Effect of Expanded Polytetrafluoroethylene Combined with Autologous Ear Cartilage in Nasal Plastic Surgery

Objective:To explore the effect of combined application of expanded polytetrafluoroethylene and autologous ear cartilage in nasal plastic surgery.Methods:76 cases of nasal plastic surgery patients in our hospital from September 2019 to September 2020 were selected as the research objects and divided into experimental group(38 cases,treated with expanded polytetrafluoroethylene+autologous ear cartilage surgery)and control group(38 cases,treated with autologous ear cartilage surgery).The treatment effect,appearance score and complications were compared.Results:The total effective rate of the experimental group(97.37%,37/38)was higher than that of the control group(78.95%,30/38),P<0.05;After treatment,the appearance score of the experimental group was(8.97±0.37),which was significantly higher than that of the control group(P<0.05);The total incidence of complications in the experimental group(5.26%,2/38)was significantly lower than that in the control group(21.05%,8/38),P<0.05.Conclusion:In the process of nasal plastic surgery,the combined application of autologous ear cartilage surgery and expanded polytetrafluoroethylene has obvious effect,improves the appearance of patients,and has less postoperative complications,which is worthy of promotion.

Integrative transcriptomic and proteomic analysis reveals that SERPING1 inhibits neuronal proliferation via the CaMKII-CREB-BDNF pathway in schizophrenia

BACKGROUND Schizophrenia(SZ),a chronic and widespread brain disorder,presents with complex etiology and pathogenesis that remain inadequately understood.Despite the absence of a universally recognized endophenotype,peripheral blood mononuclear cells(PBMCs)serve as a robust model for investigating intracellular alterations linked to SZ.AIM To preliminarily investigate potential pathogenic mechanisms and identify novel biomarkers for SZ.METHODS PBMCs from SZ patients were subjected to integrative transcriptomic and proteomic analyses to uncover differentially expressed genes(DEGs)and differentially expressed proteins while mapping putative disease-associated signaling pathways.Key findings were validated using western blot(WB)and real-time fluorescence quantitative PCR(RT-qPCR).RNAi-lentivirus was employed to transfect rat hippocampal CA1 neurons in vitro,with subsequent verification of target gene expression via RT-qPCR.The levels of neuronal conduction proteins,including calmodulin-dependent protein kinase II(caMKII),CREB,and BDNF,were assessed through WB.Apoptosis was quantified by flow cytometry,while cell proliferation and viability were evaluated using the Cell Counting Kit-8 assay.RESULTS The integration of transcriptomic and proteomic analyses identified 6079 co-expressed genes,among which 25 DEGs were significantly altered between the SZ group and healthy controls.Notably,haptoglobin(HP),lactotransferrin(LTF),and SERPING1 exhibited marked upregulation.KEGG pathway enrichment analysis implicated neuroactive ligand-receptor interaction pathways in disease pathogenesis.Clinical sample validation demonstrated elevated protein and mRNA levels of HP,LTF,and SERPING1 in the SZ group compared to controls.WB analysis of all clinical samples further corroborated the significant upregulation of SERPING1.In hippocampal CA1 neurons transfected with lentivirus,reduced SERPING1 expression was accompanied by increased levels of CaMKII,CREB,and BDNF,enhanced cell viability,and reduced apoptosis.CONCLUSION SERPING1 may suppress neural cell proliferation in SZ patients via modulation of the CaMKII-CREB-BDNF signaling pathway.

A long-term histological research on human frontalis muscle flap specimens from recurrent blepharoptosis patients

Dear Editor,We present two patients with recurrent severe blepharoptosis after frontalis muscle(FM)flap suspension.Here we describe long-term histological changes of the FM flaps observed in revision surgeries.FM flap suspension is widely applied in treating severe ptosis with poor levator function(<4 mm),and its effect is relatively stable and lasting[1].FM flap suspension is reliable and recurrent cases are observed only occasionally.Since longterm research about FM flap is rare,we investigated tissue samples of revision surgery flaps which could reflect trends of morphological changes within the functioning FM flaps to some extent.

Bioinformatics comprehensive analysis confirmed the potential involvement of SLC22A1 in lower-grade glioma progression and prognosis

Background:Although it has been established that the human Solute Carrier Family 22(SLC22)functions as a cationic transporter,influencing cellular biological metabolism by modulating the uptake of various cations,its impact on cancer prognosis remains unclear.Methods:We conducted a comprehensive analysis utilizing data from The Cancer Genome Atlas(TCGA)and other databases to assess the prognostic value and functional implications across various tumors.Silence of SLC22A1 RNA in glioma U251 cells was performed to access the impact of SLC22A1 on lowergrade glioma(LGG)progression.Results:Our findings demonstrated a significant correlation between SLC22A1 expression and the survival time of patients with various cancers(p<0.05).Importantly,we found the potential involvement of SLC22A1 in occurrence and progress of certain cancers,with a pronounced impact on LGG.Further examination of the SLC22A1-LGG relationship revealed its status as an independent risk factor for LGG,suggesting its potential involvement in regulating diverse immune pathways and metabolic activities.Chinese Glioma Genome Atlas(CGGA)data supported the reliability of the risk score as a prognostic and recurrence indicator,emphasizing the accuracy of the nomograph(1,3,and 5-year-AUC>0.8).Cell proliferation and clone formation experiment proved that decreased expression of SLC22A1 in glioma U251 cells inhibited glioma cell growth.Conclusion:Our findings suggest SLC22A1 has huge prospects as a promising biomarker and therapeutic target for LGG prognosis.SLC22A1 has only been proved to support cellular function previously.Our findings demonstrated a robust connection between the tumor microenvironment and functional proteins that maintain basal cell metabolism,which gifts unique tumor immune characteristics of gliomas.Additionally,we provide a highly practical prediction model for estimating the survival rate of LGG patients.

Effect of endoscopic submucosal dissection on gastrointestinal function and nutritional status in patients with early gastric cancer

BACKGROUND Gastric cancer(GC)endangers the survival and prognosis of patients worldwide.Improving the prognosis of patients with early GC(EGC)is crucial to prolong their survival time.AIM To analyze the effects of endoscopic submucosal dissection(ESD)on gastrointestinal function and nutritional status in patients with EGC.METHODS Eighty patients with EGC between January 2021 and January 2024 were divided according to different surgical protocol into following two groups:42 patients who underwent ESD in the ESD group and 38 patients treated with endoscopic mucosal resection(EMR)in the EMR group.Two groups were compared in the operative indices,lesion resection rate,postoperative recovery of gastrointestinal function,nutritional status,and incidence of surgical complications.RESULTS The overall resection rate of the lesion in the ESD group was higher.The operative bleeding volume and operation time were higher and gastrointestinal ventilation time was shorter in the ESD group than those in the EMR group(P<0.05).The nutritional statuses of the two groups decreased after operation;however,the levels of albumin,prealbumin,hemoglobin,and transferrin were higher in the ESD group than in the EMR group(P<0.05).The post-operative pepsinogen(PG)I level in the ESD group was higher than that in the EMR group,and the PG II level was lower than that in the EMR group(P<0.05).The incidence of postoperative complications was compared between the two groups(P>0.05).CONCLUSION ESD can promote the immediate recovery of patient’s postoperative gastrointestinal function,improve their nutritional level,and signifies its application in patients with EGC.

Different administration routes of tranexamic acid in the treatment of melasma

Melasma is a prevalent and challenging skin condition that affects the face and causes distress in many patients and physicians.Tranexamic acid(TA)has been found to be effective for treating melasma and can be administered through multiple routes.This review details the mechanisms of action of TA in treatment of melasma and assesses the efficacy and safety associated with different administrations,which can contribute to selecting appropriate melasma treatment plan for different patients.

Donor-Site Morbidity Following Harvest of Autologous Costal Cartilage in Microtia Reconstruction

Objectives: The objective of this study is to evaluate donor-site morbidity after costal cartilage harvest for microtia reconstruction. Methods: A total of 70 patients who underwent autologous costal cartilage harvest for microtia reconstruction from March 2008-March 2009 were included. Anterior chest wall deformity was evaluated with chest topography, and scar quality at baseline and at 6-months follow-up, and final outcomes analyzed with SPSS. Results: In 70 patients, 52 (74%) were male, 18 (26%) were female, and altogether 40 (57%) patients developed deformity. At 6-month follow-up, the incidence of anterior chest wall deformity was highest at 80% in Block-III, and least at 0% in Block-I. The 6 - 10 years age group was the largest group at 84% (21), and also with highest incidence of deformity in association to Block-IV harvest at 83%. The incidence of donor-site deformity was higher in female gender at 66%, and 54% in males. But in the sub-group, male had higher incidence of deformity at 75% in both Block-III, and Block-IV when compared to the respective females. The 120 - 135 cm height group had the highest deformity at 67% with Block-IV costal cartilages harvested. At the three measurement points: 1) xiphisternum, 2) intersecting points between PSL and LCM, and 3) intersecting points between MCL and LCM, significant differences (mean) were observed in chest circumference from baseline to 6-month follow-up, and between the left and right chest hemi-circumference (postoperatively). Acceptable donor-site scar was observed in all but 3% (2) developed hypertrophic scar. Conclusion: The development of chest wall deformity was observed when more than one costal cartilage was harvested, particularly the 6th (complete), 7th, 8th block. Therefore, to minimize the deformity, we recommend harvesting only the necessary amount of cartilage, and at the lowest level possible to avoid injury of costochondral junction. Additionally, age, height, gender and chest development are equally important factors which influence donor-site deformity in microtia reconstruction.

下颌骨牵引成骨术同期正畸治疗

目的探讨下颌骨牵引成骨同期正畸治疗的意义和原则。方法采用方丝托槽固定矫治器颌间牵引正畸。对正在下颌骨牵引成骨中和牵引后巩固阶段的患者进行正畸治疗。同期正畸时间为3—4个月。结果收治11例小颌畸形患者，在获得预期下颌骨延长的同时，开骀、牙齿错位等畸形程度明显减轻，患者的咬合关系改善。结论下颌骨牵引成骨同期进行正畸治疗能明显减轻牙骀畸形程度和缩短术后正畸时间，并能辅助引导下颌骨牵引成骨方向。

Skeletal muscle-derived cells repair peripheral nerve defects in mice

Skeletal muscle-derived cells have strong secretory function,while skeletal muscle-derived stem cells,which are included in muscle-derived cells,can differentiate into Schwann cell-like cells and other cell types.However,the effect of muscle-derived cells on peripheral nerve defects has not been reported.In this study,5-mm-long nerve defects were created in the right sciatic nerves of mice to construct a peripheral nerve defect model.Adult female C57BL/6 mice were randomly divided into four groups.For the muscle-derived cell group,muscle-derived cells were injected into the catheter after the cut nerve ends were bridged with a polyurethane catheter.For external oblique muscle-fabricated nerve conduit and polyurethane groups,an external oblique muscle-fabricated nerve conduit or polyurethane catheter was used to bridge the cut nerve ends,respectively.For the sham group,the sciatic nerves on the right side were separated but not excised.At 8 and 12 weeks post-surgery,distributions of axons and myelin sheaths were observed,and the nerve diameter was calculated using immunofluorescence staining.The number,diameter,and thickness of myelinated nerve fibers were detected by toluidine blue staining and transmission electron microscopy.Muscle fiber area ratios were calculated by Masson’s trichrome staining of gastrocnemius muscle sections.Sciatic functional index was recorded using walking footprint analysis at 4,8,and 12 weeks after operation.The results showed that,at 8 and 12 weeks after surgery,myelin sheaths and axons of regenerating nerves were evenly distributed in the muscle-derived cell group.The number,diameter,and myelin sheath thickness of myelinated nerve fibers,as well as gastrocnemius muscle wet weight and muscle area ratio,were significantly higher in the muscle-derived cell group compared with the polyurethane group.At 4,8,and 12 weeks post-surgery,sciatic functional index was notably increased in the muscle-derived cell group compared with the polyurethane group.These criteria of the muscle-derived cell group were not significantly different from the external oblique muscle-fabricated nerve conduit group.Collectively,these data suggest that muscle-derived cells effectively accelerated peripheral nerve regeneration.This study was approved by the Animal Ethics Committee of Plastic Surgery Hospital,Chinese Academy of Medical Sciences(approval No.040)on September 28,2016.

Surgical outcome and patient satisfaction after Z-epicanthoplasty and blepharoplasty

AIM: To evaluate surgical outcomes of modified Z-epicanthoplasty with blepharoplasty that we previously reported from the patient’s perspective using patient-reported outcome measures(PROMs) and patient satisfaction scores.METHODS: A total of patients(n=180) who underwent the surgery between January 2013 and June 2016 were randomly selected. Standardized patient satisfaction forms(total score, 40) and validated PROMs questionnaires(total score, 12) were sent to patients for completion. PROMs assesses the severity of scarring, pain and asymmetry, as well as functional and appearance issues.RESULTS: All patients were female, ranging from 18 to 35 years old(mean=24). The response rate was 73.3%(n=132). The majority of patients reported good or excellent outcomes based on PROM analysis. Patients reported minimum or non-visible scarring at both the double eyelid surgical scar(85.6%) and the inner canthus(80.3%). Issues concerning function and appearance were minimal as 80.3% reported satisfaction with both domains. Notably, the majority of patients reported either a high or very high satisfaction rate to yield a mean score of 104 out of 120(P<0.05).CONCLUSION: Integration of our modified Z-epicanthoplasty with blepharoplasty produces good outcomes based on PROM results, which shows a positive linear relationship with patient satisfaction scores.

The Characteristics of Blood Supply and Tissue Hypoxia in Pathological Scars

Blood supply is believed to be an important aspect in the development of pathological scars. However, there are controversies about vascular distribution, vascular structure and blood flow in pathological scars. Additionally, hypoxic microenvironment plays an important role in the vascularization of pathological scar tissues, and hypoxic conditions can be reflected by metabolic indexes and some cytokines. Furthermore, the correlation between blood supply and tissue hypoxia is controversial. The aim of this article is to review the literature on the characteristics of blood supply and tissue hypoxia in pathological scars, from which we can see pathological scars have unique characteristics of blood supply that are closely associated with tissue hypoxia. Moreover, development in the treatment of pathological scars is herein reviewed.

Effect of Dermabrasion and ReCell on Large Superficial Facial Scars Caused by Burn, Trauma and Acnes

Objective To explore the effects of dermabrasion combined with ReCell on large superficial facial scars caused by burn, trauma and acnes. Methods Nineteen patients with large superficial facial scars were treated by the same surgeon with dermabrasion combined with ReCell？. According to the etiology, patients were classified into post-burning group （n=5）, post-traumatic group （n=7） and post-acne group （n=7）. Fifteen patients completed the follow-ups, 5 patients in each group. Healing time, complication rate, the preoperative and 18-month-post-operative assessments using Patient Satisfaction Score （PSS）, Vancouver Scar Scale （VSS）, and Patient and Observer Scar Assessment Scale （POSAS） of each group were analyzed to compare the effect of the combined therapy on outcomes.Results The healing time of post-burning group （19.6±4.0 days）, post-traumatic group （15.8±2.6 days）, and post-acne group （11.4±3.1 days） varied remarkably （F=7.701, P=0.007）. The complication rates were 60%, 20%, and 0 respectively. The post-operative POSAS improved significantly in all groups （P〈0.05）, where the most significant improvement was shown in the post-acne group （P〈0.05）. The post-operative PSS and VSS improved only in the post-traumatic group and post-acne group （all P〈0.05）, where the more significant improvement was also shown in the post-acne group （P〈0.05）. Conclusions The combined treatment of dermabrasion and ReCell has remarkable effect on acne scars, moderate effect on traumatic scars and is not suggested for burn scars. POSAS should be applied to assess the therapeutic effects of treatments for large irregular scars.

Effect of preoperative nutrition therapy type and duration on short-time outcomes in gastric cancer patient with gastric outlet obstruction

Objective:To avoid perioperative complications caused malnutrition,nutrition therapy is necessary in gastric outlet obstruction(GOO)patients.Compared to parenteral nutrition(PN),enteral nutrition(EN)is associated with many advantages.This study aimed to investigate whether preoperative EN has beneficial clinical effects compared to preoperative PN in gastric cancer patients with GOO undergoing surgery.Methods:According to the methods of preoperative nutrition therapy,143 patients were divided into EN group(n=42)and PN group(n=101)between January 2013 and December 2017 at the Chinese People’s Liberation Army General Hospital.Multiple logistic regression models were used to assess the association between the methods of preoperative nutrition therapy and postoperative day of flatus passage.The generalized additive model and twopiecewise linear regression model were used to calculate the inflection point of the preoperative nutritional therapy time on the postoperative day of flatus passage in the PN group.Results:EN shortened the postoperative day of flatus passage in gastric cancer patients with GOO,which is a protective factor,especially in patients who underwent non-radical operations and the postoperative day of flatus passage reduced when the preoperative PN therapy was up to 3 d and a longer PN therapy(>3 d)did not accelerate the postoperative recovery of gastrointestinal functions.Conclusions:Preoperative EN therapy would benefit gastric cancer patients with GOO by accelerating postoperative recovery.For patients with absolute obstruction,no more than 3-day PN therapy is recommended if patients can tolerate general anesthesia and surgery.

Shikani Optical Stylet–guided Intubation via the Intubating Laryngeal Airway in Patients With Scar Contracture of the Face and Neck

Objective To evaluate the feasibility of the Shikani Optical Stylet （SOS）-guided inmbation through a new Intubafing Laryngeal Airway （ILA） in anticipated difficult airways caused by scar contracture of the face and neck. Methods Thirty-three adult patients with anticipated difficult airways undergoing selective faciocervical scar plastic surgery under general anesthesia were enrolled in this study. After anesthesia induction, a size 2.5, 3.5 or 4.5 ILA was inserted. Following good lung ventilation being verified, the SOS preloaded with an endotracheal tube was inserted via the ILA. Once the clear vocal cords came into view under the SOS, the endotracheal tube was advanced through glottis into the trachea. Results The ILA provided an effective airway in all patients, lntubation was successful at the first attempt on 22/33 （66.7%） occasions and at the second attempt on 6/33 （18.2%）. Intubation failed in 5 （15.1%） patients who suffered from severe limitation of head extension due to scar contracture of the neck. These patients＇ tracheas were finally intubated using a fibreoptic bronchoscope via the ILA. Conclusions The SOS-guided intubating method via the ILA is a feasible technique in patients with scar contracture of the face and neck. However, in patients with severe limitation of head extension, the use of SOS cannot be recommended. The SOS can be used as an alternative apparatus when the fibreoptic bronchoscope is not available.

Anastomotic stoma coated with chitosan film as a betamethasone dipropionate carrier for peripheral nerve regeneration

Scar hyperplasia at the suture site is an important reason for hindering the repair effect of peripheral nerve injury anastomosis. To address this issue, two repair methods are often used. Biological agents are used to block nerve sutures and the surrounding tissue to achieve phys- ical anti-adhesion effects. Another agent is glucocorticosteroid, which can prevent scar growth by inhibiting inflammation. However, the overall effect of promoting regeneration of the injured nerve is not satisfactory. In this regard, we envision that these two methods can be combined and lead to shared understanding for achieving improved nerve repair. In this study, the right tibial nerve was transected 1 cm above the knee to establish a rat tibial nerve injury model. The incision was directly sutured after nerve transection. The anastomotic stoma was coated with 0.5 × 0.5 cm^2 chitosan sheets with betamethasone dipropionate. At 12 weeks after injury, compared with the con- trol and poly （D, L-lactic acid） groups, chitosan-betamethasone dipropionate film slowly degraded with the shape of the membrane still intact. Further, scar hyperplasia and the degree of adhesion at anastomotic stoma were obviously reduced, while the regenerated nerve fiber structure was complete and arranged in a good order in model rats. Electrophysiological study showed enhanced compound muscle action potential. Our results confirm that chitosan-betamethasone dipropionate film can effectively prevent local scar hyperplasia after tibial nerve repair and promote nerve regeneration.

Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques

Nipple-sparing mastectomy(NSM) is a safe technique in patients who are candidates for conservation breast surgery. However, there is worry concerning its oncological safety and surgical outcome in terms of postoperative complications. The authors reviewed the literature to evaluate the oncological safety, patient selection, surgical techniques, and also to identify the factors influencing postoperative outcome and complication rates. Patient selection and safety related to NSM are based on oncological and anatomical parameters. Among the main criteria, the oncological aspects include the clinical stage of breast cancer, tumor characteristics and location including small, peripherally located tumors, without multicentricity, or for prophylactic mastectomy. Surgical success depends on coordinated planning with the oncological surgeon andcareful preoperative and intraoperative management. In general, the NSM reconstruction is related to autologous and alloplastic techniques and sometimes include contra-lateral breast surgery. Choice of reconstructive technique following NSM requires accurate consideration of various patient related factors, including: breast volume, degree of ptosis, areola size, clinical factors, and surgeon's experience. In addition, tumor related factors include dimension, location and proximity to the nipple-areola complex. Regardless of the fact that there is no unanimity concerning the appropriate technique, the criteria are determined by the surgeon's experience and the anatomical aspects of the breast. The positive aspects of the technique utilized should include low interference with the oncological treatment, reproducibility, and long-term results. Selected patients can have safe outcomes and therefore this may be a feasible option for early breast cancer management. However, available data demonstrates that NSM can be safely performed for breast cancer treatment in selected cases. Additional studies and longer follow-up are necessary to define consistent selection criteria for NSM.

Clinicopathologic Characteristics and Prognosis Analysis of Marjolin's Ulcer in 40 Cases

Marjolin's ulcer (MU)is a rare but aggressive epidermoid carcinoma observed in scars or wounds.This article provides comprehensive characteristics and prognostic details of MU. Clinical data of 40patients with MU between January 2010 and December 2017 were analyzed retrospectively.Squamous cell carcinoma was the most common pathological type (35/40,87.5%). Extended resection was performed to treat all cases with skin grafting or flap grafting.Follow-up duration ranged from 6 to 96 months (median,52 months)and recurrence was noted in 9 cases.The 1-,3-and 5-year recurrence-free survival (RFS)rates were 87.2%,87.2%,83.2%respectively and the recurrence rate was 22.5%.Univariate analysis revealed that cause of scars (P=0.044),lesion appearance (P=0.036),ultraviolet radiation exposure (P=0.000),depth (P=0.001)and histological grade (P=0.027)had a statistically significant correlation with prognosis of MU.Multivariate analysis revealed that depth (P=0.034,RR=2,681,95%CI:1.077-6.674)and histological grade (P=0.008,RR=2.820,95%CI:1.3156.050)were independent prognostic factors for RFS.In conclusion,superficial infiltration and high-grade differentiation predict more favorable prognosis. Careful follow-up of high-risk groups is strongly recommended to prevent recurrence and improve prognosis.

Identification and functional analyses of a novel FOXL2 pathogenic variant causing blepharophimosis, ptosis, and epicanthus inversus syndrome

AIM: To discover the molecular pathogenic basis of the blepharophimosis, ptosis, and epicanthus inversus syndrome(BPES), and to predict the clinical subtype according to in vitro experiments, which is significant to the prognosis.METHODS: A 3-year-old sporadic female patient with typical clinical manifestations of BPES was enrolled. The coding region of forkhead box L2(FOXL2) gene was sequenced, and the functional assays were performed in vitro by Western blotting, subcellular localization experiment, luciferase reporter assay, and quantitative realtime polymerase chain reaction.RESULTS: A novel FOXL2 point pathogenic variant(c.274G>T) was detected, resulting in a truncated protein(p.E92*). Functional studies demonstrated that the FOXL2 pathogenic variant induced the subcellular mislocalization and the abnormal transcriptional activity on promoters of the steroidogenic acute regulatory protein(StAR or STARD1) gene and the odd-skipped related 2 transcription factor(OSR2) gene.CONCLUSION: A novel pathogenic variant is identified to expand the spectrum of the known FOXL2 mutations. The in vitro experiments provide reference data and more insights to the molecular pathogenesis of BPES. The predicted high risk of ovarian insufficiency makes it significant for the patient enrolled to have further follow-up and therapy concerning female endocrinology.

Recent Progress in Cartilage Tissue Engineering--Our Experience and Future Directions

Given the limited spontaneous repair that follows cartilage injury, demand is growing for tissue engi- neering approaches for cartilage regeneration. There are two major applications for tissue-engineered cartilage. One is in orthopedic surgery, in which the engineered cartilage is usually used to repair cartilage defects or loss in an articular joint or meniscus in order to restore the joint function. The other is for head and neck reconstruction, in which the engineered cartilage is usually applied to repair cartilage defects or loss in an auricle, trachea, nose, larynx, or eyelid. The challenges faced by the engineered car- tilage for one application are quite different from those faced by the engineered cartilage for the other application. As a result, the emphases of the engineering strategies to generate cartilage are usually quite different for each application. The statuses of preclinical animal investigations and of the clinical translation of engineered cartilage are also at different levels for each application. The aim of this review is to provide an opinion piece on the challenges, current developments, and future directions for cartilage engineering for both applications.

Immediate Nipple Reconstruct!on Following Breast Reduction

Necrosis of nipple-areola complex is one of the major complications of breast reduction in gigatomastia.Wie present a case study of a 32-year-old patient with severe gigantomastia,who required an immediate nipple reconstruction during breast reduction.The final reconstruction was satisfactory.No complications were observed within three months postoperatively.