Zuoliang Qi

Specific Marker Expression and Cell State of Schwann Cells during Culture In Vitro

Schwann cells (SCs) in animals exist in different developmental stages or wound repair phases, distinguished mainly by the expression of SC-specific markers. No study has yet determined SC state under in vitro culture conditions, and the specific markers expressed in SC are obscure as well. In this study, we harvested sciatic nerves from newborn mice and isolated SCs by an enzyme-digestion method, then we examined the expression profiles of ten markers (S100, p75NTR, Sox10, Sox2, GAP43, NCAM, Krox20, Oct6, MBP, and MPZ) at both the RNA and protein levels in in vitro mouse SCs and speculated their relation with in vivo SC stages. We assayed RNA and protein levels of SC specific markers by immunofluorescence, Western Blot, and real-time quantitative RT-PCR. The results show that the expression of most markers (S100, p75NTR, GAP43, NCAM, Krox20, Oct6, MBP and MPZ) was not detectable in all of early stage cultured SCs. The expression of transcription factors Sox10 and Sox2 was, however, detectable in all SCs. After 8 days, the positive expression rate of all markers except GAP43 and Oct6 was almost 100%.These results indicates Sox10 is a necessary marker for SC identification, while S100 is not reliable. SCs cultured in vitro express Sox2, P75NTR, NCAM, GAP43, Oct6, and MPZ, suggesting that they are similar to in vivo undifferentiated iSCs or dedifferentiated iSCs after nerve injury.

Autologous Fat Grafting With Combined Three-Dimensional and Mirror-Image Analyses for Progressive Hemifacial Atrophy.

BackgroundAutologous fat grafting (AFG) has been widely used to treat progressive hemifacial atrophy (PHA). However, objective and quantitative analyses in patients with PHA are complicated because of multidimensional atrophy and fat absorption. This study aimed to introduce a new method to predict volumetric deficiency of soft tissues and objectively evaluate the survival of grafted fat with 3-dimensional (3D) and mirror-image analysis (MIA). MethodsThirty-one patients with PHA were classified into 2 groups based on the location of the facial midsagittal plane (FMP), which was established through our proposed method using nasion (point a), anterior nasal spine (point b), and pogonion (point c). The included cases with centered FMP were treated using serial AFG and followed up for 12 to 15 months. Images were obtained preoperatively (pre-OP) and postoperatively at 2 time points (3 months and 12 months). Three-dimensional computed tomography (CT) was performed before the first surgery to locate the FMP and predict the volumetric deficiency of soft tissues with MIA. Three months after the first surgery, 3D laser scanning was conducted to evaluate the volume of surviving fat. Patient characteristics, satisfaction, and soft tissue augmentation results were analyzed. ResultsTwenty-seven cases (9 men and 18 women) with PHA were included and treated using serial AFG (mean number of operation, 3.1 times). The mean age was 22.1 years. With 3D CT or 3D laser-scanning camera and MIA, we obtained the mean deficient volume of the affected area (30.48 mm3) and the mean volume of the total fat injection (133.61 mm3). The mean fat absorption ratio was 47.92%. The mean satisfaction score immediately obtained at first postoperative (score = 4.3) was higher than that at 3 months postoperatively (score = 4.1) and 12 months postoperatively (score = 4.0). No complications and donor-site morbidity were noted. ConclusionThe facial symmetry of patients with centered FMP can be successfully restored using serial AFG alone. The combined 3D and MIA can be used to predict the volumetric deficiency of soft tissues and objectively evaluate the survival of grafted fat.

Using the Reversed Temporal Island Flap to Cover Small Forehead Defects from Titanium Mesh Exposure After Cranial Reconstruction

BACKGROUND Skin ulcers and alloplastic implant exposure are intractable complications that arise after cranial defect reconstruction. Many methods have been used to repair these defects, including skin grafting, local flaps, and free flaps; however, in most cases, alloplastic implants must be removed to control infections. Here, we describe the use of a reversed temporal island flap to repair exposed titanium mesh without removing it. METHODS Eight cases of skin and titanium mesh exposure were included from 2010 to 2015. A preauricular flap pedicled on the reversed superficial temporal artery was designed to repair forehead defects. The titanium mesh was retained, resterilized, and reimplanted. RESULTS Flaps were survived completely, and the titanium meshes were reimplanted with no complications. The results were aesthetically and functionally sufficient, with minimal donor-site morbidity in all cases during the 10- to 24-month follow-up period. CONCLUSIONS The described method is easy to design and perform. The flap has a reliable blood supply to help fight infection. The titanium mesh is preserved completely, avoiding a second cranioplasty.

Muscle-derived stem cells in peripheral nerve regeneration: reality or illusion?

Owing to the complicated and time-consuming regenerative process, the repair of injured peripheral nerves depends largely on ongoing stem-cell therapy. Decades ago, researchers successfully isolated and identified muscle-derived stem cells (MDSCs) and discovered their potential for multidifferentiation. MDSCs play an important role in trauma repair associated with neuromuscular and vascular injury by simultaneously promoting tissue regrowth via direct differentiation and systematic secretion under physiological conditions. However, the isolation, culture, induction and application of MDSCs require further methodological analysis before clinical application. In this review, we comprehensively discuss the challenges associated with neural regeneration and reviewed the progress of stem cell based regenerative medicine, in an effort to realize the potential of MDSCs in nerve regeneration.

Clinical Efficacy and Safety of Negative-Pressure Wound Therapy on Flaps: A Systematic Review

Background Although flap transfer is a popular reconstructive procedure with a high success rate, it is associated with a high complication rate and low salvage rate. During the past decade, negative‐pressure wound therapy (NPWT) has been increasingly applied to facilitate flap transfer and salvage flaps threatened by complications. It has achieved some success, but its efficacy and safety remain controversial because of the limited number of reports and lack of systematic reviews. Methods English‐language articles describing the application of NPWT on flaps were screened using predetermined inclusion and exclusion criteria. The articles were summarized and divided into groups based on the purpose of NPWT application. The complication rate, success rate, and salvage rate were obtained. Results Among the 3,395 articles searched, 16 articles describing 137 flaps were eligible. NPWT was applied on 105 (76.4%) newly transferred flaps to facilitate flap attachment and on 32 (23.4%) complication‐threatened flaps to relieve flap infection and venous congestion. In total, complications developed in six flaps, three of which were lost; thus, the complication rate was 5.7% (6/105) and the success rate was 97.1% (102/105). Only 1 of the 32 threatened flaps was not successfully salvaged; thus, the salvage rate was 96.9% (31/32). Conclusion NPWT may facilitate flap transfer with few side effects and help to rescue flaps threatened by infection and venous congestion with a high salvage rate. Further studies are needed to test the safety of NPWT application on flaps with arterial compromise.

Bone marrow-derived cells response in proximal regions of nerves after peripheral nerve injury: Proximal changes after sciatic nerve injury

In recent years, bone marrow‐derived cells have been found to be crucial for peripheral nerve regeneration. After traumatic peripheral nerve injury, bone marrow‐derived macrophages quickly infiltrate into the distal regions of nerves. To explore the changes caused by bone marrow‐derived cells within the proximal regions of the nerves, sciatic nerves of chimeric mice carrying bone marrow cells expressing green fluorescent protein were crushed to observe the infiltration of invading bone marrow‐derived cells. Seven days after surgery, abundant bone marrow‐derived cells had infiltrated into the damaged proximal nerve segments. The numbers of these cells increased to a peak at 2 weeks and then gradually returned to normal levels within 30 weeks. Through immunofluorescence staining, many of these cells were identified as macrophages, and they showed a similar infiltration tendency toward distal nerve segments. However, fewer cells infiltrated proximal segments than distal nerve segments. In conclusion, these findings suggest that bone marrow‐derived cells response not only occurs within the distal nerve segments but may also take place within the proximal segments of nerve tissues after nerve injury.

Three-dimensional Volumetric Analysis of 3 Fat-Processing Techniques for Facial Fat Grafting: A Randomized Clinical Trial

Importance Autologous fat grafting has revolutionized the field of facial soft-tissue augmentation, despite a lack of standardization. Objective data are needed to arrive at consensus regarding the best technique for optimal volume retention. Objective To compare 3 fat-processing techniques with 3-dimensional (3-D) technology to explore the optimal fat-processing technique for improving the volume retention of grafted fat. Design, Setting, and Participants From September 2015 to December 2016, patients with facial asymmetry were treated by initial facial fat grafting at the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Sixty-three patients (21 per group) were randomized to 1 of 3 fat-processing techniques: sedimentation, centrifugation, and cotton pad filtration. Patients underwent 3-D scanning preoperatively and at 1, 3, 6, and 12 months postoperatively. Patients who did not complete preoperative or postoperative follow-up and 3-D imaging were excluded from the analysis. Intervention Autologous fat grafting to correct facial asymmetry. Main Outcomes and Measures The percentage volume maintenance of each fat-processing technique was measured with 3-D software and analyzed with variance analysis. Results Of the 63 randomized patients, 30 (7 men, 23 women; mean [SD] age at surgery, 22.2 [8.0] years) completed follow-up. The mean (SD) percentage volume maintenance of the 3 groups at 1, 3, 6, and 12 months postoperatively was, respectively, 49% (4%), 45% (3%), 43% (3%), and 41% (3%) for the cotton pad filtration group; 41% (3%), 38% (4%), 36% (4%), and 34% (3%) for the centrifugation group; and 37% (4%), 34% (4%), 31% (3%), and 31% (3%) for sedimentation group. The variance analysis showed that the cotton pad filtration group demonstrated a statistically significant higher percentage volume maintenance in comparison with the centrifugation and sedimentation groups. Conclusions and Relevance The use of 3-D technology provides an objective and accurate way to evaluate different fat-processing techniques. Autologous fat processed by cotton pad filtration had a significant higher volume retention than did that processed by centrifugation and sedimentation technique. Trial Registration chictr.org.cn Identifier: ChiCTR-IOR-14005599 Level of Evidence 1.

Clinical Application of Platelet-Rich Fibrin in Plastic and Reconstructive Surgery: A Systematic Review

BackgroundPlatelet-rich fibrin (PRF) has been applied in the clinical field for more than a decade, but largely in oral surgery and implant dentistry. Its utilization in plastic and reconstructive surgery is limited and lacking a comprehensive review. Hence, this article focuses on the various clinical applications of PRF pertaining to the plastic and reconstructive field through a systematic review.MethodsIn this review, articles describing the clinical application of PRF in plastic and reconstructive surgery were screened using predetermined inclusion and exclusion criteria. The articles were summarized and divided into groups based on the utilization of PRF. The effects and complications of PRF were analyzed and concluded.ResultsAmong the 634 articles searched, 7 articles describing 151 cases are eligible. PRF was applied on 116 (76.8%) wounds to facilitate tissue healing, and the complete wound closure rate was 91.4% (106/116). Otherwise, PRF was applied in 10 (6.6%) cases of zygomaticomaxillary fracture to reconstruct orbital floor defects and in 25 (16.6%) cases of facial autologous fat grafts to increase the fat retention rate successfully. There is no report of PRF-related complications.ConclusionsPRF could facilitate wound healing, including the healing of soft tissues and bony tissues, and facilitate fat survival rate. Further studies are needed to test the mechanism of PRF and expand its scope of application in plastic and reconstructive surgery.Level of Evidence IIIThis 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.

Strategies of Mandibular Revision: A Retrospective Study of Revisional Mandibular Surgery for Unaesthetic Results of Previous Mandibular Reduction

BackgroundMandibular reduction has been developed and popularized in Asia for decades. Despite the technical advancement and experience accumulation, complications and unaesthetic results still occur, and some need a revision surgery. This study aims to introduce the experience of revision surgery to reshape the unaesthetic mandibular contour after previous mandibular reduction.MethodsFrom May 2011 to September 2017, patients dissatisfied with the result of previous mandibular reduction and who received a secondary mandibular revision were retrospectively reviewed and analyzed.ResultsTwenty-five patients were included in this study. Under-correction (88%, 22/25) was the most common aesthetic problem requiring revision, followed by asymmetry (56%, 14/25), broad chin (40%, 10/25), second mandibular angle (32%, 8/25), and over-correction (8%, 2/25). As revision techniques, long-curve mandibular reduction, simple mandibular reduction, and mandibular grinding were performed on 60% (15/25), 36% (9/25), and 4% (1/25) of the patients, respectively. All the patients were satisfied with the results. Cephalometric measurements indicated a significant bone removal after revision.ConclusionsWhen performing a revision surgery to reshape the mandibular contour, the surgeon should have a clear surgical plan based on comprehensive evaluation, focus on the balanced harmony of the entire face, use proper technique and instruments, and avoid concomitant injury and complications. The one-staged technique that treats the whole mandible as an entirety is superior than multistaged techniques to improve the aesthetic outcomes to the largest extent.Level of Evidence IVThis 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.

Long‑term survival after corrective surgeries in two patients with severe deformities due to Roberts syndrome: A Case report and review of the literature

Roberts syndrome (RBS; OMIM 268300) is a rare autosomal recessive disease characterized by retardation before and after birth, cranial and maxillofacial deformities, limb anomalies and intellectual disability. Mutations in the establishment of cohesion 1 homologue 2 (ESCO2) gene on chromosome 8p21.1 have been found to be causative for RBS. We describe two patients with RBS with physical deformities and ll. One is an 8-year-old Yemeni male, and the other is his 13-year-old sister. These patients were diagnosed with RBS and underwent surgeries during their first to third years of life. Here, we present the cases for the two patients, focusing specifically on their surgical management and outcomes. Additionally, by reviewing the literature on RBS, we also summarize the proper surgical interventions for this rare disease. This paper describes the long-term follow-up of two patients with severe deformities who benefitted from corrective surgeries. The findings of this study indicate that patients who survive infancy and reach adulthood, even patients who present with severe disease symptoms, can benefit from corrective surgeries and lead better lives.