Matching actions to needs: shifting policy responses to the changing health needs of Chinese children and adolescents.

China is home to the second largest population of children and adolescents in the world. Yet demographic shifts mean that the government must manage the challenge of fewer children with the needs of an ageing population, while considering the delicate tension between economic growth and environmental sustainability. We mapped the health problems and risks of contemporary school-aged children and adolescents in China against current national health policies. We involved multidisciplinary experts, including young people, with the aim of identifying actionable strategies and specific recommendations to promote child and adolescent health and wellbeing. Notwithstanding major improvements in their health over the past few decades, contemporary Chinese children and adolescents face distinct social challenges, including high academic pressures and youth unemployment, and new health concerns including obesity, mental health issues, and sexually transmitted infections. Inequality by gender, geography, and ethnicity remains a feature of health risks and outcomes. We identified a mismatch between current health determinants, risks and outcomes, and government policies. To promote the health of children and adolescents in China, we recommend a set of strategies that target government-led initiatives across the health, education, and community sectors, which aim to build supportive and responsive families, safe communities, and engaging and respectful learning environments. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.

Safety and Effectiveness of Laser or Intense Pulsed Light Treatment for Early Surgical Scar: A Systematic Review and Meta-analysis.

OBJECTIVE: We aimed to investigate the safety and efficacy of laser or intense pulsed light therapy for early treatment of surgical scar. METHODS: A literature search was conducted for relevant prospective, randomized controlled trials published in PubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang Database, and VTTMS between January 2006 and January 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to extract literature data. The risk of bias was assessed by RevMan. Safety was assessed based on the presence of serious adverse reactions (blisters, infections, burns above the second degree), while effectiveness was assessed using the Vancouver Score Scale. RESULTS: 1512 related articles were preliminarily retrieved, including 1211 English articles and 301 Chinese articles. According to the inclusion criteria and exclusion criteria, 12 articles were selected for this analysis. In total, 475 patients were included (laser group, 238; control group, 236). All studies confirmed that the laser group was superior to the control group. In the subgroup analysis of 7 articles, the standardized mean difference was 1.99 (P = 0.0001). CONCLUSIONS: This meta-analysis demonstrates that laser or intense pulsed light therapy is a safe and effective approach for early surgical scar treatment, resulting in improved scar appearance and minimal adverse reactions. LEVEL OF EVIDENCE I: 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 .

Exploration of surgical approach to reconstruct smile-like lip shape in East-Asian women.

BACKGROUND: To investigate the clinical effects of surgical treatment to improve the lip morphology for a smile-like appearance (joy and happiness) in East-Asian women. METHODS: From October 2016 to April 2020, 63 patients who had received surgery to lift the commissure of the mouth and adjust the shape of the upper red lip to form a smile-like shape were analyzed and evaluated. RESULTS: The lip shape of enrolled patients was improved to a certain extent after surgery without any obvious scar hyperplasia, and the satisfaction rate of people after the surgery was 85.71%. CONCLUSION: For East-Asian women with thin and flat lips, surgical approach can be used to improve the shape of lip, such that the appearance of the lip is in a smile-like shape, which can enhance affinity and also exhibit the aesthetic characteristics of East-Asian women. This treatment can be used for clinical reference. LEVEL OF EVIDENCE: Level IV.

Application of Paranasal Augmentation Rhinoplasty in Asians With Midfacial Concavity.

BACKGROUND: For Asian rhinoplasty patients with midfacial concavity, the conventional method is to solve the problem by using structural rhinoplasty to increase the nasal height and length. However, the results are not satisfying, and many complications are caused.Paranasal augmentation as an adjunct to rhinoplasty can improve surgical results and increase satisfaction. However, there are limited studies focusing on the details and evaluation of this technique. OBJECTIVES: To investigate a minimally invasive method to correct midfacial concavity simultaneously with rhinoplasty, as well as improve satisfaction and reduce complications. MATERIALS AND METHODS: Between January 2010 and December 2019, we reviewed all rhinoplasty patient records from patients who had midfacial concavity and underwent simultaneous paranasal augmentation with our technique. The patient demographics, surgical characteristics, and outcomes were reviewed retrospectively. Satisfaction was evaluated by an independent medical staff who reviewed the preoperative and postoperative photos. RESULTS: Sixty-seven patients were included in the study. The mean age of the patients was 28.7 ± 8.0 years, and the median follow-up time was 26 months (range, 2-60 months). Overall satisfaction was high (90%). Eight (12%) patients had complications, including 5 (7.4%) cases of implant displacement and 3 (4.4%) cases of infection. All patients healed uneventfully after revision surgery. CONCLUSIONS: Paranasal augmentation can improve the outcome and increase satisfaction in Asian rhinoplasty patients who have midfacial concavity. Preoperative patient evaluation, surgery planning, and surgery details are crucial to ensure a favorable result. The expanded polytetrafluoroethylene implant has advantages over other materials and therefore is recommended in paranasal augmentation surgery.

Targeting the Glycolytic Enzyme PGK1 to Inhibit the Warburg Effect: A New Strategy for Keloid Therapy.

BACKGROUND: Aerobic glycolysis (the Warburg effect) may play an important role in keloid pathogenesis, which may be aggravated by the hypoxic microenvironment in keloids. Phosphoglycerate kinase 1 (PGK1), a key glycolytic enzyme, is essential for cellular aerobic glycolysis, but its role in keloid formation remains unknown. This study aimed to detect PGK1 expression in keloid tissue and investigate the effects of inhibiting PGK1 expression on keloid fibroblasts (KFbs) under hypoxia and normoxia. METHODS: Normal skin and keloid samples were separated into two parts, one was used for immunohistochemistry, and one for primary cell culture. PGK1 tissue expression was detected by immunohistochemistry. Reverse-transcriptase polymerase chain reaction and Western blotting were used to detect PGK1, GLUT1, LDHA, and COL1 expression, and glucose uptake and lactate production were detected with a microplate reader. Cell proliferation and apoptosis were investigated with IncuCyte and flow cytometry. Cell migration and invasion were detected with Transwell assays. Glycolytic function was explored with the Seahorse XF96 system. RESULTS: Immunohistochemistry showed PGK1 overexpression in keloid tissue compared with normal skin tissue ( P < 0.05). Consistently, PGK1 expression was significantly higher in KFbs than in normal skin fibroblasts (NFbs), and hypoxia stimulated PGK1 expression in KFbs and NFbs ( P < 0.05). PGK1 knockdown significantly inhibited KFb glycolysis, proliferation, migration, invasion, glucose consumption, and lactate production ( P < 0.05). Furthermore, GLUT1, LDHA, and COL1 expression was decreased in KFbs compared with NFbs ( P < 0.05). In addition, suppressing PGK1 may mediate the PI3K/AKT pathway to down-regulate GLUT1, LDHA, and COL1 expression ( P < 0.05). CONCLUSIONS: These findings provide new evidence that suppressing PGK1, inhibiting glycolysis, reduces KFb proliferation, migration, invasion, and type I collagen expression. Targeting PGK1 to inhibit the Warburg effect may be a new therapeutic strategy for keloids. CLINICAL RELEVANCE STATEMENT: This article may provide new suggestions into the pathogenesis and treatment of keloids. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

The mental health of transgender and gender non-conforming people in China: a systematic review.

Transgender and gender non-conforming (TGNC) individuals are at a high risk of adverse mental health outcomes due to minority stress-the stress faced by individuals categorised as stigmatised social minority groups. This systematic review sought to summarise the key mental health findings of the research on TGNC individuals in mainland China. We also aimed to consolidate research on the topic, identify specific mental health disparities, and offer new perspectives for future research to inform both policy and clinical practice. An extensive search of the literature, published in English and Chinese, was done between Jan 1, 1990, and Aug 1, 2021, using PubMed, PsycINFO, Scopus, Wanfang (in Chinese), and CNKI (in Chinese). Overall, two qualitative and 28 quantitative articles were identified. The quantitative findings showed a high prevalence of mental health problems, such as depression, anxiety, substance use disorders, and stress-related issues, and greater disparities in psychological wellbeing. High prevalence is also reported in suicidality and self-harm behaviours in this group. Across the two qualitative studies, attributable factors included gender-related discrimination, barriers to accessing health services, low social support, decreased knowledge and awareness of HIV prevention, and demographic characteristics-such as marital status, educational level, and gender identity. This Review also found little evidence of gender-affirming care and mental health interventions in mainland China. Following from these results, the next step is to integrate multi-level, social-psychological interventions with education to reduce cultural stereotypes and transphobia in mainland China. Political and social implications are also discussed to inform a standard set of guidelines for transgender-inclusive health-care services, including advocating for funding to create these special care programmes and services.

Validation of the Chinese Version of the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults.

BACKGROUND: The number of individuals with potential gender dysphoria (GD) being referred to specialized gender identity clinics or programs is increasing internationally; these cases are initially screened using the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA). AIM: The current study aimed to assess the psychometric properties of the GIDYQ-AA in a sample of adolescents and young adults from China. METHODS: A cross-sectional study was conducted in October 2020. Sociodemographic information of the participants was first collected. Participants then completed the GIDYQ-AA, the Generalized Anxiety Disorder-7 scale, the Patient Health Questionnaire-9, and a suicidal ideation assessment. A total of 2,533 participants with a mean age of 19.30 (SD = 1.19) years were recruited. Of the participants, 841 (33.2%) were cis men, 1,589 (62.7%) were cis women, 66 (2.6%) self-identified as transgender, 17 (0.7%) self-identified as non-binary, and 20 (0.8%) self-identified as gender queer. RESULTS: The GIDYQ-AA had high internal consistency with a Cronbach's alpha = 0.89. Exploratory factor analysis showed that the GIDYQ-AA had a four-factor structure in China. The GIDYQ-AA was significantly correlated with anxiety symptoms (r = -0.32, P < .01), depressive symptoms (r = -0.33, P < .01), and suicidal ideation (r = -0.20, P < .01). CLINICAL TRANSLATION: The Chinese version of GIDYQ-AA is a useful measurement with high practical value, which could promote the assessment and research of GD across China or among Chinese migrants in other countries. STRENGTHS AND LIMITATIONS: This is the first study assessing the psychometric properties of the GIDYQ-AA in Chinese adolescents and young adults. The convergent and divergent validity of the GIDYQ-AA were not examined due to the unavailability of data. Also, the sample did not have an equal distribution of male to males and female to females. CONCLUSION: The Chinese version of GIDYQ-AA is a useful measure, which could promote both the assessment and research of GD in the Chinese population. Wang Y, Feng Y, Su D, et al. Validation of the Chinese Version of the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults. J Sex Med 2021;18:1632-1640.

Development and Psychometric Evaluation of the Gender Identity Scale for Transgender Women in China.

Transgender women are an important subgroup of the transgender umbrella and have their own unique gender identity. This article aimed to understand and measure the latent concept of gender identity among Chinese transgender women from a multi-dimensional perspective. Through a two-phase, iterative scale development process, we developed the Gender Identity Scale for Transgender Women (GIS-TW) in Chinese. Literature reviews, expert consultations, and focus groups constitute phrase 1 of the study, which resulted in the first version of GIS-TW with 30 items. In phrase 2, exploratory factor analysis on a sample of 244 Chinese transgender women revealed a six-factor solution across the 22 items. The Bem Sex Role Inventory was included to test for convergent validity, and the Rosenberg Self-Esteem Scale was used to test discriminant validity. Then we conducted the confirmatory factor analysis with an independent sample of 420 Chinese transgender women, which produced the final version of GIS-TW with 21 items. The internal consistency (Cronbach's alpha = 0.71-0.87) and test-retest stability (r = 0.73-0.87) of each factor was good. In conclusion, the GIS-TW is a reliable and valid psychometric tool for the assessment of Chinese transgender women's gender identity. Future application of the scale will help transgender women obtain better gender confirmative interventions.

Altered glucose metabolism and cell function in keloid fibroblasts under hypoxia.

Keloids exhibit metabolic reprogramming including enhanced glycolysis and attenuated oxidative phosphorylation. Hypoxia induces a series of protective responses in mammalian cells. However, the metabolic phenotype of keloid fibroblasts under hypoxic conditions remains to be elucidated. The present study aimed to investigate glycolytic activity, mitochondrial function and morphology, and the HIF1α and PI3K/AKT signaling pathways in keloid fibroblasts (KFB) under hypoxic conditions. Our results showed that hypoxia promoted proliferation, migration invasion and collagen synthesis and inhibited apoptosis in KFB. The mRNA levels, protein expressions and enzyme activities of glycolytic enzymes in KFB were higher than those in normal skin fibroblasts (NFB) under normoxia. Moreover, hypoxia remarkedly upregulated glycolysis in KFB. Decreased activities of mitochondrial complexes and abnormal mitochondria were detected in KFB under normoxic conditions and the damage was aggravated by hypoxia. An intracellular metabolic profile assay suggested hypoxia increased glycolytic parameters except glycolytic reserve but inhibited the key parameters of mitochondrial function apart from H+ leak. Protein levels of HIF1α and phosphorylation levels of the PI3K/AKT signaling pathway were upregulated in the context of 3% oxygen. Enhanced total reactive oxygen species (ROS), mitochondrial ROS (mitoROS) and antioxidant activities of KFB were observed in response to hypoxia. Additionally, autophagy was induced by hypoxia. Our data collectively demonstrated potentiated glycolysis and attenuated mitochondrial function under hypoxia, indicating that altered glucose metabolism regulated by hypoxia could be a therapeutic target for keloids.

The Desire and Status of Gender-Affirming Hormone Therapy and Surgery in Transgender Men and Women in China: A National Population Study.

BACKGROUND: Gender-affirming hormone therapy and surgery are important medically necessary approaches to transgender care. However, few related data exist in China. AIM: To understand the desire and access of transgender cares in the Chinese transgender men and women population. METHODS: A cross-sectional self-selecting survey targeting the Chinese transgender population was conducted in 2017 using a snowball sampling method. Participants completed an online questionnaire anonymously. Gender identity was verified by specifically designed questions. Data analysis of this study was performed in 2019. OUTCOMES: The main outcome was the status of receiving transgender medical care, including the desire vs actual state of receiving gender-affirming hormone treatment and gender-affirmation surgery, methods of accessing hormonal therapy and surgery, and risky behaviors associated with obtaining treatments. RESULTS: Of the total 2060 valid questionnaires, there were 1,304 transgender individuals (626 transgender men and 678 transgender women), with a median age of 22 (interquartile range, 19-26) years. Among them, 1,036 (79.4%) expressed desires for hormonal therapy, but of 1,036, 741 (71.5%) considered it difficult to obtain medications from doctors. Of 1,036 individuals, 275 (26.5%) and 172 (16.6%) had thoughts or behaviors of self-injury, respectively, when lacking access to hormone therapy. Of 1,036 individuals, 602 (58.1%) had used hormones. Of those 602 hormone users, 407 (67.6%) had ever obtained medications from informal drug dealers, and 372 (61.8%) of them did not perform regular monitoring. 868 of 1,303 (66.6%) participants had received or wanted to undergo gender-affirming surgeries, but 710 of 868 (81.8%) considered the surgery resources not adequate or very scarce. CLINICAL IMPLICATIONS: The transgender medical resources in China are scarce, and many transgender individuals have engaged in high-risk activities to access care. STRENGTHS & LIMITATIONS: This is the first study to focus on the current status of gender-affirming hormone therapy and surgery in the Chinese transgender population, providing valuable and real-world data for understanding the need for transgender health care in China. But, the online questionnaire could not provide the prevalence and other epidemiologic information about transgender individuals in China, and the survey did not address specific medication regimens, dosages, sex hormone levels, and specific hormone therapy-related or surgery-related adverse events. CONCLUSION: Significant improvement in access to gender-affirming medical and surgery care is needed in China. Liu Y, Xin Y, Qi J, et al. The Desire and Status of Gender-Affirming Hormone Therapy and Surgery in Transgender Men and Women in China: A National Population Study. J Sex Med 2020;17:2291-2298.

A combined method of oral commissure lifting for perioral rejuvenation in Asians.

BACKGROUND: A drooping oral commissure shows an appearance of ageing and sadness. To improve it with less complications has become a rising aesthetic concern for Asians. OBJECTIVES: To share our method for oral commissure lifting by a combined technique including skin resection, oral commissure suspension, and dissection of the depressor anguli oris muscle (DAO), and to present the follow-up outcomes. METHODS: This was a retrospective study of patients who underwent oral commissure lifting between 10/2012 and 03/2019 at the Department of Plastic Surgery, Peking University Third Hospital. The patients were routinely followed at 1 week, 1 month, and over 6 months. After operation, cases with the cheilions (oral commissure points) located above the ipsilateral lateral thickening points were considered to be effective, with the points at the same level were considered to be mildly effective, and with the cheilions below the ipsilateral lateral thickening points were considered to be ineffective treatment. RESULTS: Surgery took around an hour. Swelling subsided within 9.2±3.4 days. The red color of the scar disappeared within 3.7±1.5 months and the natural facial expression was restored within 7.9±2.6 weeks. Among the 159 cases, 125 (78.6%) were obviously effective, 21 (13.2%) were mildly effective, and 13 (8.2%) were ineffective. After the first operation, 112 patients (70.4%) were satisfied, 39 patients (24.5%) were basically satisfied, and eight patients (5.0%) were unsatisfied. CONCLUSIONS: The combined technique for the oral commissure lifting displayed a significant effect with little complication in Asian patients.

Vertical enlargement of the palpebral aperture by surgical modification of the lower eyelid: A new cosmetic option for Chinese patients.

BACKGROUND: The distinctive features of Oriental eyes are narrow palpebral aperture and upslanting lower eyelid margin, which are not in accordance with modern appreciation of beauty. Although many ophthalmic plastic procedures have been designed to change the characteristic appearance, the methods to enlarge the palpebral aperture by lowering the lower eyelid are limited. METHODS: A total of 63 Chinese patients received the lowering the lower eyelid procedure from April 2014 to August 2018. The main criteria are patients who have vertically narrow palpebral aperture with or without upslanting lower eyelid shape. But patients who have proptosis or unhealthy lower eyelid elasticity are not suitable for this procedure. The operation is performed by suturing the lower tarsal plate and the infraorbital periosteum together, adjusting the tension of knots to reach the patient's desire for the shape of lower eyelid margin, and finally tightening all the knots. RESULTS: The lateral lower eyelid margin was lowered and the lateral part of the palpebral aperture was enlarged in all cases (P < 0.01). Only five patients (7.9%) were not fully satisfied because of the partial retraction of the lateral eyelid margin. Minor complications were observed, of which conjunctival chemosis in three patients (4.8%) and conjunctival hemorrhage in two patients (3.2%). CONCLUSION: Lowering the lower eyelid procedure is an effective and safe approach for patients who desire to smooth the upslanting shape and enlarge the eyes. The strict criteria and careful preoperative evaluations are critical to avoid complications and achieve good outcomes for Chinese patients.

Application of Trans-Areola Approach for Costal Cartilage Harvest in Asian Rhinoplasty and Comparison with Traditional Approach on Donor-Site Morbidity.

BACKGROUND: The traditional approach of harvesting costal cartilage through a chest wall incision can result in significant donor-site morbidity and usually causes notable scars in Asian patients. This has become the main concern for Asian females seeking rhinoplasty with autologous costal cartilage. OBJECTIVES: The aim of this study was to investigate the donor-site morbidity of the trans-areola approach for costal cartilage harvest in Asian rhinoplasty and to compare it with the traditional approach. METHODS: Patients' records were reviewed to determine whether their rhinoplasties had been performed with either the trans-areola or the traditional approach to costal cartilage harvest. Donor-site morbidity was evaluated 1 year postoperatively via a visual analog scale and the Modified Vancouver Scar Scale. Long-term complications of the trans-areola group were assessed at least 6 months after surgery. RESULTS: There were 26 females in the trans-areola group and 35 females in the traditional group; both groups were of similar age and body mass index range. Compared with the traditional group, the trans-areola group had a significantly longer surgery time and a higher pneumothorax rate (7.7% vs 2.9%) but a significantly better scar quality and a higher overall satisfaction. Long-term outcomes and complications of the trans-areola group included significant scars (2/26, 7.7%), concavity of the breast (1/26, 3.8%), and local chest pain/discomfort (1/26, 3.8%). CONCLUSIONS: Compared with the traditional approach to harvesting costal cartilage in Asian rhinoplasty, patients who underwent the trans-areola approach had less overall donor-site morbidity and higher overall satisfaction. We recommend this technique to patients who meet the inclusion criteria as well as those seeking a better cosmetic outcome.

LncRNA RGMB-AS1 Promotes Glioma Growth and Invasion Through miR-1200/HOXB2 Axis.

BACKGROUND: Dysfunction of long noncoding RNA (lncRNA) is associated with tumorigenesis of various malignancies, including glioma. LncRNA RGMB-AS1 (RGMB antisense RNA 1) has been reported to participate in initiation and progression of several cancers, such as lung cancer, hepatocellular carcinoma and laryngeal squamous cell carcinoma. Nevertheless, whether RGMB-AS1 regulates glioma development is not investigated. In this study, we aimed to determine its roles in glioma. METHODS: qRT-PCR and Western blotting were used to measure gene expression. CCK8 and colony formation assays were utilized to analyze proliferation. Transwell assay was used to determine cell migration and invasion. Luciferase reporter assay was used to validate the interactions among RGMB-AS1, miR-1200 and HOXB2. RESULTS: RGMB-AS1 was upregulated in glioma tissues and associated with glioma grade and patients' prognosis. Moreover, RGMB-AS1 silencing significantly inhibited the proliferation, migration and invasion of glioma cells. RGMB-AS1 downregulation led to more tumor cells arrested in the quiescent state. Mechanistically, we found that RGMB-AS1 was a molecular sponge for miR-1200. MiR-1200 level was inhibited by RGMB-AS1. And RGMB-AS1 promoted HOXB2 expression via sponging miR-1200. Restoration of HOXB2 effectively rescued the abilities of proliferation, migration and invasion in RGMB-AS1-depleted glioma cells. CONCLUSION: Collectively, our work clarified that RGMB-AS1/miR-1200/HOXB2 signaling exerts an essential role in regulating glioma progression.

Long noncoding RNA gastric cancer-associated transcript 3 plays oncogenic roles in glioma through sponging miR-3127-5p.

Evidence is emerging that long noncoding RNAs (lncRNAs) play vital roles in tumorigenesis. LncRNA gastric cancer-associated transcript 3 (GACAT3) is reported to participate in the development of breast cancer, colorectal cancer, nonsmall cell lung cancer, and gastric cancer. However, whether it is implicated in glioma has not been elucidated. Here, we found that GACAT3 level was aberrantly elevated in glioma tissues and cell lines. Higher GACAT3 expression predicted lower survival rate. Knockdown of GACAT3 suppressed the proliferation, colony formation, migration, and invasion but promoting apoptosis in glioma cells. Next, we determined that GACAT3 contributes to glioma progression through inhibiting microRNA (miR)-3127-5p. Subsequently, ELAVL1 was identified as a direct target of miR-3127-5p by bioinformatics analysis and luciferase reporter assay. Moreover, we confirmed that GACAT3 promoted ELAVL1 expression through sponging miR-3127-5p, leading to glioma progression. Taken together, our study elucidated that GACAT3/miR-3127-5p/ELAVL1 signaling regulates glioma development and might be a promising therapeutic target.

Lip Morphology and Aesthetics: Study Review and Prospects in Plastic Surgery.

The lip profile plays an important role in the perception of facial aesthetics; lip morphology and aesthetics research is receiving increasing attention. The advancement of research tools such as three-dimensional imaging technology has led to the clarification of lip morphologic and aesthetic characteristics. After studies of lip characteristics according to gender, ethnicity and age provided basic data, studies on lip aesthetics have been conducted by scholars worldwide. These studies could provide a basic theory to support diagnosis and treatment options, as well as the basis for evaluative criteria for precise treatment and technical improvements. According to the conclusions of the above studies, new ideas for cosmetic surgery design, including lip, perioral and labial-facial relationships, have been discovered.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 .

Metabolic reprogramming in keloid fibroblasts: Aerobic glycolysis and a novel therapeutic strategy.

Keloids, tumor-like fibroproliferative cutaneous lesions, were reported in metabolic disturbance. However, the metabolic character remains unclear. The purpose of this study is to determine if glycolytic reprogramming is important for the pathogenesis of keloids and to assess the inhibition potential of glycolysis in keloid treatment. An intracellular metabolic profile assay was used to compare metabolic phenotypes between normal skin fibroblasts and keloid fibroblasts (NFs and KFs). Our data indicated that KFs underwent reprogramming of their metabolic phonotype from oxidative phosphorylation to aerobic glycolysis (Warburg effect) with augmented glycolysis and glycolytic capacity. Both gene and protein assays showed that the expression of glycolytic enzymes was upregulated in KFs compared to NFs. Our data showed higher glucose influx and lactate production in KFs compared to NFs. Furthermore, the proliferation of KFs was suppressed in a dose-dependent and time-dependent manner after inhibition of glycolysis with 2-deoxy-glucose (2-DG). Taken together, these findings suggested that keloids underwent a reprogrammed metabolic phenotype of aerobic glycolysis. This was essential for keloid hyperplasia, and glycolytic inhibitors might provide a potential treatment for keloids.

Upper lip lift with a "T"-shaped resection of the orbicularis oris muscle for Asian perioral rejuvenation: A report of 84 patients.

BACKGROUND: An overlong upper lip or philtrum indicates aging. In the current study, a procedure for upper lip lift to alleviate this defect is illustrated and assessed for its esthetic effects and risks. METHODS: A total of 84 Chinese patients with overlong upper lip underwent surgery for upper lip lift from 2012 to 2014. Skin excision height was designed on the basis of the golden proportion of the lower region of the face. The incision was made at the subnasal (inferior border of the columella-nostril-alar) region. After undermining the tissue between the subcutis and orbicularis oris, a "T"-shaped region of the muscle was resected. Both sides of the muscular flaps were developed and suspended upward to the columella base to lift the upper lip. The incision was then sutured delicately. RESULTS: Of the 76 patients who were effectively followed up, recovery period, lift effect, visibility of the scar, vermilion shape, surgery-associated effects, any complications, and overall rejuvenation, among other outcomes, were evaluated at 1 week, 1 month, and 3-24 months postoperation. Assessment was performed by both objective measurements and subjective satisfaction: significant efficiency was achieved and high satisfaction, satisfaction, and dissatisfaction ratings were reported by 55 (72.4%), 18 (23.7%), and 3 (3.9%) patients, respectively. CONCLUSIONS: Upper lip lift yields a significant esthetic effect with few complications. This surgical intervention merits further clinical development and application.

[Application of trans-areola approach for costicartilage harvesting].

OBJECTIVE: To investigate the trans-areola approach for costicartilage harvesting in order to avoid the obvious scar resulted by traditional approach through chest incision. METHODS: From 2013, 7 cases who underwent rhinoplasty received costicartilage harvesting through trans-areola approach. The incision was designed along the lower interior edge of right areola. Then the dissection was performed to expose the 5th costicartilage. Then a costicartilage, 2 - 5 cm in length, was harvested. The incision was closed delicately. The suture was removed 7 days after operation. RESULTS: The patients were followed up for 3 months to 2 years without hypertrophic scar and breast deformity. The scar was located in conceal location. The satisfactory rate was higher than that in patients with chest incision. CONCLUSIONS: The scar resulted from trans-areola approach is comparatively conceal, compared with that at chest.