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08 October 2024, Volume 20 Issue 5 Previous Issue   

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“Starship”in skin regeneration：Exploring the breakthroughs and potential of acellular dermal matrix applied in skin expansion LUO Xusong 2024, 20 (5):  503.  Abstract ( 93 )   PDF (950KB) ( 46 )   The simultaneous reconstruction of appearance and function following large-area skin defects remains an unresolved challenge in clinical practice. Although skin expansion technology has been widely employed in tissue repair and reconstruction， its development has stagnated， primarily due to low expansion efficiency， high complication rates， and poorly understood mechanisms. To address this issue， an innovative approach utilizing acellular dermal matrix was proposed to assist in skin expansion and achieved promising preliminary clinical results. Acellular dermal matrix provides a “biocompatible” interface， balances mechanical forces， and serves as an active scaffold to support various cell types. However， its specific mechanism of action during the skin expansion process warrants further investigation. By acting as an expansion companion， acellular dermal matrix synergistically enhances skin expansion and holds the potential to break through current expansion limitations， thereby unlocking the full potential of skin expansion technology. Related Articles | Metrics

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Generating insulin-producing cells from human adipose-derived stem cells：Comparison of three differentiation protocols YANG Jing, LIU Xingran, YIN Xiya, et al 2024, 20 (5):  507.  Abstract ( 72 )   PDF (6161KB) ( 22 )   Objective The induced differentiation of adipose stem cells into insulin-secreting cells is a new strategy for the treatment of diabetes mellitus. The efficiency of the induced differentiation schemes reported so far varies greatly. This study aims to compare the differentiation efficiency of three induced differentiation schemes. Methods Fat samples from the same batch were collected to extract fat stem cells for passage culture， and the third-generation fat stem cells were self-aggregated into balls for induction and differentiation in different phases （one-step method， two-step method and three-step method）. The expression levels of key genes and proteins in the products of the three schemes at the corresponding stages were detected by PCR and immunofluorescence， and the function of insulin secreting cells was detected by glucose stimulation of insulin secretion experiment. Results Compared with other schemes， the gene expressions of the key transcription factors INS，NKX6.1 and PDX1 in the insulin secreting cells induced by the three-step method were significantly increased， and there were significant differences. Key protein C-peptide and NKX6.1/PDX1 were co-expressed in insulin-secreting cells. Functionally， the insulin secreting cells induced by the three-step method can significantly increase insulin secretion under high glucose stimulation. Conclusion Under the same differentiation conditions， the differentiation efficiency of adipose stem cells induced into insulin secreting cells by the three-step method is superior to that by the two-step method and the one-step method， which provides a basis for establishing an efficient and safe induction differentiation scheme of insulin secreting cells. Related Articles | Metrics

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Protective effects of Thanaka extract against skin photoaging damage of HaCaT cells caused by UVB XU Wanyu, ZHANG Yixin 2024, 20 (5):  516.  Abstract ( 84 )   PDF (3163KB) ( 14 )   Objective To investigate the protective effect of Thanaka extract against UVB-induced photoaging damage in skin. Methods HaCaT cells were treated with 0-25 μg/mL Thanaka extract and 30 mJ/cm2UVB. CCK-8 method was used to observe the effect of Thanaka extract and its effect on the viability of HaCaT cells after UVB irradiation. HaCaT cells were treated with low （3 μg/mL）， medium （6 μg/mL） and high （12 μg/mL） concentrations of Thanaka extract and 30 mJ/cm2 UVB. DCFH-DA fluorescent probe was used to detect intracellular reactive oxygen species （ROS） content； JC-1 fluorescent probe was used to detect mitochondrial membrane potential； Superoxide dismutase （SOD） and malondialdehyde （MDA） were used to detect the levels of antioxidant and oxidative damage. Results The treatment of 0-25 μg/mL of Thanaka extract at all concentrations had no significant effect on cell viability. The viability of HaCaT cells was increased after treatment with 12 μg/mL of Thanaka extract compared with that of the UVB group （P<0.05）. Further experiments showed that ROS content decreased （P<0.05）， SOD activity increased （P<0.05） in the medium and high concentration of Thanaka extract groups；MDA level decreased （P<0.05） and mitochondrial membrane potential rebounded in the low， medium， and high concentration of Thanaka extract groups compared with the UVB group. Conclusion Thanaka extract can promote the viability and antioxidant level of HaCaT cells after UVB irradiation， and reduce the oxidative stress damage produced by UVB， and its underlying mechanism may be related to mitochondrial function Related Articles | Metrics

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Preliminary research of Da Vinci robot-assisted nipple sparing mastectomy and immediate breast reconstruction with gel implant and the latissimus dorsi muscle flap Chen Kuo, LV Pengwei 2024, 20 (5):  522.  Abstract ( 88 )   PDF (14143KB) ( 10 )   Objective To explore the effectiveness and practicability of robot-assisted nipple sparing mastectomy and immediate breast reconstruction with gel implant and the latissimus dorsi muscle flap （LDMF）. Methods A retrospective analysis of 14 robot-assisted breast reconstruction with LDMF completed from September 2022 to September 2023 in a single medical center was conducted. The cohort was divided into two groups： those with skin islands （n=5） and those without （n= 9）. Variables such as surgical technique， operative duration and perioperative complications were scrutinized. Results The study encompassed 14 patients. Among these，8 underwent contralateral breast reconstruction， and one opted out of using a gel implant. Average total operative times were （392.1±61.2） minutes for the group with island flap and （351.6±67.4） minutes for the group without island flap. And indwelling drains and length of hospital stay were （11.2±0.7） d and （18.4±1.5）d for the group with island flap，（9.0±1.1） d and （11.3±1.1） d for the group without island flap. The findings were statistically insignificant due to the limited sample size and the bias between the two groups caused by the inclusion of contralateral surgery and axillary surgery. There were no postoperative necrosis and perioperative complications of the nipple areolar complex. No recurrence or death occurred during a mean follow-up of （3±1） months. All patients were satisfied with the aesthetic results after operation. Conclusion Robot-assisted nipple sparing mastectomy and immediate breast reconstruction with gel implant and LDMF is a safe surgical procedure. LDMF without island flap procedure is more advantageous in terms of drain retention time and hospitalization time， and has good cosmetic results. However， the technique  remains challenging and requires a long learning curve for the surgeon Related Articles | Metrics

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Ultraviolet-induced changes in dermal fibroblast subtypes and repair of photodamaged skin by zinc silicate bioceramics CHEN Fangzhou, TAN Pohching, ZHOU Shuangbai, et al 2024, 20 (5):  528.  Abstract ( 96 )   PDF (17321KB) ( 14 )   diseases， and facilitating the formation of malignant tumors. Fibroblasts in the dermis are categorized into papillary fibroblasts （Fp） and reticular fibroblasts （Fr）， crucial for skin regeneration. The present study elucidates that photodamage leads to alterations in different subtypes of Fb， and addresses this phenomenon to find a therapeutic strategy that can repair photodamage. Methods A mouse model of skin photodamage was established and biological specimens were collected for subsequent analyses， including HE and Masson staining to evaluate tissue structure， DHE staining to detect ROS levels in tissues，γH2AX staining to identify cells with DNA damage， immunofluorescence staining for Lrig1 and Dlk1 to identify distinct Fb subtypes. Furthermore， UVB was used to induce and culture fibroblasts， followed by flow cytometry to detect surface markers， and qPCR to assess mRNA expression related to collagen synthesis and secretion. Lrig1 and DHE， γH2AX fluorescence staining was respectively performed in in vitro assays and in vivo photodamage models by applying  ZnCS-configured ionic solutions and microneedle patch interventions loaded with ZnCS. Results In photodamaged skin， the dermis exhibited infiltrative inflammatory cells and disrupted collagen fiber structure with reduced content， accompanied by a significant increase in ROS expression throughout the epidermis and superficial dermis， accompanied by more DNA damage in superficial dermal fibroblasts. Compared to the control group， there was a marked reduction in Lrig1+Fb cells within the photodamaged skin dermis， while no significant difference was detected in Dlk1+Fb cells. Following UVB irradiation of fibroblasts， flow cytometry analysis revealed a substantial decrease in the proportion of Lrig1+Fb cells among the fibroblasts. Additionally， downregulation of COL1A1 expression was noted， alongside upregulation of MMP3 and MMP9 expressions. Finally， silicate bioceramics （ZnCS） promoted Fp proliferation， and ROS generation and damage in photodamaged skin were significantly reduced after intervention with ZnCS. Conclusion Fp reducing is associated with the progression of photodamage to photoaging. Meanwhile， ZnCS， which has a promoting effect on Fp proliferation， exerts a significant repairing effect on photodamaged skin. Related Articles | Metrics

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Analysis of the therapeutic effect of radiofrequency ablation combined with foam sclerosant on the treatment of Klippel-Trenaunay syndrome in children PI Mengqi, DING yu, ZHAO Lei, et al 2024, 20 (5):  528.  Abstract ( 23 )   PDF (6059KB) ( 13 )    Objective To explore the safety and efficacy of radiofrequency ablation （RFA） combined with foam sclerosant in the treatment of Klippel-Trenaunay syndrome （KTS） in children. Methods The clinical data of 30 children with KTS from April 2022 to April 2024 was collected. All patients were treated with RFA combined with foam sclerosant， and the marginal vein closure and complications were followed up. Results Among 30 cases of KTS，28 cases of marginal vein were completely closed，2 cases were partially closed， and 0 case was still unobstructed， with a complete closure rate of 93.3% （28/30）. All patients did not experience severe complications such as hypoxemia， pulmonary arterial hypertension， nerve damage， skin necrosis， deep vein thrombosis， or hemoglobinuria. Conclusion RFA combined with foam sclerosant is safe and effective in the treatment of KTS in children. Related Articles | Metrics

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The clinical efficacy of blepharoplasty combined SVF-gel grafting for upper eyelid rejuvenation in Asian mid-aged and elderly female NIE Lili1, LU Hua1, GUO Meili, et al 2024, 20 (5):  542.  Abstract ( 59 )   PDF (9192KB) ( 17 )   Objective To explore the feasibility of SVF-gel fat grafting to sunken upper eyelid combined with blepharoplasty to improve upper eyelid laxity and depression in middle-aged and elderly women. Methods In this study， 214 patients who underwent blepharoplasty and ROOF layer SVF-gel fat filling were retrospectively studied. All patients underwent abdominal liposuction and blepharoplasty under local anesthesia， and the SVF-gel was injected into the layers between orbicularis oris muscle and periosteum layer of designed grafting area in the form of micro-droplets in ROOF layers by using 25g blunt needles， finished by overcorrection of sunken upper eyelid. The laxity of upper eyelid was then corrected by blepharoplasty with bridge skill， fully released septum fat and removed the appropriate amount of skin as well as muscle. Standard photos were taken before and on the day after surgery，6 months after surgery， and aesthetic evaluation of upper eyelid depression， satisfaction score and postoperative effect evaluation were also performed. Postoperative effect evaluation included improvement of depression， double eyelid symmetry and complications. Results The 214 patients were all female， with an average age of （38.61±10.22） years. The overall follow-up period was 6 to 23 months， and the average follow-up period was （12.36±3.132） months. All the patients underwent bilateral blepharoplasty with SVF-gel fat grafting to ROOF  layer， the amount of fat grafting ranged from 1.2-2 mL on one side， mean （1.535±0.282） mL on one side. The final overall ratio of upper eyelid depression scored 3.569±1.517， while the preoperative ratio scored 1.115±0.502（n=428，P<0.000 1）， indicating a significant improvement in upper eyelid depression. The GAIS score was 2.384±0.193 （n=214）. Only 14 （6.54%） patients presented with hematomas within 7 days of surgery which resolved completely within two weeks. Eventually at six months after surgery，47（21.96%） patients still had insufficient improvement of the upper eyelid depression and required secondary fat grafting to achieve a better result， with a reoperation rate of 21.96%. Majority of patients were satisfied with the results of the procedure， with an average satisfaction score of （3.974±0.473） out of 5（full mark）. Conclusion SVF-gel fat grafting to ROOF layer combined with blepharoplasty is safe and effective in improving upper eyelid laxity and depression in middle-aged and elderly women. SVF-gel has a good effect in the fine filling of the upper eyelid， and it can be further developed with other surgical methods in the future. Related Articles | Metrics

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Research on the design of 3D printing protective device for infants after 　thumb deformity correction YANG Jiafei, BIAN Weiwei, TU Jingwei, et al 2024, 20 (5):  548.  Abstract ( 45 )   PDF (938KB) ( 11 )   Objective　To explore the application effect and prospect of 3D printing protectors in the fixation of affected limbs after correction of thumb deformity in infants. Methods　Based on the need for fixation of thumb deformity in infants after operation， 3D printing technology was used to print the protective device and carry out clinical application and feedback. The children who underwent polydactyly correction in our department from September 2021 to February 2022 were selected. The patients from September 2021 to November 2021 were set as the control group（ n=15）， and the patients from December 2021 to February 2022 were set as the observation group （n=12）. The control group was treated with conventional external dressing and plaster support fixation after operation. The observation group was fixed with external dressing and 3D printing protectors. The postoperative wound healing， comfort and parents' satisfaction were compared between the two groups. Results　The healing and functional recovery of the children in the two groups were good. The comfort degree of the fixation of the affected limbs and the satisfaction of the parents in the observation group were higher than those in the control group （P<0.05）. Conclusion　 The 3D printing protective device for the correction of polydactyly of thumb in infants is convenient to use and light in weight， which is helpful to fix the affected limb and improve the comfort of the fixation of the affected limb and parents' satisfaction. This 3D printing protective device is worth practicing and promoting in clinical practice. Related Articles | Metrics

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plication of nursing handover checklist based on SWITCH in oral and maxillofacial microvascular reconstructive surgery XU Kangxin, MAO Jiaxin, LIN Yan 2024, 20 (5):  551.  Abstract ( 32 )   PDF (1178KB) ( 11 )   Objective　To design the intraoperative nursing handover checklist based on SWICTH checklist and investigate its application in oral and maxillofacial microsurgical flap reconstruction. Methods　The intraoperative nursing handover checklist of oral and maxillofacial microvascular flap reconstruction was established according to SWICTH checklist. A total of 150 cases of microsurgical flap reconstruction performed in the department of oral and maxillofacial surgery from January to December 2021 were randomly divided into experimental and control groups. The handover checklist was used in experimental group， in comparison with oral handover method in control group. The quality and the duration of intraoperative nursing handover as well as the satisfaction scores from surgical team were compared between the two groups. Results　There was no statistical difference in handover duration between the two groups. In stratified analysis， the duration of circular nursing handover for fibular myocutaneous flap cases in experimental group was significantly shorter than that of control group （P=0.014 6）. The score of overall competence from scrub curses in experimental group was 6.95±0.76， significantly higher than 6.25±0.85 in control group （P=0.008 4）. In fields of organization and communication skills， the scores of scrub and circular nurses in experimental group were statistical higher than those in control group （P<0.05）. In the clinical judgment section， the score of scrub nurses in experimental group was significantly higher than that in control group（ P=0.030 5）. The nursing handover errors and omissions of scrub and circular nurses in experimental group were（ 1.25±1.02） times and（ 1.05±1.10） times， respectively， which were significantly lower than（ 3.10±2.29） times and（ 2.65±2.30） times in control group （P=0.002 1， P=0.007 9）. The score of satisfaction of surgeons and handover nurses in experiment group was significantly higher than that in control group （P<0.000 1， P=0.026 1， P=0.031 6）. Conclusion　In terms of complicated oral and maxillofacial microvascular flap reconstruction， the intraoperative nursing handover checklist based on SWITCH standardizes the procedure and content of shifting， enhances handover quality， reduces the incidence of shifting errors and omissions， and improves the satisfaction of medical and nursing staff. Related Articles | Metrics

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Effect of electrospun membrane morphology on biological behavior of bone marrow mesenchymal stem cells XU Yunrong, TANG Ziwen, HE Fei 2024, 20 (5):  558.  Abstract ( 52 )   PDF (944KB) ( 10 )   　 At present， the influence of material physical factors on cell fate is one of the research hotspots. Relevant studies have shown that the microscopic morphology of scaffolds prepared by electrospinning significantly affects the biological behavior of bone marrow mesenchymal stem cells （BMSC）， such as fiber diameter， fiber arrangement， pore size and porosity. This review focused on the effect of the micromorphology of electrospinning scaffold materials on the biological behavior of BMSC， in order to provide reference for the design of physical factors of electrospinning scaffold materials. Related Articles | Metrics

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Research progress of 3D adipose tissue model ZHU Congxiao, YIN Ningbei 2024, 20 (5):  562.  Abstract ( 74 )   PDF (975KB) ( 33 )   As the largest endocrine organ and the main energy storage system in the human body， adipose tissue plays a pivotal role in regulating energy homeostasis. Pathological conditions such as insulin resistance， chronic inflammation and mitochondrial dysfunction are closely related to adipose metabolic disorders. In vitro models are significant tools for studying the mechanism of associated disorders. At present， three-dimensional culture is a common model for in vitro adipose tissue research because it can imitate the process of adipose metabolism to a certain extent. In order to serve as a resource for future scientific investigations， an overview of three-dimensional adipose tissue models and their properties was provided in this paper. Related Articles | Metrics

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Research progress on modified hydroxyapatite-based bone repair materials HUANG Leiyun, BAI Zhenglin, FU Guangjie, et al 2024, 20 (5):  568.  Abstract ( 118 )   PDF (1027KB) ( 24 )   As a kind of biomedical material， modified hydroxyapatite-based material has good mechanical properties， biocompatibility and osteoinductive ability. It has the advantages of similar composition with natural bone， not easy to cause immune rejection， good biological activity and compatibility， non-toxic， degradable， easy to prepare and process， and makes up for the shortcomings of natural bone material transplantation. In this paper， the biological modification， physicochemical modification and composite modification methods of the material were introduced， and the effects of different modification methods on the properties of the material were compared. In addition， the current problems and challenges of modified hydroxyapatite-based material were presented in the discussion section， and the future development of this kind of material was also prospected. Related Articles | Metrics

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Application of cerium oxide nanoparticles in wound healing ZHU Yulin, LIU Jing, DENG Guoying 2024, 20 (5):  574.  Abstract ( 89 )   PDF (948KB) ( 50 )   Wound healing is a complex physiological process， which can be divided into four main stages： Hemostasis， inflammation， proliferation and migration， and tissue remodeling. At the same time， granulation formation， inflammatory cell infiltration， necrotic tissue cleaning， scar remodeling and other reactions are involved. In some pathological cases， the natural healing process of the wound may be stalled， resulting in repeated attacks and even death from shock. In recent years， the search for high safety and high efficiency medical materials has attracted much attention from researchers. Among them， cerium oxide nanoparticles are a unique material which can promote wound healing and play an important role in all stages of wound healing. Nano-cerium oxide particles not only have antioxidant， antibacterial and anti-inflammatory functions， but also can be used as drug carriers in wound repair to ensure the benign absorption of the body， and can be used as tissue scaffolds to promote the development and maturity of new structures. Therefore， exploring the role of cerium oxide nanoparticles in wound healing may be a new strategy for wound repair. In this paper， the effects of cerium oxide nanoparticles on wound repair were reviewed to provide references for their further application and development in the future. Related Articles | Metrics

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Factors affecting recurrence of plexiform neurofibromas TAN Hao, ZHU Zicheng, SU Jiaqi, et al 2024, 20 (5):  579.  Abstract ( 39 )   PDF (948KB) ( 17 )   Plexiform neurofibromas （pNF） is an autosomal dominant condition of the nervous system and surgical treatment is the main treatment for pNF. However， it is difficult to remove completely， and postoperative recurrence is common. Based on extensive investigation of domestic and foreign cohort research， the existing factors affecting recurrence of pNF were summarized and analyzed. The recurrence of pNF is mainly related to the location of the primary tumor， the extent of surgical resection， and the age of the patients. Other factors such as tumor growth pattern， depth of invasion， nerve origin， preoperative tumor size， and degree of tumor pain are possible affecting factors for recurrence. At present， there is still a lack of preoperative comprehensive evaluation criteria based on multiple factors， and it is more necessary to rely on the experience of clinicians for surgical judgment. There are some problems in previous studies， such as small sample size， imprecise classification of patients， the factors studied were relatively single， and lack of comprehensive quantitative processing. New clinical cohort studies are needed to provide further evidence support and prognostic evaluation criteria.  Related Articles | Metrics

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Research progress of in vitro wear test and computational wear simulation of ankle joint prosthesis YANG Shu, ZHANG Yanwei, GAO Jintao, et al 2024, 20 (5):  584.  Abstract ( 77 )   PDF (3042KB) ( 87 )   Aseptic loosening caused by wear and wear particles is the main cause for the failure of artificial ankle joints. The in vitro tests and computational simulation are important methods for pre-clinical evaluation of prosthetic wear performance. In this paper， the kinematic and dynamic curves used in wear studies of ankle prosthesis were compared. Afterwards， the results of the wear studies were summarized and analyzed. The results showed that： ① Due to the lack of ISO testing standard in the early stage， there are differences in the loading conditions of various studies， mainly reflected in axial load and anteroposterior displacement. Therefore， it is difficult to obtain the wear mechanism of ankle prostheses through the horizontal comparison. ② Foreign researchers have studied the effects of factors such as the implant design， materials， testing conditions， and lubricating media of artificial ankle joint prostheses on wear test results， but relevant literature has not been published in China. ③ The numerical simulation wear results of artificial ankle joint are similar to its in vitro test results， indicating that the validated simulation model can be used to predict the wear performance of ankle joint prostheses. Related Articles | Metrics

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Analysis of continuing education for fellowship in plastic and reconstructive surgery at a tertiary hospital in Shanghai ZHOU Renpeng, YU Yan, WANG Danru 2024, 20 (5):  595.  Abstract ( 64 )   PDF (920KB) ( 17 )   Objective　 To analyze the current situation and problems of continuing education for plastic surgery fellowships. Methods　The data and information of plastic surgery fellowships from a tertiary hospital in Shanghai from 2019 to 2023 were collected and analyzed. Results　In the past five years， a total of 546 fellowships have been trained in a tertiary hospital in Shanghai. The majority of training doctors were male， aged 31-40 years old， and most of them were the backbone of local business with intermediate titles. Bachelor's degree and master's degree were the main qualifications of fellowships， and most of them came from tertiary hospitals. Among them， less than half were major in plastic surgery， and the characteristic of interdisciplinary continuing education was obvious. Conclusion　 Plastic surgery covers a wide range of fields， and the teaching and training of fellowships should pay attention to systematization and specialization to achieve highquality continuing education goals. Related Articles | Metrics