Secondary release of the peripheral nerve with autologous fat derivates benefits for functional and sensory recovery

The reconstruction of nerve continuity after traumatic nerve injury is the gold standard in hand surgery.Immediate,tension-free,end-to-end nerve suture ensures the best prognosis.The recovery is mostly promising;however,in a few cases,insufficient outcomes in motor or sensory function are observed.Intra-and extra-fascicular scarring accompanies the nerve regeneration process and limits final outcomes.Secondary nerve release in those cases is recommended.Unfortunately,scarring recurrence cannot be eliminated after secondary revision and neurolysis.The supportive influences of mesenchymal stem cells in the process of nerve regeneration were observed in many preclinical studies.However,a limited number of studies in humans have analyzed the clinical usage of mesenchymal stem cells in peripheral nerve reconstruction and revisions.The objective of this study was to evaluate the effects of undifferentiated adipose-derived stromal/stem cell injection during a last-chance surgery(neurolysis,nerve release)on a previously reconstructed nerve.Three patients(one female,two males;mean age 59±4.5 years at the time of injury),who experienced failure of reconstructions of median and ulnar nerves,were included in this study.During the revision surgery,nerve fascicles were released,and adiposederived stromal/stem cells were administered through microinjections along the fascicles and around the adjacent tissues after external neurolysis.During 36 months of followup,patients noticed gradual signs of sensory and in consequence functional recovery.No adverse effects were observed.Simultaneous nerve release with adipose-derived stromal/stem cells support is a promising method in patients who need secondary nerve release after nerve reconstruction.This method can constitute an alternative procedure in patients experiencing recovery failure and allow improvement in cases of limited nerve regeneration.The study protocol was approved by the Institutional Review Board(IRB)at the Centre of Postgraduate Medical Education(No.62/PB/2016)on September 14,2016.

Rapid fabrication of modular 3D paper-basedmicrofluidic chips using projection-based 3D printing

Paper-based microchips have different advantages,such as better biocompatibility,simple production,and easy handling,making them promising candidates for clinical diagnosis and other fields.This study describes amethod developed to fabricate modular three-dimensional(3D)paper-based microfluidic chips based on projection-based 3D printing(PBP)technology.A series of two-dimensional(2D)paper-based microfluidic modules was designed and fabricated.After evaluating the effect of exposure time on the accuracy of the flow channel,the resolution of this channel was experimentally analyzed.Furthermore,several 3D paper-based microfluidic chips were assembled based on the 2D ones using different methods,with good channel connectivity.Scaffold-based 2D and hydrogel-based 3D cell culture systems based on 3D paper-based microfluidic chips were verified to be feasible.Furthermore,by combining extrusion 3D bioprinting technology and the proposed 3D paper-based microfluidic chips,multiorgan microfluidic chips were established by directly printing 3D hydrogel structures on 3D paperbased microfluidic chips,confirming that the prepared modular 3D paper-based microfluidic chip is potentially applicable in various biomedical 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.

A bionic controllable strain membrane for cell stretching at air–liquid interface inspired by papercutting

Lung diseases associated with alveoli,such as acute respiratory distress syndrome,have posed a long-term threat to human health.However,an in vitro model capable of simulating different deformations of the alveoli and a suitable material for mimicking basement membrane are currently lacking.Here,we present an innovative biomimetic controllable strain membrane(BCSM)at an air–liquid interface(ALI)to reconstruct alveolar respiration.The BCSM consists of a high-precision three-dimensional printing melt-electrowritten polycaprolactone(PCL)mesh,coated with a hydrogel substrate—to simulate the important functions(such as stiffness,porosity,wettability,and ALI)of alveolar microenvironments,and seeded pulmonary epithelial cells and vascular endothelial cells on either side,respectively.Inspired by papercutting,the BCSM was fabricated in the plane while it operated in three dimensions.A series of the topological structure of the BCSM was designed to control various local-area strain,mimicking alveolar varied deformation.Lopinavir/ritonavir could reduce Lamin A expression under over-stretch condition,which might be effective in preventing ventilator-induced lung injury.The biomimetic lung-unit model with BCSM has broader application prospects in alveoli-related research in the future,such as in drug toxicology and metabolism.

Progressive disfiguring facial masses with pupillary axis obstruction from Morbihan syndrome:A case report

BACKGROUND Morbihan syndrome is a rare illness,which presents with recurrent pitting edema on the upper two thirds of the face causing facial contour deformities,and Morbihan syndrome obstructing the pupillary axis with ptosis was seldomly reported.CASE SUMMARY A 59-year-old woman presented with a 15-year history of facial swelling that progressively invaded bilaterally from the inner canthus and eyelids outwards.Imaging examination indicated that the bilateral periorbital and the left temporal soft tissues had swelling without cranium invasion.Histopathological analysis showed a large amount of lymphocyte infiltration,and immunohistochemistry showed positive expression of CD68 in clear-cut granulomas and D2-40 in the lymphatic endothelium.Finally,the clinical diagnosis of Morbihan syndrome was confirmed.CONCLUSION Morbihan syndrome is an infrequent and refractory disease,which is characteristic with recurrent woody facial edema on the upper two thirds of the face.Solid facial edema is persistent and non-pitting,causing facial contour deformities and even vision field impairment.The diagnosis of Morbihan syndrome depends on clinical features,imaging information,and pathology.Blepharoplasty is optional to improve the visual field for these patients with severe pupillary axis obstruction.

Transcriptomic and machine learning analyses identify hub genes of metabolism and host immune response that are associated with the progression of breast capsular contracture

Capsular contracture is a prevalent and severe complication that affects the post-operative outcomes of patients who receive silicone breast implants.At present,prosthesis replacement is the major treatment for capsular contracture after both breast augmentation procedures and breast reconstruction following breast cancer surgery.However,the mecha-nism(s)underlying breast capsular contracture remains unclear.This study aimed to identify the biological features of breast capsular contracture and reveal the potential underlying mechanism using RNA sequencing.Sample tissues from 12 female patients(15 breast capsules)were divided into low capsular contracture(LCC)and high capsular contracture(HCC)groups based on the Baker grades.Subsequently,41 lipid metabolism-related genes were identified through enrichment analysis,and three of these genes were identified as candidate genes by SVM-RFE and LASSO algorithms.We then compared the proportions of the 22 types of im-mune cells between the LCC and HCC groups using a CIBERSORT analysis and explored the Cor-relation between the candidate hub features and immune cells.Notably,PRKAR2B was positively correlated with the differentially clustered immune cells,which were M1 macro-phages and follicular helper T cells(area under the ROC=0.786).In addition,the expression of PRKAR2B at the mRNA or protein level was lower in the HCC group than in the LCC group.Potential molecular mechanisms were identified based on the expression levels in the high and low PRKAR2B groups.Our findings indicate that PRKAR2B is a novel diagnostic biomarker for breast capsular contracture and might also influence the grade and progression of capsularcontracture.

Human hair follicle-derived mesenchymal stem cells promote tendon repair in a rabbit Achilles tendinopathy model

Background:Hair follicles are easily accessible and contain stem cells with different developmental origins,including mesenchymal stem cells(MSCs),that consequently reveal the potential of human hair follicle(hHF)-derived MSCs in repair and regeneration.However,the role of hHF-MSCs in Achilles tendinopathy(AT)remains unclear.The present study investigated the effects of hHF-MSCs on Achilles tendon repair in rabbits.Methods:First,we extracted and characterized hHF-MSCs.Then,a rabbit tendinopathy model was constructed to analyze the ability of hHF-MSCs to promote repair in vivo.Anatomical observation and pathological and biomechanical analyses were performed to determine the effect of hHF-MSCs on AT,and quantitative real-time polymerase chain reaction,enzyme-linked immunosorbent assay,and immunohistochemical staining were performed to explore the molecular mechanisms through which hHF-MSCs affects AT.Furthermore,statistical analyses were performed using independent sample t test,one-way analysis of variance(ANOVA),and one-way repeated measures multivariate ANOVA as appropriate.Results:Flow cytometry,a trilineage-induced differentiation test,confirmed that hHF-derived stem cells were derived from MSCs.The effect of hHF-MSCs on AT revealed that the Achilles tendon was anatomically healthy,as well as the maximum load carried by the Achilles tendon and hydroxyproline proteomic levels were increased.Moreover,collagen I and III were upregulated in rabbit AT treated with hHF-MSCs(compared with AT group;P<0.05).Analysis of the molecular mechanisms revealed that hHF-MSCs promoted collagen fiber regeneration,possibly through Tenascin-C(TNC)upregulation and matrix metalloproteinase(MMP)-9 downregulation.Conclusions:hHF-MSCs can be a treatment modality to promote AT repair in rabbits by upregulating collagen I and III.Further analysis revealed that treatment of AT using hHF-MSCs promoted the regeneration of collagen fiber,possibly because of upregulation of TNC and downregulation of MMP-9,thus suggesting that hHF-MSCs are more promising for AT.

Indications for publications

To the Editor:In an era where publications in science citation index(SCI)journals speak louder to employers and the government than patients,gratitude,"How's your paper doing"has become the new"Hello"amongst young Chinese doctors?11 Although the pressure to publish means that doctors remain abreast of medical advances and also stimulates critical thinking,121 this is a means,not an end.Fve noticed the extents that colleagues are prepared to go to have their articles published,including conducting meaningless experiments,analyzing irrelevant data,and writing redundant reviews.This is especially evident amongst medical graduate students in China who are expected to complete their studies with at least one publication;however,because they have only just begun their clinical work,they actually have 1ittie insight into their eventual specialty.The significance of publishing something outweighs the content.