Haiping Wang

Objective This study aims to investigate the role of pretarsal fascia in the formation of upper eyelid crease in East Asians. Methods Through intraoperative fascia retraction observation, fascia-stretching test, histological examination, and anatomical analysis of pretarsal fascia and surrounding tissues, we explored the mechanical consequences and their impact on upper eyelid crease formation. Results The levator aponeurosis extension comprises three parts to impact sub-orbicularis fat pad mechanically. The pretarsal fascia is anatomically distinct from the aponeurosis extension but is influenced by its mechanic forces. Differential distribution of collagen fiber bundles within the pretarsal fascia can buffer and transmit the forces of aponeurosis extension, leading to diverse upper eyelid crease patterns. Conclusion The factors determining upper eyelid crease are multifaceted, and the buffering-conduction theory of pretarsal fascia can explain both physiological and postoperative crease in East Asians. It determines the presence, depth, and stability of crease, laying the foundation for the formation of upper eyelid crease in East Asians. Level of Evidence V 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

Background: Tear trough deformity is one of the most common complaints in clinical settings. The correction of this groove is challenging in facial rejuvenation. The lower eyelid blepharoplasty varies with different conditions. A novel approach of using orbital fat in the lower eyelid to increase the volume of the infraorbital rim with granule fat injection has been applied in our institution for more than 5 years.Objectives: This article aims to describe the detailed steps of our technique and verify its effectiveness by a cadaveric head dissection after surgical simulation.Methods: In this study, a total of 172 patients with tear trough deformity underwent lower eyelid orbital rim augmentation with fat filling in the sub-periosteum pocket. According to Barton's grades, 152 patients underwent lower eyelid orbital rim augmentation with orbital fat filling, 12 patients had it combined with autologous granule fat from other body parts, and 8 patients received only transconjunctival fat removal to correct tear trough.Results: The modified Goldberg score system was used to compare preoperative and postoperative photographs. Patients were satisfied with the cosmetic results. Excessive protruding fat was released, and the tear trough groove was flattened by using autologous orbital fat transplantation. The lower eyelid sulcus deformities were well-corrected. To further illustrate the anatomical structure of the lower eyelid area and injection layers, six cadaveric heads were used for surgical simulation and demonstrated the effectiveness of our technique.Conclusions: This study indicated that the infraorbital rim could be increased by transplanting orbital fat to the pocket, which was dissected under the periosteum, and the procedure has been verified as reliable and effective.Evidence-based medicine (EBM) level: Level II.

Diabetic wounds are characterized by delayed and incomplete healing. As one of the most common complications of diabetes, diabetic wounds can be fatal in some cases. Programmed cell death (PCD) is an active and ordered cell death mode determined by genes, including apoptosis, autophagy, pyroptosis, necroptosis, ferroptosis, and cuproptosis. It is currently believed that PCD plays a crucial role in diabetic wound healing. Diabetic hyperglycemic environments can lead to abnormal PCD in various cells during healing processes, thereby affecting the activity and function of cells and interfering with diabetic wound healing. Therefore, this review focuses on the new roles and mechanisms of PCD in diabetic wound healing. Moreover, the challenges and perspectives related to PCD in diabetic wound healing are presented, which will bring new insights to improve diabetic wound healing.

Obesity is defined as a chronic disease induced by an imbalance of energy homeostasis. Obesity is a widespread health problem with increasing prevalence worldwide. Breast cancer (BC) has already been the most common cancer and one of the leading causes of cancer death in women worldwide. Nowadays, the impact of the rising prevalence of obesity has been recognized as a nonnegligible issue for BC development, outcome, and management. Adipokines, insulin and insulin-like growth factor, sex hormone and the chronic inflammation state play critical roles in the vicious crosstalk between obesity and BC. Furthermore, obesity can affect the efficacy and side effects of multiple therapies such as surgery, radiotherapy, chemotherapy, endocrine therapy, immunotherapy and weight management of BC. In this review, we focus on the current landscape of the mechanisms of obesity in fueling BC and the impact of obesity on diverse therapeutic interventions. An in-depth exploration of the underlying mechanisms linking obesity and BC will improve the efficiency of the existing treatments and even provide novel treatment strategies for BC treatment.

Breast cancer (BC) is the most frequently invasive malignancy and the leading cause of tumor-related mortality among women worldwide. Cancer metastasis is a complex, multistage process, which eventually causes tumor cells to colonize and grow at the metastatic site. Distant organ metastases are the major obstacles to the management of advanced BC patients. Notably, exosomes are defined as specialized membrane-enclosed extracellular vesicles with specific biomarkers, which are found in a wide variety of body fluids. Recent studies have demonstrated that exosomes are essential mediators in shaping the tumor microenvironment and BC metastasis. The transferred tumor-derived exosomes modify the capability of invasive behavior and organ-specific metastasis in recipient cells. BC exosomal components, mainly including noncoding RNAs (ncRNAs), proteins, lipids, are the most investigated components in BC metastasis. In this review, we have emphasized the multifaceted roles and mechanisms of tumor-derived exosomes in BC metastasis based on these important components. The underlying mechanisms mainly include the invasion behavior change, tumor vascularization, the disruption of the vascular barrier, and the colonization of the targeted organ. Understanding the significance of tumor-derived exosomal components in BC metastasis is critical for yielding novel routes of BC intervention.

Objective The authors sought to determine the efficacy of periumbilical fat block grafting to the orbital retro-orbicularis oculi fat (ROOF) layer to correct sunken-upper eyelids in Asians. Methods All patients complained about upper-eyelid hollowness and a variety of deformities. Invasive double-eyelid procedures were performed, and periumbilical fat blocks were grafted for these patients. The core procedure of this approach was to make a separation between the orbicularis oculi muscle and septum to expose the retro-orbicularis oculi fat (ROOF) and fixate the fat grafts to the desired region of ROOF. Results From February 2018 to October 2019, the novel technique was performed on 38 Chinese patients (76 eyes) in our department. After follow-up of 6–15 months, 35 patients (92%) showed satisfactory aesthetic results with approximately 20–40% fat absorption rate. No cases required a second procedure. Periumbilical scars remained hidden within the umbilicus area. Conclusions Periumbilical fat grafting in the ROOF of the sunken upper eyelid can both fill the depression and help correct over-wide double eyelid. EBM Level IV 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.

To study the anatomical location of retro-orbicularis oculi fat (ROOF) in the upper eyelid and to investigate how ROOF affects the appearance of the upper eyelid.

In recent years, because the formation mechanism of double eyelids in Asians is still controversial, many techniques for double-eyelid plasty have been developed. However, the removal of large amounts of pretarsal tissue and the obvious scars in those techniques make patients dissatisfied with the appearance. Thus, we have devised a novel surgical approach named the kiss technique. The method is to create a physiological double-eyelid fold on the basis of the formation mechanism of double-eyelid creases.

The aim of this study was to introduce and evaluate a method to prevent venous congestion in periauricular flap pedicled on the frontal branch of the superficial temporal artery (STA). Flaps based on the STA are therefore extremely versatile in reconstruction of the face and scalp. The literature on reconstructive possibilities provided by temporal flaps describes venous congestion, but there are currently no methods for preventing this problem. In this brief report, we describe a method to anastomose the parietal branch of superficial temporal vein and the middle temporal vein to ensure venous flow when a concomitant vein of the frontal branch of the STA is unavailable. The flap survived without venous congestion and donor sites healed with satisfactory outcomes. Color and texture match of the flap were excellent and morbidity at the donor site was usually minimal.

The purpose of the present research work was to demonstrate the antitumor activity of dihydrokaempferol in SK-Mel-28 human malignant melanoma cells. MTT assay was used to study the cytotoxic effects induced by dihydrokaempferol in these cells. In vitro wound healing assay and invasion assay were used to examine its effects on cell migration and invasion. Fluorescence microscopy using acridine orange/propidium iodide was used to study effects on cell morphology and apoptosis. Western blot assay revealed its effects on NF-kB/mitogen-activated protein kinase (MAPK) protein expression levels. The results indicated that dihydrokaempferol significantly inhibited the growth of these cells and the cytotoxicity pattern was shown to follow the drug dose and incubation times. Dihydrokaempferol led to onset of red fluorescence in these cells indicating that its treatment with different doses leads to induction of apoptosis. Dihydrokaempferol also led to inhibition of cell migration and invasion in a dose-dependent manner. It was also shown to up-regulate NF-kB/MAPK signalling pathways.Video Clip:In vitro wound healing assay: 4 min 25 sec