realize stable survival and long-term airway function maintenance, providing a promising tracheal substitute for the repair and permanent functional reconstruction of long-segment tracheal defects. STATEMENT OF SIGNIFICANCE: The repair of long-segment tracheal defects is always a great challenge in the clinic. Finding an ideal substitute for tracheal transplantation is the only way to solve this problem. In the current study, by technical integration of cartilage regeneration, microsurgery, and oral mucosa transplantation, a complex tracheal substitute with satisfactory vascularization, epithelialization, and tubular cartilage support was successfully constructed in a goat autologous model. The reconstructed trachea substitute possessed a multiple layer structure of muscle-cartilage-fascia-mucosa exactly similar to native trachea, and thus might realize stable survival and long-term airway function maintenance. The current study provides feasible strategies and ideal tracheal substitutes for permanent functional reconstruction of long-segmental trachea defects.

The repair and functional reconstruction of long-segment tracheal defects is always a great challenge in the clinic. Finding an ideal substitute for tracheal transplantation is the only way to solve this problem. To address these problems, the current study proposed a series of novel strategies. For large-volume cartilage regeneration, a cartilage sheet technique (without any extra materials) was adopted to avoid the inflammatory reaction triggered by the materials and form homogeneous, mature cartilage in autologous goat model. For vascularization, the flat trapezius fascia flap with double blood supply was separated by microsurgical techniques to achieve stable pre-vascularization of the regenerated cartilage and grafted epithelium simultaneously. Finally, transplantation of the oral mucosal epithelium was used to realize epithelialization. By integrating the above strategies, a vascularized and epithelialized tracheal tissue with tubular cartilage support was successfully constructed in a goat model, which provides an ideal tracheal substitute for the repair and permanent functional reconstruction of long-segment tracheal defects. Funding: This research was supported by The National Key Research and Development Program of China (2017YFC1103900), The Key Research and Development Program of Shandong (2016GGB14002), National Natural Science Foundation of China (31400830, 31700837 and 81571823), Shanghai Science and Technology Committee (16QB1400600), and Program for Shanghai Outstanding Medical Academic Leader, Graduate Student Innovation Fund of Shanghai Jiao Tong University School of Medicine (BXJ201831, to Zongqi Yin.), and PUMC Youth Fund and the Fundamental Research Funds for the Central Universities (3332014047). Declaration of Interest: We declare that we have no conflicts of interest. Ethical Approval: Animal experiments were approved by the Shanghai Jiao Tong University Committee on Animal Care and were conducted by the Key Laboratory of Tissue Engineering at Shanghai Ninth People’s Hospital, affiliated with Shanghai Jiao Tong University in China. All experiments involving animals were performed in accordance with the approved guidelines.

Background The vascularization of the distal portions of transferred tissue represents the most critical factor in the success of reconstructive surgery. In recent years, indocyanine green (ICG) fluorescence imaging techniques have been applied during surgery to evaluate flap perfusion. However, this investigation has found that there is little consensus regarding the standard dose of ICG as well as the pre-operative requirements of ICG allergy testing. The aim of this study is to summarize the applications of ICG to tissue transfers and safe dosing practices and to provide insight to the possible adverse effects of ICG on flap surgery with the goal of helping clinicians apply ICG safely and efficiently to tissue transfer procedures. Methods A literature search was performed using, Wiley InterScience, and Springer with the key words, ‘Flap,’ ‘indocyanine green,’ ‘surgery,’ and related mesh words for all publications between 2005 and 2015. Title and abstract screening was performed using predefined in- and exclusion criteria. Results Seventy-three articles were included. These were classified as “application of ICG in flap surgery” and “the security of applying ICG in flap surgery”. Conclusions ICG fluorescence imaging preoperatively facilitates the detection of perforators in tissue flaps with thickness

The increases in capillary wall permeability and capillary hydrostatic pressure are considered to be the causes for the acute swelling seen in flaps; however, disruption of the circulating flap lymphatics could be another contributory factor. In this study we monitor the development of flap edema in a series of 18 prefabricated flaps and aim to delineate the natural history of this phenomenon by use of lymphography.Postoperative swelling was monitored in a series of 18 pre-expanded prefabricated cervical skin flaps used for hemi-facial burns-scar resurfacing. Time to spontaneous resolution, presence or absence of venous congestion, and clinical outcome were recorded. In two cases, indocyanine-green (ICG) lymphography was used to monitor the dermal backflow pattern until swelling had completely resolved. Average moving velocity of ICG after injection as well as flap thickness was also recorded over the follow-up period.The average moving velocity of ICG in the flap lymphatics improved from 0.48 cm/min to 1.5 cm/min in the first 12 days after flap transfer. The dermal backflow pattern was stardust in the first 12 days, indicating moderate lymphedema, transforming to splash from week three, and a robust collecting lymphatic vessel occurring from the fifth month, indicating mild lymphedema and lymphatic channel recovery, respectively.Transient swelling was observed in all prefabricated flaps in our series. We postulate that this is mostly secondary to lymphatic disruption that subsides as lymphangiogenesis takes place. ICG lymphography is an inexpensive, safe, and easy-to-use imaging technology that could be used in the monitoring of postoperative lymphedema seen in prefabricated flaps.

Keloid scars are often considered aesthetically unattractive and frustrating problems that occur following injuries. They cause functional and cosmetic deformities, displeasure, itching, pain, and psychological stress and possibly affect joint movement. The combination of these factors ultimately results in a compromised quality of life and diminished functional performance. Various methods have been implemented to improve keloid scars using both surgical and non-surgical approaches. However, it has proven to be a challenge to identify a universal treatment that can deliver optimal results for all types of scars. Through a PubMed search, we explored most of the literature that is available about the intralesional injection treatment of hypertrophic scars and keloids and highlights both current (corticosteroid, 5-fluorouracil, bleomycin, interferon, cryotherapy and verapamil) and future treatments (interleukin-10 and botulinum toxin type A). The reference lists of retrieved articles were also analysed. Information was gathered about the mechanism of each injection treatment, its benefits and associated adverse reactions, and possible strategies to address adverse reactions to provide reliable guidelines for determining the optimal treatment for particular types of keloid scars. This article will benefit practitioners by outlining evidence-based treatment strategies using intralesional injections for patients with hypertrophic scars and keloids.

A series of hierarchically ordered macro-/mesoporous polymer resins and macro-/mesoporous carbon monoliths were synthesized using SiO2 opal as a hard template for the macropore, amphiphilic triblock copolymer PEO–PPO–PEO as a soft template for the mesopore, and phenolic resin as a precursor for the polymer or carbon. The obtained hierarchical macro-/mesoporous frameworks had highly periodic arrays of uniform macropores that were surrounded by walls containing the mesoporous structures. The mesoporous structure of the walls was adjusted using different precursors for the synthesis of FDU-14, FDU-15, and FDU-16. Results of the N2 adsorption–desorption analysis showed that the Brunauer–Emmett–Teller surface areas, the pore volumes, and the mesopore sizes of the macro-/mesoporous carbons were much larger than those of the FDU-14, FDU-15, and FDU-16 carbon materials. The mesopore size of the samples clearly increased with the increasing heat-treatment temperature when the temperature was below 700 °C. The resu...

The double "S" principle should be followed for facial reconstruction: the "similarity" of the donor site to the defect area and the reconstruction should be based on the different "subunits" of the face. In this article the pre-expanded, bipedicled supratrochlear perforator flap method is described, which is used for the resurfacing of both nasal and upper lip defects. This method can provide 2 independent flaps with sufficient tissue from 1 single donor site, resurfacing the nasal and upper lip units separately and providing an unparalleled color and texture match and ideal reconstructive result.

In vivo niche plays an important role in regulating differentiation fate of stem cells. Due to lack of proper chondrogenic niche, stable cartilage regeneration of bone marrow stromal cells (BMSCs) in subcutaneous environments is always a great challenge. This study explored the feasibility that chondrocyte sheet created chondrogenic niche retained chondrogenic phenotype of BMSC engineered cartilage (BEC) in subcutaneous environments. Porcine BMSCs were seeded into biodegradable scaffolds followed by 4 weeks of chondrogenic induction in vitro to form BEC, which were wrapped with chondrocyte sheets (Sheet group), acellular small intestinal submucosa (SIS, SIS group), or nothing (Blank group) respectively and then implanted subcutaneously into nude mice to trace the maintenance of chondrogenic phenotype. The results showed that all the constructs in Sheet group displayed typical cartilaginous features with abundant lacunae and cartilage specific matrices deposition. These samples became more mature with prolonged in vivo implantation, and few signs of ossification were observed at all time points except for one sample that had not been wrapped completely. Cell labeling results in Sheet group further revealed that the implanted BEC directly participated in cartilage formation. Samples in both SIS and Blank groups mainly showed ossified tissue at all time points with partial fibrogenesis in a few samples. These results suggested that chondrocyte sheet could create a chondrogenic niche for retaining chondrogenic phenotype of BEC in subcutaneous environment and thus provide a novel research model for stable ectopic cartilage regeneration based on stem cells. Statement of significance In vivo niche plays an important role in directing differentiation fate of stem cells. Due to lack of proper chondrogenic niche, stable cartilage regeneration of bone marrow stromal cells (BMSCs) in subcutaneous environments is always a great challenge. The current study demonstrated that chondrocyte sheet generated by high-density culture of chondrocytes in vitro could cearte a chondrogenic niche in subcutaneous environment and efficiently retain the chondrogenic phenotype of in vitro BMSC engineered cartilage (vitro-BEC). Furthermore, cell tracing results revealed that the regenerated cartilage mainly derived from the implanted vitro-BEC. The current study not only proposes a novel research model for microenvironment simulation but also provides a useful strategy for stable ectopic cartilage regeneration of stem cells.

Autologous fat grafting is a promising surgical technique for soft tissue augmentation, reconstruction and rejuvenation. However, it is limited by the low survival rate of the transplanted fat, due to the slow revascularization of such grafts. Previous studies have demonstrated that bone marrow mesenchymal stem cell‑derived extracellular vesicles (BMSC‑EVs) are proangiogenic. The present study aimed to investigate whether BMSC‑EVs could improve the survival of transplanted fat grafts. Extracellular vesicles were isolated from the supernatant of cultured rat bone marrow mesenchymal stem cells, and characterized by flow cytometry and scanning electron microscopy. Their proangiogenic potential was measured in vitro using tube formation and cell migration assays. Subsequently, human fat tissue grafts, alongside various concentrations of BMSC‑EVs, were subcutaneously injected into nude mice. A total of 12 weeks following transplantation, the mice were sacrificed and the grafts were harvested. The grafts from the experimental group had a higher survival rate and an increased number of vessels compared with grafts from the control group, as demonstrated by tissue volume, weight and histological analyses. Reverse transcription‑quantitative polymerase chain reaction analysis indicated that the expression levels of proangiogenic factors were increased in the experimental group compared with in the control group, thus suggesting that BMSC‑EVs may promote neovascularization by stimulating the secretion of proangiogenic factors. The present study is the first, to the best of our knowledge, to demonstrate that supplementation of fat grafts with BMSC‑EVs improves the long‑term retention and quality of transplanted fat.

To explore the surgical strategy for postburn cervical scar contracture.Sixty-five patients with scar contracture as a result of burn injury in the neck were hospitalized from July 2013 to July 2014. Release of cervical scar contracture was conducted according to different demands of the 3 anatomic subunits of neck, i.e. lower lip vermilion border-supramaxillary region, submaxillary region, and anterior region of neck. After release of contracture, platysma was released. For some cases with chin retrusion, genioplasty with horizontal osteotomy was performed. The coverage of wound followed the principle of similarity, i.e. the skin tissue covering the wound in the neck should be similar to the characters of skin around the wound in terms of color, texture, and thickness. Based on this principle, except for the preschool children in whom skin grafting was performed, the wounds of the other patients were covered by local skin flaps, adjacent skin flaps, or free skin flaps.All patients underwent release of scar and platysma, while 9 patients underwent genioplasty with horizontal osteotomy. Wounds were covered with local skin flaps in 32 patients, with adjacent skin flaps in 7 patients, with free skin flaps in 11 patients, and with skin grafts in 15 patients. All skin grafts and flaps survived. Good range of motion was achieved in the neck of all patients, with the cervicomental angle after reconstruction ranging from 90 to 120°. All patients were followed up for 6 to 24 months. Six patients who had undergone skin grafting were found to have some degrees of skin contracture, while none of the patients who had undergone flap coverage showed any signs of contracture recurrence.Restoration of the cervicomental angle is critical in the treatment of postburn cervical scar contracture, and the release of scar contracture should conform to the subunit principle. The coverage of wound should be based on the principle of similarity, with repair by skin flaps as the first choice, and skin grafting as the second choice. Satisfactory effect of repair would be achieved by following the above surgical principles.

Background Microcirculation is an important factor frequently overlooked when studying the survival of prefabricated flaps. In the current study, we use different prefabrication techniques for characterizing microcirculation within the flap, with the goal of finding an effective way to improve its survival area. Methods An abdominal prefabricated flap rodent model was created using a two-stage operation. All rats were randomly divided into six groups ( n = 10/group): group A, prefabricated femoral vessels; group B, prefabricated femoral artery with a connected superficial inferior epigastric vein (SIEV); group C, connected superficial inferior epigastric artery (SIEA) with a prefabricated femoral vein; group D was similar to group A along with a prefabricated SIEA, and group E was similar to group A along with a prefabricated SIEV; and group F acted as a control group and consisted of an axial flap nourished by superficial inferior epigastric vessels. Flaps were assessed for survival area, blood perfusion area, and capillary density using macroscopic analysis, near-infrared fluorescence imaging (NIFI), and histology. Results The survival area was not significantly different when comparing groups B to C, and D to E. The survival area of groups D and E was larger than that of groups B and C. Groups B through E had a smaller survival area in comparison to group F and a larger survival area than group A. NIFI were consistent with the macroscopic outcomes. The capillary density was not significantly different between groups A to C and groups D to F. Conclusion Both arterial and venous supercharging could potentially improve the survival area of prefabricated flaps.

Background Research has investigated the decrease in human skin sebum after the application of botulinum toxin. Few studies of the mechanism and objective assessments of this phenomenon have been conducted and the correlation between the sebum production and injection dosages or techniques remains unclear. Objectives We prospectively investigated the sebum regulation and its gradient around the injection site in patients who received intramuscular injections of botulinum toxin A (BTX-A) for forehead rhytides, comparing two injection doses. Methods Forty-two female volunteers with rhytides on the forehead region were randomly assigned to receive 10 or 20 units of BTX-A, which was administered in five standard injection sites. The baseline and post-treatment sebum production was measured using a Sebumeter. Results Treatment with BTX-A exhibited significant sebum alteration at the injection site of both groups, with a sebum gradient surrounding the injection point. The efficacy did not improve at higher injection doses, with the four-unit regimen generally not being more potent than the two-unit regimen. The sebum production recovered to normal levels at the 16 week follow-up for both treatment groups, indicating that a higher dosage (four units) did not result in a longer duration until relapse compared with the two-unit dose. Conclusions We determined that the sebum production has a positive correlation with the distance away from the injection point. Intramuscular injection of BTX-A significantly reduces sebum production at the injection site but increases the sebum production of the surrounding skin at a radius of 2.5 cm at the 2, 4, and 8 week follow-ups. Level of Evidence 2![Graphic][1] Therapeutic [1]: /embed/inline-graphic-1.gif

There are many methods of measuring the breast and their clinical applications are well described in the literature. However, there has been no attempt to compare these various methods to allow the user to have a broad overview of the subject. The authors have attempted to summarise all the available methods to measure the breast in this article to provide a useful reference for all. A comprehensive literature search of PubMed was performed, and the resulting articles were screened and reviewed. The data regarding the methods’ mechanism, reliability, time and cost were evaluated and compared. A total of 74 articles dating from 1970 to 2013 were included in this study. All of the methods can be classified into those that measure (1) volume, (2) shape and (3) surface area. Each category consists of several methods that work through different mechanisms and they vary in their reliability and feasibility. Based on their mechanism, the volume measurement methods were further grouped into the natural shape methods, the stereological method, the geometrical methods and the mathematical modelling method. More objective breast evaluation can be achieved if all three dimensions (volume, shape and surface area) are considered. In the volume measurements, 3D modelling and the MRI are the most reliable tools. Linear measurement (geometry) and mathematical modelling are less accurate but are more economical. In the shape measurements, besides the traditional linear measurement, 3D methods that can deliver colour-coded maps and Swanson’s 2D photographic measurement system are capable of depicting and tracking breast shape changes after surgery. Although the surface area metric has not been used extensively, it has potential in clinical and research applications. 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 .

A new restriction effect of hard templates for the shrinkage of mesoporous polymer results in anomalous increase of the mesopore size during carbonization.

Carbon nanofibers containing linear mesocage arrays were prepared via evaporation induced self-assembly method within AAO template with an average channel diameter of about 25 nm. The TEM results show that the mesocages have an elongated shape in the transversal direction. The results of N2 adsorption–desorption analysis indicate that the sample possesses a cage-like mesoporous structure and the average mesopore size of the sample is about 18 nm.