Stromal Vascular Fraction Gel (SVF-Gel) Combined with Nanofat for Tear Trough Deformity.

BACKGROUND: Tear trough deformity makes patients appear tired. Patients with less severe tear trough deformity prefer a less invasive method to correct the deformity. The infraorbital area is a multilayered tissue, and the aging of various components leads to tear trough deformity. To this end, we utilized the different characteristics of different fat derivatives to correct tear trough deformity. METHODS: Thirty-two patients with Barton Grade I/II tear trough deformity were enrolled in this study between September 2020 and March 2021. We injected Stromal Vascular Fraction Gel (SVF-Gel) into the suborbicularis oculi fat layer and Nanofat into the subcutaneous. After 12 months of follow-up, we evaluated the changes using standardized clinical photogrammetric techniques, volume, global aesthetic improvement scale, and patient self-evaluation. RESULTS: There were no major complications in any of the 32 patients. The measured data points demonstrated improvements in all aesthetic parameters. The width of the tear trough and the distance from the pupil to the tear trough improved. The Global Aesthetic Improvement Scale (GAIS) showed a high score (2.45±0.64 points), with patient self-assessment showing satisfactory results. CONCLUSION: SVF-Gel combined with Nanofat injection can effectively correct tear trough deformities. LEVEL OF EVIDENCE 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 .

Study on the Influence of CaO on the Electrochemical Reduction of Fe2O3 in NaCl-CaCl2 Molten Salt.

The presence of calcium-containing molten salts in the electrolysis of oxides for metal production can lead to the formation of CaO and, subsequently, the generation of intermediate products, affecting the reduction of metals. To investigate the impact of CaO on the reduction process, experiments were conducted using a Fe2O3-CaO cathode and a graphite anode in a NaCl-CaCl2 molten salt electrolyte at 800 °C. The electrochemical reduction kinetics of the intermediate product Ca2Fe2O5 were studied using cyclic voltammetry and I-t curve analysis. The phase composition and morphology of the electrolysis products were analyzed using XRD, SEM-EDS, and XPS. The experimental results demonstrate that upon addition of CaO to the Fe2O3 cathode, Ca2Fe2O5 is formed instantly in the molten salt upon the application of an electrical current. Research conducted at different voltages, combined with electrochemical analysis, indicates that the reduction steps of Ca2Fe2O5 in the NaCl-CaCl2 molten salt are as follows: Ca2Fe2O5 ⟶ Fe3O4 ⟶ FeO ⟶ Fe. The presence of CaO accelerates the electrochemical reduction rate, promoting the formation of Fe. At 0.6 V and after 600 min of electrolysis, all of the Ca2Fe2O5 is converted into Fe, coexisting with CaCO3. With an increase in the electrolysis voltage, the electrolysis product Fe particles visibly grow larger, exhibiting pronounced agglomeration effects. Under the conditions of a 1 V voltage, a study was conducted to investigate the influence of time on the reduction process of Ca2Fe2O5. Gradually, it resulted in the formation of CaFe3O5, CaFe5O7, FeO, and metallic Fe. With an increased driving force, one gram of Fe2O3-CaO mixed oxide can completely turn into metal Fe by electrolysis for 300 min.

Buttock Augmentation with Fat Grafting.

Refined buttock augmentation with fat grafting in Chinese women during the past decade is introduced. The ideal buttock contouring outcome and figure silhouette come from the proper individualized plan and meticulous maneuvers through fat grafting to the buttocks combined with liposuction procedures on the surrounding areas of the buttocks as well as on the other body parts. The fat grafts are collected, filtered, and condensed by gravitation in a sterilized canister during liposuction. It is recommended that fat grafts were only transplanted into the subcutaneous layers and with no injection into the musculatures of the buttocks. High patients' satisfaction was obtained with no major complications and fewer minor complications.

Novel method for correcting cephalic rotation in Asian nasal tip plasty.

BACKGROUND: To correct nasal tip cephalic rotation, SEG made of cartilage or Medpor are often used in rhinoplasty. These techniques require extensive experience for the surgeon, and not all patients can accept this procedure. In this research, we introduce a new method to correct nasal tip cephalic rotation that is relatively simple and rapid. METHODS: Fifty-nine patients who had rhinoplasty using our scaffold were enrolled in the study between January 2020 and January 2021. The authors evaluated the change of nasolabial angel by photogrammetry using standardized clinical photogrammetric techniques. Patients' satisfaction regarding postoperative results was also surveyed. RESULTS: The mean postoperative follow-up duration was 12 months. No complication (infection, extrusion, and displacement) was happened in all patients. Analysis showed our scaffold can correct nasal tip cephalic rotation effectively (98.61±1.21 preoperatively and 89.68±0.99 postoperatively, P<0.0001). And the patient satisfaction rate is 98%. CONCLUSION: We constructed an integrated scaffold by simply folding and suturing a high-density polyethylene sheet (Su-Por) sheet to correct nasal tip cephalic rotation. Using the scaffold we designed, we did not need to alter the structure of the nasal septum, which reduced the operative duration and simplified the surgical procedure.

Midface Rejuvenation With Autologous Fat Grafting.

BACKGROUND: Midface rejuvenation is important to restore a youthful and appealing appearance. However, there are several problems existed in the treatment of fat grafting, including low fat retention and undesired aesthetic outcomes. OBJECTIVE: To objectively evaluate the efficacy of midface fat grafting, and analyze the problems encountered in this process to increase patient satisfaction. METHODS: Thirty-two patients who underwent autologous fat grafting for midface augmentation were included. Facial analysis was performed based on preoperative and postoperative photographs. Satisfaction outcome was assessed by the patient, the surgeon, and a layperson postoperatively. RESULTS: After treatment, 87.5% of the patients were assessed as satisfactory and mostly satisfactory based on facial proportion and complications. The postoperative medial cheek projection was 1.92±0.26 times the height of the preoperative one ( P <0.01). A smooth lid-cheek junction, a single convex, and ameliorated nasolabial groove were obtained. The dark coloration and wrinkles in lower eyelid were improved. The most common complication was overcorrection, which could be resolved with further treatments. CONCLUSIONS: Autologous fat grafting remains an optimal option for midface rejuvenation with satisfactory results. Most of the complications are preventable and optimal outcomes can be obtained through correct comprehension of aesthetic features and proper operations.

Experimental Study on the Biological Outcome of Auricular Cartilage and Costal Cartilage at Different Time Periods After Autologous Cartilage Rhinoplasty.

Since autologous cartilage is a good transplant material, it is widely used in various fields of clinical medicine. In this study, we collected clinical specimens obtained at different numbers of years after transplantation and used histologic staining to explore the post-transplantation changes in auricular cartilage and costal cartilage. A retrospective analysis was performed on patients who underwent primary autologous cartilage rhinoplasty and secondary rhinoplasty from 2017 to 2021, and the remaining autologous cartilage tissue after surgery was used for histologic testing. As time progressed after transplantation, the density of costal chondrocytes decreased first and then increased, while the secretion of type II collagen and extracellular matrix both decreased slightly. There was a clear boundary between the cartilage tissue and the surrounding connective tissue, and there was no ingrowth of blood vessels in the cartilage. Auricular cartilage showed a decrease in the integrity of the matrix edge. Moreover, local fibrosis was visible, and vascular ingrowth was observed at the edge of the cartilage. The content of type II collagen first increased and then decreased, and the cell secretion function was lower than that of normal chondrocytes. The results of the study suggest that the histologic outcome of elastic cartilage after transplantation is significantly different from that of hyaline cartilage. Moreover, costal cartilage was more stable than auricular cartilage after transplantation.

Biological Changes of Autologous Auricular Cartilage in Rhinoplasty.

Autologous auricular cartilage is used extensively as a good graft material in rhinoplasty. In this study, clinical specimens from patients who underwent revision rhinoplasty with auricular cartilage grafts were collected to compare the changes before and after auricular cartilage transplantation with the use of histologic, immunohistochemical, and quantitative assays. Patients who underwent revision rhinoplasty from 2018 to 2022 were analyzed. Fresh auricular cartilage left after surgery and auricular cartilage graft tissue were examined and compared. Compared with fresh auricular cartilage, local fibrosis was seen in the transplanted auricular cartilage with a slight decrease in elastic fibers, type II collagen, and extracellular matrix secretion. Quantitative assays showed a decrease in glycosaminoglycan, DNA, and total collagen content in the transplanted auricular cartilage tissue. The results of the study suggest that the histologic characteristics, cell functionality, and biochemical composition of the grafted cartilage changed to a certain extent after autologous auricular cartilage graft rhinoplasty. These results provide insights into the selection of graft/filler materials for rhinoplasty and what changes to expect.

Long-term volume retention after fat processing with cotton gauze rolling and centrifugation: A comparative study in nude mice.

BACKGROUND: Autologous fat grafting for correcting soft-tissue defects in cosmetic and reconstructive procedures has grown in popularity. Fat processing is implicated as a variable affecting quality, viability, and subsequent graft retention. This study aimed to identify a better fat processing technique for optimal outcomes. METHODS: Fresh human aspirated fat was processed with cotton gauze rolling or centrifugation and named rolled fat (RF) and centrifuged fat (CF), respectively. Processed fat grafts were analyzed in vitro to determine yield, stromal vascular fraction (SVF) content, and viability. Then, RF and CF were transplanted subcutaneously to different flanks of every nude mouse. Fat samples were weighed to evaluate the volume retention 3 months post-transplantation. Tissue structure, densities of vessels, and CD68-positive macrophages were examined by histological staining. RESULTS: The compression rate of lipoaspirate by cotton gauze rolling was 25%, which was more effective than the rate of 50% by centrifugation. The numbers of SVF cells per gram of RF and CF were (1.02 ± 0.14) ×106 and (0.65 ± 0.26)×106, respectively (P < 0.05). Long-term graft retention was significantly higher in the RF group than in the CF group. Histological analysis of all implants revealed intact adipose tissue and equivalent vascularity. The number of CD68-positive macrophages in the RF group was much less than in the CF group on day 7. CONCLUSION: The results of this animal experiment showed that, compared with centrifugation, processing with cotton gauze rolling produces more condensed fat, higher SVF content, and decreased inflammatory response, thereby improving long-term volume retention. Further explorations are required to verify the superiority of cotton gauze rolling in clinical settings.

Analysis of Factors Affecting Postoperative Drainage After Comprehensive Rhinoplasty.

This study aimed to explore and analyze the factors influencing the drainage volume after comprehensive rhinoplasty. The clinical data of 102 patients who underwent comprehensive rhinoplasty at Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine from August 2019 to August 2021 were retrospectively analyzed. The effects of age, sex, body mass index, whether an osteotomy was performed, and whether a nasal septum flap was obtained on the indwelling time of the drainage tube after the operation were analyzed by single factor analysis and multiple logistic regression analysis. Age, body mass index, whether it was a primary rhinoplasty, whether an osteotomy was performed, and whether a nasal septum flap was obtained were the influencing factors for drainage time after augmentation rhinoplasty ( P <0.05). Sex had little effect on the drainage time after comprehensive rhinoplasty ( P >0.05). Body mass index, whether an osteotomy was performed and whether a nasal septum flap was obtained were the independent influencing factors for the postoperative drainage time ( P <0.05). For patients with multiple independent influencing factors, individualized management during the perioperative period should be promoted, and reasonable treatment strategies should be formulated, so as to reduce the indwelling time of the drainage tube after the operation.

Horizontal and vertical distribution of microplastics in dam reservoir after impoundment.

In freshwater ecosystems, microplastics (MPs) are commonly found in reservoirs. However, limited information is available on the distribution of MPs in the reservoirs. In this study, we investigated the horizontal and vertical distribution characteristics of MPs in the Guanyingyan reservoir (the upper reaches of the Yangtze River, China) after impoundment and the influence of free-floating plant residues on the distribution of MPs. Results indicated that the MPs abundance in the horizontal distribution of the reservoir decreased significantly while the distance from the dam increased. The abundance of MPs in shoreline waters (average: 8.45 items L-1) was significantly higher than that in central waters (average: 4.80 items L-1). As for the vertical distribution, the percentages of fibers in the three water layers (surface, intermediate, and deep) have less variation when compared to other types of MPs. Besides, MPs who are less than 0.5 mm in size are the majority. With deeper underwater, there would be more MPs with particles smaller than 200 µm in size. At the same time, there would be fewer MPs with particles ranging from 200 to 500 µm in size. PS, PP, and PE are the main polymer types of surface water, while PVC, PE, and PET are the common type in deep water. In shoreline water, the dry weight of floating plant residues showed a positive correlation with microplastic abundance in different layers. As above said, this study confirmed that MPs in reservoirs after impoundment would tend to accumulate in the front section of the reservoir and the shoreline water. Besides, free-floating plant residues would accumulate in reservoirs, resulting in the sinking of MPs.

Eyelid Lymphatics: An Anatomical Study by Microdissection.

OBJECTIVE: To obtain further understanding of the eyelid lymphatic anatomy. METHOD: Thirty-two halves of eyelids from 16 fresh fetus cadavers were studied by microdissection using a mixture of 3% Prussian blue and chloroform to visualize the lymphatic vessels. RESULTS: Three layers of lymphatic plexuses were demonstrated in the eyelids: a superficial or preorbicularis muscle plexus; a pretarsal or postorbicular muscle plexus; and a deep or posttarsal plexus. Furthermore, communicating branches among these plexuses were also spotted. CONCLUSIONS: The study results demonstrated the topographic distribution of the eyelid lymphatic vessels and confirmed the existence of communicating branches. This discovery will be conducive to understanding the route and mechanism by which inflammation of the eyelid spreads and cancer disseminates. It also provides anatomical insights to apply during eyelid surgery with regard to the prevention of possible eyelid lymphatic injury.

Bleomycin sclerotherapy for large diffuse microcystic lymphatic malformations.

BACKGROUND: Microcystic lymphatic malformations (LMs) are congenital lesions with the diameter of the majority of cysts <1 cm. Bleomycin sclerotherapy has been shown to yield beneficial results for macrocystic LMs. This study aims to evaluate the safety and efficacy of consecutive bleomycin sclerotherapy for large diffuse microcystic LMs. METHODS: The location and size of the lesions were detected by ultrasound for the 46 patients included in this study. Bleomycin lavage was performed in larger cysts and intradermal injection for the superficial lesion. The outcome and complications were assessed for its efficacy and safety. RESULTS: The large diffuse microcystic LMs mainly located in the neck, abdominal wall and axilla/lateral chest wall. The average lesion size was 10.6 cm × 7.2 cm. The mean number of treatment sessions was 4.5 with 7.3 mg bleomycin for per session averagely. Excellent (69.6%) and moderate (23.9%) responses were obtained. There was no recurrence for the 6 patients (13%) who received a long follow-up. Obvious local swelling, slight intralesional hemorrhage and low-grade fever were the most commonly occurred complications. No lung fibrosis was identified for the patients who received more than 6 sessions. CONCLUSIONS: Local lavage combined with intradermal injection of bleomycin is effective and safe for large diffuse microcystic LMs with good therapeutic effect and low complication rates, and can be regarded as the mainstay of therapy for microcystic LMs.

Surgical reconstruction of massive scrotal lymphedema associated with hidradenitis suppurativa: a case report.

Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory cutaneous disease affecting apocrine glands. It can be associated with lymphedema of the surrounding tissues and most commonly affects scrotum. As a debilitating complication of HS, lymphedema can cause significant morbidity and further exacerbate HS condition, thus causing a vicious cycle. Surgery was reported to be the most common treatment for this complication. Here, we present a 41-year-old patient with massive scrotal lymphedema following a 2-year history of HS. To reduce the volume of the scrotal mass and improve the appearance and function of the scrotum, we modified the Charle's procedure by complete excision of the affected tissue while retaining the scrotal septum, preserving the subcutaneous lymphatic tissue flap, turnover of the perididymis, and primary closure. We found that this approach achieved satisfactory cosmetic results, maintained cutaneous sensation and restored erections. There was no adverse event following surgery. No recurrence occurred over 6-month of follow-up. We believe that this modified Charles' procedure can improve the morphology and lymphatic function of the scrotum and recommend its use whenever possible. While rare, HS associated lymphedema should alert clinician to the potential consequence of an advanced disease situation. Collaborative approach with surgery in the management of this condition should be considered at early stage.

Surgical reconstruction of primary genital lymphedema-long term therapeutic efficacy.

BACKGROUND: Primary genital lymphedema is caused by congenital lymphatic dysplasia, which is often accompanied by lymphedema of the lower extremities. A lack of effective diagnostics and treatments are available in clinical practice. The purpose of this study is to present the experience of surgical treatment of genital lymphedema and follow-up magnetic resonance lymphangiography (MRL) examinations. METHODS: The clinical records of 40 patients diagnosed with primary genital lymphedema between 2010 and 2019 were retrospectively reviewed. The surgical management of all patients consisted of complete excision of the edematous subcutaneous tissue and plastic reconstruction of the penis or scrotum. This involved excision of the affected tissue while retaining the scrotal septum, preserving the subcutaneous lymphatic tissue flap, turnover of the perididymis, and primary closure. All patients were examined by MRL to assess the extent of lymphedema pre- and postoperatively. The cosmetic results, recovery of sexual function, patient satisfaction, and complications are discussed. RESULTS: A total of 40 patients underwent surgical treatment. Scrotal hematoma (2.5%) and poor wound healing (5%) were encountered postoperatively. During follow-up period, no recurrence of edema occurred. The appearance of the scrotum and penis, as well as the sexual function was improved. MRL confirmed tissue edema and lymphatic malformation in the enlarged penis and scrotum preoperatively. In follow-up MRL, new formation or reopen of lymphatic drainage can be detect in 25 (62.5%) patients. All patients showed decreased area of dermal backflow. CONCLUSIONS: Surgical treatment is necessary for genital lymphedema when swelling develops. The use of a retained scrotal septum and subcutaneous lymphatic tissue flaps can achieve improved morphology and function. MRL is a safe and accurate diagnostic imaging method for pre- and postoperative evaluation of lymphedema in patients undergoing lymphatic surgery.

The Roles of Podoplanin-Positive/Podoplanin-Negative Cells from Adipose-Derived Stem Cells in Lymphatic Regeneration.

BACKGROUND: Secondary lymphedema is a refractory disease, for which adipose-derived stem cells have shown some therapeutic potential. However, the mechanism of this action remains poorly understood. METHODS: The authors identified podoplanin-expressing adipose-derived stem cells, which allowed them to divide adipose-derived stem cells into podoplanin-positive and podoplanin-negative groups that they characterized in vitro. The authors then used a mouse hindlimb model for lymphedema to trace the fate of podoplanin-positive, podoplanin-negative, and unsorted adipose-derived stem cells in vivo. RESULTS: When induced in culture, podoplanin-positive cells were noted to up-regulate the expression of lymphatic endothelial cell markers, including LYVE-1, and assumed a cobblestone morphology. In addition, a substantial increase in lymphangiogenic cytokines was detected in the podoplanin-positive supernatant. The above findings were largely absent from the podoplanin-negative and unsorted groups. In the mouse model, the implanted cells relieved the limb lymphedema by promoting lymphangiogenesis, with the podoplanin-positive group showing the most significant effect. Immunocolocalization further revealed that the podoplanin-positive cells incorporated into lymphatic vessels were positive for LYVE-1. CONCLUSIONS: These data demonstrated that actions by means of both paracrine and differentiation pathways were involved in the adipose-derived stem cell-mediated therapeutic effects. The podoplanin-positive cells possessed lymphatic paracrine and differentiation abilities and may represent lymphatic endothelial cell precursor cells. The podoplanin-negative cells, which constitute a considerable proportion of the adipose-derived stem cells, may play an important paracrine role by secreting mesenchymal stem cell-related factors.

Magnetic Resonance Lymphography of Lymphatic Vessels in Upper Extremity With Breast Cancer-Related Lymphedema.

BACKGROUND: Magnetic resonance lymphangiography (MRL) has been proven to be able to visualize pathological lymphatic networks and accompanying complications through subcutaneous injection of commonly used contrast agents. However, no comprehensive prior studies have previously been reported regarding MRL for the evaluation of upper extremity lymphedema in patients with breast cancer-related lymphedema (BCRL). In this study, we establish a novel MRL protocol to characterize the normal and abnormal characteristics of different clinical stages of BCRL in patients using high-spatial-resolution MRL. METHODS: Fifty females with unilateral upper extremity BCRL underwent MRL. Lymphatic vessel morphology in normal and affected limbs was compared. The appearance, distribution pattern, morphologic characteristics, and maximum transversal diameter of the lymphatic vessels, dermal backflow, and regeneration of lymphatic vessels were analyzed. RESULTS: Lymph fluid was retained in the subcutis of the affected limbs, and no edema was observed in the subfascial compartment. In stage 1, tortuous and dilated lymphatic vessels exhibited a beaded appearance, and their diameters were larger than those in the contralateral forearm (P < 0.05). In stage 2, the dilated lymphatic vessels exhibited larger diameters. "Dermal backflow" and tiny regenerated lymphatic vessels appeared. The thickened subcutaneous tissue showed a honeycomb pattern induced by soft tissue fibrosis and adipose hypertrophy. In stage 3, disordered and unrecognizable affected lymphatic vessels were observed with many small regenerated lymphatics and confluent dermal backflow; the tissue fibrosis was more serious. CONCLUSIONS: Each stage presents different characteristics, and the deformity degree of the lymphatic network is consistent with the severity of the disease. Magnetic resonance lymphangiography could provide adequate information for clinical staging in patients with BCRL.

Emulsified Fat Grafting Accelerates Tissue Expansion: An Experimental Study in a Rat Model.

INTRODUCTION: Tissue expansion has been applied in tissue repair and reconstruction of large soft tissue defects. Stromal vascular fraction (SVF) transplantation is a promising treatment in raising expansion efficiency. However, the clinical utilization of SVF is limited because of its conventional collagenase-based production. The aim of this study was to evaluate the effect of emulsified fat (EF), SVF obtained by using mechanical method, on accelerating tissue expansion. MATERIALS AND METHODS: The microstructure of EF fragments and the proportion of mesenchymal stem cells (MSCs; CD45-/CD34+) in EF were detected. Wistar rats were divided into the following 3 groups randomly: the 1-mL EF group, the 0.5-mL EF group, and the control group. The tissue expansion was carried out twice a week to maintain the capsule pressure at 60 mm Hg. After 4 weeks, inflation volume and histological changes, which includes collagen content, cell proliferation, and capillary density, were observed to evaluate the effect of EF on tissue expansion. RESULTS: Mechanical emulsification effectively destroyed the mature adipocytes in adipose tissue. The proportion of MSCs population in the EF fragments was 12.40 ± 0.86%. After expansion, the inflation volume and the levels of collagen deposition, cell proliferation, and capillary density of the expanded tissue in the 1-mL EF group were significantly higher than that in the 0.5-mL EF group and the control group (P < 0.05). However, all these regenerative indicators in the 0.5-mL EF group showed no statistical difference from the control group (P > 0.05). The thickness of epidermal and dermal layers showed no significant difference among the 3 groups (P > 0.05). CONCLUSIONS: Our findings suggested that EF grafting can be used as a new alternative to increase tissue expansion efficiency.

IL-7 enhances the differentiation of adipose-derived stem cells toward lymphatic endothelial cells through AKT signaling.

Our study was designed to investigate the effects of IL-7 during the differentiation process of adipose-derived stem cells (ADSCs) toward lymphatic endothelial cells (LECs). IL-7 was added to the traditional induced medium, which was called the IL-7 (+) group, while the group that used traditional induced medium was called the IL-7 (-) group. After 7 days of induction of ADSCs, a comprehensive analysis was conducted between these two groups. We examined the changes in Prox1, LYVE-1, Podoplanin and VEGFR-3 on the RNA and protein level and found that the expression of LEC markers in the IL-7 (+) group was higher than in the IL-7 (-) group. The characteristics of differentiated cells were confirmed by flow cytometry and immunofluorescence. At the same time, we detected the MAPK/ERK and PI3K/AKT pathway involved in the differentiation process, and we found that the phosphorylation of AKT increased, however the expression of ERK was not significantly changed. In conclusion, our study found that IL-7 could improve the differentiation efficiency of ADSCs toward LECs through AKT signaling pathways.

Fluid management in extensive liposuction: A retrospective review of 83 consecutive patients.

Tumescent anesthesia makes it feasible to perform liposuction in an office setting. There are often patients who desire extensive liposuction on approximately 30% of total body surface area, which means the potential of fluid overload. In this study, the charts of 83 patients undergoing extensive liposuction were retrospectively reviewed. The intra-operative fluid ratio was 1.66 for the extensive liposuction. There were no episodes of pulmonary edema, congestive heart failure exacerbation, or other major complications. The average urine output in the operating room, the recovery room, and while on the floors was 1.35, 2.3, and 1.4 mL/kg/hour respectively. Intravenous (IV) fluid administration during operation was minimized to approximately 300 to 500 mL. The total volume of IV injection was also reduced to less than 1500 mL when the patient was in the recovery room and on the hospital floor. Our fluid management strategy in extensive liposuction reflects minimal risk of volume overload. Foley catheters are not applied and patients could resume oral intake in usual, so they can discharge after 6 hours of recovery room stay in our daily practice.

Inhibition of Pathological Phenotype of Hypertrophic Scar Fibroblasts Via Coculture with Adipose-Derived Stem Cells.

Hypertrophic scar (HS) is a dermal fibroproliferative disease characterized by fibroblast over-proliferation, overproduction, and deposition of the extracellular matrix. Growing evidence demonstrated that adipose-derived stem cells (ASCs) secrete a plethora of trophic and antifibrotic factors, which suppress inflammation and ameliorate fibrosis of different tissues. However, few studies investigate their effect on repressing HS activity. This study evaluated the suppressing effect of ASCs on HS fibroblast bioactivity and the possible mechanism via a coculture model. HS-derived fibroblasts (HSFs) and ASCs were isolated from individual patients. HSFs or HSFs treated with transforming growth factor-ß1 (TGF-ß1) were cocultured with ASCs and the change of HSF cellular behaviors, such as cell proliferation, migration, contractility, and gene/protein expression of scar-related molecules, were evaluated by cell counting assay, cell cycle analysis, scratch wound assay, fibroblast-populated collagen lattice (FPCL) contractility assay, real-time quantitative polymerase chain reaction, ELISA, and western blotting assay. After 5 days of ASC coculture treatment, the expression levels of collagen I (Col 1), collagen III (Col 3), fibronectin (FN), TGF-ß1, interleukin-6 (IL-6), interleukin-8 (IL-8), connective tissue growth factor (CTGF), and alpha-smooth muscle actin (α-SMA) in HSFs decreased significantly while the expression levels of decorin (DCN) and MMP-1/TIMP-1 (matrix metalloproteinase/tissue inhibitor of MMP) ratio increased significantly. Besides, after 5 days of exogenous TGF-ß1 stimulation, the expression levels of Col 1, FN, TGF-ß1, IL-6, CTGF, and α-SMA in HSFs increased significantly. Impressively, all these increased gene expression levels were reversed by 5 days of ASCs coculture treatment. Additionally, the proliferation, migration, and contractility of HSFs were all significantly reduced by ASC coculture treatment. Furthermore, the protein levels of TGF-ß1 and intracellular signal pathway-related molecules, such as p-smad2, p-smad3, p-Stat3, and p-ERK, were downregulated significantly in HSFs after 5 days of ASCs coculture treatment. This study demonstrated that coculture of HSFs with ASCs not only inhibited proliferation, migration, and contractility of HSFs but also decreased the expression levels of HSF-related or TGF-ß1-induced molecules. Additionally, the antifibrotic effect on HSFs was likely mediated by the inhibition of multiple intracellular signaling. The results of this study suggest the therapeutic potential of ASCs for HS treatment, which is worth of further investigation.